Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

Water quality perceptions and private well management: The role of perceived risks, worry and control

Mismanagement of drinking water supplies can pose serious public health risks. There are many concerns about water source management among private well owners, as they are often solely responsible for maintaining their wells, and monitoring and testing of their own water quality. Lack of worry about contamination and a strong sense of control over risks in relation to drinking water quality have been identified as important factors that influence peoples' perceptions and behaviour. In this paper, we investigated how worry and perceived control moderate the influence of risk perceptions on water quality perceptions and well owners' maintenance behaviours. We compare a sample of private well owners (N = 167) with a sample of members of Group Water Schemes (GWS) (N = 160) and people who are supplied via the public mains (N = 195), to validate our results. We found that, in comparison to the other groups, well owners believe that water from private wells is superior and they express a higher level of control over contamination risks of their drinking water. Moreover, strong feelings of control suppress their perceptions of risk in relation to water quality. However, well owners who feel largely in control also maintain their well more frequently. We discuss the implications of these results for communication strategies with well owners.

Molecular biosignatures reveal common benthic microbial sources of organic matter in ooids and grapestones from Pigeon Cay, The Bahamas

Ooids are sedimentary grains that are distributed widely in the geologic record. Their formation is still actively debated, which limits our understanding of the significance and meaning of these grains in Earth's history. Central questions include the role played by microbes in the formation of ooids and the sources of ubiquitous organic matter within ooid cortices. To address these issues, we investigated the microbial community composition and associated lipids in modern oolitic sands at Pigeon Cay on Cat Island, The Bahamas. Surface samples were taken along a transect from the shallow, turbulent surf zone to calmer, deeper water. Grains transitioned from shiny and abraded ooids in the surf zone, to biofilm-coated ooids at about 3 m water depth. Further offshore, grapestones (cemented aggregates of ooids) dominated. Benthic diatoms and Proteobacteria dominated biofilms. Taxa that may promote carbonate precipitation were abundant, particularly those associated with sulfur cycling. Compared to the lipids associated with surface biofilms, relict lipids bound within carbonate exhibited remarkably similar profiles in all grain types. The enhanced abundance of methyl-branched fatty acids and β-hydroxy fatty acids, 1-O-monoalkyl glycerol ethers and hopanoids bound within ooid and grapestone carbonate confirms a clear association of benthic sedimentary bacteria with these grains. Lipids bound within ooid cortices also contain molecular indicators of microbial heterotrophic degradation of organic matter, possibly in locally reducing conditions. These included the loss of labile unsaturated fatty acids, enhanced long-chain fatty acids/short-chain fatty acids, enriched stable carbon isotopes ratios of fatty acids, and very high stanol/stenol ratios. To what extent some of these molecular signals are derived from later heterotrophic endolithic activity remains to be fully resolved. We speculate that some ooid carbonate forms in microbial biofilms and that early diagenetic degradation of biofilms may also play a role in early stage carbonate precipitation around ooids.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Saving lives, limbs and livelihoods: considerations in restructuring a national trauma service

STUDY HYPOTHESIS

Level 1 trauma centers reduce mortality and improve functional outcomes in major trauma. Despite this, many countries, including Ireland, do not have officially designated major trauma centers (MTC). This study aimed to examine international trauma systems, and determine how to "best fit" trauma care in a small country (Ireland) to international models.

METHODS

The literature was reviewed to examine international models of trauma systems. An estimate of Irish trauma burden and distribution was made using data from the Road Safety Authority (RSA) on serious or fatal RTAs. Models of a restructured trauma service were constructed and compared with international best practice.

RESULTS

Internationally, a major trauma center surrounded by a regional trauma network has emerged as the gold standard in trauma care. In Ireland, there are no nationally coordinated trauma networks and care is provided by 26 acute hospitals with a mean distance to hospital from RTAs of 20.6 km ± 15.6. Based on our population, Ireland needs two Level 1 MTCs (in the two areas of major population density in the east and south), with robust surrounding trauma networks including Level 2 or 3 trauma centers. With this model, the estimated mean number of cases per Level 1 MTC per year would be 628, with a mean distance to MTC of 80.5 ± 59.2 km, (maximum distance 263.5 km).

CONCLUSION

Clearly designated and adequately resourced MTCs with trauma networks are needed to improve trauma outcomes, with concomitant investment in pre-hospital infrastructure.

Clinical review: surgical management of locally advanced and recurrent colorectal cancer

AIM

Recurrent and locally advanced colorectal cancers frequently require en bloc resection of involved organs to achieve negative margins. The aim of this review is to evaluate the most current literature related to the surgical management of locally advanced and recurrent colorectal cancer.

