EP.WE.213Short-term impact of COVID-19 on surgical services in a tertiary hospital

Aim

Since December 2019, SARS-CoV-2 has dramatically impacted the global landscape. One of the biggest challenges has been the additional strain put on healthcare systems. Although there are numerous studies on the effects of COVID-19 on intensive care beds and ventilator availability, there has been little exploration into the wider impacts of COVID-19 on the provision of other services. This study was designed to explore how COVID-19 has impacted surgical service provision at a large NHS hospital.

Methods

We compared the number and types of general surgical procedures carried out in a tertiary centre in the six months prior to the UK COVID-19 outbreak (September 2019-February 2020) and the six months after (March 2020-August 2020).

Results

We found that since March 2020 there has been a 70% decrease in the amount of operations taking place, with numbers dropping from a pre-COVID total of 1761 to a post-COVID total of 529. This mainly affected elective procedures with emergency surgeries remaining relatively constant (48 pre-COVID vs 44 post-COVID).

Conclusion

COVID-19 has caused a significant decrease in the number of surgeries being undertaken. This is due to a combination of factors including staffing issues, reduced investigative capacity, and national mandates on the cessation of non-urgent procedures. Although this mainly affected elective operations, it will have wider implications on future NHS workload and training. The knock on effects will inevitably result in a rise in delayed and emergency presentations with worse patient outcomes.

TP7.2.9 Natural orifice surgery in early rectal cancer; is it the way forward?

Aims

Transanal-endoscopic microsurgery (TEMS) for early rectal cancer is an attractive alternative to radical surgery. With proper patient selection, it is possible to achieve acceptable oncological outcomes with fewer complications. We aim to study the outcomes following TEMS for suspicious or proven rectal cancers performed in our unit.

Method

We performed a retrospective analysis of prospectively collected data between May-17 and Oct-20. The patients’ details, tumour specific data, short term outcomes, and recurrences were recorded.

Results

A total of 45 patients with early rectal cancer (M = 29, F = 15) were included in this study. With1 exclusion due to intraoperative rectal perforation, 44 were available for further analysis. Eleven had a diagnosis of cancer at the time of surgery, an additional 11 patients were confirmed on final histology, and 22 were benign. Final histology showed: T1=14, T2=4, T3=3 &Tx=1. The majority (68%) had clear resection margins (R1=3, R2=1, Rx = 3). Twelve patients went on to have further treatment. Seven had resectional surgery (AR = 5, APR=2) for unfavorable histology (2), residual disease (3), or recurrence (2). The other 5(23%) received chemotherapy+/-radiotherapy (unfit/patients’ choice) for unfavorable. Histology (3) or residual disease (2).

Conclusion

With judicious patient selection, it is possible to offer a less invasive option with acceptable oncological and patient related outcomes for suspicious and proven malignant rectal lesions. The majority of patients (84%) were able to avoid radical surgery or stoma, thereby reducing the associated morbidity. Whilst this is a single institution study, we believe with available expertise this could be widely replicated.

SP4.2.6 Colorectal cancer services during COVID-19; an experience of a tertiary centre

Aims

COVID19 has placed unprecedented constraints on healthcare services. Colorectal cancer (CRC) care was one of the many areas predicted to suffer due to these additional pressures. We believe that despite the challenges posed by COVID19, we have continued to deliver a standard of care for elective and emergency CRC resection that compares favorably with the national average.

Method

We conducted an analysis of the elective and emergency CRC resections carried out at a tertiary center over a 10-month period (Feb-Dec 2020). Data was collated from patient, operative, and theatre records and compared to the national average as defined by the 2020 National Bowel Cancer Audit (NBOCA).

Results

A total of 227 patients underwent surgery (189 elective and 38 emergencies), with a median age of 69. Of these, 153 were laparoscopic (67%), 57 open (27%), and 17 robotic (7%). The median length of stay was less than the national average; 5 days for elective surgery (NBOCA: 6) and 8 days for emergencies (NBOCA: 10). Within 30 days, overall unplanned readmissions rate was 6.5% (NBOCA: 11.6%) and return to theatre was 3.2% (NBOCA: 8.4%). Elective surgery had a 90-day mortality of 1% (NBOCA: 3%) compared to 7.8% for emergencies (NBOCA: 10.5%).

Conclusion

Despite the added constraints of the COVID19 pandemic, CRC resection in our unit remains safe with better outcomes than the national standard. We have demonstrated that with adequate precaution and a concerted team effort, delivery of safe care with reasonable outcome is achievable.

