Rectal washout eliminates exfoliated malignant cells in the rectum in the vicinity of the anastomosis.

No abstract

The location of intracranial aneurysms may be a significant independent risk factor for predicting aneurysm rupture. A recent report found high bleed rates from posterior communicating artery aneurysms which had not previously been noted. On this distinction hangs the decision whether to treat a large number of unruptured aneurysms. In the recent publication by the International Study of Unruptured Intracranial Aneurysms (ISUIA), two bleeds from small incidental posterior communicating artery aneurysms were noted and these aneurysms were reported to have a similar risk to aneurysms of the posterior circulation and as a result were grouped with them. This was a post hoc analysis so the justification for this assertion is tenuous. The hypothesis that posterior communicating aneurysms are of similar risk to posterior circulation aneurysms requires further testing on other data before it can be confidently accepted. A review of the literature was undertaken to define relative risks of rupture for different anatomical locations and to test the above hypothesis. Eleven papers were found to contain sufficient data to calculate rupture rates for anatomical sub groups. Studies contained a total of 30,204 patient years of follow up. Results showed the internal carotid artery to be the commonest site for unruptured aneurysms (38%). Aneurysms located in the posterior circulation had an overall annual bleed rate of 1.8%. This compares with 0.49% for the anterior circulation. The bleed rate from aneurysms of the posterior communicating artery (0.46% per year) was similar to that of the rest of the anterior circulation. The ISUIA post hoc hypothesis fails when tested on these data and the ISUIA data should be re-analysed with posterior communicating artery aneurysms grouped with the anterior circulation where they more traditionally belong.

Background: While the majority of fistulas-in-ano are anatomically simple and easy to treat, a significant number are high or anatomically complex and have the potential to become a major management problem. Methods: One hundred and seven consecutive patients undergoing surgery for fistula-in-ano were studied prospectively with standardized anatomic diagrams. Results: Fistulas were classified as superficial ( 15%), intersphincteric (43%), trans-sphincteric (35%) or 'high' (7%). Within each group fistulas were considered either simple or complex (high trecks, extra tracks or other complications). Trans-sphincteric fistulas were more often complex than intersphincteric fistulas (32 vs 6%).A prior history of perianal sepsis and surgery was more frequent among the trans-sphincteric and 'high' groups. An external fistula opening within a narrow arc 30" either side of the posterior midline was almost always associated with a simple superficial or intersphincteric fistula (97%). Anterior and especially posterolaterally located external openings were frequently associated with complex fistulas (16 and 47%. respectively) and often had trans-sphincteric or 'high' tracks (58 and 56%).Goodsall's Law was more accurate for posterior (91%) and intersphincteric (93%) fistulas than for anterior (69%) and transsphincteric (68%) fistulas.Histopathology of fistula material showed unremarkable fistula-in-ano in 87% of requests. Six patients had unexpected abnormal results, including three new diagnoses of Crohn's disease. Conclusions:The presence of additional anatomic complexity should always be anticipated in trans-sphincteric fistulas. Transsphincteric and 'high' fistulas are more likely to occur in females, and in patients with previous perianal sepsis or surgery for fistula. External openings close to the posterior midline almost always underlie simple fistulas, whereas posterolateral external openings are predictive of complex fistulas.

Over a 12 year period, 25 psoas abscesses occurring in 17 patients were managed at Royal Perth Hospital (900 bed hospital). Symptoms were present, on average, for 5 weeks prior to diagnosis, which was typically confirmed by computerized tomography. Fifty‐nine per cent of cases were primary and percutaneous drainage effected a cure in 80% of all cases. Percutaneous drainage resulted in a non‐significant trend towards shorter inpatient stay.