Adult stem cell activity in naked mole rats for long-term tissue maintenance.

The naked mole rat (NMR), Heterocephalus glaber, the longest-living rodent, provides a unique opportunity to explore how evolution has shaped adult stem cell (ASC) activity and tissue function with increasing lifespan. Using cumulative BrdU labelling and a quantitative imaging approach to track intestinal ASCs (Lgr5) in their native in vivo state, we find an expanded pool of Lgr5 cells in NMRs, and these cells specifically at the crypt base (Lgr5) exhibit slower division rates compared to those in short-lived mice but have a similar turnover as human LGR5 cells. Instead of entering quiescence (G0), NMR Lgr5 cells reduce their division rates by prolonging arrest in the G1 and/or G2 phases of the cell cycle.

The history of surgery and surgical training in the UK.

Surgery has a rich history, and in order to understand the various training pathways for aspiring surgeons one must have an appreciation of the evolution of surgery. This manuscript aims to deliver a brief review of the history of surgery, and explore the historical moments that have shaped the training pathway of surgeons in the United Kingdom (UK), and in doing so disseminate the latest information about surgical training in the UK.

Establishing the need for clinical follow-up after emergency appendicectomy in the modern era: Retrospective case series of 145 patients.

Introduction: Emergency appendicectomy (EA) is a commonly performed operation, with an increasing number of EAs being performed as day-case. The aim of this study is to establish if there is a need for post-operative follow-up and if this could prevent adverse outcomes.

Methods: A retrospective analysis of patients who underwent EA at multiple centres over a six-month period was undertaken.

Does surgery have a role in managing incurable gastric cancer?

Although the incidence of gastric cancer is decreasing, the outcomes of this disease are among the poorest of all solid-organ tumours, predominantly due to the frequent presence of stage IV metastatic disease at primary presentation. Stage IV gastric cancer is incurable and carries a very poor prognosis (5-year survival rate of ∼4%); palliative chemotherapy remains the standard of care, but increasing evidence indicates that palliative surgery can provide a prognostic and symptomatic benefit, particularly in combination with chemotherapy and/or radiotherapy. Ongoing prospective trials should further clarify the efficacy of palliative surgery in comparison with other treatment modalities.

Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study.

Objective: The aim of this study was to describe the presentation of patients with ruptured abdominal aortic aneurysm (rAAA) and identify factors contributing toward misdiagnosis.

Methods: This was an observational study of cases with a final diagnosis of rAAA assessed at nine Emergency Departments and managed at one of two regional vascular centres in the UK.

Results: Eighty-five consecutive cases were included.

Locoregional anesthesia for endovascular aneurysm repair.

Objective: This was a systematic review and meta-analysis of the mode of anesthesia and outcome after endovascular aneurysm repair (EVAR).

Methods: Review methods were according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Published and unpublished literature was searched.

Current evidence is insufficient to define an optimal threshold for intervention in isolated type II endoleak after endovascular aneurysm repair.

Purpose: To report a systematic review and meta-regression of the association between the threshold for intervention in patients with isolated type II endoleak after endovascular aneurysm repair (EVAR) and the fate of the aneurysm sac.

Methods: Medline, trial registries, conference proceedings, and article reference lists were searched to identify case series reporting sac outcomes following a specific treatment threshold for isolated type II endoleak. Articles were classified by the threshold for intervention as conservative, selective (intervention for >5-mm sac expansion or persistent type II endoleak >6 months), or aggressive (any type II endoleak or persistent for >3 months) and sac outcomes were extracted for review.

Gallbladder perforation: case series and systematic review.

Background: Gallbladder perforation is a serious complication of acute cholecystitis. Its management has evolved considerably since its classification by Niemeier in 1934. This review summarises the evidence surrounding the natural progression of this condition and potential problems with Niemeier's classification, and proposes a management algorithm for the more complex type II perforation.

Comparison of COX-2, Ki-67, and BCL-2 expression in normal esophageal mucosa, Barrett's esophagus, dysplasia, and adenocarcinoma with postablation mucosa and implications for ablative therapies.

Background: The neosquamous mucosa that replaces ablated esophageal endothelium after endoscopic mucosal ablation for Barrett's metaplasia or high-grade dysplasia (HGD) may retain buried glandular tissue. This study aimed to assess the neoplastic potential, cellular proliferation, and resistance to apoptosis of this buried glandular tissue by measuring COX-2, Ki-67, and BCL-2 expression in these tissues.

Methods: A prospectively collected database was sourced for esophageal biopsy specimens with normal histologic appearance, Barrett's metaplasia, HGD, adenocarcinoma, and postablation mucosa comprising ablated Barrett's and ablated HGD.

Unexpected outcome from Trousseau syndrome.

Background: Unprovoked superficial thrombophlebitis and subsequent venous thromboembolism are well-described albeit rare presenting features of advanced visceral malignancy that often manifest too late for curative intervention to be beneficial.

Case Presentation: We present the first reported case of early gastric carcinoma presenting with these paraneoplastic phenomena in an otherwise healthy farmer. The early presentation allowed for a curative partial gastrectomy, which itself was complicated by the presence of a deep vein thrombosis extending into the inferior vena cava.

Plain radiographic insight into a hard head.

Cirsoid aneurysms are rare arteriovenous malformations of the scalp, which are usually of congenital etiology. We describe the case of a young Sri Lankan farmer who presented with a progressively enlarging scalp mass of interesting character, yielding unique images on plain radiography before more advanced imaging and subsequent definitive treatment were performed. The utility of this simple imaging technique in underdeveloped settings is highlighted, and further diagnostic and treatment options are discussed in brief.

Solitary colonic metastasis from renal cell carcinoma presenting as a surgical emergency nine years post-nephrectomy.

Late colonic metastasis following curative surgery for renal cell carcinoma has rarely been described. We present the first reported case of solitary colonic renal cell carcinoma metastasis presenting as an intra-abdominal bleed, nine years post-nephrectomy.

Candida: an unexpected cause of the acute abdomen.

The infected intrauterine contraceptive device (IUCD) is a well-described cause of the acute abdomen. However, severe pelvic infection from Candida is an extremely rare complication of the IUCD. We present the first reported description of a Candida-infected IUCD manifesting as an acute abdomen where the degree of infection precluded a conclusive diagnostic workup and necessitated multiple laparotomies.

The surgical management of pancreaticoduodenal tumours in multiple endocrine neoplasia type 1.

A 48-year-old man was admitted under the care of urologists with acute renal failure and septicaemia secondary to pyelonephritis. Upon investigation, he was found to have renal stone disease secondary to a parathyroid adenoma. Further tests revealed high pituitary hormone and gastrin values, confirming the diagnosis of multiple endocrine neoplasia type 1 (MEN 1) and Zollinger-Ellison syndrome.