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Question: What factors predict postoperative pulmonary and pleural complications following aortic valve replacement? Design: Retrospective study. Participants: One thousand consecutive patients who underwent aortic valve replacement with a pericardial valve between 1986 and 2006. Of these, 610 underwent also coronary artery surgery. Outcome measures: Thirty putative predictors were investigated. Postoperative pulmonary complications (defined as respiratory failure, pneumonia, atelectasis) and postoperative pleural complications (defined as pleural effusion, pneumothorax, haemothorax, empyema) within 30 days of surgery were identified. Results: 58 (6%) patients developed pulmonary complications and 45 (5%) developed pleural complications. None of the pleural and only 3 of the pulmonary complications were fatal if they occurred alone. Postoperative heart failure (OR 4.7, 95% CI 1.8 to 11.9), previous pacemaker implant (OR 4.4, 95% CI 1.8 to 11.2) and chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.0 to 3.1) independently predicted postoperative pulmonary complications. Postoperative bleeding (OR 7.4, 95% CI 1.8 to 29.9), carotid artery disease (OR 2.8, 95% CI 1.4 to 5.5), previous coronary artery surgery (OR 2.7, 95% CI 1.1 to 6.4), chronic obstructive pulmonary disease (OR 1.9, 95% CI 1.0 to 3.8) and cardiac conduction defect (OR 1.9, 95% CI 1.0 to 3.7) independently predicted postoperative pleural complications. Conclusions: Postoperative pulmonary and pleural complications were rare. A history of cardiac and/or pulmonary problems are risk factors for pulmonary complications after aortic valve replacement. Further study is needed to reveal if preventive physiotherapeutic intervention in these patients is effective. [ABSTRACT FROM AUTHOR]

Surgical aortic valve replacement (SAVR) with a biological heart valve prosthesis (BHV) is often used as a treatment in elderly patients with symptomatic aortic valve disease. This age group is also at risk for the development of dementia in the years following SAVR. The research question is "what are the predictors for the development of dementia?". In 1500 patients undergoing SAVR with or without an associated procedure, preoperative (demographic, cardiac and non-cardiac comorbid conditions), perioperative (associated procedures, cross-clamp and cardiopulmonary bypass time) and postoperative 30-day adverse events (bleeding, thromboembolism, heart failure, conduction defects, arrhythmias, delirium, renal and pulmonary complications) were investigated for their effect on the occurrence of dementia by univariate analyses. Significant factors were entered in a multivariate analysis. The sum of the individual follow-up of the patients was 10,182 patient-years, with a mean follow-up of 6.8 years. Data for the development of dementia could be obtained in 1233 of the 1406 patients who left the hospital alive. Dementia during long-term follow-up developed in 216/1233 (17.2%) of the patients at 70 ± 37 months. Development of dementia reduced the mean survival from 123 (119-128) to 109 (102-116) months ( p < 0.001). Postoperative delirium was the dominant predictor (OR = 3.55 with a 95%CI of 2.41-4.93; p < 0.00), followed by age > 80 years (2.38; 1.78-3.18; p < 0.001); preoperative atrial fibrillation (1.47; 1.07-2.01; p = 0.018); cardiopulmonary bypass time > 120 min (1.34; 1.02-1.78; p = 0.039) and postoperative thromboembolism (1.94; 1.02-3.70; p = 0.044). Postoperative delirium, as a marker for poor condition, and an age of 80 or more were the dominant predictors.

