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BACKGROUND: Traditional surgical dogma is that paediatric appendicitis necessitates an appendicectomy; however there is an increasing cohort of evidence suggesting that non-operative management (NOM) using antibiotic therapy is safe and effective. During the COVID-19 surge (April - June 2020) with centralization of paediatric surgical care and risks from anaesthetics to both patients and staff a NOM pathway was used to manage clinically diagnosed appendicitis in the Royal Belfast Hospital for Sick Children (RBHSC). METHODS: Prospective data collection was undertaken of all children (<16 years) diagnosed with appendicitis who entered the NOM pathway in RBHSC from 01/04/2020 to 30/06/2020. This was compared to a cohort from the same timeframe in 2019. Primary end-points were inpatient success rate of NOM and 30-day success rate of NOM (success defined as no appendectomy performed). RESULTS: 47 patients completed the NOM pathway, with 43% (20/47) suspected to have complicated appendicitis. The cohort was similar to that of 2019 in terms of age (p=0.1) and sex (p=0.8), but was 155% larger (42 v. 20).For those with simple appendicitis, there was a 96% (26/27) success rate of NOM on discharge, with a 93% (25/27) 30-day success rate. For complicated appendicitis, there was a 40% (8/20) success rate on discharge, with a 30% (6/20) 30-day success rate. CONCLUSION: The use of a NOM pathway for paediatric appendicitis during the COVID-19 surge in Northern Ireland was safe and effective for staff and patients. With a small sample size and restricted follow up more evidence is required to prove if this is an effective treatment modality with a return to normal theatre availability. In the interests of antibiotic stewardship we would not advocate NOM pathways utilisation by non-surgical clinicians.

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Though many studies have explored the effects of radiation therapy on urinary, sexual, and bowel function and/or bother, few have focused on symptom experiences from diagnosis through the first year following completion of radiation therapy. The purpose of this study was to compare the effect of 3 types of radiation treatment on functions, bother, and well-being in men with prostate cancer at 1, 6, and 12 months after completion of treatment. A repeated measures survey (N = 73) found that none of the function, bother, emotional, social, or functional well-being scores were significantly different among the 3 groups. However, within-subjects-only repeated measures ANCOVA suggested that emotional well-being and social well-being are different over time. The findings show that clinical treatment of prostate cancer has an impact on functions, bother, and well-being of patients. Thus, it is important that nurses and other healthcare providers listen to what patients are saying before, during, and after treatment.

Bien que de nombreuses études aient examiné les effets de la radiothérapie sur les fonctions ou les gênes urinaires, sexuelles et intestinales, peu ont mis l'accent sur les symptômes ressentis à partir du diagnostic jusqu'à la fin de l'année suivant le traitement. L'objectif de cette étude était de comparer les effets de trois types de radiothérapie sur les fonctions, les gênes et le bien-être d'hommes atteints d'un cancer de la prostate un mois, six mois et douze mois après la fin du traitement. Un sondage intégrant des mesures répétées (N = 73) a permis de constater qu'il n'y avait pas de variation importante entre les trois groupes quant aux mesures touchant les fonctions corporelles, les gênes physiques ou le bien-être social, émotionnel ou fonctionnel. Toutefois, l'analyse de covariance des mesures répétées touchant les sujets uniquement laisse entendre que le bien-être émotionnel et le bien-être social évoluent dans le temps. Les conclusions de l'étude indiquent que le traitement clinique du cancer de la prostate a une incidence sur les fonctions corporelles, les gênes physiques et le bien-être des patients. Il est par conséquent important que le personnel infirmier et les autres professionnels de la santé prennent le temps d'écouter les patients avant, pendant et après leur traitement.

