摘要:

&NA;Controversy exists regarding the role of prophylactic oophorectomy during resection for primary colorectal cancer.PURPOSE:A prospective, randomized trial was initiated to evaluate the influence of oophorectomy on recurrence and survival in patients with Dukes Stages B and C colorectal cancer.METHOD:Between November 1986 and March 1997, 155 patients were randomized to oophorectomy or no oophorectomy at laparotomy for resection of colorectal cancer.RESULTS:No incidence of gross or microscopic metastatic disease to the ovary was found among 77 patients randomized to oophorectomy, in contrast to previous reports. Preliminary crude survival curves suggested a survival benefit for oophorectomy between two and three years from surgery, but Kaplan‐Meier survival analysis indicated that this was not statistically significant and the benefit does not appear to persist at five years. Kaplan‐Meier curves of recurrence‐free survival, however, suggest a more substantial separation of the curves, with 80 percentvs.65 percent five‐year disease‐free survival for oophorectomyvs.nonoophorectomy, but further patient accrual is necessary to provide sufficient statistical power.CONCLUSIONS:Occult colorectal carcinoma metastatic to the ovaries has not been documented in this series of putative Dukes Stages B and C tumors. The possibility of a recurrence‐free survival advantage emphasizes the need to continue this preliminary work.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:To clarify the prognostic significance of the DNA content in cases of colorectal cancer, we investigated the relationship between the DNA content, as determined by the DNA ploidy or DNA index, and disease‐free survival.RESULTS:This study included 201 cases that were treated by curative surgery between 1989 and 1995 at our hospital. 68 were diploid and 133 were aneuploid. The mean DNA index of these tumors was 1.42. Recurrence occurred in 30 cases (14.9 percent). Tumor site, venous invasion, Dukes stage, DNA ploidy (diploid or aneuploid), and a DNA index (less than or greater than 1.4) correlated well with disease‐free survival. A multivariable analysis suggested the DNA index to be a stronger predictor than DNA ploidy. Patients with aneuploid tumors had shorter disease‐free survival than those with diploid tumors (P=0.011), especially in Dukes Stage C cases (P=0.0209). Patients with a DNA index greater than 1.4 also had a shorter disease‐free survival than those with a DNA index less than 1.4 (P<0.001), especially in Dukes Stage C cases (P=0.0033).CONCLUSIONS:The DNA index value (less than or greater than 1.4) seems to be a stronger predictor than DNA ploidy (diploid or aneuploid), and the combination of Dukes stage, tumor site, and a DNA index is, therefore, considered to be clinically valuable in predicting recurrence in cases of colorectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The long‐term prognosis after curative surgery for colorectal cancer was evaluated in relation to age and life expectancy as a possible basis for assessing the risk to benefit ratios in the elderly.METHODS:Data relating to 1,256 patients operated on from 1976 to 1994 were stored in a computer database prospectively from 1987. Patients were subdivided into four age groups (A=<60 years; B=60‐69; C=70‐79; D=≥80). Distribution of general contraindications to curative surgery was examined. In the 869 patients who underwent curative treatment (A=206; B=256; C=289; D=118), distribution of tumor stage and elective/emergency surgery and the operative mortality rate were evaluated. Crude and age‐corrected survival curves were calculated in 794 patients. The median crude survival of each group was related by gender and tumor stage to demographic life expectancy, assuming as “relative median survival index” the ratio between the two values.RESULTS:General contraindications to curative surgery increased significantly with age. The operative mortality rate was higher in Group D than in Groups A, B, plus C over the total series (P<0.001) and in both elective (P<0.001) and emergency surgery (P<0.05). Intergroup analysis of long‐term survival rates showed significant differences between “crude” (P=0.0057) but not age‐corrected (P=0.66) curves. The relative median survival index increased with age, up to approximately 1 in the local stages of Groups C and D.CONCLUSIONS:To evaluate long‐term results, elderly patients should be compared with unaffected, same‐age subjects. Because the risks may be very high, the surgical policy in the elderly should be carefully weighed and related to life expectancy and actual results.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

