The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
Objectives Peritoneal ventilation (PV) can greatly increase PaO2 in hypoxemic rabbits. We tested the hypothesis that the peritoneum can provide a gas exchange surface for oxygen uptake in larger animals that, like humans, have a smaller relative peritoneal surface area and corresponding blood flow. Design Prospective, randomized, controlled animal study. Setting University research laboratory. Interventions In six anesthetized pigs, a modified endotracheal tube (9.0-inner diameter) was inserted into the peritoneal cavity, and the perltoneal cavity was ventilated with oxygen in helium in gas phase. Measurements of peritoneal oxygen uptake and mixed venous oxygen saturation were made over 30 mins of: a) baseline FIO2 0.20, no PV; b) FIO2 0.20, PV; c) FIO2 0.20, PV, dopamine 5 [micro sign]g/kg/min; d) baseline FIO2 0.15, no PV; e) FIO2 0.15, PV; and f) FIO (2) 0.15, PV, dopamine 5 [micro sign]g/kg/min. Measurements and Main Results Mixed venous oxygen saturation was 61% at the baseline FIO2 of 0.20 and 33% at an FIO2 of 0.15 and did not Increase significantly from baseline with PV or with dopamine at either FIO2. Peritoneal oxygen uptake, measured with a waterseal spirometer, was 9.1 +/- 3.1 (SD) and 11.9 +/- 3.0 mL/min when lung FIO2 was 0.20 and 0.15, respectively, and 9.7 +/- 2.8 and 12.2 +/- 2.7 mL/min when FIO2 was 0.20 and 0.15 and dopamine was infused, respectively. Conclusion Peritoneal ventilation does not result in clinically significant oxygen uptake or alter mlxed venous oxygen saturation in a porcine model of hypoxemia. (Crit Care Med 1998; 26:1564-1568)
Purpose: The use of helium for insufllation during laparoscopic surgery avoids hypercarbia and acidosis associated with absorbed CO 2, but the effects of helium gas embolism are unknown. We compared the effects of CO 2 with He gas embolism on survival, haemodynamic variables, oxygenation, and ventilation in pigs. Methods: Anaesthetized juvenile pigs were given progressively larger boluses of either CO 2 (n = 5) or He (n =4) into the right atrium. Measurements of haemodynamic variables, oxygenation, and PFTCO 2 were made before and after each gas injection. Results: All animals survived injections of 300 ml CO 2 while no animal survived more than 120 ml He (P < 0.01 ). Mean artenal pressure decreased more after 60 ml He (99 +_ 14 to 44 --- 20 mmHg) than after 60 ml CO 2 (I I 0 _+ 12 to 88 --- 14 mmHg, P < 0.001 ). Cardiac output did not change at any injection volume. The P~rCO 2 decreased more after 60 ml He (30 --- 2 to 3 -+- 6 mmHg) than after 60 ml CO 2 (35 --+ 3 to 30 --- 3 mmHg, P < 0.001 ). Only the He group showed a decrease in PaO 2 (I 90 ___ 51 to 68 --- 22 mmHg at 60 ml, m < 0.05). Conclusion: Helium gas embolism has a greater deleterious effect than CO 2 gas embolism on survival, MAP, PErCO2., and PaO 2. These different effects of gas embolism should be recognized when considering the use of helium or other insoluble gases for abdominal laparoscopic insufflation.
# 01: Iron deficiency in bariatric surgery patients — a single-centre experience over 5 years {#article-title-2} As the prevalence and severity of obesity have increased in Canada, so too has the demand for bariatric surgery. The objective of this study was to determine the incidence of
# 01 The green thumb of endoscopy: switching from sterile water to tap water {#article-title-2} The use of sterile water in endoscopy is a common practice that is not based on available evidence. Literature suggests that the use of tap water in endoscopy is safe and appropriate, even for advanced
In Canada, provincial cancer registries have been established to provide rigorous population-based data for patients with colorectal cancer. Databases maintained by regional cancer agencies contain a broader scope of information and have been used as a surrogate source of information for colorectal cancer research. It is unclear whether these data can be reliably extrapolated to all patients affected by colorectal cancer. We sought to determine whether patients included in a referral-based database are systematically different from patients who are not included.
Methods:
We conducted a retrospective cohort study to compare patients referred to the British Columbia Cancer Agency with those who were not referred. Comparison was based on age, sex and geographic location. We used univariate and logistic regression analysis to identify significant differences between the cohorts.
Results:
Univariate analysis demonstrated that the referral and nonreferral cohorts differed in sex, age and geographic location. For patients with rectal cancer, the referral and nonreferral cohorts varied in age and geographic location. Multivariate analysis demonstrated significant differences in age and geographic location but not sex for patients with colon and rectal cancer.
Conclusion:
Patients included in the referral database differed in age and geographic location from those included only in the provincial database. Studies using large data sets from referral centres must be interpreted with caution and may not be representative of the entire patient population.
Background:
Au Canada, on a établi des registres provinciaux en oncologie pour générer des données représentatives rigoureuses au sujet des patients atteints de cancer colorectal. Les bases de données maintenues par les agences régionales du cancer contiennent un éventail plus large de renseignements et ont servi de source de données de substitution pour la recherche sur le cancer colorectal. Or, on ignore s’il est possible d’extrapoler ces données de manière fiable à tous les patients atteints de cancer colorectal. Nous avons voulu déterminer si les patients inclus dans une base de données de référence sont systématiquement différents des patients qui n’y figurent pas.