METHODS

A literature review was performed on the electronic databases MEDLINE from PubMed, EMBASE and the Cochrane library for publications in the English language from January 1993 to July 2013. The MeSH search terms 'locally advanced colorectal cancer', 'recurrent colorectal cancer' and 'surgical management' were used.

RESULTS

A total of 1,470 patients with recurrent or locally advanced primary colorectal cancer were included in 22 studies. Surgical removal of the tumour with negative margins (R0) offers the best prognosis in term of survival with a 5-year survival of up to 70 %. MVR is needed in approximately 10 % with the most commonly involved organ being the bladder. The mean post-operative morbidity is 40 %, mainly relating to superficial surgical site infection, pelvic collections and delayed wound healing. Most patients will undergo radiotherapy and/or chemotherapy pre- or post-operatively. The mean 5-year overall survival for R0 resection is 50 % for recurrent and locally advanced primary tumours while survival following R1 or R2 is 12 and <5 %, respectively.

CONCLUSION

Multimodal therapy and extended surgery to achieve clear margins offers good prognosis to patients with recurrent and locally advanced colorectal cancers.

How death anxiety impacts nurses' caring for patients at the end of life: a review of literature

Nurses are frequently exposed to dying patients and death in the course of their work. This experience makes individuals conscious of their own mortality, often giving rise to anxiety and unease. Nurses who have a strong anxiety about death may be less comfortable providing nursing care for patients at the end of their life. This paper explores the literature on death anxiety and nurses’ attitudes to determine whether fear of death impacts on nurses’ caring for dying patients. Fifteen quantitative studies published between 1990 and 2012 exploring nurses’ own attitudes towards death were critically reviewed. Three key themes identified were: i). nurses’ level of death anxiety; ii). death anxiety and attitudes towards caring for the dying, and iii). death education was necessary for such emotional work. Based on quantitative surveys using valid instruments, results suggested that the level of death anxiety of nurses working in hospitals in general, oncology, renal, hospice care or in community services was not high. Some studies showed an inverse association between nurses’ attitude towards death and their attitude towards caring for dying patients. Younger nurses consistently reported stronger fear of death and more negative attitudes towards end-of-life patient care. Nurses need to be aware of their own beliefs. Studies from several countries showed that a worksite death education program could reduce death anxiety. This offers potential for improving nurses’ caring for patients at the end of their life.

Centennial-scale Holocene climate variability revealed by a high-resolution speleothem delta 18O record from SW Ireland

Evaluating the significance of Holocene submillennial delta18O variability in the Greenland ice cores is crucial for understanding how natural climate oscillations may modulate future anthropogenic warming. A high-resolution oxygen isotope record from a speleothem in southwestern Ireland provides evidence for centennial-scale delta18O variations that correlate with subtle delta18O changes in the Greenland ice cores, indicating regionally coherent variability in the early Holocene. Evidence for previously undetected early Holocene cooling events is presented, but mid- to late-Holocene ice rafting in the North Atlantic appears to have had little impact on delta18O at this ocean margin site.

Centennial-scale Holocene climate variability revealed by a high-resolution speleothem delta 18O record from SW Ireland

Evaluating the significance of Holocene submillennial delta18O variability in the Greenland ice cores is crucial for understanding how natural climate oscillations may modulate future anthropogenic warming. A high-resolution oxygen isotope record from a speleothem in southwestern Ireland provides evidence for centennial-scale delta18O variations that correlate with subtle delta18O changes in the Greenland ice cores, indicating regionally coherent variability in the early Holocene. Evidence for previously undetected early Holocene cooling events is presented, but mid- to late-Holocene ice rafting in the North Atlantic appears to have had little impact on delta18O at this ocean margin site.

ESR and U-series analyses of teeth from the palaeoanthropological site of Hexian, Anhui Province, China

ESR and U-series analyses of teeth from the palaeoanthropological site of Hexian which contained Homo erectus remains, illustrate the limited effectiveness of stand-alone ESR and U-series age estimates on faunal materials. The problem lies in the unknown U-uptake history causing very large uncertainties in the age results of both techniques. This study demonstrates the particular strength that lies in the integration of ESR and U-series dating analyses allowing the estimation of the U-uptake history. We obtained a combined ESR/U-series age estimate of 412 +/- 25 ka (average of six analyses on two teeth). This pinpoints the deposition of the faunal remains to the time of the transition between oxygen isotope stages 12 and 11. This is in agreement with the faunal composition which show a mixture of cold adapted northern mammals and more subtropical-tropical southern elements. The age also implies that the advanced Hexian Homo erectus occurred at a similar time as the less advanced Homo erectus specimens at Locality 1 at Zhoukoudian (LI-LIII).

