Age Matters: Adenoma Detection Rates in Average-risk Screening Patients Aged 45 to 49 Compared With Those Aged 50 to 54.

GOALS: This study aims to address gaps in medical knowledge by determining whether adenoma detection rate (ADR) in average-risk screening patients aged 45 to 49 is equivalent to screening patients aged 50 to 54. BACKGROUND: Current guidelines recommend initiating colon cancer screening at age 45, yet our understanding of the effects of ADR in average-risk individuals among 45- to 49-year-olds is still limited. STUDY: A retrospective analysis was conducted on records of average-risk screening colonoscopies performed on patients aged 45 to 54 from January 2018 to August 2022. Exclusions were prior diagnoses of colorectal cancer or adenomatous polyps, inflammatory bowel disease, personal or family history of genetic cancer syndromes, incomplete colonoscopy, and inadequate bowel preparation. The primary outcome was ADR in the age 45 to 49 group compared with the age 50 to 54 group. RESULTS: Of the 3199 average-risk screening colonoscopies performed, 879 and 2116 patients were included in the age 45 to 49 and 50 to 54 groups, respectively. Both groups were predominantly female, White ethnicity, never smokers, and obese. ADR was found to be 27% in the age 45 to 49 group compared with 34% in the age 50 to 54 group (odds ratio 0.70, 90% CI: 0.60-0.83, P-value for equivalence=0.81 w/ margin 0.77 to 1.30). CONCLUSIONS: The study did not demonstrate equivalent ADR between the 2 age groups, with ADR being substantially lower in the age 45 to 49 group (27% vs. 34%). Despite this, the ADR in the 45 to 49 age range surpasses the established benchmark of 25%, supporting the decision to lower the screening age to 45 years. Ongoing national monitoring is essential to comprehensively evaluate the impact of these updated guidelines.

A Rare Red Herring: Intrahepatic Splenosis Masquerading as Hepatocellular Carcinoma.

Splenosis is defined as viable splenic tissue that is autotransplanted into other compartments in the body. Intrahepatic splenosis is a rare diagnosis that can be difficult for clinicians to identify. The most common causes of splenosis include abdominal trauma and splenectomy. While most patients with intrahepatic splenosis are asymptomatic, in the presence of risk factors of hepatocellular carcinoma, it is paramount to rule out malignancy. In this report, we present a patient with imaging findings concerning for hepatocellular carcinoma, ultimately diagnosed with percutaneous biopsy and technetium-99m-tagged heat-damaged red blood cell scintigraphy-proven intrahepatic splenosis.

Outcomes of Eyes With Diabetic Macular Edema That Are Lost to Follow-up After Anti-Vascular Endothelial Growth Factor Therapy.

PURPOSE: To evaluate the effect of loss to follow-up (LTFU) on outcomes in eyes with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (VEGF). DESIGN: Retrospective cohort study. METHODS: Single-center study of 90 eyes of 73 patients with nonproliferative diabetic retinopathy (NPDR) and DME treated with anti-VEGF injections who were LTFU for >6 months. Main outcomes were the change in mean visual acuity (VA) and central foveal thickness at the return and final visits compared with the visit before LTFU. RESULTS: The mean age was 64.5 years, the mean LTFU duration was 322 days, and the mean follow-up duration after return was 502 days. Compared with the mean VA at the visit before LTFU (0.42, Snellen ∼20/52), mean VA worsened at the return visit (0.54, Snellen ∼20/69, P = .004). No significant change in the mean VA was noted at the 3-month after return visit (0.50, Snellen ∼20/63), the 6-month after return visit (0.46, Snellen ∼20/57), the 12-month after return visit (0.42, Snellen ∼20/52), or the final follow-up (0.47, Snellen ∼20/59). When analyzed by NPDR severity before LTFU, no difference in VA was found from the visit before LTFU to the final visit. Mean central foveal thickness increased when comparing the visit before LTFU (270 µm) with the return visit (305 µm, P = .012), but no difference was found by the final visit (247 µm, P = .07). CONCLUSIONS: Anti-VEGF-treated patients with DME who were LTFU for a prolonged period experienced a modest decline in VA that recovered after restarting treatment.

Incidence of Hardware Removal Following Volar Plate Fixation of Distal Radius Fracture.

PURPOSE: To assess the risk of tendon rupture or plate removal after volar plate fixation of distal radius fractures and to determine the incidence of hardware removal. METHODS: We searched the surgical database of 5 attending hand surgeons at a single institution from 2009 to 2014. All patients who had undergone volar plate fixation were included. Patients were excluded if they underwent an alternate form of fixation, had less than 1 year of follow-up, or could not be reached for follow-up. Postoperative radiographs were examined for Soong grade, plate distance to the critical line, and plate distance to the volar rim. If patients had hardware removed, the reason for plate removal was identified. For all patients who did not have documented hardware removal at our institution, we placed a follow-up call to determine whether they had hardware removed elsewhere. RESULTS: A total of 517 patients underwent volar plate fixation, 143 of whom did not have their hardware removed at our institution but could not be reached for follow-up. Of the remaining 374 patients, 37 (10%) had hardware removed. For group 1 (hardware retained), Soong grades were 13% grade 0, 85% grade 1, and 2% grade 2. For group 2 (hardware removed) the proportions were 11%, 76%, and 5%, respectively, and 8% undetermined. Mean plate distance to the critical line was significantly greater for group 2 (1.9 mm) compared with group 1 (1.2 mm). Mean plate distance to the volar rim did not differ (5.1 mm vs 5.3 mm). CONCLUSIONS: The incidence of hardware removal in our series was 10%. The vast majority of patients had Soong grade 1 prominence. Patients who had hardware removed had a greater plate prominence volar to the critical line. Plate distance to the volar rim was not associated with removal. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.