Significance of rectosigmoid polyp as a predictor of proximal colonic polyp

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.     

Long pedunculated colonic polyp with diverticulosis: case report and review of the literature

Colonic muco-submucosal elongated polyp is a rare entity (0.39% in an endoscopic polypectomy series). It is an elongated drumstick-shaped lesion characterized by oedematous, loose connective tissue with a dense submucosal layer showing dilation of blood and lymphatic vessels. First described as a polypoid lesion associated with diverticular disease of the sigmoid colon, it was histologically characterized as a separate entity by Kelly in 1991. In that study, the author reported eight cases in which a red or brown mucosal protrusion or polyp were associated with diverticular disease, and described the syndrome as "polypoid prolapsing mucosal folds in diverticular disease". In 1994, Matake et al. described a new entity defined as colonic muco-submucosal elongated polyp. Herein, we describe another case in a 77-year-old woman with abdominal pain, followed by a review of the literature.     

Massive congenital mesenchymal malformation of the lung: another cause of non-immune hydrops

A case of a hamartomatous malformation, termed 'massive congenital mesenchymal malformation of the lung', presenting with polyhydramnios and fetal hydrops, is discussed. ramnios. We report the third case of this unusual malformation which presented with polyhydran and fetal hydrops.     

Adaptive deformable model for colonic polyp segmentation and measurement on CT colonography

Polyp size is one important biomarker for the malignancy risk of a polyp. This paper presents an improved approach for colonic polyp segmentation and measurement on CT colonography images. The method is based on a combination of knowledge-guided intensity adjustment, fuzzy clustering, and adaptive deformable model. Since polyps on haustral folds are the most difficult to be segmented, we propose a dual-distance algorithm to first identify voxels on the folds, and then introduce a counter-force to control the model evolution. We derive linear and volumetric measurements from the segmentation. The experiment was conducted on 395 patients with 83 polyps, of which 43 polyps were on haustral folds. The results were validated against manual measurement from the optical colonoscopy and the CT colonography. The paired t-test showed no significant difference, and the R(2) correlation was 0.61 for the linear measurement and 0.98 for the volumetric measurement. The mean Dice coefficient for volume overlap between automatic and manual segmentation was 0.752 (standard deviation 0.154).     

Autoimmune disorders: another possible cause for in-vitro fertilization and embryo transfer failure

This study was undertaken to investigate the role of autoantibodiesin association with in-vitro fertilization (IVF) and embryotransfer failure. Anticardiolipin, lupus anticoagulant, anti-deoxyribonucleicacid and antinuclear antibody, rheumatoid factor and antithyroidantibody concentrations were measured. The study group comprised50 IVF patients with three or more previously failed cyclesafter embryo transfer. The control group comprised 80 computer-matchedwomen: 40 who had conceived and delivered following three orless IVF and embryo transfer cycles, and 40 who were healthynulligravidas. The incidence of autoantibodies in the studygroup was 22.0%, compared with 2.5% in the IVF control group(P < 0.05) and 7.5% in the nulligravida group (P < 0.05).In the study group, no statistical difference was found betweenthe patients with unexplained infertility and those with mechanicalinfertility (23.0 and 20.8% respectively). The high occurrenceof autoantibodies found in patients who failed at least threeIVF and embryo transfer cycles could imply that these autoantibodiesmay be one of the possible causes of IVF failure in either mechanicalor unexplained infertility. Further investigations are requiredto indicate the autoantibody profile as part of the work-upafter three or more failed IVF and embryo transfer attempts.     

Colchicine effect in a colonic hyperplastic polyp. A lesion mimicking serrated adenoma

Colchicine effect has been described recently in gastrointestinal biopsies, where it can result in accumulation of metaphase mitoses and epithelial disorganization. We describe the case of a colonic hyperplastic polyp with colchicine effect from a 52-year-old woman who was receiving colchicine for primary biliary cirrhosis. Biopsy of the polyp revealed prominent metaphase mitoses and focal loss of nuclear polarity in the surface epithelium, features that mimicked a serrated adenoma. Distinguishing between hyperplastic polyp and serrated adenoma is important because of the different management implications and the increased potential for neoplastic progression in the latter.     

Rice: another potential cause of food allergy in patients sensitized to lipid transfer protein

Recent studies show that the lipid transfer protein (LTP), the major Rosaceae allergen in patients not sensitized to birch pollen, is a largely cross-reacting allergen. Moreover, it is a potentially hazardous allergen due to its stability upon thermal treatment and pepsin digestion. The present study reports 3 cases of rice-induced anaphylaxis in LTP-allergic patients. In vitro inhibition studies, carried out using LTP purified from both rice and apple as well as whole peach extract, show that LTP was the relevant allergen in these patients and demonstrate the cross-reactivity between rice LTP and peach/apple LTP.     

