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Littoral cell angiomas are uncommon primary splenic haemangiomas with rare malignant potential. We report a case of a 76-year-old male with an incidental solitary littoral cell angioma found within an accessory spleen. We provide an overview of the literature of littoral cell angiomas and highlight the diagnostic challenge and treatment of this important differential for general surgeons caring for patients with splenic masses. This is the first case to describe primary resection of a littoral cell angioma with splenic preservation. [ABSTRACT FROM AUTHOR]

Background: The technical difficulty an operation creates for a surgeon is difficult to measure. Current measures are poor surrogates. In both research and teaching settings it would be valuable to be able to accurately measure this degree of difficulty. The National Aeronautics and Space Administration Task Load Index (NASA TLX) is a multi‐dimensional scale designed to obtain workload estimates relating to a task. This study aimed to evaluate the NASA TLX as an objective measure of technical difficulty of an operation. Methods: Seven surgeons performed 127 pre‐defined operations (minimally invasive right hemicolectomy & re‐do bariatric surgery) and recorded a NASA TLX score after each operation. These scores were compared to numerous clinical parameters and the score was correlated with the subjective measure of whether the surgeon categorized the operation as "easy", "moderate" or "difficult". Results: The NASA TLX score was significantly correlated with operative duration, blood loss, previous abdominal surgery and the surgeons' assessment of difficulty. It did not correlate with intra‐operative or post‐operative complications, conversion to open surgery or length of stay. Conclusions: The NASA TLX score provides a graded numerical score that that correlated significantly with the surgeon's assessment of the technical difficulty, and with operative duration, intra‐operative blood loss and previous abdominal surgery. This novel application of this tool could be employed in both research and teaching settings to score surgical difficulty and monitor a trainee's proficiency over time. [ABSTRACT FROM AUTHOR]

A study was conducted to evaluate and compare the benefits of gastric binding as against an optimal lifestyle program in the case of severely obese adolescents. Results indicated that gastric binding led to nearly 50% of weight loss and more benefits to health and quality of life.

A comparative study of the adjustable gastric banding and the conventional therapy used for the treatment of type 2 diabetes is presented. The surgical therapy is found to be more effective for the treatment, as it leads to greater weight loss.

A proportion of patients require critical care support following elective or urgent colorectal procedures. Similarly, critically ill patients in intensive care units may also need colorectal surgery on occasions. This patient population is increasing in some jurisdictions given an aging population and increasing societal expectations. As such, this population often includes elderly, frail patients or patients with significant comorbidities. Careful stratification of operative risks including the need for prolonged intensive care support should be part of the consenting process. In high-risk patients, especially in setting of unplanned surgery, treatment goals should be clearly defined, and appropriate ceiling of care should be established to minimize care that is not in the best interest of the patient. In this article we describe approaches to critically unwell patients requiring colorectal surgery and how a multidisciplinary approach with proactive intensive care involvement can help achieve the best outcomes for these patients. [ABSTRACT FROM AUTHOR]

Rectal cancer is a challenging disease process to manage, with a rising incidence in young adults. Several clinical advances have been made in the past decade with regards to optimal treatment strategies in early‐stage (T1‐2, node negative tumours) and locally advanced cancers (T3‐4 and/or nodal positivity) utilizing a multimodal approach of surgery, neoadjuvant chemoradiotherapy, and adjuvant chemotherapy, all aiming to optimize oncological outcomes, while minimizing associated morbidity. This narrative review aimed to summarize trial level evidence apropos the management of early and locally advanced rectal cancer. All relevant prospective clinical trials were identified through a computer‐assisted search of PubMed, EMBASE, Medline databases between 1990 and 30 June 2021. With regards to early rectal cancer, there is limited trial‐level evidence in the literature. Total mesorectal excision (TME) is the current standard of care, but local excision could be considered in select patients with pT1 tumours, or patients with near or complete clinical response to neoadjuvant CRT. As for locally advanced rectal cancer, the current standard of care consists of long‐course chemotheradiotherapy or short‐course radiotherapy, followed by TME. However, the role of total neoadjuvant therapy is promising, with respect to both oncological outcomes, as well as in reducing toxicity. Both induction and consolidation chemotherapy treatment approaches have been described in literature, with encouraging early results. The optimal management of rectal cancer is constantly evolving. More research is needed to investigate the long‐term oncological and functional outcomes following new multimodal therapies in the management of early‐stage and locally advanced rectal cancer. [ABSTRACT FROM AUTHOR]

