Ongoing (even if minor) elevations of liver function test parameters should prompt the need to exclude CBD stones even in the presence of a normal CBD diameter on ultrasonography.

Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.

BackgroundSerum carcinoembryonic antigen (CEA) levels are not universally measured in colorectal cancers. CEA levels have been reported to be usually normal at time of primary rectal cancer diagnosis but elevated in recurrent disease. The aims of the study were to (1) compare serum CEA levels performed at time of primary and recurrent colorectal tumour diagnosis; and (2) to determine serum CEA levels in rectal cancers at primary diagnosis to analyse potential factors influencing differing CEA levels.MethodsA retrospective analysis of patients treated for colorectal cancers at Modbury Hospital, South Australia was performed. Each admission was reviewed within the electronic database. Serum CEA levels and tumour-related factors were determined in patients who underwent curative surgery for their primary tumour and developed tumour recurrence/metastases within the study period.Results438 patients were treated for colorectal cancer in the study period. In patients who underwent curative surgery and developed a recurrence, serum CEA was elevated in 20% patients at primary diagnosis and in 46.6% patients at recurrence. Only 1 of 30 patients with rectal cancer had an elevated CEA at diagnosis of primary tumour. Tumour relationship to the peritoneal reflection did not appear to play a role.ConclusionsIn rectal cancers, serum CEA levels are often normal at the time of initial diagnosis. However, this should not preclude its use in post-operative surveillance. Serum CEA levels noted in primary rectal cancer appear unrelated to the relationship of the tumour to the peritoneal reflection. Stroma-related factors could possibly be involved and merit further investigation.

BackgroundThere is lack of consensus on the incidence of appendiceal carcinoids in recent times. The influence of number of appendicectomies performed has been postulated to play a role in this. To determine the incidence and clinico-pathological profile of appendiceal carcinoids in a cohort of patients undergoing emergency appendicectomies for clinically suspected acute appendicitis, and examine the influence of the trend (if any) of the number of appendicectomies performed on the overall incidence of appendiceal carcinoids.MethodsA retrospective analysis of patients diagnosed with appendiceal carcinoids following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011. The patient cohort was divided into Group 1 (March 2007 - March 2009) and group 2 (April 2009 - April 2011) to study the influence of time trends on incidence of appendiceal carcinoids. Statistical analyses were performed using the Statistical Product and Service Solutions, SPSS 14.0 for Windows.ResultsOf 506 patients who underwent emergency appendicectomy for acute appendicitis, 8 patients (1.6%) were found to have appendiceal carcinoids. The median age was 23 years with 7 patients being female. There was no difference in the incidence of appendiceal carcinoids over the two time periods (P < 0.12).ConclusionsAppendiceal carcinoids were found in 1.6% of patients undergoing emergency appendicectomy for acute appendicitis. These tumors are found more commonly in young females with a predilection for the tip of the appendix. The perceived increased incidence appendiceal carcinoids appear to be unrelated to the increase in the number of appendicectomies being performed.

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