Background-The risk of colorectal cancer is higher among relatives of those aVected. The neoplastic yield reported from screening such individuals varies enormously between studies and depends on the age and strength of the family history of those screened. Aims-To ascertain the neoplastic yield of endoscopic screening of first degree relatives of patients with colorectal cancer by age and familial risk. Subjects-A total of 330 individuals with a family history of colorectal cancer. Method-Endoscopic screening conducted according to a protocol. Results-Adenomas were found in 12%, and adenomas larger than 1 cm in 8%, of "high risk" individuals screened primarily by colonoscopy. Of those with neoplasia, 26% had lesions at or proximal to the splenic flexure. Neoplasia was found in 9.5% of individuals at lower familial risk, screened primarily by 60 cm flexible sigmoidoscopy, 4% of whom had neoplasia larger than 1 cm in size or cancer. Neoplastic yield was greatest in the fourth and fifth decades in those at highest risk, but increased with age in those at lower risk. Conclusions-For individuals with two or more first degree relatives, or relatives who have developed colorectal cancer at a young age, colonoscopy appears to be the only satisfactory method of screening, but 60 cm flexible sigmoidoscopy may be useful in those at lower levels of risk. (Gut 1998;42:71-75)

IntroductionThe mortality and morbidity of Ebola extends far wider than those contracting the disease. Surgical activity in Sierra Leone has been severely disrupted by the epidemic.MethodThis is a retrospective study examining the effect of the 2014–2015 Ebola virus epidemic on surgical activity in a Sierra Leone’s main teaching hospital.ResultsThe impact of national and local events on surgical provision is illustrated by the experience of Connaught Hospital, Freetown Sierra Leone. Surgical activity fell dramatically in August 2014, the month when the most health care workers died and continued to fall to just 3% of expected activity. Two of eight surgeons at Connaught Hospital died of Ebola.DiscussionThe example of Connaught Hospital serves as a graphic and poignant illustration of the difficulties faced by surgeons in low resource settings when dealing with the acute effects of a natural disaster. In any future epidemic, high levels of preparedness, training and protection, in addition to liaison with public health teams early in an epidemic, may allow surgeons to carry out at least some of their duties without the very high levels of personal risk seen here.In a country with so few specialists the loss of 25% is disastrous and will result in long term capacity reduction.

It is generally accepted that farmers manage a complex farm system. In this article we seek answers to the following questions. How do farmers perceive and understand their farm system? Are they sufficiently aware of their farm system that they are able to represent it in the form of a map? The research reported describes how causal mapping was applied to sheep/beef farmers in New Zealand and shows that farmers can create maps of their farm systems in ways that allow expression of both individual maps and the formation of group maps which represent the general character of farm systems. A group map was made for all the farmers studied and for subgroups using conventional, integrated, and organic management systems. The results are discussed in terms of the depth of meaning associated with individual elements of the map, map complexity and the limitations of causal mapping. Causal mapping has the potential to contribute to our knowledge of how farmers see their farm systems, and this can benefit farmers and other stakeholders concerned with the management of farms and their economic and environmental performance.

Failure to recognize nicorandil as an etiologic factor in the development of anal ulceration, when other potential underlying well-recognized inflammatory or neoplastic processes have been excluded, may lead to unnecessary surgical intervention in a group of high-risk patients. One of our patients had a potentially avoidable abdominoperineal resection. Pharmaceutical manipulation with alternative antiangina medication may induce healing. Pharmacologic manipulation should be coordinated with a physician to minimize precipitation of unstable angina.