摘要:

AIM:This study was designed to analyze the functional and clinical outcomes of straight coloanal anastomosis compared with colonic J‐pouch performed after low anterior resection.MATERIALS AND METHODS:Between September 1989 and June 1996, all patients who underwent low anterior resection with anastomosis less than 4 cm from the dentate line were classified into two groups based on the restoration of intestinal continuity: “straight” coloanal anastomosis (n=39) or colonic J‐pouch (n=44). Both groups were assessed according to the level of anastomosis, anastomotic complications (stricture, leak, pelvic abscess), age, and gender. For comparison of functional outcome, daily bowel movements, tenesmus, urgency, incontinence score (range, 0‐20), and anorectal manometric findings were evaluated preoperatively and at six months, and one and two years after surgery.RESULTS:There were no significant differences between the groups relative to age: (coloanal anastomosis, 66.3±10.1 (range, 46‐86),vs.colonic J‐pouch, 64.9±13.2 (range, 39‐88) years); gender (females): (coloanal anastomosis, 46.2 percentvs.colonic J‐pouch; 38.6 percent); diagnosis: (rectal carcinoma: coloanal anastomosis, 84.6 percent,vs.colonic J‐pouch, 77.3 percent); preoperative incontinence score (coloanal anastomosis, 1.5±4.6,vs.colonic J‐pouch, 1.1±4); bowel movements: (coloanal anastomosis, 2.1±2.3,vs.colonic J‐pouch, 2.1±1.9/day); level of anastomosis: (coloanal anastomosis, 1.8±1.3,vs.colonic J‐pouch, 1.5±1.3 cm from the dentate line); history of perioperative radiation therapy: (coloanal anastomosis, 15.4 percent,vs.colonic J‐pouch, 20.5 percent); or manometric findings. There was also no significant difference in postoperative mortality: (coloanal anastomosis, 5.1 percent,vs.colonic J‐pouch, 2.3 percent); or anastomotic complications: (coloanal anastomosis, 7/39 (17.9 percent),vs.colonic J‐pouch, 2/44 (4.5 percent)P=0.08); strictures: (10.3vs.0 percent); leaks: (5.1vs.2.3 percent); bleeding: (2.6vs.0 percent); rectovaginal fistula: (0vs.2.3 percent). Also, in the colonic J‐pouch group, two patients developed pouchitis, and one patient experienced difficult evacuation one year after surgery. There was a statistically significant better function judged by less frequent bowel movements (4±2vs.2.4±1.3/day;P<0.005) and urgency (36.7vs.7.7 percent;P<0.05), incontinence score (2.2±3.7vs.0.8±1.6;P<0.05) up to one year after surgery. At two years, the coloanal anastomosis group did not show statistical improvement in functional results compared with one year postoperatively. Rectal compliance in manometric findings was significantly increased in the coloanal anastomosis group at one year after surgery (12.4±12.6vs.4.2±1.5 ml/mmHg;P<0.05). However, these differences were less profound after two years.CONCLUSION:The functional superiority of the colonic J‐pouch was greatest at one year after surgery. By two years, adaptation of the “straight” coloanal anastomosis yielded similar functional results. However, the almost fourfold reduction in anastomotic complications in the colonic J‐pouch group reveals a second potential advantage of this technique.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:This study was designed to characterize the mechanisms regulating the expression of the human carcinoembryonic antigen promoter (pCEA), in terms of tissue‐specific targeting for gene therapy. The promoter was subcloned to a luciferase reporter gene (pCEA/Luc) in our laboratory and compared with a virally controlled luciferase vector (pSV40/Luc).METHODS:Four human cancer cell lines (HeLa, SW480, Caco2, and SW1116) were transfected with either pCEA/Luc or pSV40/Luc. Cells were treated with interferon‐gamma and assayed at 72 hours after treatment. Carcinoembryonic antigen level was measured by enzyme immunoassay. Luciferase expression was measured at 48 hours and one week after transfection by luminometry.RESULTS:Luciferase activity after transfection with pCEA/Luc was higher in CEA‐positive cells than in CEA‐negative cells (P<0.0001). pCEA/Luc demonstrated higher activity than pSV40/Luc in CEA‐positive cells (P<0.0001), but not in CEA‐negative cells. In Caco2 cells, which before confluence are CEA‐negative, luciferase expression increased on reaching confluence (P<0.0001). Well to moderately differentiated cells responded to the interferon‐gamma treatment, but the increase in CEA secretion did not correspond to an increase in pCEA/Luc expression.CONCLUSIONS:The expression of pCEA correlates well with the CEA production by the specific cell line offering a potential tissue‐specific targeting strategy for colon cancer gene therapy. Furthermore, the tissue‐specific CEA promoter has a higher and more persistent activity in CEA‐positive human cancer cells than a viral promoter. The lack of response to interferon‐gamma treatment suggests a different mechanism of action for interferon‐gamma other than directly interacting with the promoter.