1367 Five Years of Robotic Surgery in Colorectal Service: James Cook University Hospital Experience

Aim

This paper gives an account of our institutional experience with safe adoption of robotic surgery in colorectal service.

Method

Analysis of our prospectively maintained database of all patients who underwent robotic colorectal surgery in our institute between February 2015 and February 2020. Overall surgical and oncological outcomes were interrogated.

Results

A total of 255 patients underwent robotic surgery between 2015 and 2020. 148 were males, and 107 were females. Median age was 68 years (range: 35–89). 198 patients had bowel cancer and 57 had benign conditions. Operative procedures performed were anterior resection (n = 125), right colectomy (n = 77), abdominoperineal resection (n = 40), subtotal colectomy (n = 5), completion proctocolectomy (n = 2) and reversal of Hartmann’s procedure (n = 6). Mean operative time was 164 (SD ± 47.5) for right colectomy and 267 (SD ± 77.8) for anterior resection. Median length of hospital stay was 6 days (IQR: 4 – 9). There was no 30 days mortality or intraoperative complications. Conversion to open or laparoscopy surgery rate was 5.1% (n = 13). Anastomotic leakage occurred in 3 patients (1.2%). Median lymph nodes harvested were 21 (range 4 – 79) and the R0 resection rate was 96.5%.

Conclusions

Our results demonstrate that colorectal robotic surgery is feasible and can be adopted safely for both benign and neoplastic conditions without undermining clinical or oncological outcomes.

Development of electronic record-keeping software for remote participation in Large Volume Plasma Device upgrade using Angular 2 and NodeJS web technologies

In an era of digital transformation and collaborations, the Web Information System (WIS) becomes an essential requirement for the information and data sharing of large experimental facilities among users. With the enhancement in the capabilities and performance of web technologies, sharing of experimental data using a flexible, modular, secure, and robust mechanism is feasible. In this direction, the Large Volume Plasma Device (LVPD), an experimental device dedicated for carrying out investigations for unfolding physical phenomena of relevance to Earth's magnetosphere and fusion plasmas, also adopts web-based electronic record keeping for its operation. The nature of investigations is concerned with plasma turbulence of electron scale, induced anomalous plasma transport and mitigation of energetic electrons by excited whistler turbulence that requires large scale, and simultaneous multiple point measurements from different electrostatic and electro-magnetic diagnostics. This paper discusses the WIS implementation in LVPD for the experimental configuration, information logging, and preliminary data analysis. The architecture of the system is spread over three tiers covering application, data, and presentation layers. The presentation layer is developed using the Angular 2 framework on the progressive web application architecture. The application and data layers are developed using NodeJS and PostgreSQL, respectively. The novelty of this paper lies in the integrated application development approach and applicability of the latest web technologies in the scientific and experimental domains. This paper discusses the literature survey of similar developments at other places, requirements, scopes, development artifacts, adapted tools and technologies, obtained results from actual plasma discharges of LVPD, and future enhancements.

A massive rock and ice avalanche caused the 2021 disaster at Chamoli, Indian Himalaya

On 7 February 2021, a catastrophic mass flow descended the Ronti Gad, Rishiganga, and Dhauliganga valleys in Chamoli, Uttarakhand, India, causing widespread devastation and severely damaging two hydropower projects. More than 200 people were killed or are missing. Our analysis of satellite imagery, seismic records, numerical model results, and eyewitness videos reveals that ~27 × 10⁶ cubic meters of rock and glacier ice collapsed from the steep north face of Ronti Peak. The rock and ice avalanche rapidly transformed into an extraordinarily large and mobile debris flow that transported boulders greater than 20 meters in diameter and scoured the valley walls up to 220 meters above the valley floor. The intersection of the hazard cascade with downvalley infrastructure resulted in a disaster, which highlights key questions about adequate monitoring and sustainable development in the Himalaya as well as other remote, high-mountain environments.

1022 Socioeconomic Deprivation and Colorectal Cancer Survival

Background

Factors related to CRC survival include age, tumour site and stage. Other factors that may play a role on survival include race and socioeconomic status(SES).We aim to investigate the impact of SES on CRC survival.

Method

All patients diagnosed with CRC between January 2006-January 2019 were included. Demographics were collected from a prospective database. SES was defined using the Index of Multiple Deprivation(IMD).Cox-regression was used to investigate the effect of factors on survival and Kaplan-Meier to estimate survival.