U-Th Isotopes in Arc Magmas: Implications for Element Transfer from the Subducted Crust

Uranium-thorium isotope results from island arc volcanic rocks were used to investigate the rates of transfer of fluids and sediments from the downgoing slab. Uranium, but not thorium, is readily mobilized in the fluid. A negative array between thorium/cerium and neodymium-143/neodymium-144 indicates that significant amounts of the thorium in arc rocks are derived from subducted sediments, although perhaps only about 30 percent of the thorium in subducted sediments is returned to the crust in this way. The transfer times for fluid through the mantle wedge are about 30,000 to 120,000 years, whereas those for sediment melts may be several million years. The low average uranium/thorium ratios of bulk crust primarily reflect different crustal generation processes in the Archaean.

Mass-spectrometric U-series dates for Israeli Neanderthal/early modern hominid sites

The nature of the relationship between Neanderthals and early modern Homo sapiens is controversial, yet it is fundamental to our understanding of early human evolution. The Middle Palaeolithic sites of Israel are critical to this debate, because unlike those of western Europe and Africa they contain both Neanderthal (at Tabun and Kebara for example) and anatomically modern hominids (as at Skhul and Qafzeh). Here we present new mass spectrometric 230Th/234U dates for dental fragments from the Middle Palaeolithic burial sites of Tabun, Qafzeh and Skhul. These data, combined with published ages from electron spin resonance (ESR), provide compelling evidence that the Tabun Neanderthals and Qafzeh early modern Homo sapiens were approximately coeval in the southern Levant some 100 +/- 5 kyr ago, but indicate that some of the Skhul material is younger. The study also shows that combined mass-spectrometric 230Th/234U and ESR dating is an invaluable technique for dating archaeological sites beyond the range of radiocarbon dating.

Risk factors in breast cancer

Risk factors are identified in less than 25 per cent of women who develop invasive breast cancer. The risk factors include a family history of breast cancer in a first degree family relative, late menopause, nulliparity, a first full term pregnancy after the age of 35 years, increasing age, P2 and DY mammographic parenchymal patterns, increasing dosage of non contraceptive oestrogens, mammary dysplasia associated with epithelial proliferation, a previous invasive breast carcinoma and carcinoma in situ.

Structure of the T-cell antigen receptor: evidence for two CD3 epsilon subunits in the T-cell receptor-CD3 complex

The T-cell antigen receptor (TCR) consists of heterodimeric glycoproteins (TCR alpha beta or gamma delta) that demonstrate homology with immunoglobulins. Noncovalently associated with the alpha beta (or gamma delta) heterodimer are at least five nonvariant proteins (CD3-gamma, -delta, -epsilon, -zeta, and -eta), which together comprise the TCR-CD3 complex. The stoichiometry of the antigen receptor has been assumed to be either alpha beta gamma delta epsilon zeta zeta or alpha beta gamma delta epsilon zeta eta. In this paper we provide several lines of evidence that support the notion that the mature TCR-CD3 complex on the cell surface contains two CD3-epsilon polypeptide chains. Transfection of two murine T cell-T cell hybridomas with the human DNA encoding CD3-epsilon protein demonstrated that both murine and human CD3-epsilon chains were present within the same TCR-CD3 complex. Analysis of thymocytes isolated from transgenic mice that expressed high copy numbers of the human CD3-epsilon gene showed that the heterologous human CD3-epsilon subunits were coexpressed with murine CD3-epsilon in the same TCR-CD3 complex. Since CD3-epsilon was shown to form disulfide-linked homodimers both in human and murine T cells, the two CD3-epsilon subunits present in the TCR-CD3 complex were in direct contact with one another. The presence of two CD3-epsilon polypeptide chains in close proximity to one another in the TCR-CD3 complex may have important implications for its assembly and its signal transduction mechanisms.

Prognostic significance of the absolute lymphocyte count in acute pancreatitis

The absolute lymphocyte count was calculated with 48 hours of admission in 154 patients with acute pancreatitis. Twenty-three patients had severe pancreatitis and 131 patients had mild pancreatitis. The mean absolute lymphocyte count for the severe group was 880 +/- 102 cells/mm3 and for the mild group, 1,115 +/- 116 cells/mm3. The absolute lymphocyte count accurately predicted 78 percent of the severe attacks and 86 percent of the mild attacks.

