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Ann R Coll Surg Engl 2007; 89: 418-421 418Colorectal cancer is the third most common cancer in the UK. 1 Rates of peri-operative transfusion ranging from 20-75% have been reported in patients undergoing colorectal resection. 2,3Despite innovations in transfusion medicine, peri-operative transfusion of allogeneic blood components has inherent risks including immunomodulation, transmission of disease, allergic reaction, and allo-immunisation. More recently, the introduction of leukocyte-depleted blood has led to an increased cost pressure on health resources.Studies have shown that predictors of increased perioperative transfusion are proximal tumours, increasing tumour size, operative blood loss and pre-operative anaemia. 2,4,5Pre-operative anaemia is a frequent finding in this group of surgical patients and accounts for a substantial number of blood transfusions. Defining anaemia as a haemoglobin of less than 13.5 g/dl in men and 11.5 g/dl in women, locally recorded data from the preceding years' 223 surgical colorectal cancer patients demonstrated that 51% of men and 25% of women were anaemic (38% combined) on admission. The overall transfusion rate in the men and women was 28% and 41%, respectively, whereas in the anaemic patients it was 39% and 68%, respectively.The aim of this study was to assess whether pre-operative oral iron therapy would decrease pre-operative anaemia and, thereby, reduce the incidence of peri-operative transfusion. Patients and MethodsThe study received approval from the Plymouth Healthcare Trust Local Research Ethics Committee.Patients diagnosed with colorectal cancer were identified in out-patient clinics. All patients fit for surgery were SURGICAL ONCOLOGYAnn R Coll Surg Engl 2007; 89: 418-

ObjectiveTo investigate whether poor preoperative cardiopulmonary reserve and comorbid state dictate high-risk status and can predict complications in patients undergoing radical cystectomy (RC). Patients and MethodsIn all, 105 consecutive patients with transitional cell carcinoma (TCC; stage T1-T3) undergoing robot-assisted (38 patients) or open (67) RC in a single UK centre underwent preoperative cardiopulmonary exercise testing (CPET). Prospective primary outcome variables were all-cause complications and postoperative length of stay (LOS). Binary logistic regression analysis identified potential predictive factor(s) and the predictive accuracy of CPET for all-cause complications was examined using receiver operator characteristic (ROC) curve analysis. Correlations analysis employed Spearman's rank correlation and group comparison, the Mann-Whitney U-test and Fisher's exact test. Any relationships were confirmed using the Mantel-Haenszel common odds ratio estimate, Kaplan-Meier analysis and the chi-squared test. ResultsThe anaerobic threshold (AT) was negatively (r = −206, P = 0.035), and the ventilatory equivalent for carbon dioxide (VE/VCO2) positively (r = 0.324, P = 0.001) correlated with complications and LOS. Logistic regression analysis identified low AT (<11 mL/kg/min), high VE/VC02 (≥33) and hypertension as significant factors, such that, in their presence patients were 5.55-times more likely to have complications at 90 days postoperatively [P = 0.001, 95% confidence interval (CI) 2.2-13.9]. ROC analysis showed a high significance (area under the curve 0.78, 95% CI 0.69-0.87; P < 0.001). In addition, based on CPET criteria >50% of patients presenting for RC had significant heart failure, whereas preoperatively only very few (2%) had this diagnosis. Analysis using the Mann-Whitney test showed that a VE/VCO2 ≥33 was the most significant determinant of LOS (P = 0.004). Kaplan-Meier analysis showed that patients in this group had an additional median LOS of 4 days (P = 0.008). Finally, patients with an American Society of Anesthesiologists grade of 3 (ASA 3) and those on long-term β-blocker therapy were found to be at particular risk of myocardial infarction (MI) and death after RC with odds ratios of 4.0 (95% CI 1.05-15.2; P = 0.042) and 6.3 (95% CI 1.60-24.8; P = 0.008). ConclusionPatients with poor cardiopulmonary reserve and hypertension are at higher risk of postoperative complications and have increased LOS after RC. Heart failure is known to be a significant determinant of perioperative death and is significantly under diagnosed in this patient group.

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A series of 123 consecutive referred cases of lens dislocation in the dog were classified as primary (100), secondary (21) and congenital (two). Cases designated as primary lens luxation comprised only the terrier breeds or crossbreds and collectively appeared to represent a single clinical entity characterised by age of onset (mean four to five years), essential bilaterality and the apparent absence of antecedent ocular disease. Elevated intraocular pressures were encountered in many eyes exhibiting subluxation. However, in three Tibetan terriers, on which tonometry was performed on a daily basis for approximately one year during the period of subluxation and before the development of luxation, there was no evidence of abnormal intraocular pressure change, suggesting that ocular hypertension in primary lens luxation is a secondary and not a primary development. All but one of nine affected eyes representing three terrier breeds showed abnormalities of the suspensory apparatus of the lens (zonule) which resembled those reported previously in Tibetan terriers bred for the condition.