16.5 days; p = 0.02). Preoperative lower GI endoscopy was performed in 215/223 (96%) elective presentations with an overall median time from endoscopy to primary treatment of 40 days. When compared to current Australian clinical guidelines, only 40% of elective patients
were referred to lower GI endoscopy within four weeks of GP referral. Secondary referrals compared with tertiary referrals were twice as likely to meet this guideline (OR 2.23, 95% CI 1.21–4.13). Referral to a colorectal surgeon occurred in 70% of tertiary elective referrals within two weeks of lower GI endoscopy. Conclusions: Emergency Selleckchem Alectinib presentations of CRC are managed promptly and secondary elective referrals in a MLN2238 chemical structure timely manner. However, tertiary referrals continue to present a challenge due to the unavoidable delay associated with the inclusion of an additional secondary care provider, since shorter times from colorectal appointment to treatment do not offset the prolonged wait from GP referral to colorectal consultation. Further, measures to reduce waiting times for lower GI endoscopy are required to achieve better performance against suggested guidelines. “
“To investigate whether the patients with hypovascular liver nodules determined on the arterial phase and hypointensity on the hepatocyte phase gadoxetic acid-enhanced magnetic resonance imaging (hypovascular hypointense nodules) are
at increased risk of hepatocarcinogenesis, we assessed subsequent typical hepatocellular carcinoma (HCC) development at any sites of the liver with and without such nodules. One hundred and twenty-seven patients with chronic hepatitis B or C and without a history of HCC, including 68 with liver cirrhosis, were divided into those with (non-clean liver group, n = 18) and without (clean liver group, n = 109) hypovascular hypointense nodules.
All the patients were followed up for 3 years, and HCC development rates MCE and risk factors were analyzed with the Kaplan–Meier method and the Cox proportional hazard model, respectively. A total of 17 patients (10 in the non-clean liver group and seven in the clean liver group) developed typical HCC. Cumulative 3-year rates of HCC development were 55.5% in the non-clean liver group and 6.4% in the clean liver group (P < 0.001), and those at the different sites from the initial nodules was also higher in the non-clean liver group (22.2%) than the clean liver group (6.4%) (P = 0.003). Multivariate analysis identified older age (P = 0.024), low platelet counts (P = 0.017) and a non-clean liver (P < 0.001) as independent risk factors for subsequent HCC development. Patients with hypovascular hypointense liver nodules are at a higher risk for HCC development at any sites of the liver than those without such nodules. "
“Cholangiocarcinoma (CCA) carries a severe prognosis because of its strong invasiveness and early metastasization.