Splenic rupture in a patient with pelvic abscess and sepsis.

A 49-year-old man underwent appendicectomy through a Lanz incision for necrotic appendicitis. He subsequently developed pelvic abscess in the postoperative period, which was drained under computed tomography (CT) guidance. The bacteriology of pus swabs taken during appendicectomy and abscess drainage revealed coliforms. Six days after appendicectomy, the patient had an acute collapse due to rupture of the spleen, which was treated by splenectomy. CT of the abdomen at the time of abscess drainage had confirmed a normal spleen. Histopathological examination of the spleen revealed nonspecific acute splenitis--red pulp congested and infiltrated with neutrophils complicated by rupture. We postulate the abdominal source of sepsis and associated inflammatory response as the cause for the splenic pathology and rupture.

Audit of state-funded antiviral treatment for chronic hepatitis C in Qatar.

Hepatitis C virus (HCV) infection is a major public health problem in the Middle East. A database of 400 patients with chronic HCV in Qatar was retrospectively analysed: 242 patients underwent antiviral treatment, of whom 212 (87.6%) were naïve to treatment. The response to treatment and the predictors of response were studied. The largest group of patients were of Egyptian origin. The rate of sustained virological response (SVR) varied significantly between patients with HCV genotypes 2 or 3 (79.6%) and genotype 1 (45.6%) and 4 (the predominant genotype) (51.0%). Multivariate analysis showed that the independent predictors of SVR were age < 45 years, infection with genotypes 2 or 3, low fibrosis score on liver biopsy and naïve treatment status.

Audit of state-funded antiviral treatment for chronic hepatitis C in Qatar

Hepatitis C virus [HCV] infection is a major public health problem in the Middle East. A database of 400 patients with chronic HCV in Qatar was retrospectively analysed: 242 patients underwent antiviral treatment, of whom 212 [87.6%] were naive to treatment. The response to treatment and the predictors of response were studied. The largest group of patients were of Egyptian origin. The rate of sustained virological response [SVR] varied significantly between patients with HCV genotypes 2 or 3 [79.6%] and genotype 1 [45.6%] and 4 [the predominant genotype] [51.0%]. Multivariate analysis showed that the independent predictors of SVR were age < 45 years, infection with genotypes 2 or 3, low fibrosis score on liver biopsy and naive treatment status

The relationship between the effects of short-chain fatty acids on intestinal motility in vitro and GPR43 receptor activation.

The G protein-coupled receptors, GPR41 and GPR43, are activated by short-chain fatty acids (SCFAs), with distinct rank order potencies. This study investigated the possibility that SCFAs modulate intestinal motility via these receptors. Luminal SCFA concentrations within the rat intestine were greatest in the caecum (c. 115 mmol L(-1)) and proximal colon. Using similar concentrations (0.1-100 mmol L(-1)), SCFAs were found to inhibit electrically evoked, neuronally mediated contractions of rat distal colon, possibly via a prejunctional site of action; this activity was independent of the presence or absence of the mucosa. By contrast, SCFAs reduced the amplitude but also reduced the threshold and increased the frequency of peristaltic contractions in guinea-pig terminal ileum. In each model, the rank-order of activity was acetate (C2) approximately propionate (C3) approximately butyrate (C4) > pentanoate (C5) approximately formate (C1), consistent with activity at the GPR43 receptor. GPR43 mRNA was expressed throughout the rat gut, with highest levels in the colon. However, the ability of SCFAs to inhibit neuronally mediated contractions of the colon was similar in tissues from wild-type and GPR43 gene knockout mice, with identical rank-orders of potency. In conclusion, SCFAs can modulate intestinal motility, but these effects can be independent of the GPR43 receptor.

5-HT4 receptor agonists enhance both cholinergic and nitrergic activities in human isolated colon circular muscle.

Previous studies have demonstrated mixed inhibitory and facilitatory effects of 5-hydroxytryptamine-4 (5-HT(4)) receptor agonists on electrical field stimulation (EFS)-induced responses in human isolated colon. Here we report three types of responses to EFS in human isolated colon circular muscle: monophasic cholinergic contraction during EFS, biphasic response (nitrergic relaxation during EFS followed by cholinergic contraction after termination of EFS) and triphasic response (cholinergic contraction followed by nitrergic relaxation during EFS and a tachykininergic contraction after EFS). The effects of two 5-HT(4) receptor agonists, prucalopride and tegaserod were then investigated on monophasic responses only. Each compound inhibited contractions during EFS in a concentration-dependent manner. In the presence of N(omega)-nitro-l-arginine methyl ester (l-NAME) however, prucalopride and tegaserod enhanced the contractions in a concentration-dependent manner. In strips where the tone was elevated with substance-P and treated with scopolamine, EFS-induced relaxations were enhanced by the two agonists. The above observed effects by the two agonists were abolished by 5-HT(4) receptor antagonist SB-204070. The two agonists did not alter the tone raised by substance-P in the presence of scopolamine and l-NAME and did not affect carbachol-induced contractions in the presence of tetrodotoxin. These results suggest that in the circular muscle of human colon, 5-HT(4) receptor agonists simultaneously facilitate the activity of neurones which release the inhibitory and excitatory neurotransmitters, nitric oxide and acetylcholine respectively.

