108 results on '"large intestine"'
Search Results
2. Adult Intussusception: A Retrospective Review.
- Author
-
Zubaidi, Ahmad, Al-Saif, Faisal, and Silverman, Richard
- Subjects
INTUSSUSCEPTION in children ,INTESTINAL infections ,ABDOMINAL pain ,NAUSEA ,LARGE intestine ,PATHOLOGY ,BOWEL obstructions ,SIGMOIDOSCOPY - Abstract
Whereas intussusception is relatively common in children, it is clinically rare in adults. The condition is usually secondary to a definable lesion. This study was designed to review adult intussusception, including presentation, diagnosis, and optimal treatment. A retrospective review of 22 cases of intussusception occurring in individuals older than aged 18 years encountered at two university-affiliated hospitals in Winnipeg between 1989 and 2000. The 22 cases were divided to benign and malignant enteric, ileocolic, colonic lesions respectively. The diagnosis and treatment of each case were reviewed. There were 22 cases of adult intussusception. Mean age was 57.1 years. Abdominal pain, nausea, and vomiting were the commonest symptoms. There were 14 enteric, 2 ileocolic, and 6 colonic intussusceptions. Eighty-six percent of adult intussusception was associated with a definable lesion. Twenty-nine percent of enteric lesions were malignant. All ileocolic lesions were malignant. Of colonic lesions, 33 percent were malignant and 67 percent were benign. All cases required surgical interventions except one. Adult intussusception is a rare entity and requires a high index of suspicion. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
- View/download PDF
3. The Effect of Circumferential Tumor Location in Clinical Outcomes of Rectal Cancer Patients Treated With Total Mesorectal Excision.
- Author
-
Lee, Suk-Hawn, Hernandez de Anda, Enrique, Finne, Charles O., Madoff, Robert D., and Garcia-Aguilar, Julio
- Subjects
METASTASIS ,RECTAL cancer ,LARGE intestine ,CANCER treatment ,TUMORS ,PATHOLOGY ,PROGNOSIS ,GENITOURINARY organs ,ADJUVANT treatment of cancer ,MEDICAL research - Abstract
PURPOSE: A positive circumferential resection margin is associated with a high risk of local recurrence and distant metastasis after total mesorectal excision for rectal cancer. The mesorectum is thinner anteriorly than posteriorly, and the risk of a positive resection margin may be higher for anterior than for posterior tumors. We sought to determine the effect of the tumor's position in the circumference of the rectum on the treatment and outcomes of rectal cancer patients treated by total mesorectal excision. METHODS: We retrospectively analyzed 401 patients with rectal cancer staged by preoperative endorectal ultrasound and treated by sharp mesorectal excision with or without neoadjuvant therapy. Tumors were classified into four groups (anterior, posterior, lateral, and circumferential) according to the location of deepest point of penetration on endorectal ultrasound. Differences in recurrence and survival rates were analyzed with logistic regression analysis. RESULTS: Of the 401 tumors, 27 percent were anterior, 26 percent posterior, 32 percent lateral, and 15 percent circumferential. The groups did not differ in age, gender, tumor distance from the anal verge, or tumor grade. The ultrasound and pathology stages were more advanced in the circumferential group, and the proportion of uT4 tumors was higher in the anterior group. Circumferential and anterior tumors were more likely to receive preoperative adjuvant radiation. After an average follow-up of 44 months, 20 percent of patients had developed recurrence (13 percent distant, 6 percent local, and 1 percent distant and local). Recurrence was associated with advanced tumor stage, tumor proximity to the anal verge, and no preoperative adjuvant therapy. Early tumor stage and preoperative chemoradiation were associated with lower recurrence and improved survival. When tumor stage was controlled for, patients with poor or undifferentiated tumors and male patients with anterior tumors were shown to have a higher risk of recurrence or death. The estimated five-year disease-free survival for the entire group was 73 percent. CONCLUSIONS: Tumor stage is the main criterion to estimate prognosis in rectal cancer patients. The position of the tumor within the circumference of the rectum may provide valuable clinical information. Anterior tumors tend to be more advanced and, at least in male patients, has a higher risk of recurrence and death than tumors in other locations. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
4. Selecting an Outcome Measure for Evaluating Treatment in Fecal Incontinence.
- Author
-
Deutekom, Marije, Terra, Maaike P., Dobben, Annette C., Dijkgraaf, Marcel G. W., Felt-Bersma, Richelle J. F., Stoker, Jaap, and Bossuyt, Patrick M. M.
- Subjects
FECAL incontinence ,PHYSICAL therapy ,HEALTH outcome assessment ,SACRAL nerves ,LARGE intestine ,MEDICAL care ,MEDICAL research ,DIAGNOSIS - Abstract
PURPOSE: Various outcome measures exist to evaluate treatment in fecal incontinence, including descriptive, severity (fecal incontinence scoring systems), and impact (quality-of-life questionnaires) and diagnostic measures. We studied associations between changes after treatment for a number of outcome measures and compared them to patients' subjective perception of relief. METHODS: We analyzed data of 66 patients (92 percent female; mean age, 62 years) (Vaizey score, Wexner score, two impact scales, utility, resting pressure, and maximal incremental squeeze pressure) at baseline and after physiotherapy. In a standardized interview by phone, we asked patients to compare their situation before and after treatment. Correlations between changes in outcome measures were calculated. These changes were compared with patients' subjective perception. RESULTS: There was a high correlation between the changes in the Vaizey and the Wexner scores (r = 0.94, P > 0.01). Changes in Vaizey and Wexner scores correlated moderately with changes in maximum incremental squeeze pressure (r = -0.29, -0.30, both P > 0.05). Changes in utility and resting pressure were not correlated with changes in any of the other measurements (all r values between -0.086 and 0.18). Average severity scores (Vaizey and Wexner) were 1 point lower for patients who rated their situation as worse or equal (62 percent), 4 points lower for patients who reported their situation to be better (21 percent), and 9 points lower in patients who rated their situation much better (17 percent) (P > .05). CONCLUSION: Severity measures are best related to patients' subjective perception of relief. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
5. Magnetic Resonance Imaging of the Rectum During Distension.
- Author
-
Lago, Annalisa, Minetti, Alberto E., Biondetti, Pietro, Corsetti, Maura, and Basilisco, Guido
- Subjects
RECTUM ,MAGNETIC resonance imaging ,DIAGNOSTIC imaging ,LARGE intestine ,MORPHOLOGY ,HUMAN abnormalities - Abstract
PURPOSE: A knowledge of the relationships between the rectum and its surrounding structures during distention may improve our understanding of the results of studies assessing rectal sensory-motor responses to distention. This magnetic resonance imaging study was designed to assess the shape of the rectum and the degree of distention at which the surrounding structures are compressed. METHODS: Nine healthy patients underwent magnetic resonance imaging of the rectum under resting conditions and after the inflation of a plastic bag to volumes of 50, 100, 150, 200, and 250 ml. The thickness of the rectovesical space was assessed as a measure of the compression of the perirectal structures, and the perception of sensations were recorded. RESULTS: The shape of the rectum changed from being quasicylindrical at distention volumes of <100 ml to bean- shaped at larger volumes. The thickness of the rectovesical space at a distention volume of 50 ml was the same as when the bag was not inflated, but it progressively decreased until the difference became statistically significant at distention volumes of ⩾200 ml, corresponding to a mean ± standard deviation rectal radius of 2.66 ± 0.37 cm. Statistically significant compression of the rectovesical space was recorded when the sensations of gas, desire to defecate, and urgency were perceived. CONCLUSIONS: The shape of the rectum changes during distention; it significantly compresses the extrarectal structures in the tested range of distention that induces nonpainful sensations. Magnetic resonance imaging is a useful means of assessing the morphologic changes in the rectum during distention. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
6. Selected Abstracts Dis Colon Rectum Vol. 47, No. 7, July 2004.
- Author
-
Hyman, Neil H.
- Subjects
RECTUM ,PATIENTS ,LARGE intestine ,ANUS ,HUMAN anatomy ,SPHINCTERS - Abstract
The article presents a study that evaluates clinically and manometrically the anorectal function of patients with imperforate anus. The defecation status and anorectal manometry of patients with high or intermediate-type imperforate anus repaired with laparoscopically assisted anorectoplasty (n = 9) and age-matched patients repaired with posterior sagittal anorectoplasty (n = 123) were assessed and compared during the first postoperative year. The defecation status was classified by the frequency of bowel movements (<1, 1-4, and >5 times per day). Manometric assessment was performed by an open-tip hydraulic capillary infusion system. The presence of rectoanal relaxation reflex was determined, and the sphincter resting (squeeze) pressure and rectal resting pressure were measured.
- Published
- 2004
- Full Text
- View/download PDF
7. New Reconstructive Procedure After Intestinal Resection for Crohn’s Disease: Modified Side-to-Side Isoperistaltic Anastomosis With Double Heineke-Mikulicz Procedure Dis Colon Rectum Vol. 47, No. 6, June 2004.
