Matthew J. Bown

Interleukin 6 production during abdominal aortic aneurysm repair arises from the gastrointestinal tract and not the legs.

Abdominal aortic aneurysm (AAA) repair is associated with a systemic inflammatory response. This inflammatory response probably arises as a result of an ischaemia–reperfusion injury to the legs and gastrointestinal tract. In this study the relative contributions of these areas to the inflammatory response were assessed during elective AAA repair.

Actinomycosis of the sigmoid colon: an unusual cause of large bowel perforation

A 39-year-old man with a history of asthma and end-stage renal failure requiring regular haemodialysis, presented to the renal unit with a 2-day history of abdominal pain and diarrhoea. On admission he was apyrexial, but noted to have a C-reactive protein of 111 mg/dL, and a white cell count of 19.1 × 10 9 l. He was started on a course of ciprofloxacin, and his symptoms settled. Two weeks later however, his symptoms recurred, and his pain became progressively worse over a period of 24 h. Clinically, his symptoms were consistent with a picture of acute, complete large bowel obstruction, and an abdominal radiograph confirmed this. Once this diagnosis had been made, his condition suddenly deteriorated, and further clinical examination showed generalized peritonitis. An erect chest radiograph revealed the presence of air within the abdominal cavity (Fig. 1). The patient was resuscitated and an emergency laparotomy performed, which revealed a firm, obstructing mass arising from the sigmoid colon, with a single perforation of the transverse colon at the hepatic flexure, and faecal contamination of the peritoneal cavity. The remainder of the abdominal cavity appeared normal, except for a number of adhesions, presumably related to previous continuous ambulatory peritoneal dialysis (CAPD) and episodes of CAPD peritonitis. The patient underwent a subtotal colectomy, ileostomy formation, over-sewing of his rectal stump, and peritoneal lavage. He was also commenced on a course of broad-spectrum antibiotics. Postoperatively, the patient was ventilated for a number of days in the intensive care unit. Subsequent histological examination showed the sigmoid mass to be inflammatory rather than neoplastic, with scattered microabscesses containing colonies of filamentous Gram-positive microorganisms (Fig. 2). The appearances were diagnostic of actinomycosis. His antibiotics were therefore supplemented with penicillin, and he underwent a good postoperative recovery, remaining on a long-term course of penicillin.

The Surgical Acute Care Unit (SACU): effects on surgical workload and mortality.

Background: u2003A surgical acute care unit (SACU) is designed to provide level 1 care for surgical patients. The aim of the present study was to audit the effects of the introduction of a SACU in a teaching hospital surgical department.

A comparison of methods for determining genotypes at the tumour necrosis factor-alpha-308, interleukin (IL)-1beta+3953, IL-6 -174 and IL-10 -1082/-819/-592 polymorphic loci.

Induced heteroduplex genotyping (IHG) is one of many methods that can be used to determine single nucleotide polymorphisms (SNPs). It is relatively new in comparison to other polymerase chain reaction (PCR)‐based techniques. The aim of this study was to compare the results of genotyping using IHG with the results of genotyping using either polymerase chain reaction–sequence‐specific primers (PCR‐SSP) or polymerase chain reaction–restriction fragment length polymorphism (PCR‐RFLP) for SNPs in the tumour necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6 and IL‐10 genes. Ninety patients who consented to participate in the study had their genotypes determined by IHG and either PCR‐SSP (TNF‐α−308 and IL‐10 −1082/−819/−592) or PCR‐RFLP (IL‐1β+3953 and IL‐6 −174). Results for each locus were compared between techniques by calculating the Kappa statistic as a measure of agreement. The IHG and more traditional genotyping methods produced very similar results at all loci. The Kappa statistics for each locus were as follows: TNF‐α−308, K = 0.727; IL‐1β+3953, K = 0.886; IL‐6 −174, K = 0.909; IL‐10 −1082, K = 0.876; IL‐10 −592, K = 0.920. IHG is a valid method for the determination of genotypes at the loci examined in this study and produces comparable results to those of more traditional methods of genotyping.

Evaluation of level 1 care facilities for vascular patients

Background:u2003 A surgical acute care unit (SACU) was established within our hospital to specifically provide level 1 care to surgical patients. We assess the impact that this has had on outcome in vascular patients.