Investigation of Neospora sp. and Toxoplasma gondii antibodies in mares and in precolostral foals from Parana State, Southern Brazil.

Antibodies to Neospora sp. and Toxoplasma gondii were measured in mares and precolostral foals from a farm in Parana State, Brazil. An indirect fluorescent antibody test (IFAT) was used to determine specific antibodies. Three sampling points, 2003, 2004 and at parturition were included in the study, but not all horses are represented at a parturition time point. In 2003, antibodies to Neospora were detected in 17 mares (47%) at 1:50 dilution and in 5 mares (13.8%) at 1:100 dilution. In 2004, antibodies to Neospora were found in 11/36 (30%) horses with titers of 1:50 and in 6 mares (16.6%) at 1:100 dilution. The prevalence of antibodies against T. gondii was 2.7% in mares, either in 2003 and 2004. Evidence for the role of Neospora sp. in equine reproduction failure was not observed in the farm. Immunoglobulin G antibodies to Neospora were found in two of the nine precolostrum foals. Four seronegative foals were born from seronegative mothers, and three seronegative foals were born from seropositive mothers (1:50). Two seropositive precolostrum foals were born from seropositive mothers (1:50). The foals were born clinically normal, and T. gondii antibodies were not detected in their serum samples. The total immunoglobulins values detected on seronegative precolostrum foals were lower than the levels observed in the seropositive foals. This data warrants additional studies to differentiate N. hughesi and N. caninum serologically and determination if these parasites were associated with equine neurological disease and reproductive failure.

An Assessment of the Xenon- 133 Method of Measuring Muscle Blood Flow1.

The 113 Xe method for measuring muscle blood flow is discussed, and has been evaluated in both normal and ischaemic limbs, a standard amount of ischaemic exercise being employed as the stimulus to hyperaemia. This is considered to be a reliable technique with a high degree of reproducibility, which may be applied to advantage in the clinical assessment of patients with peripheral vascular disease.

Early postoperative perforation of the terminal ileum following total colectomy for fulminant colitis.

Perforation of the ileum following total colectomy for Crohn's colitis is an uncommon entity which was fully described in 1970 by Hawke and Turnbull. Few reports have appeared since that time. A review of the clinical and pathological aspects of two cases of ileal perforation soon after colectomy for Crohn's colitis reveals a marked similarity to the original description of this entity.

Restoration of continuity after Hartmann's procedure for the complications of diverticular disease.

Although Hartmann's procedure has been accepted by most as the treatment of choice for diverticular disease complicated by generalized peritonitis, restoration of continuity may be difficult. A retrospective review of 30 patients, having had Hartmann's procedure for complicated diverticular disease, was made to assess restoration of continuity and factors which may influence its performance. This revealed zero mortality with a morbidity rate of 31.5% and a reversibility rate of 85% (with two cases still awaiting restoration of continuity).

Lateral subcutaneous internal sphincterotomy in treatment of anal fissure.

One hundred and three patients with anal fissures have been treated by lateral internal sphincterotomy performed by a subcutaneous myotomy technique, and 99 have been successfully followed up for from 3 to 24 months (mean 11 months). The operation was free from significant complications, apart from slight reactionary bleeding in one case and a perianal abscess in another. The fissure persisted or recurred in three cases, in one of which a further lateral sphincterotomy was performed, with cure. Various minor defects of anal continence were noted in 12 cases. These results have been found to be superior to those obtained previously in the same surgical unit with open posterior internal sphincterotomy and simple sphincter-stretching respectively in the treatment of anal fissure. The most reliable and satisfactory operation at present available for this condition seems, therefore, to be lateral subcutaneous internal sphincterotomy.

Non-operative treatment of small bowel obstruction following appendicectomy or operation on the ovary or tube.