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine the value of DCC (deleted in colorectal cancer) protein for predicting metachronous distant metastases after curative surgery for rectal cancer. The DCC protein—for which a gene has been located on chromosome 18q—has recently been reported to have a prognostic value in colorectal cancer. This finding might have implications for treatment of International Union Against Cancer Stage II rectal carcinoma, in which distant metastases will develop in 14 percent of patients despite optimal surgery.METHODS:Paraffin‐embedded tissues from 85 patients who developed distant metastases, but no local recurrence, after curative surgery for rectal cancer were matched with 85 samples from patients who remained disease‐free. Matching criteria were tumor stage, age, gender, and date of surgery. Expression of DCC protein was assessed using immunohistochemistry. End points of follow‐up were recurrence of disease and death. Mean follow‐up was 9.6 years. No patient received either local or systemic adjuvant therapy.RESULTS:The DCC protein was found to be expressed in 64.9 percent of tumor samples. Nonexpression of DCC protein had an negative influence on survival (P=0.03). For all tumor stages together, sensitivity of the test for subsequent occurrence of distant metastases was 42 percent and specificity was 71 percent. In Stage II cancers, the positive predictive value was 19 percent, and the negative predictive value was 88 percent.CONCLUSIONS:Our results confirm that DCC protein is a useful prognostic marker in patients with rectal carcinomas, but the positive predictive value of DCC protein for occurrence of metachronous metastases does not appear to be sufficient to justify adjuvant therapeutic measures in Stage II rectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The accuracy of diagnosis of metastatic lymph nodes for rectal carcinoma has not improved. A low echoic lesion more than 5 mm in size detected by endorectal ultrasonography is preoperatively assessed as a metastatic lymph node. What does a low echoic lesion more than 5 mm in size correspond to histologically?METHODS:Forty‐seven patients with lower rectal carcinoma (Term I, 1986‐1990) and 48 patients with lower rectal carcinoma (Term II, 1991‐1995) undergoing endorectal ultrasonography were reviewed. Surgically resected rectal specimens from 40 patients with rectal carcinoma underwent ultrasonography. Low echoic lesions more than 5 mm in size were taken from resected specimens and were stained with hematoxylin, followed by histologic examination.RESULTS:The accuracy of diagnosis of metastatic lymph nodes of Term II was not higher than that of Term I. Twenty‐five low echoic lesions were detected by ultrasonography using 40 resected specimens. Seventeen of these 25 lesions (68 percent) were histologically confirmed to be metastatic lymph nodes. One of 25 (4 percent) was found to be lymphadenitis with no metastasis. Among the 25 lesions, 5 (20 percent) were histologically confirmed to be tumor deposits, 2 (8 percent) fatty tissue, and 22 (88 percent) carcinoma.CONCLUSIONS:Low echoic lesions were histologically confirmed to be tumor deposits (20 percent) and metastatic lymph nodes (68 percent). Although these data show deficiencies and limitations of the accuracy of endorectal ultrasonography, they compare favorably with other series, and no other current technology can show similar accuracy.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Multiple primary cancers are a feature of hereditary nonpolyposis colorectal cancer in which defects in DNA repair mechanisms result in accumulation of replication errors within tumor DNA. We assessed replication error incidence in multiple primary cancer patients who may have similar genetic defects.METHODS:DNA was obtained from 69 patients from the Yorkshire region who had developed colorectal cancer and one other primary tumor from the hereditary nonpolyposis colorectal cancer tumor spectrum (28 colorectal, 12 stomach, 15 ovary, and 14 uterus). DNA was also obtained from 86 sporadic, single primary cancer patients attending a colorectal cancer clinic. Replication error status was assessed at five microsatellite loci using fluorescent polymerase chain reaction and computer‐assisted analysis.RESULTS:The replication error phenotype was observed in 7 of 86 (8 percent) of the sporadic single primary patients. This compared with 23 of 69 (33 percent) of the multiple primary group (P<0.001). Replication error was also observed more frequently in each subgroup. Even excluding patients from families meeting the Amsterdam criteria (likely to be hereditary nonpolyposis colorectal cancer and have the replication error phenotype), this increased frequency remained in both the multiple primary group (P<0.005) and multiple colorectal and colorectal/uterine subgroups (P<0.001).CONCLUSIONS:Results suggest that genetic instability plays an important role in development of multiple primary cancers, particularly from certain cancer subsets. Testing for replication errors may be an appropriate way of identifying individuals at risk of multiple primary cancers.