ABSTRACT
AIM: To assess accuracy of CT colonography (CTC) in identifying synchronous lesions in patients with colorectal carcinoma. METHODS: This study included 174 consecutive patients undergoing CTC as part of staging or primary investigation where a colorectal cancer was diagnosed between 2004 and 2007. Prone unenhanced and portal phase enhanced supine series with air or CO(2) distension were acquired using 4- or 16-slice CT (Toshiba) and read by 2D +/- 3D formats. Synchronous lesions were classified according to American College of Radiology's (ACR) polyp classification. Segmental gold standard was flexible sigmoidoscopy/colonoscopy within 1 year and/or histology of colonic resection supplemented by follow-up. Nine patients without gold standard were excluded. Sensitivity, specificity and accuracy were calculated on a per polyp, per patient and per segment basis and discrepancies analysed. RESULTS: Direct comparable data were available for 764/990 colonic segments from 165 patients. Of 41 (C2-C4) synchronous lesions on "gold standard", 33 were correctly identified on virtual colonoscopy (VC), overall per polyp sensitivity was 80.5%, with detection rates of 20/24 C3 (83.3%) and 3/3 C4 (100%) with per patient and per segment specificity of 95.4% and 99.2%, respectively. CONCLUSION: CTC is an accurate technique to assess for significant synchronous lesions in patients with colorectal cancer and is applicable for total pre-operative colonic visualisation.
Subject(s)
Colonic Polyps/diagnostic imaging , Colonography, Computed Tomographic/methods , Colorectal Neoplasms/complications , Colorectal Neoplasms/diagnostic imaging , Adult , Aged , Colonic Polyps/complications , Female , Humans , Male , Middle Aged , Pilot Projects , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
The clinical details are presented of 29 fatal cases of pleural mesothelioma in the majority of which there was a history of exposure to asbestos during dockyard work in Portsmouth. Chest pain, breathlessness and weight loss dominated the clinical picture. Analgesia and repeated pleural aspirations provided temporary relief but symptoms invariably progressed. The mean survival time was 39 weeks. Only one patient survived longer than 2 years from hospital presentation. At autopsy, extensive local spread was usual but a high proportion of patients also had metastases at distant sites.
Subject(s)
Mesothelioma/etiology , Pleural Neoplasms/etiology , Aged , Asbestos/adverse effects , Environmental Exposure , Female , Humans , Male , Mesothelioma/pathology , Middle Aged , Pleural Neoplasms/pathology , Retrospective StudiesABSTRACT
A case is reported of Legionnaires' pneumonia in a 49-year-old woman, associated with severe and permanent disability resulting from damage to the brain stem believed to be the result of an encephalitic process.