&NA;We previously showed that intestinal tissue expression of lymphocyte function associated antigen‐1 is increased in animals with graft‐versus‐host disease after small‐bowel transplantation.HYPOTHESIS:Treatment of rats with monoclonal antibody to lymphocyte function associated antigen‐1 after small‐bowel transplantation will lessen the severity of graft‐versus‐host disease.METHODS:Graft‐versus‐host disease was created in Lewis X Brown‐Norway F1rats by heterotopic vascularized small‐bowel transplantation from Lewis donors. Transplanted rats were treated with either saline or various regimens of monoclonal antibody to lymphocyte function associated antigen‐1. Clinical characteristics, weight loss, spleen index, white blood cell counts, native intestinal histology, bowel permeability, and survival were then compared between groups and appropriate sham‐operated and lymphocyte function associated antigen‐1‐treated controls.RESULTS:Lymphocyte function associated antigen‐1‐treated rats lost less weight, had larger spleen indexes, more normal white blood cell counts, more normal native intestinal histology, less alteration in bowel permeability, and longer survival than untreated small‐bowel transplantation rats.CONCLUSIONS:In this model of graft‐versushost disease after small‐bowel transplantation, monoclonal antibody to lymphocyte function associated antigen‐1 treatment decreased the severity of graft‐versus‐host disease and prolonged rat survival.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

INTRODUCTION:Guanylyl cyclase C appears to be expressed only in colorectal cancer cells in extraintestinal tissues. Thus, guanylyl cyclase C may be useful as a marker to detect colorectal cancer micrometastases not detectable by histopathology in lymph nodes of patients.METHODS:Twelve patients with colon adenocarcinoma, Dukes Stages A through C2, and one patient with a tubulovillous adenoma were included in this study. Forty‐two lymph nodes were collected from fresh surgical specimens, and each was examined by histopathology and reverse transcription followed by polymerase chain reaction using guanylyl cyclase C‐specific primers. Histopathology identified colon cancer cells in 6 of 16 lymph nodes from five Dukes Stage C patients but not in lymph nodes from the patient with a tubulovillous adenoma, the Dukes Stage A patient, or six Dukes Stage B patients. Reverse transcription followed by polymerase chain reaction using guanylyl cyclase C‐specific primers was performed on all 42 lymph nodes.RESULTS:Guanylyl cyclase C messenger RNA was not detected by reverse transcription followed by polymerase chain reaction in lymph nodes from the patient with the tubulovillous adenoma or the patient with Dukes Stage A colon carcinoma. Seven lymph nodes from Dukes Stage C patients revealed guanylyl cyclase C messenger RNA including six lymph nodes containing histopathologically confirmed metastases. Of significance, guanylyl cyclase C messenger RNA was detected in 6 of 21 lymph nodes from Dukes Stage B patients. Indeed, clinical staging of two patients could be upgraded from B to C using reverse transcription followed by polymerase chain reaction and guanylyl cyclase C‐specific primers.CONCLUSION:Reverse transcription followed by polymerase chain reaction using guanylyl cyclase C‐specific primers might be useful to more accurately assess micrometastases in lymph nodes of colorectal cancer patients undergoing disease staging.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:The study contained herein was undertaken to investigate fecal calprotectin excretion in a series of patients with colorectal carcinoma and to determine whether the excretion was influenced by localization or stage of the tumor. Furthermore, the effect of surgical treatment on the concentrations was studied. Fecal calprotectin was also compared with plasma concentrations of calprotectin, carcinoembryonic antigen, and C‐reactive protein.METHODS:Fecal calprotectin was measured in 119 consecutive patients admitted for treatment of colorectal carcinoma. In 116 (97.5 percent) patients, resectional surgery was performed. Plasma calprotectin was measured in 90 (76 percent) patients, carcinoembryonic antigen in 88 (74 percent) patients, and C‐reactive protein in 82 (69 percent) patients.RESULTS:Median fecal calprotectin concentration in the 119 patients was 50 (range, 2‐950) mg/l, which was significantly (P<0.0001) higher than in 125 control patients (median, 5.2 mg/l). In 23 patients studied also after resection, the excretion fell greatly. There