Same-day assessment and management of urgent (2-week wait) colorectal referrals: an analysis of the outcome of 1606 patients attending an endoscopy unit-based colorectal clinic.

AIM: The Rapid Access Diagnosis and Remedy (RADAR) clinic combines 2-week wait (TWW) specialist consultation with 'straight-to-test' flexible sigmoidoscopy (FS) for left-sided 'red-flag' TWW criteria (excluding right-sided mass or iron-deficiency anaemia). The study aims were to determine the effectiveness of RADAR in differentiating colorectal cancer from benign disease and to evaluate the need for whole colonic investigation (WCI) following FS, in symptomatic patients. METHOD: Prospectively collated data of all RADAR patients from November 2005 to November 2009 were analysed, excluding patients referred internally for a FS. The local histology database was later interrogated to detect any missed cancers. RESULTS: Of 1690 patients (729 men; median (range) age: 68 (18-96) years) assessed in RADAR, 84 were excluded. Colorectal cancer (CRC) was diagnosed in 117 (7.3%). Eighty-seven cancers were diagnosed on the day of attendance and a further 13 within a week (88.9% overall). Two patients after a cancer-free FS were found to have a right-sided CRC on WCI (0.24%) and one synchronous cancer was found. No patient with a cancer-free FS having a WCI was subsequently found to have CRC at a median of 35 (12-58) months. CONCLUSION: Flexible sigmoidoscopy, in the context of an endoscopy unit TWW clinic, allows same-day diagnosis of most patients referred with left-sided symptoms, and immediate reassurance and treatment of most benign diagnoses. For these patients, the use of routine WCI following a cancer-free FS does not appear to be beneficial. Adopting this system would significantly reduce the number of barium enemas and colonoscopies currently performed.

Correction of end colostomy prolapse using a curved surgical stapler, performed under sedation.

Acute stoma prolapse most commonly occurs following emergency surgery, frequently in patients with significant medical co-morbidities. Correction often requires re-laparotomy and resiting of the stoma, placing an already frail patient at risk of further morbidity. An elderly patient experienced an end colostomy prolapse 14 days following emergency laparotomy. A novel technique was employed using the CONTOUR curved stapling device to excise the prolapsed segment, under a brief period of intravenous sedation, thereby avoiding the sequelae of general anaesthetic. No complications were experienced, and the patient was deemed fit for discharge 5-days post re-intervention.

Poncet's disease.

Tuberculous rheumatism is not generally accepted as a specific disease entity in Great Britain or the U.S.A. We are reporting a adult male whom we believe suffered from this disease, to open the controversy surrounding its existence with a review of the literature.

Imaging of the ileocaecal valve.

The ileocaecal valve can cause concern when it is enlarged. We define the normal and abnormal appearances of the ileocaecal valve and illustrate the importance of using CT and endoscopy to make the correct diagnosis, avoiding any further unnecessary interventions.

Accuracy of digital rectal examination in the estimation of height of rectal lesions.

BACKGROUND: To assess the accuracy of the digital rectal examination as a method of estimating the distance of a rectal lesion from the anal verge. METHODS: One hundred doctors of variable levels of experience and from different specialities performed digital rectal examination (DRE) on a pelvic model with two fixed buttons at different levels simulating lesions in the rectum. They were asked to estimate the distance of the lesions in centimetres from the anal verge and classify the lesion as mid or low rectal. RESULTS: Nearly half the doctors studied (45%) estimated the distance of the upper lesion accurately (7.5 cm, or within 1 cm of the correct distance), whereas 64% of the doctors estimated the distance to the lower lesion accurately (3 cm, or within 1 cm of correct distance). 93% of doctors classified the mid-rectal lesion correctly and 99% classified the lower rectal lesion correctly. CONCLUSIONS: Though less accurate in precisely estimating the distance of a lesion from the anal verge, DRE has high accuracy in classifying rectal lesions into lower and mid-rectal lesions, irrespective of experience and background of the clinicians. It is more accurate for lower rectal lesions than mid-rectal lesions.

