Cystic adventitial disease is an uncommon condition. A case of cystic adventitial disease of the popliteal artery is reported in a young man who has been followed up for 14 years after surgical treatment. Early recognition and treatment of the condition will prevent progression to popliteal thrombosis and critical ischaemia. However, diagnosis of the condition is difficult. Characteristic features in the presenting history, such as fluctuation in severity of symptoms, sudden onset after vigorous activity and delayed recovery time after cessation of exercise are identified, which should help the clinician avoid misdiagnosis and delayed diagnosis of the condition. The clinician is also warned of the associated misleading clinical features such as the presence of normal peripheral pulses and normal ankle pressures in some cases of CAD.

Seven hundred and fifty-seven consecutive patients undergoing a midline abdominal incision were stratified according to age, sex, type of operation and degree of operative contamination and were randomly allocated to mass closure of the abdominal wall with continuous 4 metric polydioxanone (PDX; 374 patients) or continuous 4 metric polypropylene (PPL; 383 patients). Wound infection was less common with PDX (PDX 3.5 per cent; PPL 7.0 per cent; P less than 0.05) and there was one dehiscence in each group. The incidence of defective wounds in patients surviving 1 year was similar (7.7 per cent PDX; 9.7 per cent PPL) but the PPL suture had to be removed because of persisting wound pain or sinus formation in five patients. PDX is the preferred suture material for closure of midline abdominal incisions.

During an 8-month interval of prospective audit, 63 of 637 (10 per cent) vascular discharge summaries were found to contain 94 errors. These comprised 11 (12 per cent) general errors, 21 (22 per cent) diagnostic errors, 19 (20 per cent) operative data errors, 19 (20 per cent) cases of incorrect clinical text information, 14 (15 per cent) missed complications and 10 (11 per cent) concerning follow-up arrangements. Overall, 2 per cent of consultant discharge summaries contained errors compared with 7 per cent for the senior registrar, 10 per cent for registrars and 17 per cent for senior house officers. Given that the majority of discharge summaries are currently prepared by junior staff, this study suggests that verification of the accuracy of clinical and management data should be an essential component of departmental audit meetings.

1. Human hepatocytes were cryopreserved for up to 14 days at -80 degrees C and the cryoprotection offered by different media investigated in terms of post-thaw cell viability and function. 2. Optimal cryoprotection was offered by a solution containing dimethylsulphoxide, propylene glycol, acetamide and polyethylene glycol 8000 in Leibowitz L15 medium. 3. The cytochrome P450 content and activities of the microsomal P450 dependent mixed function oxidase system were well maintained at above 70% of fresh cell values throughout the cryopreservation period. However, the activities of the cytosolic enzymes studied, glutathione S-transferase and glutathione reductase, were not well maintained; they declined to < 40% of fresh cell values after storage of cells for 14 days at -80 degrees C. The membrane environment may protect microsomal enzymes from denaturation by freeze-thaw damage. 4. After cryopreservation, viability of human hepatocytes was higher than that of rat hepatocytes preserved under identical conditions. For human cells maximum post-cryopreservation viability was 67% after 24 h at -80 degrees C; this declined to 49% after 14 days storage at -80 degrees C. In addition post-cryopreservation human hepatocytes remained > 70% viable when incubated at 37 degrees C in suspension compared with only 46% of rat hepatocytes. This indicates that human hepatocytes can withstand freeze-thaw damage better than those from rat. 5. The results of this study define optimal conditions for cryopreserving human hepatocytes. Although microsomal enzyme activities are retained post-cryopreservation, the decrease in viability of thawed cells upon incubation at 37 degrees C suggests that caution should be exercized when using cryopreserved cells to study integrated drug metabolizing pathways in man in vitro.

No abstract