摘要:

Abstract:We conducted a prospective study of the general population in Taiwan to determine how many patients with polyps in the proctosigmoid region would have synchronous polyps in the proximal colon. The pathology and the number of proctosigmoid polyps as well as the benefits of subsequent colonoscopy were taken into account. Proctosigmoid polyps were identified in 261 of 2746 asymptomatic patients by 60 cm sigmoidoscopy, yeilding a 9.5% (male: 11.0%; female: 5.0%) prevalence rate. Subsequent total colonoscopy combined with polypectomy was completed in 205 patients (152 males; 53 females) eligible for analysis. In all, 353 polyps were removed for pathological verification at colonoscopy. The mean size of adenomatous polyps was 6.2 mm and that of hyperplastic polyps 3.2mm (p<0.05). Five mucosal cancers as well as one submucosal cancer were identified, and one of the mucosal cancers was beyond the range of the prior 60 cm sigmoidoscopy. Of these 205 patients, 63 (31%) were found to have at least one proximal polyp. The prevalences of synchronous proximal colon polyps were 23%, 42% and 77% for the 1‐polyp, 2‐polyp and β2‐polyp groups in the proctosigmoid region, respectively. When the pathology of the proctosigmoid polyps was taken into account, it was found that 42% of patients with adenomatous polyps in the proctosigmoid region had proximal polyps, compared with 10% of those with distal hyperplastic polyps and 8% of those with other findings (p<0.05). The present study suggests that all polyps, of all sizes, found at sigmoidoscopy merit pathological verification. Furthermore, colonoscopy should be reserved for patients proved to have adenomatous or multiple polyps in the proctosigmoid

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00437.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Out of a total of 466 cases of early colorectal cancer, we analyzed 139 cases with submucosal invasion (sm cancer) according to tumor size, gross appearance, depth and degree of invasion, and the presence of adenoma components. Early colorectal cancers 11 ‐20 mm in diameter were the most common lesion in this group, and the percentage with sm cancer increased with tumor size. More than 70% of relatively small sm cancers, 6‐10 mm in diameter, had moderate or massive submucosal invasion similar to that found in large sm cancers. Only 35% of 6‐10 mm cancers had an adenoma component; the majority (65%) had no adenoma component. In marked contrast, 63% of sm cancers 11 ‐20 mm in diameter had an adenoma component and in sm cancer the percentage of tumors composed solely of cancerous tissue without an adenoma component was low. Similar results were obtained when only protruding type sm cancers, which accounted for the majority of sm cancer cases, were included in the analysis. Therefore, we believe that the protruding type sm cancer 6‐10 mm in diameter is at a stage close to advanced cancer. It is possible that many 6‐10 mm sm cancers have a histogenesis different from that of large

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00438.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:In order to clarify the rate of superficial cancer developing into colorectal cancer histologically, we examined horizontal growth type cancer in the residual mucosa of 68 samples with submucosal (sm) cancer, 91 with cancer with invasion of the muscularis propria (mp) and 311 with invasion deeper than the subserosa (ss). Among 68 samples of sm cancer, residual mucosa persisted in 65 (95.6%) and horizontal growth type cancer was found in 17 (26.2%). There was no significant difference in size between the horizontal and non‐horizontal growth type cancers. Among 91 samples of mp cancer, residual mucosa persisted in 15 (15.5%), horizontal growth type cancer was found in five (33.3%), and the latter were significantly smaller than non‐horizontal growth type cancers (p<0.05). Among 311 samples of ss cancer, residual mucosa persisted in 12 (3.9%) and horizontal growth was found in six (50.0%). In cancer with invasion deeper than the ss layer, malignant tissue is generally lost from the mucosa, such that the rates may not reflect the actual incidence. The rates of progression from superficial to sm cancer (26.2%) and mp cancer (33.3%) may be close to the present rate of superficial cancer developing into colorectal cancer. We conclude that the rate of superficial cancer developing into invasive cancer is at least 26.2%, and that superficial type cancers have a strong tendency to invade the mp even when smaller than protruded type cancers. It may be useful to focus on horizontal growth type cancers to elucidate the growth and development of colorectal can

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00439.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We reviewed 18 cases of large intestinal lipohyperplasia (LPH) to clarify the clinical and endoscopic features of this lesion. LPH was found in the ileocecal valve in 16 patients (88.9%). On colonoscopic examination, LPH showed a submucosal tumor‐like lesion with a smooth surface. The color was slightly yellowish or the same as that of the surrounding mucosa and the cushion sign was positive in all cases. According to endoscopic features, LPH in the ileocecal valve was classified into three types. The diffuse type showed a symmetrically swollen ileocecal valve. In contrast, the localized type displayed polypoid protrusion from the ileocecal valve. The intermediate type showed partial protrusion with asymmetrical swelling of the valve. Four patients had the diffuse type, three the intermediate type and nine the localized type. The upper lip of the ileocecal valve was more frequently involved in the localized and intermediate types. On rare occasion, LPH was recognized as hemispherical mucosal elevation in the ascending colon and rectum. Histological examination revealed infiltration of mature adipose tissue in the submucosal layer. It was noted that five of the 18 patients had associated malignancies of the gastrointestinal tract. As to therapy, six patients received endoscopic polypectomy and one underwent right hemicolectomy for associated advanced cancer in the cecum. In summary, this review shows that LPH is recognized primarily as focal or diffuse swelling of the ileocecal valve. On colonoscopic examination the possibility of such a lesion in the ileocecal valve should be kept in min

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00440.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Image processing of gastric ulcer scars was conducted using a computer‐equipped electronic endoscope in order to quantitatively classify the quality of gastric ulcer scars. Frontal images of 66 gastric ulcer scars (red scar stage), in 60 patients, obtained by electronic endoscopy were fed into a desktop computer system. Ulcer scars were classified according to the standard deviation of green signal intensity and unevenness of the scar surface, following repeated application of smoothing, into three groups. Group I: ulcer scars with a standard deviation of green signal intensity less than or equal to 15 and a flat surface after smoothing had been carried out 10 times. Group II: ulcers other than Group I or III. Group III: ulcers with a standard deviation greater than or equal to 25 and markedly uneven features after smoothing had been carried out 20 times. Follow‐up gastroscopy examinations were performed at 2‐week intervals and the cumulative recurrence rate, as well as the transition from red scar stage to white scar phase, were determined 7 months after initial healing. There were 15 Group I, 28 Group II and 23 Group III ulcer scars. The proportion of ulcer relapse was 6.7% in Group I, 35.7% in Group II and 47.5% in Group III. Regarding the relationship between the transition rate from red scar to white scar and the scar classification, 66.7% of Group I, 28.6% of Group II and 17.4% of Group III ulcer scars progressed to the white scar stage. This classification of gastric ulcer scars provides a representative index of the quality of ulcer healing, which is potentially useful for planning maintenance trea

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00441.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Factors predicting the efficacy of Interferon (IFN) therapy were studied in 137 (62 sustained responders, SR, and 75 non‐responders, NR) cases with chronic hepatitis C, in whom laparoscopy was done following IFN therapy. Univariate analysis demonstrated statistically significant differences in pre‐IFN therapy levels of alanine aminotransferase (ALT), HCV genotype and laparoscopic findings between the SR and NR. The SR rate in cases with Code numbers (Code Nos.) 201, 201.5 and 201.6 was 69.2% and that in cases with Code Nos. 317 and 317.4 was 10.7%, both being statistically significant in relation to other Code No. groups. Multivariate analysis was conducted in only 54 cases and statistically significant differences were demonstrated for laparoscopic findings (Odds ratio 0.051, p=0.037) and HCV genotype (Odds ratio 0.083, p = 0.012). These factors were considered useful for predicting the efficacy of IFN therapy. Laparoscopic changes after IFN therapy in the SR group were studied in 12 cases, in whom increments in whitish markings and the appearance of peliosis hepatis were observed in 75% and 42%, respectively, whereas the values in nine NR group cases were 11 % and 0%. These findings differed significantly between the SR and NR groups (both, p<0.05) and were thought to be characteristic of