Aortic valve disease is a lethal condition, once it becomes symptomatic. Surgical aortic valve replacement (SAVR) has, for a long time, been the only treatment option. In patients aged 85 and older, the consequences of SAVR have rarely been investigated. A total of 681 octogenarian patients were subdivided into a group with patients between 80 and 84 years ( n = 527) and a group with patients aged 85 or older ( n = 154). For each group, the temporal referral pattern, preoperative comorbid profile, operative data, postoperative need for resources, and adverse postoperative events including 30-day mortality and long-term survival were determined using the chi-squared test, Student's t -test, and log-rank test. For both age groups, the predictors for mortality were identified using a logistic regression analysis. In the oldest patient group, there were significantly more prior episodes of heart failure (75/154 vs. 148/527) and a greater need for urgent SAVR (45/150 vs. 109/515). The operative data and the need for postoperative resources were comparable, but the 30-day mortality was almost twice as high (24/154 vs. 45/527). The need for urgent SAVR was twice as high in the oldest group (odds ratio of 3.12 vs. 6.64). A logistic regression analysis for all 681 patients showed that age over 85 ranked fourth of six predictors for 30-day mortality. Five-year survival was favorable for both groups (67.8 ± 2.1% vs. 60.0 ± 4.3%). A Cox proportional hazard analysis failed to identify an age over 85 as a predictor for long-term mortality. Aortic valve disease and its effect on the left ventricle seemed to be more advanced in the highest age group. The mortality rate was almost double the need for urgent SAVR. This can be avoided by obtaining an earlier referral.

Transcatheter aortic valve implantation (TAVI) was first presented in 2002 as a case report. Randomized controlled trials showed that TAVI could serve as an alternative for surgical aortic valve replacement (SAVR) in high-risk patients. While the indications for TAVI have expanded into low-risk groups, favorable results of SAVR in elderly showed an increase in application of surgical treatment in this age category. This review aims to explore the effect of the introduction of TAVI in the referral for SAVR with respect to volume, patient profile, early outcome, and use of mechanical heart valves. Results show that the volume of SAVR has increased in several cardiac centers. In a small minority of series, age and risk score of the referred patients also increased. In most of the series, early mortality rate reduced. These findings, however are not universal. Different management policies could be responsible for this observation. Moreover, some patients in whom aortic valve replacement in whatever form is indicated still do not receive adequate treatment. This can be due to several reasons. Heart teams consisting of interventional cardiologists and cardiac surgeons should become a universal approach in order to minimize the number of untreated patients.

Aim: This study investigated whether Nigerian nurses' emotional exhaustion and active learning were predicted by job demands, control and social support., Background: Limited research has been conducted concerning nurses' work stress in developing countries, such as Nigeria. Accordingly, it is not clear whether work interventions for improving nurses' well-being in these countries can be based on work stress models that are developed in Western countries, such as the job demand control support model, as well as on empirical findings of job demand control support research., Method: Nurses from Nurses Across the Borders Nigeria were invited to complete an online questionnaire containing validated scales; 210 questionnaires were fully completed and analysed. Multiple regression analysis was used to test the hypotheses., Results: Emotional exhaustion was higher for nurses who experienced high demands and low supervisor support. Active learning occurred when nurses worked under conditions of high control and high supervisor support., Conclusion: The findings suggest that the job demand control support model is applicable in a Nigerian nursing situation; the model indicates which occupational stressors contribute to poor well-being in Nigerian nurses and which work characteristics may boost nurses' active learning., Implications for Nursing Management: Job (re)design interventions can enhance nurses' well-being and learning by guarding nurses' job demands, and stimulating job control and supervisor support., (© 2016 John Wiley & Sons Ltd.)

