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The commonest form of pancreatic cancer is pancreatic ductal adenocarcinoma. The long-term outcome of pancreatic cancer is extremely poor, the overall median survival from diagnosis being 3–6 months without treatment, which increases to around 20 months with resectional surgery and adjuvant treatment. Pancreatic cancer is usually diagnosed late and has a biological phenotype characterized by resistance...
Diverticulosis simply describes the presence of diverticula; no symptoms need be present. It is common in older individuals in industrialized countries and is seldom found in developing countries. The prevalence increases with age, affecting more than 50% of people aged over 80 years. Men and women are equally affected. A diet poor in fibre is associated with the development of diverticula. The majority...
Chronic pancreatitis is a painful inflammatory disease affecting the exocrine and endocrine pancreas. Pancreatic failure may ultimately supervene, along with complications to the surrounding viscera and vasculature. Alcohol remains the commonest aetiology although there are many other causes, including toxins, structural abnormalities, autoimmune inflammation and genetic predisposition. This contribution...
Current routine diagnostic endoscopy is limited by the length of the endoscope, the skill of the endoscopist, and awareness of potentially subtle mucosal abnormalities. The biggest single advance in endoscopic practice in the last five years has been the widespread introduction of capsule endoscopy. This has revolutionized gastroenterologists’ ability to detect small bowel lesions. Capsule endoscopy...
There have been significant advances in gastrointestinal endoscopy. Developments in endoscopic technology suggest that even greater achievements in diagnosing and treating gastrointestinal disorders will be possible. This review focuses on the recent developments in the field of therapeutic endoscopy.
Patients may need an ileal pouch or permanent ileostomy if they require proctocolectomy for inflammatory bowel disease or, occasionally, for familial colorectal cancer. An ileal pouch is constructed from the terminal ileum and anastomosed to the top of the anus. This allows evacuation per anus and is generally preferred to an end ileostomy. In contrast to colitis, patients do not have urgency and...
The last decade has seen a dramatic change in the management of colorectal cancer. This has been delivered through more thorough and informed preoperative assessment, widespread use of multimodal treatments, including neoadjuvant therapy, and the introduction of minimally invasive procedures and improvement in rectal cancer surgery. This contribution discusses current issues in the management of cancer...
The development of new methods of contraception takes a long time. No new methods have become available in the UK in recent years and there are none on the near horizon. Activity in the arena of contraception has recently focussed on the production of guidelines designed to improve contraceptive prescribing among health professionals. New data on the effect on unintended pregnancy and abortion rates...
Colorectal cancer (CRC) is a curable disease; over 90% of patients who have surgical resection of a Dukes’ A tumour will still be alive after 5 years. This is direct evidence that an early diagnosis will reduce mortality from CRC. Despite this, CRC is the second most important cause of cancer-related deaths in the UK. The discrepancy suggests that outcomes can be improved by a better understanding...
The clinical assessment of patients with renal disease is an important skill for all clinicians as these patients can present to any hospital department, or in the community. This article provides the reader with a simple and logical approach to patients presenting with renal disease, by dividing them into three categories: acute renal failure (ARF), sub-acute or intrinsic renal disease, such as glomerulonephritis,...
Renal insufficiency alters both the disposition of drugs in the body (pharmacokinetics) and tissue responses to drugs (pharmacodynamics). If drugs or their active metabolites are excreted by the kidneys they can accumulate in renal insufficiency and cause adverse effects. Using simple principles, one can calculate changes in drug dosages that are required in renal insufficiency. Usually it is necessary...
A wide variety of pharmacological agents, drugs of misuse and environmental pollutants can cause an equally wide variety of renal disease. Consequently, the clinician should always consider these a potential cause for any newly diagnosed case of renal disease. In this contribution we present some of the commoner and more important presentations.
The renal biopsy is of fundamental importance in nephrology and transplantation. Using appropriate guidelines for including or excluding patients it is generally safe with the commonest complication being bleeding. The adequacy and safety have been improved using real-time ultrasound imaging and automated biopsy needles. To fully interpret the pathological findings and understand their significance,...
Inherited disorders of renal structure and function are relatively common causes of end-stage renal disease requiring renal replacement therapy. A family history of haematuria, urinary tract infection or renal failure can alert the clinician to the possible diagnosis of underlying renal genetic abnormalities. In practice, autosomal dominant polycystic kidney disease (ADPKD) is the commonest inherited...
In recent years, the rates of nearly all sexually transmitted infections (STIs) have continued to rise. The epidemic of syphilis among men having sex with men has continued to escalate, sexually transmitted hepatitis C, and the re-emergence of Lymphogranuloma venereum has also been seen in this group. Promising developments include a vaccine against some common types of genital human papilloma virus...
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