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Diffusion tensor imaging (DTI) provides an indirect measure of tissue structure on a microscopic scale. To date, DTI is the only imaging method that provides such information in vivo, and has proven to be a valuable tool in both research and clinical settings. In this study, we investigated the relationship between white matter structure and diffusion parameters measured by DTI. We used micrographs from light microscopy of fixed, myelin-stained brain sections as a gold standard for direct comparison with data from DTI. Relationships between microscopic tissue properties observed with light microscopy (fiber orientation, density and coherence) and fiber properties observed by DTI (tensor orientation, diffusivities and fractional anisotropy) were investigated. Agreement between the major eigenvector of the tensor and myelinated fibers was excellent in voxels with high fiber coherence. In addition, increased fiber spread was strongly associated with increased radial diffusivity (p = 6 × 10(-6)) and decreased fractional anisotropy (p = 5 × 10(-8)), and was weakly associated with decreased axial diffusivity (p = 0.07). Increased fiber density was associated with increased fractional anisotropy (p = 0.03), and weakly associated with decreased radial diffusivity (p < 0.06), but not with axial diffusivity (p = 0.97). The mean diffusivity was largely independent of fiber spread (p = 0.24) and fiber density (p = 0.34).

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We build on previous work to show how serial diffusion-weighted MRI (DW-MRI) data can be used to estimate proliferation rates in a rat model of brain cancer. Thirteen rats were inoculated intracranially with 9L tumor cells; eight rats were treated with the chemotherapeutic drug 1,3-bis(2-chloroethyl)-1-nitrosourea and five rats were untreated controls. All animals underwent DW-MRI immediately before, one day and three days after treatment. Values of the apparent diffusion coefficient (ADC) were calculated from the DW-MRI data and then used to estimate the number of cells in each voxel and also for whole tumor regions of interest. The data from the first two imaging time points were then used to estimate the proliferation rate of each tumor. The proliferation rates were used to predict the number of tumor cells at day three, and this was correlated with the corresponding experimental data. The voxel-by-voxel analysis yielded Pearson's correlation coefficients ranging from −0.06 to 0.65, whereas the region of interest analysis provided Pearson's and concordance correlation coefficients of 0.88 and 0.80, respectively. Additionally, the ratio of positive to negative proliferation values was used to separate the treated and control animals (p <0.05) at an earlier point than the mean ADC values. These results further illustrate how quantitative measurements of tumor state obtained non-invasively by imaging can be incorporated into mathematical models that predict tumor growth.

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The cervicoscope, a camera that takes a photograph of the cervix, has been designed in America by Staff to increase the sensitivity and specificity of cervical cancer screening. There are no reports of its use in British general practice. This study found the cervicoscope easy to use in general practice and acceptable to patients. The number of abnormal screening results increased. The technique failed to detect a woman with carcinoma-in-situ.

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OBJECTIVE: To report an "epidemic" of pseudomeningitis related to cytocentrifuge funnel and Gram-stain reagent contamination, and our evaluation and responses. DESIGN: Investigation was stimulated by the recognition of Gram-stained, smear-positive, culture-negative cerebrospinal fluid (CSF) specimens. Cytofunnels, glass slides, Gram-staining reagents, and an automated Gram-staining apparatus were subjected to repeated staining and culture. Control stains and cultures using fetal bovine serum (simulated CSF) were performed for comparison. SETTING: The clinical microbiology laboratory of Parkland Memorial Hospital, a large acute-care teaching hospital. SPECIMENS: Cerebrospinal fluid specimens were submitted to the clinical microbiology laboratory in the course of routine patient care. MAIN OUTCOME MEASURES: Gram's stains and cultures of test and control preparations. RESULTS: Most of the smear-positive, culture-negative, original CSF specimens contained Gram-positive bacilli or Gram-negative bacilli. Smears of cytofunnels revealed similar organisms, and cultures revealed Bacillus species. Cytofunnels from several lots were culture-positive. Glass slides were not contaminated. Of 25 CSF specimens stained during the initial week of investigation, 23 were negative by culture and two grew Cryptococcus neoformans (from acquired immunodeficiency syndrome patients). Control stains and cultures of simulated CSF were negative. Gram-stain reagents were frequently smear-positive, and cultures repeatedly yielded Flavimonas oryzihabitans from the crystal violet well of an automated Gram-staining apparatus. These latter contaminants could not be eliminated consistently. INTERVENTIONS: No alternative sources of cytofunnels were found. The Gram-staining apparatus was cleaned and reagents changed frequently. Cytocentrifugation and use of automated Gram staining was discontinued for CSF and other normally sterile fluids. The laboratory staff was repeatedly educated about the problem. CONCLUSIONS: Contamination of cytocentrifuge funnels and an automated Gram-staining apparatus contributed to an "epidemic" of pseudomeningitis. The problem was corrected by education of the laboratory staff and by altered management of CSF and other sterile body fluid specimens.