Results

A total of 5,073 patients diagnosed with CRC with a median follow up of 65 months were include. Overall survival was 72.2% (76.0%0-78.4%), 59.6%(58.2%-61.0%) and 50.3% (48.8%-51.8%) at 1 year, 3 years and 5 years, respectively. Colon cancer was associated with worse survival(p = 0.00256,HR = 1.163). On multivariate analysis, socioeconomic deprivation was associated with poorer survival (HR = 1.02,p=0.00302).Male and female sex were associated with similar survival outcomes(HR = 0.9831 and 0.9341,respectively; p = 0.986 and 0.946 respectively).

Conclusions

SES impact on CRC survival seems to be inconsistent across the literature potentially due to lack of uniformity of indices used to assess SES and the heterogeneity of access to healthcare. This could ultimately impact comparability across different studies investigating the impact SES on CRC survival.

Anal cancer survival: a socioeconomic analysis

INTRODUCTION

Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre.

MATERIALS AND METHODS

All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan-Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival.

RESULTS

A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0-93.7%), 75.5% (95% CI 67.5-84.5%) and 68.9% (95% CI 59.7-79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61-1.63), (p = 0.99, HR=1.00; 95% CI 0.61-1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02-5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12-2.41).

CONCLUSION

In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.

Toxicity and survival of anal cancer patients treated with intensity-modulated radiation therapy

INTRODUCTION

The definitive treatment of anal cancer with chemoradiotherapy spares abdominoperineal resection for salvage treatment but carries a high burden of toxicity. Intensity-modulated radiation therapy has been implemented to reduce toxicity, reduce treatment breaks and improve survival. However, large and long-term studies are lacking. We aimed to investigate the toxicities and long-term survival of anal cancer patients treated with intensity-modulated radiation therapy at James Cook University Hospital, Middlesbrough.

MATERIALS AND METHODS

We conducted a retrospective analysis of all patients with squamous cell anal cancer treated at James Cook University Hospital between July 2010 and April 2017. All patients were uniformly treated with intensity-modulated radiation therapy-based chemoradiation with curative intent. A subset of these patients was followed-up prospectively by an oncologist for acute and late toxicity. We calculated Kaplan-Meier estimates of survival statistics and compared our results with those of previous trials which used conventional radiotherapy.

RESULTS

We studied 132 patients, including a toxicity subset of 64, for a median follow-up time of 43 months (range 3-84 months). Eleven patients (8.3%) underwent salvage abdominoperineal resection. Grade 3+ acute non-haematological, gastrointestinal, genitourinary and dermatological toxicity were found in 56.2%, 12.3%, 0% and 50.7% of the toxicity subset (n = 64). Median treatment duration was 37 days. Overall and colostomy-free survival at five years were 68.3% and 85.3%, respectively. Tumour size (P = 0.006) and age (P = 0.002) predicted shorter overall survival.

CONCLUSIONS

Intensity-modulated radiation therapy probably reduces acute gastrointestinal and genitourinary toxicity compared with conventional radiotherapy, while resulting in similar overall and colostomy-free survival. We suggest that further dose escalation may improve survival in patients with T3/T4 tumours.

Short-term surgical outcomes and patient quality of life between robotic and laparoscopic extralevator abdominoperineal excision for adenocarcinoma of the rectum

Introduction Some studies advocate a laparoscopic extralevator abdominoperineal excision (l-ELAPE) approach for low rectal cancer. The da Vinci™ robot (r-ELAPE) technique has potential to overcome some limitations of l-ELAPE, such as reduction of the learning curve and more precise tissue handling. It is unknown whether this approach results in improved surgical or quality of life outcomes compared with l-ELAPE. This study aimed to address this issue. Methods Consecutive patients having undergone either robotic or laparoscopic ELAPE for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by postoperative histology and short-term complications. Quality of life was prospectively assessed using the European Organisation for Research and Treatment of Cancer QLC-CR30 and QLC-CR29 questionnaires. Results A total of 22 patients (11 r-ELAPE) with a median follow-up of 13 months (8 months robotic; 22 months laparoscopic) were studied. The groups were similarly matched for age, gender, American Society of Anesthesiologists status, preoperative chemoradiotherapy and tumour height. All had R0 resection. There was no significant difference in short-term surgical outcomes between groups. There was no significant difference in mean global health scores between the two groups (74 ± 14 r-ELAPE vs. 73 ± 10 l-ELAPE). The r-ELAPE group had a lower mean impotence score compared with the I-ELAPE group (55.5 ± 40 vs. 72.2 ± 44), although this was not statistically significant. Conclusions The newly introduced r-ELAPE was non-inferior to l-ELAPE in either patient quality of life or surgical outcomes. Robotic surgery could be particularly beneficial in the technically challenging area of low rectal cancer surgery with a shorter learning curve than laparoscopy.

