Multiple rounds of one sample versus two sample faecal immunochemical test-based colorectal cancer screening: a population-based study.

BACKGROUND: Faecal immunochemical test (FIT)-based colorectal cancer screening requires successive rounds for maximum preventive effect. Advanced neoplasia can bleed intermittently and thus might be missed by single faecal sampling. Few studies have been done on two sample FIT (2-FIT) screening over multiple rounds. Therefore, we compared multiple rounds of one sample FIT (1-FIT) with 2-FIT screening with respect to participation, positive predictive value (PPV), diagnostic yield, and interval colorectal cancer. METHODS: In this population-based study, a random selection of asymptomatic individuals aged 50-74 years in the Rotterdam-Rijnmond region, Netherlands, were invited by post for four rounds (every 2 years) of 1-FIT or 2-FIT screening. Key exclusion criteria were a history or colorectal cancer or inflammatory bowel disease, colon imaging in the previous 2 years, and life expectancy of less than 5 years. Per round, invitees received one or two FITs to sample either one or two consecutive bowel movements. OC-Sensor Micro (Eiken Chemical Co., Ltd, Japan) FITs were used by all participants, except the fourth round of screening for the 1-FIT cohort, for which participants used either an OC-Sensor or a FOB-Gold (Sentinel Diagnostics, Milan, Italy). A faecal haemoglobin cutoff concentration of 10 µg/g of faeces in at least one test was used for referral for colonoscopy. FINDINGS: Between 2006 and 2015, of 10 008 invited individuals for the 1-FIT cohort, 9787 were eligible for inclusion, of whom 7310 participated at least once in four successive rounds. Of 3197 invited individuals for the 2-FIT cohort, 3131 were eligible for inclusion, and 2269 participated at least once in four successive rounds. In the 1-FIT screening cohort, 74·7% (7310 of 9787) of invitees participated at least once versus 72·5% (2269 of 3131) of invitees in the 2-FIT cohort (p=0·013). Among participants who participated at least once, the cumulative positivity rate over four rounds was 19·2% (1407 of 7310) for the 1-FIT cohort versus 28·5% (647 of 2269) for the 2-FIT cohort (p<0·0001). The cumulative PPV for advanced neoplasia was 33·0% (432 of 1308 colonoscopies) for the 1-FIT cohort versus 24·2% (147 of 607 colonoscopies) for the 2-FIT cohort (p<0·0001). The cumulative diagnostic yield of advanced neoplasia among invited individuals was 4·4% (432 of 9787) for 1-FIT versus 4·7% (147 of 3131) for 2-FIT screening (p=0·46)). FIT interval colorectal cancers were detected in eight (0·1%) of 7310 participants in the 1-FIT cohort and two (0·1%) of 2269 with 2-FIT screening (p=1·00). INTERPRETATION: Four rounds of 2-FIT screening with a low faecal haemoglobin cutoff level did not result in a significant increase in diagnostic yield or a decrease in interval colorectal cancers compared with 1-FIT, despite higher colonoscopy demand. Therefore, 1-FIT colorectal cancer screening programmes should be preferred. FUNDING: None.

[Halothane and antituberculous drugs--a hepatotoxic combination? (author's transl)]. / Halothan und Tuberkulostatika als hepatotoxische Arzneimittelkombination.

A case report is given on two patients receiving halothane anesthesia while beeing treated with isoniacid, ethambutol and rifampicin. Following halothane anesthesia, both patients developed a severe liver disease with encephalopathy grade III. We observed a moderate increase of bilirubin and SGOT and a more severe increase of serum ammonia. Histologically, both patients had alterations compatible with drug hepatitis. Within 14 days remission occurred spontaneously. The two case reports do not fit with typical isoniacid hepatitis or typical halothane hepatitis. The possibility of combined drug toxicity on liver during halothane and isocianid treatment is discussed.

[Differential diagnosis of tumors of the duodenal bulb by endoscopy and biopsy (author's transl)]. / Endoskopisch-bioptische Differentialdiagnose der Bulbustumoren

Duodenoscopy was performed in 2 602 patients; malignant tumors were found in 5, hyperplasia of Brunner's glands in 5, hyperplasia of lymphatic follicles in 26, inflammatory pseudo-polyps in 9, and ectopic gastric mucosa in 5 cases. Only 3 of the big tumors had been detected by x-ray examinations; enlarged lymphatic follicles and the polyps had escaped x-ray detection altogether. Infiltration of the mucosa by tumor tissue can be suspected merely on the ground of endoscopic inspection with a high degree of probability. Histological diagnosis depends on forceps biopsy. Big particle biopsy of submucosal tumors with a sling carries a high risk, which however has to be taken in order to obtain a definite diagnosis. Tumors of the duodenal bulb caused by inflammatory processes do present considerable diagnostic problems. Special problems of diagnosis and therapy of the cases presenting with hyperplasia or adenoma of Brunner's glands are discussed in a special section.

[The arteriography of the liver diseased with Echinococcus alveolaris (author's transl)]. / Angiographische Darstellung der Leberarterien beim Echinococcus alveolaris

In 2 patients with Echinococcus alveolaris of the liver an angiography of the celiac axis, superior mesenteric artery and -- indirectly -- of the splenic vein was performed. The findings -- obliteration, dislocation, corc screw collaterals -- are not diagnostic. This statement is supplemented by a review of the special literature. The value of an arterial angiography consists in delineating the extent of the process. In this sense the method seems to be superior to a liver scan. Angiography is indicated when curative surgical therapy is discussed.