Objective: The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before and 6 months after an endurance, strength, and motor control exercise program in preprofessional dancers., Methods: This uncontrolled trial was completed at a college offering a professional bachelor degree in dance. Forty preprofessional dancers underwent a test battery before and after a 6-month lasting exercise program in addition to their regular dance lessons. Physical fitness was evaluated by means of a submaximal exercise test with continuous physiological monitoring and by a field test for explosive strength. Anthropometric measurements were taken to analyze the influence of fitness training on body composition. Musculoskeletal injury incidence and quality of life were recorded during the 6-month lasting intervention. An intention-to-treat analysis ("last observation carried forward" method) was used with a Student t test for normally distributed variables. The Wilcoxon signed rank and Mann-Whitney U tests were used as nonparametric tests., Results: Physical fitness improved after the 6 months of additional training program (P<.05). The waist:hip ratio (P=.036) and the sum of the measured subcutaneous skin thickness (P=.001) significantly decreased. Twelve dancers developed musculoskeletal complaints, requiring temporary interruption of dancing., Conclusions: The combination of regular dance lessons with an additional exercise program resulted in improved physical fitness in preprofessional dancers, without affecting the aesthetical appearance. A relatively high injury rate was observed during the intervention period. These results suggest that a randomized, controlled trial should be performed to examine the effectiveness of additional exercise in dancers on physical fitness and musculoskeletal injury rate., (Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Background: Damage to the perineum is common after vaginal delivery, and it can be caused by laceration, episiotomy, or both. This study investigated the effects of maternal position (lateral vs lithotomy) and other variables on the occurrence of perineal damage., Methods: A retrospective study included the examination of hospital records from 557 women. The effects of demographic characteristics, gravidity, parity, duration of pregnancy, reason for admission, and mode of labor on perineal outcomes were investigated through univariate (independent sample t test, chi-square test) and multivariate analysis (logistic regression analysis)., Results: Considering episiotomy as perineal damage, univariate analysis showed a protective effect of the lateral position (45.9% vs 27.9%, p > 0.001), and fewer episiotomies were performed (6.7% vs 38.2%) with this position. This protective effect for perineal damage disappeared on excluding women undergoing episiotomy from analysis. Multivariate analysis including all participants showed an increase of 47 percent in the likelihood of an intact perineum for the lateral position when compared with the lithotomy position (OR: 0.53; 95% CI: 0.36-0.78). Parity was associated with a reduction of 44 percent in perineal damage (OR: 0.56; 95% CI: 0.47-0.78, p < 0.001). Moreover, the lithotomy position was associated with significantly more episiotomies than the lateral position (7% vs 38%, p < 0.001). The odds of perineal damage increased in deliveries performed by physicians (OR: 2.92; 95% CI: 1.79-4.78)., Conclusions: Childbirth in the lateral position resulted in less perineal trauma when compared with childbirth in the lithotomy position, even after correcting for parity and birth attendant. The probability of an intact perineum increased in deliveries performed by midwives. (BIRTH 39:2 June 2012)., (© 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.)

This paper presents the initial research results of mentorship in Flanders, Belgium. A validated questionnaire has been used as well as a semi-structured interview, to investigate perceived characteristics, advantages and drawbacks of mentorship, as well as practical aspects in mentoring education. The questionnaire has been validated for the Dutch language. The response rate of 62% has been rather high. The ability to give feedback, experience, availability of time and a positive attitude were the elements considered important for mentors. In spite of workload, lack of time and drawbacks such as adverse effects on the team work on the ward, transferring of enthusiasm onto students was still possible. Benefits for mentors were immaterial and included closer follow-up of new developments, teaching and sharing of experiences. The benefits outweighed the drawbacks. Support by mentoring courses, additional study and especially of link lecturers proved to be beneficial. Especially the help of link lecturers proved to be necessary in problems and in evaluation of "unsafe" students. In the latter case, the link lecturer helps to solve the inherent conflict of interest by being mentor and assessor at the same time., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Cancer and chronic fatigue syndrome (CFS) are both characterised by fatigue and severe disability. Besides fatigue, certain aspects of immune dysfunctions appear to be present in both illnesses. In this regard, a literature review of overlapping immune dysfunctions in CFS and cancer is provided. Special emphasis is given to the relationship between immune dysfunctions and fatigue. Abnormalities in ribonuclease (RNase) L and hyperactivation of nuclear factor kappa beta (NF-kappaB) are present in CFS and in prostate cancer. Malfunctioning of natural killer (NK) cells has long been recognised as an important factor in the development and reoccurrence of cancer, and has been documented repeatedly in CFS patients. The dysregulation of the RNase L pathway, hyperactive NF-kappaB leading to disturbed apoptotic mechanisms and oxidative stress or excessive nitric oxide, and low NK activity may play a role in the two diseases and in the physiopathology of the common symptom fatigue. However, in cancer the relation between the immune dysfunctions and fatigue has been poorly studied. Immunological abnormalities to such as a dysregulated RNase L pathway, hyperactive NF-kappaB, increased oxidative stress and reduced NK cytotoxicity, among others, are present in both diseases. These anomalies may be part of the physiopathology of some of the common complaints, such as fatigue. Further studies to confirm the hypotheses given here are warranted.

