Neoadjuvant chemoradiation for rectal cancer is not associated with higher rates of thromboembolism.

AIM: Thromboembolism (TE) is a leading cause of death amongst cancer patients. The effect of neoadjuvant chemoradiotherapy (nCRT) on the risk of TE in rectal cancer patients is unknown. The aim of this study was to determine whether nCRT was associated with an increased risk of TE in patients with rectal cancer, either during therapy or with subsequent treatment. METHOD: This was a retrospective study from a prospectively maintained database at a tertiary referral centre. Participants included patients with rectal cancer treated between January 2000 and December 2013. The primary outcome was the rate of TE in patients with rectal cancer who had nCRT compared with those who did not. RESULTS: One hundred and seventy-one (7.8%) of 2181 rectal cancer patients developed TE. Patients who had nCRT did not have an increased incidence of TE compared with those who had surgery alone (81/946, 8.6% vs 94/1235, 7.6%, P = 0.42) after a median follow-up of 95 months. Ten (1.1%) of 946 patients who received nCRT developed TE during or immediately after nCRT. Most TE events occurred in the 30-day postoperative period (70 patients, 3.2%). CONCLUSION: The prevalence of TE in patients with rectal cancer was 7.8%, with most events occurring in within 30 days of surgery. Neoadjuvant chemoradiation was not associated with an increased risk of TE.

Thromboembolism during neoadjuvant therapy for rectal cancer: a systematic review.

AIM: Thromboembolism (TE) is a common, costly and morbid complication that is also associated with decreased survival in cancer patients. However, the risk of cancer-associated TE varies because of the multitude of patient-, cancer- and treatment-related influences. Thromboprophylaxis (TP) is currently not widely adopted in the ambulant population. A review of the literature was undertaken to determine the rate of TE and the benefit of TP in patients with rectal cancer during neoadjuvant therapy (nT). METHOD: A systematic literature search of electronic databases, including PubMed and Embase, was performed (1995-2012) for all studies assessing nT in rectal cancer. Data were extracted and used to assess study design, patient demographic and clinical characteristics, treatment protocols and TE incidence. A systematic review was conducted to identify the rates of TE. The search strategy included text terms and MeSH headings for TP, rectal cancer and nT. RESULTS: Twelve of 86 studies met quality criteria for reporting TE complications and described 10 pulmonary emboli and three deep-vein thromboses in 3375 patients (overall TE rate = 0.38%). Ninety per cent of pulmonary emboli reported were fatal, suggesting significant under-reporting of TE events, even in high-quality studies. CONCLUSION: The risk of fatal pulmonary embolism in studies examining nT in rectal cancer that reported complications systematically was one in 375 (0.27%; 95% CI: 0.09-0.44%). The overall TE rate, as well as the effectiveness of TP during nT, remains unknown. TE events should be systematically reported using common terminology frameworks in cancer studies.

Cervical spine injuries to children under 11: should we use radiography more selectively in their initial assessment?

OBJECTIVES: To assess the effectiveness of cervical spine radiography in injured children under 11 years old, and suggest improvements. METHODS: Retrospective survey of radiographs and accident and emergency records for children examined during a one year period in a large teaching hospital. RESULTS: No cervical spine fractures occurred in this age group during the year. The recorded clinical findings did not always justify radiography. CONCLUSIONS: Clinical examination appears undervalued by those assessing injured children and is poorly recorded. Radiography can be used more selectively. Initial assessment using a single lateral projection can be followed in doubtful cases by cross sectional imaging.

Anomalous inferior vena cava demonstrated by contrast-enhanced magnetic resonance venography.

We discuss the technique of contrast-enhanced magnetic resonance venography and its advantages over other methods of imaging the veins of the chest. An example is presented of the results of this technique in a patient with agenesis of the hepatic segment of the inferior vena cava and azygos continuation.

Childhood steroid-sensitive nephrotic syndrome: does the histology matter?

Renal biopsy specimens from 51 children with steroid-sensitive nephrotic syndrome who were following a frequently relapsing or steroid-dependent course were reviewed by two histopathologists. In all cases the biopsy was performed prior to the commencement of an 8-week course of cyclophosphamide. The clinical courses of these patients both prebiopsy and for a minimum of 2 years after completion of cyclophosphamide therapy were analyzed using retrospective case note analyses. The distribution of histologic diagnoses differed significantly from that reported by the International Study of Kidney Disease in Children in their study of children who underwent biopsy at the time of presentation, there being an excess of focal segmental glomerulosclerosis and mild mesangial hypercellularity in this series. The prebiopsy clinical course did not predict for histologic diagnosis, and there was no correlation between prebiopsy course or histology and postcyclophosphamide course. The findings of this study support the clinical impression that steroid sensitivity rather than histology is the major determinant of prognosis in childhood nephrotic syndrome and that frequency of relapse alone is not an indication for biopsy.

Prospective evaluation of sutured, continuous, and interrupted single layer colonic anastomoses.

