Brit J Hosp Med
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National guidance for cancer multidisciplinary teams recommends streamlining cases according to clinical complexity and guidelines. This article explores how the existing knowledge base and resources, accumulated since the introduction of multidisciplinary teams, can help to improve their effectiveness.
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Diaphragm disease of the small bowel has been described in the literature over the last three decades. The pathognomonic characteristic of multiple circumferential stenosis is noted on gross examination of the bowel. It is a severe form of non-steroidal anti-inflammatory drug-induced enteropathy, often presenting as acute small bowel obstruction. A systematic review was performed to identify risk factors and patient outcomes in histologically-proven diaphragm disease of the small intestine in patients undergoing emergency operation for small bowel obstruction. ⋯ This is a rare disease, difficult to diagnose and often confirmed by the intra-operative macroscopic appearance of circumferential stenosis of the bowel. Risk factors for developing small bowel diaphragm disease include long-term use of non-steroidal anti-inflammatory drugs, and female gender. Patients with this disease are at increased risk of developing acute small bowel obstruction, so early identification is important.
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In 1970, 50 years ago, I had headed the newly established Academic Unit of Surgery at the Westminster Medical School for 10 years. Since my appointment there in 1960, and for the next 30 years, one of my main interests as a general surgeon was the management of diseases of the breast - breast cancer in particular.