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Background: In recent years, certain body composition measures, assessed by computed tomography (CT), have been found to be associated with chemotherapy toxicities. This review aims to explore available data on the relationship between skeletal muscle and adiposity, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular and intermuscular adipose tissue and their association with chemotherapy toxicity in non‐metastatic colorectal cancer (CRC) patients. Methods: A systematic literature search following PRISMA guidelines was conducted in Medline, Embase, Cochrane and Web of Science, for papers published between 2011 and 2023. The search strategy combined keywords and MESH terms relevant to 'body composition', 'chemotherapy toxicities', and 'non‐metastatic colorectal cancer'. Results: Out of 3868 studies identified, six retrospective studies fulfilled the inclusion criteria with 1024 eligible patients. Low skeletal muscle mass was strongly associated with increased incidence of both chemotherapy toxicities and dose‐limiting toxicity (DLT). The association of VAT, intramuscular and intermuscular adiposity was heterogeneous and inconclusive. There was no association between SAT and chemotherapy intolerance. No universal definitions or cut‐offs for sarcopenia and obesity were noted. All studies utilized 2‐dimensional (2D) CT slices for CT body composition assessment with varied selection on the vertebral landmark and inconsistent reporting of tissue‐defining Hounsfield unit (HU) measurements. Conclusion: Low skeletal muscle is associated with chemotherapy toxicities in non‐metastatic CRC. However, quality evidence on the role of adiposity is limited and heterogeneous. More studies are needed to confirm these associations with an emphasis on a more coherent body composition definition and an approach to its assessment, especially regarding sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer poses a major burden. Its incidence increases with age and older patients with comorbidities have a higher likelihood of major complications. This study investigated the impact of age on health outcomes in colorectal cancer patients treated by surgery. Methods: A prospective database of all patients undergoing colorectal cancer surgery with curative intent between 2012 and 2017 was used to identify patients. A retrospective review of existing medical records investigating health‐related outcomes in colorectal cancer patients undergoing surgery was performed. Primary outcomes measured were overall survival (OS) and disease‐free survival (DFS). Difference in restricted mean survival times (RMST) up to a pre‐specified time point of 24 months was used to compare four age groups. Results: Six‐hundred and fifty‐one patients were divided into four age group categories: ≤65‐years (n = 244), 66 to 75‐years (n = 213), 76 to 85‐years (n = 162) and >85‐years (n = 32). Older patients were found to have a higher rate of post‐operative medical complications (including confusion) (P = 0.001) and a longer length of stay (LOS) (P = 0.01). There was no difference between the 76 to 85‐year age group and >85‐year age group in OS and DFS. However, there was a reduced OS in older patients (>65) compared to their younger cohorts (<65) (P = 0.04). Conclusion: Older patients who undergo curative surgery have reduced OS, increased LOS and higher complication rates. Complex older patients may benefit from geriatric assessment and management in the peri‐operative period. [ABSTRACT FROM AUTHOR]

Backgrounds: A loop ileostomy may reduce the severity of acute anastomotic complications after low rectal resection, but some patients have persistent rectal anastomotic problems. No consensus exists for the management of patients with a chronic low rectal anastomosis complication and a loop ileostomy. There is need for a standard description of these anastomotic complications and to determine whether it is safe to reverse the ileostomy. This study proposes a classification of chronic rectal anastomotic complications and to report the correlation with successful restoration of rectal continuity. Methods: This was a retrospective project from a prospectively maintained database at a single colorectal unit in a large tertiary hospital in Metropolitan Melbourne. Patients with rectal anastomotic complications following rectal cancer resections between March 2012 and October 2019 were included. A classification of chronic rectal anastomotic complication was developed by reviewing the interval assessments of the rectal anastomosis. The classification categories were correlated with outcomes after stoma closure. Results: Of the 149 patients, 20 patients had an anastomotic complication identified during work up prior to loop ileostomy reversal. Eleven patients had an anastomotic stenosis and nine had an anastomotic defect. Eighteen patients were eligible for stomal closure. The majority (11/12) of patients with a Type 1 stenosis or defect had no rectal complications after stoma closure. Conclusion: The classification system helps to describe chronic rectal anastomotic abnormalities and guide management. Although these patients may be a challenge, many can undergo successful ileostomy reversal. [ABSTRACT FROM AUTHOR]

