Straight-to-test colonoscopy for 2-week-wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high-volume unit.

AIM: We have introduced 'straight-to-test' (STT) colonoscopy as part of our 2-week-wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) within the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC. METHOD: We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin. Our 2WW referrals were screened by a colorectal consultant and a nurse specialist. Those deemed unsuitable for STT were offered outpatient assessment (OPA). RESULTS: Of 553 2WW referrals screened, 352 were considered suitable, 65 of whom failed a telephone assessment or were uncontactable, and accordingly 287 were offered the STT pathway. The STT group was significantly younger than the OPA group (median 65.9 years vs 78.7 years; P < 0.0001). STT colonoscopy significantly reduced the time to first test (13 days vs 22 days; P < 0.0001) and tissue diagnosis from the referral date (17 days vs 24.5 days; P < 0.0001). Thirty-seven (6.8%) CRCs were detected. Proportionately fewer patients in the STT pathway were managed with 'best supportive care only' compared with patients attending OPA (one of 15 vs six of 22, respectively). STT colonoscopy obviated the need for clinic attendance before testing in 287 patients, representing a potential net cost benefit of at least £48 500 in 4 months. CONCLUSION: STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly.

Evaluation of an aviator with chronic disequilibrium, oscillopsia, and central sleep apnea.

A case is presented of an aviator with chronic disequilibrium, oscillopsia, and central sleep apnea. History, physical examination, and special studies are presented establishing a diagnosis of epidermoid tumor at the foramen magnum. Differential diagnosis and relation of findings to the lesion are presented. The aeromedical significance of this case is to reinforce the importance of persistence and the team concept in establishing diagnoses when aviators present with confusing or unexplained symptoms.

Videolaparoscopia topográfica de equinos em estação com três diferentes massas corpóreas / Topographic videolaparoscopy in standing equines of three different corporal masses

Descreveu-se a anatomia topográfica, obtida por videolaparoscopia, da cavidade abdominal de 21 equinos hígidos, em estação, distribuídos em três grupos conforme massa corpórea. No grupo A foram incluídos animais com até 250kg; no grupo B, animais entre 251 e 350kg; e no grupo C, animais acima de 351kg. A técnica cirúrgica realizada foi a laparoscopia com acesso pelas fossas paralombares esquerda e direita, utilizando a introdução videoassistida da cânula, iniciando sempre pelo flanco esquerdo. O acesso esquerdo permitiu a observação do diafragma, estômago, lobo hepático esquerdo, baço, área renal, intestino delgado, cólon menor, bexiga, órgãos reprodutivos internos do macho e da fêmea e reto. No acesso paralombar direito, foram observados diafragma, lobo hepático direito, área renal, cólon dorsal, duodeno, ceco, intestino delgado, cólon menor, bexiga, órgãos reprodutivos internos do macho e da fêmea e reto. O procedimento videolaparoscópico para estudo da anatomia abdominal de equinos é viável, não sendo observadas limitações decorrentes do tamanho do animal.

The present study aimed to perform an anatomic description of the abdominal cavity of equines in standing position. Twenty-one healthy equines were allotted into three groups according to their corporal mass. Animals weighing up to 250kg were included in group A, 251 to 350kg in group B and over than 351kg in group C. Laparoscopy was the surgical technique performed, with access through the left and right paralumbar fossas using a video-assisted introduction of cannula, starting from the left flank. This first access allowed the observation of the diaphragm, stomach, left hepatic lobe, spleen, renal area, small intestine, descending colon, bladder, rectum and internal reproductive organs of the male and female. During the right access were observed: diaphragm, right hepatic lobe, renal area, dorsal colon, duodenum, cecum, small intestine, descending colon, bladder, rectum and internal reproductive organs of the male and female. The video-laparoscopic for the study of the abdominal anatomy of equines is feasible, and no limitations due to animal size have been observed.

Ectrodactilia em cão: relato de caso / Ectrodactyly in dog: case report

Descreve-se um caso de ectrodactilia em um cão, sem raça definida e dois meses de idade. No exame clínico e radiográfico, foi verificada a separação óssea e de tecidos moles entre o segundo e o terceiro dígitos, estendendo-se proximalmente até a região distal do rádio e da ulna, e luxação do cotovelo ipsilateral. O animal foi submetido a procedimento cirúrgico para redução da luxação do cotovelo e reaproximação óssea e dos tecidos moles. Após 16 meses da cirurgia, o animal apresentava uso parcial do membro

A case of ectrodactyly is described in a 2-month-old male mixed Terrier dog. The defect was a complete osseous and soft tissue separation extending from between digits 2 and 3 proximally to the level of the radius and ulna. Radiography revealed elbow luxation. Treatment consisted of surgical reduction of elbow luxation and soft tissue reconstruction. Sixteen months after surgery, the dog was intermittent nonweight-bearing lameness