Colonoscopy performed three years after colonoscopic removal of adenomatous polyps detects important colonic lesions as effectively as follow-up colonoscopy after both one and three years. An interval of at least three years is recommended before follow-up colonoscopy after both one and three years. An interval of at least three years is recommended before follow-up examination after colonoscopic removal of newly diagnosed adenomatous polyps. Adoption of this recommendation nationally should reduce the cost of post-polypectomy surveillance and screening.

In patients who have undergone colonoscopic polypectomy, colonoscopic examination is a more effective method of surveillance than double-contrast barium enema.

Background The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for colorectal cancer (CRC) in adequately screened elderly aged over 75. The USPSTF did not address the appropriateness of screening in elderly aged over 75 without prior screening. Objective To determine up to what age CRC screening should be considered in unscreened elderly with no, moderate, and severe comorbidity and to determine which test is indicated at what age. Design Microsimulation modeling study. Data Sources Derived from the literature. Target Populations Unscreened elderly aged 76, 77, (...), and 90 with no, moderate, and severe comorbidity. Time Horizon Lifetime. Perspective Societal. Interventions Once-only colonoscopy, sigmoidoscopy, and fecal immunochemical test (FIT) screening. Outcome Measures CRC cases prevented, CRC deaths prevented, life-years gained, quality-adjusted life-years (QALYs) gained, costs, and costs per QALY gained. Results of Base-Case Analysis In unscreened elderly with no, moderate, and severe comorbidity, CRC screening was cost-effective up to age 86, 83, and 80, respectively. In unscreened elderly with no comorbidity, colonoscopy screening was most effective and still cost-effective up to age 83; sigmoidoscopy screening was indicated at age 84; and FIT screening was indicated at ages 85 and 86. In unscreened elderly with moderate (severe) comorbidity, colonoscopy screening was indicated up to age 80 (77); sigmoidoscopy screening was indicated at age 81 (78); and FIT screening was indicated at ages 82 and 83 (79 and 80). Results of Sensitivity Analyses Results were most sensitive to lowering the threshold for the willingness-to-pay per QALY gained from $100,000 to $50,000. Limitation We only considered cohorts at average risk for CRC. Conclusions In unscreened elderly with no, moderate, and severe comorbidity, whose physical condition allows a colonoscopy, CRC screening should be considered well beyond age 75: up to age 86, 83, and 80, respectively. At most ages, colonoscopy screening is indicated. Primary Funding Source The U.S. National Cancer Institute.

An unexpected association between history of vasectomy and increased risk of prostate cancer emerged when multiple comparisons were carried out in data collected from 1976-1988 in a US hospital-based case-control study of many diseases and exposures. The association was assessed in detail in these data, in a comparison of 220 men with first episodes of prostate cancer with 571 noncancer controls and 960 cancer controls. The age-adjusted relative risk of prostate cancer was 5.3 (95% confidence interval 2.7-10) when noncancer controls were used and 3.5 (95 percent confidence interval 2.1-6.0) when cancer controls were used. The magnitude of the relative risk estimate appeared to be unrelated to the length of the interval after vasectomy. Allowance for several factors did not alter the estimates, but we did not have information on testosterone level or sexual activity, which may have been confounding factors. The association was stronger among men most likely to have been under more intensive medical surveillance; selective detection of asymptomatic cancer in such men would have led to an excess of cases. Further studies are needed to rule out chance, bias from medical surveillance, and uncontrolled confounding as explanations for the finding.

We report a case of loss of diabetic control in a patient given high doses of inhaled fluticasone propionate for asthma.A 67 year old man who had had asthma for 10 years was referred for respiratory assessment. He had had noninsulin dependent diabetes mellitus for 40 years and was taking glibenclamide 5 mg and metformin 1700 mg daily. Glycaemic control was monitored every six weeks in an outpatient clinic using the percentage of glycated haemoglobin (haemoglobin A 1c ) (Corning-Drew Glycomat low pressure chromatography system).1 The normal range is < 6% and the within batch coefficient of variation is 2.6% and 1.5% for concentrations of 7% and 10% respectively. During the previous year he had had only occasional trace glycosuria ( < 2 positive urinary glucose readings a week) and glycated haemoglobin concentrations (measured every 8 weeks) ranged from 7.0% to 7.3% (data not shown). His asthma treatment comprised ipratropium bromide 0.5 mg and salbutamol 5 mg by nebuliser four times daily. Computed spirometry (12 hours after his last nebuliser) showed that forced expiratory volume in 1 second was 1.48 litres (45% of predicted values) and 1.98 litres 30 minutes after bronchodilatation (Morgan plethysmograph). He had taken no other drugs and no oral corticosteroids in the previous 6 months. He did not drink alcohol or smoke. He was meticulous in taking his treatment and in recording his peak expiratory flow rate twice daily (morning and evening before treatment using a hand held mini-Wright meter) and urinary glucose measurements (Baker Diagnostics).At week 0 he started treatment with inhaled fluticasone propionate 2000 g per day by metered dose inhaler through a Volumatic spacer device (figure). During the next 30 weeks of monitoring he did not take oral corticosteroids, his diabetic treatment and strict diet and exercise regimens remained unchanged, and his weight remained stable. After starting inhaled fluticasone propionate subjective breathlessness and wheeze improved and average weekly peak expiratory flow rate increased from 410 l/min to 440 l/min, but he developed persistent glycosuria during week 3. All 28 urinary glucose measurements were positive for glucose in weeks 3 and 4 and the dose of inhaled fluticasone propionate was thus reduced in a stepwise fashion to 500 g per day in week 14.To our knowledge, deterioration in diabetes has not been documented with the use of inhaled corticosteroids. Furthermore, tolerance to the hyperglycaemic effect of systemic corticosteroids might have explained the subsequent improvement in diabetic control between weeks 15 and 24. 4 With his consent we rechallenged him (single blind fashion) by increasing his daily dose of inhaled fluticasone propionate from 500 g to 1000 g in week 25. Within a week he developed glycosuria (from week 24 to 28, 21 out of 70 urinary readings were positive for glucose). Glycosuria resolved after reducing the dose of fluticasone propionate.In this case the administration of high dose inhaled fluticasone propionate was matched by both a ris...