- Author
-
Sasaki, Iwao, Shibata, Chikashi, Funayama, Yuji, Fukushima, Kouhei, Takahashi, Ken-ichi, Ogawa, Hitoshi, Ueno, Tatsuya, Hashimoto, Akihiko, Nagao, Munenori, Watanabe, Kazuhiro, Haneda, Sho, Shiiba, Ken-ichi, Rikiyama, Toshiki, and Naito, Hiroo
- Subjects
COLON (Anatomy) ,LARGE intestine ,ROUND fungus beetles ,CLINICAL medicine ,MEDICINE ,CLINICAL indications - Abstract
Although side-to-side isoperistaltic anastomosis is a useful strictureplasty technique when long segments of intestinal stenosis complicate Crohn’s disease, concerns have been raised regarding disease recurrence adjacent to the anastomosis. We performed side-to-side isoperistaltic anastomosis without spatulated intestinal ends as a method of reconstruction after intestinal resection for Crohn’s disease; both intestinal ends were transversely closed like a Heineke-Mikulicz-type strictureplasty. With this procedure, the luminal diameter proximal and distal to the anastomosis became wider than the original diameter of the intestine. This new procedure, which we refer to as the “modified side-to-side isoperistaltic anastomosis with double Heineke-Mikulicz procedure” could become an alternative operation after intestinal resection in persons with Crohn’s disease, although long-term outcome analysis is necessary. [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
8. Clinical Significance of Early-Onset “Sporadic” Colorectal Cancer With Microsatellite Instability.
- Author
-
Jass, Jeremy R.
- Subjects
COLON cancer ,CANCER ,LARGE intestine ,INTESTINES ,MICROSATELLITE repeats - Abstract
Comments regarding the clinical significance of early-onset sporadic colorectal cancer with microsatellite instability. Characterizations of colorectal cancers; Significance of DNA mistmatch repair deficency in early-age-onset colorectal cancer in the absence of a strong family history of colorectal cancer; Types of microsatellite instability-high colorectal cancer.
- Published
- 2003
- Full Text
- View/download PDF
9. Laparoscopic-Assisted Bowel Resection in Pediatric/Adolescent Inflammatory Bowel Disease: Laparoscopic Bowel Resection in Children.
- Author
-
Simon, Timothy, Orangio, Guy, Ambroze, Wayne, Schertzer, Marion, and Armstrong, David
- Subjects
INFLAMMATORY bowel diseases ,INFLAMMATION ,INTESTINES ,SURGICAL excision ,LARGE intestine ,LAPAROSCOPIC surgery ,JUVENILE diseases - Abstract
PURPOSE: The purpose of this study is to discuss indications, technical approach, and morbidity of laparoscopic approaches to major bowel resection in the pediatric/adolescent population with inflammatory bowel disease and familial polyposis. METHODS: Retrospective review of laparoscopic-assisted bowel procedures between May 1991 and January 2002 was performed. Laparoscopic-assisted bowel resection is defined as complete intracorporeal mobilization and devascularization of a segment of colon or rectum. The indications for extracorporeal vs. intracorporeal anastomosis will be discussed. Clinically unstable, septic, or massively bleeding patients were not candidates for this technique. The decision to attempt the laparoscopic approach was based on the experience of the consulting surgeon. There were 31 patients, including 14 females. Five patients had undergone prior surgery. Twenty-nine patients had inflammatory bowel disease, one had familial polyposis, and one had a cavernous hemangioma. We included all pediatric/adolescent patients in our practice undergoing laparoscopic resection. RESULTS: Twenty-nine patients had 33 laparoscopic operations, including proctocolectomy with ileal pouch-anal anastomosis (n = 14), proctocolectomy with ileostomy (n = 3), ileocolectomy with ileocolic anastomosis (n = 13), and small-bowel obstruction (n = 1). Average operating time was 158 (range, 30–400) minutes, with average blood loss of 159 ml. Average wound length was 4.9 cm. The complication rate was 16 percent (n = 5), with one anastomotic leak. The rate of conversion to open operations was 5.8 percent. Liquid diet was begun on Day 3, and the average length of stay was 5.9 days. CONCLUSION: Major laparoscopic bowel surgery can be performed safely in the pediatric/adolescent population, with reasonable operative times, low conversion to open operations, and low morbidity. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
- View/download PDF
10. Local Excision of Large Rectal Villous Adenomas: Long-Term Results.
- Author
-
Pigot, François, Bouchard, Dominique, Mortaji, Majid, Castinel, Alain, Juguet, Frédéric, Chaume, Jean-Claude, and Faivre, Jacques
- Subjects
SURGERY ,SURGICAL excision ,LARGE intestine ,RECTUM ,RECTAL medication ,LUMPECTOMY - Abstract
PURPOSE: Transanal excision of rectal villous adenomas is a widely used surgical technique, because it is a one-step procedure, requiring no sophisticated instrumentation, and allowing complete histologic analysis of the excised tumor. Therefore, it ranks alongside radical surgery and palliative destructive procedures, but its results are highly variable in the published series. This discrepancy may be explained by the variable completeness of tumor excision because of potential dissection difficulties. Because intraoperative exposure may be a major limiting factor, one of us (JF) has developed a tractable cutaneomucous flap procedure to lower the rectal tumor to the anal verge, where control of the dissection line is easier. This retrospective review of consecutive patients operated on during ten-year period reports long-term results after transanal excision for large rectal villous adenomas with the tractable flap technique. PATIENTS: From 1978 to 1988, 207 consecutive patients (100 males), mean age 68 (range, 24–90) years, were operated on for an apparently benign villous rectal adenoma. Twenty-one patients (10 percent) were referred after failure of previous treatments: 11 endoscopic, 8 surgical, 1 laser, 1 radiotherapy. Mean distance of lower tumor edge from anal margin was 5.6 (range, 0–13) cm and was <10 cm in 82 percent. RESULTS: Three patients (1.5 percent), including one with a Tis carcinoma, underwent a secondary treatment for immediate gross failure of resection: one further local excision and two palliative laser destructions. Immediate postoperative course was uneventful for 96 percent; there was one death from perineal gangrenous infection, four cases of hemorrhage, and three urinary retentions. Subsequently one case of transient fecal incontinence and 11 medically managed stenoses were noted. Mean size of resected tumor was 5.4 (range, 1–17) cm. Deep excision margins concerned the rectal muscular layers in 199 patients (96 percent) and perirectal fat in 8 (4 percent). Specimen margins were negative for cancer in 175 (85 percent) and positive or unknown in 32 cases. Histologic evaluation demonstrated in situ cancer in 28 (14 percent) and invasive carcinoma in 9 (4 percent). In three patients (1 percent), two abdominoperineal resections were immediately performed (one T2 with a mucinous contingent, one T3) and one adjuvant radiotherapy (one undifferentiated T2). Four patients (2 percent) did not return for postoperative evaluation. For the remaining 198 patients, mean follow-up was 74 ± 34 (median, 75; range, 1–168) months. Forty-four died from unrelated causes. Recurrence occurred in seven (3.6 percent) and was malignant in two, who subsequently died. Specific recurrence-free probability was 99.5 percent at one year, 96 percent at five years, and 95 percent at ten years. A lesion size >6 cm (10 vs. 1 percent for smaller tumors) and the presence of an invasive carcinoma (20 vs. 3 percent without invasive carcinoma) were significantly associated with an increased probability of recurrence at five years. CONCLUSION: Providing that adequate intraoperative exposure is obtained and advanced malignant tumors receive immediate secondary treatment, transanal resection of clinically benign, large rectal villous adenomas is safe and effective. It is an alternative to rectal resection, which exposes the patient to potentially adverse effects, and also to destructive procedures, which preclude any histologic evaluation of the tumor. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
- View/download PDF
11. Budding Is Useful to Select High-Risk Patients in Stage II Well-Differentiated or Moderately Differentiated Colon Adenocarcinoma.
- Author
-
Okuyama, Takashi, Nakamura, Tetsuro, and Yamaguchiv, Masahiko
- Subjects
CANCER patients ,COLON cancer ,COLON (Anatomy) ,LARGE intestine ,ADENOCARCINOMA ,CANCER - Abstract
PURPOSE: Budding at the invasive front of tumors has recently been thought to suggest greater malignant potential of the colorectal carcinoma. We examined whether budding is associated with poor prognosis after curative resection in Stage II and Stage III colon carcinoma. Furthermore, we examined whether budding is useful to select high-risk patients in Stage II colon carcinoma. METHODS: Surgically resected specimens of 196 Stage II and Stage III colon carcinomas were studied. All the resections were curative (R0), and the median postoperative follow-up was 75.5 months. Using hematoxylin-eosin–stained sections, we determined the presence or absence of budding according to Morodomi’s criteria. Routine pathologic findings were also recorded. RESULTS: Budding was detected significantly more frequently in lesions with lymph node metastasis (Stage III) than in lesions without it (Stage II; P < 0.0001). Patients with budding-positive lesions had worse outcome than those with budding-negative lesions: 43 patients (50.6 percent) with budding-positive lesions and 9 (8.1 percent) with budding-negative lesions developed recurrence (P < 0.0001). Patients with budding-positive lesions had a worse prognosis than patients without it (P < 0.0001). Moreover, no significant difference in survival curves was observed between patients with budding-positive Stage II lesions and those with Stage III lesions (P = 0.930). Multivariate analysis revealed budding as the significant prognostic cofactor of postoperative survival in Stage II and Stage III colon carcinoma (P < 0.0001). CONCLUSION: Budding is useful to select high-risk patients in Stage II colon carcinoma. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
- View/download PDF
12. The Management of Cecal Volvulus.
- Author
-
Madiba, T. E., Thomson, S. R., and Church, James M.
