Background Although surgery is the treatment of choice for rectal cancer, local recurrence is common even after apparently curative resection. We aimed to assess the role of postoperative radiotherapy in reducing rates of local recurrence, and improving disease-free and overall survival in patients with mobile Dukes' stage B and C rectal cancers.Methods We carried out a prospective, randomised trial of surgery alone (n=235) versus surgery followed 4-6 weeks later by radiotherapy (n=234), of 40 Gy in 20 fractions of 2 Gy over 4 weeks. The 469 patients, from 46 hospitals in the UK and the Republic of Ireland, were randomised between 1984 and 1989, and followed up for a minimum of 5 years or to death.Findings 284 patients died, 145 of 235 allocated surgery alone and 139 of 234 allocated postoperative radiotherapy. The hazard ratio for overall survival was 0.84 (95% CI 0.65-1.07, p=0.17). At 5 years' follow-up 79 patients who received surgery alone and 48 who received postoperative radiotherapy had had local recurrence (hazard ratio 0.54 [0.38-0.77], p=0.001). The corresponding numbers with distant recurrence were 83 and 75 (hazard ratio 0.85 [0.63-1.114], p=0.18). The hazard ratio for disease-free survival was 0.85 (0.65-1.08; p=0.18). Radiotherapy was generally well tolerated; assessment of late events showed serious late bowel complications to be rare and not significantly increased after radiotherapy, even when this followed anterior resection.Interpretation Our results have provided further evidence of the ability of postoperative radiotherapy to delay and prevent local recurrence of rectal cancer. Although the local recurrence rate in the control group is in keeping with other multicentre trials of the mid to late 1980s, it is undoubtedly higher than would be regarded as acceptable now. The combination of larger trials required to provide definitive answers on the impact that postoperative radiotherapy will have on survival.

Vertical Silastic ring gastroplasty was carried out in 71 patients as treatment for morbid obesity. The mean excess weight loss at 6 months (59 patients) and 2 years (43 patients) was 48 per cent and 65 per cent respectively. Subsequently the weight stabilized around this level with 58 per cent of the excess weight lost at 5 years (14 patients) postgastroplasty. Five patients (7 per cent) failed to lose weight. Sixteen patients (23 per cent) required revision for technical complications but continued to lose weight or to maintain a satisfactory weight. Vertical Silastic ring gastroplasty is an effective surgical method of achieving sustained weight loss.

The surgical management of insulinoma is frequently complicated by difficulty in pre- and intra-operative localization of the tumour. An early and reliable post-operative indicator of successful surgery would therefore be useful in the management of this condition. In a prospective, controlled study serial measurements of blood glucose and serum insulin concentrations were performed in 5 patients with insulinoma during surgical removal of the tumour. Results were compared with 5 patients, matched for age and body weight, undergoing abdominal surgery for non-malignant disease. Serum insulin (mean +/- s.e.m.) was significantly elevated in the insulinoma patients at the start of surgery (32.1 +/- 3.1 vs 6.1 +/- 2.2 mU/l; P less than 0.01). A significant fall (P less than 0.01) to levels comparable with the control patients (7.5 +/- 1.8 vs 10.0 +/- 3.3 mU/l) occurred following removal of the tumour. We conclude that serial intra-operative measurements of serum insulin concentration are technically simple to perform and provide useful retrospective corroboration of successful surgery in patients with insulinoma.

It is not clear whether the glucose tolerance test diagnosis of Impaired Glucose Tolerance introduced in the recent revisions of diagnostic criteria is associated with abnormalities of intermediary metabolism other than glucose. Intermediary metabolite concentrations have therefore been studied fasting and in response to oral glucose in 35 patients referred with morbid obesity accompanied by either normal glucose tolerance (18 patients) or Impaired Glucose Tolerance (17 patients). When fasting obese patients with Impaired Glucose Tolerance had significantly higher blood total ketone body concentrations, 0.24 (0.19‐0.30) vs 0.14 (0.12‐0.16) mmol I−1 (antilog of mean‐SE to mean+SE) (p < 0.05), and lower blood glycerol concentrations, 0.14 ± 0.01 vs 0.18 ± 0.01 mmol I−1 (mean ± SE) (p < 0.05), than obese patients with normal glucose tolerance. There were no significant differences in fasting insulin, 16 (15–18) vs 14 (12–15) mU I−1, or glucose levels, 5.3 ± 0.2 vs 5.1 ± 0.2 mmol I−1. After oral glucose there was an exaggerated rise in glucose, insulin, lactate, and pyruvate in patients with Impaired Glucose Tolerance.

