The incidence of rectal cancer is higher in the older population. In developed nations, there has been a rise in incidence in young onset colorectal cancer (CRC). We examined the outcomes of locally advanced rectal cancer (LARC) in younger patients (yRC) compared with older patients, using a retrospective audit.
Abstract Granular cell tumours (GCTs) are generally benign neoplasms, which are believed to be of neural origin. They are uncommon in the gastrointestinal tract. They are rarely found in the colon and even more rarely found to be multiple. We present a case of a man who underwent a right hemicolectomy for a submucosal lesion and polyps and was found to have multiple nodules diagnosed as caecal GCTs with cellular atypia. While uncommon, this case shows it remains an important differential due to implications for patient management, given the often benign nature of disease.
Cette étude cherche à saisir, à travers l’analyse de quatre plans extraits de quatre westerns différents, l’évolution syntaxique et historique d’un genre, de ses discours et de son idéologie, à travers l’apparente immuabilité de ses éléments sémantiques – narratifs, formels ou iconographiques. À partir de l’analyse comparative de quatre plans tirés de Stagecoach (Ford, 1939), de The Searchers (Ford, 1957), de The Ox-Bow Incident (Wellman, 1942) et de Once Upon a Time in the West (Leone, 1968), l’étude s’inscrit au confluent de plusieurs approches, aussi bien générique, formaliste que pragmatique. Elle part du genre et de certaines de ses conventions dramatiques et esthétiques pour déterminer, à travers les jeux parfois improbables, mais passionnants, de l’interprétation, son impact dans des contextes socioculturels déterminés et les modalités de ses transformations en fonction de ce que l’historiographie américaine a connu de modifications radicales.
Parodie des romans de chevalerie, Don Quichotte est construit sur l'incapacité du protagoniste à aligner ses désirs et ses actions sur ceux de ses héros fictifs. A partir du roman, René Girard développe la théorie de la médiation externe du désir, centrée sur la disposition d'un personnage à imiter et à se conformer aux actes d'un modèle qui n'appartient pas à son propre univers diégétique. Cette donnée, mise en lumière par Girard, n'est pas assez mise en avant dans le cadre d'études sur l'esthétique et les mécanismes du comique. Dans ce sens, nous identifions chez les héros comiques modernes ce que nous désignons par « syndrome de Don Quichotte », qui les rend victimes d'une appropriation mimétique de modèles illusoires, les plongeant dans une série de mésaventures avant un retour pénible et inévitable à la lucidité. Nous essayons ainsi de relever la spécificité du roman de Cervantès, sa manière d'expliciter la dimension parodique et la syntaxe de la comédie, et de relever chez les héros comiques modernes des traits qui en font les descendants du prototype « quichottien ».
Background: Long term Capsule Endoscopy (CE) retention is an uncommon, but potentially serious complication of CE. It is most frequently due to Crohn’s related small bowel strictures or neoplastic lesions but can be caused by post-surgical stenosis and non-steroidal anti-inflammatory drug (NSAID) enteropathy. We present a case of retained CE in the distal ileum due to NSAID enteropathy with striking photographs of the small bowel stricture and the moment of laparoscopic device retrieval.
Case report: An 83-year-old female on amlodipine and esomeprazole presented with a month-long history of melaena and was found to have iron deficiency anaemia. She had been investigated two years prior for a similar episode with gastroscopy, colonoscopy and CE without finding an underlying cause. Gastroscopy and colonoscopy were repeated, revealing gastritis and diverticular disease but no bleeding source. CE showed an inflamed distal ileal stricture, which prevented capsule passage. The patient was asymptomatic and X-ray and computed tomography (CT) confirmed retention of the capsule with no bowel obstruction. On directed questioning she admitted to infrequent use of a COX-II inhibitor for arthritis over the previous 3 years. She underwent double balloon enteroscopy with dilatation, which identified the stricture and the retained capsule, but it could not be safely retrieved at that time or one week later. She developed abdominal pain and ultimately proceeded to laparoscopic removal of the capsule and resection of the stricture. Histology was consistent with an NSAID etiology.
Conclusion: CE retention is a serious complication and can be caused by strictures related to occult NSAID use. Directed history taking and use of patency capsules could reduce the incidence of this problem.
There has been a resurgence of interest in the use of mechanical bowel preparation (MBP) and oral antibiotics (OAB) before elective colorectal surgery. Until now, clinical trials and meta-analyses have not compared all 4 approaches (MBP with OAB, OAB only, MBP only, or no preparation) simultaneously.
Objective
To perform a network meta-analysis to clarify which approach in colorectal surgery is associated with the lowest rate of surgical site infection (SSI).
Data Sources
Five electronic databases were searched, including PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club. and Database of Abstracts of Review of Effectiveness from database inception to November 27, 2017.
Study Selection
Only data from randomized clinical trials were included. Inclusion criteria were RCTs that reported on SSI rates or other complications based on MBP or OAB status. Quality of studies was appraised by the Cochrane Collaboration risk of bias tool.
Data Extraction and Synthesis
The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Main Outcomes and Measures
Total, incisional, and organ/space SSI rates. Secondary outcomes included rates of anastomotic leak, mortality, readmissions/reoperations, urinary tract infection, and pulmonary complications.
Results
Thirty-eight randomized clinical trials among 8458 patients (52.1% male) were included, providing 4 direct comparisons and 2 indirect comparisons for 8 outcome measures. On Bayesian analysis, MBP with OAB vs MBP only was associated with reduced SSI (odds ratio [OR], 0.71; 95% equal-tail credible interval [CrI], 0.57-0.88). There was no significant difference between MBP with OAB vs OAB only (OR, 0.95; 95% CrI, 0.56-1.62). Oral antibiotics without MBP was not associated with a statistically significant reduction in SSI compared with any other group (except for a risk reduction in organ/space SSI when indirectly compared with no preparation) (OR, 0.13; 95% CrI, 0.02-0.55). There was no difference in SSI between MBP only vs no preparation (OR, 0.84; 95% CrI, 0.69-1.02).
Conclusions and Relevance
In this network meta-analysis of randomized clinical trials, MBP with OAB was associated with the lowest risk of SSI. Oral antibiotics only was ranked as second best, but the data available on this approach were limited. There was no difference between MBP only vs no preparation. In addition, there was no difference in rates of anastomotic leak, readmissions, or reoperations between any groups.
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