A study in general practice of the symptoms and delay patterns in the diagnosis of gastrointestinal cancer

Gastrointestinal cancer was classified into four groups according to the site: stomach, caecum and ascending and transverse colon, sigmoid colon and rectum. The incidence of these cancers in general practice is as rare as three per 10,000 consultations. I report on a study in general practice of the symptoms and delays in diagnosis in 150 patients with gastrointestinal cancer. There was an interval of many weeks between the onset of symptoms and diagnosis in the majority of cases. In approximately 50 per cent of cases there was an interval of weeks between the patient consulting the general practitioner and being referred for hospital investigation. No association was demonstrated between delay and social class, age, physical isolation, or the regular consulting rate of the patient. There was evidence that the consulting rate of some patients with gastrointestinal cancer increased in the 12 months before diagnosis because of the presence of symptoms not specific to the gastrointestinal tract.Much more knowledge of the early symptoms of these cancers is required if the general practitioner is to be able to identify those patients with a high probability of early cancer from others who have symptoms which are common both to non life-threatening conditions and to cancer lesions.     

Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

Retrospective case review of capsular contracture after two-stage breast reconstruction: is colonization of the tissue expander pocket associated with subsequent implant capsular contracture?

Periprosthetic capsular contracture is a common problem associated with implant-based breast reconstruction. The purpose of this study was to determine if bacterial colonization of the tissue expander contributes to contracture of the permanent implant. Medical records were reviewed for 86 patients (124 tissue expanders) between 1997 and 2001 in 1 institution. Three specimens taken from the expander were cultured. The overall incidence of colonization was 42.7%; 49.4% (38.8-60.0) of immediate and 28.2% (14.1-42.3) of delayed expanders had at least 1 positive culture site (P = 0.043). The most common organisms were Propionibacterium acnes (57.6%), Staphylococcus epidermidis (31.0%), and Peptostreptococcus (5.8%). Statistical analysis revealed no significant difference between colonization of the expander and capsular contracture of the permanent prosthesis (P = 0.59). 45.8% (25.9-65.8) of breasts irradiated preoperatively developed contracture versus 14% (7.2-20.8) with no irradiation (P = 0.0013). These results suggest that colonization of the expander occurs frequently, irradiation predisposes to contracture, and colonization did not contribute to secondary implant contracture in this study population.     

Endocrine and metabolic response in the human newborn to first feed of breast milk

The hormonal and metabolic response to the first feed of breast milk was studied in 12 infants at 4-6 hours of age. After the feed there was an increase in blood glucose concentration but no changes in the concentrations of lactate, pyruvate, alanine, or ketone bodies. The feed was followed by an increase in the concentrations of plasma insulin, growth hormone, gastrin, and enteroglucagon, but no change in levels of plasma glucagon or gastric inhibitory peptide. Several hormone systems are functionally active at birth and are stimulated by the first feed of milk.