Congenital diverticula of the ventricles are rare and Skapinker (1951) was able to collect only twelve reported cases. In most of these, as in Skapinker's own patient, the diverticulum arose from the left ventricle but in two it communicated with both ventricles. Skapinker resected the diverticulum in his case, an operation that had previously been reported only once (Roessler, 1944); but further cases treated in this way have since been reported by Potts et al. (1953) and Bailey (1955). Other recent reports are by Formijne (1950), Snellen et al. (1952), and Parsons (1957).Included in the following description of a patient, in whom surgical resection was successfully undertaken, are electrocardiographic and manometric observations not hitherto recorded. The latter are possibly relevant to the mechanism of rupture of such diverticula, an accident known to have been the cause of death in at least three of the published cases. CASE REPORTThe patient, an eight-year-old girl, was referred for surgical treatment of a pulsatile epigastric mass which, because of its superficial position, was considered to be a potential threat to her in the event of trauma. The pulsation had been present at birth and was at that time associated with an umbilical hernia. When she was one year old the hernia had been repaired, the surgeon noting what he took to be an anomalous artery passing up from the epigastrium to disappear under the right costal margin. Visible epigastric pulsation had since persisted without change and without related symptoms. In addition cyanotic congenital heart disease with isolated dextrocardia had been recognized in the neonatal period and the patient had had nonprogressive slight cyanosis and impairment of effort tolerance throughout her life. At the age of eight she was able to run no further than thirty yards. She did not squat and there had been no attacks of severe cyanosis or unconsciousness. The family history and history relating to the maternal pregnancy revealed no unusual features.Examination showed a thin girl, rather small for her age, with slight central cyanosis and finger clubbing. Physical findings relating to the heart argued for pulmonary hypertension rather than pulmonary stenosis as the cause of shunt reversal; and these, together with the radiographic demonstration of isolated dextrocardia with a left-sided aortic arch and pulmonary vascularity verging on the upper limit of normal (Fig. 1) and the electrocardiogram, consistent in this context with right ventricular hypertrophy (Fig. 4), pointed to a clinical diagnosis of the Eisenmenger complex with dextrocardia. This was supported by the results of cardiac catheterization which included a pulmonary arterial pressure of 112/64 mm. Hg, reduction of brachial arterial oxygen saturation to 88 per cent, and a rise in oxygen saturation from 65 per cent in the superior vena cava and right atrium to 70 per cent in the right ventricle and pulmonary artery.In the epigastrium there was a pulsatile structure which extended upwards from just above the...

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the intraoperative use of surgical adhesives in patients undergoing lung resection would reduce the incidence and length of postoperative air leaks. The reported search strategy identified 261 papers of which 12 were considered to represent the best evidence available. The author, journal, publication date, patient groups studied, study types, relevant outcomes, results and study weaknesses were tabulated. We conclude that six of the identified randomised trials found a significant reduction in air leak duration, but five found no significant difference. In contrast to significant reductions in air leak, only two studies identified a reduction in time to chest drain removal. Also, only two studies found a significant reduction in length of stay. There are multiple issues surrounding these studies ranging from identifying the optimal glue and delivery system, dealing with the learning curve of surgeons and robust protocols for chest drain removal to selection of patients suitable for surgical adhesive usage. Thus, routine usage of surgical adhesive for all operations cannot yet be recommended, although there is a wide range of adhesives available to surgeons which may be useful in selected situations.

SummaryA variety of bile duct cannulation methods have been used in the study of biliary excretion in the rat . We now report the validation and use of one such method. In this method, the common bile duct and duodenum were cannulated, the free ends of the cannulae tunnelled through the abdominal wall, passed through a trochar and exteriorized at the ventral aspect of the tail. A purpose-designed stainless steel tai l cuff was then attach ed, to protect the cannulae from the rat. T he cannulae were passed through the top of a metabolism cage and attach ed to a dual swivel that allows the rat freedom of movement within the metabolism cage. Where necessary an additi onal cannula could be placed in the femoral vein to allow infusion of test mat erial or blood sam pling. T he results demonstrate that the method is robust and that its use allows a reliable correlation between surgically prepared and intact animals, as physiological parameters are allowed to return to normal prior to inclusion of the animals in the study. T he technique allows the anim als a great deal of freedom and, as such, is considered to minimize stress associat ed with the procedure. T his fact is re¯ected in the reliabilit y and reproducibility of the data obtain ed over the wide range of studies that have been conducted using this method. T his method has been in use for over 4 years at Inveresk and this paper describes the authors' experience with the method to date.

SummaryThe athymic (nude) rat (rnu/rnu) has been used for a number of years in research into various human tumours involving xenotransplantation. We now report the validation of a continuous intravenous infusion method in nude rats using a tail cuff tether, which enables the study of the efficacy of novel anti-cancer materials in this mutant strain, using intravenous infusion and with no restriction of the animals or of the tumour implantation sites by jackets.Ten animals each had a cannula surgically implanted into the vena cava via the femoral vein and exteriorized via a tail cuff. Animals were housed singly in conventional cages following surgery. Following a recovery period of 5 days all animals were continuously infused with physiological saline at an infusion rate of 0.5 ml/h for a further 37 days. Body weights and food consumption were recorded weekly. Blood samples were taken approximately 14 days post-surgery and analysed for haematology and clinical chemistry parameters. All animals were successfully cannulated, and no unexpected adverse clinical signs were noted during the recovery period and the 37 days of infusion.The results demonstrate that it is possible to surgically cannulate the femoral vein of athymic (nude) rats and infuse them in conventional cages for a period of up to 37 days with minimal adverse effects. The minimal restraint required provides benefits both to the animal and to the conduct of studies such as assessment of tumour growth in the absence of a jacket. Recent work has demonstrated that the same techniques can be successfully applied to the nude mouse. Keywords Continuous intravenous infusionj nude rat; anti-cancer agentsEffective rat infusion models have been developed over the last two decades. The most common infusion model consists of a surgically implanted cannula into the jugular vein with exteriorization at the scapular region. The animals wear a jacket connected to a steel spring and tethering device to protect the cannula (Francis et al. 1992).At Inveresk Research we use a modified technique based on a publication by Jones and Hynd 119811 and modified by Cave et al. (1995) for long-term infusion in the rat, involving surgical implantation of a cannula Correspondence to: Hans van Wi;k into the caudal vena cava via the femoral vein, with exteriorization at the tail, within a protective tail cuff.Following safety assessment studies in the Sprague-Dawley rat with a novel anti-cancer compound, an efficacy study was required in athymic (nude) rats. The objective of this efficacy study was to assess the anti-tumour effect of a novel anti-cancer agent on a human tumour subcutaneously implanted in rnu/rnu nude rats (Schuurman 1995), while monitoring treatment-related toxic effects in the same animals, within a Good Laboratory Practice (GLP) environment.

An 80-year-old female presented with progressive breathlessness, worse on sitting or standing and relieved by lying flat. Subsequent investigations identified a patent foramen ovale (PFO) with right-to-left flow across the interatrial septum (IAS). A diagnosis of platypnoea orthodeoxia syndrome secondary to inter-atrial shunting was made. Technical features precluded a percutaneous PFO closure so an open surgical repair was performed with complete resolution of symptoms. We discuss the pathophysiology and management of platypnoea orthodeoxia syndrome.