Hereditary nonpolyposis colorectal cancer

Delayed Cord-Cutting Seems Warranted, Meta-Analysis Concludes.

Posted by

0


Delaying clamping of the umbilical cord for more than 1 minute after birth increases the infant’s iron stores and hemoglobin concentration, aCochrane Library meta-analysis finds.

The analysis included 15 randomized trials comprising almost 4000 mother-infant pairs. Severe maternal postpartum hemorrhage was no more frequent with delayed clamping. Neonatal mortality rates did not differ between the early- and late-clamping groups; phototherapy for jaundice was less common with early clamping (relative risk, 0.62).

Late clamping was associated with higher neonatal hemoglobin levels in the early postpartum period, as well as a lower risk for iron deficiency at 3 to 6 months postpartum.

The authors conclude that delayed clamping “is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.”

Source:Cochrane Library

span� sy�8 ��m size:9.0pt;font-family:”Helvetica“,”sans-serif”;color:#454545′>In a prospective study, endoscopists were given training to ensure familiarity with the classification of polypoid versus nonpolypoid colorectal neoplasms. Among 59 patients with Lynch syndrome undergoing colonoscopy, and 590 matched control patients, conventional adenomas were more likely to be nonpolypoid in patients with Lynch syndrome than in control patients — both overall (43.4% vs. 16.9%) and in the proximal colon (58.1% vs. 16.3%). Serrated polyps were also more likely to be nonpolypoid in patients with Lynch syndromes than in control patients (49.2% vs. 20.4%).

 

COMMENT

Current guidelines recommend that patients with Lynch syndrome undergo colonoscopy at 2-year intervals beginning at age 20 to 25 years, and annually after age 40. Many experts perform colonoscopy at 1-year intervals even in younger patients who are proven gene carriers. The basis for these short intervals is the repeated observation that patients appear to develop colorectal cancers within a few years of a normal colonoscopy. The current study suggests that this phenomenon could be based not only on the rapid accumulation of mutations in small lesions, but also on an increased tendency toward nonpolypoid shape that could contribute to missing neoplasms during colonoscopy. The data certainly support performance of colonoscopy in patients with Lynch syndrome by endoscopists who are thoroughly trained in the full endoscopic spectrum of both conventional adenoma and serrated lesion appearances.

Source: NEJM

Lesions Are Flatter in Lynch Syndrome.

Posted by

1


 

A higher prevalence of nonpolypoid-shaped adenomas and serrated polyps in these patients might explain some of their increased risk for colorectal cancer.
The polyp-to-cancer sequence occurs on average more quickly in Lynch syndrome than in sporadic cancers. Loss of mismatch repair, which can lead to more rapid accumulation of mutations in cancer genes, is believed to underlie this clinical observation. Now, researchers in the Netherlands have investigated whether nonpolypoid morphology of colorectal neoplasms might be another factor associated with the increased risk for colorectal cancer in patients with Lynch syndrome.

In a prospective study, endoscopists were given training to ensure familiarity with the classification of polypoid versus nonpolypoid colorectal neoplasms. Among 59 patients with Lynch syndrome undergoing colonoscopy, and 590 matched control patients, conventional adenomas were more likely to be nonpolypoid in patients with Lynch syndrome than in control patients — both overall (43.4% vs. 16.9%) and in the proximal colon (58.1% vs. 16.3%). Serrated polyps were also more likely to be nonpolypoid in patients with Lynch syndromes than in control patients (49.2% vs. 20.4%).

COMMENT

Current guidelines recommend that patients with Lynch syndrome undergo colonoscopy at 2-year intervals beginning at age 20 to 25 years, and annually after age 40. Many experts perform colonoscopy at 1-year intervals even in younger patients who are proven gene carriers. The basis for these short intervals is the repeated observation that patients appear to develop colorectal cancers within a few years of a normal colonoscopy. The current study suggests that this phenomenon could be based not only on the rapid accumulation of mutations in small lesions, but also on an increased tendency toward nonpolypoid shape that could contribute to missing neoplasms during colonoscopy. The data certainly support performance of colonoscopy in patients with Lynch syndrome by endoscopists who are thoroughly trained in the full endoscopic spectrum of both conventional adenoma and serrated lesion appearances.

Source: NEJM