Prospective study of biofeedback for treatment of constipation.

Purpose: This study was designed to evaluate prospectively the results of pelvic floor physiotherapy with the aid of biofeedback in a heterogeneous group of patients with intractable constipation.

Methods: Biofeedback was used to treat 19 patients (age range, 16-78 (median, 63) years) with intractable constipation. Assessment, using visual linear analog scales of symptoms, was performed prospectively by an independent researcher.

Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma.

Traditionally radical hysterectomy has formed the mainstay of treatment for early stage cervical carcinoma. More recently radical trachelectomy and laparoscopic lymphadenectomy have been introduced to allow preservation of fertility. We present a new approach to fertility-sparing surgery, namely abdominal radical trachelectomy.

Bile duct imaging and injury: a regional audit of laparoscopic cholecystectomy.

Background: The aim of the present study was to report details of practice with respect to bile duct imaging and bile duct injury.

Methods: A prospective audit of laparoscopic cholecystectomy (LC) was undertaken in the Otago region from the introduction of LC in 1991 through to December 1995. The audit includes all procedures done by all surgeons in public and private hospitals over the period without exclusion.

Total mesorectal excision: evaluating the evidence.

The present paper reviews information from pathological and clinical studies examining the role of total mesorectal excision (TME) in the treatment of rectal cancer. The pathological studies provide information about the spread of rectal cancer within the mesorectum, and the adequacy of excision obtained with conventional surgery and TME. The clinical studies provide information about the safety of TME and the reported local recurrence rates.

Systematic review of randomized controlled trials comparing laparoscopic with open appendicectomy.

Background: The role of laparoscopic surgery in the management of patients with suspected appendicitis is still debated despite a number of recent randomized controlled trials (RCTs).

Methods: A systematic review has been undertaken of all published RCTs comparing laparoscopic appendicectomy with open appendicectomy. Studies were identified through Medline and supplemented with a manual search of relevant journals and meeting abstracts.

Prospective trial of pelvic floor retraining in patients with fecal incontinence.

Purpose: Our aim was to prospectively evaluate pelvic floor retraining (PFR) in improving symptomatic fecal incontinence.

Methods: PFR was used to treat 30 patients with fecal incontinence (28 women; age range, 29-85 (median, 68) years). PFR was performed by a physiotherapist in the outpatient department according to a strict protocol and included biofeedback using an anal plug electromyometer.

Reduced transdermal absorption of N,N-diethyl-m-toluamide from a new topical insect repellent formulation.

Extensive absorption of the topical insect repellent N, N-diethyl-m-toluamide (DEET) causes systemic and local toxicities. This report describes the preparation and characterization of a new insect repellent formulation (FA), a PEG-polyacrylic acid polymer system, for its DEET release, in vitro skin permeation, and in vivo transdermal absorption properties; and for its relative repellency against Aedes aegypti mosquitoes. DEET release and skin permeation were studied in Franz diffusion cells.

Antegrade catheterization of the brachial artery for embolizing a sarcoma of the forearm.

A case is described in which embolization of an alveolar soft part sarcoma, involving a forearm, was successfully achieved via cannulation of the brachial artery. The procedure was performed safely and more easily from this direct approach.

Detection of micrometastases in colorectal cancer patients by K19 and K20 reverse-transcription polymerase chain reaction.

Tumor stage in bowel and breast cancer is the chief determinant of prognosis and the need for adjuvant therapy. The intermediate filament protein keratin 19 (K19) is expressed by epithelia and corresponding malignancies. Recently, the detection of K19 gene expression by RT-PCR has been reported as a sensitive tool for detecting occult metastasis to the lymph nodes and bone marrow of patients with primary epithelial tumors.

Evaluation of ivermectin and milbemycin oxime efficacy against Dirofilaria immitis infections of three and four months' duration in dogs.

Objectives: To determine the efficacy of ivermectin (IVM) and milbemycin oxime (MBO) against induced heartworm infection, where monthly treatment is started 3 or 4 months after infection, and to monitor microfilaremia and antigenemia.

Animals: 21 heartworm-naive Beagles.

Procedures: Each of 21 dogs was given 50 infective larvae of Dirofilaria immitis by SC inoculation.