Preparation, optimization, characterization, and stability studies of salicylic acid liposomes.

Salicylic acid has been used widely in the treatment of dry skin conditions and also helps reduce acne symptoms. However, it suffers from the disadvantages of being a mild to strong irritant. Hence, its control can be achieved through encapsulation in liposomes. Liposomes were prepared by the conventional thin film hydration technique as described by Bangham et al. (J. Mol. Biol., 1965). The prepared liposomal dispersions were then characterized for entrapment efficiency, particle size by transmission electron microscopy (TEM), phase transition studies by differential scanning calorimetry (DSC), and lamellarity by nuclear magnetic resonance (NMR). The results showed the formation of bilayered liposomes in the particle size range of 0.2-0.8276 microm with a maximum entrapment efficiency of 42.6%. The liposomes stored at 4-5 degrees C demonstrated maximum stability as compared to those stored at any other temperature.

47,XYY karyotypes and pervasive developmental disorders.

OBJECTIVE: The presence of a 47, XYY karyotype in boys with pervasive developmental disorders (PDDs) has rarely been described in the past. Herein, 2 boys with PDDs and a supernumerary Y chromosome are presented. METHODS: The case histories of the 2 patients are described along with the results of associated testing. The literature on psychosocial development as well as brain morphology and physiology in males with 47, XYY karyotypes is reviewed. RESULTS: Both boys had presentations typical of PDDs, one with autistic disorder and the other with PDD not otherwise specified. CONCLUSION: The finding that, in a clinic for children with developmental disorders, 2 of 40 male referrals had 47, XYY karyotypes suggests that the rate of this sex chromosome anomaly may be increased in PDDs. An extra Y chromosome may be related to abnormal brain development, which may, in turn, predispose vulnerable males to PDDs.

Agenesis of corpus callosum - a rare case.

A case of corpus callosum agenesis associated with a chromosomal structural defect is described.

Study of processing parameters influencing the properties of diltiazem hydrochloride microspheres.

Diltiazem hydrochloride-ethylcellulose microspheres were prepared by the water-in-oil emulsion-solvent evaporation technique. Small and spherical microspheres having a mean microsphere diameter in the range of 40-300 microm and entrapment efficiency of approximately 60-90% were obtained. Scanning electron micrographs of drug-loaded microspheres showed the presence of uniformly distributed small pores and absence of drug crystals on their surface, indicating simultaneous precipitation of drug and the polymer from the solvent during solvent evaporation. Differential scanning calorimetric analysis confirmed the absence of any drug-polymer interaction. The in vitro release profile could be altered significantly by changing various processing parameters to give a controlled release of drug from the microspheres. The stability studies of the drug-loaded microspheres showed that the drug was stable at storage temperatures, 5-55 degreesC, for 12 weeks.

The use of bupropion in the treatment of restlessness after a traumatic brain injury.

The occurrence of restlessness after a traumatic brain injury (TBI) is common. Severe restlessness can be a barrier in the multidisciplinary treatment of patients with TBI. The following case describes a patient with restlessness after a head-on motor vehicle accident. The patient was tachycardic, diaphoretic, demonstrating decerebrate posturing and a Rancho Los Amigos Stage II--III. Significant left lower leg restlessness was severe enough to cause bruising and ulceration. A multidisciplinary look was taken at the effects of using different neurotransmitter modulators in the treatment of restlessness after a TBI. Current biology treatment options include the use of medications that either modulate dopamine or noradrenaline alone. Bupropion effects both the dopaminergic and noradrenergic pathways. In the following case, the patient's restlessness was resistant to almost every medication employed. The only medication that proved to be effective in significantly reducing the patient's restlessness was bupropion. The evidence for the use of bupropion in the treatment of restlessness after a TBI has never been discussed previously, aside from anecdotal accounts. It is hoped that this case will prove insight into another treatment option for patients who have severe restlessness.