Long term results of restorative resection and total excision for carcinoma of the middle third of the rectum

Restorative resection for carcinoma of the middle third of the rectum has been facilitated by the recent introduction of the staplers. Before restorative resection with end-to-end anastomosis can become the treatment of choice, it must be proved that survival prospects after restorative resection are similar to those obtained after total abdominoperineal excision. The results of curative restorative resection and total excision in 417 patients with a single carcinoma of the middle third of the rectum managed by one of us are examined. Between 1950 and 1980, the proportion of patients treated by restorative resection for carcinoma of the middle third of the rectum increased from 26 to 93 per cent. Distribution by sex, age, tumor stage and tumor differentiation did not differ significantly between the two groups of patients operated upon. Cancer specific survival did not differ significantly between patients treated by restorative resection or total excision. Ten year survival rates were 60 and 59 per cent, respectively. Survival related to tumor stage and differentiation was not influenced by the type of operation. Tumor size, greater--p less than 0.04--in patients managed by total excision, had no significant influence on survival prospects. The results justify sphincter preservation and suggest that increased usage of restorative resection by stapling technique is not likely to lessen survival prospects in patients with carcinoma of the middle third of the rectum.

Symptom duration, tumor staging and survival in patients with carcinoma of the breast

Between 1950 and 1980, 435 patients were operated upon for carcinoma of the breast. Symptom duration data were available for 402 patients. Fifty-three of the patients had preoperative symptoms for less than one one week; 113, for one week to one month; 144, for one to six months and 92, for six months or more. Tumor staging was available on 353 of the 402 patients. With increasing peroperative symptom duration, there was an increase in the incidence of Stage IV tumors, p=0.003, and a reduction in Stage I tumors, p=0.006. Cancer specific survival time was better for the total patient series and for those treated by potentially curative operation when symptoms had been present for one week or less as compared with those who had symptom duration of six months or more, p=0.007. Survival prospects were also better in those patients who had symptoms from one week to one month as compared with those who had six months or more symptom duration, p=0.005. These results indicate that patients in whom diagnosis is made and operation performed early in the symptomatic phase of carcinoma of the breast have less advanced tumors and better survival prospects.

Symptom duration and survival prospects in carcinoma of the rectum

Between 1950 and 1978, 1,228 patients were operated upon by one of us for carcinoma of the rectum. Symptom duration data were available for 1,081 patients. Forty-five per cent of the patients had symptoms preoperatively for less than three months, 22 per cent for three to six months, 15 per cent for six to 12 months and 18 per cent for 12 months or longer. The frequency of major symptoms did not differ significantly with increasing symptom duration. Symptom duration was not related to sex, age, tumor site within the rectum or tumor stage distribution. The proportion of curative to palliative operative procedures performed was unrelated to the duration of symptoms. The cancer specific survival rate was better for the total patient series and for those treated by curative resection if symptoms had been present for 12 months or longer compared with those of less than three months' duration, p = 0.001 and p = 0.01, respectively. Survival prospects were also better for patients with symptoms of less than six months' duration compared with those of six months or longer, p = 0.01 and p = 0.04, respectively. These results indicate that earlier diagnosis during the symptomatic period of carcinoma of the rectum cannot be expected to improve cancer specific survival rates. They direct attention to the importance of preclinical diagnosis.

Ovarian involvement in adenocarcinoma of the colon and rectum

Thirty-six of 998 female patients with carcinoma of the colon and rectum had ovarian involvement at the time of the initial operation. Resection of tumor of the colon and rectum was performed upon 882 patients. The ovarian tumors were removed in 30 of the 36 patients with ovarian involvement. Ovarian involvement was associated with a significantly worsened, p = 0.009, cancer specific five year survival rate; five year survival prospects for patients with, and without, ovarian involvement were 38 and 60 per cent, respectively. Ovarian involvement also significantly, p = 0.014, worsened the survival rate of the 25 patients treated by curative resection of the tumor of the colon and rectum and associated ovarian spread. The five year cancer specific survival rate for female patients without ovarian involvement was 72 per cent, whereas ovarian involvement reduced the survival rate to 50 per cent.

Mortality and morbidity of Crohn's disease and ulcerative colitis in Australia

In Australia, between 1968 and 1977, the number of fatalities attributed to Crohn's disease increased significantly from 0.07/10(5) mean population (1968 to 1972) to 0.12/10(5) mean population (1873 to 1977). Over the same period, the mortality rate for ulcerative colitis was 0.23/10(5), with no increase. The ratio of the mortality rate for ulcerative colitis to that for Crohn's disease was similar in Australia to that in England and Wales, but the mortality rates for both diseases in Australia were approximately one-third of the corresponding rates in northern Europe and North America. Between 1959 and 1978 the relative frequency of public hospital admissions for Crohn's disease increased markedly in comparison with that for ulcerative colitis. A registry for inflammatory bowel disease should be established for monitoring epidemiological changes in Australia.