Aim: Postoperative renal dysfunction after aortic valve replacement is a serious complication. To minimize its occurrence, risk factors have to be identified, and if possible eliminated., Methods: Of 1000 consecutive patients, who underwent AVR, a file study was performed chi(2)nd logistic regression analysis were performed to study the effect of 24 preoperative, 7 peroperative and 7 postoperative factors on the occurrence of 30-day postoperative worsening of renal function., Results: Fifty-three patients had a 30-day postoperative decrease of renal function. Nine of these patients died, which is significantly more than the mortality without this complication (P<0.0001). In those nine patients, another complication (postoperative heart failure, thromboembolism or respiratory failure) was present. Thirteen factors were significant in an univariate analysis: preoperative renal dysfunction (P<0.001), age>80 (P<0.001), atrial fibrillation (P<0.001) , preoperative pulmonary edema (P=0.001), conduction defect (P=0.002), diabetes (P=0.006), myocardial infarction (P=0.006), postoperative heart failure (P=0.007), cross clamp time >75 min (P=0.015), previous coronary artery bypass grafting (CABG) (P=0.018), concomitant CABG (P=0.031), ejection fraction <50% (P=0.033) and CVA (P=0.035). Four factors were identified as independent predictors in a multivariate analysis: renal dysfunction (P<0.001, Odds ratio [OR] 5.5; 95% confidence interval [CI] 2.9-10.4), preoperative atrial fibrillation (P=0.010, OR=2.3, 95% CI=1.2-4.2), age>80 (P=0.014, OR=2.2, 95% CI=1.2-4.1) and myocardial infarction (P=0.022, OR=2.2, 95% CI=1.1-4.4)., Conclusions: Few factors are liable for therapeutic intervention, especially in elderly and patients with comorbidity. In patients with risk factors, shortening of cross clamping time or installation of minimal extracorporeal circulation might be beneficial.

Degenerative aortic valve disease is the most frequent acquired valve disease. Especially in the elderly, its prevalence is increasing. Once the disease becomes symptomatic, it is rapidly fatal. The disease cannot be considered a result of aging alone. The condition is an active process, which occurs with rapid progression, especially when calcification can be documented. This calcification can be the end result of cellular mechanisms involving cell death pathways (such as autophagy) and cellular matrix remodeling. These processes are beginning to be unraveled in the initiation and propagation of the disease. Autophagy could be the common step through which these mechanisms lead to this pathway of cell death in this disease. Autophagy can be detected by procedures described hereafter.

Background and Aim of the Study: Over the past 20 years, both the typical age and co-morbidity of patients referred for aortic valve replacement (AVR) have increased. In order to assess the effect of these changes on hospital complications, an evaluation was conducted of patient characteristics within this time period., Methods: This retrospective study included 1,000 consecutive patients who underwent AVR with a pericardial valve. Concomitant coronary artery bypass grafting (CABG) was performed in 610 cases. Among 25 preoperative and five perioperative factors, and eight hospital complications, the changes in incidence that occurred during the periods 1986-1991, 1992-1996, 1997-2001, and 2002-2006, were investigated. Predictive factors for non-cardiac hospital complications required further exploration, as these were the only complications to increase significantly with time; however, this type of complication is less lethal., Results: Significant increases were identified in age, and in the incidence of non-cardiac co-morbidity, previous CABG and preoperative congestive heart failure (p mostly <0.0001). Among hospital complications, only non-cardiac problems showed a significant increase. The independent predictors included previous CABG (p = 0.004), concomitant CABG (p = 0.006), renal impairment (p = 0.008), conduction defects (p = 0.010), previous pacemaker implantation (p = 0.014), chronic obstructive lung disease (p = 0.015), and concomitant carotid artery surgery (p = 0.032)., Conclusion: During the past 20 years, patients referred for AVR have become older and have more co-morbidity. However, the incidence only of non-cardiac hospital complications was increased. Previous and concomitant surgery, as well as non-cardiac co-morbidity, are important predictors that must be taken into account at referral, but should not contraindicate AVR.

