Genome Sequencing of Sub-Arctic Mesomycetozoean Sphaeroforma sirkka Strain B5, Performed with the Oxford Nanopore minION and Illumina HiSeq Systems.

The Mesomycetozoea branch near the animal-fungal divergence and are believed to be important to understanding the origins of multicellularity. In 2012, a free-living saprotrophic mesomycetozoean was isolated from the sub-Arctic Bering Sea. A hybrid assembly using Illumina and Nanopore sequences yielded 2,688 contigs with a total length of 125,635,304 bases.

Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies.

The accepted radionuclide method for imaging abnormal parathyroid tissue has been the combined use of [99mTc]pertechnetate 201Tl-chloride. Various problems with this approach, however, have suggested the need for an improved parathyroid imaging agent. This study examined the use of 99mTc-sestamibi as a parathyroid imaging agent compared with 201Tl-chloride. Fifty-seven patients were scanned with both 99mTc-sestamibi and 201Tl preoperatively. There were 40 adenomas, of which 37 were localized with 201Tl and 39 with sestamibi. Fifteen patients had hyperplastic glands, of which 29 glands were localized with 201Tl and 32 with sestamibi. Possible differences in uptake of the two agents by thyroid and parathyroid tissue were examined by administering 10 MBq of each agent to patients undergoing surgical exploration and biopsy. Preoperatively 20 patients were studied (13 adenomas and 7 with hyperplasia). Thallium-201 uptake was higher in both the parathyroid and thyroid tissue than sestamibi. However, the uptake per gram of parathyroid tissue of sestamibi was higher than the uptake per gram of thyroid tissue. This was not true for 201Tl. Technetium-99m-sestamibi was at least as effective as 201Tl in parathyroid localization. This may be partly due to a higher target-to-background ratio, but also to the superior physical characteristics of 99mTc.

Prevention of deep vein thrombosis in neurosurgical patients: a controlled, randomized trial of external pneumatic compression boots.

A prospective, randomized clinical trial in 95 patients undergoing neurosurgical operative procedures was performed to investigate the efficacy of external pneumatic compression (EPC) of the calves as compared with results in a control group that received no specific form of prophylaxis for prevention of deep vein thrombosis (DVT). The diagnosis of DVT was established by the I125 fibrinogen scan and radiographic contrast phlebography. The data indicate that EPC provides significant protection against the development of DVT in comparison with results in the control group (p less than 0.005). There were no known pulmonary emboli in any of the EPC-treated patients. There were no complications of EPC.

Prevention of deep vein thrombosis in urological patients: a controlled, randomized trial of low-dose heparin and external pneumatic compression boots.

A prospective, randomized clinical trial in 83 patients undergoing open urological operations was performed to compare the relative prophylactic efficacy of low-dose heparin and external pneumatic compression (EPC) of the calves in comparison to no treatment in the prevention of deep vein thrombosis (DVT). The diagnosis of deep vein thrombosis was established by the I125 fibrinogen scan and contrast phlebography. The data indicate that EPC is more effective than no treatment (p less than 0.04) and more effective than low-dose heparin (p less than 0.04) in the prevention of DVT. There was one pulmonary embolus in each of the three groups, and in the treatment groups this occurred without evidence of DVT.

Cardiovascular changes during mental stress: correlations with presence of coronary risk factors and cardiovascular disease in physicians and dentists.

Stress may play a role in the etiology of cardiovascular disease. Research showing that mental stress administered in laboratory settings causes great change in cardiovascular and hemodynamic functioning supports this hypothesis. In a small sample of physicians and dentists, those who showed greater cardiovascular reactivity (hot reactors) to stress were more likely to be hyperlipidemic or to have had a myocardial infarction or coronary bypass surgery. In addition, some of the nonreactive group were hypertensives taking medication, which may have blunted their response to stress. Persons with higher cholesterol, higher triglyceride levels, and lower HDL levels all showed greater increases in blood pressure (BP) in response to stress. Also, the reactive group reported less emotional support and experienced greater numbers of family-related stressful events in the previous year. The degree of aerobic fitness influenced resting hemodynamics and percentage of body fat but not reactivity to stress. Likewise, smoking did not affect reactivity, but former smokers did have a significantly elevated total systemic resistance at rest. While it is impossible to say whether reactivity causes disease, is the result of the presence of risk factors and disease, or is caused by some other factor which also contributes to disease, these results suggest that the presence of cardiovascular reactivity to mental stress is a sign of potential illness and indicates the need for further medical and risk factor study of the patient.

99Tcm sestamibi--a new agent for parathyroid imaging.

Parathyroid imaging using 99Tcm sestamibi has been carried out prior to surgery in five patients with hyperparathyroidism and the results compared with a standard preoperative localization technique using 201Tl (thallous chloride). The 99Tcm sestamibi correctly localized all abnormal glands and showed higher parathyroid to thyroid uptake in three of four parathyroid adenomas. Both agents showed localization in a thyroid adenoma. The higher uptake of sestambi and better imaging properties of its 99Tcm radiolabel means that the agent may replace thallium for routine preoperative parathyroid localization.

123I-methylene blue: an unsatisfactory parathyroid imaging agent.

This study was designed to examine the possible use of 123I-labelled methylene blue as a parathyroid imaging agent. Five patients were studied, all of whom had parathyroid adenomas which were successfully localized preoperatively with 201Tl and 99Tcm-sestamibi, and which were subsequently proven at surgery. The 123I-labelled methylene blue localized only one of these adenomas, was negative in two and had equivocal uptake in the remaining two patients. It is therefore concluded that compared to other radionuclide methods for localizing parathyroid adenomas this agent is unsatisfactory.

Unilateral breast atrophy.

