Efficacy of alcohol screening in the accident and emergency department managed by reception staff: a pilot study.

Hazardous levels of alcohol consumption are associated with presentations to the accident and emergency department. Although screening and brief interventions are effective at reducing levels of hazardous drinking, a low number of departments has implemented such a strategy. Time constraints upon clinical staff have been cited as one reason for this inertia. This pilot study demonstrates that self-completion of screening materials is possible before a patient is seen by clinical staff.

Feasibility of screening for Chlamydia trachomatis in young men attending an emergency department.

OBJECTIVE: To determine the feasibility of screening asymptomatic young men for genital Chlamydia trachomatis infection in a suburban emergency department setting. DESIGN: Prospective observational study. SETTING: Chase Farm Hospital Emergency Department in Enfield, North London. PARTICIPANTS: Asymptomatic sexually active men aged 16-24 years. METHODS: A convenience sample of men aged 16-24 years attending the emergency department was offered urine-based screening for Chlamydia at triage. Verbal consent was obtained and first pass urine specimens were tested using the strand displacement amplification technique. Participants were traced by their preferred method of contact in order to be offered treatment within 2 weeks of attendance at the emergency department. RESULTS: 67 men participated, 64 of whom were tested, 3 returning positive tests. The prevalence of Chlamydia in asymptomatic men attending the emergency department was 4.7%. CONCLUSION: Urine testing for genital C trachomatis in the emergency department can identify asymptomatic men in the community who may otherwise remain undetected. It is suggested that this is a worthwhile screening test to offer in the emergency department, providing follow-up for treatment can be arranged locally. There is no requirement for increased emergency department input into these patients over and above introducing them to the screening programme.

The laryngeal mask airway. Two cases of prehospital trauma care.

Two cases of emergency prehospital airway control using the laryngeal mask are described. The patients were trapped following road traffic accidents and limited access prevented tracheal intubation. The laryngeal mask airway may be a useful alternative to tracheal intubation in some cases of prehospital trauma care.

Carcinoma of the caecum.

This study presents a review of 519 of 553 unselected patients with carcinoma of the caecum presenting in the Plymouth Health District between 1975 and 1987. A large proportion of the patients were elderly and the median age increased throughout the study period to 76 years. One third of cases presented as an emergency and a small number was discovered at autopsy. Bowel obstruction accounted for over half the emergencies and chronic anaemia for half the elective cases. At presentation many tumours were advanced and only 5% were Dukes' A. One quarter of patients had synchronous tumours. Resection was performed in most cases, and this was attempted even in the presence of local invasion and liver metastases. Morbidity following resection was low and only six anastomotic leaks were clinically apparent. The mortality rate following resection was 2.6% and was higher for emergency procedures. The age-adjusted 5-year survival rate was 37% and rose to 64% for those undergoing 'curative' surgery. These results suggest that future improvements in the management of right colon cancer may lie with early referral and diagnosis. This study further highlights the importance of good perioperative care in the increasingly elderly patient.

Appendicectomy and carcinoma of the caecum.

A total of 519 patients presenting with carcinoma of the caecum in the Plymouth Health District between 1975 and 1987 were reviewed. The clinical course was determined in relation to patients with and without a history of previous appendicectomy. There was no difference in the incidence of previous appendicectomy between patients with carcinoma of the caecum and an age and sex matched control group. The presence of synchronous carcinomas and/or adenomas was unrelated to previous appendicectomy. Ten patients presented with appendicitis and 11 with a mucocele of the appendix as the first sign of carcinoma of the caecum. Previous appendicectomy was associated with a higher incidence of local fixity, invasion of the abdominal wall, metastatic spread and poor differentiation. These differences were reflected in a significantly lower resection rate for carcinomas in patients who had previously undergone appendicectomy. The survival of patients who had previously had appendicectomy was significantly reduced. Four independent prognostic factors for survival were identified using multivariate discriminant analysis. These were Dukes' classification, local invasion, tumour differentiation and previous appendicectomy. Local recurrence was more common in patients who had previously had appendicectomy and was often in the old appendicectomy wound itself. Appendicectomy does not increase the risk of carcinogenesis in the caecum. In this study a history of appendicectomy was an independent risk factor for survival and significantly worsened the prognosis for patients who subsequently developed carcinoma of the caecum.