OBJECTIVE: To evaluate the merits of continuous and interrupted colonic anastomoses. DESIGN: Prospective non-randomised study. SETTING: District hospital, UK. SUBJECTS: 53 Patients (24 male and 29 female) of whom 26 underwent continuous and 27 interrupted sutured colonic anastomoses. MAIN OUTCOME MEASURES: Mortality at 30 days, time taken to complete anastomosis, anastomotic dehiscence and anastomotic stricture. RESULTS: No patient died within 30 days. There were no significant differences in (median, range) time taken to complete the anastomosis (continuous: 15 (7-23) minutes; interrupted: 26 (10-34) minutes, p = 0.27); anastomotic leak rate (continuous 1; interrupted 1) and anastomotic stricture (continuous 1 and interrupted 1). Patients were followed up for a mean of 15 months after continuous and 18 months after interrupted colonic anastomoses. CONCLUSION: As both techniques were equally safe, it is probable that the type of colonic anastomosis done will remain a matter of individual preference.

Postoperative uterine granulomata following endometrial resection.

Granulomatous endometritis is an uncommon condition. We describe a case in which the granulomata were related to the previous endometrial resection. The importance of recognizing this entity is to avoid confusion with other causes of uterine granulomata and thus preventing inappropriate therapy being instituted.

A comparison between radioligand and immunohistochemical assay of hormone receptors in primary breast cancer.

The detection of oestrogen and progesterone receptor (ER and PgR) levels in human breast carcinoma has traditionally been performed using a biochemical radioligand binding method. This method has several disadvantages including the requirement for generous tissue samples, the production of radioactive waste products and the inability to exclude non-malignant cellular material from the assay process. An alternative method for detecting hormone receptors is available with the use of a monoclonal antibody specific for the ER or PgR receptor using immunocytochemical assay (ER-ICA or PgR-ICA). Although designed for use on frozen section material, with modifications this method can be used on paraffin sections of routinely fixed and processed tissue, on archival material and on very small specimens. Further, an objective assessment or scoring of staining intensity is possible using computerized video-image analysis. Forty-three cases of primary breast carcinoma, treated from 1989 to 1991 at Goulburn Valley Base Hospital, Shepparton were assessed for ER and PgR content using both the radioligand method and immunohistochemistry with video-image analysis, and the results were compared. Of the 43 cases, ER-ICA and ER had a concordance of 81% (P < 0.001, r = 0.58) and in 39 cases, PgR and PgR-ICA had a concordance of 87% (P < 0.001, r = 0.54). Because the sample for radioligand assay is of uncertain composition and the immunohistochemical stain can be scored specifically for malignant epithelium, a degree of discordance is thought to be mostly attributable to the limitations of the radioligand assay.

Choristoma of the submandibular gland: a rare cause of cervical swelling.

A case of choristoma of the submandibular gland excised from a 4-week-old female infant is reported. The differential diagnosis is discussed and suggestions are made for the possible etiology of the lesion.

Wegener's granulomatosis: parotid involvement and associated pancreatitis with C.T. findings.

Parotid enlargement is an uncommon physical sign and even less commonly the reason for referral for computerised tomography (CT) as the aetiology is usually self-evident. In cases referred for CT examination Wegener's granulomatosis should be considered, particularly if the pathology appears bilateral. This diagnosis may be confirmed by biopsy and/or supported by Anti-Neutrophil Cytoplasmic Antibody (ANCA) assay. A case of Wegener's granulomatosis with parotid gland involvement and temporally related pancreatitis with pseudocyst formation is reported. This is the second reported case of possible pancreatic involvement in Wegeners granulomatosis and approximately the tenth reported case of salivary gland involvement.

Ultrasonographic and biochemical abnormalities associated with the prenatal diagnosis of epignathus.

A case of epignathus, detected prenatally in a 20-week fetus, is described. The pathological features are discussed in relation to the biochemical and ultrasonographic findings.

Primary mucinous adenocarcinoma developing in an ileostomy stoma.

We report a mucinous adenocarcinoma arising in an ileostomy stoma of a 60 year old woman after a subtotal colectomy done 28 years previously for ulcerative colitis. A study of the histochemical profiles of the mucin within the mucosa of the ileostomy and the carcinoma was undertaken. Previously documented cases are reviewed.

Jejunal carcinoma associated with non-absorbable suture material.

A case of adenocarcinoma of the jejunum arising at the site of non-absorbable surgical material is reported. This appears to be a unique observation.

PLANTS AND PEAT CUTTINGS: HISTORICAL ECOLOGY OF A MUCH EXPLOITED PEATLAND - THORNE WASTE, YORKSHIRE, UK.

Although many lowland raised bogs have been much modified or completely destroyed by agricultural reclamation, peat cutting, unaccompanied by reclamation, is not necessarily so destructive, and abandoned workings may provide a range of habitats that can support some of the original wetland plant species. Thome Waste, a much exploited raised bog in Eastern England, has a varied and well-documented management history and comparatively good botanical records. It thus provides an exemplary site to assess the effect of peat exploitation upon its flora. The origin and development, and subsequent drainage, reclamation and peat extraction history of the site are described, and their impact upon the past and present flora is evaluated. Some ombrotrophic mire species have been lost from the site, but one section of peat cuttings (the Dutch canal system, abandoned about 1920) has revegetated and supports an important range of these plants. Fen species, which once occupied the marginal lagg, have been almost completely eliminated from their original sites (which have mostly been reclaimed) but many have become re-established in various new habitats created within the peat-cutting complex. This illustrates the potential of artificial modification of worked-over peatland sites to sustain a range of wetland plants.