User login
Pediatric vs. Standard Colonoscopes
Pediatric colonoscopes are no more effective than the standard equipment for outpatient adult colonoscopy, although having the option of an alternative scope after an unsuccessful examination may help achieve passage to the caecum, reported S.H. Al-Shurieki and J.B. Marshall of the division of gastroenterology, University of Missouri School of Medicine, Columbia.
Their randomized controlled trial of 240 consecutive adult outpatients found that initial frequency of total colonoscopy was similar with pediatric and adult colonoscopes (95.8% vs. 96.6%). Patients were randomized to either scope, but if the endoscopists encountered difficulty performing the procedure with the assigned scope, they had the option of switching to the alternative instrument. Also, if a severely fixed, angulated sigmoid colon was encountered, a final backup option was available—that of switching to a thinner-diameter pediatric colonoscope than the original (Dig. Liver Dis. 2005;37:698–704).
After colonoscope changes, the final frequency of total colonoscopy improved, compared with rates for initial assignments, to 98.3% for pediatric and 99.2% for standard instruments.
Fordyce Granules in Colorectal Cancer
The presence of recognizable Fordyce granules (intraoral ectopic sebaceous glands) may be associated with systemic diseases, and a previously unrecognized activation of the sebaceous gland system may occur in individuals carrying hereditary nonpolyposis colorectal cancer syndrome, or Lynch syndrome, according to a controlled study of genetically unrelated patients.
C. De Felice of Azienda Ospedaliera Universtaria Senese, Siena, Italy, and associates reported on 15 members of five different genetically unrelated hereditary nonpolyposis colorectal cancer syndrome (HNPCC) kindreds and 630 unrelated, age- and sex-matched healthy controls. Following examination of the subjects' oral mucosa surfaces, they were categorized as either Fordyce granule (FG) positive or FG negative. The most common site for the FGs in HNPCC patients was the lower gingival and vestibular oral mucosa (Gut 2005;54:1279–82).
FGs were evident in 13 of the 15 affected patients (86.7%) versus 6 of the 630 controls (0.95%). The difference in FG proportions remained significant only when carriers of germline mutations in mismatch repair genes were accounted for; mismatch repair genes were detectable in 8 of the 15 cases (three of the five families) and identified as MLH1 mutations.
Pancreatic Cancer-Induced Diabetes
Approximately 1% of subjects aged 50 or older will develop pancreatic cancer within 3 years of first meeting criteria for diabetes—a rate nearly eight times higher than that for persons of similar age and sex in the general population, according to a population-based study in Rochester, Minn.
Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn., studied 2,122 Rochester residents who first met criteria for diabetes at or above age 50 and identified 18 (0.85%) who were diagnosed with pancreatic cancer within 3 years (Gastroenterology 2005;129:504–11). This result, along with earlier epidemiologic studies, suggests that subjects with new-onset diabetes are a high-risk group for pancreatic cancer, the researchers said.
However, they note, “The success of the strategy to use hyperglycemia as a screening tool … will depend largely on our ability to differentiate pancreatic cancer-induced diabetes from type 2 diabetes using a serologic marker.” Thus, hyperglycemia and diabetes may be useful as clinically relevant markers of undiagnosed pancreatic cancer, although further study will be required to test that strategy.
Aspirin Lowers Colorectal Cancer Risk
Regular, long-term use of aspirin reduces the risk of colorectal cancer, but significant reduction is not achieved until more than 10 years of use have elapsed, according to a prospective cohort study.
Maximum benefits were gained at doses exceeding 14 standard (325 mg) tablets per week. Andrew T. Chan, M.D., of Massachusetts General Hospital and Harvard Medical School, and his colleagues therefore noted that “optimal chemoprevention may require substantially higher doses of aspirin than currently recommended for the prevention of cardiovascular disease” (JAMA 2005;294:914–23).
The researchers, who used medication intake data from 82,911 of the 121,701 women enrolled in the Nurses' Health Study, also found that nonaspirin NSAIDs appeared to have a similar protective effect, again in a dose-dependent manner.
As in many other studies, they noted, “we did observe an increase in the incidence of reported major gastrointestinal bleeding with increasing aspirin dose.”