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00442.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We report a case of pneumatosis cystoides coii associated with Sjogren's syndrome. This 53‐year‐old woman initially developed constipation and had bloody stools while she was taking prednisolone 5 mg daily for Sjogren's syndrome. Plain abdominal X‐ray revealed a gaseous pattern that resembled a bunch of grapes in the left abdomen. Endoscopic examination of the large intestine revealed numerous hemispheric cystic protrusions in the sigmoid colon and at the splenic flexure of the colon. Pneumatosis cystoides coli was thus diagnosed. Treatment included oxygen inhalation, 5 L/min for 5 hours/day. The X‐ray image indicating the collection of gas cleared 17 days after starting treatment. This disorder may merit consideration in the differential diagnosis of intestinal disorders in patients with collagen

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00443.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:A 64‐year old woman visited our hospital with a chief complaint of diarrhea of nearly one year's duration. One month before seeking medical treatment at our hospital, she noticed dysgeusia, hyperpigmentation of the skin, and nail shrinkage and loss without hypoalbuminemia. Endoscopic examination demonstrated numerous sessile and semipedunculated polyps in the stomach and colon. Histological examination of biopsy specimens showed epithelial hyperplasia with cystic dilation, interstitial edema and infiltration of inflammatory cells. Based on these characteristic clinical and pathological features, a diagnosis of Cronkhite‐Canada syndrome was made. As her symptoms gradually improved, she was placed under observation without specific treatment. The initial magnifying colonoscopy revealed enlargement of epithelial glands and cryptal dilation in both the protruding lesions and the intervening mucosa. On follow‐up magnifying colonoscopic examination, small islets of abnormal glandular tissue persisted for 1.5 years but did eventually disappear. Magnifying colonoscopy may be useful for observation of the healing process in patients with Cronkhite‐Canada s

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00444.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:A 48‐year old man was admitted to our hospital for rectal prolapse and anal bleeding. A diagnosis of type III complete rectal prolapse with two carcinomatous lesions had been made, based on examinations at his hospitalization. However, he refused abdominoperineal resection with colostomy, despite the probability of death due to carcinoma. Therefore, per anal local excision of the lesions was the method of first choice, as the patient hoped to maintain fecal continence for as long as possible. At the second operation, the rectum was fully mobilized with great care, so as to avoid injuring the testicular vessels, ureter and seminal vesicle, under laparoscopic control. The mobilized rectum was wrapped in a sheet of Teflon mesh which was fixed to the presacral fascia, and the rectum was fixed to the mesh by suturing. The front side of the rectum was not sutured to the Teflon mesh, with the aim of preventing subsequent stricture. There were no perioperative complications and the postoperative course was uneventful. Laparoscopic rectopexy for rectal prolapse is thought to be effective and worthy of trial in special situations such as that of the patient described herei

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00445.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:A 36‐year‐old man was admitted to our hospital with complaints of right lower abdominal pain and fever. Radiological and endoscopic examination revealed a polypoid lesion composed of several nodules in the orifice of the appendix in addition to irregular ulcers among the nodules. Macroscopic examination of the ileocolectomized specimen also revealed a polypoid lesion in the orifice of the appendix and a thickened appendiceal wall. The resected appendix and the polypoid lesion in the cecum exhibited Crohn's disease as characterized by transmural inflammation with non‐caseating epithelioid granulomas and fissuring ulcers. This patient was diagnosed as a rare case of Crohn's disease confined to the appendix manifesting as a polypoid lesion in the orifice of the app

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00446.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY