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Aim Social media are used daily by both healthcare workers and patients. Online platforms have the potential to provide patients with useful information, increase their engagement and potentially revolutionize the patient-physician relationship. This survey aimed to evaluate the impact of the Internet and social media (I&SM) on patients affected by colorectal and proctological diseases to define a pathway to develop an evidence-based communications strategy. Method A 31-item anonymous electronic questionnaire was designed. It consisted of different sections concerning demographics and education, reason for the visit, knowledge of the diseases, frequency of I&SM use and patients' opinions about physicians' websites. Results Over a 5-month period, 37 centres and 105 surgeons took part in the survey, and a total of 5800 patients enrolled. Approximately half of them reported using the Internet daily, and 74.6% of the study population used it at least once per week. There was a correlation (P < 0.001) between those who used the Internet for work and those who had knowledge of both symptoms and the likely diagnosis before consultation. Patients who used the Internet daily were more likely to request a consultation within 6 months of symptom onset (P < 0.0001). Patients with anorectal diseases were more likely to know about their disease and symptoms before the visit (P < 0.001). Conclusion Colorectal patients use I&SM to look for health-related information mainly after their medical visit. Surgeons and hospital networks should plan a tailored strategy to increase patient engagement, delivering appropriate information on social media.

Muscle psoas metastasis from uterine squamous cell carcinomaIntramuscular metastases distant from primary tumour are rare (1%), some authors have reported 16% in autopsied cases. 1 There have been many suggestions for the rarity of neoplastic cells implanted in skeletal muscle, such as constant movement, lactic acid production and lymphocytes, natural killer cells and peptidic factors/protease inhibitors.The affected muscles are psoas, iliopsoas, proximal musculature of the upper and lower limbs and paraspinal muscles. Tumours known to metastasize more frequently to the muscle are melanomas and kidney, lung and thyroid cancers.We report a 29-year-old European patient, who underwent Wertheim-Meigs-Novak radical hysterectomy in July 2005 for moderately differentiated squamous cell carcinoma of uterine portio. The International Federation of Gynecology and Obstetrics stage was III. She underwent 5 weeks of adjuvant external radiotherapy with cisplatin. She was admitted to our unit in December 2006 for a left leg pain that irradiated anteriorly on the muscle quadricipitis femoris and was resistant to drugs. Ultrasound, magnetic resonance imaging and computed tomography scan showed a ovalar lesion (4.5 cm · 7 cm) involving the left psoas muscle (Fig. 1), causing a medial dislocation of the ureter with homolateral hydronephrosis and a dislocation of common iliac artery. Fine-needle aspiration showed metastasis from squamous cell carcinoma. Complete removal of the left psoas muscle, including the lesion, and left ovariectomy were carried out. Metastasis of portio uterine squamous cells carcinoma was confirmed by histopathological examination, pT1b2N1M0, ANZ J. Surg. 2008; 78: 213-219