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Aim Biennial screening for colorectal cancer using faecal occult blood testing has been shown to reduce the relative risk of mortality from colorectal cancer. The Norwich screening centre commenced screening in July 2006 and so far has diagnosed over 350 patients with colorectal cancer. We compared the stage at diagnosis and cancer-specific mortality and survival in patients diagnosed through screening with a cohort of symptomatic patients with colorectal cancer within the same age range. Method A comparative analysis was undertaken of all screen-detected colorectal cancer patients diagnosed between July 2006 and December 2010, with an age-matched group of patients diagnosed in the Norfolk and Norwich Hospital through the 2-week suspected colorectal cancer guidelines. Results Three hundred and fifty-six cases of colorectal cancer were diagnosed through the screening programme, in patients with an age range of 60–79 years. In the same time period, 292 patients in the same age range were diagnosed with colorectal cancer through the 2-week suspected colorectal cancer pathway. Sixteen patients in the screening group had evidence of metastatic disease at presentation compared with 62 in the symptomatic group (χ2, P

Background Perforated diverticulitis (PD) remains a serious acute abdominal condition. The aims of this study were to measure its incidence in a large UK population and to identify factors affecting outcomes. Methods Computerized searches of hospital coding databases for PD were performed in five hospitals in East Anglia, UK. Data were collected from hospital records over 5 years (1995–2000). Incidence was calculated using population data, and factors associated with mortality and morbidity were identified using univariable and multivariable testing. Results Some 202 patients with PD were identified, of whom 93·1 per cent underwent surgery and 24·3 per cent died. The age-adjusted adult incidence of perforation was 3·5 per 100 000 per annum, with a standardized female to male ratio of 1·3 (95 per cent confidence interval (c.i.) 1·1 to 1·5) to 1. Risk factors for death were increased age (odds ratio (OR) 3·5 (95 per cent c.i. 1·9 to 6·1)), pre-existing renal disease (OR 18·7 (1·6 to 211·4)) and pre-existing use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR 3·1 (1·3 to 7·3)). Conclusion PD is uncommon, with the highest incidence in women over 65 years old. Mortality rates are high, particularly in those taking NSAIDs or with pre-existing renal impairment.

Background Acute perforated colonic diverticular disease has a mortality rate of up to 30 per cent, but little is known about its aetiology. The aim of this study was to test the hypothesis that three classes of drugs, namely non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics and corticosteroids, are risk factors for perforated diverticular disease. Methods All patients with confirmed perforated colonic diverticular disease were identified over a 5-year period in two hospitals in Norfolk, UK. Two control groups were selected and matched for age, sex and hospital of admission. Data on medication use were obtained from hospital records. Odds ratios for each drug were calculated using conditional logistic regression. Results Opioid analgesics, NSAIDs and corticosteroids were all positively associated with perforated colonic diverticular disease. The odds ratio for opioid analgesics was 1·8 (95 per cent confidence interval (c.i.) 1·1 to 3·0) in the analysis with ophthalmology controls and 3·1 (95 per cent c.i. 1·8 to 5·5) in that with dermatology controls. Respective odds ratios for NSAIDs were 4·0 (95 per cent c.i. 2·1 to 7·6) and 3·7 (95 per cent c.i. 2·0 to 6·8), and those for corticosteroids were 5·7 (95 per cent c.i. 2·2 to 14·4) and 7·8 (95 per cent c.i. 2·6 to 23·3). Conclusion Opioid analgesics, NSAIDs and corticosteroids are all positively associated with perforated colonic diverticular disease. The consistency of these associations, together with plausible biological mechanisms, suggests that these drugs may have a causative role in this condition.

Perforated colonic diverticular disease results in considerable mortality and morbidity. This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. Computerised searches were used to identify published articles relating to the epidemiology, pathophysiology, and clinical features of perforated colonic diverticular disease. Several drug and dietary exposures have potential biological mechanisms for causing perforation. Of these only non-steroidal anti-inflammatory drugs have been consistently identified as risk factors in aetiological studies. The causes of perforated colonic diverticular disease remain largely unknown. Further aetiological studies, looking specifically at perforation, are required to investigate whether cause-effect relationships exist for both drug and dietary exposures. The identification of risk factors for perforation would allow primary public health prevention, secondary risk factor modification, and early prophylactic surgery to be aimed at people at high risk.

