Sharad Karandikar

The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes' stage B disease.

Objective  An adequate lymph node harvest is necessary for accurate Dukes’ stage discrimination in colorectal cancer. The aim of this study is to identify the effect of variables, including the individual surgeon and pathologist, on lymph node harvest in a single institution.

Volume and accreditation, but not specialty, affect quality standards in colonoscopy

The Global Rating Scale, defined by the Joint Advisory Group for Gastrointestinal Endoscopy, requires monitoring of endoscopic performance indicators. There are known variations in colonoscopic performance, and investigation of factors causing this is needed. This study aimed to analyse the impact of endoscopist specialty and procedural volume on the quality of colonoscopy.

Socioeconomic deprivation adversely affects survival of patients with rectal cancer

The aim was to examine the influence of socioeconomic deprivation on stage at presentation, perioperative mortality, permanent stoma rates and overall survival in patients with rectal cancer.

Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms

Background Computed tomographic colonography (CTC) is now an established method for imaging the colon and rectum in the screening and symptomatic setting. Additional benefit of CTC is the ability to assess for extracolonic findings especially in patients presenting with colorectal symptoms. Purpose To determine prevalence of extracolonic findings (ECF) in symptomatic patients undergoing CTC and determine accuracy of CTC for exclusion of significant abdominal disease and extracolonic malignancy (ECM). Material and Methods A total of 1359 unenhanced prone and postcontrast supine CTC studies were performed between March 2002 and December 2007. ECF were retrospectively classified according to C-RADS criteria into E1 to E4 findings. For ECM, a gold standard of clinical and/or radiological follow-up supplemented with data from the regional cancer registry with a median follow-up of 42 months was created. Sensitivity and negative predictive values for ECM was calculated. Results Following exclusions, 1177 CTCs were analyzed. Of 1423 extracolonic findings reported, 328/1423 (23%) E3 and 100/1423 (7%) E4 (including six eventual FP studies) findings were identified. Thirty-two ECMs were confirmed following further investigations. Seven further small ECMs were detected during the entire follow-up, of which two were potentially visible in retrospect (false-negative studies). Additional tests were generated from 55/1177 (4.7%) studies. Sensitivity and negative predictive value for ECM was 94.1% (95% CI 78.9–98.9%) and 99.8% (95% CI 99.3–99.9%), respectively. Conclusion One in 37 patients were found to have an ECM. Two potentially detectable cancers were missed. Only a small proportion of patients underwent additional work-up.

Plasma magnesium should be monitored perioperatively in patients undergoing colorectal resection

Objective  Hypomagnesemia has been shown to have several clinically important sequelae. The aims of this study were: to assess the impact of bowel preparation, with sodium picosulphate (Picolax®), on plasma electrolytes, with particular regard to plasma magnesium, in patients undergoing bowel preparation for colonoscopy and colorectal resection and to evaluate the influence of perioperative magnesium levels on postoperative cardiac dysrhythmias.

Engaging with Faith Councils to Develop Stoma-specific Fatawās: A Novel Approach to the Healthcare Needs of Muslim Colorectal Patients.

Intestinal stomas are common. Muslims report significantly lower quality of life following stoma surgery compared to non-Muslims. A fatwā is a ruling on a point of Islamic law according to a recognised religious authority. The use of fatawās to guide health-related decision-making has becoming an increasingly popular practice amongst Muslims, regardless of geographic location. This project aimed to improve the quality of life of Muslim ostomates by addressing faith-specific stoma concerns. Through close collaboration with Muslim ostomates, a series of 10 faith-related questions were generated, which were posed to invited local faith leaders during a stoma educational event. Faith leaders received education concerning the realities of stoma care before generating their fatawās. The event lead to the formulation of a series of stoma-specific fatawās representing Hanafi and Salafi scholarship, providing faith-based guidance for Muslim ostomates and their carers. Enhanced communication between healthcare providers and Islamic faith leaders allows for the delivery of informed fatawās that directly benefit Muslim patients and may represent an efficient method of improving health outcomes in this faith group.

