Benign rectal strictures managed with transanal resection – A novel application for transanal endoscopic microsurgery

Objective Six cases of management of rectal strictures by transanal endoscopic microsurgery (TEM) are described. Method Patients are placed in the lithotomy – Trendelenburg position and the stricture is resected from 4–8 o’clock through the entire thickness of the fibrosis. The upper resection edge is mobilized including all layers of the rectal wall and the defect is sutured along the circumference. Results Satisfactory anatomical and functional long‐term results were obtained in 5 of 6 patients. Conclusion TEM resection of benign strictures is feasible in some patients and should be tested in a randomized study against known procedures.     

Stability of the interstitial matrix after crystalloid fluid loading studied by volume kinetic analysis

To investigate if fluid therapy changes the prerequisites for the development of oedema, four i.v. infusions of Ringer's solution 25 ml kg-1 were given over 15 or 30 min in a randomized crossover study to 10 healthy male volunteers, aged 28-40 (mean 31) yr. Blood haemoglobin concentration, measured every 5 min for 90 min, and urinary excretion were used as input data for volume kinetic analysis. The results showed that the elimination rate constant (kr) was higher when another infusion had been given earlier on the same day (208 vs 140 ml min-1; P < 0.002) and the size of V1 was larger during the 15-min infusions (4.7 vs 3.2 litre; P < 0.02). However, the size of V2 and the rate constant for the exchange of fluid between V1 and V2 were similar during all infusions. We conclude that a fluid challenge makes elimination of further infused fluid more effective but does not change compliance with volume expansion in healthy volunteers.      

Cell uptake, distribution and response to aluminium chloro sulphonated phthalocyanine, a potential anti-tumour photosensitizer

The uptake, retention and effects of aluminium chloro sulphonated phthalocyanine (AlSPc) were measured in two cell lines, UV-2237 a murine fibrosarcoma and the non-tumorigenic NIH/3T3 fibroblast line. The behaviour of cells treated with AlSPc was compared with that of those treated with haematoporphyrin derivative (HpD), a photosensitizer often used in photodynamic therapy (PDT) of cancer. AlSPc absorbs light strongly in the red region, is taken up by cells in a dose dependent fashion and is retained in vitro over a period of days (5 days after exposure greater than 40% remains cell-associated versus less than 25% of HpD). Additionally AlSPc was less cytotoxic to cells, maintained in darkness or exposed to room light, compared to HpD (100% viability versus 0% viability 3 days after 60 min exposure to room light). However red light (approximately 600-700 nm) caused greater toxicity in AlSPc-treated cells (100%) than in similarly exposed HpD-treated cells (less than 60%). No significant differences were detected between the responses of the fibrosarcoma and the fibroblast cell lines. These characteristics of AlSPc suggest that it may prove to be a useful photosensitizer for PDT of cancer and this possibility is discussed.     

The functionality and reliability of an Internet interface for assessments of endoscopic still images and video clips: distributed research in gastroenterology

BACKGROUND: Validation studies of medical images are required before the general use of new imaging techniques, and they necessitate a substantial number of observers. Multicenter studies are desirable but the logistic challenges are considerable. OBJECTIVE: The aim of the present study was to develop and test the functionality and reliability of an Internet interface for distributed evaluation of endoscopic still images and video clips. DESIGN: An Internet site for assessment of endoscopic still images and video clips was developed. To avoid limitations of the bandwidth, a solution was developed to launch and score high-quality video clips on digital video disks (DVDs) from the Internet interface. SETTING: Fifty-five observers were enrolled in the randomized, prospective multicenter study of still images. The feasibility study of video clips included 7 observers. PATIENTS: Four patients presenting with various degree of ulcerative colitis, ranging from normal to severe, were included. MAIN OUTCOME MEASUREMENTS: We tested the reliability of the interface by dual-image assessment, as well as the feasibility of Internet assessment of endoscopic images. We physically distributed high-quality DVD video footage. RESULTS: We recorded 2084 assessments of endoscopic still images and 35 assessments of video clips. The reliability of the Internet interface was confirmed by adequate repeatability and intraobserver agreement of the assessments. Video clips running from a DVD were also successfully shown on the Internet interface. Thus, high-quality video may be assessed independently of the Internet bandwidth. CONCLUSIONS: The present Internet-based tool is functional, efficient, and reliable for high-volume assessment of endoscopic images and video clips.     

Hemorrhage and operation cause a contraction of the extracellular space needing replacement--evidence and implications? A systematic review

BACKGROUND: Hemorrhagic hypotension or operative trauma is believed to cause a contraction of the extracellular fluid volume (ECV) beyond the measured fluid losses. The aim of this review was to explore the evidence and implications of ECV loss. METHODS: We performed a systematic review of original trials measuring ECV changes during hemorrhage or operation. PubMed, relevant periodicals, and reference lists were searched until no further original articles appeared. The quality of both the scientific and the technical methods of the trials were evaluated. RESULTS: A total of 61 original articles were found. The pattern appeared that all investigators reporting shock or operation to cause a disparate reduction of the ECV had measured the ECV with the same method. The ECV was calculated from very few blood samples that were withdrawn after 20 to 30 minutes of equilibration of a tracer (the (35)SO(4)-tracer). Trials calculating ECV from multiple blood samples, after longer equilibration times, or using other tracers did not find a contraction of the ECV. On the contrary, trials using a bromide tracer found the ECV to be expanded after operation. CONCLUSIONS: The evidence supporting the idea that hemorrhage or operation cause a contraction of the ECV is weak, and probably a result of flawed methodology.