Calcific aortic valve stenosis is the most common and increasing heart valve disease in the western world. In the last 30 years, diagnosis and management were revolutionized by the development of cardiac catheterisation, echocardiography, cardiac surgery, and medication. Recently, new strategies were introduced for aortic valve replacement using more sophisticated bioprosthetic heart valves. Moreover, tissue-engineered heart valves are under development to improve management strategies. In this article we review the current morphological and histopathological findings in the progression of calcific aortic valve stenosis. This is, to our understanding, important to contribute to the knowledge of fundamental management strategies of this disease.

Background and Aim of the Study: Calcification in aortic valves is the most common valvular lesion in western populations. This event is correlated with cellular degeneration in the valvular cusps, although there is no exact evidence how these cells die: this requires further exploration., Methods: Twelve human severely calcified aortic valves obtained during cardiac surgery were studied by semi-quantitative analysis, and results compared with data from 12 human control aortic valves obtained during autopsy. Tissue analysis was by hematoxylin and eosin and Alcian blue staining. Detection of neurons was by immunohistochemical staining of PGP9.5 and neurofilament. In order to detect autophagy, an immunohistochemical staining for ubiquitin was used. The TUNEL technique was used to detect apoptosis. Co-localization of Alizarin red with ubiquitin labeling was performed on non-decalcified aortic valves., Results: Hematoxylin and eosin staining showed moderate to severe mineralization in 10 of 12 patients in the surgical group, but in only one of 12 in the autopsy group. No significant observations were made with regard to PGP9.5 and neurofilament staining. Moderate to severe ubiquitin labeling was found initially in the majority of the surgical resection group (9/12) compared to a minority in the autopsy group (1/12). TUNEL-positive labeling was very rare and found mostly at the endothelial layer of the valvular cusps., Conclusion: Immunohistochemical methods showed the main cell death mechanism involved in the calcification of aortic leaflets to be autophagy rather than apoptosis. These findings suggest that autophagic cell death might play a role in the release of matrix vesicles in early degenerative aortic valves, thereby attracting inflammatory cells, and this could eventually lead to mineralization.

Background and Aim of the Study: The study aim was to determine if aortic valve replacement in octogenarians is still rewarding., Methods: Between 1986 and 2000, 500 patients received a Carpentier-Edwards pericardial valve in the aortic position. Of these patients, 348 also underwent coronary artery bypass grafting (CABG). Sixty patients were aged > or =80 years. A retrospective follow up totaled 2,022 patient-years. A Cox multivariate regression analysis included 17 preoperative potential risk factors: age >80 years; gender; carcinoma; chronic obstructive pulmonary disease; renal failure; stroke; arterial hypertension; carotid artery disease; myocardial infarction; coronary artery disease; conduction defects; atrial fibrillation; medically treated endocarditis; severity of symptoms; urgent operation; left ventricular function; and need for digitalis., Results: For hospital mortality, independent predictors were urgent surgery (Risk Ratio 10.2, 95% CI 2.5-42.0, p = 0.001); age over 80 (RR 4.5, CI 1.3-14.9; p = 0.015); need for digitalis (RR 3.8, CI 1.3-10.6, p = 0.010); male gender (RR 3.7, CI 1.1-12.4; p = 0.035); and myocardial infarction (RR 3.1, CI 1.0-9.4, p = 0.051). For long-term mortality, independent predictors. were urgent surgery (RR 4.5, CI 1.6-12.6; p = 0.004), age >80 (RR 2.5, CI 1.4-4.5, p = 0.002); myocardial infarction (RR 2.1, CI 1.3-3.4; p = 0.003); carcinoma (RR 2.0; CI 1.1-3.7; p = 0.021); and digitalis use (RR 1.8; CI 1.2-2.7; p = 0.004). Univariate analysis revealed that age >80 years (38.6% versus 77.0%), need for urgent operation (0% versus 75.1%), need for digitalis (69.4% versus 76.3%) and myocardial infarction (57.1% versus 76.4%) had a significant effect on five-year survival., Conclusion: For hospital mortality and long-term mortality, a need for urgent surgery was the most determining factor. Age >80 years was the second most important factor, but previous myocardial infarction and need for digitalis were almost equally important. Aortic valve replacement in octogenarians is still rewarding, as five-year survival is 38.6%. Thus, surgery in these patients should not be postponed.

