How informative is the print media coverage of colorectal cancer?

AIM: To date there has been no assessment of the educational content of colorectal newspaper articles. We aimed to analyse articles in the print media concerning colorectal cancer for their public health content. METHOD: Articles mentioning colorectal cancer in the top 10 UK newspapers were analysed over a 1-year period for their educational content. The number of articles mentioning 'red flag' symptoms, celebrity connections or specific cancer charities was recorded. RESULTS: Of the 349 articles identified, 146 were not relevant. Of the remaining 203 articles, 62 (30%) were concerned with celebrities with colon cancer, 13 (6.4%) made reference to red flag symptoms and 14 (6.9%) mentioned cancer charities by name. CONCLUSION: About 13% of newspaper articles have any educational content. If this increased, the general public might benefit.

Assessing the internet prevalence of cancer.

INTRODUCTION: The internet is one of the most frequently accessed sources of information by patients. There is a variety of cancer-related information provided by the internet, aimed at both the general public (from official sites and non-regulated sites) and health care professionals. Little is known about whether the information provided reflects the prevalence of disease. METHODS: Searches for the 10 most common UK cancers were performed using five internet search engines. The number of relevant webpages was recorded and compared to the prevalence of each cancer according to Cancer Research UK. RESULTS: Of the 985,687,623 webpages identified, the majority were related to breast cancer (37.2%), followed by lung (16.2%) and prostate cancer (12.5%). Colorectal cancer, Oesophageal cancer and non-Hodgkin's lymphoma had the least number of websites (4.1%, 0.3% and 0.9%, respectively). There was over-representation of breast, kidney and stomach cancer with ratios of prevalence to number of websites of 1.7, 2.6 and 2.5 to 1, respectively. There was under-representation of colorectal cancer, non-Hodgkin's lymphoma and oesophageal cancer (ratios 0.2, 0.2 and 0.1, respectively). CONCLUSION: This data highlights the enormity of information available on the internet. However, there is over-representation of certain cancers (and under-representation of others) which may influence how patients perceive their illness. Healthcare professionals should be aware of the nature of information available on the internet and known when and how to direct patients to reputable sites that provide high quality information.

Death and illness as depicted in the media.

INTRODUCTION: The media may affect how illness is perceived, in terms of its prevalence, severity and outcomes. The media also influences our perception of death and leads to an overestimation of incidence of some causes of mortality. Articles depicting medical subjects may not be in-depth and are often influenced by non-medical issues. The media has both a positive impact on the population, in providing opportunistic health information, and a negative impact, causing an overestimation of severity and incidence of certain diseases. This article aims to assess if media reporting of illness and death represents national statistics. METHOD: The 10 most common daily read UK newspapers were assessed for articles relating to the most common causes of UK mortality. The searches were performed via each newspaper's online search facility over a 12-month period. Where appropriate, media friendly terms were used as search terms. RESULTS: A total of 18,482 pertinent articles were found relating to the most common causes of death in the UK. When the reportage of illness was compared with the actual incidence cerebrovascular accidents and chronic obstructive pulmonary disease were under-represented in the media, with ratios 0.31 and 0.01 to 1, respectively. Flu/pneumonia, prostate cancer, dementia and breast cancer all have a large media profile, with ratios of 5.52, 3.06, 4.09 and 4.9 to 1, respectively. CONCLUSION: The media has a significant impact on our perceptions of illness and death. This may influence how patients seek medical attention and their concerns at consultation. Strategies to improve the educational content of the media may enhance the dissemination of health information via this resource.

Assessing the readability statistics of national consent forms in the UK.

INTRODUCTION: When obtaining consent for an invasive procedure, the patient needs to understand what is happening to them in broad terms. Best medical practice advocates that written consent is given to acknowledge patient agreement. Across the UK, the Department of Health has provided standard consent forms for obtaining consent in all situations. Potentially these written sources of information may not be comprehended by patients and thus invalidate consent. METHOD: Consent forms were assessed by the Flesch readability and Flesch-Kincaid grade formulae and compared with the national reading age, the recommended level for patient medical information, three newspaper articles and a journal article. RESULTS: The consent forms have acceptable statistics [average Flesch readability 61.1 (range 57.2-66.1) and Flesch-Kincaid grade 7 (range 6.3-8)]. This grade, however, is above the recommended level of patient health information (Flesch-Kincaid grade 6). When the patient statements are isolated the reading statistics worsen [average Flesch readability 52.6 (range 41-62.6) and Flesch-Kincaid grade 9.6 (range 7.9-11.1)]. CONCLUSION: Consent forms should be used as adjuncts to detailed conversations, describing what a procedure involves to ensure that a patient understands, in broad terms, what is happening to them. The patient's statement section of the form may be being written at a level above patient comprehension currently and thus could invalidate any consent given. We would advocate a documented conversation with patients to ensure they have a broad understanding of the procedure and using the consent form as an adjunct to this discussion. The patient's statement section should be re-written to avoid invalidating consent.