Patient quality of life and short-term surgical outcomes between robotic and laparoscopic anterior resection for adenocarcinoma of the rectum

PURPOSE

To compare patient quality of life (QoL) and short-term surgical outcomes between robotic anterior resection (r-AR) and laparoscopic (l-AR) approach.

METHODS

Consecutive patients having undergone either robotic or laparoscopic AR for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by post-operative histology and short-term complications. QoL was prospectively assessed using the EORTC QLC-CR30 and QLC-CR29 questionnaires.

RESULTS

In total, 36 patients (18 r-AR) with a median follow-up of 12 months following surgery (9-month robotic and 20-month laparoscopic) were studied. The two groups were similarly matched for age and gender. Laparoscopic patients had a lower ASA grade (p = 0.02). There was no significant difference in surgical outcomes between groups. r-AR patients reported lower pain scales (2 ± 6 vs. 11 ± 13) (p = 0.04), lower levels of insomnia 0 vs. 8 ± 15 (p = 0.04) and a lower abdominal pain scale (2 ± 9 vs. 17 ± 27) (p = 0.04). Male impotence scores were higher in l-AR 33 ± 35 compared to r-AR 7 ± 21 (p = 0.03).

CONCLUSION

Despite its recent introduction to our centre, the quality of oncological resection using the robotic surgery is comparable to laparoscopy. Lower impotence and QoL scores in patients after robotic procedure may be explained on the basis of better visualisation and precise tissue handling.

Solution phase synthesis and intense pulsed light sintering and reduction of a copper oxide ink with an encapsulating nickel oxide barrier

Copper oxide nanoparticle inks sintered and reduced by intense pulsed light (IPL) are an inexpensive means to produce conductive patterns on a number of substrates. However, the oxidation and diffusion characteristics of copper are issues that must be resolved before it can be considered as a viable solution. Nickel can provide a degree of oxidation protection and act as a barrier for the diffusion of copper. In the present study we have for the first time synthesized copper oxide with an encapsulating nickel oxide nanostructure using a solution phase synthesis process in the presence of a surfactant at room temperature. The room temperature process enables us to easily prevent the formation of alloys at the copper-nickel interface. The synthesis results in a simple technique (easily commercializable, tested at a 10 g scale) with highly controllable layer thicknesses on a 20 nm copper oxide nanoparticle. These Cu(2)O@NiO dispersions were then directly deposited onto substrates and sintered/reduced using an IPL source. The sintering technique produces a highly conductive film with very short processing times. Films have been deposited onto silicon, and the copper-nickel structure has shown a lower copper diffusion. The nanostructures and resulting films were characterized using electron and x-ray spectroscopy, and the films' resistivity was measured.

Androblastoma of the Ovary

 Androblastoma of the ovary occurs most frequently in the 3rd to 4th decades of life and about 75% of the lesions are seen in women younger than 40 years. This tumor produces androgen and virilization is present in more than 70% of the patients. Due to the early diagnosis and treatment of such type of tumor, the prognosis is very good. This was a case report of an 18 years’ unmarried girl who presented with signs of virilization and amenorrhea for two years. On abdominal examination mass was up to epigastric reason, after all investigation we planned for laparotomy. Histopathology report revealed androblastoma of the ovary. After a month of operation, she had regular menstruation. DOI: http://dx.doi.org/10.3126/njog.v9i2.11765

All trans 1-(3-arylacryloyl)-3,5-bis(pyridin-4-ylmethylene)piperidin-4-ones as curcumin-inspired antineoplastics

A series of eleven N-acryloyl/N-cinnamoyl 3,5-bis(pyridin-4-yl)methylene-4-piperidones were synthesized as curcumin-based candidate antineoplastic agents. The cytostatic potency of these compounds was evaluated against three representative cell lines and all compounds were found to exhibit significant anti-cancer cell activity in vitro. QSAR studies using several physicochemical parameters and 50% inhibitory concentration (IC50) values resulted in certain important correlations which will aid design of more potent analogs. Representative test compounds were investigated in the NCI 60-cell line panel where they were found to display a profound cytotoxicity. These compounds were also potent anti-oxidants and inhibitors of human topoisomerase IIα. Representative compounds were well-tolerated by human fibroblasts and by mice during the survival/toxicity studies.