- Subjects
BOWEL obstructions ,ACUTE abdomen ,NECROSIS ,SURGICAL excision ,DIAGNOSIS ,LARGE intestine - Abstract
Cecal volvulus is second only to sigmoid volvulus in its frequency of occurrence. Diagnostic doubt is not uncommon in cecal volvulus; nonoperative decompression is rarely achievable; and if gangrene supervenes, mortality rises appreciably. Resection is mandatory for gangrene and a grossly distended, thin-walled cecum. Cecopexy and cecostomy seem less-effective and more morbid options than resection and anastomosis for viable bowel. However, their role needs reappraisal in the light of advances in minimally invasive techniques. [ABSTRACT FROM AUTHOR]
- Published
- 2002
- Full Text
- View/download PDF
13. Endosonographic Anatomy of the Normal Anal Canal Compared with Endocoil Magnetic Resonance Imaging.
- Author
-
Williams, A. B., Bartram, C. I., Halligan, S., Marshall, M. M., Nicholls, R. J., and Kmiot, W. A.
- Subjects
LARGE intestine ,DIAGNOSTIC imaging ,SPHINCTERS ,ENDOSCOPIC ultrasonography ,MAGNETIC resonance imaging ,COLON diseases - Abstract
PURPOSE: This study was designed to clarify the sonographic anatomy of the normal anal canal by comparison with endoanal magnetic resonance imaging, to determine agreement between these imaging modalities and interobserver error in measuring layer thickness. METHODS: Three-dimensional endosonographic and endocoil magnetic resonance images of the anal canal were obtained in four males and five nulliparous females aged 22 to 34 years. Images were analyzed at similar levels throughout the canal using a graphics-overlay technique to compare sonographic with magnetic resonance images. Measurements were taken at one level for agreement analysis between modalities and for interobserver variability in the measurement of the thickness of the main anal canal layers. RESULTS: The muscularis submucosae ani, muscle bundles in the longitudinal muscle layer, and puboanalis were identified on sonography. The outer border of the external sphincter was demarcated by an interface reflection with ischioanal fat. Clarification of the external sphincter anatomy allowed excellent correlation (Ri = 0.96) for the assessment of thickness. There was excellent correlation for the interobserver measurement of the external and internal sphincters and the submucosal width on endosonography, but there was poor correlation for the longitudinal muscle (0.12). CONCLUSION: The overlay technique has improved endosonographic interpretation, and measurement of external sphincter thickness has been validated both by comparison with magnetic resonance and on interobserver agreement. [ABSTRACT FROM AUTHOR]
- Published
- 2002
- Full Text
- View/download PDF
14. Ligation-Anopexy for Treatment of Advanced Hemorrhoidal Disease.
- Author
-
Hussein, Ahmed M.
- Subjects
HEMORRHOIDS ,RECTAL diseases ,PATIENTS ,MEDICAL research ,LARGE intestine - Abstract
PURPOSE: Destruction of the anchoring tissue system is considered to be the essential prerequisite to the pathogenesis of advanced hemorrhoidal disease. Ligation-anopexy was designed to 1) restore fixation of the hemorrhoidal cushions to the underlying internal sphincter, 2) reduce hemorrhoidal prolapse, and 3) minimize the hemorrhoidal blood flow. The purpose of this study was to evaluate the ligation-anopexy as a new technique for the treatment of advanced stages of hemorrhoidal disease. METHODS: This study included 40 patients with hemorrhoidal disease (mean age 29.63 ± 9.79 years, male/female ratio 34:6). Twenty-two patients had third-degree and 18 patients had fourth-degree hemorrhoids; of those with fourth-degree hemorrhoids, two patients had associated anal fissure and three patients had partial mucosal prolapse. Informed consent was obtained from all patients. After reduction of hemorrhoidal prolapse and under general or spinal anesthesia, a needle with 2-0 polyglactin (Vicryl®) was inserted 1.5 cm above the dentate Une using a Sims' speculum. The needle was inserted deep enough to fix the mucosa and the submucosa to the underlying internal sphincter. After the suture was tied, the redundant mucosa was pulled distally to be incorporated in the ligature, and the thread was religated around it to form a mucosal tag. RESULTS: Inclusion of a part of the internal sphincter with ligation of the redundant mucosa ensures adequate retraction of prolapsed hemorrhoids (hemorrhoid lift). Postoperative pain was accepted by 90 percent of the patients and disappeared after treatment with oral diclofenac. The immediate complications included anal spasm in 10 percent, postoperative bleeding in 2.5 percent, and thrombosis of the external hemorrhoids in 2.5 percent of patients. Neither recurrence nor anal stenosis was observed after 12 months of follow-up. CONCLUSION: Despite the limited number of patients and the short follow-up, the preliminary results of ligation-anopexy in the treatment of advanced hemorrhoidal disease are encouraging. [ABSTRACT FROM AUTHOR]
- Published
- 2001
- Full Text
- View/download PDF
15. Twenty-Four Hour Recordings of Colonic Motility in Patients with Diverticular Disease.
- Author
-
Bassotti, Gabrio, Battaglia, Edda, Spinozzi, Fabrizio, Pelli, Maria A., and Tonini, Marcello
- Subjects
MOTILITY of the colon ,COLON diseases ,PATIENTS ,LARGE intestine ,MEDICAL research - Abstract
INTRODUCTION: Diverticular disease of the colon is one of the most common pathologic entities in western countries. Although altered motility of the large bowel is commonly believed to be one of the major pathophysiologic mechanisms, no convincing evidence has been reported yet. In fact, only a few conflicting studies concerning distal colonic motility (with no information on forceful propulsive activity are available in the literature. PURPOSE: The purpose of the present study was to investigate basal and stimulated (postprandial) colonic motility from the transverse (not affected), descending, and sigmoid colon in patients with diverticular disease, together with detection of high-amplitude propagated contractions (mass movements). Motility data from patients were compared with those obtained in healthy control subjects. METHODS: Ten patients and 16 control subjects of both sexes were recruited for the study. In all subjects, colonic motility was recorded for a 24-hour period by a colonoscopically positioned manometric catheter. Two 1000-kcal mixed meals were served during the study. RESULTS: Compared with control subjects, patients with diverticular disease displayed significantly increased amounts of motility in the affected segments; the response to a physiologic stimulus (meal) was also abnormal in the patients' group. Diverticular disease patients also had a significant increase of forceful propulsive activity compared with control subjects (average = 103 ± 2.7/subject/day high-amplitude propagated contractions for patients and 5.5 ± 0.8/subject/day for control subjects; P = 0.051); interestingly, about 20 percent of such activity was abnormal, being propagated in a retrograde fashion. CONCLUSIONS: We concluded that patients with diverticular disease of the colon have abnormal motor and propulsive activities of the large bowel, which are confined to the affected segments. [ABSTRACT FROM AUTHOR]
- Published
- 2001
- Full Text
- View/download PDF
16. Neoadjuvant External Beam Radiation and Proctectomy for Adenocarcinoma of the Rectum.
- Author
-
Read, Thomas E., Ogunbiyi, Olajungu A., Fleshman, James W., Birnbaum, Elisa H., Fry, Robert D., Myerson, Robert J., and Kodner, Ira J.
- Subjects
ADENOCARCINOMA ,RECTAL cancer ,LARGE intestine ,CANCER patients ,CANCER research - Abstract
PURPOSE: The aim of this study was to determine the survival rate, local failure, and perioperative morbidity in patients with adenocarcinoma of the rectum undergoing curative proctectomy who were felt to have transmural disease on preoperative assessment. Eighty-nine percent of these patients were treated with preoperative external beam radiotherapy. METHODS: The records of 191 consecutive patients undergoing abdominal surgical procedures for primary treatment of rectal cancer were reviewed. The product-limit method (Kaplan-Meier) was used to analyze survival rate and tumor recurrence. RESULTS: One patient was excluded from survival analysis because of incomplete record of tumor stage. The study population comprised 109 males and 81 females, median age 64 (range, 33-91) years. Curative resection was performed in 152 of these 190 patients (80 percent), including low anterior resection with coloproctostomy or coloanal anastomosis (n = 103), abdominoperineal resection (n = 44). Hartmann's procedure (n = 4), and pelvic exenteration (n = 1). Mean follow-up of patients undergoing curative resection was 96 ± 48 months. Palliative procedures were performed in 38 of 190 patients (20 percent). Perioperative mortality was 0.5 percent (1/190). Complications occurred in 64 patients (34 percent). The anastomotic leak rate was 4 percent (5/128). Disease-free five-year survival rate by pathologic stage was as follows: Stage I, 90 percent: Stage II, 85 percent; Stage III, 54 percent; Stage IV, 0 percent; and no residual tumor, 90 percent. Of the 152 patients treated with curative resection, disease-free survival rate was 80 percent at five years. Preoperative external beam radiation was administered to 135 of these 152 patients (89 percent). Tumor recurred in 32 of 152 patients (21 percent) treated with curative resection. The predominant pattern of recurrence was distant failure only. Kaplan-Meier overall local recurrence (local and local plus distant) at five years was 6.6 percent. The local recurrence rate paralleled tumor stage: Stage I, 0 percent; Stage II, 6 percent; Stage III, 20 percent; and no residual tumor, 0 percent. CONCLUSION: Preoperative external beam radiotherapy and attention to mesorectal dissection can achieve low local recurrence and excellent long-term survival rate in patients with adenocarcinoma of the rectum. Moreover, these goals can be obtained with low morbidity and mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2001
- Full Text
- View/download PDF
17. Comparison of Methods Used for Measurement of Rectal Compliance.
- Author
-
Krogh, K., Ryhammer, A. M., Lundby, L., Gregersen, H., and Laurberg, S.