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OBJECTIVE: The sulphation of the neurotransmitters dopamine and 5-hydroxytryptamine, and of the prototypical xenobiotic 4-nitrophenol, by phenolsulphotransferases was measured in platelet homogenates prepared from a group of migraine sufferers and a group of control subjects. RESULTS: The activity of the M form of phenolsulphotransferase, responsible for the sulphation of dopamine and 5-hydroxytryptamine was significantly reduced in the migraine population, by 28% with dopamine as substrate and by 20% with 5-hydroxytryptamine. The activity of the P form of the enzyme towards 4-nitrophenol was the same in both groups. We also report that the selective inhibition of P form phenolsulphotransferase by red wine is much more potent than previously thought, with a 2000-fold dilution of dealcoholised red wine having the ability to inhibit sulphation by this enzyme by 50%. CONCLUSION: Our findings suggest that a reduced capacity for sulphation and inactivation of biogenic amines and catecholamines may be related to susceptibility to migraine.

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PURPOSE: To report clinical experience with an implantable capsule for treating endobronchial carcinoma by means of bronchoscopic insertion and retrieval. MATERIALS AND METHODS: The capsule consists of a plastic cylinder containing high-activity iodine-125 seeds and four restraining legs. Twelve patients with recurrent (n = 11) or inoperable carcinoma (n = 1) received a median dose of 4,500 (range, 2,633-6,299) cGy at a 1-cm radius from the center of the implant. RESULTS: No acute toxicities were observed. Five patients had complete regression of the endobronchial tumor, evidenced at bronchoscopy 2 months after therapy, and four patients had partial regression. Three patients failed to return for bronchoscopy. Symptomatic relief was achieved in eight of 10 patients with dyspnea, four of nine with cough, and two of three with hemoptysis. The median survival of the 12 patients was 6 months. The actuarial 1-year survival rate was 25%. CONCLUSION: This capsule is safe and efficacious in treating recurrent or inoperable carcinoma of the lung.

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The modified lithotomy position frequently is used in general surgery because it gives excellent simultaneous access to the abdomen and perineum. There are a variety of complications that may occur including lumbosacral plexus stretch, sciatic and peroneal nerve injury, and compartment syndrome of the legs. Through preoperative nursing assessment of a patient's age, nutritional status, skin condition, pre-existing disease state, and anticipated type and length of surgical procedure, patients at risk for developing postoperative complications may be identified. The perioperative nurse's role is to use this knowledge to assist the surgical team in safe patient positioning and optimal intraoperative care.

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Nested-primer polymerase chain reaction (PCR) has been applied to the molecular cloning of 4.6-kb half-genome fragments of human immunodeficiency virus type 1 (HIV-1) taken directly from the peripheral blood mononuclear cells (PBMC) of an individual with neurological symptoms of HIV-1 infection. In a similar manner, gp120-coding portions of the envelope gene were cloned after PBMC from the same blood sample were cocultivated with uninfected PBMC for 28 days. The complete 1.6-kb nucleotide sequence of the gp120 gene was determined from each of 35 clones examined. Two of 13 (15%) PBMC-derived gp120 genes and 3 of 22 (14%) coculture-derived gp120 genes were defective as a result of frameshifts and an in-frame stop codon(s). Mean diversity between individual gp120-coding sequences in PBMC was fivefold greater (3.24%) than after coculture (0.65%). A predominant sequence of "strain" was found after coculture that was distinct from the diverse viral genotypes detected in vivo and therefore was selectively amplified during in vitro propagation. Multiple distinct third variable (V3) regions encoding the principal neutralizing domain of the envelope protein were detected in PBMC-derived genes, suggesting the presence of immunologic diversity of HIV env genes in vivo not reflected in the cocultured virus sample. The large size of the HIV fragments generated in this study will permit analysis of the diversity of immunologic reactivity, gene function, and pathogenicity of HIV genomes present within infected individuals, including the functional significance of the loss of diversity that occurs upon coculture.