Intra-amniotic Digoxin for Fetal Anomaly in Second and Early Third Trimester

Aims: Carrying a baby with major anomaly is emotional trauma for mother and her family. If born alive, these babies would either not survive or would have significant disability. The objective of this study was to induce fetal demise by instillation of digoxin intra-amniotically for fetal anomaly before termination of pregnancy. Methods: This was a cross-sectional study undertaken at Paropakar Maternity and Women’s Hospital from April 13, 2012 to October 13, 2013. Patient characteristics, gestational age, types of fetal anomaly and its time of detection were recorded in 32 cases with fetal anomaly in second and early third trimester. One milligram digoxin was instilled intra-amniotically under ultrasound guidance and after 24 hours, ultrasonography was done to check fetal cardiac activity. Induction of labour using misoprostol as per FIGO guideline and augmentation with oxytocin was done if already in labour. Induction to delivery interval, effectiveness and side effects of digoxin were recorded. Results: Among 32 cases of fetal anomaly, majority occurred in primigravida (n=17, 53.12%). The mean age was 25 years and mean gestational age was 26.5 weeks’. Majority of them were anencephaly (n=16, 50%) followed by multiple anomaly (n=6, 18.75%). Thirty one (96.87%) cases visited out-patient department, 25% of them had presented late at 30-34 weeks’. Following 24 hours of intra-amniotic digoxin, cardiac activity was absent in all cases and there was no side effect of digoxin. Spontaneous expulsion occurred in 9.37%, oxytocin augmentation (n=6, 18.75%) and misoprostol induction (n=23, 71.87%). The mean induction to delivery interval was 47.3 hours. Conclusions: Intra-amniotic digoxin instillation appeared safe and effective in inducing fetal demise for fetal anomaly in second and early third trimester. DOI: http://dx.doi.org/10.3126/njog.v9i1.11188 NJOG 2014 Jan-Jun; 2(1):48-51

Puerperal Uterine Inversion

DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11148 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 57-58

Search for top squark and Higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top quark (the top squark) and the Higgs boson (Higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7  fb-1 of proton-proton collision data at s=8  TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the top squark mass below 360 to 410 GeV, depending on the Higgsino mass.

Efficacy of Misoprostol as a Post Abortion Care

Aims: This study was done to find the efficacy of Misoprostol as a post-abortion care in our setting. Methods: Women with incomplete abortion of gestational age ≤ 12 weeks or uterine size ≤ 12 weeks with open cervical os, haemoglobin ≥ 9 gm% and stable physical condition; were given 600 microgram Misoprostol orally and were observed for 24 hours for complete expulsion. If the patient failed to expel within 24 hours of Misoprostol administration manual vacuum aspiration or suction evacuation was done. Results: One hundred and twenty-two women were enrolled in the study. Among them, 41% had complete expulsion within 24 hours of administration of misoprostol and 49% had incomplete expulsions. The success rate was high in the group of < 8 weeks of pregnancy. Among 50 (41%) successful cases, 38 (76%) belonged to 8 weeks of gestation by bimanual examination (p = 0.02). Conclusions: Single dose of oral Misoprostol was effective, safe and alternative method to the management of incomplete abortion compared to the manual vacuum aspiration or suction evacuation in case of early pregnancy abortion.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 71-74 DOI: http://dx.doi.org/10.3126/njog.v8i2.9778

No effect of sperm interactions or egg homogenate on sperm velocity in the blue mussel, Mytilus edulis (Bivalvia: Mytilidae)

We investigated the possible effects of sperm interactions and homogenized eggs on sperm velocity in blue mussels ( Mytilus edulis L., 1758) using computer-assisted sperm analysis. To test whether sperm competition results in an increase in sperm velocity, using seven pairs of males, we compared the mean curvilinear and average path velocities of sperm from two males measured separately with the corresponding values from a mixture of sperm from the same two males. To test whether the presence of eggs results in an increase in sperm velocity, we compared curvilinear and average path velocities from 11 individual males with the corresponding measures from the same 11 sperm samples mixed with aliquots of homogenized eggs. Neither experimental treatment resulted in an increase in sperm velocity. We interpret these results as consistent with the hypothesis that mussel sperm have been selected to immediately begin swimming at an optimal initial velocity that is adaptive for the particular environment in which they are located. Critical factors affecting the evolution of sperm velocity for broadcast spawning, external fertilizers such as M. edulis likely include population density and intraspecific spawning synchronicity. As has been suggested by others, the importance of sperm limitation (i.e., having much less than 100% of eggs being fertilized in the wild) may be as important an evolutionary driving force in broadcast spawning invertebrates as sperm competition is in internally or directly fertilized species.