Surgery at this point has been proposed as a means of reducing tumour burden, promoting a durable response to immunotherapy in patients with demonstrated tumour regression or stable disease after this time. Resection of residual disease in patients with metastatic gastrointestinal stromal tumors responding to treatment with imatinib. Int. J. Cancer 2005; 117: 316 - 25. 9 Okamura T, Kanda T, Hirota S, Nishimura A, Kawahara M, Nikkuni K. Imatinib therapy for a patient with metastasis of colonic gastrointestinal stromal tumor: report of a case. [Extracted from the article]

Background: Small bowel obstruction (SBO) is a common general surgical presentation and there has been a shift towards non-operative management (NOM) for patients with previous abdominal surgery. Historically, exploratory surgery has been mandated for SBO in patients with a virgin abdomen. However, there is increasing evidence for NOM in this group of patients. Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was undertaken between 1995 and 2020 on Ovid MEDLINE, EMBASE and PubMed. Primary outcome measures were success and failure rates, whereas secondary outcome measures were morbidity, mortality rates and identifying underlying aetiologies. Results: Six observational studies were included, with 205 patients in the NOM and 211 patients in the operative group. There was a high success rate of 95.6% and low morbidity rate of 3.1% in the NOM group compared to 88.6% and 26% in the operative group, respectively. Both groups reported no mortalities. The most common aetiologies for SBO in a virgin abdomen were adhesions (63%), malignancy (11%), foreign body/bezoar (5%), internal hernia (4%) and volvulus (4%). Conclusion: NOM for SBO is a safe and feasible option for a select group of clinically stable patients with a virgin abdomen without features of closed-loop obstruction. Adhesions are the most common cause of SBO in this group of patients. Further large-scale prospective clinical studies with standardized NOM modality, homogenous clinical resolution indicators and long-term follow-up data are warranted to allow for quantitative analysis to reinforce this evidence. [ABSTRACT FROM AUTHOR]

Abdominal and pelvic computed tomography (CT) demonstrated numerous rounded radiodense material within the small bowel and caecum, with associated dilatation and air fluid levels (Fig. A 67-year-old man presented to hospital with 3 days of abdominal pain, nausea and obstipation after consuming whole cherries with pips 1 week prior to presentation (standard practice for patient). The patient was discharged home with a plan for outpatient CT colonography prior to elective bowel resection. [Extracted from the article]

Background: Anal intraepithelial neoplasia (AIN) is dysplasia in the epithelium of the anus and is a pre‐malignant condition associated with a low rate of progression to invasive squamous cell carcinoma (SCC). The natural history of progression for AIN to anal SCC is poorly defined. This study aims to review our experience with AIN and investigate the natural history of progression. Methods: Data on all patients with AIN from January 2005 to December 2015 were retrospectively reviewed. Three separate databases were searched – Colorectal, Radiation Oncology and Infectious Diseases. All databases were cross‐referred to obtain a complete but non‐duplicated data set. Electronic charts were reviewed to obtain clinical information. Results: Twenty‐eight patients were identified with AIN of various grades. There were 25 males, three females. Twenty of the male patients were human immunodeficiency virus (HIV) positive. Mean length of follow up was 56 months. Complete regression of AIN to normal was noted in 13 patients (46%). Four patients had persisting AIN III with no evidence of regression or malignant transformation. Nine patients with pre‐existing AIN developed SCC (32%). Seven were positive for HIV infection (all males). Median time to progression was 36 months. None of the patients demonstrated clear linear pattern of progression of AIN to SCC. Conclusion: High grade AIN may progress to anal SCC and surveillance is indicated. The exact natural history of progression for AIN is difficult to predict. There is no linear progression over time evident. HIV patients with AIN are at higher risk of developing SCC. [ABSTRACT FROM AUTHOR]