Vechile-occupant fatalities after legislation for compulsory wearing of seat belts in Australia: different trends between the sexes

The protective value of legislation for compulsory wearing of seat belts has been supported by Australian and overseas experience. An evaluation of changes during the period from 1957 to 1977 in the incidence of road crash fatalities for male and female vehicle occupants in Victoria and the rest of Australia (that is, in Australia minus Victoria) is presented. Reduction in the number of fatalities and the fatality rate in the number of fatalities per 10,000 vehicles) for vehicle occupants has resulted largely from statistically significant decreases for male drivers and adult passengers, especially females. However, the fatality rates have remained within the 95% confidence limits of expected post-legislation values for female drivers in Victoria and the rest of Australia, and for male adult passengers in the rest of Australia. There has been virtually no reduction in road crash fatalities for passengers less than 17 years of age. Hypotheses are advanced to explain these findings and further countermeasures are suggested.

Compulsory blood alcohol testing of road crash casualties in Victoria: the first three years

The history, rationale and implementation of legislation for compulsory blood alcohol tests on adult road crash casualties presenting at Victorian hospitals are reviewed. Drinking drivers admitted to casualty departments can now be identified and prosecuted; doctors can obtain blood alcohol test results on road crash casualties without threat of litigation; drinking drivers with alcohol problems may be directed to appropriate re-education or rehabilitation programmes; the opportunity also exists for treatment of non-driver casualties with alcohol problems. In the first three years of testing, 27.1% of 21,863 male driver casualties had blood alcohol concentrations in excess of the legal limit of 0.05 g/100 mL (11 mmol/L), and 13.7% had blood alcohol levels in excess of 0.15 g/100 mL (33 mmol/L); the blood alcohol levels in 8.7% of 9187 female driver casualties exceeded 0.05 g/100 mL, and in 3.7% exceeded 0.15 g/100 mL. Non-drivers had a slightly lower incidence of elevated alcohol concentrations. The implementation of further drink-driving countermeasures, expansion of services for the management of alcohol problems, and development of a national policy directed at prevention of alcohol abuse are recommended.

Control of road trauma epidemic in Australia

This lecture discusses initiatives taken by the Road Trauma Committee of the Royal Australasian College of Surgeons to reduce fatality and injury on Australian roads. In 1970 the Road Trauma Committee and the communications media initiated a national campaign in support of legislation for the compulsory wearing of seat belts. Public ignorance and Parliamentary inertia were countered. Victoria became the first State in the Western world to introduce this legislation. All other Australian States followed. Significant and marked reductions in fatality and injury were achieved and have been maintained. Recognising alcohol as the single most important cause of serious road crashes and injuries in Australia, the committee advocated legislation for compulsory blood alcohol tests on all adult road crash casualties. In 1973-74 legislation was enacted in South Australia and Victoria and in 1976 in Queensland. Results show that more than one-quarter of driver casualties have alcohol concentrations above the legal limit of 0.05 g%. Half of these exceed 0.15 g%. On the other hand less than 3% of the general driving population exceed the legal limit. Further advocacy led in 1976 to the enactment of random roadside breath-test legislation in Victoria. The majority of Australian convicted drinking drivers have alcohol-related social problems. A quarter incur reconvictions. The conventional penal approach has failed. At present the Road Trauma Committee is campaigning for compulsory medical assessment of convicted drinking drivers. Reissue of a driving licence would be dependent upon evidence of re-education and/or rehabilitation. Pilot re-education programmes have been shown to lessen recidivism markedly. Prevention of drink-driving behaviour is the major strategy. The tactics entail deterence, improved secondary-school and driver education, and the implementation of a national policy for control of alcohol abuse.

Epithelial cell population kinetics of isolated ileal loops (thirty-vella fistulae) after 40% small in testinal resection. Autoradiographic studies in the rat

The influence of 40% small intestinal resection on epithelial cell population kinetics of isolated ileal loops (Thirty-Vella fistulae) was investigated by autoradiography with H3-thymidine in the rat. Sixty days after resection increases were found in the size of the proliferative (0.05 less than P less than 0.1) and villous (P less than 0.01) zones. In isolated ileal loops of animals not subjected to 40% small bowel resection proliferative and villous zones were reduced in size in comparison to those of ileum in continuity in a group subjected to jejunal transection and anastomosis (P less than 0.002). The findings support the hypothesis that villous size is increased after resection by the action of a systemic factor. However, they provide only limited evidence for the influence of a systemic factor on crypt cell proliferation.