ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

INTRODUCTION:A recent hamster model study suggests that the abdominal wall wound implantation rate increases following laparoscopic colon cancer surgery compared with the traditional open technique. However, results of that study were confounded by several factors, including a midline incision in the laparoscopy group, an unclear definition of wound implantation, significant age variations in study subjects, and cell line use with low viability. The aim of this study was to compare the abdominal incision implantation rates following a pneumoperitoneum‐laparoscopic‐type procedure with a standard open incision using a syngeneic host/colon cancer rat model.METHODS:Viable DHD/K12 rat colon carcinoma cells (2 × 105cells/rat) were injected intraperitoneallyvia18G angiocath into anesthetized, immunocompetent BD‐IX rats (syngeneic host rats). Rats were then randomly divided into open incision and laparoscopy groups. At three weeks post‐operatively, tumor growth at the injection, incision, and port sites was measured.RESULTS:Following standard midline incision, 50 percent of rats (26/50 rats) developed wound implantations, whereas only 25 percent of rats (14/57 rats) developed at least one trocar site wound implantation after laparoscopy with pneumoperitoneum. Fourteen percent of trocar sites (16/114 port sites) developed wound implantations. No tumor growth was noted on the peritoneal surfaces other than in the incisional sites.CONCLUSION:Laparoscopic‐type procedure with pneumoperitoneum did not increase wound implantation in a syngeneic host/colon carcinoma rat model compared with the standard open incision technique.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:This study was designed to evaluate the anatomic and functional consequences of lateral internal sphincterotomy in patients who developed anal incontinence and in matched controls.METHODS:The study includes 13 patients with anal incontinence after lateral internal sphincterotomy and 13 controls who underwent the same operation and were continent and satisfied with the results of the procedure. Patients underwent clinical evaluation, anorectal manometry, pudendal nerve terminal motor latency testing, and endoanal ultrasonography.RESULTS:Sphincterotomies were longer in incontinent patients (75vs.57 percent), but the resting pressure and length of the high‐pressure zone were not different between groups. Surprisingly, maximum voluntary contraction was higher in incontinent patients than in continent controls (136vs.100 mmHg). Rectal sensation and pudendal nerve terminal motor latency were similar in both groups. The defect in the internal sphincter was wider in incontinent patients than in continent controls (17.3vs.14.4 mm), but these differences were not statistically significant. The thickness of the internal sphincter measured by endoanal ultrasound was identical in both groups, but the external sphincter was thinner in incontinent patients both at the site of the sphincterotomy (6.8vs.8.1 mm) and in the posterior midline (7.1vs.8.6 mm).CONCLUSIONS:Anal incontinence after lateral internal sphincterotomy is directly related to the length of the sphincterotomy. Whether secondary to preoperative sphincter abnormality or the result of lateral internal sphincterotomy, the external sphincter is thinner in incontinent patients than in continent controls.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:This clinical case review aimed to identify phenotypic variations in colorectal and extracolonic cancer expression between hereditary nonpolyposis colorectal cancer (HNPCC) families with MLH1 and MSH2 germline mutations and the general population.METHODS:Colorectal cancer onset and site distribution were compared among 67 members of MLH1 kindreds, 45 members of MSH2 kindreds, and 1,189 patients from the general population. Synchronous and metachronous cancer rates, tumor stage, extracolonic cancer incidence, and survival were also compared.RESULTS:Mean ages of colorectal cancer onset were 44, 46, and 69 years for MLH1, MSH2, and the general population, respectively (P<0.001). More proximal and fewer distal colon cancers were noted in HNPCC than the general population (P<0.001,P=0.04). Site distribution showed disparity of rectal cancers (8 percent MLH1vs.28 percent MSH2;P=0.01) based on genotypes. Overall, synchronous colorectal cancer rates were 7.4, 6.7, and 2.4 percent for MLH1, MSH2, and the general population, respectively (P=0.016). Annual metachronous colorectal cancer rates were 2.1, 1.7, and 0.33 percent for MLH1, MSH2, and the general population, respectively (P=0.041). Colorectal cancer stage presentation was lower in HNPCC than the general population (P=0.0028). Extracolonic cancers were noted in 33 percent of MSH2 patients, compared with 12 percent of MLH1 patients and 7.3 percent of the general population with colorectal cancers (P<0.001). Combined MLH1 and MSH2 ten‐year survival was 68.7 percent compared with 47.8 percent for the general population (P=0.009 stage stratified, hazard ratio 0.57).CONCLUSION:The presence of rectal cancer should not preclude the diagnosis of HNPCC, because the incidence of rectal cancer in MSH2 was comparable with that in the general population. Phenotypic variations, including the preponderance of extracolonic cancers in MSH2 patients, did not result in survival differences between genotypic subgroups. These phenotypic features of HNPCC genotypes may have clinical significance in the design of specific screening, surveillance, and follow‐up for affected individuals.