- Subjects
RECTUM ,PLANIMETERS ,DEFECATION disorders ,POLYVINYL chloride ,LARGE intestine - Abstract
INTRODUCTION: Compliance is defined as the change in volume or cross-sectional area divided by the change in pressure. Pressure-volume measurement during distention with a compliant balloon is the most commonly used method for computation of rectal compliance. However, intraindividual and interindividual variations are large, restricting the usefulness of the method. Other methods such as rectal distention by a large, noncompliant bag and rectal impedance planimetry for assessment of pressure-cross-sectional-area relations have been proposed as alternatives owing to the reduction of errors from elongation of the balloon within the rectal lumen. However, in vivo reproducibility of pressure-volume measurement during distention with a compliant balloon, pressure-volume measurement during rectal distention by a large, noncompliant bag, and rectal impedance planimetry have never been compared. PURPOSE: The aim of this study was to compare in vivo reproducibility of the above-mentioned methods and to study their in vitro reproducibility and validity. METHODS: Ten healthy volunteers (six men) aged 21-59 years were randomized to either rectal pressure-volume measurement with a compliant balloon or rectal impedance planimetty. After a one-hour rest, the other procedure was performed. After two weeks, both procedures were again performed in the same order. During rectal impedance planimetry the volume of the bag used (maximum volume 450 ml; secured at both ends to the probe) was continuously registered, measuring pressure-volume relations during rectal distention by a large, noncompliant bag. Reproducibility was tested by comparing the difference divided by the mean for each method at eight pressure steps in the range from 5 to 40 cm H
2 O. Furthermore, the in vitro reproducibility and validity of the three methods were studied using polyvinyl chloride tubes with known cross-sectional areas. RESULTS: In vivo reproducibility for pressure-volume measurement with a large, noncompliant bag and rectal impedance planimetry was significantly better than for pressure-volume measurement with a compliant balloon (P = 0.005 and P = 0.019, respectively). No statistically significant difference was found between pressure-volume measurement with a large, noncompliant bag and rectal impedance planimetry (P = 0.20). In vitro reproducibility of pressure. volume measurement with a large, noncompliant bag and rectal impedance planimetry was good, but some elongation occurred, reducing the validity of pressure-volume measurement with a large, noncompliant bag. Coiling and elongation of the balloon within the lumen were major sources of error for pressure-volume measurement with a compliant balloon. CONCLUSION: In vivo and in vitro reproducibility of methods used for measurement of rectal compliance can be improved by restricting the effects of elongation within the lumen either by using a large-volume, noncompliant bag or by rectal impedance planimetry. However, pressure-volume measurement will to some degree depend on the properties of the balloons or bags. [ABSTRACT FROM AUTHOR]- Published
- 2001
- Full Text
- View/download PDF
18. Contribution to the Surgical Anatomy of the Ligaments of the Rectum.
- Author
-
Nano, M., Dal Corso, H. M., Lanfranco, G., Ferronato, M., and Hornung, J. P.
- Subjects
SURGICAL & topographical anatomy ,RECTAL surgery ,LIGAMENTS ,FASCIAE (Anatomy) ,GENITOURINARY organs ,LARGE intestine - Abstract
PURPOSE: Many authors have discussed the presence and the importance of the lateral ligaments of the rectum. Our contribution aims at clarifying some aspects of surgical anatomy that help in the preservation of the urogenital functions and may influence the surgical practice. METHODS: From 1994 to 1998 we examined 27 fresh cadavers and five embalmed pelves. We performed all dissections with a technique similar to that used for the surgical mobilization of the rectum. RESULTS: The lateral ligaments of the rectum are trapezoid structures originating from mesorectum and are anchored to the endopelvic fascia; as lateral extensions of the mesorectum, they must be included in the surgical specimen. According to our results, three main structures can be recognized laterally to the rectum: 1) the lateral ligament, which does not contain important structures; 2) the inferior hypogastric plexus and the urogenital bundle; and 3) the lateral neurovascular pedicle of the rectum that comprises the nervi recti and the middle rectal artery, both running under the lateral ligament, although at different angles. CONCLUSION: At the point of insertion into the endopelvic fascia, the lateral ligaments run close to the urogenital bundle. Nevertheless, the dissection at its attachment is safe if the urogenital bundle is kept under visual control. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
19. SELECTED ABSTRACTS.
- Author
-
Cintron, Jose R., Hyman, Neil H., Khanduja, Karamjit S., Cataldo, Peter A., Sentovich, Stephen M., Rubin, Marc S., Congilosi, Susan M., and Thorson, Alan G.
- Subjects
RECTAL cancer ,COLON diseases ,LARGE intestine ,BILIARY tract surgery ,ONCOLOGIC surgery - Abstract
This article presents abstracts of studies on colon and rectum diseases. They include "Anatomic Segmental Hepatic Resection Is Superior to Wedge Resection As an Oncologic Operation for Colorectal Liver Metastases," "Survival After Resection of Multiple Bilobar Hepatic Metastases From Colorectal Carcinoma," "Hospital Procedure Volume and Teaching Status Do Not Influence Treatment and Outcome Measures of Rectal Cancer Surgery in a Large General Population."
- Published
- 2000
20. Rectosigmoidal Adenomatous Polyposis: A Novel Entity of Polyposis?: Report of a Case.
- Author
-
Umetani, Naoyuki, Watanabe, Toshiaki, Sasaki, Shin, and Nagawa, Hirokazu
- Subjects
TUMORS ,ADENOMA ,INTESTINAL polyps ,RECTUM ,LARGE intestine - Abstract
PURPOSE: We report a patient with rectosigmoidal adenomatous polyposis. METHODS: A 57-year-old male presented with a submucosally invasive well-differentiated adenocarcinoma in the rectum and approximately 100 adenomatous polyps with an extremely unusual distribution limited exclusively to the rectum and sigmoid colon. RESULTS: There was no family history of colorectal disease or any related disorders. No extracolonic manifestations were found. Because this case was considered to be a discriminative phenotype of familial adenomatous polyposis, DNA from a peripheral sample of whole blood was screened for APC germline mutation by a combination of protein truncation test and single stranded conformation polymorphism, but no mutation was found. CONCLUSION: This patient may have a novel entity of adenomatous polyposis with a peculiar distribution. It may be caused by some genetic alteration other than APC mutation. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
21. Anorectal Nomenclature: Fundamental Terminology.
- Author
-
Wendell-Smith, Colin P.
- Subjects
RECTUM ,LARGE intestine ,ANUS ,ANATOMY ,NAMES - Abstract
There is lack of agreement on the definitions of the anal canal and its parts. To facilitate mutual understanding and communication between workers, it is highly desirable that a set of agreed-upon definitions be developed. The development of the different definitions and their purposes is followed and they are analyzed. As a basis for discussion, a possible revised entry for the next edition of Terminologia Anatomica is presented. Draft definitions of the terms in the entry are provided. Practitioners are invited to become involved in the process of developing agreement on definitions by providing comments and criticism. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
22. Intraobserver and Interobserver Measurements of the Anorectal Angle and Perineal Descent in Defecography.
- Author
-
Jeong Seok Choi, Wexner, Steven D., Young Soon Nam, Mavrantonis, Constantinos, Salum, Mara R., Yamaguchi, Takuya, Weiss, Eric G., Nogueras, Juan J., and Cheng Fang Yu
- Subjects
DEFECOGRAPHY ,LARGE intestine ,PERINEAL care ,RECTAL radiography ,DIAGNOSIS of defecation disorders - Abstract
PURPOSE: Anorectal angle and perinea descent can be measured either by drawing a line defined by the impression of the puborectalis muscle and the tangential of the posterior rectal wall (Method A) or by drawing a straight line at the level of the posterior rectal wall parallel to the central longitudinal axis of the rectum (Method B). The aim of this study was to assess the reproducibility of measuring anorectal angle and perineal descent by two different methods according to intraobserver and interobserver measurement and to evaluate which method yields more consistent results. METHODS: Five physicians who have had an average of 1.3 years (range, 6 months to 1.5 years) experience in defecographic measurement drew both lines on 63 randomly selected defecographic films and measured anorectal angle and perineal descent by the two methods. The defecographic parameters were measured twice by each observer during a three-week interval. To avoid potential bias, one physician who did not participate in either measurement of perineal descent or anorectal angle performed all data collection. Intraobserver and interobserver agreement was quantified using Shrout and Fleiss intraclass correlation coefficients. RESULTS: The mean and range of intraclass correlation coefficients for intraobserver agreement of measuring anorectal angle and perineal descent by Method A were 0.71 (0.6-0.78) and 0.89 (0.74-0.97), respectively, whereas with Method B the coefficients were 0.81 (0.73-0.89) and 0.93 (0.89-0.99), respectively. Regarding the interobserver agreement of the five observers, the mean coefficients for measurement of both anorectal angle and perineal descent by both methods showed similar agreement levels (0.88 and 0.98 by Method A and 0.89 and 0.97 by Method B). The mean (± standard deviation) values of anorectal angle and perineal descent found by Method B were significantly larger than those found by Method A (103-3° ± 19-6 and 6.56 ± 3-20 cm and 91.1° ± 25.6 and 5.64 ± 3.42 cm, respectively; P < 0.001). CONCLUSION: Intraobserver and interobserver intraclass correlation coefficients of anorectal angle and perineal descent, which were measured by both methods, were more than 0.60, indicating that both methods are reliable and consistent for measurement of anorectal angle and perineal descent. However, centers should consistently use the same line for measurement of anorectal angle and perineal descent because of the statistically significant differences between the two methods and the possibility of inconsistent results. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
23. Dieulafoy's Lesion of the Anal Canal: A New Clinical Entity.
- Author
-
Azimuddin, Khawaja, Stasik, John J., Rosen, Lester, Riether, Robert D., and Khubchandani, Indru T.