Pediatric vs. Standard Colonoscopes
Pediatric colonoscopes are no more effective than the standard equipment for outpatient adult colonoscopy, although having the option of an alternative scope after an unsuccessful examination may help achieve passage to the caecum, reported S.H. Al-Shurieki and J.B. Marshall of the division of gastroenterology, University of Missouri School of Medicine, Columbia.
Their randomized controlled trial of 240 consecutive adult outpatients found that initial frequency of total colonoscopy was similar with pediatric and adult colonoscopes (95.8% vs. 96.6%). Patients were randomized to either scope, but if the endoscopists encountered difficulty performing the procedure with the assigned scope, they had the option of switching to the alternative instrument. Also, if a severely fixed, angulated sigmoid colon was encountered, a final backup option was available—that of switching to a thinner-diameter pediatric colonoscope than the original (Dig. Liver Dis. 2005;37:698–704).
After colonoscope changes, the final frequency of total colonoscopy improved, compared with rates for initial assignments, to 98.3% for pediatric and 99.2% for standard instruments.
Fordyce Granules in Colorectal Cancer
The presence of recognizable Fordyce granules (intraoral ectopic sebaceous glands) may be associated with systemic diseases, and a previously unrecognized activation of the sebaceous gland system may occur in individuals carrying hereditary nonpolyposis colorectal cancer syndrome, or Lynch syndrome, according to a controlled study of genetically unrelated patients.
C. De Felice of Azienda Ospedaliera Universtaria Senese, Siena, Italy, and associates reported on 15 members of five different genetically unrelated hereditary nonpolyposis colorectal cancer syndrome (HNPCC) kindreds and 630 unrelated, age- and sex-matched healthy controls. Following examination of the subjects' oral mucosa surfaces, they were categorized as either Fordyce granule (FG) positive or FG negative. The most common site for the FGs in HNPCC patients was the lower gingival and vestibular oral mucosa (Gut 2005;54:1279–82).
FGs were evident in 13 of the 15 affected patients (86.7%) versus 6 of the 630 controls (0.95%). The difference in FG proportions remained significant only when carriers of germline mutations in mismatch repair genes were accounted for; mismatch repair genes were detectable in 8 of the 15 cases (three of the five families) and identified as MLH1 mutations.
Pancreatic Cancer-Induced Diabetes
Approximately 1% of subjects aged 50 or older will develop pancreatic cancer within 3 years of first meeting criteria for diabetes—a rate nearly eight times higher than that for persons of similar age and sex in the general population, according to a population-based study in Rochester, Minn.
Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn., studied 2,122 Rochester residents who first met criteria for diabetes at or above age 50 and identified 18 (0.85%) who were diagnosed with pancreatic cancer within 3 years (Gastroenterology 2005;129:504–11). This result, along with earlier epidemiologic studies, suggests that subjects with new-onset diabetes are a high-risk group for pancreatic cancer, the researchers said.
However, they note, “The success of the strategy to use hyperglycemia as a screening tool … will depend largely on our ability to differentiate pancreatic cancer-induced diabetes from type 2 diabetes using a serologic marker.” Thus, hyperglycemia and diabetes may be useful as clinically relevant markers of undiagnosed pancreatic cancer, although further study will be required to test that strategy.
Aspirin Lowers Colorectal Cancer Risk
Regular, long-term use of aspirin reduces the risk of colorectal cancer, but significant reduction is not achieved until more than 10 years of use have elapsed, according to a prospective cohort study.
Maximum benefits were gained at doses exceeding 14 standard (325 mg) tablets per week. Andrew T. Chan, M.D., of Massachusetts General Hospital and Harvard Medical School, and his colleagues therefore noted that “optimal chemoprevention may require substantially higher doses of aspirin than currently recommended for the prevention of cardiovascular disease” (JAMA 2005;294:914–23).
The researchers, who used medication intake data from 82,911 of the 121,701 women enrolled in the Nurses' Health Study, also found that nonaspirin NSAIDs appeared to have a similar protective effect, again in a dose-dependent manner.
As in many other studies, they noted, “we did observe an increase in the incidence of reported major gastrointestinal bleeding with increasing aspirin dose.”
