Space allowance influences individually housed Holstein bull calf innate immune measures and standing behaviors after castration at 3 weeks of age.

Dairy calves in the Southwest regions of the United States are typically raised individually in wooden hutches with 1.23 m2 of space. The objective of the study was to determine if increased space allowance in wooden hutches influences measures of innate immunity and behaviors of Holstein bull calves pre- and postcastration. Calves were randomly assigned at 4 d of age to conventional (CONV; 1.23 m2 of space; n = 18), moderate (MOD; 1.85 m2 space; n = 17), or maximized space allowance (MAX; 3.71 m2 space; n = 19) in hutches. Calves were surgically castrated at 24 d of age. Peripheral whole blood samples were collected at -1, +1, +5, and +12 d of castration. Accelerometer loggers (n = 16 calves per treatment) were used from -3 to +5 d of castration to assess standing behaviors. All calves decreased total standing duration the day of castration versus precastration. Overall, MAX spent the most time in the stand position postcastration versus CONV and MOD. Within treatments, MOD and MAX had increased plasma cortisol 1 d postcastration versus precastration. A treatment × time tendency was observed for cortisol at 12 d postcastration; MAX had the least circulating cortisol. A treatment × time tendency for circulating haptoglobin (Hp) was observed and Hp was greatest among CONV 1 d pre- and 12 d postcastration. Compared with precastration, CONV had increased Hp at 1, 5, and 12 d, whereas MOD had increased Hp at 5 d, and Hp remained similar within MAX. A treatment × time tendency for tumor necrosis factor-α (TNF-α) from lipopolysaccharide-stimulated whole blood was observed; at 1 d postcastration, MOD had the most TNF-α, whereas MAX had the least. Within MAX, calves had increased TNF-α from precastration to 5 d postcastration. A treatment × time interaction was observed for whole blood bactericidal activity against Escherichia coli (WB anti-E). The CONV tended to have the greatest WB anti-E at d -1, but at d 1 and 5 postcastration, CONV had the least WB anti-E. Overall, MAX had less intensity of neutrophil oxidative burst versus CONV and MOD. The lower response of neutrophil oxidative burst and slower Hp secretion after castration is indicative that the wound site likely had less microbial exposure. The findings of this study suggest that calves housed with more space are potentially at less risk of too much inflammation after castration, which may likely be due to the effects of increased space on hide cleanliness and increased standing time.

Wooden hutch space allowance influences male Holstein calf health, performance, daily lying time, and respiratory immunity.

Dairy calves in the western United States are commonly raised individually in wooden hutches with a space allowance of 1.23m(2)/calf. Recent legislative initiatives in California and across the United States were passed regarding concern over space allowance for farm animals. The objective of this study was to determine if rearing male Holstein calves in wooden hutches modified to increase space allowance would influence measures of performance, lying time per day, health, and respiratory immunocompetence. At 4d of age, 60 calves were randomly assigned to 1 of 3housing treatments: (1) conventional housing (CONV; 1.23m(2)/calf), (2) 1.5 × CONV (MOD; 1.85m(2)/calf), or (3) 3 × CONV (MAX; 3.71m(2)/calf). Intakes of milk and solid feed were recorded daily and body weight was measured at 0, 3, 6, 10, and 12 wk of age. For the first 3 wk of the trial, calves were scored daily for fecal consistency, hydration, and hide cleanliness. In addition, calves were scored for respiratory health (i.e., nasal and eye discharge, ear position) until 7 wk of age. The total lying duration per day was recorded using data loggers at 3, 6, and 10 wk of age. Eight clinically healthy calves from each treatment were sensitized with subcutaneous ovalbumin (OVA) and then challenged with aerosolized OVA to assess calf respiratory immunity at 11 wk of age. Bronchoalveolar lavage fluid (BALF) was collected 4d after the OVA challenge and analyzed for leukocyte differentials and OVA-specific IgG, IgG1, IgA, and IgE. Calf average daily gain and body weight were positively associated with space allowance at approximately 3 wk before weaning and throughout postweaning, respectively. A greater space allowance decreased lying time after 46d. Space allowance did not influence fecal consistency, but there was a tendency for MAX calves to take 1d longer to recover from loose feces than MOD calves. The MAX calves had the fewest (%) observations with feces on their body compared with CONV or MOD. At 3 wk of age, peripheral eosinophil concentrations decreased with increased space allowance. However, observations (%) of eye discharge increased with greater space allowance. Among calves challenged with OVA, MOD calves had the least BALF OVA-IgE, and the percent of BALF eosinophils decreased with increased space allowance. Increased space allowance for calves raised in wooden hutches may improve some measures of calf performance, health, and respiratory immunocompetence.