- Subjects
ANUS ,WOUNDS & injuries ,HEMORRHAGE ,COLON (Anatomy) ,LARGE intestine - Abstract
Dieulafoy's lesion is an unusual source of massive lower gastrointestinal hemorrhage. It is characterized by severe bleeding from a minute submucosal arteriole that bleeds through a punctate erosion in an otherwise normal mucosa. Although Dieulafoy's lesions were initially described only in the stomach and upper small intestine, they are being identified with increasing frequency in the colon and rectum. To our knowledge, however, Dieulafoy's lesion of the anal canal has not been described previously. We present two patients with Dieulafoy's lesion of the anal canal who presented with sudden onset of massive hemorrhage. The clinicopathologic features of this unusual clinical entity are discussed and suggestions are made for diagnosis and management. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
24. Local Somatothermal Stimulation Inhibits Motility of the Internal Anal Sphincter Through Nitrergic Neural Release of Nitric Oxide.
- Author
-
Jeng-Kae Jiang, Jen-Hwey Chiu, and Jen-Kou Lin
- Subjects
ANUS ,NITRIC oxide ,RECTUM ,LARGE intestine ,HUMAN anatomy - Abstract
PURPOSE: A somatoanal reflex had been demonstrated in our previous work. Because nitric oxide plays an important role in mediating relaxation of the internal anal sphincter, our purpose was to examine whether and how local somatothermal stimulation inhibits the function of the internal anal sphincter by stimulating nitric oxide release via nitrergic neurons and to elucidate the possible mechanism. METHODS: The activity of the internal anal sphincter in anesthetized rabbits was measured by use of continuously perfused, open-tip manometric methods. Local somatothermal stimulation was achieved by applying an electroheating rod 1 cm away from the skin area at the right popliteal region. The responses were further manipulated by pretreating the rabbits with agonists or antagonists linked to nitric oxide synthesis. RESULTS: The motility of the internal anal sphincter before and during local somatothermal stimulation was significantly different (tonic pressure (mean ± standard error of the mean), 5.4 ± 0.3 vs. 4.9 ± 0.3 mmHg, P = 0.0195; phasic pressure, 3.9 ± 0.6 vs. 2.9 ± 0.4 mmHg. P = 0.0002; frequency distribution of the phasic contractions (peak-to-peak interval), 28.9 ± 3.7 vs. 65.3 ± 10.4 seconds, P = 0.0001). The response began at approximately one minute after local somatothermal stimulation when the skin temperature was 41 ± 0.3°C. No anal response was observed when local somatothermal stimulation was applied at the control area. The local somatothermal stimulation-induced internal anal sphincter relaxation was not inhibited by pretreatment with atropine. propranolol. or phentolamine (tonic pressure, 5.8 ± 1 vs. 5-2 ± 0.8 mmHg, P = 0.038; phasic pressure, 4.2 ± 0.9 vs. 3-1 ± 0.6 mmHg, P = 0.020; peak-to-peak interval, 27.2 ± 4.3 vs. 52.9 ± 14.5 seconds, P = 0.043) but was completely blocked by pretreatment with a nitric oxide synthesis inhibitor. The effect of the nitric oxide synthesis inhibitor could be reversed by pretreatment with L-arginine (tonic pressure, 6 ± 0.7 vs. 5.6 ± 0.7 mmHg, P = 0.047; phasic pressure, 4.7 ± 0.7 vs. 3.9 ± 0.5 mmHg, P = 0.048; peak-to-peak interval, 23.8 ± 3 vs. 33 ± 3.7 seconds, P = 0.048), but not by D-arginine. CONCLUSION: Local somatothermal stimulation inhibits internal anal sphincter motility through the activation of nonadrenergic noncholinergic neural release of nitric oxide. This procedure may represent a simplified approach for the treatment of anorectal diseases with hypofunction of the L-arginine/nitric oxide pathway. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
25. Effect of Morphine and Incision Length on Bowel Function After Colectomy.
- Author
-
Cali, Rebecca L., Meade, Paul G., Swanson, Melvin S., and Freeman, Carl
- Subjects
LARGE intestine ,COLECTOMY ,POSTOPERATIVE care ,POSTOPERATIVE pain ,MORPHINE - Abstract
PURPOSE: Return of bowel function remains the rate-limiting factor in shortening postoperative hospitalization of patients with colectomies. Narcotics are most commonly used in the management of postoperative pain, even though they are known to affect gut motility. Narcotic use has been felt to be proportional to the length of the abdominal incision. The aim of this study was to determine whether return of bowel function after colectomy is directly related to narcotic use and to evaluate the effect of incision length on postoperative ileus. METHODS: A prospective evaluation of 40 patients who underwent uncomplicated, predominantly left colon and rectal resections was performed. Morphine administered by patient controlled analgesia was the sole postoperative analgesic. The amount of morphine used before the first audible bowel sounds, first passage of flatus and bowel movement, and incision length were recorded. Spearman correlation coefficients were calculated between all variables. RESULTS: The strongest correlation was between time to return of bowel sounds and amount of morphine administered (r = 0,74; P = 0.001). There were also significant correlations between morphine use and time to report of first flatus (r = 0.47; P = 0.003) and time to bowel movement (r = 0.48; P = 0.002). There was no relationship between incision length and morphine use or incision length and return of bowel function in the total group. CONCLUSIONS: Return of bowel sounds, reflecting small-intestine motility after colectomy. correlated strongly with the amount of morphine used. Similarly, total morphine use adversely affects colonic motility. Because no relationship with incision length was found, efforts to optimize the care of patients with colectomies should be directed less toward minimizing abdominal incisions and more toward diminishing use of postoperative narcotics. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
26. Anal pressures impaired by stapler insertion during colorectal anastomosis.
- Author
-
Ho, Yik-Hong, Tan, Margaret, Leong, Adrian, Eu, Kong-Weng, Nyam, Denis, and Seow-Choen, Francis
- Abstract
The significance of anal sphincter injury from transanal inserted staplers was studied. A randomized, controlled comparison was made of anorectal manometry and clinical function after sigmoid colectomy (avoiding nerve injury from rectal mobilization), anastomosed by either transanal inserted stapler or biofragmentable anastomotic ring (avoiding anal manipulation).Fifty-eight consecutive patients with sigmoid adenocarcinoma were randomly assigned to transanal inserted stapler or biofragmentable anastomotic ring groups. Anorectal manometry and clinical bowel function assessment were performed by an independent blinded observer before surgery and six weeks and six months after surgery.At six weeks after surgery, there was significant impairment of mean anal resting pressures (mean impairment, 23 percent; P <0.001) and physiologic anal length (mean impairment, 31 percent; P <0.01) in the transanal inserted stapler group (27 completed the trial), but not in the biofragmentable anastomotic ring group (18 completed the trial). Pressures remained impaired at six months. When changes in the anal pressures were compared between groups, the mean anal resting pressure (P <0.001) and maximum squeeze pressure (P <0.01) at six weeks and mean anal resting pressure at six months (P <0.01) were significantly more impaired in the transanal inserted stapler group. Postoperative bowel function was not different between the two groups. Postoperative complications were similar. In the transanal inserted stapler group one patient died of anastomotic leak sepsis and one had wound infection; in the biofragmentable anastomotic ring group one patient died of myocardial infarct and one had wound infection.Direct injuries to the internal anal sphincter occurred after transanal inserted stapler but not biofragmentable anastomotic ring anastomoses. Clinical function was not correspondingly affected, probably because of the adequate residual rectal reservoir after sigmoid colectomy. [ABSTRACT FROM AUTHOR]
- Published
- 1999
- Full Text
- View/download PDF
27. Bowel function survey after segmental colorectal resections.
- Author
-
Ho, Yik-Hong, Low, Deborah, and Goh, Hak-Su
- Abstract
Long-term bowel function after right hemicolectomy (RHC), extended right hemicolectomy (ERHC), left hemicolectomy (LHC), sigmoid colectomy (SC), and anterior resection (AR) was evaluated.Three hundred fifteen patients (52.3 percent) replied to a questionnaire on stool frequency, fecal continence, and defecation problems. All patients had undergone surgery at least one year before questionnaire was sent to them. Patients with anastomotic leaks and recurrences were excluded.Stool frequency was one to two bowel movements per day in 78 percent of patients after RHC, 75 percent after ERHC, 57.6 percent after LHC, 64.3 percent after SC, and only 44.8 percent after AR (P =0.01). Continence affected lifestyle in 32 percent of patients after AR, but affected only up to 11.5 percent of patients who had had more proximal resections (P =0.001). Defecation problems occurred in less than 15.4 percent after RHC, ERHC, and LHC but were encountered more frequently after SC (25 percent) and AR (28.4 percent;P =0.009).Problems with postoperative bowel function were appreciably more common after SC and AR. [ABSTRACT FROM AUTHOR]
- Published
- 1996
- Full Text
- View/download PDF
28. Ischemic colitis.
- Author
-
Gandhi, Sanjiv K., Hanson, Morin M., Vernava, Anthony M., Kaminski, Donald L., and Longo, Walter E.
- Abstract
Ischemic colitis represents the most common form of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops “spontaneously,” in the absence of major vasculature occlusion, and in the presence of viable intestine elsewhere. It is most usefully classified into gangrenous and nongangrenous forms, the latter of which may be subdivided into transient and chronic types. Ischemic colitis may develop in people who are otherwise healthy, although a variety of clinical settings, such as shock, predispose to its occurrence. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy. Therapy and outcome are dependent on the severity of disease. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis. The chronic subtype may lead to the sequelae of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent operative intervention and a high morbidity and mortality are the hallmarks of gangrenous colonic ischemia. Special considerations must be given to those patients in whom ischemic colitis develops in the context of colon carcinoma or obstructing colon lesions, after abdominal aortic surgery, and following cardiopulmonary bypass. This review will discuss the clinical spectrum of ischemic colitis. [ABSTRACT FROM AUTHOR]
- Published
- 1996
- Full Text
- View/download PDF
29. Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine.
