Orations relating to the conferment of Doctor of Science honoris causa to Professor William Bannister

We are gathered here today to recognise a distinguished international scientist and alumnus of this University and it is indeed my honour and privilege to present Professor William Bannister for the award of the degree of Doctor of Science honoris causa. His career spans almost six decades and during this time he has helped shape numerous individual careers, whole Departments and our understanding of several branches of Physiology.peer-reviewe

A message from the Dean

It is perhaps with a certain degree of pride that I am writing this letter in what can be considered as the first 100 days in my position as Dean. I say this because a number of important changes are about to take place in the light of recent events. We may now be in a position to redraw our medical education starting from the undergraduate education right through to postgraduate studies.peer-reviewe

Hepatic metastases from colorectal carcinoma

Colorectal carcinoma is one of the increasing afflictions and is the 2nd commonest cause of death from cancer in the Western world. It accounts from 14% of cancer deaths in men and 16% of deaths in women. The best prognostic indicator for survival in colorectal disease has been based on the extent and spread of the disease. In this article the author mentions chemotherapy and surgery as the possible treatment options.peer-reviewe

Choledocholithiasis : whither surgery?

Choledocholithiasis is a common condition. It has been estimated that as many as 24% of patients with cholelithiasis have stones in the common bile duct. Until the last decade, the ’gold standard’ for treatment has been surgery. Because of the reported high incidence of morbidity and mortality associated with surgical exploration of the bile duct clinicians have turned their attention to other modalities of treatment. These recent advances for the management of choledocholithiasis are reviewed.peer-reviewe

Splenic Trauma: should we treat differently?

A 36 year old male was admitted to Accident and Emergency Department following a motor vehicle accident. Clinical examination revealed a haemodynamically stable patient. Abdominal examination showed tenderness in right upper quadrant. Ultrasonography of the abdomen was normal. Haemoglobin on admission was 13 gm/dl. A repeated haemoglobin six hours later revealed a Hb of 10 gm/dl. Computerized tomography(CT) of the abdomen showed a ruptured spleen. As the patient was haemodynamically stable, it was decided to treat the patient in the HDU setting. His condition remained stable and he was fit to be discharged home on the fifth post-operative day.peer-reviewe

Some Aspects of Gastrointestinal Adaptation to Obstruction of the Small Intestine: Modulating Role of Diet

The "well being" of the gastrointestinal tract is maintained by the interplay of several -factors, notably diet, pancreatic and biliary secretions and gastrointestinal hormones. These same factors may be responsible for enabling the organ to adapt to chanqing circumstances. To date, most of what is known about gastrointestinal adaptation has been derived from animal experimentation and the progress in this field has, to some extent, been limited by the suitability of the animal models. One such example is the adaptive response of the gastrointestinal tract to small intestinal obstruction. Whereas a wealth of information exists regarding adaptation to acute obstruction, knowledge of the changes to the chronic event is limited. The first aim of the thesis was therefore to further develop and modify a reproducible model of chronic small bowel obstruction in the rat. The study was then extended to investigate the changes in both the proximal (i.e. oesophagus, stomach and proximal small intestine) as well as the distal (i.e. distal small intestine) bowel to obstruction. In addition, the presence and absence of food bulk on these changes was also investigated. The gastrointestinal hormone profiles under each experimental condition were also identified. It was found that: 1. An increase in oesophageal weight occurred following a high small bowel obstruction. Other levels of small bowel obstruction had no noticeable effect on the oesophagus. 2. The response of the stomach to obstruction varied with the site of the small bowel obstruction. A high obstruction produced a marked dilatation of the stomach. A mid small intestinal obstruction generated marked gastric muscle hypertrophy. 3. The jejunum and the ileum behaved in a similar fashion in that both showed an increase in weight and and in luminal circumference in response to obstruction. However the magnitude of the ileal response was far greater. 4. The administration of a low residue diet did not result, during the time period of the experiment, in a reduction of the mucosal weight of the gastrointestinal tract. However a reduction in both the DNA and protein concentration was observed. When this low residue diet was administered to rats subjected to a small bowel obstruction, the hypertrophic response noted in chow-fed obstructed animals was abolished. 5. Disuse atrophy of the mucosa was seen in the ileum of rats with a mid small bowel obstruction fed on chow. Although some degree of atrophy did occur in similarly obstructed rats fed on a low residue diet, the degree of atrophy was significantly less than that in chow fed obstructed animals. 6. Hormonal assays showed that: a. Serum gastrin was raised following a high obstruction and following the administration of a low residue diet. b. Serum N-glucagon levels showed significant increases following mid and distal small bowel obstruction. c. Vasoactive intestinal peptide levels were increased following a distal obstruction

