Methods: We selected 32 patients among 241 patients with advanced pancreatic cancer. All 32 patients took abdominal CT more than one time, before their pancreatic cancers were diagnosed. Eight of the 32 patients underwent pancreatic resection.We reviewed all patients' abdominal CT and checked how abnormal findings appeared in the pancreas before finding their pancreatic cancer. Results: Twenty-three (71.8%) of the 32 patients had a localized constriction of the pancreatic parenchyma before appearing the pancreatic cancer. We named it "K-shaped sign" based on the figure. All of the 23 patients showed focal fatty changes around the area the K-shaped sign appeared. Four (17.3%) of the 23 patients had both K-shape sign and a partial main pancreatic duct dilatation. Nineteen of the 32 patients had a normal pancreas without focal fatty change on CT before the K-shaped sign occurred. Thirteen of the 32 patients had detected the Kshaped sign since the initial abdominal CT. All the 32 patients had the pancreatic cancer in the K-shaped sign's area. Conclusion: We introduced new CT finding before pancreatic cancer could be found, and named it "K-shaped sign" on CT. Although the "K-shaped sign" phenomenon has to be associated with early pancreatic cancer, it is unclear what the cause of the phenomenon is. When the K-shaped sign is observed on CT, the onset of a pancreatic cancer should be considered and determined by using more precise modalities.
Introduction Laparoscopic appendicectomy (LA) is the most common emergency surgical operation. Recently Same day discharge after uncomplicated LA has been more popular. Our study has sought to assess the safety of same day discharge and creating a pathway for day case appendicectomy. Inclusion Criteria Pre-operative: No signs of sepsis. CT proven or clinically suspected mild appendicitis (WCC<15, CRP<150) Intra-operative: Mild appendicitis, No perforation, No Gangrene, No free pus. Post-operative: Pain is controlled with oral analgesia. Patient is tolerating oral intake. No need for post-operative antibiotics according to WSES Jerusalem Guideline for diagnosis and treatment of acute appendicitis 2016. Social circumstances do allow safe discharge. Method A prospective case series study was undertaken at a large district general hospital over a 9-month period. 27 patients were included in the study, age range (10-78) years. 74% had ASA 1. 8 patients underwent day case LA & were sent home on oral antibiotics the day before the operation and asked to come back the following morning. 22 patients did not require any post op antibiotics. 5 patients received 1 dose of IV antibiotics post-operative. The 30-day morbidity/ mortality were zero. There were no readmissions during this time and patient satisfaction was high. Conclusions Same day discharge after laparoscopic appendectomy is safe and valid. Day case appendectomy should be considered for appropriate patients. Both approaches will decrease patients’ risk of hospital acquired infection and also decrease the burden on the NHS.
Introduction Patients on the cancer pathway should be investigated on the 2 weeks wait pathway, but Covid-19 pandemic had universal impact on the Healthcare systems. One of the main worries was the impact on cancer patients due to delayed diagnosis and management. Our study looks at the timeframe of investigations for colorectal cancer during the second wave of the pandemic compared to pre covid time. Method Retrospective study looking at the waiting time to investigate patients with +ve qFIT test during the second wave of pandemic (from November 2020 till March 2021). Results During this period 150 patients had +ve qFIT test, the main presenting symptom was Change in bowel habits. 90 patients were investigated with colonoscopy, only 16 (17%) patients had the colonoscopy done within 2 weeks from the qFIT result. 23 patients had colonoscopy 2–3 weeks from the result. 30 patients (33%) had the colonoscopy between 3–4 weeks, and 21 patients had to wait between 1–6 months to have the colonoscopy. Out of the 150 patients, 60 patients were investigated primarily with CT scan or CT colon. Conclusion During the covid-19 pandemic, majority of patients in our trust were investigated within one month of +ve qFIT test but yet there was some delay in carrying out the investigations compared to the normal pathway and more patients had CT scans as primary investigations before being referred for colonoscopy.
Introduction Colorectal cancer is one of the most common cancers. In 2013 in the UK, 41,112 people were diagnosed with colorectal cancer and 15,903 people died from it. The qFIT(quantitative faecal immunochemical test) is now widely used in the National Bowel Cancer Screening Program (NBSCP). It is also a good test to identify symptomatic people at higher risk of having a diagnosis of colorectal cancer. We present single center experience with Q fit testing. Methods Retrospective cohort study performed in a large district general hospital looking at the outcome of patients with +ve qFIT test (≥10 micrograms). Results Over the period from July 2020 till November 2021, over 2000 patients had qFIT tests to investigate red flag lower GI symptoms. Out of the 2000 patients, 448 patients had +ve qFIT. Over 70% of the patients Referred by the GP with Change in bowel habits, the test was organized by the hospital not the primary care. 260 patients were investigated with colonoscopy, 17 patients had histology confirming colorectal cancer. 172 patients were not fit enough for colonoscopy and were investigated with CT colon/CT, only 3 patients out of this group had features suggesting colorectal cancer on the CT scan. Conclusion 20 out of 448 patients were diagnosed with colorectal cancer, the rest of the patients had either benign colorectal polyps or diverticular disease. As the qFIT test is now more widely used, it needs to be organised by the primary care centers to speed up the process of diagnosis and management.
Introduction When FIT is used for symptomatic patients presenting to primary care a positive result is considered ≥10 mcgHb/gStool. When qFIT is used for the asymptomatic screening population (i.e NBCSP) a positive result is ≥120mcgHb/gStool. During covid-19 Pandemic the 120 cut off was used in some of the hospitals to triage patients who require further investigations for either colonoscopy or CT scan. Methods Retrospective cohort study done in general district hospital comparing the pathology identified in patients with Qfit results>120 and patients with result <120. Results In the period between July 2020 and November 2021, 448 patients had +ve qFIT result (≥10 micrograms).In the first group, 340 patients had qFIT result <120. 191 patients had colonoscopy with 8 confirmed colorectal cancer, and 137 patients had CT/CT colon with only 1 patient was found to have colorectal cancer. Overall 2.6% of the patients had cancer. While in the second group, 108 patients had qFIT>120. 69 patients had colonoscopy with 9 confirmed cancer. the rest of the patients had CT/CT colon with 2 patients showing features of malignancy. Overall 10.1% of the patients had cancer. Conclusion The incidence of colorectal cancer in patients with qFIT result >120 is much higher than the other group, but the incidence of colorectal cancer in patients with qFIT<120 is still significant and the patients shouldn't be discharged without investigations.
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