摘要:

INTRODUCTION:Patients with ulcerative colitis and primary sclerosing cholangitis have an increased risk of developing carcinoma both in the bile ducts and in the colon.PURPOSE:To investigate whether this patient group also has an increased risk of developing atrophy and neoplasia in the ileal pouch mucosa after construction of a pelvic pouch with an ileoanal anastomosis or a continent Kock ileostomy.METHODS:Flexible video endoscopic examinations of the ileal pouch were performed in 16 patients with ulcerative colitis and primary sclerosing cholangitis and in 16 matched patients with ulcerative colitis without sclerosing cholangitis. Biopsies were sampled from different locations in the pouch for histologic assessment of mucosal atrophy and dysplasia and for flow cytometric DNA analysis assessing chromosomal aberrations.RESULTS:The patients with sclerosing cholangitis developed moderate or severe atrophy in the pouch significantly more often (P< 0.01). Persistent severe mucosal atrophy was revealed in eight patients with sclerosing cholangitis and only in two controls. One patient with sclerosing cholangitis had high‐grade dysplasia in multiple locations. Low‐grade dysplasia was assessed in three patients with sclerosing cholangitis and in two of the controls. DNA aneuploidy was displayed in three patients, all with sclerosing cholangitis and dysplasia. All patients with neoplastic transformation had a pouch with ileoanal anastomosis and a long pouch duration (> 8 years).CONCLUSION:Patients with ulcerative colitis and primary sclerosing cholangitis with an ileal reservoir are more prone to developing mucosal atrophy in the pouch and seem to have a higher risk of neoplastic transformation in the pouch mucosa than patients with ulcerative colitis without sclerosing cholangitis.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Total mesorectal excision is an alternative surgical approach for resectable rectal cancer and is associated with favorable results and a low rate of local recurrence. Despite the popularity of this technique, few data exist regarding the location and distribution of lymph nodes within the rectal mesentery. The purpose of this study was to define the distribution, size, and location of lymph nodes within the mesorectum and on the pelvic side wall.METHODS:Seven fresh cadavers at our institution's Fresh Tissue Dissection Laboratory were studied. The rectum, its mesentery, and all fatty tissue from both pelvic side walls were removed and placed in a lymph node clearing solution for 24 hours. After appropriate dissection, the distribution, size, and location of lymph nodes within the rectal mesentery and pelvic side wall tissue were documented.RESULTS:A total of 174 lymph nodes were identified (approximately 25 per patient). The majority (>80 percent) of lymph nodes were smaller than 3 mm in diameter. Fifty‐six percent of the nodes within the rectal mesentery were located in the posterior mesentery, and most were located in the upper two‐thirds of the posterior rectal mesentery.CONCLUSIONS:The majority of perirectal lymph nodes are small. There are few lymph nodes within the mesentery of the lower third of the rectum and relatively few in the right and left lateral portions of the mesorectum. We confirm that the majority of nodes are located in the proximal two‐thirds of the posterior rectal mesentery. It is possible that removal of these nodes is responsible for the superior oncologic results found with total mesorectal excision in contrast to more traditional surgical techniques.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Cyclooxygenase‐2 is an important target for nonsteroidal anti‐inflammatory drugs in suppressing colorectal tumorigenesis. To evaluate the role of cyclooxygenase‐2 in sporadic colorectal adenoma, we correlated cyclooxygenase‐2 expression in adenomas with other adenoma characteristics.METHODS:Cyclooxygenase‐2 expression was evaluated immunohistochemically in 95 endoscopically resected colorectal adenomas.RESULTS:Cyclooxygenase‐2 was expressed mainly in the cytoplasm of adenoma cells, where it was seen in 74 percent (70/95) of adenomas. Expression was related significantly to grade of dysplasia (P< 0.001) and tumor size (P= 0.028). Multivariate logistic regression analysis showed cyclooxygenase‐2 expression in adenoma cells to be independently associated with grade of dysplasia (P= 0.001).CONCLUSION:Observed associations suggest that cyclooxygenase‐2 plays an important role in progression of the adenoma‐to‐carcinoma sequence.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:The overall aim of this study was to develop a novel treatment for colorectal cancer based on the use of gene therapy. Genetic modification of T lymphocytes has been used to specifically target and kill tumor cell lines directly. To test the efficacy of this method with clinically relevant materials, this study investigated the potential of T lymphocytes derived from patients with advanced colorectal disease to target autologous primary tumor material.METHODS:T lymphocytes isolated preoperatively were modified genetically with recombinant retroviruses encoding CD3&zgr;‐based chimeric immune receptors and were tested for functional activity against freshly isolated autologous tumor cells harvested from hepatic colorectal metastases.RESULTS:Patient‐derived T cells were successfully transduced, and chimeric immune receptor expression was confirmed. Carcinoembryonic antigen expression on freshly isolated colorectal tumor cells was also demonstrated by molecular and immunohistochemical techniques. T cells expressing the anticarcinoembryonic antigen receptor were specifically activated by coculture with disaggregated or intact, diced tumor, whereas control non‐carcinoembryonic antigen‐targeted T‐cell populations failed to activate.CONCLUSIONS:These results indicate that gene‐targeted primary T lymphocytes depict specific functional activity against autologous colorectal tumor cells. This evidence indicates that chimeric immune receptor‐expressing T cells may be able to circumvent the mechanisms used by tumor cells to avoid immune cell activityin vivo. This study emphasizes the potential of this approach as a therapy for carcinoembryonic antigen‐expressing primary colorectal tumor and its metastases.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Nifedipine (administered orally or applied topically) has been effective for nonsurgical treatment of anal fissure. We compared the efficacy of nifedipinevs.glyceryl trinitrate for chemical sphincterotomy of anal fissure.METHODS:In a prospective, double‐blind trial, 52 patients suffering from chronic anal fissure were randomly and equally allocated to receive either glyceryl trinitrate or nifedipine, both applied topically to the perianal region. The end point of the study was healing within a predetermined period (6 months). Variables assessed included demographic data (age, gender), symptoms associated with the fissure, duration of treatment, percentage of healing, untoward effects of treatment, pain scores, duration of follow‐up, recurrence, and need for complementary means of treatment. Descriptive data are presented as mean ± standard deviation and quantal data as percentage. Inference analysis was performed using the Student'st‐test for the descriptive data and the chi‐squared or Fisher's exact test for nominal variables.RESULTS:No significant differences were recorded with regard to age, gender, symptoms associated with the fissure, or duration of treatment. Healing rate was higher (P< 0.04) with nifedipine (89 percent) as compared with glyceryl trinitrate (58 percent). Treatment side effects (headache, flushing) were more frequent (P< 0.01) with glyceryl trinitrate (40 percent) as compared with nifedipine (5 percent). Pain scores were significantly lower (P< 0.03) on completion of treatment in both groups (3.2 in glyceryl trinitrate and 3.4 in nifedipinevs.6.2 and 6.1, respectively), but did not differ between the two groups. Recurrence occurred in 31 percent of patients treated with glyceryl trinitrate and 42 percent of those treated with nifedipine after a mean period of 18 ± 3 weeks and 12 ± 4 weeks, respectively.CONCLUSION:Topical application of nifedipine for management of chronic anal fissure was more effective and had fewer side effects than topical glyceryl trinitrate. Recurrence was frequent with both drugs.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:This study investigated the role of the sacral nerves in the mechanism of defecation using adult mongrel dogs. The possibility of designing a colonic pacemaker as a new therapeutic device to treat defecation disturbances, such as fecal incontinence and severe constipation, is also discussed.METHODS:Colorectal motility during spontaneous defecation was monitored with force strain‐gauge transducers implanted in the proximal, distal, and sigmoid colon, rectum, and internal anal sphincter. Under general anesthesia, the sacral nerve was stimulated electrically, and the colorectal motility response was examined.RESULTS:During spontaneous defecation, three characteristic motility patterns were