Two week rule referral for patients with colorectal cancer below the age of 50; are we being ageist?

OBJECTIVES: The TWR system was introduced in July 2000. The purpose of this study was to investigate whether patients below the age of 50 years with colorectal cancer (CRC) are experiencing delays in treatment. METHODS: The CRC database was searched for all newly diagnosed colorectal cancers between January 2001 and December 2005 in patients who were aged less than 50 years. RESULTS: There were 911 patients with CRC during the study period. Of these, 41 patients (4.5%) were aged under 50. Thirty-eight case notes were retrieved and reviewed; the median age was 47 years. Fourteen (37%) presented as an emergency, 9 (24%) via the TWR, 8 (21%) were non-TWR referrals to outpatients and the remainder were referred via miscellaneous routes. The median time from referral to initial consultation was 11 days (range 8-14 days) in the TWR group, 24 days (range 14-135 days) in the surgical outpatients group and 44 days (range 11-93 days) in the miscellaneous (direct endoscopy, in-hospital physician's referral) group. The median time from referral to initiation of treatment was 51 days (range 15-116 days) in the TWR group, 103 days (range 43-174 days) in the outpatient group and 96 days (range 27-270 days) in the miscellaneous group. Excluding age as a factor, 73% of the non-TWR referrals met the TWR criteria. CONCLUSION: Patients with symptoms of CRC below the age of 50 years may face referral and diagnostic delay if not referred via the TWR system; many of these would be eligible if age was not a deciding factor.

Phosphorus digestibility and phytate degradation by yearlings and mature horses.

Inorganic P is often added to growing horse diets because organic P, or phytate-P, is believed to have lower digestibility. If horses can efficiently digest organic P, then the need for inorganic P may be reduced. Much of the P in grain-based concentrates fed to growing horses is in the form of phytate-P. Little is known about the ability of growing horses to degrade phytate-P or whether horse age affects mineral digestion in horses. The objective of this study was to examine the effect of age on P, Ca, and Mg digestibility as well as phytate-P degradation. Four yearling geldings and 4 mature geldings were fed a diet of alfalfa cubes, timothy cubes, and a pelleted concentrate. The diet contained 0.28% total P and 17.4% of that P was in the phytate form. There was a 14-d diet adaptation period followed by a 4-d fecal collection period. Apparent total tract P digestibility was higher for yearlings than mature geldings ( = 0.036; 7.7 and -6.6% for yearlings and mature geldings, respectively). Phytate-P disappearance was 94.8% and did not differ between ages ( = 0.190). Apparent Ca digestibility was lower in mature geldings ( = 0.043), but apparent Mg digestibility did not differ between ages ( = 0.414). Phytate is broken down in the gastrointestinal tract, but the low P digestibilities suggest that either degradation occurs after the site of P absorption or liberated P is recycled back into the gastrointestinal tract. Yearlings can utilize organic P as well as mature horses; therefore, diets without inorganic P are acceptable for growing horses.

Undertaking procedure-based assessment is feasible in clinical practice.

INTRODUCTION: With the development of a new curriculum, workplace based assessments such as procedure-based assessment (PBA) are becoming increasingly common within surgical training. However, there have been concerns about the impact of these assessments on clinical practice. This study assessed the time taken to complete PBA forms to determine whether it is feasible in clinical practice. MATERIALS AND METHODS: PBAs for three colorectal procedures (anterior resection, right hemicolectomy and anal fistula) were undertaken by various trainers and trainees. A pilot study was performed to identify potential reasons for incomplete forms and procedural modifications subsequently applied in the main study. Times taken to complete the consenting and operative components of the forms were recorded. RESULTS: Incomplete forms in the pilot were mainly attributable to time constraints. In the main study, all assessments were completed within 30 min. Assessment times increased with complexity of the procedure. Median times for completing the consenting and operative components in anterior resection were 13 min (range, 8-15 min) and 15 min (range, 10-18 min), respectively. CONCLUSIONS: PBAs are feasible in clinical practice and are valued by trainees as a means of enabling focused feedback and targeted training. Commitment from trainers and trainees will be required but, with adequate planning, the assessment tool is effective with minimal impact on clinical practice.