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The differential diagnosis of rectal pain is extensive, and etiologies range from common anorectal disorders to more complex pelvic floor dysfunctional syndromes. The authors present a case of a man with rectal pain secondary to a congenital pelvic arteriovenous malformation. These malformations are rare and, to the authors' knowledge, have not been reported in association with rectal pain.

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One hundred thirty-eight consecutive patients undergoing elective colonic resections were treated prospectively and randomly with either a long intestinal (Cantor) tube preoperatively, a nasogastric tube placed intraoperatively, or no gastrointestinal tube at all. Patients were evaluated for length of hospital stay, duration of postoperative ileus, adequacy of intraoperative intestinal decompression, gastric dilatation, and operative complications. No significant difference could be seen in the tubed or no-tube group.

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A therapeutic hyperthermia protocol using a radio frequency (rf) electrode placed adjacent to a bronchial wall tumor has been modeled using the finite element technique. Variable physical properties and variable blood perfusion have been assigned to the tumor and to the surrounding normal lung tissue. The Laplace equation was solved on a curvilinear grid for a single rf source electrode to determine the steady-state electric field, which in turn governs the energy deposition function. The heat generation in the tumor and in the lung tissue is then calculated from the energy deposition profile, and the bioheat equation is solved on the same finite element mesh to determine the transient temperature history. The temperatures are displayed as isothermal contours at designated times during the protocol and as temperature histories at selected points. In addition, an Arrhenius-type injury model has been implemented to predict thermally induced damage, from which equal total amounts of energy are deposited into the tissue using a constant power density for an appropriate time or using a cyclic heating pattern. The cyclic heating pattern consisted of a series of equal duration time periods during which the rf current source is alternately turned on and off (50% duty cycle). This study illustrates how a finite element model could be used to evaluate alternative protocols for heating a tumor of a specific geometry and to evaluate thermally induced damage to surrounding normal tissue.

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An effective, simple sampling device was developed to obtain improved cytologic specimens from the cheek pouches of hamsters; it was tested in the sampling of squamous-cell carcinomas induced with 9,10-dimethyl-1,2-benzanthracene (DMBA). Cellular samples collected by this modified syringe lavage-aspirator using Hanks' balanced salt solution contained an average of 1.3 X 10(5) cells per milliliter. Of the heterogeneous contents of the cheek pouch (food, debris, erythrocytes, leukocytes, macrophages, squamous cells, atypical cells and cancer cells), the cells of diagnostic significance from cancer and dysplasia were increased by this procedure to 3.7% of the cells recovered, as compared to 2.5% of the cells obtained by direct scraping of the same pouches. The inexpensive, disposable device allowed repeated sampling of cheek pouches without causing injury to the animals.

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We describe the characteristics which patients with chronic pain ascribe to themselves and present some of the data we have gathered in the areas of demographics, economic and family problems, difficulty in rehabilitation, and the failure of treatment methods such as surgery and medications to provide relief. We compared the responses of men and women and found significant differences in sexual difficulties and pain relief from nerve blocks.

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The light microscopic and ultrastructural features of an aortico-pulmonary paraganglioma (A-PP) are presented. The tumor was characterized by organoid clustering of neoplastic chief cells to form Zellballen. Argyrophilic granules were demonstrated within chief cell cytoplasm using a modified Grimelus technique. Ultrastructurally, three distinct cell types were present within the tumor: endothelial cells, pericytes and neoplastic chief cells. Membrane-bound neurosecretory granules were present and measured 100 to 2000 nm in diameter. "Light" and "dark" chief cells were less distinct than previously reported in other head and neck paragangliomas. Analysis of the 36 documented A-PP reported in the English literature reveals that the tumor has been either incompletely excised or has been considered unresectable in one-third of the cases. The reported surgical mortality is 9%, or approximately equal to the incidence of malignant behavior. The treatment of choice is surgical resection but when this is not possible, radiation may be a useful adjunct in therapy.

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