摘要:

PURPOSE:Whereas lymph node metastases in colorectal carcinoma are an important prognostic factor, the prognostic relevance of occult tumor cells in lymph nodes is not elucidated at present. Therefore, our study intended to assess the rate of patients with occult tumor cells in histopathologically negative lymph nodes. Furthermore, we tried to evaluate an eventual influence of these occult tumor cells on patients' prognoses.METHODS:For examination, we used paraffin blocks of lymph nodes, tumor‐negative by conventional histopathology, from 49 patients with colorectal carcinoma (Stage I‐III) after a curative (RO) tumor resection in 1987. After preparation of tissue blocks using the serial sectioning technique, the specimens were stained with the alkaline phosphatase, antialkaline phosphatase method and two monoclonal antibodies (AE1/AE3 and Ber‐EP4).RESULTS:In 13 of 49 patients (26.5 percent), we disclosed tumor cells, mostly located in subcapsular sinuses as single cells or in groups. There was a good correlation between the detection rate and N category, tumor stage, and grading. Moreover, 33 percent of patients in Stage I/II with occult tumor cells (NO+) developed a local relapse and/or distant metastases in contrast to 12 percent of patients without tumor cells (NO−). With a median follow‐up of 84 months, we found no difference in disease‐free survival between the tumor cell negative and positive groups in Stage I/II patients.CONCLUSION:The results show that occult tumor cells might increase the risk for development of a local tumor relapse and/or distant metastases but do not influence patients' prognoses at all.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUND:Superficial rectal tumors are said to involve regional lymph nodes rarely. This presumption must be proven beyond any doubt if less radical surgery is to be offered for such patients.PATIENTS AND METHODS:Eight hundred five cases (467 males; median age, 64 (range, 19‐97) years) of rectal cancer were reviewed.RESULTS:Lymph node positivity, number of lymph nodes involved, lymphatic vessel, and venous and perineural invasion were significantly increased with increasing depth of invasion of tumor through the bowel wall in univariate analysis. The percentage of lymph node involvement at each tumor depth was as follows: T1, 5.7 percent; T2, 19.6 percent; T3, 65.7 percent; T4, 78.8 percent. Overall lymph node involvement was 59 percent. For patients younger than 45 years of age, the percentage of lymph node involvement was 33.3, 30, 69.3, and 83.3 percent compared with 3.1, 8.4, 64.2, and 78.8 percent for patients aged 45 years or above for T1, T2, T3, and T4, respectively.CONCLUSION:Increased depths of tumor penetration beyond T1 and age less than 45 years have an excessive incidence of lymph node positivity. The finding of lymphatic vessel invasion on biopsy is highly indicative of lymph node metastasis.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:The aim of the present study was to evaluate how distention of the rectum with contrast medium at defecoperitoneography affected pelvic anatomy,i.e.,position, form, and size, of organs and pouch of Douglas.PATIENTS AND METHODS:Twenty‐six female patients with a peritoneocele at defecoperitoneography were selected for the present study. Radiographs taken at the start, before, and after filling the rectum with contrast medium were compared.RESULTS:There was an obvious change in the position of the organs in the pelvis when the rectum was distended with contrast medium. The peritoneocele disappeared completely in 19 of the patients and was reduced in size in the remaining 7 patients, and the enterocele disappeared completely in 13 patients. The small bowel and vaginal portion of the uterus moved cranially.CONCLUSIONS:A distended rectum may conceal existing pathology, such as peritoneocele and enterocele, at defecoperitoneography. Defecoperitoneography should, therefore, include a radiograph before the rectum is filled. This radiograph shows the habitual anatomy of the patient in the sitting position and may demonstrate pathologic findings.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUND:Many patients who require endoscopic treatments such as biopsy and polypectomy are given antiplatelet agents reluctantly. We have studied the effects of aspirin on colonic mucosal hemostasis.METHODS AND PATIENTS:We developed a new endoscopic device to make a standard incision (7‐mm length) on the colonic mucosa to study colon bleeding time. We measured the colon bleeding time of normal colonic mucosa in 47 cases. The colon bleeding time and skin bleeding time (Simplate method) were measured before and one hour after aspirin ingestion (990 mg) in ten healthy subjects.RESULTS:The bleeding time of normal colonic mucosa was 156±71 (mean±standard deviation) seconds. Significant prolongation was noted in both skin bleeding time (357±192vs.477±183 seconds;P<0.05) and colon bleeding time (155±47vs.244±169 seconds;P<0.05) after aspirin ingestion.CONCLUSIONS:Bleeding time was measured safely under direct colonoscopic visualization. Aspirin prolonged the colon bleeding time. Therefore, endoscopists should be aware of a risk of abnormal bleeding after endoscopic biopsy and polypectomy in patients with aspirin use. Two days were necessary for colon bleeding time to become normalized in patients with aspirin use.