- Author
-
Davies, Neal M.
- Abstract
Adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDS) on the upper gastrointestinal (GI) tract and small intestine are well described. Evidence is also accumulating that implicate NSAIDS in inducing and exacerbating damage in the distal GI tract. The purpose of this review is to identify possible adverse effects of NSAIDS on the large intestine and increase the clinical awareness of these toxicologic effects.A literature review identified the diversity of toxicologic effects induced by NSAIDS in the large intestine. The epidemiology, pathogenesis, and clinical implications of these adverse effects are described.NSAID use has been associated with colonic bleeding, iron deficiency anemia, strictures, ulcerations, perforations, diarrhea, and death. In addition, NSAIDS can exacerbate inflammatory bowel disease and ulcerative colitis. The prevalence of NSAID-induced large intestinal damage is unknown. Diagnosis can be made by colonoscopy and barium scans. Although the clinical presentation of NSAID-induced gastropathy and enteropathy, bleeding or perforation, may be more dramatic than colonopathy, the overall clinical significance of these adverse effects of NSAIDS on the large intestine has not been fully characterized.This review illustrates that NSAID-induced large bowel toxicity can cause significant morbidity in some patients, ranging from profuse diarrhea, chronic blood loss, and iron deficiency anemia to fatality. The pathogenesis is likely multifactorial and is thought to be related to inhibition of prostaglandin synthesis. Because NSAIDS are widely prescribed and some are available without a prescription, heightened awareness of these toxicologic manifestations throughout the GI tract may reduce morbidity. [ABSTRACT FROM AUTHOR]
- Published
- 1995
- Full Text
- View/download PDF
30. Surgery for radiation injury to the large intesine.
- Author
-
Pricolo, Victor E. and Shellito, Paul C.
- Abstract
Surgery for colorectal radiation injury is technically difficult and often followed by complications. This study evaluates factors affecting outcome.A retrospective 30-year review was carried out. Preoperative characteristics and operative variables were correlated with morbidity, mortality, and success in providing symptomatic relief.A total of 60 cases and 75 colon and rectal lesions were analyzed. After surgery, the morbidity rate was 65 percent, and the mortality was 6.7 percent. A successful outcome in providing symptomatic relief was achieved in 71.7 percent of cases. When comparing success after operations for the different lesions (stricture, 78.1 percent; hemorrhage, 64.3 percent; perforation, 100 percent; and fistula, 54.5 percent), the presence of a fistula was associated with symptomatic relief significantly less often than the remainder (P=0.03). The type of operation had no effect on success rate: 72 percent for diversion, 66.7 percent for resection, and 83.3 percent for bypass. Morbidity and mortality rates were not significantly influenced by site of lesions, type of lesions, or choice of surgical operation. A permanent stoma was necessary in 70 percent of patients.The morbidity for surgical treatment of large bowel radiation injury is substantial, and largely unrelated to the type and location of the radiation lesion, as well as the type of operation. Success rates are reasonably high, but worst after fistula repair. The selection of therapy (medical, endoscopic, surgical) for radiation-induced colorectal lesions must take into account numerous factors and be highly individualized. [ABSTRACT FROM AUTHOR]
- Published
- 1994
- Full Text
- View/download PDF
31. Polyamine levels in healthy and tumor tissues of patients with colon adenocarcinoma.
- Author
-
Becciolini, Aldo, Porciani, Sauro, Lanini, Aldo, Balzi, Manuela, Cionini, Luca, and Bandettini, Luca
- Abstract
Tissue polyamine levels were determined in patients with colon adenocarcinoma to try to identify biochemical indicators able to characterize the growth and the metabolism of human solid tumors. Polyamine content was determined in the tumor and in the “healthy” mucosa sampled at different distances within the resection edges. For each patient the polyamine content in the tumor was compared with that in the mucosa. The results demonstrated that the spermidine concentration was higher in the tumor than in the healthy mucosa; the differences were statistically significant. However, spermine in the tumor increased to a lesser degree. No statistically significant differences were observed among these mucosae at different localizations, but the spermine concentration in the mucosa after the tumor showed values very close to those of the neoplasia. [ABSTRACT FROM AUTHOR]
- Published
- 1991
- Full Text
- View/download PDF
32. Spatial clustering of multiple hyperplastic, adenomatous, and malignant colonic polyps in individual patients.
- Author
-
Cappell, Mitchell S. and Forde, Kenneth A.
- Abstract
Analysis of relative polyp locations in 426 consecutive patients with multiple colonic polyps found on colonoscopy showed novel findings. First, synchronous and metachronous neoplastic polyps showed spatial clustering in individual patients. For example, patients with their largest neoplasm in the cecum or proximal ascending colon, had 34.3 percent±4.6 percent (standard error) of their other colonic neoplasms in the same location. Second, hyperplastic polyps showed spatial clustering in individuals that was statistically significantly greater than expected from the increased hyperplastic polyp concentration in the rectum and sigmoid. Third, hyperplastic polyps showed spatial clustering with neoplastic polyps; this clustering was similar in magnitude to clustering for exclusively hyperplastic or neoplastic polyps. In contrast, lipomas were not spatially clustered with hyperplastic and neoplastic polyps. The magnitude of clustering between hyperplas and neoplasia showed a closer association between these histologic types than previously appreciated. Because of clustering, regions with prior polyps appear to merit closer surveillance. These findings suggest clinical study, using a randomized controlled clinical trial, of whether a patient who had only rectal and sigmoid adenomas on initial and follow-up colonoscopy should have surveillance with flexible sigmoidoscopy alternating annually with colonoscopy. A patient with a prior cecal adenoma should have surveillance only with a complete colonoscopy or adequate cecal views on barium enema. [ABSTRACT FROM AUTHOR]
- Published
- 1989
- Full Text
- View/download PDF
33. Squamous differentiation in colorectal adenomas.
- Author
-
Cramer, Stewart F., Velasco, Manuel E., Whitlatch, Stephen P., and Graney, Michael F.
- Abstract
Patterns of stratified squamous epithelium have been recognized recently in colorectal adenomas. Light microscopic and keratin immunohistochemical analysis of four cases in the present report suggested origin from large intestinal reserve cells, with impaired and disorderly maturation in the squamous foci. One case had an invasive adenocarcinoma separately in the same polyp, bringing the reported incidence of malignant transformation in these adenomas to seven of 48 (15 percent). Evidence is presented to support the notion that squamous differentiation may be an inherently neoplastic phenomenon in colorectal adenomas, which may be added to the list of markers for colorectal polyps at higher risk for malignant transformation. [ABSTRACT FROM AUTHOR]
- Published
- 1986
- Full Text
- View/download PDF
34. Comparative study of familial polyposis coli and nonpolyposis coli on the histogenesis of large-intestinal adenoma.
- Author
-
Oohara, Takeshi, Ihara, Osamu, Saji, Kohki, and Tohma, Hiroyuki
- Abstract
The entire length of the large intestine resected from six patients with familial polyposis coli (FPC) was step-sectioned, and microscopic adenomas composed of one to several glands were prepared into complete serial sections. Histopathologic comparison of these microscopic adenomas was made between FPC and nonpolyposis coli (those not included in the special disease group of FPC). The histogenesis of adenomas in FPC and nonpolyposis coli was considered as follows. (1) In nonpolyposis coli, adenomas arise from basal cells of the deep layer of the mucosa. (2) In FPC, most of the adenomas (81.2 per cent) arise in the same manner as described above, although there are some (18.8 per cent) that appear to have arisen in the middle or superficial layer of the mucosa. (3) Therefore, it is believed that the morphologic difference of the large-intestinal mucosa between FPC and nonpolyposis coli comes not from the difference in the number of adenomas present but from the difference in the position and/or timing of appearance of adenomas. [ABSTRACT FROM AUTHOR]
- Published
- 1982
- Full Text
- View/download PDF
35. Self-Assessment Quiz: Answers, Critiques, and References.
- Subjects
CONTINUING medical education ,CONTINUING education ,SURGEONS ,COLON (Anatomy) ,RECTUM ,LARGE intestine - Abstract
The article provides information about the self-assessment, continuing education program offered by the American Society of Colon and Rectal Surgeons (ASCRS) for its members and interested physicians. The program is designed to provide surgeons with in-depth and up-to-date knowledge relative to surgery of the colon and rectum. Also, ASCRS offers a Syllabus as a preparatory vehicle to taking the Self-Assessment Examination.
- Published
- 2006
- Full Text
- View/download PDF
36. Sphincter-Sparing Surgery for Diffuse Crohn’s Disease of the Large Intestine: Who Really Has a Choice?
- Author
-
Scott A. Strong
- Subjects
medicine.medical_specialty ,Clinical Decision-Making ,MEDLINE ,Anal Canal ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,Quality of life ,Clinical decision making ,Severity of illness ,medicine ,Humans ,Large intestine ,Colectomy ,Crohn's disease ,business.industry ,Patient Selection ,General surgery ,Gastroenterology ,General Medicine ,Colitis ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Quality of Life ,Sphincter ,030211 gastroenterology & hepatology ,business ,Organ Sparing Treatments - Published
- 2016
37. The effect of luminal pH on large intestinal absorption in ulcerative proctocolitis.
- Author
-
McNeil, N. I.