Analysis of patient information leaflets provided by a district general hospital by the Flesch and Flesch-Kincaid method.

INTRODUCTION: Patient information leaflets (PILs) remain the most frequently used sources of medical information. There is a concern that the reading age of these leaflets may exceed patient comprehension, thus negating their beneficial effect. The 'Flesch Reading Ease' and the 'Flesch-Kincaid grade level' are established methods for providing reliable and reproducible scores of readability. METHOD: All available hospital PILs (171) were assessed and divided into 21 departments. Microsoft Word was used to provide Flesch and Flesch-Kincaid readability statistics and compared against the national reading age and the recommended level for provision of medical information. RESULTS: The average Flesch readability of all of the hospital's PILs is 60, with a Flesch-Kincaid grade of 7.8 (12-13 years old). There is considerable variation in the average readability between departments (Flesch readability 43.8-76.9, Flesch-Kincaid 5.4-10.2). The average scores of two departments have PILs scores suitable for patient information. CONCLUSION: Although our PILs were well laid out and easy to read, the majority would have exceeded patient comprehension. The current advice for provision of NHS information does not highlight the importance of a recommended reading level when designing a PIL. Potentially a wide group of patients are being excluded from the benefits of a PIL.

Popliteal venous aneurysm causing pulmonary embolism and paradoxical embolisation in a patient with antiphospholipid syndrome.

INTRODUCTION: Popliteal venous aneurysms are rare and can cause recurrent pulmonary emboli despite adequate anticoagulation. REPORT: A 43-year old patient with known antiphospholipid syndrome developed an extensive pulmonary embolus and ischaemic stroke despite anticoagulation. Duplex ultrasound confirmed a right popliteal venous aneurysm containing non-adherent multi-layered thrombus. At operation an 8 cm x 5 cm true aneurysm of the popliteal vein was excised. A postoperative echocardiogram revealed a patent foramen ovale. DISCUSSION: This case is unusual as the patient suffered a paradoxical embolism due to his patent foramen ovale. Although antiphospholipid syndrome is associated with venous thrombosis, this is usually prevented by therapeutic anticoagulation.

Operative ligation of multiple splenic artery aneurysms.

The incidence of splenic artery aneurysms (SAAs) in the background population is less than 1%. They are found with increasing frequency in the elderly, and there is a female predominance. The majority (95%) of SAAs are asymptomatic; although, symptoms include pain and a pulsating feeling in the upper abdomen. Treatment of SAAs depends on aneurysmal size and associated symptoms. Multiple SAAs are noted in 20% of patients. A 71-year-old woman with a history of both systemic and portal hypertension, hyper-splenism, and cirrhosis post chronic active hepatitis presented with a pulsating sensation and pain in her left hypochondrium. Abdominal ultrasound and CT confirmed the presence of two splenic aneurysms, which subsequently showed signs of enlargement 6 months later. At operation both aneurysms were successfully ligated and post-operative ultrasonography confirmed absence of aneurysmal flow and viability of the spleen.

Metachronous small bowel metastasis from a mixed Müllerian mesodermal tumour.

A mixed Müllerian mesodermal tumour (MMMT) is a rare aggressive carcinosarcoma. Metastatic progression is uncommon, and occurs via haematological, lymphatic and intraperitoneal spread. Although the latter is seen most frequently, the small intestine seems to be relatively preserved from disease progression with only one reported case of synchronous involvement. We report a case of metachronous MMMT involvement of the small bowel presenting with subacute obstruction that was successfully resected at operation.

Delayed laparoscopic mesh infection presenting as an abdominal mass.

A 56-year-old man presented with a delayed mesh infection 8 years following an elective laparoscopic totally extraperitoneal (TEP) bilateral hernia repair. Sterile pus was drained percutaneously as a temporising measure prior to removal of the right-hand mesh; the left-sided mesh was adherent to the femoral vessels and minimally contaminated. Delayed mesh infection is a rare occurrence. This case is the fourth example and the longest following initial operation. Removal of the infected mesh is advocated.

