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Clinical Reviews.

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Argirios Argiriou:
Summary points:

Perennial allergic rhinitis is a common condition in general practice.

The most common allergen is the house dust mite, followed by cats and dogs.

Diagnosis is through history and skin prick testing.

Patients with unilateral symptoms, especially if they have pain or bleeding, should be referred to an ear, nose, and throat specialist.

Avoidance measures should be taken where appropriate.

Medical treatment, mainly with antihistamines, topical corticosteroids, or both, is usually highly effective.

Immunotherapy is reserved for severe cases in which avoidance measures and medical treatment are either not effective or not tolerated.

Surgery is reserved for certain patients who have structural abnormalities.



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Argirios Argiriou:
Summary points:

• The prevalence of coeliac disease is 0.5-1% in international population studies.

• A combination of tissue transglutaminase antibody, endomysial antibody, and immunoglobulin A should be used for initial testing.

• Antibody negative coeliac disease with villous atrophy is now recognised.

• Treatment should involve a gluten-free diet, with support from a dietitian and a gastroenterologist.


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Argirios Argiriou:
Summary points:

The lifetime risk of developing colorectal cancer is about 5%.

Increasing age and a family history of colorectal cancer are the greatest risk factors for the disease.

Patients presenting with suspicious symptoms and signs should be referred and investigated urgently in a specialised unit.

Colonoscopy and computed tomographic colonography are of equal sensitivity for detection of colorectal cancer.

Colonoscopy allows biopsy of suspicious lesions and removal of polyps.

Population screening by testing for faecal occult blood has begun in the United Kingdom.


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Argirios Argiriou:
Summary points:

Cervical cancer disproportionately affects women in developing countries, which have no effective screening systems.

Cervical biopsy is the most important investigation in diagnosing cervical cancer.

Cervical cancer is a clinically staged disease.

Fertility sparing surgery (conisation or radical trachelectomy (excision of the cervix)) is an option for women with early stage disease.

Chemoradiotherapy is the standard of care for locally advanced and early stage cancers with poor prognostic factors.

Chemotherapy is palliative only in patients with recurrent or metastatic disease.



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Argirios Argiriou:
Summary points:

Venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism, are common and treatable in hospital and the community.

Major risk factors include age, recent surgery (especially orthopaedic), cancer, and thrombophilia.

Established treatments are unfractionated heparin, low molecular weight heparin, fondaparinux, and warfarin.

Treatment agents and duration depend on the cause.




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