This study examined the hypothesis that small bowel obstruction in patients whose only previous laparotomy was for appendicectomy or operation on the ovary or tube is unlikely to resolve with non-operative management. Results of 330 admissions for small bowel obstruction were examined. In 40 cases the only previous laparotomy was at appendicectomy or tubo-ovarian operation; in 38 (95 per cent) of these division of adhesions was undertaken compared with 154 (53 per cent) of the remaining 290 (P < 0.00001). In the former group band adhesions were commoner (86 versus 45 per cent, P < 0.00001), bowel resection was required more frequently (22 versus 10 per cent, P = 0.02) and it was considered safe to give a trial of non-operative management less often (60 versus 85 per cent, P = 0.0004). A trial of conservative management may be unsafe or not worth while in patients with obstruction following earlier appendicectomy or operation on the ovary or tube.

The Effects of External Pneumatic Splint Pressure on Muscle Blood Flow.

The effects of external pneumatic pressure on muscle blood-flow through the calf have been estimated by a Xenon-133 clearance curve technique. Flow was found to be greatly reduced at 40 mm. of mercury external pressure, and it was concluded that for first-aid purposes inflation pressures in excess of 30 mm. of mercury should not be used.

Management of the malignant colorectal polyp: the importance of clinicopathological correlation.

The results of management of colorectal adenomas removed endoscopically and found to contain invasive cancer seen in a single institution over a 10 year period are presented. Clinical data were obtained retrospectively from patient case notes and all specimens were reviewed by one pathologist. Fifty-four patients with malignant polyps were studied after exclusion of others with polypoid carcinomas, epithelial misplacement and cases managed by primary segmental resection. Of the various considered predictors of adverse outcome, only histologically incomplete excision proved significant. However, when excision was considered macroscopically complete there was no significant association between incomplete histological excision and adverse outcome. Consideration should be given to conservative management of such cases.

Right-sided diverticular disease of the colon: a morphological analysis of 16 cases.

Right-sided diverticular disease is uncommon and represents a heterogeneous group of cases with varying clinical presentation often confused with other disorders. Based on number, size, distribution and histological appearance of the diverticula, four distinct groups were identified, each with a distinct clinical presentation. Six patients had solitary false diverticula mimicking acute appendicitis and at operation were found to have inflamed caecal masses. Five patients had diverticula formed on the basis of defects in the muscularis propria. The mean age of these patients was 30 years older than the previous group and all of them presented with rectal haemorrhage, often confused with angiodysplasia clinically. At laparotomy the external appearance of the bowel was unremarkable. Three patients had diverticular disease similar to that seen in the left side of colon. Two patients had true congenital caecal diverticula confirming that the minority of caecal diverticula conforms to this group.

Rectal gangrene: a complication of phosphate enema.

Three cases of rectal gangrene are reported. All cases were compromised with intercurrent illnesses and all patients had complicated haemorrhoids before the gangrene developed. Rectal gangrene as a complication of haemorrhoids is rare and, whereas reports have suggested that this complication is due to nozzle injury, we believe that it may be due to a direct necrotizing effect of the phosphate on the rectum. We no longer recommend its use in compromised patients.

Jejunal diverticulosis.

Jejunal diverticulosis is considered to be a generally asymptomatic condition in which the diverticula are pulsion mucosal herniations with walls lacking a muscle layer. These opinions in particular are examined in this review of 20 cases of jejunal diverticulosis treated during an 8 year period. The predominant complication in each case was inflammation or perforation (nine), diarrhoea or malabsorption (five), haemorrhage (three), chronic abdominal pain (two) and pseudo-obstruction (one). At least 10 patients had more than one complication, although this was often unrecognized. Ten patients complained of chronic abdominal pain, in eight of whom the cause was not diagnosed until other complications supervened. Unrecognized malabsorption may be common, as the mean serum albumin in 12 patients presenting acutely with inflammation, perforation or haemorrhage, was low (mean 32 g/L, normal 39-48 g/L). Histology sections were reviewed in the 12 cases that underwent resection, of whom 11 were suitable for classification. Four cases had narrow-mouthed pulsion diverticula with a thin or absent muscle coat, and had developed at the point of blood vessel penetration. Four cases had wide-mouthed diverticula in which the muscle layer was present, suggesting an abnormality of the intestinal wall. Two had features of both. In one case a Meckel's type diverticulum was located 10 cm from the duodenal-jejunal flexure. Seven had mucosal villous atrophy consistent with bacterial overgrowth. In conclusion, jejunal diverticulosis may be associated with complications more frequently than has been recognized and pathologically is a diverse condition.