The routine use of intra-operative ultrasound in patients with colorectal cancer improves the detection of hepatic metastases.

INTRODUCTION: Up to one fifth of patients with carcinoma of the colon have occult liver metastases at the time of presentation. Intra-operative hepatic ultrasonography might improve disease staging. We report the use of intra-operative ultrasonography (IOUS) in routine clinical practice over a five-year period. METHOD: Seventy-six patients with colorectal carcinoma (F 21, M 55) of median age 67 years (range 43-89 years) for whom full data were available had IOUS at the time of colonic resection. All patients had had a computerized tomography (CT), magnetic resonance imaging (MRI) or ultrasonography (USS). RESULTS: Of 76 patients, 10 had a Dukes A, 32 had a Dukes B and 34 a Dukes C carcinoma. In 20 patients IOUS detected lesions not seen on pre-operative scanning including 11 metastases (one suitable for resection), seven benign hepatic cysts and two were benign hepatic nodules. Forty-nine patients have remained free of disease and 25 have died with systemic disease (mean survival 10 months, range 2-24 months). In the seven patients diagnosed as having hepatic cysts at IOUS two have died of systemic disease. The remaining patients (n=12) who died with systemic disease had a negative IOUS. CONCLUSION: IOUS increases diagnostic yield but a significant proportion of patients with occult hepatic metastases are not detected. IOUS improves disease staging in some patients refining the indications for adjuvant therapy and enhancing the estimate of prognosis and improving decision-making.

Single-fiber electromyography correlates more closely with incontinence scores than pudendal nerve terminal motor latency.

BACKGROUND: The investigation of fecal incontinence is important in deciding the most appropriate treatment. The presence of neuropathy has been shown to affect surgical outcomes adversely. Latency studies are of dubious value in assessing neuropathy; needle electromyography is the gold standard test. The relationship between these two tests and the symptoms of fecal incontinence has not been studied. METHOD: A cohort of 57 patients underwent neurologic and symptom assessment using latency studies, concentric and single-fiber electromyography, and symptom assessment using the Cleveland Clinic Scoring System. RESULTS: There was a significant correlation between left mean fiber density and Cleveland Clinic Scoring (correlation: 0.32, P = 0.02) but not between right or left latency studies. CONCLUSION: Single-fiber electromyography gave relevant results that could be obtained easily on modern equipment. Latency values were not reliable.

Bowel function following insertion of self-expanding metallic stents for palliation of colorectal cancer.

OBJECTIVE: Self-expanding metallic stents (SEMS) are an important addition to the treatment of large bowel obstruction. The aim of this study was firstly to assess bowel function following SEMS placement and secondly to identify any potential factors which might aid in the prediction of technical failure of stent insertion. METHODS: A review of all patients undergoing attempted SEMS placement for palliation of malignant left-sided colorectal obstruction over a four-year period (1st May 2000-30th April 2004) was performed. RESULTS: Twenty-one patients (12 male) with a median age of 76 years (range 48-92 years) were included, 11 with metastatic disease and 10 severe comorbidity. SEMS insertion was technically successful in 16 (76%) of 21 cases. Contrast successfully passed through the obstructing lesion in all 16 cases where SEMS placement was technically successful. It only passed through 1 of 5 cases where stenting was not possible (P = 0.0008, Fisher's Exact test). Complications included colonic perforation (1 case), stent migration (1 case) and tumour ingrowth requiring a second stent (1 case). Median survival after SEMS was 12 months (range 1-30 months), and 9 patients died during follow-up. Median bowel frequency following SEMS was 3.5 times per day (range 1-7). Eight patients always passed a liquid stool, 3 others regularly required laxatives and one further patient with poor function after stenting requested a defunctioning stoma. CONCLUSION: Failure of contrast to pass through the obstructing lesion may predict those cases where stenting will not be technically possible. Median survival following SEMS insertion is encouraging in this series, but bowel function is often poor. Expected bowel function should be discussed fully when consenting patients for a SEMS, particularly those with metastatic disease who are otherwise fit for resectional surgery.

Direct appositional (no flap) closure of deep anal fistula.