Pediatric vs. Standard Colonoscopes
Pediatric colonoscopes are no more effective than the standard equipment for outpatient adult colonoscopy, although having the option of an alternative scope after an unsuccessful examination may help achieve passage to the caecum, reported S.H. Al-Shurieki and J.B. Marshall of the division of gastroenterology, University of Missouri School of Medicine, Columbia.
Their randomized controlled trial of 240 consecutive adult outpatients found that initial frequency of total colonoscopy was similar with pediatric and adult colonoscopes (95.8% vs. 96.6%). Patients were randomized to either scope, but if the endoscopists encountered difficulty performing the procedure with the assigned scope, they had the option of switching to the alternative instrument. Also, if a severely fixed, angulated sigmoid colon was encountered, a final backup option was available—that of switching to a thinner-diameter pediatric colonoscope than the original (Dig. Liver Dis. 2005;37:698–704).
After colonoscope changes, the final frequency of total colonoscopy improved, compared with rates for initial assignments, to 98.3% for pediatric and 99.2% for standard instruments.
Fordyce Granules in Colorectal Cancer
The presence of recognizable Fordyce granules (intraoral ectopic sebaceous glands) may be associated with systemic diseases, and a previously unrecognized activation of the sebaceous gland system may occur in individuals carrying hereditary nonpolyposis colorectal cancer syndrome, or Lynch syndrome, according to a controlled study of genetically unrelated patients.
C. De Felice of Azienda Ospedaliera Universtaria Senese, Siena, Italy, and associates reported on 15 members of five different genetically unrelated hereditary nonpolyposis colorectal cancer syndrome (HNPCC) kindreds and 630 unrelated, age- and sex-matched healthy controls. Following examination of the subjects' oral mucosa surfaces, they were categorized as either Fordyce granule (FG) positive or FG negative. The most common site for the FGs in HNPCC patients was the lower gingival and vestibular oral mucosa (Gut 2005;54:1279–82).
FGs were evident in 13 of the 15 affected patients (86.7%) versus 6 of the 630 controls (0.95%). The difference in FG proportions remained significant only when carriers of germline mutations in mismatch repair genes were accounted for; mismatch repair genes were detectable in 8 of the 15 cases (three of the five families) and identified as MLH1 mutations.
Pancreatic Cancer-Induced Diabetes
Approximately 1% of subjects aged 50 or older will develop pancreatic cancer within 3 years of first meeting criteria for diabetes—a rate nearly eight times higher than that for persons of similar age and sex in the general population, according to a population-based study in Rochester, Minn.
Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn., studied 2,122 Rochester residents who first met criteria for diabetes at or above age 50 and identified 18 (0.85%) who were diagnosed with pancreatic cancer within 3 years (Gastroenterology 2005;129:504–11). This result, along with earlier epidemiologic studies, suggests that subjects with new-onset diabetes are a high-risk group for pancreatic cancer, the researchers said.
However, they note, “The success of the strategy to use hyperglycemia as a screening tool … will depend largely on our ability to differentiate pancreatic cancer-induced diabetes from type 2 diabetes using a serologic marker.” Thus, hyperglycemia and diabetes may be useful as clinically relevant markers of undiagnosed pancreatic cancer, although further study will be required to test that strategy.
Aspirin Lowers Colorectal Cancer Risk
Regular, long-term use of aspirin reduces the risk of colorectal cancer, but significant reduction is not achieved until more than 10 years of use have elapsed, according to a prospective cohort study.
Maximum benefits were gained at doses exceeding 14 standard (325 mg) tablets per week. Andrew T. Chan, M.D., of Massachusetts General Hospital and Harvard Medical School, and his colleagues therefore noted that “optimal chemoprevention may require substantially higher doses of aspirin than currently recommended for the prevention of cardiovascular disease” (JAMA 2005;294:914–23).
The researchers, who used medication intake data from 82,911 of the 121,701 women enrolled in the Nurses' Health Study, also found that nonaspirin NSAIDs appeared to have a similar protective effect, again in a dose-dependent manner.
As in many other studies, they noted, “we did observe an increase in the incidence of reported major gastrointestinal bleeding with increasing aspirin dose.”