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.     

Progressive diaphyseal dysplasia (Camurati-Engelmann): radiographic follow-up and CT findings

Sixteen patients with progressive diaphyseal dysplasia (PDD) and aged six months to 76 years were examined. Fourteen cases were hereditary, two were not. The progression of the radiologic manifestations in 13 patients who were followed up from 1 to 32 years and the computed tomography (CT) scans from five patients were obtained. The progression of PDD was slow and unpredictable, from minimal endosteal thickening of the mid-diaphyses in one pair of long bones to severe sclerosis of long bones, skull, and vertebrae. The severity of the osseous changes was not age dependent. A six-stage system was used to grade the severity of involvement and progression of PDD. CT scans demonstrated muscle mass that was preserved and showed the distribution of the osteosclerotic process, which was irregular and inhomogeneous. CT scanning was advantageous over plain radiography in this respect. Endosteal involvement was more extensive than periosteal thickening. CT scans also showed a distinct pattern of vertebral sclerosis that was confined to the posterior areas of the vertebral body and arches. In light of the paucity of characteristic clinical signs of PDD, the recognition of the radiologic features is mandatory for the diagnosis of this disease.     

Compound heterozygous hemochromatosis genotype predicts increased iron and erythrocyte indices in women

BACKGROUND: Women who inherit heterozygosity for the C282Y mutation of the HFE gene may have increased serum iron indices and hemoglobin and are less likely to develop iron deficiency compared with women with the wild-type genotype. METHODS: We performed a cross-sectional analysis of 497 women 20-44 years of age and 830 women >51 years of age drawn from the Busselton (Australia) population study to assess the effects of the HFE genotype on serum iron and hematology indices. RESULTS: Heterozygosity for the C282Y mutation occurred in 13.8% of the study population, comprising 11.8% C282Y wild-type heterozygotes and 2.0% C282Y/H63D compound heterozygotes. In the younger age group, C282Y wild-type women did not have significantly increased serum iron, transferrin saturation, or hemoglobin values, and were not protected from developing iron deficiency, compared with women of the same age with the wild-type genotype. Young compound heterozygous women had higher means for serum iron (25.0 vs 16.9 micromol/L; P <0.001), transferrin saturation (42.0% vs 25.6%; P <0. 05), hemoglobin (139.4 vs 132.3 g/L; P <0.05), and corpuscular volume (91.1 vs 87.7 fL; P <0.05), and a higher median ferritin (53 vs 44 microg/L; P <0.05) compared with the wild-type genotype. Similar results were observed for compound heterozygotes in the >51 years age group. CONCLUSIONS: Women with the compound heterozygous HFE genotype C282Y/H63D, but not the C282Y wild-type genotype, had increased values for serum iron and transferrin saturation, and the younger age group also had increased hemoglobin values. We conclude that the compound heterozygous genotype may have a beneficial effect in protecting women from iron deficiency.     

Analysis of Non Enemy Action Deaths in Counter Insurgency Operations through Mortuary Services

Background

Regional Trauma Centre in the northern India receives the mortal remains of all fallen soldiers for embalming. Non enemy action deaths during counter insurgency operations (CI Ops) were analysed for planning preventive measures.

Methods

Mortal remains received for embalming from Jan 1999 to Dec 2006 were analysed with respect to mode of injury, causation, body parts involved, fatality, seasonal variation and changing trends.

Result

Accidents accounted for 3.02 deaths per thousand troops and environmental factors were responsible for 1.14 deaths per thousand troops deployed. Accidental deaths peaked in 2000, declined in 2001 and then remained more or less static. Of the accidental deaths, 88% were brought in dead and 12% died after reaching hospital. Road traffic accidents were the major killers accounting for 48.2%, followed by accidental discharge of weapon 35.5%. The latter is showing a rising trend from 8% of total accidents in 2001 to 65% in 2005 and 51% in 2006 (p<.01). Most (49.7%) of the deaths were below 25 years of age. Proportion of persons below 25 years was more in fatalities due to accidental gunshot wound. Amongst the road traffic accidents, 40% died of head injury and 51.2% due to multiple injuries. When deaths occurred due to accidental discharge of own weapon, 36.4% had brain injury and 22% heart injury. Of the environmental fatalities all but one were brought in dead. Majority were due to avalanches and landslides (51.2%), followed by earthquake (22.4%), lightning (12.8%), high altitude pulmonary oedema (10.4%) and hypothermia (3.2%). Most of the deaths due to avalanches occurred in February while all deaths due to earthquake were in October 2005. Of the deaths due to lightning, 75% occurred in April and May.

Conclusion

Prevention of death caused by road traffic accidents, accidental discharge of weapon, avalanches and lightning will conserve manpower and add to operational preparedness.Key Words: Non enemy action deaths, Counter insurgency operations, Accidental discharge of weapon, Road traffic accidents     

The regulation of cellular iron metabolism

While iron is an essential trace element required by nearly all living organisms, deficiencies or excesses can lead to pathological conditions such as iron deficiency anemia or hemochromatosis, respectively. A decade has passed since the discovery of the hemochromatosis gene, HFE, and our understanding of hereditary hemochromatosis (HH) and iron metabolism in health and a variety of diseases has progressed considerably. Although HFE-related hemochromatosis is the most widespread, other forms of HH have subsequently been identified. These forms are not attributed to mutations in the HFE gene but rather to mutations in genes involved in the transport, storage, and regulation of iron. This review is an overview of cellular iron metabolism and regulation, describing the function of key proteins involved in these processes, with particular emphasis on the liver's role in iron homeostasis, as it is the main target of iron deposition in pathological iron overload. Current knowledge on their roles in maintaining iron homeostasis and how their dysregulation leads to the pathogenesis of HH are discussed.     

22-year longitudinal study of repetitive colonoscopy in patients with a family history of colorectal cancer

Introduction

We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer.

Methods

The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy.

Results

The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines.

Conclusions

Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines.     

Effect of topical calcipotriol on congenital ichthyoses

We investigated the clinical efficacy of topically applied calcipotriol in six patients with congenital ichthyosis, using a double-blind, bilaterally paired, comparative approach. Unilateral improvement, in favour of the calcipotriol-treated side, was observed in three patients with lamellar ichthyosis. A beneficial response was also observed in a patient with bullous ichthyotic erythroderma of Brocq. No clinical side-effects or laboratory anomalies were observed. This study indicates that calcipotriol constitutes a new and promising approach in alleviating disorders of keratinization characterized by hyperproliferation, other than psoriasis.