Functional and mechanical sequelae of colon interposition for benign oesophageal disease.

OBJECTIVE: In an attempt to estimate the incidence and severity of the functional and mechanical problems associated with colon interposition for benign oesophageal disease, a retrospective analysis of a single centre experience was undertaken. METHODS: Between 1961 and 1990, a total of 365 patients who survived the postoperative stay in hospital were followed up over 7-38 years and form the basis for this study. Upper gastro intestinal symptoms in these patients were investigated clinically, radiologically, endoscopically and in the oesophageal laboratory. Mechanical and functional abnormalities requiring surgical intervention for relief of symptoms were documented. RESULTS: There were two late presentations of colo bronchial fistulae, two instances of persistent colo cutaneous fistulae, three cases of diaphragmatic herniation and two adenocarcinomata of the colo gastric junction in the patients with short segment colon interposition. Amongst the long segment colon interposition patients there was one hiatal obstruction, two thoracic inlet delays associated with pseudo diverticulosis and one hiatal obstruction. One other patient presented with an adenocarcinoma of the intrathoracic colon. There were four patients requiring revision of the cervical oesophago colic anastomosis, two of them on recurrent occasions. The remaining sequelae were functional and were associated with increasing redundancy of the colonic segments at different levels. There were 17 such patients, two of whom developed significant redundancy at two different levels. CONCLUSIONS: Although the patients with short segment colon interposition developed predominantly avoidable iatrogenic complications, those undergoing long segment colon interposition developed functional sequelae requiring re-operations in later life.

Revisional surgery after colon interposition for benign oesophageal disease.

Although the short-term results of colon interposition for replacement of the oesophagus in part or as a whole are known to be satisfactory, there have been several reports of functional problems associated with total replacement in the long-term follow-up of patients. We have retrospectively studied patients who have required revisional surgery for anatomical and functional sequelae over a 7- to 38-year period. Although the short-segment colon interpositions have been relatively trouble free, several mechanical and functional problems requiring revisional surgery have been encountered in the long-term follow-up of patients who underwent long-segment colon interposition.

Limitations of quality control in physicians' offices and other decentralized testing situations: the challenge to develop new methods of test validation.

Traditional quality-control methods are effective for detecting systematic error caused by deterioration of reagents or instruments, but ineffective for detecting sporadic error, which is more likely to occur in low-volume testing environments. Decentralized testing performed by individuals without formal laboratory training has a high potential for sporadic errors. New methods for validating test results, used each time a test result is produced, should replace current quality-control procedures. Under the rules of CLIA '88, manufacturers and the US Food and Drug Administration have an opportunity to develop new approaches to test validation.

Long-term follow-up of children with colon and gastric tube interposition for esophageal atresia.

BACKGROUND: There are two major methods of esophageal substitution for children born with long-gap esophageal atresia. This study was undertaken to see whether one method of substitution emerged as clearly superior to the other. METHODS: Twenty-four UK children who received a colon transposition for esophageal atresia were compared with 15 US children with esophageal atresia who received a gastric tube. The charts of all patients were reviewed. Follow-up data were obtained by questionnaire, and more than 80% of patients were personally evaluated at follow-up clinics. RESULTS: At follow-up US children were 3 1/2 to 18 1/2 years of age; UK children were 7 1/2 to 19 years of age. Most of the children fell at or below the 10th percentile for height and weight, reflecting the tendency for prematurity in infants with esophageal atresia. One half of the children needed to eat slowly and to avoid certain meats. Dysphagia was rare. Older children ate socially with their friends without embarrassment. Early complications were technical; there were few late complications, and no difference was apparent between the two groups. CONCLUSIONS: In subjects who were growing, no difference was noted between the two methods of substitution as far as nutrition, growth, patient acceptability, or complications, early or late. Both groups functioned well and appeared to improve with the passage of time.

An evaluation of a whole blood prothrombin analyzer designed for use by individuals without formal laboratory training.

BACKGROUND: The prothrombin time (PT) test, which is the most common coagulation test used in the outpatient setting, has not been recommended for office laboratory use because it has been technically difficult to perform. Consequently, serious errors in patient care could occur because of an erroneous result. The Coumatrak (E.I. Du Pont, Wilmington, Del) now allows nontechnically trained office staff to perform PT tests using a fresh capillary whole blood sample, individually packaged reagent cartridges, and a portable battery-operated instrument. METHODS: Coumatrak PT testing was compared with standard methods for both precision and accuracy, using protocols developed by the National Committee for Clinical Laboratory Standards (NCCLS). Reagent stability and operator variability were also studied. RESULTS: The results produced by a trained technologist and nontechnically trained staff were comparable. Test results obtained with the Coumatrak were approximately 10% higher than results obtained using standard laboratory equipment and methods using comparable blood samples from the same patients. It was found that the capillary blood specimen had to be rapidly transferred to the reagent cartridge in order to avoid factitiously low results. CONCLUSIONS: The Coumatrak can rapidly provide PT test results that are clinically useful for the office management of patients being treated with a warfarin anticoagulant and for the diagnosis of selected disorders. The system was found to be easy to operate, appropriate for use by individuals with little laboratory experience, and was subject to few operational problems during this study.

A survey of state regulation of testing for drugs of abuse outside of licensed (accredited) clinical laboratories.

We surveyed all 50 states to find out if testing for drugs of abuse outside of clinical laboratories was regulated. In 14 states such regulations existed or were contemplated. Eight additional states indicated that regulatory language does not restrict their oversight of such testing. Content of the regulations is described for each of these 22 states.