Validation of a cost-effective appendicectomy model for surgical training.

BACKGROUND: Appendicitis is a commonly occurring condition worldwide. The gold standard treatment is appendicectomy. Although training models are commercially available for this procedure, they are often associated with high cost. Here we present a cost-effective model. AIM: To establish construct validity of a cost-effective laparoscopic appendicectomy simulation model. METHODS: Three groups of surgeons were recruited; novices (n = 31), of intermediate expertise (n = 13) and experts (n = 5) and asked to perform a simulated laparoscopic appendicectomy using the new model. Their performance was assessed by a faculty member and compared between the three groups using a validated scoring system (Global Operative Assessment of Laparoscopic Skills [GOALS] score). RESULTS: One-way ANOVA test showed a significant difference in task performance between groups (p < 0.0001). Post-hoc comparisons after the application of Bonferroni correction (statistically significant p value <0.017) demonstrate a significant difference in performance between all groups for all GOALS categories as well as the total score. Effect size calculations showed that experience level had moderate (Eta-squared >0.5 and <0.8) and significant (>0.8) impact on the performance of the simulated procedure. CONCLUSION: The model described in this study is cost-effective, valid and can adequately simulate appendicectomy. The authors recommend inclusion of this model to postgraduate surgical training.

Squamous cell carcinoma at an ileostomy site-Fifty-four years following colectomy for ulcerative colitis: A case report and literature review.

INTRODUCTION: Carcinoma arising at an ileostomy site is an extremely rare occurrence. The rate of malignancy arising at an ileostomy site is reported as being 2-4 of every 1000 cases. The development of squamous cell carcinoma at the mucocutaneous junction of an ileostomy is extremely rare. PRESENTATION OF CASE: We present a case of a 76-year-old male who developed squamous cell carcinoma at an ileostomy site fifty-four years after total colectomy as management for ulcerative colitis. DISCUSSION: Our literature review has identified only four similar cases previously published in English literature. All cases of squamous cell carcinoma developing in ileostomy have occurred after a minimum of twenty-six years following ileostomy. This suggests that the etiology may be due to chronic factors. CONCLUSION: Patients with chronic stomal inflammation, bleeding or persistent induration and/or mass formation should be followed up closely and investigated for recurrence or development of a new malignancy. There should be a low threshold to obtain an early definitive tissue diagnosis by taking biopsies to prevent local or systemic invasion.

An unusual presentation of caecal diverticulitis.

Solitary caecal diverticulitis is a rare and often misdiagnosed cause of abdominal pain. A 63-year-old Caucasian woman was admitted with a 3-day history of left upper quadrant pain and constipation. Preoperative imaging identified a possible transverse colonic tumour. At laparotomy a long, mobile ascending colon resulted in the caecal pole lying in the left upper quadrant and an inflamed gangrenous solitary caecal diverticulum was found. A right hemicolectomy was performed and the patient recovered promptly.

p16INK4a polymorphism: associations with tumour progression in patients with sporadic colorectal cancer.

Deregulated tumour expression of p16INK4a has previously been described in association with clinical progression in sporadic colorectal cancer patients (CRC). Furthermore, p16INK4a promoter hypermethylation leading to gene silencing has been shown to occur in advanced colorectal tumours and has been associated with patient survival. p16INK4a is polymorphic, with variant alleles being associated with tumour progression in melanoma. In this study we have examined p16INK4a polymorphism as a marker of tumour progression in sporadic CRC. Polymorphic sites G/A(442), C/G(500), and C/T(540), were studied, these alleles obeyed Hardy Weinberg equilibrium in a control group, but not in the CRC cases. G/A(442) and CG(500) alleles were in linkage disequilibrium in both cases and controls. In controls the C/T(540) alleles demonstrated no linkage with either other site, whilst an association was demonstrated between C/G(500) and C/T(540) alleles in the cases (p=0.011). Furthermore, the distribution of C/T(540) genotypes was different between the groups (p=0.002). Within the CRC cases, patients with the GG(442) genotype were more commonly associated with decreased tumour differentiation (p=0.018), advancing Dukes' stage (p=0.006) and T-stage (p=0.007) than patients with the GA(442) and AA(442) genotypes. Patients with the CC(500) genotype were more commonly associated with decreased tumour differentiation (p=0.012), advancing Dukes' stage (p=0.015), and N-stage (p=0.031). No associations between patient C/T(540) genotype and clinical prognostic parameters were found. An analysis of patient tumour expression with p16INK4a genotype revealed patients with the CC(500) genotype were more commonly associated with reduced tumour p16 expression (p=0.046). In summary our data indicate that p16INK4a polymorphism is associated with tumour progression in patients with sporadic CRC.