Introduction: Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up.Methods: Systematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented.Results: Systematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques.Conclusion: All current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures. [ABSTRACT FROM AUTHOR]

De Jong, Tanya A., Stewart A. Skinner, Cathy Malcontenti-Wilson, Daphne Vogiagis, Michael Bailey, Ian R. van Driel, and Paul E. O'Brien. Inhibition of rat colon tumors by sulindac and sulindac sulfone is independent of K-ras (codon 12) mutation. Am. J. Physiol. Gastrointest. Liver Physiol. 278: G266-G272, 2000.--Nonsteroidal anti-inflammatory drug (NSAID) use reduces the risk of colorectal cancer by 40-50%. Previous studies suggest that effective inhibition of colorectal cancer by NSAIDs may be dependent on the presence or absence of a K-ras mutation. This study was aimed at determining the relationship between inhibition of colorectal cancer by sulindac and sulindac sulfone and the presence of activating K-ras mutations in the 1,2-dimethylhydrazine dihydrochloride rat model. Sulindac (20 mg [multiplied by] [kg.sup.-1] [multiplied by] [day.sup.-1]), sulindac sulfone (40 mg [multiplied by] [kg.sup.-1] [multiplied by] [day.sup.-1]), or vehicle was administered orally to male Sprague-Dawley rats for a 4-wk period beginning 20 wk after tumor induction. Tumor number and volume were measured before treatment by laparotomy and colonoscopy and again after treatment. Sulindac and sulindac sulfone treatment significantly reduced the number and volume of colorectal tumors compared with control rets. For K-ras (codon 12) mutation detection, frozen tumor tissue was collected at the endpoint. We found K-ras codon 12 mutations in 11 of 21 (52%) control tumors. The proportion of tumors with K-ras mutations in the sulindac-treated group [5 of 8 (62%); odds ratio = 1.51 (95% confidence interval = 0.29, 8.33)] and the proportion of sulindac sulfone-treated tumors [9 of 14 (64%); odds ratio = 1.63 (95% confidence interval = 0.41, 6.66)] were not significantly different from controls. Tumor inhibition did not correlate with K-ras (codon 12) mutation status, which suggests that the mechanism of inhibition of rat colorectal cancer by sulindac and sulindac sulfone is independent of K-ras mutation. colorectal cancer; 1,2-dimethylhydrazine dihydrochloride, nonsteroidal anti-inflammatory drugs

Background Botulinum toxin ( Botox) injection for chronic anal fissure ( CAF) is commonly performed, yet there remains no consensus on optimal dosage or frequency of injections required to achieve complete resolution of anal fissure. The aim of this study was to determine the effectiveness of Botox and side-effect profile in the management of CAF. Methods A retrospective clinical study of patients between 2010 and 2014 who underwent a Botox injection for CAF at a tertiary centre was performed. The effectiveness of Botox was measured using standardized outcomes including overall healing rate, presence of anal pain, recurrence and need for repeat botulinum injection. Binary outcomes were assessed using logistic regression model. The analysis was performed using Stata version 13 ( Stata Corp, College Station, TX, USA). Results One hundred and one patients underwent 126 Botox injections within the study period. The mean first post-operative visit was at 1 month. The overall recurrence rate was 32%. The majority of patients were given 33 U. No statistically significant relationship between dose and recurrence was identified. The presence of pain at the first post-operative visit was a predictor of future recurrence (odds ratio 3.92, confidence interval 1.58-9.74, P = 0.003). Conclusion Botox is an effective strategy for CAF. Low doses can be given with good efficacy as highlighted by our audit and has the potential for great cost saving. The best predictor of recurrence is the presence of pain at the first post-procedure visit. [ABSTRACT FROM AUTHOR]

