Computer analysis of upper gastrointestinal endoscope images.

Gastro-oesophageal reflux disease (GORD) occurs in up to 40% of adults in the West. Oesophagitis is a major determinant in the treatment of GORD but its current classification systems are subjective. In order to help to provide objective interpretation of upper gastro-intestinal (GI) endoscope examination and reduce inter-observer variability, we developed a computer image analysis system. Digital video recordings were made on patients with clinical evidence of reflux oesophagitis. Cross-sectional profiles of hue and saturation data were analysed on images from seven patients with grade B or C oesophagitis (LA grading). This analysis showed clear changes in hue (p = 0.01) and saturation (p = 0.001). These results suggest that quantification of upper GI endoscopic images is feasible and may help in objective assessment.

A training course for the UEB examination. The case for retaining an examination for overseas doctors excluded from practising in the UK.

BACKGROUND: Some overseas medical graduates choose to take the United Examining Board (UEB) examination to achieve UK registration; others have no other option. We have devised a course for overseas doctors who wish to re-qualify via this route. THE COURSE: Eighteen doctors enrolled during 1995-1997; all passed the UEB examination. Regular formative assessment allowed us to identify students adequately prepared to pass the examination. The main predictor of examination outcome was performance in a mock examination. Gender, residential status and interval since original qualification were not predictive. The eight doctors whose primary medical course was conducted in a language other than English did not seem to be disadvantaged. OUTCOME: Successful examinees obtained pre-registration house officer posts without delay; one has since passed the full MRCP (UK) and another MRCP Part I. All but one of the intend to pursue their medical careers in the UK. SUMMARY: After a structured course (average 9.5 months) at this medical school, selected overseas doctors can reach a standard appropriate to a UK primary qualifying examination. These findings have implications for overseas doctors living here and not practising, as well as for those concerned with expanding the UK medical workforce.

Cholecystocolic fistula at laparoscopic cholecystectomy: primary closure and laparoscopic caecostomy.

This report suggests a strategy for managing unsuspected cholecystocolic fistula discovered during laparoscopic cholecystectomy by means of tube caecostomy.

Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up.

The expectation that cholecystectomy is effective treatment for symptomatic gallstones is not always achieved in surgical practice. The impact of cholecystectomy on the relief of gastrointestinal symptoms was evaluated in 92 patients followed up after surgery for a mean of 31.1 months (range 12-83 months). Abdominal pain continued to be present, or arose de novo, in 28 (30.4%) patients. Pain-free outcome after cholecystectomy was associated with a preoperative clinical diagnosis of biliary colic, fatty food intolerance, and a thick-walled gallbladder on ultrasound (P = 0.02). Logistic regression associated a thick-walled gallbladder, elevated gamma-glutamyl transpetidase, body mass index < 26, fat intolerance, and normal bowel habit with good postoperative results (P = 0.001). Application of each of these five factors to a clinical index failed to predict long-term pain-free outcome after cholecystectomy. Abdominal bloating (P = 0.03), dyspepsia (P < 0.001), heartburn (P < 0.007), fat intolerance (P < 0.001), nausea (P = 0.001) and vomiting (P < 0.001) were significantly improved after cholecystectomy, but diarrhoea, constipation and excessive flatus were not. Outcome benefit ratios confirmed that vomiting (0.96), nausea (0.87), dyspepsia (0.67), fat intolerance (0.57) and heartburn (0.51) were relieved by surgery. Cholecystectomy improved symptoms compared with a matched control group, suggesting that surgery remains the gold standard treatment of symptomatic gallstones.

Surgical technique. Intracorporeal laparoscopic-guided feeding jejunostomy.

Laparoscopic feeding jejunostomy is a safe and reproducible method of establishing enteral feeding in patients in whom percutaneous endoscopic gastrostomy is contraindicated. Current technology enables the jejunostomy to be achieved within the peritoneal cavity, without retrieval of the small bowel through the abdominal wall. This quick and simple technique is described.

The Kieturakis balloon dissector--an aid to the extraperitoneal approach for laparoscopic repair of groin hernias?

A novel balloon device was evaluated as an access and dissection aid for laparoscopic hernia surgery based on the Dulucq method. The device was found to provide reliable access and good preliminary dissection with a saving in operating time. It is of particular value when learning laparoscopic hernia surgery.

The floating shoulder: ipsilateral clavicle and scapular neck fractures.

In ipsilateral mid-clavicular and scapular-neck fractures, the mechanical stability of the suspensory structures is disrupted and muscle forces and the weight of the arm pull the glenoid fragment distally and anteromedially. To prevent late deformity we recommend internal fixation of the fractured clavicle by a plate and screws. We treated seven patients with this unusual injury; all achieved an excellent functional result without deformity.

Released prophospholipase A2 activation peptides in the rapid early prediction of trauma outcome: a preliminary report.

Clinical scores of trauma severity may not be adequate measures of trauma-related systemic pathophysiology to be useful in the early prediction of individual patient outcome. This preliminary study evaluates the role of Prophospholipase A2 Activation Peptide (PLAP), measured in patient urine by modified enzyme-linked immunosorbent assay (ELISA), as an early prognostic in the severely injured. Of nine polytrauma patients requiring intensive care after a major accident, two died and one was permanently severely disabled (group 1), whilst six made a full recovery (group 2). These two groups had different ranges of urine PLAP concentration (P = 0.024). Phospholipase A2 (PLA2) activation may be an early event in tissue damage pathways that lead to multisystem organ failure (MSOF). We believe urine and plasma PLAP concentrations merit further evaluation for the early prediction of individual trauma outcome.

Growth rate of human tumour xenografts measured in nude mice by in vivo cast modelling.

Caliper measurement of xenograft tumour volume incurs shape-dependent errors of up to 230 per cent. A more sensitive and accurate method is described for repeated in vivo measurement of tumour volume by cast modelling. The technique can provide electronic data for further analysis and its accuracy and limitations can themselves be determined. Week-on-week changes in tumour volume may be detected with up to 99 per cent confidence.

Human tumour cell lines established in vitro from tumours after long-term passage as nude mouse xenografts. Comparative fingerprinting of their concanavalin-A acceptor glycoproteins.

Two human colon cancer xenografts (EC and AC) were established in tissue culture only after long-term passage in nude mice. Earlier attempts to establish cell lines were unsuccessful. The epithelioid cells retain their tumourigenicity after in vitro growth, giving rise to tumours with a take rate of 60-80%. After reimplantation, the xenografts retain a similar morphology to that of the original human tumours. Both cell lines show human karyology. Comparative mapping of Concanavalin-A acceptor glycoproteins provides a fingerprint characteristic of each cell line. These glycoprotein patterns are similar to those shown by HT-29, an established colon cancer cell line.

Combined medical and surgical treatment of spinal hydatid disease: a case report.

A case of chronic hydatid disease of the dorsal spine is described. The patient had undergone four previous operations over a 26 year period and had suffered recent further deterioration leading to complete paraplegia. On this occasion she was treated by a combination of drug therapy and surgery. She showed some neurological recovery after a two and a half month interval, without evidence of recurrence. The surgery would not have been feasible without concurrent drug therapy.