Type III congenital cystic adenomatoid malformation of the lung: another cause of elevated alpha fetoprotein?

In this report we document the first observation of highly elevated alpha fetoprotein (AFP) levels in the amniotic fluid of a 23-week gestation male fetus with cystic adenomatoid lung malformation (CCAML) Type III and caudal regression. The increase of AFP levels may be related to the presence of tumor-like lung masses of embryonic origin.     

Pregnancy does not influence colonic polyp multiplicity but may modulate upper gastrointestinal disease in patients with FAP

Background

Reproductive factors have been shown by epidemiology studies to alter colorectal cancer risk in women. Familial adenomatous polyposis (FAP) patients carry a germline adenomatous polyposis coli (APC) mutation predisposing to multiple adenoma formation in the intestine. The Min mouse provides a good model of FAP, and we recently reported a significant increase in intestinal tumour multiplicity in a recombinant line of mice following pregnancy.

Aim

We considered whether reproduction modulates intestinal tract disease in a large cohort of female patients with FAP (n = 180).

Results

Multiple regression analysis showed that the number of colonic polyps observed was not related to the person''s pregnancy status nor the position of their APC germline mutation. The proportion of women attaining a high Spigelman stage (3 or 4) was unrelated to having a pregnancy prior to attaining the maximum Spigelman stage (p = 0.6). On the other hand, having a pregnancy significantly increased the proportion of women that attained the highest Spigelman stage when their APC germline mutation occurred within the mutation cluster region or at or after codon 1020 (50%, 6/12, p = 0.005 and 42%, 13/31, p = 0.006, respectively; multivariable logistic regression).

Conclusion

Our data suggest that reproduction may influence disease severity in the upper gastrointestinal tract in patients with FAP.Patients with familial adenomatous polyposis (FAP) develop hundreds to thousands of colorectal polyps and, consequently, have an enhanced risk of colorectal cancer (CRC). Therapy consists of prophylactic colectomy, usually performed in the late teens or early 20s.^1,2 Adenomatous polyps also arise in the small intestinal tract, especially in the duodenum, and severity of disease can vary from no polyps to numerous lesions and carcinoma. Progressive disease is measured using a semi‐quantitative assessment, referred to as the Spigelman stage.^3,4 patients with FAP carry a germline mutation in the APC gene, commonly within the β‐catenin binding domains (codons 1020–1170 and 1265–2035). Furthermore, the position of the germline mutation determines the nature and location of the second hit.^5,6 If the mutation occurs within the mutation cluster region (MCR; codons 1194–1392), then there is strong selection for allelic loss of APC as the somatic mutation (“second hit”) in colorectal adenoma development.⁷In the general population, men and women vary in CRC aetiology, and reproductive factors have been shown to alter CRC risk in women: parity has been inversely associated with colon cancer and use of hormone replacement therapy (HRT) decreases risk.^{8,9,10,11,12,13,14,15} An analysis of the influence of pregnancy on both duodenal and colonic disease severity in female FAP has yet to be undertaken. However, we have recently shown that pregnancy leads to an increase in adenoma numbers in the small intestine of a recombinant line of Min mice. These mice carry a truncating mutation at codon 850 of the APC gene and are regarded as a good model of human FAP.¹⁶ This observation provided impetus to considering pregnancy as a factor that might modulate intestinal disease severity in patients with FAP. Such a study is necessary because a significant proportion of female patients have completed a pregnancy before colectomy, and fecundity in patients with FAP is close to that of the general population.[17] The extensive database of patients with FAP at St Mark''s Hospital, which includes a unique collection of accurate counts of polyp numbers in the colon, provided an ideal opportunity to undertake a detailed analysis on the influence of pregnancy on both duodenal and colonic disease severity in female patients with FAP.     

Parkinson's: another look

Recent studies in the Parkinson's literature have cited a tuberculosis-like germ called Nocardia as being responsible for Parkinson's disease. Kohbata seemingly cemented a relationship between Nocardia and Parkinson's by finding serologic evidence in 20 of 20 Parkinson's patients, acknowledging that blood tests for Nocardia and the mycobacteria such as tuberculosis often cross-react, as they belong to the same order of bacteria, the Actinomycetales. Besides this difficulty in differentiation, a well-used medical school textbook of microbiology, Atlas, points out that even among experts, different observers may classify the same strain of bacteria as Nocardia or Mycobacterium tuberculosis. Parkinson's: another look is a theoretical article which presents compelling, well-documented evidence for an infectious cause for Parkinson's disease on historical, epidemiological, pharmacologic, microbiological, and biochemical levels.