What is the likelihood of colorectal cancer when surgery for ulcerative-colitis-associated dysplasia is deferred?

Surgery aims to prevent cancer-related morbidity for patients with ulcerative colitis (UC)-associated dysplasia. The literature varies widely regarding the likelihood of dysplastic progression to higher grades of dysplasia or cancer. The aim of this study was to characterise the likelihood of the development of colorectal cancer (CRC) of patients with UC-associated dysplasia who chose to defer surgery.A retrospective review was carried out of patients undergoing surgery for UC at the Mayo Clinic, who were diagnosed to have dysplasia between August 1993 and July 2012. The relationships between grade of dysplasia, time to surgery and the detection of unsuspected carcinoma were investigated.175 patients underwent surgery at a median of 4.9 DEAR AUTHOR PLEASE BE HAPPY WITH THIS [IQR:2.5-8.9] months) after a diagnosis of dysplasia. Their median age was 52 (IQR:43-59) years. An initial diagnosis of indeterminate dysplasia was not associated with CRC (0/23; 17.7[8.1-29.6] months). Thirty six patients who had an initial diagnosis of dysplasia progressed from indeterminate to low-grade dysplasia (24.2[11.0-30.4] months). Low-grade dysplasia was associated with a 2% (1/56; T2N0M0) risk of CRC when present in random surveillance biopsies and a 3% (2/61; T1N0M0, T4N0M0) risk if detected in endoscopically visible lesions (7.4[5.2-33.3] months). Eighteen patients progressed from indeterminate to high-grade dysplasia (19.1 [9.2-133.9] months). Seventeen patients progressed from low- to high-grade dysplasia (11.0[5.8-30.1] months). None of the patients with high-grade dysplasia (0/35) progressed to CRC (4.5[1.7-9.9] months).Dysplasia was associated with a low incidence of node negative CRC if surgery was deferred for up to five years. These findings may help inform the decision-making process for asymptomatic patients who are having to decide between intensive surveillance or surgery for UC associated-dysplasia. This article is protected by copyright. All rights reserved

Early Detection, Diagnosis and Intervention Services for Young Children with Autism Spectrum Disorder in the European Union (ASDEU): Family and Professional Perspectives

International audienc

Narrowly versus broadly defined autism spectrum disorders: differences in pre- and perinatal risk factors

Contains fulltext : 115406.pdf (publisher's version ) (Closed access)This study examined the differential contribution of pre- and perinatal risks in narrowly versus broadly defined autism spectrum disorder (ASD) and across core symptom domains, IQ and co-morbid problems. Children with a DSM-IV diagnosis of autistic disorder (AD) (n = 121) or pervasive developmental disorder not otherwise specified (PDD-NOS) (n = 75) were compared to a typical control sample (n = 311). Diagnoses were based on extensive assessments between 12 and 49 months of age (M = 33.3, SD = 6.4) and re-evaluated at 43-98 months (M = 68.1, SD = 10.7) in 70 % of the cases. Compared with controls, cases with ASD were more likely to be firstborn and show a suboptimal condition after birth. Case mothers reported more infections and more stress during pregnancy. Although the ASD subgroups showed mostly overlapping risks, cases with PDD-NOS differed from those with AD by higher exposure to smoking during pregnancy (SDP) and by a negative association of smoking with IQ, regardless of confounders. SDP appears to contribute more to broadly defined (PDD-NOS) than to narrowly defined ASD (AD). Findings suggest differences in etiological contributors between ASD phenotypes