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BACKGROUND Illness and death are part of life for everyone, including people with intellectual disabilities. This study investigated the extent to which staff communicate about death with people with intellectual disability facing terminal illness or bereavement. METHOD Staff who support people with intellectual disability in the UK (n = 690) completed an electronic survey. Detailed data were obtained from staff where a client had died in the past 12 months (n = 111), was terminally ill (n = 41) or had been bereaved (n = 200). Analysis included descriptive and chi-squared statistics. RESULTS 52.6% of people with intellectual disability who were terminally ill were told about their illness, and 18.1% were told they would die. Of those experiencing an anticipated bereavement, 32.4% of staff said no one talked about this with them beforehand. A quarter of staff had received training on end of life or bereavement. CONCLUSION Death affects many people with intellectual disability. Staff require training and support in communicating death. © 2020 John Wiley & Sons Ltd.BACKGROUND Colorectal cancer remains a common cancer in the western world, with liver resection being the only potentially curative option for isolated colorectal cancer liver metastases (CRCLM). Cancer is a disease of aging, with the optimum management of elderly patients with CRCLM presenting an ongoing dilemma. METHODS We analysed the outcome of CRCLM using prospectively collected patient data from the multidisciplinary Treatment of Recurrent and Advanced Colorectal Cancer registry, collected from July 2009 to July 2018 at 12 Australian hospitals. RESULTS Of 2742 patients with metastatic colorectal cancer, liver-limited disease was present in 977 (36%) patients, of whom 338 (35%) underwent hepatic resection. Resection rates varied with age, including 186 (43%) of 428 patients aged 64 years and younger, 99 (40%) of 245 aged 65-75 years and 53 (17%) of 303 aged 76 and older (P  less then  0.001). The 30-day mortality rate was 0.9%. Median survival post resection also varied with age, 96 versus 89 versus 68 months (P  less then  0.001). Selleck DL-Buthionine-Sulfoximine In a separate analysis of the oldest patients, those aged over 80 years, where only 11% underwent resection, the median survival was 49 months. CONCLUSION The operative mortality for patients undergoing liver resection at Australian hospitals is low. With advancing age, the rate of liver resection of CRCLM and the post-resection survival decline. However, excellent survival outcomes can be achieved in selected elderly patients. © 2020 Royal Australasian College of Surgeons.BACKGROUNDS Perianal sepsis occurs in up to 10% of neutropaenic patients with haematological malignancy and is associated with significant morbidity and mortality. The management of this condition is challenging in neutropaenic patients due to its atypical pathophysiology. The aim of this study is to assess the role of magnetic resonance imaging (MRI) and surgery in neutropaenic patients with perianal sepsis. METHODS A retrospective chart review was performed on all neutropenic patients with a haematological malignancy who had a diagnosis of perianal sepsis during the inpatient admission between 2008 and 2017. Patient characteristics, symptoms, haematological data, MRI result, surgical intervention, intraoperative findings and outcomes including recurrence and mortality were collected. RESULTS Nineteen neutropaenic patients with haematological malignancy were treated for perianal sepsis, eight (42%) patients were managed conservatively and 11 (58%) were managed surgically. Nine patients underwent MRI, which identified a collection in 88% of cases despite severe neutropaenia. In patients with a collection identified on MRI prior to surgery, 80% had a drainable collection confirmed intraoperatively. Post-operative complications included two cases of sepsis from a presumed perianal source and one death. A total of 82% of patients experienced symptom resolution after surgery compared to 88% of patients managed conservatively. CONCLUSION This study has demonstrated that MRI is a useful diagnostic tool in evaluating perianal sepsis in patients with haematological malignancy, even during periods of severe neutropenia. We found that both conservative and surgical management strategies lead to resolution of symptoms. © 2020 Royal Australasian College of Surgeons.BACKGROUND AND PURPOSE Parasitic neuroinfections in humans have etiological agents spanning a broad spectrum from unicellular (protozoan) to multicellular helminthic (metazoan) organisms. Cerebral coenurosis is a rare cestodal helminthic infection caused by Taenia multiceps. The neuroimaging features of this entity were reviewed to discern an imaging phenotype. METHODS Retrospective analysis was performed on 6 cases of cerebral coenurosis, whose diagnoses were confirmed by histopathology. The clinical, imaging, and histopathological features were recorded for analysis. RESULTS Clinical expressions included focal neurological deficit due to mass effect (n = 4), intraventricular obstruction with features of raised intracranial tension (n = 1), headache (n = 3), seizures (n = 3), and incidental lesions (n = 1). One patient presented with recurrence 1 year after surgical excision. Neuroimaging revealed cystic thin-walled lesions with clustered eccentric internal nodules corresponding to the plenitude of protoscolices of the tapeworm. Three of the lesions showed a multilocular cystic morphology. Spectroscopic metabolite signature of alanine and succinate commensurate with the parasitic etiology was remarkable in the lesions. Enhancement and edema inversely correlated with the signal suppression on fluid-attenuated inversion recovery (FLAIR) imaging. The lesions had a predominantly juxtacortical distribution. CONCLUSIONS In an appropriate clinical setting, a cystic lesion with clustered eccentric internal nodular foci ought to raise the suspicion of this rare infection. Magnetic resonance spectroscopic signature of succinate and alanine, if present, further strengthens the likelihood of coenurosis. Signal characteristics, wall enhancement, and perilesional edema may vary, possibly determined by the stage in the evolution of the parasite. © 2020 by the American Society of Neuroimaging.