OBJECTIVE: After sphincter-sparing core fistulectomy for deep anal fistula most surgeons advance a rectal mucosal flap to reinforce closure of the internal opening. Our own method having for many years been simple appositional closure the resulting series presented an opportunity for comparison. PATIENTS AND METHODS: From November 1987 to January 2001, 44 patients underwent 46 core fistulectomies with flap-less direct appositional closure in our unit. Records were kept prospectively. Twenty-six fistulae (in 28 patients) appeared healed at two to five months follow-up and the patients had been discharged. A full review was mounted in May 2001, when 16 of the healed patients could be contacted and questionnaires completed. Two patients were excluded from the study. RESULTS: The procedure failed in 16 patients initially and was found to have done so in two more at long-term follow-up (41% overall). Three patients had died and five could not be traced. CONCLUSION: Simple appositional closure after core fistulectomy for deep anal fistula seems inferior to methods using flap reinforcement.

A study of the complications and pelvic visceral function after restorative proctocolectomy and W pouch construction.

OBJECTIVE: Aspects of ileal pouch surgery remain controversial. The authors' single practice experience of 107 operations illustrates many of them. It was hoped that its study would contribute usefully to the debate. PATIENTS AND METHODS: Details of all 107 restorative proctocolectomies carried out since the operation was started in Gloucester in 1984 until the study period ended have been kept prospectively. All patients had proctectomy by mesorectal dissection, and 106 had W pouch restoration. Four suffered functional failure requiring reversion to ileostomy and three patients have died. The remaining 99 were sent a questionnaire concerning pelvic visceral function and evidence of pouchitis. Records of all but one of the patients have been reviewed. RESULTS: Surgical morbidity was low with neither chronic pelvic sepsis, pouch related fistula, pouch haemorrhage nor pouch ischaemia. Mucosectomised patients had similar bowel control to the stapled group. The policy change from routine to selective protective ileostomy proved satisfactory. W pouch function was found to be comparable to that reported from major J pouch series, although anti-diarrhoeal usage was reduced, and was not influenced by either gender, age or time since surgery. CONCLUSION: None of the following reasonably intuitive assumptions seem supported by our findings: that mesorectal excision necessarily poses a greater danger to pelvic visceral function than close rectal dissection, that the greater capacity of W pouches will be reflected in markedly less frequency, that mucosectomy would impair anal control, or that a defunctioning ileostomy is a mandatory precaution. Pouch frequency is less if wind can be passed separately; otherwise functional outcome seems determined by other, non-technical, factors.

Comparison of ultrasound and manometric sphincter length and incontinence scores.

PURPOSE: Fecal incontinence can be assessed by a wide variety of means that vary in their clinical relevance. This study assesses the correlation between two methods of recording sphincter length and incontinence scores. METHODS: A retrospective review of results from 1999 to 2001 of 137 patients with fecal incontinence was undertaken on patients who had both ultrasound and manometric assessment. Incontinence scores, ultrasonic sphincter length, and manometrically derived sphincter length were recorded. The data were analyzed using the Spearman rank correlation coefficient (r(s)) for nonparametric data. RESULTS: There was negative correlation between incontinence scores and manometric sphincter length (r(s) = -0.27; P = 0.002) but not with ultrasonic length (r(s) = -0.08; P = 0.38). There was correlation between manometric and ultrasonic lengths (r(s) = 0.21; P = 0.02). In males, all three correlated but none of the values were significant (n = 12). Internal and external sphincter defects had no effect on correlation coefficients. CONCLUSION: Given that all measurements include a degree of subjectivity, manometry more closely correlates with the fecal incontinence scores than ultrasound measurements. There seems to be little benefit in measuring the sphincter length with ultrasound. Manometric sphincter length measurement seems to have a role in assessing patients with fecal incontinence.

Laser ablation of ampullary carcinoma.

BACKGROUND AND STUDY AIMS: The aim of this study was to assess whether the use of laser ablation could palliate or potentially cure ampullary carcinoma. PATIENTS AND METHODS: This study involved patients with confirmed ampullary carcinomas who were deemed fit for repeated endoscopic treatment but who were unfit for more radical treatment, and included six patients in Oxford and six in Gloucester. Repeated laser therapy was used after endoscopic stenting, following investigation as described. RESULTS: Good periods of survival were seen with good palliation and no complications of treatment. The longest survival was 36 months (range 4-36, median 21). Duodenal obstruction was successfully relieved in one patient. CONCLUSION: The treatment shows promise in selected patients, but conclusions are limited by the small numbers and lack of controls in this study.