Surgery for the morbidly obese patient. M. Deitel. 270 × 790 mm. Pp. 400. Illustrated. 1989. Beckenham: Leu and Febiger. £45.20 Get access Surgery for the morbidly obese patient. MDeitel. 270 × 790 mm. Pp. 400. Illustrated. 1989. Beckenham: Leu and Febiger. £45.20. R M Baddeley R M Baddeley Consultant Surgeon The General Hospital, Birmingham B4 6NH, UK Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 77, Issue 1, January 1990, Page 114, https://doi.org/10.1002/bjs.1800770142 Published: 08 December 2005

Gastric banding was carried out in 30 patients as a treatment for morbid obesity. The mean excess weight lost at 3 months was 32.6 per cent (27 patients) and 69.7percent at 2 years (eight patients). Fifteen patients required 22 reoperations for technical complications. Two patients underwent removal of the band and seven patients were converted to a stapled vertical Silastic® ring gastroplasty. Although gastric banding appears to be a satisfactory method of achieving weight loss, the complication and reoperation rates are unacceptable in our hands. It is recommended that this operation should no longer be used as a treatment for morbid obesity.

Conference Abstract| December 01 1988 Insulin and Proinsulin Concentrations in Patients with Insulinoma before and after Surgical Treatment PJ Hale; PJ Hale 1General Hospital, Birmingham, UK Search for other works by this author on: This Site PubMed Google Scholar I Jensen; I Jensen *Novo Research Institute, Bagsvaerd, Denmark Search for other works by this author on: This Site PubMed Google Scholar RM Baddeley; RM Baddeley 1General Hospital, Birmingham, UK Search for other works by this author on: This Site PubMed Google Scholar M Nattrass M Nattrass 1General Hospital, Birmingham, UK Search for other works by this author on: This Site PubMed Google Scholar Author and article information Publisher: Portland Press Ltd Online ISSN: 1470-8736 Print ISSN: 0143-5221 © 1988 The Biochemical Society and the Medical Research Society1988 Clin Sci (Lond) (1988) 75 (s19): 15P. https://doi.org/10.1042/cs075015P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation PJ Hale, I Jensen, RM Baddeley, M Nattrass; Insulin and Proinsulin Concentrations in Patients with Insulinoma before and after Surgical Treatment. Clin Sci (Lond) 1 December 1988; 75 (s19): 15P. doi: https://doi.org/10.1042/cs075015P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1988 The Biochemical Society and the Medical Research Society1988 Article PDF first page preview Close Modal You do not currently have access to this content.

Intermediary metabolite and serum insulin concentrations have been measured during incremental intravenous low-dose insulin infusion in massively obese patients before, and 3 months and 12 months after gastroplasty. Fasting blood glucose was similar on the three occasions, but fasting serum insulin was significantly higher preoperatively and showed a progressive fall with weight loss. Significant negative linear correlations were found between serum insulin and blood glucose, plasma nonesterified fatty acids, blood glycerol and blood total ketone bodies concentrations. The insulin-glucose dose-response curve showed a significant left shift at 3 months with a further significant improvement at 12 months. No significant change in the responses for nonesterified fatty acids, glycerol, and ketone bodies was observed at 3 months, but all three showed a significant left shift at 12 months. Massively obese patients are resistant to the action of insulin on carbohydrate and fat metabolism. Weight loss following gastroplasty results in an improvement in sensitivity to insulin, which is evident earlier in carbohydrate metabolism than in fat metabolism.

Journal Article Insulinoma and ganglioneuroma Get access P J Hale, P J Hale The Diabetic Clinic, General Hospital, Steelhouse Lane, Birmingham B4 6NH, UK Correspondence to: Dr P. J. Hale Search for other works by this author on: Oxford Academic Google Scholar Valerie Suarez, Valerie Suarez The Diabetic Clinic, General Hospital, Steelhouse Lane, Birmingham B4 6NH, UK Search for other works by this author on: Oxford Academic Google Scholar A Williams, A Williams The Diabetic Clinic, General Hospital, Steelhouse Lane, Birmingham B4 6NH, UK Search for other works by this author on: Oxford Academic Google Scholar R M Baddeley, R M Baddeley The Diabetic Clinic, General Hospital, Steelhouse Lane, Birmingham B4 6NH, UK Search for other works by this author on: Oxford Academic Google Scholar M Nattrass M Nattrass The Diabetic Clinic, General Hospital, Steelhouse Lane, Birmingham B4 6NH, UK Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 74, Issue 12, December 1987, Page 1183, https://doi.org/10.1002/bjs.1800741235 Published: 08 December 2005 Article history Accepted: 17 February 1987 Published: 08 December 2005