Aim: The problem of postoperative sudden death and the effect of age, gender and association of coronary artery bypass grafting were studied after implantation of a bioprosthetic valve in aortic position., Design: retrospective investigation during 13 year., Setting: general hospital., Patients: 500 mostly symptomatic patients who received this bioprosthesis had a follow-up of 2,022 patient-year for 499 patients., Intervention: aortic valve replacement with a Carpentier-Edwards pericardial prosthesis., Measures: hospital complications and mortality, long-term mortality with focus on sudden death and its risk factors, valve related complications and other cardiac events., Results: Within the hospital: atrial fibrillation was the most frequent complication, for which only gender had an effect (p=0.014). The most occurring valve related complications were thrombo-embolic events. Mortality was adversely affected by male gender (p=0.040). Long-term results: thrombo-embolic events were the most important valve related complications. These events and haemorrhage, endocarditis and reoperation rate were not affected by the association of a CABG. Univariate analysis in patients over 73 showed that the need for CABG significantly increased global mortality (p=0.0001), occurrence of cardiac fatality (p=0.0003) and congestive heart failure (p=0.0036). Non-valve related factors seemed most responsible for postoperative sudden death., Conclusion: Age, male gender and the association of a CABG remain important determinants for postoperative survival, but not for the occurrence of valve related complications. Sudden death seems not always related to the valve prosthesis, but is as such classified by convention.

Background/aims: Stress can delay gastric emptying rate. This phenomenon has not yet been investigated with a physiological solid test meal or a regional analysis., Methodology: We investigated the gastric emptying rate in beagle dogs using a radio-labeled solid test meal and a gamma camera. The transport to an unknown environment served as a stress stimulus. This offers the advantage to mimic fairly well the clinical situation just before a diagnostic or therapeutic procedure. Control values were obtained after the third investigation, in which all dogs were accustomed to the environment., Results: Regional analysis of the emptying curves from the whole gastric region revealed that the length of the lag phase increased with stress, but the post-initial emptying rate remained unchanged. Emptying of the fundus changed hardly, but the antropyloral motor activity decreased during stress., Conclusions: Gastric emptying rate is impeded during stress. It is necessary to limit the unnatural stress-stimuli, in order to mimic the clinical situation. Measurement techniques that influence directly gastric emptying or act as a stress-stimulus by themselves are undesirable. A radionuclide solid test meal is preferable and a regional analysis reveals the impairment of the antral motility as the mechanism of the delay of gastric emptying.

Background and Aim of the Study: The effect of concurrent disease and cardiac comorbidity on survival after bioprosthetic valve replacement in elderly patients was assessed retrospectively. Risk factors were categorized as general, non-cardiac (age, diabetes, previously treated carcinoma) and cardiac (LVEF, three-vessel disease, previous CABG or valve replacement, and endocarditis)., Methods: A total of 400 elderly patients (median age 73 years; range: 71-76 years) was studied. Medical history included diabetes, previous CABG or aortic valve replacement (AVR), endocarditis and treatment of previous carcinoma. A left ventricular ejection fraction (LVEF) of <0.66 and presence of three-vessel disease were also investigated. Hospital deaths (and cause) were recorded; survival or date and cause of death after discharge were obtained by questionnaire. Kaplan-Meier univariate and Cox proportional hazards multivariate regression analyses were carried out., Results: Mortality during follow up was 28.3%; hospital mortality was 3.8%. Univariate analysis showed five factors significantly to affect survival: LVEF, history of endocarditis, carcinoma, age and three-vessel disease. Fifteen of 38 patients with history of carcinoma died, 10 due to a malignancy. Of 76 patients with three-vessel disease, 26 died. A history of diabetes and previous CABG did not influence survival significantly. Four of eight patients with preoperative endocarditis died, all in hospital. Six of 11 patients died after redo-AVR, none before 36 months follow up. By Cox regression analysis, LVEF and histories of carcinoma and endocarditis remained significant., Conclusion: AVR should be performed before ventricular deterioration occurs. Previous CABG is not a contraindication for AVR. Endocarditis impaired survival. Long-term mortality after redo-AVR in this population was relatively high, but acceptable. AVR should also be performed in elderly patients with aortic valve disease. Since prognosis of symptomatic aortic valve disease is poor in the short term, AVR is indicated in patients treated for carcinoma.

