No abstract

This a preprint and has not been peer reviewed. Data may be preliminary.

Malignant lesions of the vermiform appendix make up a rare subset of colorectal cancer. While colorectal cancer frequently metastasises to the liver, lung, regional lymph nodes and peritoneum, metastasis to the breast is extremely rare. Here, we describe the case of an 84-year-old woman who had the incidental finding of appendiceal adenocarcinoma following emergency laparoscopic appendectomy. She declined further operative or adjuvant treatment for her disease. She represented 1 year later with metastatic appendiceal adenocarcinoma disease to her left breast. A simple mastectomy for symptomatic treatment was performed. In this report, we describe the first case of appendiceal adenocarcinoma metastases to the breast. Due to its rarity, there is a paucity of evidence related to the management of this condition. The limited evidence is reviewed and discussed.

Results Data published in the Bowel Screening Wales First Round Report dated 29 September 2011 shows that 6493 (82.2%) of SSP appointments were completed by telephone. 0.5% of participants required or requested a face to face assessment. 90% of participants assessed were fit for colonoscopy of which 89.4% attended a procedure. The 10% of participants found not fit were offered an alternative to colonoscopy such as CT colonography. Conclusion The literature reviewed clearly shows that telephone assessment for Bowel Screening Wales participants following a positive FOBt is an effective and acceptable form of information gathering and provision. Good attendance rates for assessment appointments and colonoscopy procedures are evidenced by the Bowel Screening Wales first round report.Competing interests None declared. Introduction Endoscopy in UK is performed under conscious sedation in daycase (DC) endoscopy units. Patients intolerant of the procedure subsequently undergo the procedure under a general anaesthetic in operating theatres. However whether this service could be effectively offered in a "non-operating theatre room" setting through an anaesthetist-led sedation service (ALS) is not well established within the UK. Aim To evaluate a new provision of an ALS in a day case endoscopy unit. Methods Service evaluation audit (JuneeAugust 2011) of a new weekly dedicated ALS at the Royal Liverpool Hospital was performed. Administrative, anaesthetic and case records and satisfaction scores (1¼unsatisfactory; 5¼fully satisfied; patients, anaesthetists, endoscopists) and "patient journey" was evaluated.Results Administration: Three cases were scheduled per listed. Waiting time was a median 9 weeks compared to a median 6 weeks for other lists. Of the 25 patients listed, only 20 (80%) had a procedure. DNA rate was 16% and cancellation rate 4%. Patients and Indication: Median age was 53 years (range 18e80 years), median ASA was 2 (range 1e3), 8 (42%) were female. 20 underwent propofol assisted endoscopy (7 colonoscopy, 8 HALO