- Abstract
The sensitivity of large intestinal absorption to pH and the absorption of short-chain fatty acids were measured in ulcerative proctocolitis by a dialysis bag method. Lowering luminal pH from 7 to 5.5 significantly reduced absorption of salt and water in proctocolitis, but not in normal controls. Short-chain fatty acid absorption was not affected by inflammation or change in pH when patients with ulcerative proctocolitis were compared with controls. [ABSTRACT FROM AUTHOR]
- Published
- 1986
- Full Text
- View/download PDF
38. Total colonic ischemia.
- Author
-
Welch, G. H., Shearer, M. G., Imrie, C. W., Anderson, J. R., and Gilmour, D. G.
- Abstract
The involvement of the entire colon in an ischemic process is unusual because of the dual source of blood supply to the large bowel. Three cases of total ischemic colitis are presented. A precipitating cause to account for the distribution of ischemia was identified in each patient. [ABSTRACT FROM AUTHOR]
- Published
- 1986
- Full Text
- View/download PDF
39. Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon
- Author
-
Andreas Püspök, Georg Oberhuber, and Hans-Peter Kiener
- Subjects
Adult ,Male ,medicine.medical_specialty ,Abdominal pain ,Diclofenac ,Colonoscopy ,Gastroenterology ,Ischemic colitis ,Internal medicine ,medicine ,Humans ,Medical history ,Large intestine ,Intestinal Mucosa ,Colitis ,Ulcer ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,Collagenous colitis ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,General Medicine ,Middle Aged ,medicine.disease ,Diarrhea ,medicine.anatomical_structure ,Delayed-Action Preparations ,Female ,medicine.symptom ,business ,Intestinal Obstruction - Abstract
PURPOSE: It has become increasingly clear that nonsteroidal anti-inflammatory drugs may cause damage not only to the upper gastrointestinal tract but also to the small and large intestine. Although the colon may be readily investigated by endoscopy, drug-induced lesions are not well known, probably because they are considered to occur only rarely. In the present study we describe endoscopic, histologic, and gross characteristics of nonsteroidal anti-inflammatory drug-induced colonic damage. Furthermore, pathogenetic mechanisms and therapeutic options are discussed. METHODS: The histories of all patients diagnosed as having nonsteroidal anti-inflammatory drug colitis during the last two years at the department of gastroenterology or the department of pathology at our hospital were reviewed. Endoscopic, histologic, and gross pathologic findings were systematically recorded. In addition, data on duration and type of nonsteroidal anti-inflammatory drug intake and time from onset of symptoms to diagnosis were collected. Therapy and outcome of our patients, if available, are reported. RESULTS: During the study period 11 patients were diagnosed as having nonsteroidal anti-inflammatory drug colitis. Most patients presented with diarrhea with or without blood loss and complained about diffuse abdominal pain. Endoscopy revealed flat ulcers in the entire colon being more severe in the right colon in the three cases with acute onset of diarrhea. In four cases concentric “diaphragm-like” strictures were seen, all located in the right colon. In the remainder endoscopy showed nonspecific erosions and was normal in one patient. Histology revealed findings similar to ischemic colitis. Additionally, in two cases collagenous colitis was found. Diclofenac slow release was the most commonly involved drug. The median time from onset of symptoms to diagnosis was 1.8 (range, 0–11.5) years. CONCLUSIONS: Nonsteroidal anti-inflammatory drug colitis is a clinically significant disease, which may present with diarrhea, anemia, and nonspecific abdominal complaints. Careful history taking, together with awareness of endoscopic and histologic findings, allows a timely diagnosis of this disease.
- Published
- 2000
40. Host expression of matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 in normal colon tissue affects metastatic potential of colorectal cancer
- Author
-
Hideki Masuda and Hisayuki Aoki
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Colon ,Colorectal cancer ,Matrix metalloproteinase ,Matrix (biology) ,Metastasis ,medicine ,Humans ,Neoplasm Invasiveness ,Protease Inhibitors ,Large intestine ,RNA, Messenger ,Neoplasm Metastasis ,Aged ,Electrophoresis, Agar Gel ,Tissue Inhibitor of Metalloproteinase-2 ,Tissue Inhibitor of Metalloproteinase-1 ,business.industry ,Liver Neoplasms ,Gastroenterology ,Metalloendopeptidases ,Cancer ,General Medicine ,Middle Aged ,Tissue inhibitor of metalloproteinase ,medicine.disease ,medicine.anatomical_structure ,Gelatinases ,Colonic Neoplasms ,Cancer cell ,Matrix Metalloproteinase 2 ,Female ,business - Abstract
PURPOSE: To clarify the mechanism of cancer cell invasion, we paid close attention to the role of matrix metalloproteinases and tissue inhibitors of metalloproteinases in normal tissue that is located in the same organ as the cancer. METHODS: Samples were obtained from a tumor lesion and normal tissue in the resected large intestine of 59 patients with colorectal cancer, including 13 cases with liver metastasis (Group A) and 46 cases without liver metastasis (Group B). In each sample the expression of m-RNA for matrix metalloproteinase-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2 was examined using reverse transcription-coupled polymerase chain reaction and southern hybridization. RESULTS: In normal colon tissue the expression rate of matrix metalloproteinase-2 in Group A (76.9 percent) was significantly higher than that of Group B (15.2 percent;P
- Published
- 1999
41. Ischemic colitis
- Author
-
Walter E. Longo, Garth H. Ballantyne, and Richard J. Gusberg
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Enema ,Comorbidity ,Ischemic colitis ,Hospitals, University ,Postoperative Complications ,Sex Factors ,Clinical Protocols ,Risk Factors ,Surgical oncology ,Laparotomy ,Diabetes mellitus ,medicine ,Humans ,Large intestine ,Colitis ,Intubation, Gastrointestinal ,Colectomy ,Retrospective Studies ,business.industry ,Age Factors ,Gastroenterology ,Colonoscopy ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Colorectal surgery ,Anti-Bacterial Agents ,Surgery ,Connecticut ,medicine.anatomical_structure ,Female ,Barium Sulfate ,business ,Follow-Up Studies - Abstract
We identified 47 patients with nonocclusive ischemia of the large intestine over a seven-year period. The mean age at presentation was 56.2 years, with a 2∶2∶1 male predominance. Associated medical illnesses were diabetes (17 percent), renal failure (5 percent), and hematologie disorders (5 percent). Six patients developed ischemic colitis after aortic surgery. The mean delay in diagnosis was 1.8 days (range, three hours to 23 days). The right colon was involved in 21 patients (46 percent). Overall, 15 of 16 patients were successfully treated non-operatively with bowel rest and antibiotics; one patient who was managed nonoperatively died. Among the 31 requiring intestinal resection, enteric continuity was reestablished in 14. Second-look laparotomy in eight patients revealed further ischemia in two (20 percent). Mortality in the operative group was 29 percent (9 of 31). No patient has developed recurrent ischemia (mean follow-up, 5.3 years). Ischemic colitis often occurs without an obvious predisposing event, may involve all segments of the large intestine, and frequently requires surgery. While its course may be self-limited, elderly and diabetic patients, as well as those developing ischemia following aortic surgery or hypotension, continue to have a poor prognosis.
- Published
- 1992
42. Official Journal of the American Society of Colon and Rectal Surgeons International Society of University Colon and Rectal Surgeons
- Author
-
P. L. Roberts, Veidenheimer Mc, John A. Coller, David J. Schoetz, and John J. Murray
- Subjects
medicine.medical_specialty ,business.industry ,Primary anastomosis ,medicine.medical_treatment ,Gastroenterology ,General Medicine ,Diverticulitis ,Anastomosis ,medicine.disease ,digestive system diseases ,Surgery ,Colon resection ,Surgical anastomosis ,medicine.anatomical_structure ,Laparotomy ,Medicine ,Large intestine ,Segmental resection ,business - Abstract
In selected individuals requiring emergency colon resection, intraoperative colonic lavage with primary anastomosis represents a safe alternative to staged reconstruction. This procedure achieves excellent mechanical preparation of the colon, facilitates safe anastomosis, and avoids the disadvantages associated with multistaged operations. At our institution, 25 patients requiring urgent segmental resection of the left colon have undergone intraoperative colonic lavage. Primary anastomosis without fecal diversion has been performed in 21 of these patients. Obstruction of the large intestine was the indication for operation in 56 percent of the patients in this series. Ten patients (40 percent) required laparotomy for an acute intra-abdominal inflammatory process. No post-operative deaths have occurred in our series, and no patient has sustained clinically evident anastomotic leakage. A pelvic abscess developed in one patient after sigmoid colectomy for diverticulitis. Three patients required treatment for wound infection. Based on our results, we recommend resection with intraoperative colonic lavage and primary anastomosis as the preferred treatment for the majority of patients requiring nonelective segmental left colon resection.
- Published
- 1991
43. Polyamine levels in healthy and tumor tissues of patients with colon adenocarcinoma
- Author
-
A. Lanini, S. Porciani, Luca Bandettini, Aldo Becciolini, Manuela Balzi, and Luca Cionini
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Colon ,Spermidine ,Spermine ,Adenocarcinoma ,chemistry.chemical_compound ,Surgical oncology ,medicine ,Humans ,Large intestine ,Intestinal Mucosa ,Chromatography, High Pressure Liquid ,Aged ,Aged, 80 and over ,business.industry ,Gastroenterology ,Proteins ,General Medicine ,Metabolism ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,chemistry ,Colonic Neoplasms ,Female ,Colon adenocarcinoma ,Polyamine ,business - Abstract
Tissue polyamine levels were determined in patients with colon adenocarcinoma to try to identify biochemical indicators able to characterize the growth and the metabolism of human solid tumors. Polyamine content was determined in the tumor and in the "healthy" mucosa sampled at different distances within the resection edges. For each patient the polyamine content in the tumor was compared with that in the mucosa. The results demonstrated that the spermidine concentration was higher in the tumor than in the healthy mucosa; the differences were statistically significant. However, spermine in the tumor increased to a lesser degree. No statistically significant differences were observed among these mucosae at different localizations, but the spermine concentration in the mucosa after the tumor showed values very close to those of the neoplasia.