Mesenteric fat necrosis after recent surgery causing bowel obstruction: a case report and review of the literature

Mesenteric fat necrosis causing bowel obstruction is a rare occurrence with only one case reported in humans. It is due to accidental or surgical trauma to the adipose tissue with extracellular liberation of fat or enzymatic lysis of fat due to the release of lipases resulting in fibrosis. Preoperative imaging may often be misleading and fail to identify fat necrosis as the cause of bowel obstruction. As surgical intervention is the only suitable treatment option in cases of failed conservative treatment, the diagnosis is made postoperatively. There is no published advice on the management of mesenteric fat necrosis. We recommend safe operating techniques to minimize the risk of developing fat necrosis and its potential harmful consequences.

Sperm motility in Mytilus edulis in relation to mitochondrial DNA polymorphisms: implications for the evolution of doubly uniparental inheritance in bivalves

Bivalves of the families Mytilidae, Unionidae, and Veneridae have an unusual mode of mitochondrial DNA (mtDNA) transmission called doubly uniparental inheritance (DUI). A characteristic feature of DUI is the presence of two gender-associated mtDNA genomes that are transmitted through males (M-type mtDNA) and females (F-type mtDNA), respectively. Female mussels are predominantly homoplasmic with only the F-type expressed in both somatic and gonadal tissue; males are heteroplasmic with the M-type expressed in the gonad and F-type in somatic tissue for the most part. An unusual evolutionary feature of this system is that an mt genome with F-coding sequences occasionally invades the male route of inheritance (i.e., a "role reversal" event), and is thereafter transmitted as a new M-type. Phylogenetic studies have demonstrated that the new or "recently masculinized" M-types may eventually replace the older or "standard" M-types over time. To investigate whether this replacement process could be due to an advantage in sperm swimming behavior, we measured differences in motility parameters and found that sperm with the recently masculinized M-type had significantly faster curvilinear velocity and average path velocity when compared to sperm with standard M-type. This increase in sperm swimming speed could explain the multiple evolutionary replacements of standard M-types by masculinized M-types that have been hypothesized for the mytilid lineage. However, our observations do not support the hypothesis that DUI originated because it permits the evolution of mitochondrial adaptations specific to sperm performance, otherwise, the evolutionarily older, standard M genome should perform better.

Simulation of normal, carrier and affected controls for large-scale genotyping of cattle for factor XI deficiency

An insertion mutation within exon 12 of the factor XI gene has been described in Holstein cattle. This has opened the prospect for large-scale screening of cattle using the polymerase chain reaction (PCR) technique for the rapid identification of heterozygous animals. To facilitate such a screening process, the mutant and normal alleles of factor XI gene, represented by 244- and 320-bp PCR amplified fragments, were individually cloned in Escherichia coli using a multicopy plasmid cloning vehicle to generate pFXI-N and pFXI-M, respectively. The authenticity of the inserts was confirmed by nucleotide sequencing. A nested PCR method was developed, by which PCR amplicons generated from primers with annealing sites on the recombinant plasmids and by flanking the insert were used as templates for amplification of the diagnostic products using factor XI gene-specific primers. An equimolar mixture of both PCR amplicons, originating from pFXI-N and pFXI-M, constituted the carrier control while the individual amplicons were the affected and normal controls. The controls were used as references for in-gel comparison to screen a population of 307 cattle and 259 water buffaloes; the frequency of the mutant allele was found to be 0. No DNA size standards were required in this study. The simulated control DNA samples representing normal, carrier and affected cattle have the potential to help in large-scale screening of a cattle population for individuals that are carriers or affected by factor XI deficiency.

