Patient reported outcome measures following specialist nurse-led clinics in preparation for breast reconstruction surgery.

We compared patient reported outcome measures following information given about breast reconstruction surgery by either a specialist nurse or operating consultant surgeon using a comparative and validated questionnaire. One hundred and nineteen patients considering breast reconstruction were seen by a single consultant plastic surgeon (60 participants) or by a single specialist nurse (59 participants). Response rates to the questionnaires were 70% and 71% respectively and the overall conversion rate to surgery was 86%. There were no significant differences between the outcome reported for those receiving information from the specialist nurse or the operating consultant. In conclusion we found that pre-operative specialist nurse-led information provision and preparation for breast reconstruction is effective and acceptable to patients.

Role of FDG-PET in surgical management of patients with colorectal liver metastases.

BACKGROUND: [(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET) is reported to change the management in 20-56% of patients with recurrent or metastatic colorectal cancer. It is not clear if FDG-PET has a role in all such patients or only a subgroup. The aim of the present study was to assess the influence of FDG-PET on the surgical management of patients with known or suspected colorectal liver metastases. METHODS: Patients undergoing FDG-PET for investigation of known or suspected colorectal liver metastases were identified from a South Australian database. Case notes were reviewed retrospectively to determine the influence of FDG-PET findings on patient management. Findings from FDG-PET scanning were compared with findings from conventional diagnostic investigations and operative findings. RESULTS: Overall, in four of 16 patients (25%) management was influenced by FDG-PET findings. FDG-PET altered management in four of eight (50%) patients with non-diagnostic liver lesions on computed tomography (CT) or with elevated carcinoembryonic antigen levels but no liver lesion on CT. In all eight patients with CT diagnosed resectable liver metastases, the addition of FDG-PET did not influence the management. CONCLUSIONS: The findings support the use of FDG-PET in the assessment of selected patients with suspected colorectal liver metastases and equivocal findings on conventional diagnostic investigation.

The lack of a systemic inflammatory response syndrome supports the safety of pancreatic electrolysis: experimental studies.

BACKGROUND: Per-ductal pancreatic electrolysis is a new minimally invasive ablation treatment. Possible applications include tumor debulking and treatment of chronic pancreatitis. Both solid organ ablation and pancreatitis are associated with the risk of an overwhelming systemic inflammatory response syndrome (SIRS) and multiorgan failure. TNF-alpha and IL1-beta are important cytokine mediators of this response. The aim of this study was to measure the circulating levels of IL1-beta and TNF-alpha following pancreatic electrolytic ablation as a marker of the risk of SIRS complicating per-ductal pancreatic electrolysis. METHODS: Serum TNF-alpha and IL1-beta were measured in six treatment and six control pigs before and after laparotomy and pancreatic electrolytic ablation via a per-ductal approach. RESULTS: There was no significant rise in serum TNF-alpha and IL1-beta in association with per-ductal pancreatic electrolysis. CONCLUSIONS: This study supports the evidence that per-ductal electrolysis is a safe procedure with potential for palliative treatment of pancreatic cancers.

Subtotal hepatectomy: a porcine model for the study of liver regeneration.

BACKGROUND: This study aimed to devise a simple, reproducible method of subtotal hepatectomy in a large animal model. Such an experimental model could be useful in the investigation of liver regeneration and liver insufficiency after partial hepatectomy. Equally, this technique could be used for assessing the effect of artificial liver support systems on both liver function and regeneration. MATERIALS AND METHODS: Twenty pigs were subjected to either 70-80% liver resection (n = 11), or 85-90% liver resection (n = 9), using a simplified technique. RESULTS: Most tolerated the procedure well and showed restoration of full liver volume within 3 weeks. Three animals in the 90% resection group died with significantly raised levels of International Normalized Ratio (INR) and ammonia. CONCLUSIONS: These two techniques have been shown to be easily reproducible and well tolerated by the animals and allow easy assessment of liver function and regeneration in the postoperative period. The deaths in the 90% resection group supports the hypothesis that 90% partial hepatectomy represents a model of critical residual liver parenchyma.

