Journal of the Royal Society of Medicine
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Comment Letter Biography Historical Article
Beethoven's nephropathy and death.
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Familial adenomatous polyposis (FAP) is characterized by the presence of premalignant adenomas of the large and small bowel. Prophylactic colectomy deals with the risk for colon cancer, leaving duodenal cancer as the leading cause of death. Although most FAP patients have duodenal adenomas, only approximately 5% develop duodenal cancer. ⋯ When histology was ignored, comparison of video recordings in 52 patients showed a worsening in 21 (40%). In conclusion, further surveillance appears warranted so that patients at high risk for duodenal cancer might receive early treatment. Should slow progression of duodenal polyposis be shown to be associated with low risk, then most patients can be safely offered less frequent endoscopies than hitherto.
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Improved emergency care may be achieved by closer integration of hospital and community management. This has been promoted in Salford by the appointment of an Emergency Services Practice Manager jointly funded by the Family Health Services Authority and Salford Health Authority. Communication has improved, complementary working relationships developed and health promotion initiatives established.