The feed ingredient price increases that have adversely affected livestock producers may be offset through the use of coproducts from one of the potential reasons for the price increase in ethanol production. Dried distillers grain with soluble (DDGS) was found to be a more cost-effective source of energy, amino acids, and phosphorus than either corn, soybean meal, or canola meal, and consequently, its inclusion in the ration reduces feed costs by approximately 13% across the three growth phases for a representative Ontario pig farm. It would require a significant increase in the relative price of DDGS before it would not be part of the least-cost feed formulation at the maximum rate allowed (25% of the ration). The inclusion of DDGS increases the protein and phosphorus content of the ration, and consequently, the manure content of nitrogen and phosphorus, respectively, if DDGS makes up more than 15% of the ration. The resulting savings to fertilizer costs associated with DDGS will depend on factors such as fertilizer prices, crop needs, and manure nutrient changes, but the benefits, regardless of the scenario, are significantly smaller than the savings to feed costs. Consequently, the use of DDGS in the swine ration is determined primarily through its ability as a cost-effective source of energy and phosphorus, but the saving has been less than the overall feed ingredient price increase since 2006. Les augmentations de prix des ingrédients entrant dans la composition des aliments pour animaux qui ont touché défavorablement les éleveurs de bétail peuvent être contrebalancées par l'utilisation de coproduits issus de l'une des raisons possibles de ces augmentations de prix, à savoir la production d'éthanol. Les solubles de distillerie (DDGS) se sont révélées une source d'énergie, d'amino-acides et de phosphore plus économique que le maïs, le tourteau de soya ou de canola, et leur utilisation dans les rations a permis de diminuer les coûts des aliments pour animaux d'environ 13 p. 100 au cours des trois phases de croissance sur une ferme porcine typique en Ontario. Il faudrait que le prix relatif des DDGS augmente considérablement pour que les DDGS n'entrent pas dans la formulation des aliments pour animaux à moindre coût au taux maximal permis (25 p. 100 de la ration). L'ajout de DDGS accroît la teneur de la ration en protéines et en phosphore et, par conséquent, la teneur du fumier en azote et en phosphore à condition que les DDGS constituent plus de 15 p. 100 de la ration. Les économies de coûts des engrais liées à l'utilisation des DDGS dépendent de certains facteurs tels que le prix des engrais, les besoins des cultures en éléments nutritifs et les changements dans les éléments nutritifs du fumier mais les avantages, peu importe le scénario, sont significativement moins élevés que les économies de coûts des aliments pour animaux. En conséquence, l'utilisation de DDGS dans la ration pour porcs est principalement déterminée par la capacitéà constituer une source d'énergie et de phosphore économique, mais les économies sont inférieures aux avantages alimentaires globaux. [ABSTRACT FROM AUTHOR]

Background: Obesity is a major, growing health problem. Observational studies suggest that bariatric surgery is more effective than nonsurgical therapy, but no randomized, controlled trials have confirmed this.Objective: To ascertain whether surgical therapy for obesity achieves better weight loss, health, and quality of life than nonsurgical therapy.Design: Randomized, controlled trial.Setting: University departments of medicine and surgery and an affiliated private hospital.Patients: 80 adults with mild to moderate obesity (body mass index, 30 kg/m2 to 35 kg/m2) from the general community.Interventions: Patients were assigned to a program of very-low-calorie diets, pharmacotherapy, and lifestyle change for 24 months (nonsurgical group) or to placement of a laparoscopic adjustable gastric band (LAP-BAND System, INAMED Health, Santa Barbara, California) (surgical group).Measurements: Outcome measures were weight change, presence of the metabolic syndrome, and change in quality of life at 2 years.Results: At 2 years, the surgical group had greater weight loss, with a mean of 21.6% (95% CI, 19.3% to 23.9%) of initial weight lost and 87.2% (CI, 77.7% to 96.6%) of excess weight lost, while the nonsurgical group had a loss of 5.5% (CI, 3.2% to 7.9%) of initial weight and 21.8% (CI, 11.9% to 31.6%) of excess weight (P < 0.001). The metabolic syndrome was initially present in 15 (38%) patients in each group and was present in 8 (24%) nonsurgical patients and 1 (3%) surgical patient at the completion of the study (P < 0.002). Quality of life improved statistically significantly more in the surgical group (8 of 8 subscores of Short Form-36) than in the nonsurgical group (3 of 8 subscores).Limitations: The study included mildly and moderately obese participants, was not powered for comparison of adverse events, and examined outcomes only for 24 months.Conclusions: Surgical treatment using laparoscopic adjustable gastric banding was statistically significantly more effective than nonsurgical therapy in reducing weight, resolving the metabolic syndrome, and improving quality of life during a 24-month treatment program. [ABSTRACT FROM AUTHOR]