Background/aims: Gastric emptying rate for solid and for liquid test meals was investigated retrospectively in patients with longstanding epigastric distress after partial gastrectomy, either as primary treatment or after failure of vagotomy for peptic ulcer in order to find an explanation for the postoperative symptoms., Methodology: Radionuclide-labeled liquid and solid test meals were used to evaluate gastric emptying rate, at least one year after surgery., Results: The lag phase for liquid test meals disappeared in all operated patients. Partial gastrectomy usually lead to fast emptying but this resective procedure, if performed after vagotomy, lead to stasis in a significant number of patients. Gastric emptying rate for solids increased in only a few of these symptomatic patients. In most of them however, there was a normal to decreased emptying rate. If a vagotomy had preceded the resective procedure, gastric emptying rate decreased significantly., Conclusions: In all these symptomatic patients, gastric emptying had been disturbed for at least one type of test meal. This makes investigation for both meals necessary, especially since there is a lack of correlation. Furthermore, if vagotomy fails to prevent ulcer recurrence, one should carefully consider all options before performing partial gastrectomy since gastric emptying rate after these consecutive procedures worsens considerably.

Background/aims: Since the development of highly selective vagotomy (HSV), simplified procedures such as posterior truncal vagotomy with anterior gastric wall stapling (PTV-AGS) became available to achieve parietal cell denervation. The purpose of this investigation was to detect possible gastric emptying disturbances due to complete vagotomy of the posterior gastric wall and to stapling of the anterior stomach wall., Methodology: Six female dogs, undergoing HSV, were compared with six others, in which PTV-AGS was performed. Radionuclide labeled liquid test meals were used to evaluate gastric emptying rate (GER) and results were compared with solid test meal emptying., Results: A small, statistically insignificant fastening of liquid gastric emptying was seen early after HSV, as well as after PTV-AGS, and persisted one year after operation. There proved to be a striking lack of correlation between the GER-results after liquid versus solid meals., Conclusion: Just as after HSV, gastric emptying rates of liquid meals after PTV-AGS do not show a statistical difference as compared with preoperative values. Both operations therefore do not induce clinically important gastric motility changes. Separate test meals with liquid and solid food prove to be necessary in order to detect such changes.

A series of 39 patients with peptic ulcer disease is investigated with respect to gastric outlet obstruction. Two diagnostic tools are compared, namely endoscopy and evaluation of radionuclide meal emptying. Endoscopic obstruction was qualified as non passage of a 14 mm gastroscope. Gastric emptying reduction was considered clinically relevant when half emptying times exceeded 60 minutes for solids and 12 minutes for liquids. Comparison of both techniques of radionuclide meal emptying with endoscopy showed a poor correlation (accuracy 15/28), especially when liquid gastric emptying versus endoscopy was concerned.

Merkel cell tumours are rare skin cancers with an unpredictable clinical course. Correct diagnosis requiring immunohistochemical staining is essential since the treatment differs entirely from that of basalioma. Locally limited disease as well as rapidly fatal course have been observed. In a small series of 5 patients and from literature data, surgery continued with radiotherapy for locoregional control is advocated as optimal approach since this type of tumour can behave differently compared to basal cell carcinomas.

In a group of clinical patients with duodenal ulcer submitted to highly selective vagotomy, gastric emptying studies were performed pre-operatively and 2 weeks and 6 months after surgery. A standard liquid meal labeled with radioactive technetium was used for scanning. In this group of duodenal ulcer patients, no abnormal emptying was noted prior to surgery as compared with controls. After highly selective vagotomy, the gastric emptying time for liquids was statistically shorter as compared with preoperative values. It is concluded that highly selective vagotomy may be the operative treatment of choice for duodenal ulcer patients with respect to acid secretion, but that it alters gastric motility and emptying significantly.