Delayed diaphragmatic rupture presenting with acute gastric volvulus.

Gastric volvulus is a rare complication of diaphragmatic rupture. We report the case of an 82-year-old man who presented following an out-of-hospital cardiac arrest. Chest radiography and thoracic computed tomography revealed an acute gastric volvulus and a chronic diaphragmatic hernia containing transverse colon and abdominal viscera. He had complained of retching and associated epigastric pain prior to collapse, and had sustained a motorcycle accident approximately 60 years earlier. Insertion of a nasogastric tube was unsuccessful (completing Borchardt's diagnostic triad) and his condition prevented both operative and endoscopic reduction of his volvulus. He died soon afterwards.

Surgical resection of hepatic and cardiac neuroendocrine metastases from a caecal primary tumour.

A 66-year-old patient had an incidentally detected caecal neuroendocrine tumour that had metastasised to the liver and left atrium. He was asymptomatic with regard to this tumour and did not have carcinoid syndrome. Resection of the primary tumour and the metastatic deposits (with the ablation of one lesion) is thought to be curative.

Endoscopic ultrasonography allowing expectant management of pancreatic haemangioma.

Pancreatic haemangiomas are rare benign tumours that can affect both adults and children. They have an unknown incidence and only 15 adult cases have been reported, all from histological examination. Patients present with vague symptoms relating to tumour mass or they are detected incidentally. Cross-sectional imaging is the mainstay of investigation and may reveal arterially enhancing cystic lesions but in the case presented here, it was non-diagnostic. The use of endoscopic ultrasonography confirmed the nature of the benign lesion, allowing a conservative approach as opposed to operative resection.

Hepatobiliary cystadenomas.

INTRODUCTION: Hepatobiliary cystadenomas are rare cystic tumours that can arise from any portion of the biliary tract but most commonly develop intrahepatically. They typically cause non-specific symptoms and are often detected incidentally. Cystadenomas can be mistaken for simple hepatic cysts on radiological imaging, which leads to inadequate treatment. Hepatobiliary cystadenomas have a malignant predisposition and a high recurrence rate. Complete excision including hepatic resection is therefore generally recommended. METHODS: Three cases of hepatobiliary cystadenoma were identified at one unit over a six-month period. Their clinical details and management are reported. RESULTS: Three female patients are described aged 25, 37 and 73 years. One patient presented because of recurrent infection, one presented because of pressure related symptoms and one lesion was identified incidentally. All patients were investigated by ultrasonography and computed tomography (CT), two additionally had magnetic resonance imaging (MRI) and one had a liver biopsy. The tumours were 4-16cm in size and all lesions were excised by non-anatomical, parenchyma sparing resections. Histology revealed mixed epithelium with underlying ovarian-like stroma. CONCLUSIONS: The management of hepatic cystadenomas as well as operative and pathological findings are discussed. Preoperative ultrasonography, CT and MRI is recommended, and early referral for specialist hepatobiliary review is advised. Operative resection is also recommended and complete excision was achieved in these cases. This strategy is supported by the current literature and recurrence has been shown to be unlikely.

Managing pancreatoduodenal trauma.

Pancreatoduodenal injuries are an uncommon but important source of morbidity and mortality in the trauma patient. They require a multidisciplinary approach, with a pancreatic surgeon involved at the earliest opportunity. The investigation and management of these injuries are discussed along with the role of operative intervention.

Subacute reaction to endoscopic mucosal resection mimicking perforation.

A 25-year-old woman underwent routine day-case endoscopic mucosal resection (EMR) of two ascending colonic polyps. Six hours later she re-presented with severe abdominal pain. On examination she was tachycardic with tenderness and peritonism in the right lower quadrant. Urgent abdominal computed tomography (CT) did not reveal any signs of free intra-abdominal gas or fluid but did detect transmural thickening and oedema in the ascending colon and caecum. As there was no radiological evidence of perforation, the patient was managed conservatively and made a full recovery. The exact aetiology of this patient's symptoms is not known. She may have developed post-polypectomy electrocoagulation (a transmural diathermy injury), localised ischaemia of the colonic wall (secondary to the adrenaline used during EMR) or an allergic reaction to the dye used during EMR. As EMR is an increasingly used treatment modality in the management of colonic polyps, clinicians should have an awareness of the complications of treatment. We would advocate a low threshold for prompt CT investigation in any patient presenting with abdominal pain after EMR to detect any evidence of free intraperitoneal air. Patients without signs of perforation may be managed conservatively, as in this case.