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:We studied serum ELAM‐1 levels in colon cancer patients.METHODS AND RESULTS:Serum ELAM‐1 levels were significantly higher in 52 patients with colon cancer (mean ± standard deviation, 69.3±28.6 U/ml) compared with 32 healthy volunteers (36.5±11.9 U/ml;P<0.001). The mean serum ELAM‐1 level in patients with metastatic tumors was significantly greater than that of patients with nonmetastatic tumors. Sensitivity and specificity of serum ELAM‐1 elevation in detecting metastasis was 75 and 87.5 percent, respectively. Those of carcinoembryonic antigen and carbohydrate antigen 19‐9 elevations were 71.4 and 62.5 percent and 35.7 and 91.7 percent, respectively. Twenty‐five (89.3 percent) of 28 metastatic tumors showed either serum ELAM‐1 or carcinoembryonic antigen elevation. There were weak but significant correlations found between serum ELAM‐1 and carcinoembryonic antigen or carbohydrate antigen 19‐9 levels. Moreover, serum ELAM‐1 increased before detecting the recurrency by imaging in five of seven recurrent colon cancer patients.CONCLUSION:These findings suggest that serum ELAM‐1 could be a useful tumor marker for colon cancer, especially in synchronous and metaclonous metastasis.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to demonstrate the advantages of rhombic excision and Limberg flap closure in the treatment of pilonidal sinus disease.METHODS:We treated 24 patients who had chronic pilonidal sinus disease with rhomboid excision and Limberg flap closure.RESULTS:All patients were followed up for a period of 27 months. Mean hospital stay was 4.1 days, and mean time until return to work was 17.5 days. There was no surgical wound infection. Complication rate was 12.5 percent. During the follow‐up period, no recurrence was found.CONCLUSION:Because other treatment methods carry a significant failure rate, this technique is an effective alternative in the treatment of pilonidal sinus disease.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Constipation is a common problem in patients with spinal cord injury. The aim of this study is to analyze the role of pelvic floor dysfunction in the development of constipation.METHODS:Twenty‐five patients with clinically complete supraconal spinal cord injury were studied by means of colonic transit time, anal manometry, electrophysiologic testing, and sensory‐evoked potentials.RESULTS:Sixteen patients had prolonged total and segmental colonic transit times (Group C), and nine patients had normal colonic transit times (Group NC). Basal pressure and anal pressure during coughing, Valsalva's maneuver, and rectal distention were diminished in all patients, but no differences were observed between Group C and Group NC. Rectal sensation was preserved in eight patients, but this was not related to the absence of constipation. In seven of these eight patients, somatosensory‐evoked potentials could be recorded, which indicated an incomplete cord lesion. Synergic relaxation of the pelvic floor during straining was never observed; dyssynergia was seen in ten (7 in Group C and 3 in Group NC;P= not significant) patients. Associated peripheral nerve damage was present in 40 percent of patients but did not predispose these patients to constipation.CONCLUSIONS:Loss of rectal sensation, dyssynergic pelvic floor contraction during straining, associated peripheral nerve damage, and insufficient rise of intra‐abdominal pressure could not be held responsible for constipation as a result of spinal cord injury. A prolongation of the colonic transit time is the most important mechanism, and therapy should be directed toward it.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

&NA;Successful repair of rectovaginal fistula in patients with Crohn's disease has been reported when these patients have a normal appearing rectum. We report the performance of stricturectomy in conjunction with circumferential rectal sleeve advancement for patients who have a rectovaginal fistula arising from an anorectal stricture secondary to Crohn's disease. This technique provides for repair of rectovaginal fistula and correction of the anal stricture and maintains continence.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The aim of the present study is to demonstrate further reconstruction of a double‐gracilis anorectal neosphincter that had been destroyed because of a severe postoperative perineal infection, with necrosis of the distal part of the muscles.METHOD:Each residual gracilis muscle was split longitudinally into two branches, which surrounded the neorectum, one posteriorly and the other one anteriorly, so as to perform a perineorectal double sling.RESULT:Owing to a poor functional result, continence was achieved only by the support of an implantable pulse generator.CONCLUSION:This technique seemed to permit the optimum use of the contractile potential of the residual gracilis muscles, which did not show evidence of defunction‐related or ischemia‐related fibrosis.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID