Rapid Access Palliative Radiation Therapy Clinics: The Evidence Is There, but Where Are the Clinics? An Australian and New Zealand Perspective.

Purpose: First developed in Canada in the 1990s, Rapid Access Palliative Radiation Therapy (RAPRT) clinics have subsequently spread internationally to expedite treatment for near end-of-life patients, sparing them the need for multiple visits to the department. A "classical" RAPRT clinic is herein defined as "a dedicated clinic specifically established to enable (ideally) same day consultation, planning for, and delivery of palliative radiation treatment." The aim of this work was to determine the current status of these clinics in Australia and New Zealand (ANZ).

Thirty years of the Association of Coloproctology of Great Britain and Ireland.

This is a summary of the history of the Association of Coloproctology of Great Britain and Ireland from its inception in the late 1980s to the present day.

Interplay between mast cells, enterochromaffin cells, and sensory signaling in the aging human bowel.

Background: Advanced age is associated with a reduction in clinical visceral pain perception. However, the underlying mechanisms remain largely unknown. Previous studies have suggested that an abnormal interplay between mast cells, enterochromaffin (EC) cells, and afferent nerves contribute to nociception in gastrointestinal disorders.

Combined modality treatment for complex fistulating perianal Crohn's disease.

Aim: Perianal disease affects 33% (range 8-90%) of patients with Crohn's disease. Fistulae are often complex and their management is often difficult and unsatisfactory. This study was a retrospective assessment of a combination of surgical treatment with a standardized protocol of infliximab (IFX) therapy.

Pragmatic lifestyle intervention in patients recovering from colon cancer: a randomized controlled pilot study.

Objective: To investigate the feasibility of a pragmatic lifestyle intervention in patients who had recently completed surgery and chemotherapy for colon cancer and to obtain preliminary data of its impact on important health outcomes.

Design: A prospective, randomized, controlled pilot trial.

Setting: University rehabilitation facility.

A rare case of male breast ductal carcinoma in-situ associated with prolactinoma.

A case of ductal carcinoma in-situ (DCIS) associated with prolactinoma in a male patient is described. A 56-year-old gentleman presented with lethargy and loss of libido. His prolactin at presentation was 3680 mU/l and an MRI scan of the head revealed a pituitary tumour suggestive of prolactinoma.

A proposal for the annotation of recurrent colorectal cancer: the 'Sheffield classification'.

Aim: Current classification systems of large bowel cancer only refer to metastatic disease as M0, M1 or Mx. Recurrent colorectal cancer primarily occurs in the liver, lungs, nodes or peritoneum. The management of each of these sites of recurrence has made significant advances and each is a subspecialty in its own right.

A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon).

Background: No standardized approach is available for the management of complicated appendicitis defined as appendiceal abscess and phlegmon. This study used meta-analytic techniques to compare conservative treatment versus acute appendectomy.

Methods: Comparative studies were identified by a literature search.

Nicorandil-induced terminal ileal ulceration--a probable link.

Nicorandil, a commonly prescribed anti-anginal agent, has been reported to be associated with ulceration in various parts of the gastrointestinal tract. A 68-year-old general practitioner presented with severe rectal bleeding and abdominal pain associated with terminal ileal ulceration diagnosed by colonoscopy. Capsule endoscopy revealed no other source of bleeding and CT was normal.

Asymptomatic isolated coccygeal metastasis in low rectal carcinoma.

As well as being relatively rare, osseous metastases from colorectal cancer are frequently asymptomatic and represent a late manifestation of disease. We report a case of an unidentified, asymptomatic coccygeal metastasis discovered on histological processing of the resection specimen from a patient with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by radical abdomino-perineal resection with coccygectomy. The anatomical explanation for this finding may involve passage of tumour cells via the vertebral venous plexus.

Surgery for obstructed defaecation: does the use of the Contour device (Trans-STARR) improve results?

Aim: The objective of the study was to assess safety, efficacy and outcomes of stapled transanal rectal resection (STARR) procedure for obstructed defaecation syndrome (ODS) with two stapling devices, PPH01 and Trans-STARR.

Method: Data were collected on all patients undergoing PPH01 or Trans-STARR over a 2 year period. Initially, all were treated using the PPH01 device and during the last 8 months using the Trans-STARR.

Long-term failure and function after restorative proctocolectomy - a multi-centre study of patients from the UK National Ileal Pouch Registry.

Objective: There is little information on the long-term failure and function after restorative proctocolectomy (RPC). The results of data submitted to a national registry were analysed.

Method: The UK National Pouch Registry was established in 2004.

PNET/Ewing's sarcoma of the rectum: a case report and review of the literature.

A 34-year-old female presented with anorectal pain and rectal bleeding due to an extensive rectal tumour. A trephine loop ileostomy was fashioned and biopsies were initially reported to show a poorly differentiated cloacogenic carcinoma. CT revealed numerous liver metastases.

Colonic carcinoma presenting as strangulated inguinal hernia: report of two cases and review of the literature.

Inguinal hernia and colonic carcinoma are common surgical conditions, yet carcinoma of the colon occurring within an inguinal hernia sac is rare. Of 25 reported cases, only one was a perforated sigmoid colon carcinoma in an inguinal hernia. We report two cases of sigmoid colon carcinoma, one of which had locally perforated.

Direct photographic documentation of ileal mucosa in routine colonoscopy is not an independent valid or reliable proof of completion: quality assurance issues for the national colorectal cancer-screening programme.

Introduction: The implementation of bowel cancer screening in the UK requires the maintenance of high standards in colonoscopy. Part of this quality control requires the reliable documentation of complete colonoscopy that can be externally audited and assessed. It has been suggested that terminal ileal biopsy is the only definitive and reliable method of confirming caecal intubation, but it is not cost-effective and may now be contraindicated because of potential prion infection.

A selective approach to restorative proctocolectomy without ileostomy: a single centre experience.

Objective: A single surgeon series on complications and functional outcomes following restorative proctocolectomy (RPC) is presented.

Method: An ethically-approved database was used to collect data on all patients undergoing RPC at a single institution. Patient demographics, operative details, complications and functional outcomes were assessed.

Salvage endoscopic submucosal dissection for residual or local recurrent intraepithelial neoplasia in the colorectum: a prospective analysis.

Objective: A prospective technical feasibility study of cap assisted ESD for 'curative intent' in patients with residual or local neoplastic recurrence following EMR. Primary end points were second stage R0 resection rate, safety and recurrence.

Method: Salvage ESD was performed using the Olympus GIF-XQ240 gastroscope and KD-630L insulation tipped knife.

The long-term efficacy of fissurectomy and botulinum toxin injection for chronic anal fissure in females.

Introduction: Healing rates for botulinum toxin injection for anal fissure may be improved if combined with fissurectomy. This procedure has a decreased risk of incontinence, which is particularly important in females. We investigated the long-term efficacy of fissurectomy and botulinum toxin injection for chronic resistant fissures in females.