Endoscopic ablation of Barrett's neoplasia with a new focal radiofrequency device: initial experience with the Halo60.

Radiofrequency ablation (RFA) is an accepted treatment for the eradication of dysplastic Barrett's esophagus (DBE) and residual Barrett's esophagus after endoscopic resection of intramucosal adenocarcinoma. Circumferential balloon-based and focal catheter-based RFA devices are currently used (the Halo360 and Halo90). However, a new smaller focal ablation device (the Halo60) has been developed, which may be of benefit in patients with short tongues of Barrett's neoplasia, small residual islands, difficult anatomy, or strictures. We report the first use of this device in 17 patients with either DBE or residual Barrett's esophagus after endoscopic resection of intramucosal adenocarcinoma.

Age at death of patients with colorectal cancer and the effect of lead-time bias on survival in elective vs emergency surgery.

AIM: Colorectal cancer survival depends on stage at presentation, and current strategies aim for improvements through early detection. Previous studies have demonstrated improved survival from diagnosis but not increased life expectancy. While lead-time bias may account for variations in known prognostic indicators and also influence screening programmes, only age at death provides a true representation of the effectiveness of an intervention. We aimed to compare age at death for patients with colorectal cancer presenting on an emergency or elective basis. METHOD: Patients presenting with colorectal cancer (2000-2006) were entered into a prospective database (analysis 1 December 2008). Fields included age at death, emergency/elective presentation, palliative/curative intent and disease stage. RESULTS: One thousand six hundred and fifty patients (922 men) were identified. Elective patients presented younger than emergency patients (67.9 vs 70.6 years; P < 0.005). Dukes B patients presented older than Dukes D (P = 0.02). Mortality was 41% at time of analysis; no difference was seen in mean age at death between emergency and elective presentation (72.8 vs 72.0 years; P = 0.379) or palliative and curative intent (72.0 vs 72.5 years; P = 0.604). CONCLUSION: Colorectal cancer is common in a population where actuarial life expectancy is limited. Current colorectal cancer early detection strategies may improve cancer-specific survival by increasing lead-time bias but do not influence overall life expectancy.

Use of magnesium sulphate in Scottish obstetric units.

The greater efficacy of magnesium sulphate compared with diazepam or phenytoin in the treatment of eclampsia is now generally accepted. We used a postal questionnaire to establish the frequency and nature of use of magnesium sulphate in obstetric units in Scotland. Ninety percent of units responded and of these 90% were either using the drug or intended to do so. There was considerable heterogeneity in the indications for its use and some important omissions in the monitoring of patients receiving the drug. The introduction of magnesium sulphate for a rare indication to units with no previous experience of its use may be associated with significant risks to obstetric patients.

Scottish gynaecologists: their views on hormone replacement therapy.

In a postal questionnaire Scottish gynaecologists were asked their views on the use of Hormone Replacement Therapy (HRT). They were almost unanimous in support of HRT, but varied in the circumstances in which they would recommend it and in the length of time they would prescribe it. The need for designated Menopause Clinics was seen to be limited, with most smaller Units preferring the present practice of menopausal patients being seen at general Gynaecology Clinics. Most of those replying thought that General Practitioners (GPs) should continue to be the main providers of the therapy but 89 (77%) felt that Well Women/Family Planning Clinic (WW/FPC) doctors could be an alternative source. Several problems associated with the use of the therapy were indicated. These included uncertainties about the risks of long term use and the management of unscheduled vaginal bleeding, but there was also concern over the administrative and prescribing costs if the therapy is to be widely used as prophylactic medication.

Use of telephone enquiries to a microbiology laboratory as a proxy measure of reporting efficiency.

AIMS: To assess the efficacy of a bacteriology service in respect of the time interval between collection of specimen and receipt of final report using the number and type of incoming telephone enquiries as a proxy measure. METHODS: For three months, all incoming telephone enquiries regarding the results of bacteriology specimens were monitored. Specimen type, date of sampling, the sender's location and the reason for making the telephone enquiry were recorded. RESULTS: The number of telephone enquiries made during the study was 1170, about 5% of the total number of samples received. Most enquiries related to results of urine cultures. These accounted for 33.9% of the calls, but only 5% of the total number of urines cultured. Enquiries relating to blood cultures were the next largest group accounting for 14.9% of calls, but 11% of the blood cultures received resulted in a telephone enquiry. The most frequent reason for making the telephone call was that the sender had not received the final report. CONCLUSIONS: Clinicians may have unrealistic expectations of the time taken to examine a specimen. A requirement for reporting sterile blood cultures after a shorter incubation period was found, and the value to patient management of earlier reporting of negative urine samples was identified.

Teenage pregnancy in Scotland: trends and risks.

Teenage pregnancy, considered to be associated with social and medical risks, is seen as a growing problem. Population based information from the Registrar General (Scotland) and Notification of Abortion permitted an analysis of the trends in the numbers, rates and outcomes of pregnancies among women aged less than 20 years. In addition, clinical information is available on all deliveries in Scottish hospitals from the standard hospital discharge document permitting analysis of the association of defined complications with age. Contrary to current perceptions, pregnancies and births among teenagers are not more frequent in 1988 when compared to 1975. There has been, however, a large increase in births to single women, a group with particular problems. The obstetric risks when compared to older women, are small and probably socially, not age related. These include a slightly higher rate of pre-term delivery and low birthweight and a later presentation for specialist antenatal care. The proportion of pregnancies affected by neural tube defects which are terminated is lower among women under 20. These medical risks are small, however, compared to the well-documented social and economic problems which will have long term and indirect effects on health.

PIP: An analysis of trends in numbers, rates, and outcomes of pregnancies in women of 19 years and less was performed using population-based data from the Registrar General of Scotland, of all deliveries in Scottish hospitals from 1975 to 1988. The data were taken from the standard maternity discharge document including live and stillbirths, and from the 1975-87 Notifications of Abortion records. Pregnancies/1000 women ranged from 40 in 1983 to 50 in 1975. Proportionally more pregnancies were terminated in 1987. The number of live births to single women rose from 11.4 to 22.2/1000 over the period. In 1987 there were fewer marriages during pregnancy, and a lower proportion of pregnancies in married women. The total number of live births to women 20 decreased from 8267 in 1975 to 6158 in 1988, while those in single women rose from 2297 to 4558, from 28% to 74%. There were no evident trends in teen pregnancies, but an increase in the termination rate in teens was apparent. Most teen births occurred in mature out-of-school women. While 32% of primiparous women aged 18 booked for prenatal care at 21 weeks or more, there was no increase in anencephaly or spina bifida, which would have been detected by prenatal screening. Hypertension occurred in 14% of women 20 and in 21% of those 20. Operative deliveries were more common in women aged 20-24, and more often resulted in low birth weight. Low birth weight occurred in 8% of women, compared with 7% in those 20 (p0.01). When social factors were controlled, there were no differences in birth weight and gestation length. Indicators of social deprivation are discussed. The longterm implications of loss of education, training, employment, and stable marriages were considered more detrimental to the young mothers than the adverse health effects of early pregnancy.

Co-incidental Von Willebrands disease and immune thrombocytopenia in pregnancy: treatment with high dose intravenous immunoglobulin.

We report a rare association of Von Willebrands disease and idiopathic immune thrombocytopenia in pregnancy. The major threat to the successful outcome of the pregnancy was posed by the acquired disorder. The use of high dose immunoglobulin allowed a normal delivery, without any adverse effects on mother or child.

The effect of the synthetic steroid Org OD14 on fibrinolysis and blood lipids in postmenopausal women.

Two groups of postmenopausal women were compared. One group of 13 was given the synthetic steroid Org OD14 to suppress climacteric symptoms and one group of 14 was given placebo. After a 2 week baseline period the subjects received daily for 12 weeks, either 2.5 mg Org OD14 or placebo. There were no significant differences between the groups pre-treatment. Compared with the placebo group, during treatment, the Org OD14 group showed the following significant differences: higher haemoglobin, haematocrit, platelet count, plasminogen, fibrinolytic activity on fibrin plates and antithrombin III and lower fibrinogen. No significant differences between the groups were found in alpha 2 antiplasmin levels, total cholesterol, total triglycerides, bilirubin or transaminase levels but the Org OD14 group had significantly lower levels of HDL cholesterol. With the exception of the haemoglobin and haematocrit levels all of the differences had disappeared by 2 weeks post treatment.

Abnormally elevated pregnancy specific beta 1 glycoprotein (SP1 beta) with very low placental lactogen (hPL) concentrations in a pregnancy with satisfactory outcome.

Pregnancies with very low maternal serum concentrations of placental function monitors, yet resulting in a normal outcome, have been reported occasionally before (4, 6). We report here a case in which maternal serum placental lactogen (hPL) concentrations were very low, urinary estrogen output assessed by estrogen/creatinine ratio was satisfactory, but maternal serum pregnancy specific beta 1 glycoprotein (SP1 beta) concentrations were grossly elevated. Ultrasound findings suggested impairment of growth. The outcome of the pregnancy was satisfactory, although the baby, apparently of 38-40 weeks' gestation, developed mild respiratory distress.