Young onset colorectal cancer: How does it differ from its older counterpart?

BACKGROUND

Colorectal cancer in the young has been a debated topic in literature with conflicting reports as to its pattern of occurrence and survival as compared to the older age group.

MATERIALS AND METHODS

Retrospective study to analyze the clinicopathological characteristics, treatment modalities and survival of sporadic young-onset colorectal cancer (YOCR) patients (<40 years) and compare them with the older group (>40 years).

RESULTS

Of 172 patients managed, 72 (42%) were in the YOCR group. Among 72 patients, six were excluded because of hereditary syndromes. Incontinence (P = 0.02) and obstruction at time of presentation (P = 0.03) was significantly more common in the YOCR group. Left sided disease was more common in YOCR group (47/66) compared to the older group (65/100), but the difference was not statistically significant (P = 0.45). The proportion of rectal cancers was significantly more in the YOCR group (39/47) compared to the older group (39/65) (P = 0.01). Significant difference in resectability was noted in the left sided (YOCR 26/47 vs. older 49/65 P = 0.04) and the rectal cancers (YOCR 18/39 vs. Older 29/39 P = 0.02). The survival was similar among the two groups.

CONCLUSIONS

Sporadic colorectal cancers in the young are more advanced and less resectable when compared to older population. Genetic studies are needed to elaborate the reasons for left sided predominance and aggressiveness of sporadic colorectal cancers in the younger subgroups.

High patency of proximal splenorenal shunt: A myth or reality ? - A prospective cohort study

BACKGROUND

Proximal splenorenal shunt (PSRS) is a well-accepted surgical procedure for non-cirrhotic portal hypertension (NCPH). Though a patent shunt is important for good long term outcome, there are very few studies on patency of these shunts. We analysed shunt patency using dynamic computed tomographic (CT) portography and compared it with other modalities.

METHODS

From 2004 to 2014, 50 patients with PSRS were evaluated prospectively for shunt patency using dynamic CT portography, clinical parameters and ultrasound Doppler.

RESULTS

The causes of NCPH were extrahepatic portal vein obstruction (EHPVO) in 38 patients and non-cirrhotic portal fibrosis (NCPF) in 12 patients. The shunt patency rate using clinical parameters, ultrasound Doppler and dynamic CT portography were 70%, 40% and 60% respectively. Clinical parameters overestimated while ultrasound Doppler underestimated the shunt patency rate. Dynamic portography had 100% correlation with conventional angiography in the five patients when this was done. The site of shunt could be demonstrated convincingly by dynamic CT portography. The shunt patency rate decreased over time. It was 64%, 60% and 43% in <1 year, 1-5 years and >5 years respectively. Our NCPF patients had a greater shunt patency rate compared to EHPVO patients (9/12 vs. 21/38) though the difference was not significant. Only size of the splenic vein had a significant impact on the shunt patency rate on statistical analysis.

CONCLUSIONS

Dynamic CT portography is useful for evaluation of shunt patency. Proximal splenorenal shunts have a high blockage rate which has hitherto not been reported.

Myocardial infarction-induced ventricular aneurysm in the presence of complete left bundle branch block: a case report suggesting a new electrocardiographic diagnostic criterion

A 65-year-old man who had suffered an anterior myocardial infarction (MI) 10 years ago, complicated by a ventricular aneurysm (VA), and subsequently many years later developed complete left bundle branch block (LBBB), is described, with main emphasis on the feasibility of the electrocardiographic (ECG) diagnosis of VA in the presence of this conduction abnormality. Ventricular aneurysm in our patient was repeatedly confirmed by echocardiography over the intervening years. During the time the patient maintained normal intraventricular conduction, the ECG showed persisting ST-segment elevations in the precordial leads. After the development of LBBB, the ECG displayed accentuated ST-segment elevations in the precordial leads with predominantly negative QRS complexes, and ST elevation in V5, despite its primarily positive QRS complex. The authors extend the findings from the previous literature on the diagnosis of acute MI in patients with LBBB or right intraventricular pacing, and the concept of primary and secondary repolarization changes, to the diagnosis of VA in the presence of LBBB.