Bioartificial liver support devices: historical perspectives.

Fulminant hepatic failure (FHF) is an important cause of death worldwide. Despite significant improvements in critical care therapy there has been little impact on survival with mortality rates approaching 80%. In many patients the cause of the liver failure is reversible and if short-term hepatic support is provided, the liver may regenerate. Survivors recover full liver function and a normal life expectancy. For many years the only curative treatment for this condition has been liver transplantation, subjecting many patients to replacement of a potentially self-regenerating organ, with the lifetime danger of immunosuppression and its attendant complications, such as malignancy. Because of the shortage of livers available for transplantation, many patients die before a transplant can be performed, or are too ill for operation by the time a liver becomes available. Many patients with hepatic failure do not qualify for liver transplantation because of concomitant infection, metastatic cancer, active alcoholism or concurrent medical problems. The survival of patients excluded from liver transplantation or those with potentially reversible acute hepatitis might be improved with temporary artificial liver support. With a view to this, bioartificial liver support devices have been developed which replace the synthetic, metabolic and detoxification functions of the liver. Some such devices have been evaluated in clinical trials. During the last decade, improvements in bioengineering techniques have been used to refine the membranes and hepatocyte attachment systems used in these devices, in the hope of improving function. The present article reviews the history of liver support systems, the attendant problems encountered, and summarizes the main systems that are currently under evaluation.

Unusual case of Morgagni hernia associated with malrotation.

Morgagni herniae are rare congenital diaphragmatic hernia, which normally present late in adult life with minimal symptoms. They are always associated with a peritoneal hernial sac, and often contain transverse colon or stomach. We present an unusual case of a Morgagni hernia containing caecum in an 81-year-old woman, post ruptured aortic aneurysm repair.

Postoperative colonic perforation in a right-sided congenital diaphragmatic hernia in an adult.

Congenital posterolateral hernias rarely present in the adult. We describe an unusual case that presented after a routine total abdominal hysterectomy. The patient developed acute respiratory symptoms caused by a perforated colon and hypoplastic right hemi-liver contained within a right-sided hernia. There was also an associated hypoplastic right lung. The hernia was repaired through a midline laparotomy, with no long-term complications.

Experimental studies of serum cytokine concentration following pancreatic electrolytic ablation.

BACKGROUND: Pancreatic cancer has a poor prognosis, with symptomatic palliation being the priority in the majority of cases. Alternative palliative techniques, such as local ablation, are under investigation. Palliative per-ductal electrolytic ablation of the pancreas has been reported, in an experimental series. It is important to establish that this technique is associated with low morbidity and mortality if it is to be acceptable. The 'systemic inflammatory response syndrome' (SIRS) is a recognised and serious complication of both acute pancreatitis, and certain locally ablative techniques. This study aimed to determine whether pancreatic electrolytic ablation is associated with an increase in serum IL-1b and TNF-a concentrations, these cytokines playing integral roles in the inflammatory pathway of SIRS. MATERIAL/METHODS: Eight pigs underwent per-ductal electrolytic ablation of the pancreas. Serum samples, taken pre-operatively and post-operatively for two weeks, were analysed for IL-1b and TNF-a concentrations. Variations in cytokine levels were statistically analysed. RESULTS: Post-operative serum IL-1b and TNF-a concentrations did not significantly increase on pre-operative figures. There were no other clinical, biochemical or histological indicators of a SIRS-like phenomenon. CONCLUSIONS: The results from this study suggest that electrolytic ablation of normal pancreas is not associated with either an increase in serum concentrations of IL-1b and TNF-a or a SIRS phenomenon. Although this study has only investigated the serum levels of two cytokines, IL-1b and TNF-a have both been shown to have a central role in the inflammatory cascade that leads to SIRS.