Conference Abstract| January 01 1986 Improved Insulin Sensitivity of Glucose and Intermediary Metabolism with Weight Loss B.M. Singh; B.M. Singh 1The Birmingham Hospital, Steelhouse Lane, Birmingham B4 6NH Search for other works by this author on: This Site PubMed Google Scholar R.M. Baddeley; R.M. Baddeley 1The Birmingham Hospital, Steelhouse Lane, Birmingham B4 6NH Search for other works by this author on: This Site PubMed Google Scholar M. Nattrass M. Nattrass 1The Birmingham Hospital, Steelhouse Lane, Birmingham B4 6NH Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1986) 70 (s13): 42P. https://doi.org/10.1042/cs070042P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation B.M. Singh, R.M. Baddeley, M. Nattrass; Improved Insulin Sensitivity of Glucose and Intermediary Metabolism with Weight Loss. Clin Sci (Lond) 1 January 1986; 70 (s13): 42P. doi: https://doi.org/10.1042/cs070042P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1986 The Biochemical Society and the Medical Research Society1986 Article PDF first page preview Close Modal You do not currently have access to this content.

The results of vertical and horizontal gastroplasty were evaluated in 26 grossly obese patients. Weight loss with both techniques over 2 years was comparable to that of jejuno-ileal bypass, but without the metabolic complications. Horizontal gastroplasty however, had a higher rate of stoma revision as compared with vertical gastroplasty. Vertical gastroplasty is now the operation favoured in this unit.

Postoperative arthropathy has been reported in patients undergoing jejunoileal bypass for morbid obesity. The true frequency of this complication, and its independence from preexisting joint disease and from osteomalacia have not been clearly established. Of 107 patients who had undergone jejunoileal bypass, and in whom osteomalacia had been excluded, 38 developed a distinctive arthropathy. This consisted of episodic polyarthralgia, and occasionally arthritis, affecting both large and small joints. The articular symptom complex was independent of other major postoperative complications and unrelated to metabolic disturbances consequent upon rapid weight reduction. Preoperative joint symptoms had a similar incidence in those who did and in those who did not subsequently develop the postoperative arthropathy. Reversal of the intestinal bypass was always associated with an immediate, complete, and permanent remission of arthropathic symptoms.

A consecutive series of 33 grossly obese individuals treated by gastric partitioning is described. There was no operative mortality. Weight loss at one year was 19% of original body weight and little loss occurred thereafter. Radiological assessment of the proximal compartment demonstrated progressive postoperative enlargement.

The complications and results of rectal anastomoses carried out with the end-to-end anastomosis (EEA) stapling instrument on 50 patients by 5 consultant surgeons are recorded. There was a clinical leakage rate of 6% and a radiological leakage rate of 20% assessed by water-soluble contrast enema. The technique has advantages compared with hand-suture by allowing low anastomoses and preservation of sphincters and is accompanied by an acceptably low leakage rate. Despite the cost of disposable cartridges these advantages make the technique economical because of the avoidance of colostomies and reduction in hospital stay.

Jejuno-ileal bypass has been performed in 226 massively obese patients, 190 of whom have been followed for a minimum of 1 year. End-to-side and end-to-end anastomoses were compared and no difference in the weight reduction achieved by either technique was seen throughout the 5-year follow-up. There was no significant difference in weight reduction achieved between groups of patients in which the jejunal length varied from 10 to 35 cm and the ileal length from 35 to 10 cm. The weight reduction achieved in the entire series averaged 36-7 +/- 9-4 per cent at 2 years, after which no further loss occurred. Good psychological benefits were recorded. Remission of diabetes occurred in 12 of 13 patients and marked long term lowering of serum lipids was seen. Side effects included fluid and electrolyte disturbances and fatty changes in the liver during the first year, improving thereafter. Early cirrhosis of the liver occurred in 8-6 per cent. Other side effects included abdominal bloating, arthralgia and renal colic. The operative mortality was 0-9 per cent and the late mortality directly attributable to the jejuno-ileal bypass, 3-1 per cent. In 19 patients the bypass was discontinued because of severe side effects.