Background: Currently no consensus exists regarding what pre-reversal investigations are required to assess integrity of the rectal anastomosis. The objective of this study was to compare pre-reversal assessments of anastomotic integrity and to evaluate trends that might have influenced timings for reversal. Methods: From a prospectively maintained database, patients with colorectal cancer resections between March 2012 and October 2019 were identified. Patient characteristics, pre-reversal contrast enema and flexible sigmoidoscopy findings were recorded, and management of complications were recorded. Time-to-ileostomy reversal and time series for trends were analysed. Results: There were 154 patients included. Pre-reversal contrast enema or sigmoidoscopy detected a possible stricture or leak at the rectal anastomotic site in 11% (15/132) and 15% (18/112), respectively. When both modalities were used there was concordance of 86.1% and a positive likelihood ratio of 5.73. Of 125 (81.2%) ileostomies reversed, the median time-to-reversal was 11.99 months; time series analysis over the 7-year period showed no significant trend for average patient-days from booking to reversal (P = 0.60). Cox regression modelling did not identify any influential risk factors for the times taken to reversal. Conclusion: This study supports the use of both contrast enema and flexible sigmoidoscopy in the assessment of rectal anastomosis integrity. Most patients with complications can have their ileostomies reversed. Patients who have adjuvant chemotherapy have a prolonged time to reversal. [ABSTRACT FROM AUTHOR]

Background: The size of thyroid nodules as measured by ultrasound (ultrasound size, USS) is routinely used in clinical decision‐making. Reports of discrepancy between USS and pathological size (PS) evaluation have not analysed their systematic differences. The objective of this study was to uncover the lack of agreement (bias) between USS and PS measurements. Methods: A retrospective study was performed on 121 patients who had a total or hemi‐thyroidectomy for a solitary nodule. Ordinary least product regression was used to detect and distinguish constant and proportional bias in unidimensional size measurements between USS and PS evaluation. Three‐dimensional volume measurements were compared in a subgroup of 31 patients. Pre‐specified acceptable limits of interchange were defined as 20% difference. Results: Ordinary least product regression demonstrated no constant or proportional bias between the two methods; regression equation: USS = (0.863) + (1.040) × PS. When nodules were grouped by size, discrepancies between the two methods were observed in nodules <10 mm (P = 0.004). However, potential overtreatment of patients with USS >10 mm but PS <10 mm only accounted for 4.1% of total patients. Subgroup analysis of volume measurements showed no bias between USS and PS evaluation. Conclusions: USS and PS measurements were interchangeable, as there was no evidence of constant or proportional bias between the two measurements. However, USS may misclassify the size for smaller nodules and potentially lead to unnecessary workup and treatment. Discrepancy in size measurements between USS and PS should be taken into account in clinical practice, particularly in smaller nodules. [ABSTRACT FROM AUTHOR]

Background: Prior to all surgical procedures, possible risks are outlined to patients during an informed consent discussion, and they are invited to ask questions. Written consent records this discussion and signals a patient's willingness to proceed with surgery. This study aims to improve the documentation of complications discussed during laparoscopic cholecystectomy consent through the introduction of a procedure‐specific consent form. Methods: Phase 1 included a retrospective analysis of possible complications documented on standard consent forms for laparoscopic cholecystectomy. Phase 2 was a prospective randomized comparison of existing standard consent forms versus procedure‐specific consent forms measuring the documentation of significant complications as identified from the Royal Australasian College of Surgeons brochure for laparoscopic cholecystectomy. These include bile duct injury, bile leak, bleeding, infection, conversion and damage to other organs. The proportion of participants in each cohort with the documentation of specific complications was assessed using the two‐sample test of differences in proportions. Results: Phase 1 of the study found that the possible risk of bleeding was documented in 82.1% of cases, while damage to other organs was only documented in 7.7%. Phase 2 of the study showed significant improvements in the documentation of specific complications for both standard and procedure‐specific consent cohorts; 76.5% of participants in the procedure‐specific consent cohort had all complications documented, while no participants in the phase 1 cohort had all complications documented. Conclusion: Introduction of a procedure‐specific consent form for laparoscopic cholecystectomy has improved the documentation of a standard set of complications. [ABSTRACT FROM AUTHOR]

The article describes the case of a 42-year-old female with a gallbladder cavernous lymphangioma with numerous irregular ectatic vascular spaces, mature lymphocytes and lymphatic vessels. Topics discussed include three histological groups of lymphangiomas, complementary in preoperative diagnosis that show a multiloculated cystic mass in the gallbladder fossa, and laparoscopic cholecystectomy as a safe option for this rare condition.