observed: 1) giant migrating contractions of the colon were propagated to the rectum or anus; 2) the rectum relaxed before the giant migrating contractions were propagated; and 3) the internal anal sphincter was relaxed during the propagation of the giant migrating contraction. Sacral nerve stimulation elicited the following three unique responses: 1) contractile movements were propagated from the distal colon to the rectum; 2) a relaxation response was noted in the rectum; and 3) the internal anal sphincter exhibited a relaxation response. The duration and propagation velocity of the contractile responses and the duration of relaxation responses elicited by electrical stimulation of the sacral nerve were similar to those that occurred during spontaneous defecation, but their amplitudes were smaller.CONCLUSION:The coordinated processes of the colon and anorectum during defecation were affected by the sacral nerves. This suggests that it is possible to design a colonic pacemaker to control lower colonic and rectal movements.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to compare carcinoembryonic antigen levels with detection of messenger ribonucleic acid coding for the tumor‐associated antigen L6 in patients with colorectal cancer. Not only are carcinoembryonic antigens expressed by the corresponding tumor cell, but the messenger ribonucleic acid of tumor‐associated antigens, in contrast, is produced exclusively by viable tumor cells.METHODS:L6 messenger ribonucleic acid was determined by reverse‐transcription polymerase chain reaction. Carcinoembryonic antigen was measured by the enzyme‐linked immunosorbent assay technique, with a cutoff value of 40 &mgr;g/l. Blood serum was sampled from 187 patients with colorectal cancer. Statistical significance was calculated with the McNemar chi‐squared test.RESULTS:Preoperatively, 79 percent of patients in all stages were positive for L6 messenger ribonucleic acid, whereas only 35 percent had elevated carcinoembryonic antigen titers (P< 0.001). In Dukes A tumors, 84.9 percent of patients were positive for L6 messenger ribonucleic acid, whereas carcinoembryonic antigen was elevated in only 16.9 percent of patients. Only in Dukes D tumors did the enzyme‐linked immunosorbent assay for carcinoembryonic antigen exhibit the same sensitivity as reverse‐transcription polymerase chain reaction for L6 messenger ribonucleic acid. Recurrence was detected significantly earlier by reverse‐transcription polymerase chain reaction for L6 messenger ribonucleic acid than by enzyme‐linked immunosorbent assay for carcinoembryonic antigen.CONCLUSION:L6 is more sensitive and precise than carcinoembryonic antigen in diagnosing and monitoring colorectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:We describe a rare case of an alpha‐fetoprotein‐producing carcinoma originating in the transverse colon of a 59‐year‐old Japanese male.METHODS:The patient reported an abdominal mass and weight loss. On examination, a tumor of the transverse colon and multiple masses in the liver were found. The serum alpha‐fetoprotein level was extremely high (12,873 ng/ml). The patient underwent right hemicolectomy and intraoperative biopsy of a liver mass.RESULTS:Histologically, the colon cancer was composed of three different components: a well‐differentiated tubular adenocarcinoma, a tubulopapillary carcinoma consisting of cells with clear cytoplasms, and a “hepatoid carcinoma.” The hepatoid carcinoma was composed of large polygonal cells with abundant eosinophilic or clear cytoplasms, arranged in a trabecular or solid pattern, and showing marked vascular invasion. Immunohistochemically, alpha‐fetoprotein was strongly expressed, largely in the hepatoid carcinoma and partially in the tubulopapillary carcinoma. The liver biopsy specimen showed morphologic and immunohistochemical features similar to those of the hepatoid carcinoma of the colon and was therefore diagnosed as a metastasis. The patient died of the cancer two months after surgery.CONCLUSION:Based on our experience of this patient and a review of the literature, alpha‐fetoprotein‐producing colorectal carcinomas are generally associated with a poor prognosis because of the frequent occurrence of blood‐borne metastases.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Damaged mucosal sites seem to be vulnerable to tumor cell implantation. We describe a case of exfoliated tumor cells from a sigmoid colon cancer seeding a long‐standing anal fistula. The implications of this finding are reviewed.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID