Wait times for gastroenterology consultation in Canada: the patients' perspective.

Long wait times for health care have become a significant issue in Canada. As part of the Canadian Association of Gastroenterology's Human Resource initiative, a questionnaire was developed to survey patients regarding wait times for initial gastroenterology consultation and its impact. A total of 916 patients in six cities from across Canada completed the questionnaire at the time of initial consultation. Self-reported wait times varied widely, with 26.8% of respondents reporting waiting less than two weeks, 52.4% less than one month, 77.1% less than three months, 12.5% reported waiting longer than six months and 3.6% longer than one year. One-third of patients believed their wait time was too long, with 9% rating their wait time as 'far too long'; 96.4% believed that maximal wait time should be less than three months, 78.9% believed it should be less than one month and 40.3% believed it should be less than two weeks. Of those working or attending school, 22.6% reported missing at least one day of work or school because of their symptoms in the month before their appointment, and 9.0% reported missing five or more days in the preceding month. A total of 20.2% of respondents reported being very worried about having a serious disease (ie, scored 6 or higher on 7-point Likert scale), and 17.6% and 14.8%, respectively, reported that their symptoms caused major impairment of social functioning and with the activities of daily living. These data suggest that a significant proportion of Canadians with digestive problems are not satisfied with their wait time for gastroenterology consultation. Furthermore, while awaiting consultation, many patients experience an impaired quality of life because of their gastrointestinal symptoms.

Carcinoids of the common bile duct: a case report and literature review.

Carcinoids of the extrahepatic bile ducts and particularly the common bile duct are extremely rare. A 65-year-old woman presented with obstructive jaundice. Laboratory and imaging studies gave results that were consistent with an obstructing lesion in the common bile duct. In this case, a stent was inserted initially to decompress the bile ducts. Subsequently a laparotomy and pancreaticoduodenectomy were performed and a tissue diagnosis of carcinoid of the common bile duct was made. The patient was well with no evidence of recurrence 17 months postoperatively. The authors believe this is the 19th reported case of an extrahepatic bile duct carcinoid.

A comparison of methods of screening for sperm antibodies in the serum of women with otherwise unexplained infertility.

Sera from 102 women with infertility due to a variety of causes and from 40 pregnant women were studied for the presence of antisperm factors. Three techniques were used: sperm microagglutination, sperm immobilization, and an indirect immunofluorescent technique for detection of sperm-bound immuno-globulins. There was no correlation between the results obtained using these three different techniques. Of the three, only the results of sperm immobilization tests correlated with primary unexplained infertility. The sperm microagglutination test appeared to measure nonspecific factors. Methanol fixation of spermatozoa used in the indirect immunofluorescent technique apparently resulted in nonspecific binding of immunoglobulins. When fresh spermatozoa were used no binding of immunoglobulin to spermatozoa could be demonstrated. The nature and location of the antigen(s) involved remain to be determined.