An association between colorectal cancer and previous peptic ulcer surgery is reported. In a prospective screening study, 100 asymptomatic patients (80 men and 20 women) who had undergone truncal vagotomy at least 10 years previously were investigated by barium enema, colonoscopy and gallbladder ultrasonography. Control data were obtained from forensic autopsy subjects. The incidence of neoplasms greater than or equal to 1.0 cm in the vagotomized group was 14 per cent (11 adenomas, 3 carcinomas) and 3 per cent in controls (P = 0.01). Duodenal bile obtained at endoscopy from 21 vagotomized patients with normal gallbladders and from 21 control patients undergoing endoscopy was analysed by high performance liquid chromatography. The mean percentage of cholic (CA), chenodeoxycholic (CDCA), deoxycholic (DCA) and lithocholic (LCA) acids in the bile of vagotomized patients was 32.3, 45.6, 20.7 and 1.4 per cent respectively compared with 45.3, 36.2, 17.9 and 0.7 per cent respectively in controls. The increased proportions of CDCA and LCA and decreased proportions of CA in the duodenal bile of vagotomized patients were significant (P less than 0.001; P = 0.02; P = 0.007). Abnormalities in bile acid metabolism may help to explain the increased risk of colorectal neoplasia 10 years after truncal vagotomy.

Our study showed that 40 patients out of 119 had nodal metastases, and ultrasound correctly identified 19 of those patients.

Introduction: This multicentre randomised controlled trial investigated whether a computed tomography (CT) scan of the axilla could more accurately assess whether the axillary lymph nodes were involved with malignancy in patients with newly diagnosed breast cancer and therefore influence surgical decision-making with regard to axillary surgery. Methods: Patients with newly diagnosed breast cancer (via screening and symptomatic routes) at two NHS Trusts in the North East of England were recruited and randomised in equal numbers. Both groups received routine diagnostic and surgical care (usual care). In addition, one group received a CT scan of their axilla on the same side as the breast cancer. Results: The study recruited 297 patients, of whom 291 contributed to findings. CT scan-guided care did not result in a change in the need for a second operation, with about 20% of both groups needing further surgery. Patients within the two groups were similar before treatment, had similar types and grade of cancer, experienced similar pattern complications and reported similar experiences of care. Conclusion: New diagnostic imaging technologies regularly enter NHS centres of excellence as research tools. It is important these are evaluated rigorously before becoming routine care. In patients newly diagnosed with breast cancer, CT-augmented diagnosis of cancer in the axilla was not found to improve surgical outcomes or patient experience. O2Preoperative assessment of breast volume to aid surgical planning: comparison of software-based mammographic measurements with subsequent mastectomy volumes. Introduction: The proportion of breast volume excised during conservation surgery for breast cancer is crucial to cosmetic outcomes. Validated, expedient methods for accurate preoperative quantification of breast volume are lacking. This study evaluated breast volume measurements calculated by Volpara® breast density software, by comparing them with actual mastectomy volumes. Methods: From a prospective clinical database, 31 patients were identified for whom Volpara® (Matakina Technology Limited, New Zealand) volume measurements and mastectomy volumes were available. All patients had undergone skin-sparing mastectomy (SSM), bilateral in one case. Specimen volumes had been measured using a water-displacement technique. Volpara® volumes for the corresponding CC and MLO view of each of the 32 breasts were averaged and compared with the mastectomy volumes. Correlation was assessed using the Pearson correlation coefficient. Results: Volpara® breast volumes were, as expected, consistently higher than SSM volumes but with a very strong correlation (Pearson correlation coefficient for average Volpara® volumes and mastectomy volumes = 0.82 (P < 0.01)). Conclusion:The excellent correlation between Volpara® and SSM volumes suggests that this readily available and convenient preoperative measure of breast volume could be used as a tool to aid surgical planning in women with breast cancer, which might be particularly useful in those women not ...

Successful minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accuracy of pre-operative localisation studies Ultrasound (US) and sestimibi (SM) scanning remain the imaging modalities of choice reserving MRI, CT and PET for patients who have not been cured by previous explorations or for whom other localization techniques are uninformative or discordant The aim of this study was to review the accuracy of US and SM in the pre-operative localisation of parathyroid adenomas

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