The portrayal of bariatric surgery in the UK print media.

BACKGROUND: Bariatric and metabolic surgery is a recent introduction into mainstream surgical practice. It has been shown to have a beneficial effect on the health of an individual and a positive economic impact for society. Nonetheless, bariatric surgery faces a problem of perception from both the public and healthcare commissioners. The media functions as an interface between the medical community, government and the public. It therefore plays a critical role in shaping public opinion regarding health issues. METHODS: Articles relating to bariatric surgery in the ten most frequently read UK daily newspapers were assessed over a 24-month period (January 2010-December 2011). Each article was rated via a five-point scale from very negative (1) to very positive (5) by two independent assessors to produce an average score. RESULTS: A total of 197 relevant articles were identified and analysed for content. Sixty-four (33 %) of all articles were negatively slanted (mean score 1-2.5), 105 (53 %) were positive (mean score 3.5-5) and 28 (14 %) were neutral (mean score 2.5-3.5). The average score of all articles was 3.3 (neutral, but slightly positive). CONCLUSIONS: The print media will influence public perceptions of bariatric surgery. There is huge variation in how bariatric surgery is reported, but overall the coverage is neutral. We feel that negative reportage distorts the overall awareness of bariatric surgery and may affect both how and when the obese seek medical intervention.

Gastric schwannoma: a benign tumour often mistaken clinically, radiologically and histopathologically for a gastrointestinal stromal tumour--a case series.

INTRODUCTION: Gastric schwannomas are rare mesenchymal tumours that arise from the nerve plexus of the gut wall. They present with non-specific symptoms and are often detected incidentally. Pre-operative investigation is not pathognomonic and many are therefore diagnosed as gastrointestinal stromal tumours (GISTs). Operative resection is usually curative as they are almost always benign, underpinning the importance of differentiating them from GISTs. METHODS: Three cases of gastric schwannomas were identified over a seven-year period. The clinical details and management were reviewed retrospectively. RESULTS: There were two women and one man with a mean age of 62 years (range: 51-69 years). Two patients presented with bleeding and one with abdominal pain. The mean tumour size was 5.2 cm (range: 2-10 cm) and the tumours were resected completely following total or wedge gastrectomies. Histology in all cases showed spindle cells with a cuff of lymphoid tissue. Immunohistochemistry confirmed positive S100 staining and negative CD117 and DOG-1 staining in all cases. CONCLUSIONS: We report our experience with these unusual primary stromal tumours of the gut and their presentations, pre-operative investigations, operative findings and pathological findings are discussed. Operative resection in all cases has been considered curative, which is supported by previous series confirming the excellent prognosis of gastric schwannomas.

Current management of Barrett's oesophagus.

Barrett's oesophagus is one of the most common pre-malignant conditions in the world and its incidence is increasing. The management of this disease is currently the subject of research and debate, with medical, endoscopic and operative intervention all having a therapeutic role.

Transient myocarditis associated with fulminant colitis.

Case Summary. An 18-year old man presented with a three-week history of abdominal pain, weight loss and bloody diarrhoea. He was profoundly septic, with generalised abdominal tenderness. CT and flexible sigmoidosopy confirmed colitis of the colon with rectal sparing. Laparotomy was performed when conservative management failed to improve his condition. Subtotal colectomy, with end ileostomy and mucus fistula formation, was performed in light of active colitis. Despite successful operative intervention the patient acute left ventricular failure, raising the possibility of giant cell myocarditis, which fully resolved before a definitive diagnosis could be reached. Discussion. It is possible that the transient cardiac failure in this case may represent an overwhelming inflammatory response or myocarditis. Inflammatory bowel disease is rarely associated with giant cell myocarditis (GCM). GCM usually affects a young population and its prognosis is variable, ranging from complete recovery, remission with recurrence and fatality. The management of this group of patients is still relatively experimental. Conclusion. Fulminant colitis can be associated with a rapid deterioration in cardiac function. Causes include sepsis, systemic inflammatory response syndrome or myocarditis. GCM should be considered in patients with new onset of left ventricular failure that decline rapidly.