Ileostomy Adenocarcinoma : a case report

Proctocolectomy is the standard treatment for patients suffering from ulcerative colitis which is long-standing, refractory to pharmacotherapy or otherwise associated with complications. An ileal pouch with pouch-anal anastomosis is fashioned in the majority of cases; however, in some instances terminal ileostomy is preferable. Ileostomy cancer is rare but a number of cases have been reported over the past twenty years suggesting a rising incidence. We report a case that developed thirty years post-operatively.peer-reviewe

Health and the Economy : a statement of concern

The relationship between health and the economy is an intimate and complex one. The economy of health and the apportioning of funds to different medical services and health care programs are issues that depend on the health profile of a given community as well as the expectations of its members. Decisions ultimately depend on available resources and political priorities. Health and the economy cannot be isolated and contrasted, as the integrity of a given economic system clearly depends on the state of health of the community both at an individual level as well as at a population level.peer-reviewe

Thr300Ala ATG16L1 polymorphisms and bone strength in Crohn’s disease patients

Introduction: Studies on the effect of deletion of ATG5 and ATG7 proteins on bone cell function and bone strength in laboratory mice have revealed an association between autophagy and osteoporosis. The effect on bone strength of the Thr300Ala variant (rs2241880 polymorphism) of the ATG16l1 gene, a Crohn’s disease susceptibility gene essential in macroautophagy, has not yet been explored. Methods: 101 Crohn’s disease patients underwent DEXA bone density scanning. Real time PCR, high resolution melt (HRM) and restriction fragment length polymorphism (RFLP) were made use of as to assess for the rs2241880 polymorphism of the ATG16L1 gene in these patients. Results: HRM and RFLP demonstrated that 39.6% had the wild type rs2241880 (Thr300Ala) polymorphism while 7.9% were homozygous and 52.5% were heterozygous for the polymorphism. Mean DEXA bone mineral density scores in these patients showed lower T scores at the hip (1.74) among patients with the homozygous polymorphism than among patients with the heterozygous polymorphism (mean T score hip: -1.29). The highest mean T scores were found in patients with the wild type polymorphism (-1.04). Discussion: This study demonstrates the first evidence that polymorphisms in the ATG16L1 gene may play a role in bone metabolism.peer-reviewe

Glycosylated haemoglobin (HbA1c) and cortisol levels on admission to intensive care as predictors of outcome

Objective: To evaluate the predictive value of glycosylated haemoglobin and cortisol on admission, in critical care patients. Design: Prospective, observational, single centre study. Setting: 14 bedded Intensive care unit of a tertiary-level university hospital. Patients: 124 consecutive emergency medical and surgical patients. Methods: Data collected on admission included patient demographics, medical history, medication, diagnosis, type of nutrition, TISS28 score, serum blood glucose, Glycosylated haemoglobin (HbA1c), cortisol, mean arterial blood pressure, and the use of inotropes in the first 24hrs. Daily baseline tests included complete blood count, urea and electrolytes, creatinine, twice weekly liver function tests. The primary outcome measure was intensive care unit mortality. Secondary outcome measures were ITU stay, days of ventilation, peak urea, peak creatinine, lowest platelet count, peak bilirubin, lowest Pa/FiO2, and the number of transfusions. Measurements and results: 124 patients (mean age 56.2 years SD 23.2) were included. Regression analysis was used to identify any potential predictors of outcome: HbA1c levels on admission were not found to be significantly associated with mortality (p=0.51), or any other secondary endpoints listed above. However, subgroup analysis revealed a predictive role of HbA1c with regards to length of ITU stay (p= 0.01) and number of days of ventilation (p=0.007) in those patients with a history of diabetes. Glucose level on admission emerged as an independent marker of mortality (p=0.009). Conclusions: This study suggests that HbA1c may not be a predictor of outcome in the general ITU population but may be of predictive value in diabetic ITU patients. On the other hand, blood glucose levels on admission emerged as a predictor of mortality, whilst no association was found between HbA1c and cortisol levels on admission.peer-reviewe