Impact of bowel cancer screening on the management of colorectal cancer

The National Bowel Cancer Screening Programme (NBCSP) was introduced in the West Midlands in 2006. Studies, including the UK Bowel Cancer Screening Pilot, have reported an 18% reduction in mortality. This regional study assesses the impact of screening on elective and emergency colorectal cancer (CRC) surgery.

Administration of hyoscine- n-butylbromide during colonoscopy: a survey of current UK practice

Objective Current British Society of Gastroenterology (BSG) guidelines suggest that hyoscine-n-butylbromide (Buscopan) should be avoided during colonoscopy in patients with a history of angle-closure glaucoma. Angle-closure glaucoma, however, is not very common, is asymptomatic before onset and is treated definitively by a single laser treatment (if spotted early). Open-angle glaucoma is not affected by hyoscine. The aim of this study was to assess the use of hyoscine among colonoscopists, with particular reference to glaucoma. Design and setting Following BSG endoscopy subcommittee approval, a short questionnaire was electronically administered to members of the BSG and the Association of Coloproctology of Great Britain and Ireland. Main outcome measures Hyoscine use among colonoscopists, and effect of glaucoma history upon prescribing practice. Results 188 colonoscopists responded to some or all of the questions. 123/183 (67.2%) of respondents claimed they were aware of the BSG guidelines. 160/187 (85.6%) sometimes or always use hyoscine, while 27/187 (14.4%) never do. 137/177 (77.4%) always enquire about glaucoma history prior to administration, although 147/176 (83.0%) make no differentiation between open-angle or angle-closure forms. 126/178 (70.8%) would (incorrectly) withhold hyoscine if the patient declares a history of any form of glaucoma. 140/179 (78.2%) do not substitute glucagon as an antispasmodic. 4/180 (2.2%) had encountered ophthalmic complications post-administration. Conclusions Current BSG guidelines pertaining to hyoscine use and glaucoma are inappropriate; the authors recommend revision. Patients undergoing colonoscopy who have received hyoscine should, instead, be advised to seek urgent medical advice if they develop ophthalmic symptoms.

CT Colonography after Colorectal Cancer Resection: A One-Stop Assessment of Metachronous Mucosal Lesions, Local Recurrence, and Distant Metastases

Summary of ADC Measurements for Fetuses with and without Placental Insuffi ciency ParameterRegion 1 * Region 2 † Fetuses with Placental Insuffi ciency ( n = 33)Fetuses without Placental Insuffi ciency ( n = 69)Fetuses with Placental Insuffi ciency ( n = 33)Fetuses without Placental Insuffi ciency ( n = 69) Mean 1.454 1.771 1.415 1.752 Median 1.461 1.773 1.397 1.767 Standard deviation 0.106 0.208 0.132 0.181 Confidence interval 1.428, 1.498 1.705, 1.805 1.358, 1.455 1.686, 1.818 Note.— All measurements are given in 10 2 9 m 2 /sec. The average measurements of both readers are given. * Region 1 is located 2 cm from the insertion of the umbilical cord. † Region 2 is loca ted 5 cm from the insertion of the umbilical cord. “Reduction in False-Positive Results after Introduction of Digital Mammography: Analysis from Four Population-based Breast Cancer Screening Programs in Spain.” Radiology 2011;258(2):388–395 Page 388, the affi liations at the bot-tom left should read as follows: From the

VATER/VACTERL syndrome (vertebra/anus/cardiac/trachea/esophogus/radius/renal/limb anomalies) with a noncommunicating functioning uterine horn and a unicornuate uterus: a case report

OBJECTIVE To describe the presentation and outcome of a patient with an unusual association of VATER/VACTERL syndrome (vertebra/anus/cardiac/trachea/esophogus/radius/renal/limb) and noncommunicating functioning uterine horn and a unicornuate uterus. DESIGN Descriptive case report. SETTING A foundation trust in the United Kingdom. MATERIALS AND METHOD(S): A patient known to have VATER/VACTERL syndrome was diagnosed with a hematometra of a noncommunicating uterine horn and hematosalpinx. She underwent multidisciplinary surgery to remove the functioning uterine horn, after which she had a full recovery. CONCLUSION(S) This case documents the association of VATER/VACTERL syndrome with a unicornuate uterus and noncommunicating horn.