Flexible sigmoidoscopy screening for colorectal neoplasia in average-risk people: evaluation of a five-year rescreening interval

OBJECTIVE: To determine the prevalence of colorectal neoplasia detected by rescreening people with average risk five years after initial screening by flexible sigmoidoscopy. DESIGN: Prospective survey of results of a colorectal cancer screening program. PARTICIPANTS: People aged 55-64 years with no symptoms or family history of colorectal cancer who were recruited from the community for flexible sigmoidoscopy screening five years previously (July 1995 to December 1996) and had no colorectal neoplasms detected. SETTING: Fremantle Hospital, Western Australia, a community-based teaching hospital, December 2000 to June 2001. MAIN OUTCOME MEASURES: Number and size of colorectal neoplasms (adenomas or cancer) compared between rescreened patients and initial screening population (all 982 people screened between July 1995 and December 1996). RESULTS: 803 people were eligible for rescreening; 138 were no longer at the recorded address, and 361 of the remaining 665 (54%) were rescreened. Rescreening found a significantly lower prevalence of colorectal adenomas than initial screening (8% [95% CI, 5%-11%] versus 14% [95% CI, 13%-15%]; P < 0.05) and also a lower percentage of adenomatous polyps over 5 mm in diameter (32% [95% CI, 15%-49%] versus 51% [95% CI, 46%-56%]; no significant difference). CONCLUSION: Average-risk people who have been screened for colorectal neoplasms, with none found, have a low prevalence of neoplastic lesions five years later. Longer rescreening intervals need to be considered.     

Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals

Context  Knowledge of risk factors for colorectal neoplasia could inform risk reduction strategies for asymptomatic individuals. Few studies have evaluated risk factors for advanced colorectal neoplasia in asymptomatic individuals, compared risk factors between persons with and without polyps, or included most purported risk factors in a multivariate analysis. Objective  To determine risk factors associated with advanced colorectal neoplasia in a cohort of asymptomatic persons with complete colonoscopy. Design, Setting, and Participants  Prospective, cross-sectional study of 3121 asymptomatic patients aged 50 to 75 years from 13 Veterans Affairs medical centers conducted between February 1994 and January 1997. All participants had complete colonoscopy to determine the prevalence of advanced neoplasia, defined as an adenoma that was 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. Variables examined included history of first-degree relative with colorectal cancer, prior cholecystectomy, serum cholesterol level, physical activity, smoking, alcohol use, and dietary factors. Main Outcome Measures  An age-adjusted analysis was performed for each variable to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) associated with having advanced neoplasia compared with having no polyps. We developed a multivariate logistic regression model to identify the most informative risk factors. A secondary analysis examined risk factors for having hyperplastic polyps compared with having no polyps and compared with having advanced neoplasia. Results  Three hundred twenty-nine participants had advanced neoplasia and 1441 had no polyps. In multivariate analyses, we found positive associations for history of a first-degree relative with colorectal cancer (OR, 1.66; 95% CI, 1.16-2.35), current smoking (OR, 1.85; 95% CI, 1.33-2.58), and current moderate to heavy alcohol use (OR, 1.02; 95% CI, 1.01-1.03). Inverse associations were found for cereal fiber intake (OR, 0.95; 95% CI, 0.91-0.99), vitamin D intake (OR, 0.94; 95% CI, 0.90-0.99), and use of nonsteroidal anti-inflammatory drugs (NSAIDs) (OR, 0.66; 95% CI, 0.48-0.91). In the univariate analysis, the inverse association was found with cereal fiber intake greater than 4.2 g/d, vitamin D intake greater than 645 IU/d, and daily use of NSAIDs. Marginal factors included physical activity, daily multivitamin use, and intake of calcium and fat derived from red meat. No association was found for body mass index, prior cholecystectomy, or serum cholesterol level. Three hundred ninety-one patients had hyperplastic polyps as the worst lesion found at colonoscopy. Risk variables were similar to those for patients with no polyps, except that past and current smoking were associated with an increased risk of hyperplastic polyps. Conclusions  Our data endorse several important risk factors for advanced colonic neoplasia and provide a rationale for prudent risk reduction strategies. Further study is needed to determine if lifestyle changes can moderate the risk of colorectal cancer.      

Dietary fibre and colonic neoplasia.

Dietary plant fibre, or plantix, is thought to play a significant role in the pathogenesis of colon cancer in humans. It is a complex polymeric substance that has several distinct components resistant to hydrolysis by the digestive enzymes of humans. These components include cellulose, hemicelluloses, pectins, lignin, gums, mucilages and, in certain instances, algal polysaccharides. These polymers have different physicochemical properties, and recent evidence from experimental studies in animals treated with carcinogens suggests that some may exert protective effects in the intestine and others may enhance colon carcinogenesis. This review synthesizes information on the chemical composition, methods of analysis and physicochemical properties of dietary plant fibre and reviews available studies examining the role of fibre in colonic neoplasia in animals and humans.     

