Colorectal cancer following negative colonoscopy: is 5-year screening the correct interval to recommend?

Background

Despite the high sensitivity of screening colonoscopy, polyps and cancers can still go undetected. With the polyp-to-cancer transformation cycle averaging 7–10 years, present guidelines recommend repeat colonoscopy within 10 years after negative screening. However, not all colorectal malignancies follow this decade-long progression. This study evaluates the incidence and pathology of colorectal cancers following a previous negative screening colonoscopy.

Methods

Records of patients who underwent a colectomy at our institution, from 1998 to 2009, were reviewed retrospectively. A total of 1,784 patient records were screened using exclusion criteria for inclusion in this study. The patients were divided as follows: Group 1 included patients with a negative colonoscopy within the previous 5 years; Group 2 included patients without a previous colonoscopy or with a previous colonoscopy more than 5 years prior. Group 1 patients were evaluated by colonoscopy for anemia, diverticulitis, signs of obstruction, and bleeding. Age, tumor location, operation performed, and pathology findings were recorded. The χ² test and paired t test were used for statistical analysis.

Results

A total of 233 patients were included in this study. Group 1 contained 43 patients with a mean age of 73 years (range = 35–94, median = 75). Group 2 had 190 patients with a mean age of 68 years (range = 19–91, median = 70). Group 1 consisted of 18 male and 25 female patients, and Group 2 included 94 male and 96 female patients. Both groups were further classified into the following age categories: <50 years, 50–80 years, and >80 years. Eighteen percent of the total study population had newly discovered colorectal cancer within a 5-year colonoscopy screening period. There were no significant differences in the distribution of the T and N stages between the two groups and no statistically significant differences when the rate of lymphovascular invasion (19 vs. 17 %; p = 0.39) and perineural invasion (7 vs. 11 %; p = 0.58) were compared.

Conclusions

Within 5 years, 18 % of our study population developed colorectal cancer. Most of these malignancies were found within the 50–80-year age group and located predominantly in the right colon and distally in the sigmoid and rectum. While distal cancers may be visualized by flexible sigmoidoscopy, those located more proximally may be missed, necessitating the need for a full colonoscopy. Although staging was similar between the two groups, Group 1 tumors were less aggressive despite having appeared within 5 years. As a result of our incidence of colorectal cancer within a 5-year interval, a shorter period for routine colonoscopy may be considered.     

A Pilot Randomized Controlled Trial of a Daily Living Skills Intervention for Adolescents with Autism

Journal of Autism and Developmental Disorders - Adolescents with autism spectrum disorder (ASD) without an intellectual disability have daily living skills (DLS) impairments. An initial feasibility...     

Mimicking liver iron overload using liposomal ferritin preparations.

Close monitoring of liver iron content is necessary to prevent iron overload in transfusion-dependent anemias. Liver biopsy remains the gold standard; however, MRI potentially offers a noninvasive alternative. Iron metabolism and storage is complicated and tissue/disease-specific. This report demonstrates that iron distribution may be more important than iron speciation with respect to MRI signal changes. Simple synthetic analogs of hepatic lysosomes were constructed from noncovalent attachment of horse-spleen ferritin to 0.4 microm diameter phospholipid liposomes suspended in agarose. Graded iron loading was achieved by varying ferritin burden per liposome as well as liposomal volume fraction. T1 and T2 relaxation times were measured on a 60 MHz NMR spectrometer and compared to simple ferritin-gel combinations. Liposomal-ferritin had 6-fold stronger T2 relaxivity than unaggregated ferritin but identical T1 relaxivity. Liposomal-ferritin T2 relaxivity also more closely matched published results from hemosiderotic marmoset liver, suggesting a potential role as an iron-calibration phantom.     

MSWs With and Without Long-Term Substance Abuse Training: Agency,Community, and Personal Outcomes

Behavioral outcomes in agency, community, and personal arenas were examined for 81 social workers with Masters degrees (MSWs) who completed a clinical postgraduate substance abuse (SA) training program (trainees) and a matched group of 78 MSWs not enrolled in such a program (comparison subjects). Subject self-report data was collected via telephone interviews of 30–40 min. With little or limited prior SA training, trainees took this clinical training to a broader level: they were significantly more likely than comparison subjects to provide agency SA training, receive SA training and supervision outside the agency, engage in SA community service, present SA papers at conferences, and intervene with their SA-troubled significant others. With more MSW students now receiving SA training in their graduate programs, the impact of such postgraduate education is likely to be even greater.     

Fluorescence remission spectroscopy of psoriatic lesions and the effect of topical anthralin therapy

Background  Psoriatic lesions are characterized by induration, scaling and erythema. Erythema is a result of inflammation and increased microvascular blood flow. Anthralin is the strongest topical antipsoriatic drug that causes clearing of psoriatic lesions and temporary remission.
Objective  The objective evaluation of skin perfusion might be a suitable way to gain a better insight in the pathophysiological process of this disease and to evaluate the response to antipsoriatic anthralin therapy.
Methods  We evaluated 21 psoriatic lesions (plaques, patches and pinpoint lesions) including 4 lesions in remission with anthralin induced erythema and 4 controls of healthy, uninvolved skin. We performed the measurements with a combined fluorescence and remission imaging (FRIS). The FRIS sensor is coupled with a touch screen industrial computer. The equipment consists of a white-light halogen lamp (20 W), two VIS-spectrometer modules (Zeiss) for remission detection and references. Imaging is realized by CCD-colour camera module and white light ring-lighting. Fluorescence emission was realized using an ultraviolet LED with a wavelength of 370 nm. The fluorescence detector is a highly sensitive MCS CCD (Zeiss) with an integration time of 2.5 sec.
Results  Spectral remission of psoriatic skin is characterized by a pronounced decrease (60–80%) of the haemoglobin double-peak compared to uninvolved skin. The NADH-fluorescence is diminished in lesional psoriatic skin including anthralin-treated areas with clinical remission.
Conclusions  Vascular perfusion is increased in psoriatic lesions as demonstrated by remission spectroscopy. NADH-fluorescence is reduced in lesional psoriatic skin and in anthralin-induced erythema. FRIS is a suitable tool for objective evaluation of the cutaneous response to antipsoriatic treatment.     

Entéroscopie et capsule vidée-endoscopique

Acta Endoscopica - La capsule endoscopique est une technologie innovante qui n’est qu’au début de son histoire. Elle constitue un progrès réel pour le diagnostic des...     

Cisapride and metoclopramide in the treatment of gastroesophageal reflux disease

In a double-blind, randomized study, the clinical effects of 5 mg and 10 mg of cisapride three times daily were compared with those of 10 mg of metoclopramide three times daily in 114 patients with symptoms of gastroesophageal reflux, mainly diurnal and nocturnal heartburn and regurgitation. The symptoms significantly (P less than 0.001) improved in the three groups; the mean severity score decreased by at least 78% after four weeks of treatment. Initial symptoms were more severe in the cisapride-treated patients, especially in those receiving 10 mg three times daily; however, the patients' condition after four weeks was similar in the three groups. Central nervous system side effects were reported by one patient from each of the cisapride-treated groups and by nine of the 43 metoclopramide-treated patients (P less than 0.02). Six metoclopramide-treated patients and one cisapride-treated patient dropped out of the study because of side effects. These findings favor the use of cisapride when prokinetic treatment of gastroesophageal reflux is considered.