Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: A retrospective analysis of stoma database.

AIMS: Low anterior resection (LAR) has higher risk of anastomotic leak with its attendant morbidity -mortality. De-functioning loop ileostomy (DLI), claimed to mitigate the consequences of anastomotic leak, has been questioned in recent years. This study aims to evaluate the impact of ileostomy on LAR. METHODS: A retrospective analysis of stoma database. 136 patients with stoma (March 2011-July 2015) were assessed. Data was analysed in respect to LAR anastomotic leak rate, impact on morbidity-mortality, short and long-term stoma complications, rate of ileostomy reversal and reasons for non-reversal. RESULTS: 45 patients had loop ileostomy for LAR. Male (28) to female (17) ratio was 1.65:1 with median age of 69 (IQR: 56-75.5). Only 3 anastomotic leaks (3/45, 6.5%) occurred, all treated conservatively with no mortality. 29 had reversal, average reversal time is 10 months (3-24) and 5 awaiting. Reasons for non-reversal included patients' choice (7), death from cardiac cause (1), chemotherapy (1), unfit for surgery (1) and failed reversal (1). Acute complications included high output & reversible AKI (1), bleeding (3) and minor complications (6) as skin excoriation, separation and appliance issues. Parastomal hernia was repaired during reversal (12/15). CONCLUSIONS: De-functioning ileostomy for LAR is a safe procedure with low morbidity. Most stomas are reversible. Series highlights a late reversal contrary to the nationally recommended guidelines. Most interestingly, the study demonstrated de-functioning mitigated clinical consequences of anastomotic leak to an extent that reoperation was avoidable, in keeping with recent meta-analysis indicating a significantly low anastomotic leakage rates and reoperation. Larger study is invaluable to substantiate findings.

Perfluorooctane sulphonate and perfluorooctanoic acid in drinking and environmental waters.

Perfluorooctane sulphonate (PFOS) and perfluorooctanoic acid (PFOA) are chemicals that have been used for many years as surfactants in a variety of industrial and consumer products. Owing to their persistent, bioaccumulative and toxic (PBT) characteristics, PFOS has been phased out by its principal producer and the use of PFOA has been reduced. This PBT potential and a number of pollution incidents have led in recent years to an increase in studies surveying the concentrations of PFOS and PFOA in environmental waters worldwide. This paper reviews the results of these studies, as well as the monitoring that was conducted after the pollution incidents. The results of surveys suggest that PFOS and PFOA are found in environmental waters worldwide at low levels. In general, these levels are below health-based values set by international authoritative bodies for drinking water. There have been limited measurements of these chemicals in drinking water, but again these are below health-based values, except in some cases following pollution incidents. Monitoring studies suggested that where PFOS and PFOA were detected, they were at similar levels in both source and drinking water, suggesting that drinking water treatment does not remove these chemicals. However, new data show that PFOS and PFOA are effectively removed by granular activated carbon absorbers in practice. Further research is required on the newer perfluorinated chemicals that appear to be safer, but their degradation products have not as yet been fully studied.

Quantitative analysis of mitoxantrone by surface-enhanced resonance Raman scattering.

Mitoxantrone is an anticancer agent for which it is important to know the concentration in blood during therapy. Current methods of analysis are cumbersome, requiring a pretreatment stage. A method based on surface-enhanced resonance Raman scattering (SERRS) has been developed using a flow cell and silver colloid as the SERRS substrate. It is simple, sensitive, fast, and reliable. Both blood plasma and serum can be analyzed directly, but fresh serum is preferred here due to reduced fluorescence in the clinical samples available. Fluorescence is reduced further by the dilution of the serum in the flow cell and by quenching by the silver of surface-adsorbed material. The effectiveness of the latter process is dependent on the contact time between the serum and the silver. The linear range encompasses the range of concentrations detected previously in patient samples using HPLC methods. In a comparative study of a series of samples taken from a patient at different times, there is good agreement between the results obtained by HPLC and SERRS with no significant difference between them at the 95% limit. The limit of detection in serum using the final optimized procedure for SERRS was 4.0 x 10(-11) M (0.02 ng/mL) mitoxantrone. The ease with which the SERRS analysis can be carried out makes it the preferred choice of technique for mitoxantrone analysis.

SERRS dyes. Part I. Synthesis of benzotriazole monoazo dyes as model analytes for surface enhanced resonance Raman scattering.

The synthesis of seven monoazo benzotriazole dyes for use in surface enhanced resonance Raman scattering, SERRS, is reported. The dyes are all capable of complexing to the silver surface used to provide the surface enhancement found in SERRS and hence act as 'model' analytes. One dye was examined in detail and showed a quantitative relationship between concentration and signal intensity.