A retrospective study on the management of rectal bleeding.

This paper reports on a retrospective study of 70 patients who were admitted to the Royal Adelaide Hospital with rectal bleeding. The study demonstrates several points; first, that there are two distinct groups of patients. The majority of patients had minor bleeds that ceased spontaneously. The remaining group of patients (12%) had what could be described as massive rectal bleeds. There was also noted to be a significant number of patients (21%) who were discharged with no final diagnosis. The utilization of investigations such as angiography and nuclear medicine scans was minimal. The paper concludes that there is a need to establish a protocol for the management of rectal bleeding and, if diagnostic yield is to be satisfactory, energetic attempts must be made to commence investigations at presentation, as soon as resuscitative measures are in progress.

Investigation of fecal incontinence with endoanal ultrasound.

PURPOSE: This study was undertaken to audit the results of endoanal ultrasound in patients with fecal incontinence. METHODS: Endoanal ultrasound was used to investigate 53 patients with fecal incontinence. Data for endoanal ultrasound were collected prospectively. Results were compared with clinical and obstetric history, obtained retrospectively from case notes, and were compared with manometric and operative findings. RESULTS: Sphincter abnormalities were identified in 42 of 53 patients. A total of 28 anterior defects were thought to be obstetric in origin. Fourteen other defects were secondary to anal pathology or surgery. Patients with anterior external sphincter defects either had complete defects (4 patients; mean age, 31 years) or proximal defects (24 patients; mean age, 55 years). For patients with a proximal defect, 38 percent gave a history of obstetric tear, episiotomy, or forceps delivery, and the rest declared having had an apparently normal delivery. Only 50 percent had a sphincter weakness that was evident on clinical examination. Of those studied with manometry, only 21 percent had low squeeze pressures consistent with an external sphincter defect. CONCLUSIONS: Sphincter defects seen on ultrasound may not have a history of obstetric trauma or abnormal clinical and manometric findings. Endoanal ultrasound is recommended in all patients with fecal incontinence to detect occult sphincter defects.

A modification of single stapled colorectal anastomosis using the transanal insertion device (TAIS).

A modification of single stapled colorectal anastomosis utilizing a reusable stapler head (transanal insertion device [TAIS]) is described. This modification minimizes the time that the proximal bowel is open by allowing early placement of the circular stapler head, and minimizes the risk of rectal injury that may be associated with the passage of a circular stapling device without the head in situ.

Evaluation of an immunochemical test for faecal occult blood in screening for colorectal neoplasia in a high risk group.

A group of 1615 asymptomatic individuals presumed to be at increased risk of colorectal neoplasia were selected as the study group. All were tested by an immunochemical test for faecal occult blood. In the second half of the study, individuals who were occult blood negative were offered colonoscopy. Ninety-nine individuals (6.1%) returned stools which were occult blood positive. Investigation by full colonoscopy was possible in 90 cases, revealing nine patients (10%) with invasive cancers, four patients (4.4%) with carcinomata in situ, and 36 patients (40%) with adenomata. Non-neoplastic pathology capable of producing occult blood positive stools was found in 31 individuals (34.4%). No pathology was found in 10 instances (11.1%). Of the 53 occult blood negative subjects who underwent colonoscopy, eight were found to have adenomata. Only one of these was larger than 5 mm in diameter (18 mm). No carcinomata were found. The site within the large bowel of the tumour did not appear to significantly affect the occult blood status of the faeces but the size of the tumours detected suggests that the presence of blood within the stool is more likely to be associated with larger lesions. The frequency of detection of both carcinomata and adenomata was greatest in individuals who had a past history of colorectal neoplasia. The individual cost of this immunochemical test is nominal. The high diagnostic yield and low false positive and negative rates suggest that case follow-up, surveillance, or screening utilizing this test is justified.