- Published
- 1991
44. A case of cecocolic intussusception with complete invagination and intussusception of the appendix with villous adenoma
- Author
-
Seiya Akatsuka, Toshiro Ohmura, Yoshinari Yamada, Toshiaki Saito, and Sotaro Sadahiro
- Subjects
Adenoma ,Adult ,Male ,Villous adenoma ,medicine.medical_specialty ,Appendix ,digestive system ,Cecum ,Intussusception (medical disorder) ,otorhinolaryngologic diseases ,medicine ,Cecal Diseases ,Humans ,Large intestine ,business.industry ,Gastroenterology ,Invagination ,General Medicine ,bacterial infections and mycoses ,medicine.disease ,digestive system diseases ,Colorectal surgery ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Appendiceal Neoplasms ,Abdomen ,business ,Intussusception - Abstract
Villous adenoma of the appendix is a rare neoplasm and intussusception of the appendix is a rare pathologic condition. A very rare case seen in a 35-year-old male with pain in the right lateral abdomen is reported. In this patient, the appendix along with the villous adenoma intussuscepted and invaginated into the cecal lumen, and presented as cecocolic intussusception. A polypoid lesion was diagnosed in the cecum by fiberoptic colonoscopy. Unlike polypoid lesions at other sites in the large intestine, polypoid lesions of the cecum may accompany intussusception and invagination of the appendix. Consequently, caution is required in performing endoscopic polypectomy in cases of polypoid lesions of the cecum.
- Published
- 1991
45. Leiomyosarcoma of the transverse colon
- Author
-
Thomas R. Magill and William R. Nuessle
- Subjects
Leiomyosarcoma ,Male ,medicine.medical_specialty ,Pathology ,Colonoscopy ,Myosins ,Organometallic Compounds ,medicine ,Humans ,Large intestine ,Aged ,medicine.diagnostic_test ,business.industry ,Indium Radioisotopes ,Gastroenterology ,Transverse colon ,Rare entity ,Antibodies, Monoclonal ,General Medicine ,medicine.disease ,Colorectal surgery ,medicine.anatomical_structure ,Colonic Neoplasms ,Radiology ,business - Abstract
Leiomyosarcoma of the transverse colon is uncommon. A case report involving a 68-year-old man is presented. Included is a discussion of the characteristics of this rare entity based upon a review of the literature. The potential role of colonoscopy and indium-111 antimyosin in the diagnosis of this tumor is addressed.
- Published
- 1990
46. The influence of dairy and nondairy calcium on subsite large-bowel cancer risk
- Author
-
P.-H. Chyou, G. N. Stemmermann, and Abraham M. Y. Nomura
- Subjects
Male ,medicine.medical_specialty ,Colorectal cancer ,chemistry.chemical_element ,Physiology ,Calcium ,Cohort Studies ,Japan ,Risk Factors ,Internal medicine ,medicine ,Humans ,Large intestine ,Prospective Studies ,Risk factor ,Prospective cohort study ,Lactose intolerance ,Rectal Neoplasms ,business.industry ,Gastroenterology ,Cancer ,General Medicine ,medicine.disease ,Dietary Fats ,digestive system diseases ,Calcium, Dietary ,Endocrinology ,medicine.anatomical_structure ,chemistry ,Colonic Neoplasms ,Population study ,business - Abstract
This prospective study assesses the impact of fat and calcium intake on the risk of developing cancer in each large-bowel subsite. The study population is a cohort of Hawaii Japanese men who experience high rates of colon cancer, especially of the sigmoid segment. Total calcium intake is not related to the risk of colon cancer, and separation of calcium into dairy and nondairy sources does not alter the result. There is, however, a significant, monotonic increase in sigmoid colon cancer risk with decreasing total calcium intake. Similar trends are shown for both dairy and nondairy calcium. Dietary calcium is not consumed in large quantities among the Hawaii Japanese, partly because of their limited consumption of milk due to lactose intolerance. If calcium plays a protective role against sigmoid colon cancer, this effect is unlikely to be related to fat intake. Sigmoid colon cancer subjects had lower intakes of fat than other cohort men, and a statistical test for the interaction effect of total calcium and fat intake on colon cancer risk was statistically insignificant (P = 0.2).
- Published
- 1990
47. Immunoscintigraphy of colorectal cancer with an antibody to epithelial membrane antigen (EMA)
- Author
-
John Westwood, Brian R. Davidson, Gill Clarke, C. G. Clark, Caroline Ward, Michael Ward, Louise Baker, Ken Roberts, Paul Boulos, and Chu-Yiu Yiu
- Subjects
Male ,Pathology ,medicine.medical_specialty ,medicine.drug_class ,Colorectal cancer ,Rectum ,Scintigraphy ,Monoclonal antibody ,Immunoscintigraphy ,Immunoenzyme Techniques ,Antigen ,Antigens, Neoplasm ,medicine ,Humans ,Large intestine ,Radionuclide Imaging ,Aged ,Aged, 80 and over ,Membrane Glycoproteins ,biology ,medicine.diagnostic_test ,business.industry ,Indium Radioisotopes ,Liver Neoplasms ,Mucin-1 ,Gastroenterology ,Antibodies, Monoclonal ,General Medicine ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,biology.protein ,Female ,Neoplasm Recurrence, Local ,Antibody ,Colorectal Neoplasms ,business - Abstract
Immunoperoxidase staining of LICR-LON M8, a mouse monoclonal antibody reactive with epithelial membrane antigen, showed a strong reaction with colorectal cancer. This finding prompted an immunoscintigraphic study of colorectal cancer patients using this antibody. Sixteen patients had external gamma scintigraphy after intravenous injection of indium 111-labeled M8. Positive scans were obtained in 11 of the 13 patients with primary colorectal cancers, and 2 of the 3 patients with recurrent tumors. The high indium 111 background in the liver prevented the detection of hepatic metastases in 5 patients. Twelve patients had samples taken of tumor, normal colon, and venous blood at the time of surgery. The ratio of labeled antibody uptake in tumor to that of blood was 5.1 (+/- 3.6 S.D.), which was significantly different (P = 0.001) to that of the similar ratio for normal colon (2.0 +/- 1.6 S.D.). The tumor to normal colon uptake ratio was 2.6 (+/- 1.3 S.D.). These results suggest a specific uptake of indium 111-labeled M8 by colorectal cancer.
- Published
- 1990
48. Depressed adenoma in the large intestine
- Author
-
Michio Kaminishi, Takeshi Oohara, Shigeru Sakai, Shu Kuramoto, Ryo Shimazu, and Osamu Ihara
- Subjects
Adenoma ,Adult ,Male ,medicine.medical_specialty ,Pathology ,Adolescent ,Rectum ,Colonoscopy ,Gastroenterology ,Internal medicine ,medicine ,Humans ,Large intestine ,Prospective Studies ,Child ,Prospective cohort study ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Infant ,General Medicine ,Middle Aged ,medicine.disease ,digestive system diseases ,Colorectal surgery ,Endoscopy ,Sigmoid Neoplasms ,medicine.anatomical_structure ,Child, Preschool ,Colonic Neoplasms ,Adenocarcinoma ,Female ,business - Abstract
To clarify the presence of depressed adenomas in the human large intestine, a prospective study was performed from January 1986 to December 1987. During these two years, 997 colonoscopies were conducted in patients, bdexcluding cases of familial adenomatosis coli. Of 32 small, depressed lesions biopsied, seven were depressed adenomas, demonstrating that depressed adenomas do exist in the colon and rectum, and can be detected endoscopically. Resembling a sucker, they are easily detected through inflation and deflation.
- Published
- 1990
49. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery.
- Author
-
Hughes, E. S. R., McDermott, F. T., Polglase, A. L., and Johnson, W. R.
- Abstract
In the Melbourne (Monash) series reviewed here the development of apparently isolated incisional scar tissue recurrences after curative excisions for large-bowel cancer proved unusual. Eleven patients with such a recurrence all died of disseminated disease within four years, and most within 12 months, of its development. This suggests that an incisional recurrence is a manifestation of disseminated cancer rather than isolated implantation. [ABSTRACT FROM AUTHOR]
- Published
- 1983
- Full Text
- View/download PDF
50. Intussusception of the sigmoid colon because of an intramuscular lipoma
- Author
-
A. A. M. Geraedts, C. J. A. M. Zeebregts, H. F. W. Hoitsma, and J. L. G. Blaauwgeers
- Subjects
Adult ,Male ,medicine.medical_specialty ,Intussusception (medical disorder) ,otorhinolaryngologic diseases ,medicine ,Humans ,Large intestine ,Intestinal Mucosa ,Sigmoid Diseases ,business.industry ,Gastroenterology ,Invagination ,Intramuscular Lipoma ,Sigmoid colon ,Muscle, Smooth ,General Medicine ,Lipoma ,medicine.disease ,Colorectal surgery ,Surgery ,body regions ,Sigmoid Neoplasms ,stomatognathic diseases ,medicine.anatomical_structure ,Intestinal intussusception ,business ,Intussusception - Abstract
A clinical case of intestinal intussusception because of an intramuscular lipoma of the large intestine is presented.
- Published
- 1995
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.