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The present study was designed to determine the frequency of germline mutations in the hMLH1 and hMSH2 genes in 31 families suspected of having hereditary nonpolyposis colorectal cancer who do not fulfill the criteria of the International Collaborative Group on Hereditary Nonpolyposis Colorectal Cancer but in whom a genetic basis for colon cancer is strongly suspected and 45 patients with sporadic early‐onset colorectal cancer who developed colorectal cancer before the age of 40 years without any family history of colorectal cancer.METHODS:Genomic DNAs were prepared from peripheral blood samples of patients who were tested. All coding exons and exon‐intron borders of these two genes were screened, first with the polymerase chain reaction‐single‐strand conformation polymorphism method, followed by sequencing of the DNA fragments displaying an abnormal single‐strand conformation polymorphism pattern.RESULTS:In 31 families with suspected hereditary nonpolyposis colorectal cancer, we found six different germline mutations in seven unrelated families, including one missense mutation and three frame‐shift mutations in the hMLH1 gene and one missense mutation and one frame‐shift mutation in the hMSH2 gene. Totally, frequency of mutation was 23 percent, 16 percent and 7 percent in the hMLH1 and hMSH2, respectively. Only one missense mutation of the hMSH2 gene was identified in 45 patients (2 percent) with sporadic early‐onset colorectal cancer. The mutation detection rate in families with suspected hereditary nonpolyposis colorectal cancer was significantly higher than that of patients with sporadic early‐onset colorectal cancer (P<0.05).CONCLUSION:Our definition of suspected hereditary nonpolyposis colorectal cancer is useful in the diagnosis of hereditary nonpolyposis colorectal cancer and for identifying those families who need genetic presymptomatic diagnosis. Our results indicate that it may be important to perform DNA testing in families suspected of having hereditary nonpolyposis colorectal cancer. On the other hand, we only detected a low mutation rate (2 percent) in 45 patients with sporadic early‐onset colorectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:This study contained herein assessed long‐term results, toxicity, and prognostic variables following combined modality therapy of patients with International Union Against Cancer Classification T1‐4, N0‐3, M0 squamous‐cell carcinoma of the anal canal.PATIENTS AND METHODS:Between 1985 and 1996, 62 patients completed treatment with combined modality therapy. A median total dose of 50 Gy was given to the primary, perirectal, presacral, and inguinal nodes followed by a local boost in selected cases. 5‐Fluorouracil was scheduled as a continuous infusion of 1,000 mg/m2per 24 hours on days 1 to 5 and 29 to 33 and mitomycin C as a bolus of 10 mg/m2on days 1 and 29. Routinely processed paraffin‐embedded sections were stained using monoclonal antibodies for detection of proliferating cell nuclear antigen and MIB1 (Ki‐67) antigen to determine the labeling index. In addition, DNA ploidy was assessed after Feulgen staining.RESULTS:Actuarial cancer‐related survival, no evidence of disease survival, and colostomy‐free survival rates at five years were 81, 76, and 86 percent, respectively. In univariate analysis, T category (T1/2 vs. T3/4) was predictive for no evidence of disease survival (87vs.59 percent;P=0.03) and colostomy‐free survival (94vs.73 percent;P=0.05). N category (N0vs.N1‐3) influenced actuarial cancer‐related survival (85vs.58 percent;P=0.002) and no evidence of disease survival (80vs.53 percent;P=0.02). A higher proliferative potential as measured by the MIB1 labeling index was associated with a better colostomy‐free survival (90vs.50 percent;P=0.04). In multivariate analysis, actuarial cancer‐related survival was only influenced by the N category (P=0.03) and no evidence of disease survival by N category (P=0.03) and mitomycin C dose (P=0.04). Salvage abdominoperineal resection achieved long‐term control in only four of seven patients with local failures.CONCLUSION:Treatment with a combination of radiotherapy and chemotherapy is safe and effective for patients with anal canal carcinoma. Abdominoperineal resection is indicated as a salvage procedure in nonresponding and recurrent lesions and may be of benefit in a small subgroup of patients with poor prognostic factors.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The aim of the study contained herein was to investigate the association between blood transfusion and long‐term outcome for patients treated for colorectal cancer, controlling for the effect of other prognostic factors. We also wanted to study whether blood storage time influenced the prognosis.METHODS:Cox's proportional hazards regression analysis was used to analyze data from 336 patients who survived resection with curative intent. Median follow‐up was 5.8 (2‐16.8) years or until death.RESULTS:Local recurrences and distant metastases were significantly more frequent when more than two units of blood had been transfused. In the multivariate Cox's analysis, with backward elimination of nonsignificant factors at the 10 percent level, the following risk factors were significantly related to death by colorectal cancer: tumor stage (T stage and N stage), perforation of tumor, age, and the need for a blood transfusion. Transfusions of more than two units of blood were independently and significantly associated with death from colorectal cancer (relative hazard, 2.7; 95 percent confidence intervals, 1.4‐5.2). Time of blood storage had no effect on the prognoses. In patients dying from diseases unrelated to colorectal cancer, age and American Society of Anesthesiologists group were significantly related to death, whereas blood transfusion was not.CONCLUSION:We found an independent and significant association between perioperative blood transfusion and poor prognosis in colorectal cancer patients. Blood storage time was not a prognostic factor.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