潜血试验对人群大肠病变的普查意义

为验证潜血试验对人群大肠癌普查的筛检效果,在对4337例年龄在35岁以上的人群进行潜血试验的同时,作了全乙状结肠镜和部分全结肠镜检查。结果表明,肠镜病变检出率在非筛选人群为10.1％,在筛选人群中方13.3％,共查出大肠癌10例(含早期大肠癌5例),腺瘤167例,非腺瘤息肉131例,慢性肠炎171例。1％联苯胺试验阳性率为6.0％,检出60％大肠癌及3.9％腺瘤;免疫双扩试验阳性率为3.4％,检出40％大肠癌及2.0％腺瘤;SPA免疫潜血试验阳性率为14.7％,检出80％大肠癌(包括3例早期癌)及42.2％腺瘤。结果提示,潜血试验确能检出一些包括早期大肠癌在内的肠道肿瘤病变,尤以SPA免疫潜血试验敏感性最强。虽然潜血试验存在一定的漏检率(1％联苯胺为40％,免疫双扩为60％,SPA法为20％),但鉴于该法简易、经济,作为大规模大肠癌普查筛检.仍不失为一种值得推广的积极措施。     

软乙状结肠镜初筛法在大肠癌普查中的应用

软乙状结肠镜初筛法指用软乙状结肠镜检查筛选大肠癌高危人群,进一步行结肠镜检查全结肠,是将两种检查方法有机地结合起来.该方法既节省大规模结肠镜检查所需的人力、物力,又在一定程度上避免了软乙状结肠镜检查的不足.本文回顾了软乙状结肠镜初筛法在大肠癌普查中的应用现状,评析了软乙状结肠镜初筛法的优缺点,并展望了其研究方向和应用前景.     

硫酸粘液分泌的变化在胃癌、结肠癌发生中的意义

目的：通过检测胃粘膜、结肠粘膜癌变过程中硫酸粘液的变化及p53蛋白的表达，寻找有助于胃癌、结肠癌发病高危人群的随访指标，以提高胃癌、结肠癌的早期诊断率。方法：应用粘液组织化学染色高铁二胺一阿尔辛蓝（HID-AB）染色法，对60例慢性胃炎伴肠化、27例胃癌癌旁肠化及35例胃腺癌的胃癌组织，24例正常结肠粘膜，71例溃疡性结肠炎及结肠癌的结肠粘膜组织进行粘液分泌变化分析；应用免疫组织化学染色En Vision两步法，检测胃腺癌、溃疡性结肠炎及结肠腺癌中硫酸粘液阳性组及阴性组p53蛋白的表达。结果：硫酸粘液阳性率在胃粘膜组中，胃腺癌和癌旁肠化（91．43％，92．67%）高于慢性胃炎伴肠化（30％）（P〈0．05）；在结肠癌组织，结肠腺癌（22．41％）低于正常结肠粘膜（91．67％）（P〈0．05）及溃疡性结肠炎（63．38％）（P〈0．05）。p53蛋白的检出率：硫酸粘液阳性胃腺癌（60．40％）高于硫酸粘液阴性组（22．41％）；硫酸粘液阴性结肠癌（53．33％）高于硫酸粘液阳性组（21．43％）；硫酸粘液阴性组p53蛋白阳性率结肠癌（53．33％）高于溃疡性结肠炎（6．67%）（P〈0．05）。结论：（1）胃粘膜出现分泌硫酸粘液的肠上皮化生与胃腺癌的发生关系密切。（2）结肠粘膜中硫酸粘液分泌减少，在癌发生中具有重要意义。（3）对胃癌、结肠癌发病的高危人群（胃粘膜肠化、溃疡性结肠炎患者）随访硫酸粘液分泌变化及p53蛋白的检出，有助于发现早期癌变病例，从而提高胃癌、结肠癌的早期诊断率。     

Outcomes after 10 years of a community-based flexible sigmoidoscopy screening program for colorectal carcinoma

OBJECTIVE: To evaluate the outcomes 10 years after a flexible sigmoidoscopy colorectal cancer (CRC) screening program in asymptomatic average-risk individuals. DESIGN, SETTING AND PATIENTS: In 1995, a program of flexible sigmoidoscopy-based screening of asymptomatic average-risk individuals aged 55-64 years was established at Fremantle Hospital, Western Australia. Insertion depths, pathological findings and subject-rated pain scores have been prospectively recorded. A follow-up flexible sigmoidoscopy examination was offered to attendees 5 years after the initial screening. Post-screening malignancies were determined by linkage with the Western Australian Cancer Registry in September 2006. MAIN OUTCOME MEASURES: Yield of neoplasia at initial and follow-up sigmoidoscopy, and the incidence of CRC detected after screening. RESULTS: Between 1995 and 2005, 3402 people underwent an initial flexible sigmoidoscopy screening examination (mean age, 60 years; women, 41%) and 1025 had a 5-year recall examination. Mean insertion depth was greater in men than women (60 cm v 52 cm, P<0.001). The insertion depth in women was more likely to be <40 cm (17% v 6%, P<0.001). Mean pain score was 2.9 for men and 4.0 for women (P<0.001). Fourteen per cent of initial screenings detected at least one adenoma. Over a mean follow-up time of 8 years, invasive CRC was detected by flexible sigmoidoscopy screening in 0.4% of participants; 0.7% of those with a normal result of screening later developed CRC, with 75% of these found proximal to the splenic flexure. CONCLUSIONS: Flexible sigmoidoscopy is a viable screening method, with well defined utility and limitations, for CRC screening of asymptomatic people with average risk.     

仅行单次软质乙状结肠镜筛查结直肠癌不能减少其发病率或病死率

设计随机对照临床试验（挪威结直肠癌预防试验[NORCCAP]1）NCT00119912。分组 隐匿分配。盲法 设盲的（对结局评价者设盲）。     

Flexible sigmoidoscopy screening for colorectal cancer in average-risk people: update of a community-based project

OBJECTIVES: To analyse results of a screening program for colorectal cancer using flexible sigmoidoscopy. DESIGN: Survey of results of screening program and follow-up colonoscopies and identification of missed cases from State cancer registry data. PARTICIPANTS: Asymptomatic, average-risk people aged 55-64 years who were either mailed invitations after random selection from the electoral roll or volunteered after hearing about the program. SETTING: Fremantle Hospital, Western Australia (a public teaching hospital), July 1995 to November 1999 (first 4.5 years of the screening program). MAIN OUTCOME MEASURES: Participation rates; lesions detected; stage of colorectal cancers diagnosed at the hospital before and after the screening program began (1989-1995 versus 1996-1999); and diagnoses of colorectal cancer in previously screened individuals (from State cancer registry data). RESULTS: 6446 people were mailed invitations, and 1483 were screened (23% participation rate). Another 1122 people volunteered, giving 2605 people screened overall. Flexible sigmoidoscopy showed adenomatous polyps in 352 people (14%), and colonoscopy was recommended in 399 (15%) on the basis of clinically suspicious lesions. Colonoscopy was performed in 302 (76% participation rate). Screening and follow-up colonoscopy detected 14 colorectal cancers (10 invasive, with eight of these Dukes stage A). One participant was diagnosed with colorectal cancer 12 months after sigmoidoscopy gave normal results. Incidence of colorectal cancer was 119 per 100000 per year, and prevalence was 0.5%. Before the screening program, 12% of cancers diagnosed at our hospital were Dukes stage A, compared with 28% after (P<0.001). CONCLUSIONS: Flexible sigmoidoscopy screening is an acceptable strategy in asymptomatic, average-risk people which detects colorectal cancer and adenomatous polyps. Screening has been associated with a trend to earlier presentation of cancer in our institution.     

进展期结肠癌局部浸润的多层螺旋CT特征

目的:总结进展期结肠癌局部浸润的多层螺旋CT(MSCT)特征。方法:经手术病理证实的进展期结肠癌患者31例,术前行MSCT检查。以病理切片所见为标准,对术前影像资料进行回顾性对比分析。结果:对照手术病理,31例进展期结肠癌患者中,以MSCT显示肠壁增厚、伴肠周脂肪间隙内条索状或云絮状密度增高影、伴肠壁外相续楔形或结节状软组织密度影判定癌肿局部浸润至深肌层、浆膜外的准确性分别为77.42%、22.58%、80.65%,敏感性分别为37.50%、13.04%、78.26%,特异性分别为91.3%、50.00%、87.50%。MSCT显示肿块旁淋巴结肿大判定淋巴结转移的准确性为80.65%,敏感性为61.54%,特异性为94.44%。结论:进展期结肠癌的局部浸润具有一定的MSCT表现特征,MSCT征象的正确识别和对肿瘤局部浸润程度的评价有助于制定合理的治疗方案及判断预后。     

Genetic screening in families with multiple endocrine neoplasia type 2A for possible medullary thyroid cancer

To the editor:A 38-year-old woman suffered from repeatedly episodes of headache,palpitations and sweating for 5 days before admission.Her elder sister has pheochromocytoma and medullary thyroid cancer (MTC),while her niece has MTC.Further physical examinations disclosed paroxysmal hypertension and bilateral thyroid large nodules.An enhanced computed tomography (CT) revealed adrenal mass in both sides,with 7 cm by 8 cm in the left and 1 cm by 2 cm in the right (Figure 1A).An octreotide somatostatin receptor image only confirmed a focus of intense uptake in the left side of adrenal.Meanwhile,plasma calcitonin was 352.84ng/L (reference range 0-100).Both ultrasonography and CT (Figure 1E) disclosed thyroid malignant nodules in both lobules.Moreover,the parathyroid hormone was 146 pg/ml (15-683);a parathyroid ultrasonography revealed a left lower dorsal lobe parathyroid adenoma.Therefore,laparoscopic left adrenalectomy was first performed followed by total thyroidectomy and parathyroidectomy two weeks later.     

螺旋CT仿真内镜在结肠肿瘤筛选中的应用

目的 探讨螺旋CT结肠仿真内镜(CTVE)对高危人群进行筛选检出结肠肿瘤的应用价值.方法 回顾性分析我院经结肠镜检查活检和/或手术病理证实20例结肠病变高危人群的临床影像学资料.所有患者均行螺旋CT仿真内镜检查和纤维肠镜检查.结果 20例患者2例正常,18例有占位病灶(包括良性和恶性肿瘤)共28个.CTVE共发现病灶21个(75%),14个直径10mm以上病灶全部检出(100%),8个6～9mm病灶检出5个(62.5%),6个5mm以下病灶检出2个(3 3.3%).CTVE拟诊结肠癌12个,结肠息肉8个,术前定性诊断准确率为90.4%.结论 结肠仿真内镜检查可部分取代结肠镜的有创检查,作为筛选结肠肿瘤的方法之一.     

Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis

Background This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum （No. 10 lymph nodes）. Methods The clinical records of 216 patients with advanced proximal gastric cancer and No. 10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy （splenectomy group）, while 143 patients did not （spleen-preserving group）. Five-year survival rates, mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.
Results The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group （χ^2=14.73, P 〈0.05）. The mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes in the splenectomy group were significantly greater than in the spleen-preserving group （P 〈0.05）. Multivariate analysis revealed that the depth of invasion, splenectomy, and type of gastrectomy were independent prognostic factors. The survival rate for T3 patients with and without splenectomy was 38.7% and 18.9%, respectively （χ^2 =15.03, P 〈0.05）. For patients undergoing total gastrectomy, survival rates were 33.4% and 20.7%, respectively （χ^2 =13.63, P〈0.05）. Operative morbidity and mortality in splenectomy group was 24.7% and 4.1%, respectively, and in the spleen-preserving group was 17.5% and 3.5%, respectively. The differences were not statistically significant （P 〉0.05）. Conclusions Splenectomy is beneficial for No. 10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.     

液基薄层制片宫颈细胞学的临床应用价值

目的:对应用液基薄层制片法新技术进行宫颈病变的细胞学诊断进行评价.方法:对2001年5月～2003年10月,在我院妇产科门诊行宫颈细胞学检查者11340例,应用液基薄层法和传统法制片对比,细胞病理学专职人员光镜下读片,TBS法进行诊断分类.阳性者阴道镜下活检、组织病理学检查.结果:液基薄层法与传统法的阳性预测值分别为91.25%和76.22%(P＜0.01).结论:液基薄层法制片是宫颈细胞学诊断的重要革新,在宫颈病变的筛查中具有重要作用.     

Hepatocellular carcinoma with colonic metastasis

Hepatocellular carcinoma with colonic metastasis is rare. It mainly occurs by direct invasion and presents with bloody stools. We describe a patient with haematogenous metastasis to the rectum who presented with tenesmus. To our knowledge, such an association has not been reported previously. Colonic metastasis should be considered when patients with hepatocellular carcinoma present with bloody stools or tenesmus.     

Philos钢板治疗肱骨近端骨折的临床应用

目的 探讨应用AO肱骨近端内固定锁定系统(Philos)治疗肱骨近端骨折的临床疗效.方法 我院2007年1月至2010年2月间使用Philos钢板治疗肱骨近端骨折25例,根据Neer分型:二部分骨折10例,三部分骨折12例,四部分骨折3例,其中3例骨折累及肱骨干上段.术后悬吊固定3周左右,术后3d开始适量肩关节被动运动...     

左半结肠癌并发肠梗阻切除一期吻合的临床效果观察

目的探讨左半结肠癌肠梗阻术中肠梗阻切除一期吻合术的临床效果。方法 92例左半结肠癌合并肠梗阻患者随机分为治疗组和对照组,各46例。治疗组行肠梗阻切除一期吻合术,对照组采用传统的二期闭瘘手术。结果治疗组手术时间明显高于对照组,差异有明显的统计学意义(P<0.05);住院时间、住院费用低于对照组,差异有统计学意义(P<0.05);两组并发症发生情况无统计学差异(P>0.05)。结论左半结肠癌并发肠梗阻切除一期吻合能明显减少患者住院时间和费用,值得临床推广应用。