Squamous cell carcinoma of the rectum 21 years after radiotherapy for cervical carcinoma.

Squamous cell carcinoma (SCC) of the rectum is an extremely rare malignancy, accounting for 0.1-0.2% of rectal malignancies. It is associated with ulcerative colitis, prior radiation, schistosomiasis, ovarian cancer, endometrial cancer, human papilloma virus, colocutaneous fistulas and colonic duplication. Prior reported cases of SCC of the rectum have involved treatment with brachytherapy and external beam radiation. This case is particularly interesting because of the remote exposure of radiation (21 years previously) and the subsequent development of SCC of the rectum. Although extremely rare, SCC of the rectum can occur decades after radiation exposure.

Who is willing to undergo endoscopy without sedation: patients, nurses, or the physicians?

OBJECTIVES: Some studies suggest that the majority of the United States population is now willing to undergo unsedated endoscopy. We studied the willingness of patients, nurses, and physicians to undergo endoscopy without sedation. METHODS: Adult patients presenting to us for outpatient endoscopy at two large tertiary care level 1 trauma hospitals were asked to fill out a survey questionnaire recording their demographic information, prior experience with endoscopy and sedation, and whether they were willing to undergo unsedated endoscopy. Their anxiety level was assessed using the Beck Anxiety Inventory. After the endoscopic procedure, patients were asked whether they had any change in their decision regarding unsedated endoscopy. A random convenience sample of physicians and nurses were also given a questionnaire asking about their experience with endoscopy and whether they were willing to undergo such procedures without sedation. RESULTS: A total of 127 patients, 117 nurses, and 51 physicians participated in the study. Only 19.5% of patients were willing to undergo upper endoscopy without sedation. Among patients, the willingness dropped to 6.75% postprocedurally. Results were similar for colonoscopy. Physicians were least likely to agree to an unsedated procedure (2.2%). Gastroenterology (GI) nurses were more likely to undergo unsedated esophagogastroduodenoscopy (39.3%) as opposed to non-GI nurses (7.1%, P < 0.001). 19.6% of GI nurses agreed to unsedated colonoscopy versus 0% in the non-GI group (P = 0.001). Preprocedure anxiety level was not found to be a predictor for willingness to undergo unsedated endoscopy. Female patients were more likely to forego sedation preprocedurally (OR = 5.75; 95% CI = 2.05-16.2). However, postprocedurally, gender was no longer a significant predictor. Similarly, among the nurses and physicians, neither age nor gender was a significant predictor of willingness to undergo unsedated endoscopy. Patients with a high school (OR = 0.01; 95% CI = 0.01-0.06) or associates degree (OR = 0.02; 95% CI = 0.01-0.35) were less likely to forego sedation. CONCLUSION: In contrast to reports from some major medical centers, the current study found that most patients as well as medical professionals were unwilling to undergo endoscopy without sedation.