Spindle cell proliferations of the sigmoid colon, rectum and anus: a review with emphasis on perineurioma.

A wide range of spindle cell proliferations are found uncommonly in the sigmoid colon, rectum and anus. They usually present as polyps, and include reactive lesions and benign and malignant neoplasms which may be primary or metastatic. They are less frequently described in the literature compared to those in the upper gastrointestinal tract, and may be underdiagnosed. The widespread use of sigmoidoscopy in symptomatic patients and bowel cancer screening programmes means that histopathologists must be aware of, and adopt a logical approach to, diagnosing spindle cell proliferations in biopsy and polypectomy specimens. This is particularly relevant given the strong association of some mesenchymal polyps with hereditary cancer syndromes. This review article will focus on perineurioma and the recent debate in relation to its overlap with fibroblastic polyp. The clinical, endoscopic, histological and immunohistochemical features of spindle cell proliferations which should be considered in the differential diagnosis of perineurioma will be discussed. There is also a brief reference to malignant spindle cell tumours of diagnostic importance.

Sexual health of women aged 40 and over attending an inner city integrated sexual health clinic.

Sexual health policy remains focussed on younger adults. However, rates of sexually transmitted infections (STIs) in older people continue to increase. We explored the sexual healthcare needs of women aged 40 and over attending an integrated sexual health clinic in South London. We conducted a retrospective case note review and found that almost 20% of these women had STIs. These included genital herpes, trichomoniasis, genital warts, chlamydia and gonorrhoea. Less than a quarter of women reported use of condoms during most recent sexual contact, indicating sexual risk-taking behaviour. 38% of women attended for contraception. The sexual health needs of older people can only continue to increase, given our rapidly ageing population. Age-specific health promotion strategies are needed.

Implementation and outcomes of a new safeguarding pathway for vulnerable adults presenting to sexual health services.

Adult safeguarding is the process of protecting vulnerable adults from harm or exploitation. In 2014, our sexual health clinic implemented a new adult safeguarding pathway, including an adult safeguarding proforma, an electronic database and a monthly adult safeguarding meeting. We conducted a retrospective case note review of patients entered onto the safeguarding database and found that greater numbers of adults were identified as vulnerable following the introduction of this pathway. Many required referral for onward support, highlighting the importance of robust safeguarding procedures in a sexual health setting.

Long-term antipsychotic polypharmacy: how does it start, why does it continue?

BACKGROUND: Antipsychotic polypharmacy remains a widespread and persistent practice, despite a lack of empirical evidence to support its safety and efficacy. This study aimed to assess antipsychotic treatment prior to the initiation of polypharmacy and ascertained clinicians' reasons for coprescribing long term. We also aimed to determine patterns of antipsychotic coprescription and associated outcome. METHOD: Prescription charts across a large mental health trust were reviewed to identify all patients coprescribed two or more antipsychotics excluding clozapine. For those receiving antipsychotic polypharmacy for at least 6 months, electronic patient records were examined to obtain demographic data, documented reasons for initiating polypharmacy and prior prescribing information. Sequence of prescribing, clinical outcome, adverse effects and prescriber considerations to revert to monotherapy were determined. RESULTS: In all, 38 patients had been receiving two antipsychotics excluding clozapine for longer than 6 months. In 39% of cases patients had been prescribed no or only one antipsychotic before initiation of polypharmacy while 48% had been trialled on clozapine. The most frequently documented reason for coprescribing was that residual psychotic symptoms remained with monotherapy. An improvement in psychotic symptoms was documented in 26% of patients receiving polypharmacy. Prescribers considered stopping polypharmacy in 23 patients. CONCLUSION: Antipsychotics were coprescribed largely to improve symptoms and clinical outcome in patients with inadequate response to monotherapy. Polypharmacy was not solely reserved for patients in whom all other therapeutic options had failed. There was some evidence to suggest that patients did benefit from coprescription, albeit at the expense of an increased adverse effect burden. Prospective randomized trials of specific antipsychotic combinations are required to assess the therapeutic utility of this under-researched practice.