Emergency abdominal surgery in the elderly.

A retrospective survey of 152 patients undergoing emergency abdominal surgery was carried out to examine factors which may have affected the outcome of surgery. The operative diagnosis and procedure carried out, pre-operative health of the patient, duration of surgery and grade of surgeon were studied to assess whether these factors had any bearing on the eventual outcome. A large variety of surgical emergencies were treated but none of the factors under study were related to the eventual morbidity or mortality recorded. The overall mortality among these patients was 25% which concurs with other studies. The presence of an obstructing cancer of the left colon or upper gastro-intestinal haemorrhage had a particularly poor outcome. Most patients were discharged to their own homes within 3 weeks of admission and they did not comprise an undue burden on the surgical service.

Collagen promotes perianastomotic tumour growth in an experimental animal model.

Local application of growth factors promote wound healing and may find clinical application for use in high-risk intestinal anastomoses such as that following anterior resection. Since viable tumour cells are present in the bowel lumen and circulation after curative colorectal cancer surgery, it is unclear what effect such factors may have on tumour recurrence. The aim of this study was to examine the effect of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) in a collagen suspension on perianastomotic tumour growth in an animal model. Significantly (P < 0.05) more animals in the collagen treated groups developed anastomotic tumours. The area of tumour growth at the anastomosis was also significantly greater for the collagen (median 14.7 mm2) and collagen + EGF (median 10.8 mm2) groups compared with controls (median 0.78 mm2). We were unable to demonstrate any promotion of tumour by growth factors alone. Collagen promotes perianastomotic tumour growth in this model and is not a suitable vehicle for growth factor application in colorectal cancer surgery.

Effect of the surgeon's specialty interest on the type of resection performed for colorectal cancer.

PURPOSE: The aim of this study was to examine the type of resection performed for colorectal cancer by surgeons with a colorectal interest and compare this with the type of resection performed by surgeons with other specialty interests. METHODS: One hundred sixteen patients had curative surgery performed for primary colorectal cancer over a one-year period by ten surgeons with four different specialty interests. RESULTS: Surgeons with an interest in colorectal cancer resected twice as much colon (280 mm vs. 130 mm; P > 0.0001, Mann-Whitney U test) and were more likely to remove adjacent clinically involved organs (15 percent vs. 0 percent) for left-sided colon and rectal cancers compared with surgeons with vascular or transplant interests. Surgeons with an interest in gastroenterology performed a resection that was intermediate between the colorectal and other specialty groups for left-sided cancers. Distal resection margins were significantly greater (55 mm vs. 20 mm; P > 0.001) for sigmoid cancers in the colorectal group, but were similar in all groups for rectal cancer. Resection lengths and margins for right-sided cancers were similar in all groups, although the number of lymph nodes retrieved from the mesentery was greater in the colorectal group (13 vs. 7.5; P = 0.08). CONCLUSION: This study shows a wide variability in the type of resection performed for colorectal cancer and illustrates the need for clinical trials to evaluate the effect of such variability on patient outcome.

Acute perforated duodenal ulcer is not associated with Helicobacter pylori infection.

Most patients with chronic duodenal ulcer disease have Helicobacter pylori infection and eradicating it considerably reduces the relapse rate. The prevalence of H pylori in 80 patients (mean age = 52 years, range 17-85) presenting with acute perforated duodenal ulcer was examined and compared with age and sex matched hospital control patients. H pylori state was assessed by serum anti-H pylori IgG (Helico-G kit, Porton) using a titre of 18 or less as negative with a specificity of 89% and sensitivity of 88%. Only 47% of the perforated duodenal ulcer patients were positive for H pylori and this was similar to the value of 50% in the controls. In 51 of the perforated duodenal ulcer patients 14C-urea breath tests were also performed 4-10 weeks after surgery and this confirmed that only 49% were positive for H pylori. None of these patients had received perioperative drugs that might have eradicated the infection. The H pylori positive and H pylori negative perforated duodenal ulcer patients were similar with respect to age (53, 51), smoking (84%, 83%), and consumption of more than 15 units of alcohol per week (42%, 38%). Duodenal ulcer disease had been diagnosed before acute perforation in only 24% of those with H pylori and also 24% of those without the infection. Regular non-steroidal anti-inflammatory drug (NSAID) use was common in both those with (44%) and without (45%) H pylori. In conclusion, the lack of association of acute perforated duodenal ulcer and H pylori infection suggests that perforated duodenal ulcer has a different pathogenesis from chronic duodenal ulcer disease, and that the first should not be regarded simply as a complication of the second.

Effect of fibrin sealant on perianastomotic tumor growth in an experimental model of colorectal cancer surgery.

Viable intraluminal tumor cells can penetrate a clinically intact rodent colonic anastomosis and give rise to perianastomotic tumor growth. The aim of this study was to determine whether transanastomotic cell migration can be prevented by fibrin-based tissue sealant. Following distal colonic transection and reanastomosis with 5/0 silk sutures, Fischer F344 rats were randomly allocated to three experimental groups. In Group A, a circumferential ring of tissue sealant was placed around the serosal surface of the anastomosis; in Group B, sealant was limited to 50 percent of the anastomotic circumference; and, in Group C, no sealant was applied. All rats then had 10(5) Mtln3 carcinoma cells injected into the proximal colonic lumen via a rectal catheter. The incidence of perianastomotic tumor at 21 days was significantly lower in Group A (3 of 14 animals) than in Group B (11 of 16 rats) (P = 0.012; Fisher's exact test) or Group C (10 of 14 rats; P = 0.011). A further experiment demonstrated that sealant did not protect the anastomosis when tumor cells were instilled directly into the peritoneal cavity. A topical carcinocidal action therefore appears unlikely, but our results suggest that a circumferential anastomotic ring of fibrin sealant forms an effective mechanical barrier preventing intraluminal tumor cells from reaching the peritoneal cavity.

Effect of suture material on tumour cell adherence at sites of colonic injury.

In an experimental animal model, radiolabelled viable intraperitoneal adenocarcinoma cells adhered in similar numbers to normal rat colon and that injured by a 1-cm colotomy, with median cell counts of 7002 and 8602 respectively (P not significant). Repair of the colotomy with interrupted silk resulted in a significant increase in the median number of cells adhering to the injury site (21,888; P = 0.0001 versus normal colon). Repair with Prolene had no effect on tumour cell adherence (a median of 7449 cells adhered; P not significant versus normal colon). Tumour cell adherence at sites of colonic injury is dependent on the suture material used and not on the injury itself in this model. This may be important when choosing suture type for anastomosis in patients undergoing surgery for colorectal cancer.

Synchronous male breast carcinoma and soft tissue sarcoma occurring within a cancer family.

Male breast carcinoma is uncommon and accounts for less than 1% of all cases of breast carcinoma. Soft tissue sarcomas also occur infrequently and cause less than 1% of all cancer related deaths. We report a case of breast carcinoma and soft tissue sarcoma occurring simultaneously in a 34-year-old male with a family history of gastrointestinal neoplasia suggestive of Cancer Family Syndrome. Features, diagnosis and management of this syndrome are reviewed.