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:The study contained herein was aimed at finding some possible pathologic factors that have significance for the prediction of liver metastasis in colorectal cancer.METHOD:Resected specimens of colorectal cancer from 23 patients with liver metastasis and 30 patients without liver metastasis were subjected to pathologic study, including microscopic characteristics and proliferating cell nuclear antigen immunohistochemistry assay.RESULTS:Strongly positive expression of proliferating cell nuclear antigen was present in 65.21 percent (15/23) of the liver metastasis group, whereas it was found in only 20 percent (6/30) of the group without liver metastasis (P<0.005). Deeper invasion to the muscularis propria or serosa and less infiltration of lymphocytes surrounding the tumor were more frequently found in the liver metastasis group than in the other group (P<0.025).CONCLUSION:Extent of proliferating cell nuclear antigen expression, depth of invasion, and reaction of lymphocyte infiltration of the primary tumor could have predictive significance of colorectal cancer in liver metastasis.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE AND METHODS:We report herein a case of a patient with rectal carcinoma in whom a new anus was constructed following an abdominoperineal resection of the anorectum. This is the first reported case in which reconstruction of the anal sphincter was performed using the lower part of the gluteus maximus muscle with a pudendal nerve anastomosis. The pudendal nerve anastomosis maneuver was designed to achieve proper innervation and function of the external anal sphincter. This newly reconstructed sphincter was physiologically evaluated after surgery.RESULTS:The patient's defunctioning colostomy was not closed following his initial surgery because part of the transposed muscle was devitalized by infection following blood flow damage. However, purposeful contraction of the new sphincter was easy to achieve without special training. The patient's rectal sensation for the desire to defecate was satisfactory. Electromyographic studies demonstrated that the newly reconstructed anal sphincter had characteristics of the original external anal sphincter.CONCLUSIONS:This method is a promising procedure for reconstructing the anal sphincter.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Although extended surgery has been established as an effective method for the treatment of advanced carcinoma of the colon, there are no reports in the literature ofen blocresection of the tumor together with the iliac bone. We report herein a 46‐year‐old woman with a second local recurrence after right colectomy, with the main objective of showing the possibility of indicating this type of surgery in selected cases.METHODS:In view of the lack of therapeutic options for the case and the absence of metastases, extended curative surgery for recurrent carcinoma of the colon was performed, withen blocresection of the right iliac bone and of the crural nerve (Type I internal hemipelvectomy).RESULTS:After a 27‐month follow‐up, the patient is asymptomatic, with no signs of local recurrence or metastases.CONCLUSIONS:In selected cases, recurrent carcinoma of the colon can be treated by extended and aggressive surgery, including bone resection, to obtain an appropriate safety margins.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Colonoscopy with biopsy(ies) is performed in patients with colorectal cancer for diagnosis and screening of synchronous lesions. There is some fear of spreading the disease related to implantation of tumor cells at sites of mucosal damage or to hematogenous or lymphatic spread as a result of tumor manipulation.METHODS:A total colonoscopy including biopsies, performed in a patient because of anal blood loss and tenesmus, revealed a circular, polypoid, ulcerated mass from 1.5 to 12 cm above the anal verge. After preoperative radiotherapy, the patient was subjected to surgical intervention.RESULTS:Histopathology revealed a poorly differentiated rectum adenocarcinoma, staged pT4N1Mx. At approximately 12 cm proximally from the tumor, a biopsy taken through a minute irregularity of the mucosa revealed some granulation tissue with adjacent normal colon mucosa. The basis of this granulation tissue, corresponding to submucosa, contained poorly differentiated tumor elements.CONCLUSIONS:This tiny lesion might have been caused by implantation of exfoliated cancer cells in a biopsy site. It may not be without risk to create excessive biopsy lesions in the presence of a manifestly malignant tumor because of the possibility of tumor cell implantation.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Dynamic graciloplasty is one of the methods now used to re‐establish anal function. Among complications, pain in the local tissue and skin irritation have been reported, both caused by lead wires. By passing the leads posterior to the adductor longus muscle, the wires do not irritate the local skin and are fixed well without sutures. We performed this procedure in three patients, with good results. The technique is easy, and complications involving the lead wires were minimized.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID