Patients who take NSAIDs have an increased risk of nonspecific ulceration of the small-intestinal mucosa. These ulcers are less common than ulcers of the stomach or duodenum, but can lead to life-threatening complications.

We aim to compare the outcomes of patients undergoing R0 esophagectomy by a multidisciplinary team (MDT) with outcomes after surgery alone performed by surgeons working independently in a UK cancer unit. An historical control group of 77 consecutive patients diagnosed with esophageal cancer and undergoing surgery with curative intent by six general surgeons between 1991 and 1997 (54 R0 esophagectomies) were compared with a group of 67 consecutive patients managed by the MDT between 1998 and 2003 (53 R0 esophagectomies, 26 patients received multimodal therapy). The proportion of patients undergoing open and closed laparotomy and thoracotomy decreased from 21% and 5%, respectively, in control patients, to 13% and 0% in MDT patients (chi2 = 11.90, DF = 1, P = 0.001; chi2 = 5.45, DF = 1, P = 0.02 respectively). MDT patients had lower operative mortality (5.7%vs. 26%; chi2 = 8.22, DF = 1, P = 0.004) than control patients, and were more likely to survive 5 years (52%vs. 10%, chi2 = 15.05, P = 0.0001). In a multivariate analysis, MDT management (HR = 0.337, 95% CI = 0.201-0.564, P < 0.001), lymph node metastases (HR = 1.728, 95% CI = 1.070-2.792, P = 0.025), and American Society of Anesthesiologists grade (HR = 2.207, 95% CI = 1.412-3.450, P = 0.001) were independently associated with duration of survival. Multidisciplinary team management and surgical subspecialization improved outcomes after surgery significantly for patients diagnosed with esophageal cancer.

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The use of loop diuretics in oliguric patients with ARF can result in a diuresis. There is no evidence that these drugs can alter outcome.

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To compare the outcomes after D1 gastrectomy with those after modified D2 gastrectomy (preserving pancreas and spleen) performed by specialist surgeons for gastric cancer in a large UK NHS Trust. In all, 118 consecutive patients with gastric adenocarcinoma were referred by postcode, to undergo either a D1 gastrectomy (North Gwent (RJ), n ¼ 36, median age 76 years, 21 m) or a modified D2 gastrectomy (South Gwent (WL), n ¼ 82, 70 years, 57 m). Operative mortality in the two groups of patients was similar (D1 8.3% vs D2 7.3%, w 2 0.286, DF 1, P ¼ 0.593). Overall cumulative survival at 5 years was 32% after D1 gastrectomy compared to 59% after D2 gastrectomy (w 2 4.25, DF 1, P ¼ 0.0392). In patients with stage III cancers, survival was 8% after D1, compared with 33% after D2 gastrectomy (w 2 6.43, DF 1, P ¼ 0.0112). In a multivariate analysis, T stage (hazard ratio 2.339, 95% CI 1.683 -2.995, P ¼ 0.01), N stage (hazard ratio 4.026, 95% CI 3.536 -4.516, P ¼ 0.0001) and the extent of lymphadenectomy (hazard ratio 0.258, 95% CI -0.426 -0.942, P ¼ 0.0001) were independently associated with durations of survival. In conclusion, modified D2 gastrectomy can improve survival four-fold for patients with stage III gastric cancer, without significantly increasing morbidity and mortality when compared with a D1 gastrectomy. Opinion over the optimum resection for patients with gastric cancer remains divided, and the literature polarised. The impressive outcomes after D2 gastrectomy published in large retrospective series from Japan (Soga et al, 1979;Maruyama et al, 1987) have not been reproduced in randomised comparative studies from Europe (Bonenkamp et al, 1995(Bonenkamp et al, , 1999Cuschieri et al, 1996Cuschieri et al, , 1999. The two largest randomised studies both report significantly greater operative morbidity and mortality associated with an extended D2 lymphadenectomy when compared with the less aggressive D1 lymphadenectomy, and have failed to demonstrate any survival advantage for a D2 resection. Many of the serious complications associated with D2 resections were associated with resections of the pancreas and spleen (Bonenkamp et al, 1995;Cuschieri et al, 1996), and the best long-term survival was observed in patients undergoing D2 gastrectomy without pancreatico-splenectomy (Cuschieri et al, 1999). Although this latter report concluded than a classical D2 resection offered no survival advantage over a D1 resection, the possibility that a modified D2 resection, preserving pancreas and spleen, might be better than a D1 resection was not dismissed (Cuschieri et al, 1999).The first reports of outcomes after modified D2 gastrectomy for gastric cancer were originally published in Britain by Sue-Ling

We studied the initial rectal biopsy from 46 patients in whom subsequent follow-up established the diagnosis of either self-limited colitis or inflammatory bowel disease. An additional 12 non-inflamed rectal biopsies were also studied. There was between 2 and 8 years of follow-up in each of these cases. Staining for fibrin (MSB, fibrinogen), platelets (factor XIIIA, Y2/51), and capillary basement membrane (reticulin, collagen 4) was performed to identify thrombotic material within capillaries. Mucosal capillary thrombi were best identified by staining for factor XIIIA; thrombi were observed in 8/13 cases of ulcerative colitis, 4/10 cases of Crohn's disease, 1/3 cases of unspecified inflammatory bowel disease and 5/20 cases of self-limited colitis. The presence of capillary thrombi was not related to the severity of inflammation, but none of the control biopsies showed capillary thrombi. Their presence seems of little diagnostic value in distinguishing inflammatory bowel disease from self-limited colitis. The pathogenetic significance of these mucosal capillary thrombi is uncertain.

SUMMARY Immunohistological techniques using monoclonal antibodies were employed to study the morphology and phenotypic expression of macrophage like cells in ulcerative colitis, Crohn's colitis and histologically normal colonic mucosa. The antibody RFD1 identifies interdigitating (antigen presenting) cells whereas RFD7 binds to mature tissue macrophages. In normal colonic mucosa, the majority of cells recognised by these reagents were positive for Class II antigen expression and a median 87% (range 80-95%) were positive for both RFD1 and RFD7, with 6.5% (ranges 1-14%) positive for either antibody alone. There was much greater macrophage heterogeneity in the ulcerative colitis and Crohn's colitis biopsies than in normal mucosa. Clusters of RFD9+ cells (epithelioid cells) were found in Crohn's colitis and, to a lesser extent, in ulcerative colitis. Some Crohn's colitis sections showed replacement of the normal colonic macrophage phenotype with RFD1-RFD7+ cells (classical scavenger macrophages). The degree of this replacement correlated with the histological severity ofthe disease. By contrast, large numbers of RFD1+ RFD7-cells, with long dendritic processes, were found in intimate association with the lymphoid infiltrates in the lamina propria of the ulcerative colitis sections. Future studies of the factors controlling macrophage differentiation in tissues may help to explain the greater macrophage heterogeneity in inflammatory bowel disease and the differences between ulcerative colitis and Crohn's colitis observed in this study.It is probable that non-lymphoid mononuclear cells