Young patients with benign anal diseases and rectal bleeding: should a colonoscopy be performed?

BACKGROUND AND AIM: There is no consensus whether a colonoscopy should be recommended for patients under 50 years of age who present with both anal bleeding and benign anal diseases. The aim of this study is to evaluate the effectiveness of colonoscopy to detect neoplastic lesions in this specific group of patients. METHODS: A prospective study analyzing the results of colonoscopies performed in patients younger than 50 years of age who reported a rectal bleeding and also had a diagnosis of benign anal disease at first clinical visit. RESULTS: One hundred and eighty-seven consecutive patients were prospectively included in this study. In 35 patients (18.7%), adenomatous polyps were diagnosed. Thirty-seven percent of those lesions (13 cases) were further classified as either advanced adenomas or serrated adenomas. The prevalence of adenomas was 14.6% among patients under the age of 40 and 20% among those between 40 and 50 years of age. Thirty-one percent of the adenomas (11 cases) were located in the right colon, without any other concomitant lesion in the distal colon. In addition, an unsuspected case of sigmoid carcinoma was diagnosed. CONCLUSION: The performance of colonoscopy in young patients with benign anal diseases and hematochezia resulted in a high rate of detection of neoplastic lesions. The method might be considered as a valid strategy of investigation in this frequent clinical situation.

Evolving treatment strategies for colorectal cancer: a critical review of current therapeutic options.

Management of rectal cancer has markedly evolved over the last two decades. New technologies of staging have allowed a more precise definition of tumor extension. Refinements in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this malignancy. Although, preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors, many controversial matters in management of rectal cancer still need to be defined. These include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy, the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor resection. In this article, after an extensive search in PubMed and Embase databases, we critically review the current strategies and the most debatable matters in treatment of rectal cancer.

Metastatic renal cell carcinoma involving the rectum.

BACKGROUND AND AIMS: Metastatic spread of a distant tumor to the rectum is extremely rare. To our knowledge, there have been no published reports of hematogenic metastasis from a renal cell carcinoma to the rectum. PATIENTS AND METHODS: A patient with a renal cell carcinoma was initially treated by a radical right nephrectomy. RESULTS: Nine months after the surgery he started to have multiple episodes of hematochezia. Colonoscopy showed a nodular lesion located in the distal rectum, and biopsy revealed an undifferentiated carcinoma. The patient then underwent abdominoperineal resection of the rectum, and histological examination showed metastatic renal clear cell carcinoma. CONCLUSION: This case represents an exceedingly rare condition, which has never been reported before.

Frequencia de realizaçäo e acurácia do auto-exame das mamas na detecçäo de nódulos em mulheres submetidas à mamografia / Frequency of performance and accuracy of breast self-examination in the detection breast lumps in women who underwent mammographic examination

Realizamos um estudo transversal prospectivo cujo objetivo foi avaliar a acurácia do auto-exame de mamas (AEM) na detecçao de nódulos mamários palpáveis e a relaçao com sua freqüência. Foram entrevistadas 2672 mulheres que realizaram mamografia na Regiao do Vale dos Sinos/RS no período de janeiro de 94 a julho de 97, questionando-se quanto à freqüência da realizaçao de AEM. As mulheres foram divididas em dois grupos: grupo I (mensalmente), grupo II (quase nunca). As mulheres que relataram realizar o AEM ocasionalmente foram excluídas da análise principal. Foi perguntado à pacicente se ela ou seu médico haviam palpado alguma lesao mamária. Comparou-se os achados de palpaçao da paciente com os do médico (relatados pela paciente). A sensibilidade do AEM foi maior no grupo I comparado ao II (57,4 por cento versus 33,3 por cento; P<0,05). Concluímos que existe uma associaçao entre a realizaçao mensal de AEM e uma maior sensibilidade na detecçao de nódulos mamários palpáveis.