Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the

This article highlights the role of prucalopride in the management of chronic constipation based upon the principles of meta-analysis using data reported in the published randomized, controlled trials.

Introduction CONTACT is a national multidisciplinary study assessing the impact of the COVID-19 pandemic upon diagnostic and treatment pathways among patients with pancreatic ductal adenocarcinoma (PDAC). Methods The treatment of consecutive patients with newly diagnosed PDAC from a pre-COVID-19 pandemic cohort (07/01/2019-03/03/2019) were compared to a cohort diagnosed during the first wave of the UK pandemic (‘COVID’ cohort, 16/03/2020-10/05/2020), with 12-month follow-up. Results Among 984 patients (pre-COVID: n = 483, COVID: n = 501), the COVID cohort was less likely to receive staging investigations other than CT scanning (29.5% vs. 37.2%, p = 0.010). Among patients treated with curative intent, there was a reduction in the proportion of patients recommended surgery (54.5% vs. 76.6%, p = 0.001) and increase in the proportion recommended upfront chemotherapy (45.5% vs. 23.4%, p = 0.002). Among patients on a non-curative pathway, fewer patients were recommended (47.4% vs. 57.3%, p = 0.004) or received palliative anti-cancer therapy (20.5% vs. 26.5%, p = 0.045). Ultimately, fewer patients in the COVID cohort underwent surgical resection (6.4% vs. 9.3%, p = 0.036), whilst more patients received no anti-cancer treatment (69.3% vs. 59.2% p = 0.009). Despite these differences, there was no difference in median overall survival between the COVID and pre-COVID cohorts, (3.5 (IQR 2.8–4.1) vs. 4.4 (IQR 3.6–5.2) months, p = 0.093). Conclusion Pathways for patients with PDAC were significantly disrupted during the first wave of the COVID-19 pandemic, with fewer patients receiving standard treatments. However, no significant impact on survival was discerned.

carcinoma (SCC). Methods: Patients with a histological diagnosis of AIN3 in Cardiff and Vale NHS trust between 2007 and 2012 were reviewed. Results: 26 patients were identified with a mean follow up of 3 years.11 (42%) presented with SCC on a background of AIN3, 15 (58%) with AIN3. 73% of patients were current or ex smokers. Of patients presenting with AIN3, 7 (47%) reported previous anogenital warts and 3 (20%) were HIV positive. 6 women (35%) had concurrent genital intraepithelial neoplasia (4 cervical, 1 vulval, 1 vaginal). 1 patient (4%) was immunosuppressed after a renal-allograft.10 patients underwent chemo-radiotherapy for SCC, with no recurrence of AIN3 whilst 1 died of metastatic disease. 60% of AIN3 patients were disease free at the time of the study after local excision. The rate of progression of AIN3 to SCC was 20% despite on-going surveillance and treatment. Conclusion:The cohort demonstrated known risk factors for AIN3 and showed a rate of progression to SCC higher than previously reported.