The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.
Background
Mortality from malignant mesothelioma is expected to peak in the UK in the current decade. Areas of the country which have historically high rates of industrial exposure to asbestos, such as South East Wales, are expected to bear a disproportionately high burden of mesothelioma, making a priority. Medical thoracoscopy is an effective and safe procedure, affording both a high diagnostic yield in mesothelioma and an opportunity to carry out therapeutic drainage of pleural effusion.
Methods
We evaluated the diagnostic yield and safety of medical thoracoscopy at our centre over a 5-year period from 2010 to 2015 including 104 consecutive patients.
Results
We found that thoracoscopy provided a conclusive result effected 91.6% of successful biopsies. Thoracoscopy was especially superior to pleural cytology in the diagnosis of malignant mesothelioma, revealing 37 cases when cytology suggested only 5. The procedure was particularly safe with no mortality and only 6.7% of patients experiencing minor complications such as hypotension, and more than 75% of patients tolerated the procedure with mild or no discomfort.
Conclusion
We conclude that the awake sedation thoracoscopy service at our institution is safe and effective, particularly in the diagnosis of mesothelioma, which is common in our area.
Aims
Interval colorectal cancer is defined as cancer that has developed within a short interval of a diagnostic test that did not detect a cancer. Many authors define this interval as five years, though more complex definitions of interval cancer have been proposed. Our aim was to determine what percentage of colorectal cancers diagnosed at our hospital had a negative colonoscopy within the 5 years prior to their diagnosis.
Methods
We obtained details of all colorectal cancers diagnosed between 2017-2019 at our department. We then surveyed the endoscopy system to detect the patients who had a negative colonoscopy within the 5 years prior to their diagnosis, to calculate what percentage of cancers diagnosed within that period were interval cancers.
Results
Between 2017-2019, 539 patients were diagnosed with colorectal cancer. Age at diagnosis varied widely from 21 to 107, and 310 (57.5%) of patients were male. Seventeen patients had a negative colonoscopy within 5 years (though two of these were planned repeat procedures within a few months of the index ‘negative’ colonoscopy). We can therefore calculate the rate of interval cancer at 3.1% between 2017-2019.
Conclusions
The aetiology of interval colorectal cancer has been attributed to patient/tumour factors (right colon and female sex) and technical factors (adenoma detection and caecal intubation rate). Though the rate of interval cancer at our department seems pleasingly low compared to the literature, we plan to investigate the risk factors that might be at play: are biological factors to blame or can our endoscopy service be improved?
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