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Purpose: In March 2005, the Simplified Wells Scoring System was introduced as a predictive tool for pulmonary embolism at Hairmyres Hospital in Scotland. This study was conducted to evaluate the efficacy of the Wells score in predicting the presence of pulmonary embolism in terms of rate of positive computed tomography pulmonary angiographies (CTPAs)., Materials and Methods: Two hundred patients with suspected pulmonary embolism were retrospectively reviewed using a sequential method: 100 patients before implementation of the Wells score and a further 100 after its introduction., Results: The rate of positive CTPAs for pulmonary embolism changed from 23% before to 27% after the introduction of the Wells Scoring System., Conclusions: The rate of positive CTPAs did not change significantly after the introduction of the Wells score.

There are no significant differences in 5-year survival and local recurrence rates between the sphincter-saving techniques and the abdomino-perineal resection. Many changes in anorectal function, the most obvious being a marked reduction in rectal capacity and a significant decrease in anal pressure occur after sphincter-saving resection. The construction of a colonic J-pouch may result in good functional outcome, reducing postoperative faecal leakage and urgency of defecation.

Background: Transesophageal echocardiography with transversal planes offers many advantages in the evaluation of patients with congenital anomalies of atrium, allowing visualization of obscure areas, not visualized with traditional echocardiography, as appendages, venous connections, upper interatrial defects. The aim of this paper is to check what advantages the transesophageal imaging in longitudinal plane, recently insert in biplane probes, might confer over transversal plane imaging in the evaluation of patients with congenital heart disease of atrium and venous connections., Methods: We carried out a prospective study on 70 patients (49 adults and 22 children) with congenital heart diseases of this area. Fifty-six studies out of 71 were preoperative diagnostic, 15 were carried out in the late postoperative period. Twenty-two studies were performed under general anaesthesia during concomitant cardiac catheterisation, 49 were carried out in outpatient clinic. All the transesophageal diagnoses were subsequently confirmed at either catheterization or surgery. Lesions studied included 36 atrial septal defects (ASD) ostium secundum, 6 interatrial septal aneurysms, 1 ASD coronary sinus, 5 ASD venous sinus, 5 partial and 2 complete atrioventricular septal defects, 1 double outlet right ventricle; in operated patients 2 ASD ostium secundum, 2 ASD sinus venosus, 11 post Mustard or Senning in TGA., Results: Anomalies either better defined or that obtained important additional informations by long axis scanning (vs transverse scanning) included: ASD ostium secundum 36/36, ASD multiple 1/3, caval obstruction in Mustard or Senning 4/5, anterior mitral valve cleft 2/5, left superior vena cava to coronary sinus 3/3. Features visualized by longitudinal plane alone were: ASD coronary sinus 1/1, caval obstruction in sinus venosus operated 1/1, multiple ASD 2/3, coronary artery fistula to right atrium 1/1; for associated features anterior bringing leaflets 2/2, left ventricular outflow tract obstruction 2/2, right ventricular outflow tract obstruction 1/1. Anomalies better characterized by transversal plane versus longitudinal plane were: ASD ostium primum 2/7, ASD sinus venosus sinus 3/5; for associated anomalies VSD inlet 1/1. Features visualized by transversal plane alone were: right upper pulmonary vein in superior vena cava 4/4, right upper pulmonary vein to right atrium 1/1, DIA ostium primum 5/7, ASD sinus venosus 2/5, superior vena cava obstruction in Mustard 1/5, left juxtaposition of the atrial appendages 1/1. The transversal plane alone provided the correct morphologic and hemodynamic diagnosis in 74/88 (84%) (in this group longitudinal plane gave 68% additional informations), the longitudinal planes in 69/88 (78%). However in 11% of cases longitudinal plane was the only means for identifying the congenital lesion and transversal plane in 16%. It was the combination of longitudinal and transverse scanning which gave in 97% the correct complete morphologic diagnosis., Conclusions: Thus we conclude that both planes are required for optimal transesophageal evaluation of congenital disease of atrium and venous connection.

Ten patients with median age of 51 years (range 24-75; 9 female) presenting idiopathic faecal incontinence and twelve normal subjects with median age of 34 years (range 25-71; 5 female) underwent fine wire anal sphincter electromyography and anal manometry. The results were analysed using non-parametric methods of statistical analysis. The median IAS EMG was 0.30 Hz (range 0.18-0.38), in incontinent and 0.48 Hz (range 0.31-0.55) in controls; p. < 0.01. Ambulatory resting pressures were a median of 66 cmH2O (range 49-83 cmH2O), for the incontinent and 82 cmH2O (range 66-120) for controls; p < 0.04. IAS EMG frequency correlated with resting anal pressures in both groups (p < 0.003). IAS EMG silence not attributable to electrode movement or to the recto-anal inhibitory reflex, lasting 0.5-4 minutes, occurred in all but two of the incontinent patients. No recruitment of the external sphincter or puborectalis muscle was noted during these episodes. Such electromechanical dissociation was not seen in the control group.

In this brief review, we outline the properties of the new macrolide immunosuppressant FK-506. This selective anti-T cell agent has a similar mode of action to cyclospirin A (CSA). It is, however, more powerful, has the capacity (unlike CSA) to reverse liver allograft rejection and appears to have a higher therapeutic index than CSA in patients receiving organ transplants. Preliminary data suggest that renal function is better in recipients of liver transplants given FK-506 as primary therapy compared with those given CSA. In addition, evidence has been presented that FK-506-treated patients have shorter hospital stay than those receiving treatment with CSA. Other factors require to be taken into account, but it may be that it will prove less expensive in the future to treat patients with FK-506 than with CSA. The potential of FK-506 for the control of autoimmune diseases has been demonstrated in rodent models of rheumatoid arthritis, type I diabetes, posterior uveitis, allergic encephalomyelitis and glomerulonephritis. In the clinical field, FK-506 has been used in two cases of nephrotic syndrome resulting from glomerulonephritis; there was improvement in proteinuria and no decline in renal function. Studies to date have been restricted to one clinical centre although many hundreds of organ graft recipients have been studied. Both longer term and multi-centre investigations are urgently required, but it appears that FK-506 may offer considerable potential as an immunotherapeutic agent.