BACKGROUND: Severe fecal incontinence remains a disabling condition for the patient and a major therapeutic challenge for the physician. A series of observational studies have indicated that placement of an artificial bowel sphincter is associated with marked improvement of continence and quality of life. We have performed a prospective, randomized, controlled trial to evaluate the effect of placement of an artificial bowel sphincter (Acticon Neosphincter®) on continence and quality of life in a group of severely incontinent adults. METHODS: Fourteen adults (male:female, 1:13; age range, 44-75 years) were randomized to placement of the artificial bowel sphincter or to a program of supportive care and were followed for six months from operation or entry into the study. The principal outcome measure was the level of continence, measured with the Cleveland Continence Score, which provides a scale from 0 to 20, representing perfect control through to total incontinence. Secondary outcome measures were perioperative and late complications in the artificial bowel sphincter group, and the changes in quality of life in both groups. RESULTS: In the control group, the Cleveland Continence Score was not significantly altered, with an initial value of 17.1 ± 2.3 and a final value of 14.3 ± 4.6 at six months. The artificial bowel sphincter group showed a highly significant improvement, changing from 19.0 ± 1.2 before placement to 4.8 ± 4.0 at six months after placement. One patient in the artificial bowel sphincter group had failure of healing of the perineal wound and explantation of the device (14 percent explantation rate). There were two other significant perioperative events of recurring fecal impaction initially after placement in one patient and additional suturing of the perineal wound in another. There were major improvements in the quality of life for all measures in the artificial bowel sphincter group. There was significant improvement in all eight subscales of the Medical Outcome Study Short Form-36 measures. The American Medical Systems Quality of Life score was raised from 39 ± 6 to 83 ± 14 and the Beck Depression Inventory showed reduction from a level of mild depression (10.8 ± 9.3) to a normal value (6.8 ± 8.7). No significant changes in any of the quality of life measures occurred for the control group. CONCLUSIONS: Through a prospective, randomized trial format, we have shown that placement of an artificial bowel sphincter is safe and effective when compared with supportive care alone. Perioperative and late problems are likely to continue to occur and between 15 percent and 30 percent of patients may require permanent explantation. For the remainder, the device is easy and discrete to use, highly effective in achieving continence, and able to generate a major improvement in the quality of life. [ABSTRACT FROM AUTHOR]

Abstract Background Standard non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of colorectal cancer; however, their use as preventive agents is limited by their inherent toxicity. Drugs that selectively inhibit cyclooxygenase-2 (COX-2) may be useful in this setting as they are supposedly less toxic. No study has directly compared the ability of standard NSAIDs and selective COX-2 inhibitors to inhibit colorectal cancer at clinically relevant doses. Methods Aberrant crypt foci (ACF) were induced in Sprague–Dawley rats by using 1,2-dimethylhydrazine (DMH). Test agents or vehicle were then administered for 3 weeks, twice daily through orogastric gavage. At the end of this period, the number and multiplicity of ACF were determined. The agents tested at equivalent anti-inflammatory doses were: sulindac and indomethacin (standard NSAIDs), meloxicam (selective COX-2 inhibitor), celecoxib (specific COX-2 inhibitor) and sulindac sulfone (no known COX activity). Acute gastrotoxicity of NSAID in rats was compared by using quantitative histology. Results All test agents reduced the number of ACF. There was a 42% reduction with indomethacin, 46% with sulindac, 46% with meloxicam, 22% with celecoxib and 36% with sulindac sulfone. Only the COX-2 inhibitors caused no significant gastrotoxicity in rats. Conclusions Cyclooxygenase-2 inhibitors are potentially ideal chemopreventive agents as they inhibit ACF and are not gastrotoxic. [ABSTRACT FROM AUTHOR]

Abstract Background Standard non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of colorectal cancer; however, their use as preventive agents is limited by their inherent toxicity. Drugs that selectively inhibit cyclooxygenase-2 (COX-2) may be useful in this setting as they are supposedly less toxic. No study has directly compared the ability of standard NSAIDs and selective COX-2 inhibitors to inhibit colorectal cancer at clinically relevant doses. Methods Aberrant crypt foci (ACF) were induced in Sprague–Dawley rats by using 1,2-dimethylhydrazine (DMH). Test agents or vehicle were then administered for 3 weeks, twice daily through orogastric gavage. At the end of this period, the number and multiplicity of ACF were determined. The agents tested at equivalent anti-inflammatory doses were: sulindac and indomethacin (standard NSAIDs), meloxicam (selective COX-2 inhibitor), celecoxib (specific COX-2 inhibitor) and sulindac sulfone (no known COX activity). Acute gastrotoxicity of NSAID in rats was compared by using quantitative histology. Results All test agents reduced the number of ACF. There was a 42% reduction with indomethacin, 46% with sulindac, 46% with meloxicam, 22% with celecoxib and 36% with sulindac sulfone. Only the COX-2 inhibitors caused no significant gastrotoxicity in rats. Conclusions Cyclooxygenase-2 inhibitors are potentially ideal chemopreventive agents as they inhibit ACF and are not gastrotoxic. [ABSTRACT FROM AUTHOR]

PURPOSE: Anal incontinence is a socially disabling problem affecting 1 to 2 percent of the population. Anal sphincter replacement is a treatment option if the problem is severe and not amenable to direct repair. The artificial bowel sphincter is an innovative approach. We report the technique for placement and the outcomes which have occurred in an initial series of 13 patients. METHODS: The Acticon Neosphincter® artificial bowel sphincter consists of an inflatable cuff of silicone elastomer placed around the anal canal and connected to a pressure-regulating balloon in the iliac fossa via a control pump placed in the labium or scrotum. Thirteen patients with severe anal incontinence not amenable to other methods were treated. Causes of incontinence included obstetric damage in eight patients, surgical damage in two patients, imperforate anus in two patients, and spina bifida in one patient. RESULTS: Surgical placement of the device was straightforward, mean operating time was 65 minutes, and median length of stay was 3.6 days. One infection of the perineal wound occurred in the early postoperative period necessitating removal of the device. In two further patients the artificial bowel sphincter was removed because of late infection in one at seven months and because of erosion through the skin in another at three months. The artificial bowel sphincter has been activated in ten patients resulting in full continence to solids and liquids except in one patient with postvagotomy diarrhea who had some leakage of liquids during episodes of diarrhea. The mean (± standard deviation) continence score (Cleveland Clinic system; maximal incontinence = 20) changed from 18.7 ± 1.6 preoperatively to 2.1 ± 2.6 after activation (P < 0.0001). Quality of life measured using a continence-specific series of up to 39 questions changed from 77 ± 16 percent of maximal reduction of quality preoperatively to 12 ± 19 percent postoperatively (P < 0.001). CONCLUSIONS: The artificial bowel sphincter can be placed without technical difficulty and with low morbidity. Preliminary experience shows full restoration of continence in most patients and ease of use. Longer follow-up is needed to determine the extent of problems with infection, erosion, and mechanical failure. [ABSTRACT FROM AUTHOR]

Determines the relationship between inhibition of colorectal cancer by sulindac and sulindac sulfone and the presence of activating K-ras mutations in the 1,2-dimethylhydrazine dihydrochloride rat model. Measurement of tumor number and volume prior to treatment by laparotomy and colonoscopy; Control of tumors with K-ras codon-12 mutations.