Objectively assessing nursing practices: a curricular development.

In preparation for the changing needs of undergraduate nursing students undertaking a Project 2000 degree, it was necessary to rethink the nursing skills programme. After studying the literature a nursing skills laboratory was designed which provided both an institutional and a domestic setting. A progressive programme was developed, to help the students learn nursing practices, which was based on the Objective Structured Clinical Evaluation (OSCE).

The efficacy of percutaneous cholecystostomy in critically ill patients.

Percutaneous cholecystostomy (PC) has been proposed as a method of biliary decompression in critically ill patients with acute cholecystitis. We evaluated the efficacy of PC in this setting. The charts of 33 critically ill patients (mean age 52, range 5-87) who underwent PC for suspected acute cholecystitis were retrospectively examined.

Prospective randomized comparison of open versus laparoscopic appendectomy in men.

A prospective, randomized trial was performed to compare open appendectomy with laparoscopic appendectomy in men with a clinical diagnosis of acute appendicitis. Sixty-four patients with a median age of 25 years (range 18-84 years) were randomized to open appendectomy (n = 31) or laparoscopic (n = 33) appendectomy. Of the 64 men, 56 (87.

Laparoscopic hepatic cryotherapy: a study of safety in rabbits.

Hepatic cryotherapy is used to treat unresectable liver tumors and could potentially be undertaken laparoscopically; however, the risk of gas embolism during laparoscopic hepatic cryotherapy has not been studied. Eight New Zealand White rabbits underwent laparoscopic hepatic cryotherapy with continuous precordial ultrasound monitoring for gas embolism. No episodes of gas embolism were detected, and at postmortem no intracardiac gas was found in any rabbit.

Laparoscopic vs open ultrasound of the liver: an in vitro study.

Intra-operative contact ultrasound is a sensitive method of detecting liver tumours. The aim of this study was to compare the sensitivity of open contact ultrasound (OUS) of the liver with laparoscopic contact ultrasound (LUS). Hypoechoic "lesions" were created in 5 fresh pig livers by inserting 28 grapes via small incisions in the inferior surface.

Hepatic cryotherapy for metastatic liver tumours.

Liver resection is the treatment of choice for resectable hepatic metastases; however, most patients have unresectable disease when diagnosed. Hepatic cryotherapy has been advocated to treat unresectable tumours in the liver although its precise role is still being evaluated. This article discusses mechanisms of action, technical considerations, current indications and the early results of cryotherapy in treating metastatic liver disease.

Pharmacokinetic studies of methotrexate in plasma and synovial fluid following i.v. bolus and topical routes of administration in dogs.

Purpose: The pharmacokinetic properties of methotrexate (MTX) in the plasma and synovial fluid (SF) after bolus i.v. and topical administration were studied in dogs to assess the feasibility of topical delivery of MTX for the treatment of rheumatoid arthritis.

Hepatic artery chemotherapy for colorectal liver metastases.

Fifty per cent of patients with colorectal cancer develop hepatic metastases but only a minority are candidates for potentially curative surgical resection. Hepatic artery chemotherapy (HAC) has been used to treat patients with non-resectable metastases confined to the liver. Although response rates to HAC have been shown to be higher than response rates to systemic chemotherapy, the advantage in terms of survival has been debated.

Laparoscopic surgery in women with a clinical diagnosis of acute appendicitis.

Objectives: To assess the routine use of diagnostic laparoscopy and laparoscopic appendicectomy in women with a clinical diagnosis of acute appendicitis.

Methods: Women who presented with a clinical diagnosis of acute appendicitis between 1 January 1992 and 31 August 1993 were prospectively assessed and 107 underwent diagnostic laparoscopy.

Results: Appendicitis was confirmed in 63 women (59%) and no diagnosis could be made in seven (6%).

Analysis of local recurrence rates after surgery alone for rectal cancer.

Local recurrence (LR) continues to be a major problem following surgical treatment for rectal cancer, and proposed ways of reducing this remain controversial. The aim of this study was to review results from published surgical series in which adjuvant therapies were not used. A Medline search identified series published between January 1982 and December 1992 with follow-up on at least 50 patients with rectal cancer treated surgically for cure, without adjuvant therapy.