This represents the only known case of acquired unilateral breast atrophy described after previously normal bilateral breast development. Our patient developed left breast atrophy with normal microscopic examination (biopsy) subsequent to infectious mononucleosis. Her reconstruction utilized tissue expansion followed by prosthetic augmentation of the affected side. Despite an exhaustive search, no definitive cause to explain these findings has been found. Perhaps there is some unknown underlying viral etiology that may have further implications for other breast pathology.

Surgeons and the new deal--good deal or raw deal?

New regulations concerning the training of junior doctors are being introduced. The effect of some of these is already beginning to be noted and the new style Calman training will be introduced shortly. In the South East Thames the implications of Calman type training programme have been piloted in a unified registrar training grade in general surgery for the last three years. It seems an appropriate time to reflect on the changes already operational and the impact of those to come.

Surgical outpatient practices--a time for change?

Outpatient services are becoming increasingly overburdened and delays for appointments are commonplace. The recent NHS reforms have laid down stricter guidelines on waiting times for hospital services and reorganisation of healthcare provision is necessary in order to meet some of these recommendations. The outpatient service is a case in need. Open access referral for minor cases, endoscopy and vascular assessment, for example, may help to utilise more usefully consultations for new referrals. Follow-up in outpatient clinics should become rationalised with clear objectives being made for investigation and reintervention. The long-term follow-up of patients should rest with their general practitioners. Recommendations have been made for a consultant-based service and more patients are expecting to be seen by a consultant. Until an expansion in consultant numbers is forthcoming patients will continue to experience delays in their management. The current service has scope for improvement and some suggestions are made in this paper.

General surgeons and the management of head injuries.

Most head injuries in Great Britain and Ireland are managed either by orthopaedic or general surgeons. In response to growing anxiety about the arrangements for the management of head injuries, the Royal College of Surgeons of England late in 1997 set up a working party to report to the Senate of Surgery. The results of that survey are presented here.

Use of operating theatres: the effects of case-mix and training in general surgery.

Details of theatre occupancy times for a surgical unit in a district general hospital and associated cottage hospital were recorded over a 4-month period. The average time of the procedures individually and reclassified within the BUPA schedule showed that both the severity of the procedure and the grade of surgeon influenced future theatre needs. For almost every type of procedure, as expected, consultants were quicker than registrars, who in turn were faster than SHOs. The hidden cost of training surgeons in general surgical operative procedures can be estimated as a result. It is concluded that current measures of resource use which rely only on the bed use and ignore operating theatre needs and training requirements for non-consultant grades will be misleading, particularly in relation to the large element of minor or intermediate surgery which constitutes the bulk of most district health authorities' workload.

'Unseen' on-call workload of a general surgical team.

Over a four-month period, we assessed the contribution made to the on-call workload of a general surgical team, by referrals and assessments of patients who had not been admitted under surgical care and were therefore not recorded in current audits of general surgical activity--the 'unseen workload'. Up to 5 1/2 hours per day on-call (mean 101 minutes) was spent assessing these referrals. There was a mean number of 3.6 referrals (range 1 to 7). Although 51 percent of these referrals were deemed to be non-surgical after assessment, the majority (77 percent) were believed to be appropriate. The Accident & Emergency Department referred 46 per cent of patients with only 7 percent requiring surgical management. This study shows that while hours of work are important in assessing the workload of a junior doctor on-call, the intensity of the workload is just as important in determining the impact on staff. There is a greater workload than revealed by audit of just surgical admissions and operations alone.

Chest injuries in a district general hospital.

Patients with chest injuries requiring admission to the Kent and Canterbury Hospital over a period of one year have been reviewed. Good survival figures are possible when these patients are managed by general surgeons and anaesthetists once the initial traumatic insult and immediate resuscitation period are survived. Among the 54 patients admitted there were 11 deaths, of which 10 occurred within a few hours of the patient's reaching hospital. It seems unlikely that even with specialist facilities the outcome would have been different in these 10 patients. Provided that a combination of experienced surgical and anaesthetic teams supported by intensive care facilities are mobilised quickly enough the absence of specialised cardiothoracic expertise is not important.

Surgical relief of obstructive jaundice in a district general hospital.

Fifty consecutive patients with obstructive jaundice treated by operation in Canterbury & Thanet Health District hospitals under the care of one surgeon (RECC) over a 6-year period have been studied. The pathology was found to be common bile duct (CBD) stone in 22 patients (44%); pancreatic carcinoma in 15 (30%), 3 of whom also had CBD stones; chronic pancreatitis in 4 (8%); extrahepatic CBD carcinoma in 4 (8%); ampulla of Vater carcinoma in 3 (6%); primary duodenal carcinoma in 1 (2%); and portahepatis obstruction in 4 (8%). The 8 postoperative deaths (16%) were found to be associated with high preoperative levels of serum bilirubin, but all occurred in patients with malignant disease. Complications occurred in 20 patients (40%) and bile culture state was found to be intimately related to the morbidity rather than operative mortality. The study represents a careful audit of the pathology distribution and the surgical management of obstructive jaundice as seen in district hospitals.

Glucose concentrations in parotid fluid and venous blood of patients attending a diabetic clinic.

Measurements of the glucose concentration in venous blood and parotid saliva taken from 31 diabetics attending a diabetic clinic showed values ranging respectively from 3.9 to 19.1 mmol/l and 0.06 to 0.83 mmol/l (means 9.6 mmol/l and 0.32 mmol/l respectively). Linear regression of salivary glucose on blood glucose gave a simple correlation coefficient of 0.18 (NS). Since salivary glucose levels did not reflect blood glucose levels, the possibility of diabetics regulating their metabolic control by the noninvasive technique of monitoring salivary glucose concentrations is not possible.