INTRODUCTION:Despite development of many chemotherapeutic regimens, colorectal cancer continues to have a high mortality. One of the major new potential therapies is interleukin‐12, a heterodimeric cytokine produced by antigen presenting cells.In vitroandin vivostudies have demonstrated the role of interleukin‐12 in stimulating a cell‐mediated anti‐tumor response against a number of colon adenocarcinoma tumor models. However, it is unknown whether patients with colorectal cancer have impaired interleukin‐12 production. A study was performed to investigate production of interleukin‐12 preoperatively and the relationship between these levels and disease stage at surgery.METHODS:Preoperative peripheral blood mononuclear cells from colorectal cancer patients and agematched controls were stimulated byStaphylococcus aureusCowan's Strain 1 (0.0075 percent wt/vol)in vitrofor 24 hours. Expression of interleukin‐12 was then assessed by enzyme‐linked immunosorbent assay. A single pathologist assessed the tumors for stage according to TNM and Dukes classifications.RESULTS:Twenty‐eight patients with colorectal cancer and 14 controls were recruited for the study. Interleukin‐12 production was significantly impaired in patients with colorectal cancer compared with controls (P=0.014), especially those with advanced disease: Dukes C,P=0.001 and T4,P<0.05.CONCLUSION:Interleukin‐12 production is impaired in patients with colorectal cancer, especially those with advanced disease, suggesting a defective Th1‐mediated anti‐tumor response. These patients may well benefit from exogenous interleukin‐12 treatment.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Antibiotics suppress normal gut flora, allowing overgrowth of acquired or nativeClostridium difficile, with release of toxins that cause mucosal inflammation. Oral metronidazole is used to treat antibiotic‐associated colitis (pseudomembranous colitis). This study was designed to determine whether oral metronidazole, as part of preoperative bowel preparation, prevents or decreases incidence of antibiotic‐associated colitis after elective colonic and rectal procedures.METHODS:Eighty‐two patients (40 men) were prospectively, randomly assigned to receive one of two oral antibiotic regimens before colorectal surgery. All patients underwent mechanical bowel preparation with polyethylene glycol‐electrolyte lavage solution before administration of oral antibiotics. Group 1 (n=42) patients received three doses (1 g/dose) of neomycin and erythromycin. Group 2 (n=40) patients received three doses (1 g/dose) of neomycin and metronidazole. Both groups received one preoperative and three postoperative doses of intravenous cefotetan (2 g/dose). Both groups had stool samples tested forC. difficiletoxin in the preoperative and postoperative periods by enzyme‐linked immunoabsorbent assay or by tissue culture cytotoxicity. Patients with preoperative stool studies positive forC. difficilewere excluded from the study.RESULTS:Treatment groups were not different for age, gender, or surgical procedure. Mean age ±1 standard deviation was 67.6±13.6 (range, 34‐94) years in Group 1 and 62.1±13.5 (range, 35‐84) years in Group 2 (P=0.069). Mean length of hospital stay ±1 standard deviation was 9.76±4.9 (range, 4‐28) days for Group 1 and 8.05±2.6 (range, 3‐14) days for Group 2 (P=0.053). Five patients in Group 1 (neomycin and erythromycin) and one patient in Group 2 (neomycin and metronidazole) had positive stool studies forC. difficile. Relative risk of colonization withC. difficilein Group 1 was 4.76 times that in Group 2 (95 percent confidence interval, 0.581, 39). This difference was not statistically significant (P=0.202). There were no significant differences inC. difficilecolonization rates with respect to age, length of stay, or gender.CONCLUSIONS:This study suggests that there may be a clinical association between use of metronidazole preoperatively and inhibition of intestinal colonization byC. difficilein this patient population undergoing colonic and rectal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BACKGROUND:Experimental studies on healing of colonic anastomosis have been thoroughly investigated. However, clinical parameters of the healing process of anastomosis in the inflamed colon has not yet been reported.METHODS:In the present study, healing of anastomosis in trinitrobenzene‐sulfonic acid‐induced colitis in rats was assessed by measuring the bursting pressure and bursting wall tension.RESULTS:On postoperative day 4, bursting pressure and bursting wall tension were significantly lower (P<0.001) in rats with colitis with or without anastomosis and normal colon with anastomosis, compared with normal colon without anastomosis. On postoperative day 7, bursting pressure and bursting wall tension of normal colon with anastomosis approached that of normal colon without anastomosis. However, bursting pressure and bursting wall tension of rats with colitis with or without anastomosis remained significantly lower (P<0.001) than the latter. Furthermore, unlike rats without colitis in which perforation occurred mostly at the anastomotic line, the bursting site in colitic rats was predominantly away from the anastomotic line.CONCLUSIONS:These results suggest that in surgery for inflammatory bowel disease, it is the adjoining inflamed bowel wall that is vulnerable to be perforated in response to increasing intraluminal pressure rather than the anastomosis that is braced by the sutures.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID