Colorectal carcinoma over 30 years at one hospital: no evidence for a shift to the right.

Many recent reports in the North American literature have documented an increase in the ratio of proximal to distal colorectal cancers with an increase in right-sided lesions. In order to assess trends in the distribution of large bowel carcinoma at our hospital we reviewed the files of 1553 patients who presented with primary colorectal carcinoma over a 30-year period. Thirty-nine percent of patients were over 70 years old and 51% were in the 50-69 year age group. Seventy five percent of the carcinomas were left-sided, 22% right-sided and caecal carcinomas accounted for 18%. This distribution varied only slightly over the study period. Left-sided lesions were more common in males (55%: p less than 0.005), and right-sided lesions were more common in females (57%: p less than 0.005). Caecal carcinoma was more common in patients over 69 years old than in younger patients (p less than 0.001). In elderly females (greater than 69 years) 30% of colorectal carcinomas occurred in the caecum. These findings may have important implications for the investigation of patients with suspected colorectal disease or for screening programmes.

Non-specific abdominal pain in pre-menopausal women.

Non-specific abdominal pain (NSAP) is a well-recognized clinical problem which places a significant burden on health resources. We studied 100 premenopausal women who were admitted consecutively through the Accident and Emergency Department of the Mater Misericordiae Hospital to assess final diagnosis, duration of hospital stay, extent of investigation, recurrence of symptoms and final diagnosis. The patients were placed in the following diagnostic categories: Gynaecological (30%), Renal (9%), Acute appendicitis (23%), Miscellaneous (9%) and Non-specific abdominal pain which accounted for 29% of the admissions. The mean duration of hospital stay for patients with NSAP was 67 days, one third underwent specialized investigations and one third underwent appendicectomies for normal appendices. On review, one year after admission, 66% of patients admitted with NSAP were asymptomatic.

Angiographic evaluation of gastrointestinal haemorrhage complicating pancreatic disease.

Seven patients with gastro-oesophageal varices due to splenic or portal vein obstruction from a diseased pancreas have been seen at the Mater Hospital during the past three years. Four of these patients had episodes of acute and massive gastrointestinal bleeding and this paper emphasises the role of angiography in the management of this complication. In three instances the bleeding was the result of the varices, but in one patient with carcinoma of the head of the pancreas the bleeding was shown to result from invasion of the tumour into the duodenum.