Background Colorectal surgery carries a significant mortality risk, with reported rates of 1-6% for elective surgery and up to 22% in the emergency setting. Both clinicians and patients will benefit from being able to predict the likelihood of death before surgery. Recently, we have described and validated two risk stratification models for colorectal surgery, the Barwon Health 2012 and Association Française de Chirurgie models. However, these models are not suitable for assessment at patient's bedside. The purpose of this study is to develop a simplified preoperative model capable of predicting mortality following colorectal surgery. Methods The new model is termed Colorectal pre Operative Surgical Score ( CrOSS). The development and internal validation of CrOSS was performed using a prospectively maintained colorectal database. External validation was performed using retrospective data. Univariate and multivariate analyses were performed in model development. Calibration and discrimination were used for model validation. Results There were 474 and 389 consecutive colorectal surgeries at Geelong Hospital and Western Hospital. Overall mortality rates were 5.16% and 1.03%, respectively. Significant predictors for mortality were as follows: age ≥70, urgent operation, albumin ≤30 g/L and congestive heart failure (receiver operating characteristic ( ROC) = 0.870, calibration P-value = 0.937). The predicted risk of mortality was stratified according to the risk profile of 0.39-66.51%. When validated externally, CrOSS predicted mortality accurately ( ROC = 0.847, calibration P-value = 0.199). Conclusions A robust and simple preoperative model has been created to risk-stratify patients for colorectal surgery. This was successfully validated at another tertiary hospital. [ABSTRACT FROM AUTHOR]

The functional site of ‘phospholipase A2 inhibitor from python’ (PIP) was predicted based on the hypothesis of proline brackets. Using different sources of secretory phospholipase A2 (sPLA2 s) as enzyme, and [3 H]arachidonate-labelled Escherichia coli as substrate, short synthetic peptides representing the proposed site were examined for their secretory phospholipase A2 (sPLA2 ) inhibitory␣activity. A decapeptide P-PB.III proved to be the most potent of the tested peptides in inhibiting sPLA2 enzymatic activity in vitro , and exhibited striking anti-inflammatory effects in␣vivo in a mouse paw oedema model. P-PB.III inhibited the enzymatic activity of class I, II and III PLA2 s, including that of human synovial fluid from arthritis patients. When tested by ELISA, biotinylated P-PB.III interacted positively with various PLA2 s, suggesting that the specific region of PIP corresponding to P-PB.III, is likely to be involved in the PLA2 –PLI interaction. The effect of P-PB.III on the peritoneal inflammatory response after surgical trauma in rats was also examined. P-PB.III effectively reduced the extent of postsurgical peritoneal adhesions as compared to controls. sPLA2 levels at seventh postoperative day in the peritoneal tissue of P-PB.III-treated rats were also significantly reduced (P < 0.05) in comparison to those of the untreated controls. The present results shed additional insight on the essential structural elements for PLA2 binding, and may be useful as a basis for the design of novel therapeutic agents. [ABSTRACT FROM AUTHOR]

OBJECTIVE To test the hypothesis that urinary catheter balloons filled with sterile water, saline or glycine have equivalent rates of failure to deflate. MATERIALS AND METHODS This was an in vitro equivalence study designed to test whether saline or glycine are neither substantially worse nor substantially better than water in terms of balloon-deflation failure rates. Glycine was chosen as the third arm, as it is readily available during endoscopic procedures and would be useful to use in such situations. We hypothesised that balloon-deflation failure rates using saline or glycine were no worse than water by 10%. We calculated the sample size for equivalence testing; 600 catheters were randomized by computer-generated random numbers to receive 10 mL of water, saline or glycine, and then immersed in a heated artificial urine solution for 6 weeks. The catheter balloons were then deflated, noting any failures to deflate and recording the deflation volumes. RESULTS There was no failure to deflate in all 600 catheters. The median deflation volume for water, saline and glycine was 9.0, 9.2 and 9.1 mL, respectively ( P < 0.001 Kruskal–Wallis test). Post-hoc pair-wise comparisons showed that the deflation volume difference between water and saline was significant ( P < 0.001), as was that between water and glycine ( P < 0.001). The practical implication of this difference is not apparent from this study. CONCLUSIONS The use of saline or glycine in catheter balloons has an equivalent deflation failure rate to using water, which in this study was zero. [ABSTRACT FROM AUTHOR]

Changes in hepatic blood flow reflect adaptive responses of the liver to injury, regeneration, and the development of disease states. The measurement of hepatic blood flow is, however, technically challenging and although theoretically useful has not become routine in clinical work. The different techniques that have been developed for quantitative measurement of hepatic blood flow require careful interpretation of the results obtained but are frequently applied without careful considerations of their technical limitations. In particular, many noninvasive techniques depend on good hepatocellular function and are thus irrelevant under most clinical conditions. Many other potentially useful techniques are poorly validated and standardized and there is a need for further research into smethodology.This review summarizes the salient technical features of the different techniques for quantitative measurement of hepatic blood flow. The techniques are divided into invasive, minimally invasive, and noninvasive categories and the relevance of each technique to both routine clinical application or research is discussed. [Copyright &y& Elsevier]

Esophageal perforation is a surgical emergency with significant morbidity. Management of this condition is complex and constantly evolving. To our knowledge, this is the first case series describing repair of esophageal perforation with the use of an isoperistaltic gastroesophagostomy tube connected to continuous suction. We present three patients successfully managed using this technique., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)