Colorectal foreign bodies: a systematic review

Aim To perform a systematic review of the published reports on retained colorectal foreign bodies (CFBs) to collate the features and formulate a simple management plan based on the available evidence. Method An extensive search was carried out to identify articles on CFBs. The search was carried out on electronic databases Cinahl, Embase, Medline, PubMed and PsychInfo from 1950 to January 2009. Internet journals were also scoured and a general search was carried out using the search engine ‘Google’. Papers published in languages other than English were not included. Results This review covers a total of 193 patients with 196 presentations. There were 188 men and 5 women, a ratio of approximately 37:1. The mean age at presentation was 44.1 years (SD 16.6) in the single case reports and 39.3, 40 and 60.8 years in the three case series. Household objects, such as bottles and glasses, accounted for the largest percentage (42.2%) of inserted objects. Presentation for treatment occurred most often within 24 h of insertion and the majority of objects were removed transanally using manual manipulation with or without the use of a variety of tools, or via a scope. Conclusions The incidence of CFBs is disproportionately higher in men. Various techniques for removal are available, including some that are minimally invasive. The appropriate technique will depend on the size and surface of the retained object and the presence of complications such as perforation or obstruction.     

硒蛋白-P在大肠癌组织中的表达及临床意义

目的：研究硒蛋白-P在大肠癌、转移淋巴结及正常大肠组织中的表达情况,探讨其在大肠癌发生、发展中的作用。方法：采用免疫组织化学方法检测81例大肠癌组织和20例癌旁正常黏膜中硒蛋白-P的表达。结果：硒蛋白-P在大肠癌、转移淋巴结组织中的阳性表达率分别为53.1%（43/81）和55.7%（39/70）,在正常黏膜中的阳性表达率为80.0%（16/20）,硒蛋白P在正常大肠黏膜中的表达明显高于大肠癌组织（P〈0.05）,且硒蛋白-P在大肠癌组织中的表达与肿瘤的大体类型、大小、分化程度、浸润深度及有无转移淋巴结等临床病理因素无关（P〉0.05）。且患者5年存活率与硒蛋白-P在大肠癌组织中的表达无关（P〉0.05）。结论：硒蛋白-P在大肠癌组织中表达降低,提示其可能在大肠癌的发生、发展过程中起重要作用,但不能作为判断预后的指标。     

慢性鼻窦炎、鼻息肉患者鼻窦内镜手术201例疗效分析

目的探讨鼻窦内镜手术治疗慢性鼻窦炎、鼻息肉的疗效。方法对201例慢性鼻窦炎、鼻息肉患者进行鼻窦内镜手术治疗。结果术后随访6—12个月，痊愈149例（74．1％），好转35例（17．4％），无效17例（8．6％），总有效率91．3％。结论鼻窦内镜手术治疗慢性鼻窦炎、鼻息肉，具有视野清楚、直视下操作、病灶清除彻底、疗效好等优点。     

Giant fibro epithelial polyp in a young girl: A rare case report

IntroductionFibro epithelial Polyp (FEP) is a polypoid outgrowth of epidermis and dermal fibro vascular tissue. This polyp is most commonly found in oral cavity, neck and axilla, though any skin fold may be affected like groin. These polyps are usually less than 5 cm in size and rarely occur before 4th decade of life. Excision is the treatment of choice for such lesion.Presentation of caseA 20 year old female patient presented with a large pedunculated mass originating from the left groin area extending up to the left knee joint. It measured 42 cm in diameter. Surgical excision with primary closure was performed. We present this case because of its size and its occurrence at early age.DiscussionIn this case, a mass of 42 × 22 × 10 cm in a 20 years female has been described. This mass was diagnosed as a giant FEP, which is the largest size FEP reported, to the best of our knowledge. FEP usually occurs in females of reproductive age group but in the present case it occurred in a 20 years old female. Various other lesions like leiomyomas, superficial angiomyxoma and neurofibroma mimic FEP. Complete excision with long term follow-up is the best option in such patient.ConclusionGiant FEP is a benign lesion, sometimes it may be misdiagnosed as malignant lesion because of its larger size and occurrence in early age. Hence excisional biopsy is important to confirm the diagnosis.     

膳食纤维与结直肠肿瘤的研究进展

长久以来,膳食纤维被认为可以降低结直肠肿瘤发生风险.膳食纤维做为益生元,被肠内益生菌酵解,可产生多种短链脂肪酸,降低肠内致癌物浓度,加速致癌物的排出,影响胆汁酸代谢.但有少数前瞻性研究结果并不支持该假说,其抗结直肠肿瘤作用的机制尚需要进一步研究.     

Primary lesion location influences postoperative survival in patients with metastatic colorectal spinal lesions

Spinal metastasis from colorectal cancer occurs rarely. However, with increasing incidence of colorectal cancer in the setting of improved therapies, physicians are more likely to encounter such patients. We performed a retrospective review of patients who underwent spine surgery for metastatic colorectal cancer from 2005–2011. Preoperative, operative and postoperative factors; functional outcome as determined by Karnofsky Performance Status (KPS) and modified Rankin scale (mRS); and survival were recorded. Univariate analysis was performed, with patients stratified into two groups based on the position of the primary cancer, either proximal (colon) or distal (rectum) to the rectosigmoid junction. Fourteen patients, with a median age of 52 (interquartile range [IQR] 48–66) years, underwent 21 spine surgeries for metastatic colorectal cancer. Pain was the common presenting symptom (n = 11, 79%), followed by motor weakness (n = 8, 57%). Twenty-seven postoperative complications occurred in 11 (52%) patients. Baseline KPS and mRS remained stable in four (29%), improved in two (14%), worsened in six (43%), and was unknown in two (14%) at last follow-up. Patients with spinal metastasis from a rectal primary (n = 6) had a significantly longer survival compared to those with a colon primary (n = 8), with a median survival of 84 (IQR 56–103) versus 26 (IQR 19–44) months after primary diagnosis (p = 0.002), 19 (IQR 13–27) versus five (IQR 3–9) months after spine metastasis diagnosis (p = 0.010), and six (IQR 4–14) versus three (IQR 2–4) months after surgery (p = 0.030). Patients with spinal metastasis arising from rectal primary lesions display longer survival compared to colon lesions. Consideration of these factors is essential to appropriately assess surgical candidacy.     

Long‐term compliance with endoscopic surveillance for familial adenomatous polyposis

Aim The study assessed compliance of patients with familial adenomatous polyposis (FAP) with endoscopic surveillance. Method In this nationwide, cross‐sectional study, individuals from FAP families registered with the Netherlands Foundation for the Detection of Hereditary Tumours were invited to complete a questionnaire on endoscopic screening experiences. Results A total of 328 individuals were eligible for the study of whom 85 were at risk for FAP, 108 had an intact rectum after a colectomy with ileorectal anastomosis (IRA), and 135 had had a pouch following a proctocolectomy with ileoanal anastomosis (IPAA). Based on medical record data, 20% of the at‐risk group and 26% of the IRA‐group were found to be undercompliant with surveillance advice which was associated significantly with perceived self‐efficacy, use of sedatives during surveillance, pain after surveillance and low perceived benefits of surveillance (P < 0.05). Conclusion One in five individuals at risk for FAP and one in four with a retained rectum are undercompliant with screening advice. We recommend that sedatives should be patient‐tailored for FAP individuals undergoing surveillance and that adequate pain medication be provided after endoscopy.