A critical appraisal of internet resources on colorectal cancer.

OBJECTIVE: The significance of the internet as a source of healthcare information for professionals and public is widely recognized. Access to good quality information is very important for informed decisions making on healthcare issues. This is an introduction to the critical appraisal of clinical information on the internet, discussion of the significance of quality checking of healthcare internet resources and the application of critical appraisal tools to selected internet resources on colorectal cancer care. METHODS: Internet resources were identified on the basis of a general criterion that it provides information on colorectal cancer and selected on the basis of explicit inclusion and exclusion criteria. Each selected website is assessed for quality of information with validated criteria. RESULTS: The search strategy identified 10 well known internet resources on healthcare information (e.g. Cochrane, NICE) and 12 websites which are dedicated to cancer related information (e.g. CancerBacup, cancer.gov). The websites of NHS Direct, cancerBACUP, cancer.gov, NICE and Cancer Survivors Network were qualified as resources providing good quality information. DISCUSSION: The critical appraisal process assures quality of the available information and the tool is applicable to all healthcare related internet resources. The process is discussed with respect to colorectal cancer information resources and will be equally useful to healthcare professional and public. The healthcare professionals can apply the tool in practice and advise the public more confidently on internet information.

Microporous chiral metal coordination polymers: hydrothermal synthesis, channel engineering and stability of lanthanide tartrates.

L-Tartrate ions can endure hydrothermal conditions up to 160 degrees C to form the robust, enantiopure open-framework coordination polymers [Ln2(L-TAR)3(H2O)2]3H2O, 1; the addition of succinate results in formation of the related [Ln2(L-TAR)2(SUC)(H2O)2]5.5H2O, with larger channels than , whereas racemic D/L-tartrate gives the more condensed [Ln2(D/L-TAR)3(H2O)2], . TAR = [C4H4O6]2-.

A double stapled technique for oesophago-enteric anastomosis.

AIM: Leakage from oesophageal anastomosis is associated with substantial morbidity and mortality. This study presented a novel, safe and effective double stapled technique for oesophago-enteric anastomosis. METHODS: The data were obtained prospectively from hospital held clinical database. Thirty nine patients (26 males, 13 females) underwent upper-gastrointestinal resection between 1996 and 2000 for carcinoma (n = 36), gastric lymphoma (n = 1), and benign pathology (n = 2). Double stapled oesophago-enteric anastomosis was performed in all cases. RESULTS: No anastomotic leak was reported. In cases of malignancy, the resected margins were free of neoplasm. Three deaths occurred, which were not related to anastomotic complications. CONCLUSION: Even though the reported study is an uncontrolled one, the technique described is reliable, and effective for oesophago-enteric anastomosis.

Colonic metastasis from bronchogenic carcinoma presenting as pancolitis.

The colonic metastases from bronchogenic carcinoma are rare. We present a 73-year-old man presented with features suggestive of pan colitis after metastasis from undifferentiated large cell carcinoma of the lung. The plain radiograph and computed tomography scan of the chest had revealed a mass lesion in the right lower lobe of lung. He had no evidence of significant lesions elsewhere. Considering the advanced stage and poor differentiation of the tumour, no active therapy was undertaken and he survived for three months.

Partial splenectomy for splenic cyst: a case report and literature review.

Splenic cysts are very rare. They were traditionally treated by splenectomy. The recognition of post-splenectomy complications has led to emphasis on conservative techniques. We present a thirteen year old girl with epithelial splenic cyst treated by partial splenectomy. The post-operative CT scan after two weeks confirmed the residual splenic tissue.

Double breasting technique for residual cavity in hepatic hydatid.

Nine patients with univescicular echinococcal cysts in the liver were subjected to operative removal followed by a novel technique of obliteration of the residual space in the liver. The simple double breasting procedure was not associated with any complications and there was a considerable reduction in the median operating time (2 h 15 min) as well in median hospital stay (5 days). There was no recurrence with a median follow-up of 2 years and 4 months. None of the patients received albendazole either prophylactically or post-operatively.