Clinical appraisal of Ascaris lumbricoides, with special reference to surgical complications

Over a period of 4 years (January 1993-December 1997), 509 patients were treated for abdominal colic with or without intestinal obstruction and a history of passage of adult roundworms either in the stool or in vomitus. All patients were below the age of 10 years, the youngest 6 months old, and were treated successfully with antispasmodics and normal saline enemas. When the pain subsided, an anthelminthic drug was given. Of 209 patients admitted to the hospital, 105 responded to conservative management and 104 (50%) required surgical intervention. The procedures included squeezing out of worms, resection and anastomosis, and treatment of other pathologies like acute appendicitis, tubercular stricture of the small intenstine, etc. Five patients died in the postoperative period due to various complications. There were no deaths among those treated by conservative management. Early recognition of the condition can prevent serious surgical complications and morbidity.

Usability issues in developing a Web-based consumer health site

ClinicalTrials.gov is a Web-based system intended for a diverse audience, including patients, family members and other members of the public. Throughout the system design and development process, our decisions have been driven by usability concerns. We first describe the overall design of the site, including the home page, which provides a site overview and rapid access to the information contained within it. Next we discuss the data presentation format which has been standardized in spite of data coming to us from many different sources. We provide a detailed description of the search and browse features that are intended to simplify the complexities of medical terminology and support information discovery. We conclude with a review of our evaluation activities and future plans.

Pregnancy and cirrhosis of the liver

Pregnancy in patients with cirrhosis of the liver is uncommon. We reviewed 9 pregnancies in 7 patients with cirrhosis. One patient conceived within 1 month of diagnosis and in another the disease was diagnosed during the index pregnancy. Four patients has associated portal hypertension and 1 of them conceived after lienorenal shunt. Complications associated with these pregnancies were jaundice (1) jaundice plus ascites (2) and gastrointestinal bleeding (1). In 2 patients endoscopic sclerotherapy was done during the index pregnancy. The incidence of preterm delivery was 50% (4 of 8) and the majority (75%) occurred in pregnancies where associated complications were present. There was 1 maternal death in the postpartum period due to fulminant hepatic failure.

Urinary excretion of glycosaminoglycans, hydroxyproline and hydroxylysine in rabbits after excessive ingestion of fluoride

Urinary levels of glycosaminoglycans (GAG) and hydroxyproline from normal and fluoride treated rabbits were estimated. The hydroxylysine content of serum and urine of rabbits after excessive ingestion of fluoride was also investigated. There was a progressive decrease in GAG content, reduction in hydroxylysine, whereas the hydroxyproline content was increased after fluoride ingestion. Enhanced hydroxyproline in urinary excretion is due to collagen breakdown after fluoride ingestion. The reduction in hydroxylysine content is due to reduced collagen cross-link formation. The report suggests the possibility of using the urinary levels of GAG or hydroxyproline or hydroxylysine as an index of fluoride intoxication.

Cellular and histochemical characteristics of osteoid formed in experimental fluoride poisoning

The present study on the cellular and histochemical characteristics of osteoid formed in iliac crest bone during fluoride poisoning in rabbits was carried out as there is no information available to date either on its structural or biochemical characteristics. Osteoid formation in bone is prevalent both in fluorosis and in sodium fluoride therapy for osteoporosis. The report provides evidence which indicates that fluoride induces osteophytic activity leading to the formation of cartilagenous loci (fibrocartilage) in bone, the matrix of which is loaded with glycosaminoglycans (GAG) and proteoglycans. The occurrence of dermatan sulphate is demonstrated histochemically. Accumulation of dermatan sulphate in the cartilagenous matrix possibly prevents the normal process of mineralization.

Excessive ingestion of fluoride and the significance of sialic acid: glycosaminoglycans in the serum of rabbit and human subjects

The levels of sialic acid and glycosaminoglycans were explored in the sera of rabbit and human subjects who ingested fluoride and had clinical manifestation of fluorosis. Changes observed in the level of these chemical constituents in sera possibly reflect changes occurring in calcified and noncalcified tissues due to fluoride intoxication. The ratio of sialic acid content vs glycosaminoglycans revealed there was a 50% reduction in rabbit and human sera. The test is recommended for evaluating the prognosis of fluoride poisoning/fluorosis.

Age-related changes in pyridinoline content of rabbit collagen

The age related changes in the content of pyridinoline were followed for collagen from rabbit muscles. Pyridinoline content of the muscle collagen in 2-week-old rabbits is very low and increases markedly with growth of the animals. However, it decreases after maturation in cardiac muscle but not in red & white muscle. Pyridinoline may serve as an interesting index for aging in connective tissue.