Familial colorectal cancer referral to regional genetics department--a single centre experience.

Evaluation of familial colorectal cancer referral can assist in the planning of future cancer surveillance. The aim of the study is to assess colorectal cancer referral pattern to our regional genetics service. Hospital computer records and/or department referral books were used to identify cases referred to the regional genetic service during a 10-year period (1992-2001 inclusive). All files were reviewed along with associated demographic data, risk assessments, referral details, results from mutation testing and screening recommendations. In terms of result, a total of 1100 family files were reviewed (Familial Adenomatous Polyposis families were in a separate register). The number of referrals showed a 10-fold increase over the 10 years. 171 (15.6%) of families met the Amsterdam criteria II were classified as high-risk, 589 (53.5%) families were classified as moderate-risk and 337 (31.0%) as average or low risk. 22.9% families were referred with inaccurate cancer history. Sixty-one families have been identified with mismatch repair mutations. 56.8% of referred individuals were recommended to have regular colonoscopy ranging from 18 monthly to 5 yearly depending on their risks. In conclusion, there has been a 10-fold increase in individuals with suspected hereditary bowel cancer referred to the North West Regional Genetics Service in the last ten years. Genetic assessment may reduce the number of low-risk individuals and those who were found not to be mutation carriers from having unnecessary colonoscopic screening. Thus genetic risk assessment should precede the initiation of regular endoscopic screening.

In open heart surgery is there a role for the use of carbon dioxide field flooding techniques to reduce the level of post-operative gaseous emboli?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether there is any benefit to the use of carbon dioxide (CO(2)) field flooding techniques in open heart surgery in order to reduce post-operative gaseous emboli. Altogether 103 papers were found using the reported search, of which 3 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is no large clinical study to prove that there is a neurocognitive benefit to the use of CO(2) field flooding. However, experimental evidence shows that the solubility of CO(2) emboli justifies efforts to replace intracavital air with CO(2) in open heart surgery to reduce gaseous emboli but that caution is warranted as use of excessive cardiotomy suction may result in hypercarbia.

Detecting high-risk patients with chest pain.

AIM: To assess the ability of nurses using the Manchester Triage System (MTS) to identify those patients with chest pain requiring immediate electrocardiogram (ECG) and physician assessment within ten minutes. METHOD: A four-week prospective cohort of all patients attending with chest pain compared detection of risk by nurses using the MTS to that of researchers using best available evidence-based prognostic indicators from history. RESULTS: The study of 167 patients showed that nurses using MTS had a sensitivity of 86.8 per cent (95 per cent confidence interval (CI), 78.4-92.3 per cent) and a specificity of 72.4 per cent (95 per cent CI, 61.4-81.2 per cent) when identifying high risk cardiac chest pain. CONCLUSION: Nurses using the MTS are a sensitive tool for identifying high risk cardiac chest pain but further work is required to assess whether additional training can improve sensitivity.