The study was planned to determine the proportion of parents that wish to know the sex of their fetus at the 20-week anomaly scan, and to investigate our ability to diagnose correctly the sex of the fetus when undertaken as part of a routine scan. A total of 472 patients gave their informed consent. An attempt was made to identify the genitalia as part of the routine scan. No extra time was allowed to determine the sex of the fetus. Altogether 353 (74.7%) women wanted to know the sex, of which four (0.9%) wanted to know but did not want their partners to know. In 50 (10.6%) cases, it was not possible to determine the fetal sex in the time allowed. When the sex was identified, it was correct in 408 (96.7%) cases, and incorrect in 14 (3.3%) cases. Where the parents wanted to know the sex of the fetus, 24 (6.8%) scans were inconclusive, 319 (97%) were correctly identified, and ten (3%) were incorrectly identified (six male, four female). There were no terminations of pregnancy. The majority of prospective parents wish to know the sex of their child, and, in most cases, it is possible to determine the fetal sex at the time of the routine anomaly scan. During the time allowed, the fetal sex was undetermined in one in ten cases, and 3% were sexed incorrectly. If parents wish to know the gender of their fetus, it would appear reasonable to provide this information, provided that the parents are aware of the failure and error rates of sex identification using ultrasound.
Introduction Background: Loss of the gallbladder reservoir function at cholecystectomy may critically alter the dynamics of bile storage and release. Consequent iatrogenic duodeno-gastro-esophageal reflux (DGER) may be associated with oesophago-gastric adenocarcinoma. Aims To examine the histological and molecular effects of chol-ecystectomy-induced DGER on gastric and oesophageal mucosae. Methods Patients and Methods: In a retrospective study we compared 26 gallstone-free controls with 25 patients pre-chol-ecystectomy and 29 patients post-cholecystectomy for one or more years. In a prospective study we compared 26 controls with 25 patients before and within 1 year of cholecystectomy. All underwent oesophago-gastro-duodenoscopy (EGD) with biopsies from the antrum, esophagogastric junction (EGJ) and 5 cm above the EGJ. A histochemical bile reflux index (BRI) was calculated and immunohistochemistry was performed for p53 and Ki67. Results Results: In the retrospective study antral BRI positivity was 11% in controls vs 69% in cholecystectomy patients (p¼0.001); at the EGJ BRI positivity was 19% in controls vs 41% in chol-ecystectomy patients (p¼0.032). p53 was expressed at the antrum in 4% of controls vs 52% cholecystectomy patients(p¼0.001) and in 19% vs 66% at the EGJ (p¼0.001). Ki67 was expressed at the antrum in 23% vs 59% (p¼0.001) and at the EGJ in 19% vs 62% (p¼0.001). Prospectively, BRI positivity increased from 11% to 36% (p¼0.04) at the antrum within 1 year of cholecystectomy. Ki67 expression increased from 19% to 48% (p¼0.044) at EGJ in patients within 1 year of cholecystectomy while p53 remained unchanged. Conclusion Changes attributable to DGER occur early in the gastric and LES mucosae of patients following cholecystectomy. Ki67 and p53 over-expression suggests that these changes may be precursors of malignant transformation. Such concerning changes suggest that options other than cholecystectomy be considered for patients with gallstones in a functioning gallbladder. Introduction Colorectal cancer is the second most common cause of cancer related death in the UK causing around 16 000 deaths each year. Colorectal adenomas are slow growing precursor lesions which progress to cancer. The lesion of most interest in this context is advanced adenoma (size 10+ mm/with 20%e25% villous histology/
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