Background: Type-2 diabetes is strongly driven by obesity. Observational studies suggest that weight loss through bariatric surgery is more effective than conventional therapy for the management of type-2 diabetes, but no randomized controlled trial has been performed. Methods: We conducted a 2-year randomized controlled trial involving 60 obese (BMI > 30 and < 40 kg/m2) subjects with recently diagnosed (<2years) typo-2 diabetes. Subjects drawn from the general community were randomly allocated to either a program of conventional diabetes therapy with an intensive lifestyle change to induce weight loss or had substantial weight loss induced by the placement of a laparoscopic adjustable gastric band (LAGB; LAP-BAND®, Allergan Health) in addition to conventional care. The intensity of programs was similar. Key outcome measures were diabetes remission (fasting plasma glucose <7mmol/l, plus HbA1c <6.2% while taking no hypoglycaemic drug therapy or insulin), HbA1c levels, indirect measures of insulin resistance, and presence of metabolic syndrome. Results: At 2 years, the LAGB group and conventional groups had lost mean (SD) of 20.7 (8.6) % and 1.7 (5.2) % of weight respectively (P <0.001). Remission of diabetes was achieved by 22 of 29 (76%) the LAGB, and 4 of 26 (15%) of the conventional 2-year completers (p<0.001). Weight loss was the major driver of remission (R2 =0.46, p<0.001), with a 13% weight loss cutoff providing an 85% sensitivity and 86% specificity for remission. HbA1c levels fell 22.5 (11.6) % in the LAGB and 5.4 (15.2) % in the conventionally treated groups. The surgical group also had greater improvements in fasting plasma glucose, insulin, triglycerides and HDL-cholesterol. The metabolic syndrome was present in 29 of 30 in each group initially and in 8 of 29 LAGB and 22 of 26 conventional groups at 2 years. There were no serious complications in either treatment group. Conclusions: There is a direct relationship between weight loss and remission of type 2 diabetes in obese subjects. Substantial weight loss induced by LAGB is associated with a significantly better outcome than conventional therapy. LAGB placement should be considered when planning a treatment program for obese subjects diagnosed with type-2 diabetes. [ABSTRACT FROM AUTHOR]

Background: This study aimed to characterise the outcomes associated with colorectal cancer (CRC), comparing young adults (<50 years), patients of screening age (50-79 years), and octogenarians (>80 years)., Methods: All consecutive CRC resections with curative intent were recruited into this study from a prospectively maintained CRC database at a tertiary academic centre., Results: A total of 745 eligible cases were identified. Five-year survival in young adults was poorer than that of patients of screening age. Young adults had the highest incidence of rectal cancer resections, and presented with the most advanced tumour stages. Independent associations for poorer survival in young adults were increased nodal stage, the presence of distal metastases, and loss of MLH1/PMS2 staining on immunohistochemistry. Young adults had similar survival to octogenarians, when comparing patients treated with curative intent, regardless of oncological treatment., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Liver diseases progress faster in human immunodeficiency virus (HIV)-hepatitis C virus (HCV)-coinfected persons than HIV-monoinfected persons. The aim of this study was to compare rates of liver fibrosis progression (measured by the aspartate-to-platelet ratio index [APRI]) among HIV-HCV-coinfected users of modern protease inhibitor (PI)- and nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens with a backbone of tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC)., Methods: Data from a Canadian multicenter cohort study were analyzed, including 315 HCV polymerase chain reaction-positive persons who initiated antiretroviral therapy with a PI or NNRTI and a backbone containing either TDF/FTC or ABC/3TC. Multivariate linear regression analyses with generalized estimating equations were performed after propensity score matching to balance covariates across classes of anchor agent., Results: A backbone of TDF/FTC was received by 67% of PI users and 69% of NNRTI users. Both PI and NNRTI use was associated with increases in APRI over time when paired with a backbone of ABC/3TC: 16% per 5 years (95% confidence interval [CI], 4%, 29%) and 11% per 5 years (95% CI, 2%, 20%), respectively. With TDF/FTC use, no clear association was found among PI users (8% per 5 years, 95% CI, -3%, 19%) or NNRTI users (3% per 5 years, 95% CI, -7%, 12%)., Conclusions: Liver fibrosis progression was more influenced by the backbone than by the class of anchor agent in HIV-HCV-coinfected persons. Only ABC/3TC-containing regimens were associated with an increase of APRI score over time, regardless of the class of anchor agent used., (© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America.)