Biennial screening for colorectal cancer using faecal occult blood testing has been shown to reduce the relative risk of mortality from colorectal cancer. The Norwich screening centre commenced screening in July 2006 and so far has diagnosed over 350 patients with colorectal cancer. We compared the stage at diagnosis and cancer-specific mortality and survival in patients diagnosed through screening with a cohort of symptomatic patients with colorectal cancer within the same age range.A comparative analysis was undertaken of all screen-detected colorectal cancer patients diagnosed between July 2006 and December 2010, with an age-matched group of patients diagnosed in the Norfolk and Norwich Hospital through the 2-week suspected colorectal cancer guidelines.Three hundred and fifty-six cases of colorectal cancer were diagnosed through the screening programme, in patients with an age range of 60-79 years. In the same time period, 292 patients in the same age range were diagnosed with colorectal cancer through the 2-week suspected colorectal cancer pathway. Sixteen patients in the screening group had evidence of metastatic disease at presentation compared with 62 in the symptomatic group (χ(2) , P0.001). The proportion of T1/T2 and Dukes A cancers was significantly greater in the screening group (χ(2) , P 0.001). There were 21 colorectal cancer-related deaths in the screening group compared with 66 in the symptomatic group. Survival analysis curves showed significantly better survival in the screening group (log-rank analysis P0.001).Screening for colorectal cancer identifies cancers at a significantly earlier stage than in symptomatic patients, with subsequent improvement in cancer-specific survival.

AIM: To study the factors that contribute to postoperative stay following colorectal surgery. DESIGN: A prospective observational study. SETTING: Three colorectal surgical units - a teaching hospital, a large district general hospital and a district general hospital. PARTICIPANTS: 350 patients undergoing colorectal surgery. MAIN OUTCOME MEASURES: 28 pre-, peri- and postoperative patient- and treatment-related factors. RESULTS: Stepwise regression analysis suggests that the factors that significantly lengthen postoperative stay include a low albumin on admission, stoma formation, operative blood loss, urinary and respiratory complications, wound infections, postoperative ventilation and social delay at the time of discharge. The postoperative stay was not affected by patient age or by the seniority of the surgical team. CONCLUSIONS: Factors have been identified that determine the postoperative length of stay. These data may allow better planning and treatment of patients undergoing colorectal surgery.

The aetiology of perforation of large bowel diverticula is poorly understood and a case-control study is required to identify the causes. Before such a study can be attempted, the incidence must be determined and groups at particular risk identified. Cases of perforated large bowel diverticula living in the Norwich postal code region treated between 1995 and 1997 were identified. Fifty-eight cases presented in a population of 531 241. The incidence was 4.0 cases per 100,000 per year, increased with age and was higher in men than women (5.8 vs 3.1). The most frequently used drugs were non-steroidal anti-inflammatory drugs (NSAIDs) (29%) and opiate analgesics (26% of cases). This is the first report of the incidence of perforated diverticular disease and allows a calculation of the population size needed to recruit sufficient cases for an aetiological investigation. The differences in incidence between genders should prompt a search for factors which differ between the sexes such as diet. NSAIDs are a known risk factor, although the data show that opiate analgesics should be investigated.

Sixty-five patients with suspected deep venous thrombosis (DVT) in 68 limbs were entered consecutively into a study to compare venography with duplex ultrasonography scanning. Both tests were performed on 64 limbs, venography being contraindicated in four. Overall, duplex scanning correctly identified 86 per cent of DVTs diagnosed on venography and correctly excluded 80 per cent with negative venograms. Nearly all errors arose in the diagnosis of calf DVT. In the femoral vein duplex scanning had a specificity of 100 per cent and a sensitivity of 95 per cent. In addition, duplex scanning provided data on the limb not undergoing venography. Of 55 limbs that underwent bilateral duplex scanning, five had thrombus in the femoropopliteal segment and a negative contralateral venogram. In addition, three Baker's cysts were diagnosed. Duplex scanning can be used in patients in whom venography is contraindicated and may also provide information about the contralateral limb. We regard femoropopliteal duplex scanning as sufficiently accurate that treatment can be initiated on the basis of the scan. Duplex scanning should replace venography as the standard method of diagnosing femoropopliteal DVT; radiographic studies should now be required only when the scan result is in doubt.

Summary A retrospective review of 201 patients with stab wounds admitted to an East London Hospital over a period of six years was performed. There was no striking increase in the annual incidence of these injuries over the period reviewed. The majority of patients were young males who arrived at the Accident and Emergency Department after 1800 h on a Friday, Saturday, or Sunday and had consumed alcohol prior to admission. There were 47 abdominal injuries (23%), 69 thoracic (34%), 51 limb injuries (25%) and 34 injuries involving the head and neck (17%). Forty patients (20%) had injuries involving more than one site. Abdominal stabbings were managed by a selective approach resulting in 28 laparotomies of which only 2 (7%) were negative. Evisceration of small bowel or omentum was always associated with significant intraperitoneal injury.

The effect of hormone therapy on the growth of human colonic adenocarcinoma xenografts in nude mice was evaluated. Primary xeno-transplantation for ten different human colorectal adenocarcinomas into nude mice yielded a tumour take of 50%. One of these host tumours was found to contain androgen receptors (8 fmol/mg cytosol protein; Kd 0.73 x 10(-9) M), which were maintained in the xenograft at the third and ninth passages, but not expressed at the tenth and twelfth passages. The host tumour and its xenograft did not express either oestrogen or progesterone receptors. Administration of dihydrotestosterone led to inhibition of xenograft growth at the ninth passage compared with untreated controls (P less than 0.05), but had no effect on xenograft growth at the tenth and twelfth passages when androgen receptors were absent. Stilboestrol and progesterone failed to influence xenograft growth. In conclusion, dihydrotestosterone administration led to inhibition of xenograft growth only in the presence of androgen receptor, suggesting that some colorectal cancers might be considered steroid-hormone-sensitive tumours.

Existing techniques for androgen receptor (AR) assay are complicated by cross-reactivity of ligand binding affinities that can lead to incorrect estimation of receptor concentration. Two most frequently used ligands are [3H]dihydrotestosterone [( 3H]DHT) and [3H]methyltrienolone [( 3H]R1881), which in addition to binding to AR also bind to sex hormone binding globulin (SHBG; Kd = 1.5 nM) and progesterone receptors (PgR; Human Kd = 1 nM, rat Kd = 6 nM) respectively. Triamcinolone acetonide (TMA) is commonly used to block binding of [3H]R1881 to PgR, however at high concentrations TMA itself will bind AR (Kd = 7 microM). We have developed a hybrid ligand method for the measurement of AR in the presence of SHBG and PgR. This method used [3H]R1881 as the high specific activity labelled tracer and DHT as the unlabelled competitor of specific AR binding. Using this assay, 20% of human colorectal carcinomas were found to contain AR.

To evaluate the potential effect of androgens on human colorectal cancer, the prevalence and concentration of cytosolic androgen receptors were analyzed in 23 rectal and 13 cecal adenocarcinomas by a hybrid radioligand assay. Androgen receptors were detected in nine of the rectal (39 percent) and five of the cecal tumors (38 percent). Androgen receptor levels demonstrated were low, ranging from three to 17 fmol/mg cytosol protein. Dissociation constants were 1 nM or less. The presence of androgen receptors was independent of age or sex of the patient, and of the state of histologic differentiation and Dukes' staging of the tumor. Androgen receptor prevalence was similar in mucosa adjacent to rectal and cecal adenocarcinomas and in mucosa from five of ten patients (50 percent) with diverticular disease. Our findings suggest that androgen dependency does not play a major role in endocrine control of the development of rectal cancer.

To evaluate the potential effect of androgens on the development and growth of human colorectal adenomas, the prevalence and concentration of cytosolic androgen receptors (AR) were analysed in 26 adenomas and 19 samples of normal colonic mucosa by a hybrid ligand receptor-binding assay. AR were detected in 7 of the adenomas (26.9%), and in 6 of the normal mucosa samples (31.6%). In the adenomas, AR levels demonstrated were low, ranging from 6 to 31 fmol/mg cytosol protein, and dissociation constants (Kds) ranged from 0.17-2.7 X 10(-9) M. Of 13 adenomas excised from men, 6 (46%) had positive receptor activity, whereas only 1 of 13 (7.7%) from women was positive (P = 0.03, Fisher's exact test). There was no correlation between AR titre and patient age, or between adenoma size and histological type or degree of dysplasia. In normal mucosa, AR levels ranged from 7 to 33 fmol/mg and Kds ranges from 0.24-3.1 X 10(-9) M. There was no significant difference between either AR prevalence or levels in the adenomas and normal mucosa. The sex difference was exclusive to the adenoma. Endogenous androgen may play a role in adenoma development early in the promotional process.

Summary Two cases of male breast carcinoma presenting as cystic swellings are reported. Cysts of the male breast are rare, but unlike cysts in female breasts are more likely to represent significant pathology. We recommend consideration of excision biopsy of isolated cysts in male breasts.