were no significant differences in fecal calprotectin concentration among patients with different tumor stages. Elevated plasma calprotectin concentrations were found in 67 of 90 (73.3 percent) patients with colorectal carcinoma, compared with elevated fecal calprotectin in 111 of 119 (93.3 percent) patients, and there was no significant correlation between plasma and fecal calprotectin concentrations. Plasma calprotectin concentrations were significantly lower in patients with T1 or T2 tumors than in those with more advanced stages (P=0.0025).CONCLUSION:Measurement of fecal calprotectin may become a diagnostic tool in detecting colorectal carcinoma. The specificity in relation to colorectal carcinoma has not, however, been completely investigated. Both neoplastic and inflammatory conditions may be associated with elevated values; therefore, it is unlikely that calprotectin can predict specific colonic disorders.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to investigate factors that influenced differential diagnosis of dysplasia‐associated lesion or mass and coincidental adenoma in patients with ulcerative colitis.METHODS:Among 346 patients with ulcerative colitis who underwent colonoscopy between 1979 and 1995, 27 patients had macroscopic neoplastic lesions and were divided into two groups: those with dysplasia‐associated lesion or mass (16 patients) and those with adenoma (11 patients), each being categorized by the presence and absence of dysplasia in the flat mucosa adjacent to the elevated lesions, respectively.RESULTS:Thirteen of 27 patients had dysplasia‐associated lesion or mass detected by colonoscopic biopsy; 10 of these patients underwent colectomy, and all had dysplasia‐associated lesion or mass in the colectomy specimens. Two patients whose biopsy findings were adenoma had an unsuspected dysplasia‐associated lesion or mass in the operative specimens. In the remaining 12 patients, the macroscopic lesions were excised during colonoscopy because of clinical and colonoscopic evidence of adenoma. One of them was proved to have dysplasia‐associated lesion or mass, and the other 11 were confirmed as having adenoma in the polypectomy specimens. Patients with dysplasia‐associated lesion or mass were significantly younger (P<0.05), had longer duration of ulcerative colitis (P<0.01), and had more extensive disease (P<0.005) than those with adenoma. The colonoscopic appearance was plaque‐like in 13, sessile in 13, and pedunculated in 2 of the 28 lesions with dysplasia‐associated lesion or mass, whereas it was plaque‐like in only 1 and sessile or pedunculated in 15 of the 16 lesions with adenoma (P<0.001). The mean size of the lesions that were considered to be dysplasia‐associated lesions or mass and adenoma was 1.8 and 0.5 cm, respectively (P<0.0001).CONCLUSIONS:Colonoscopic biopsy for detection of dysplasia in the flat mucosa adjacent to macroscopic neoplastic lesions is an appropriate preoperative approach to distinguish dysplasia‐associated lesions or mass from adenomas in patients with ulcerative colitis. The statistically significant variables that influenced the differential diagnosis were age, duration of disease, extent, tumor size, and tumor colonoscopic appearance.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:It is still controversial whether a low selenium level and a reduced activity of the selenium‐dependent enzyme, glutathione peroxidase, in blood are associated with an increased risk and poor prognosis of cancer in humans. This study evaluates whether colorectal cancer patients have lower serum selenium and glutathione peroxidase levels than a gender‐matched and age‐matched control group and whether there is a correlation to clinical data and prognosis.METHODS:In a retrospective study, serum selenium and glutathione peroxidase activity of 106 patients with colorectal cancer were determined. Clinical data were provided by our long‐term follow‐up program for colorectal cancer patients.RESULTS:Patients with a selenium level <70 &mgr;g/l had a significantly lower mean survival time and a lower cumulative cancer‐related survival rate than patients with a selenium level >70 &mgr;g/l (P=0.0009). When considering the different tumor stages, a decline of the mean selenium level in the T4 carcinoma group was found in the analysis of variance (P<0.05). The lowest selenium level was found for patients with advanced tumor disease and in a preoperative situation,i.e., high tumor burden. In comparison with the control group, the cancer group showed a significant reduction of serum glutathione peroxidase activity (P<0.01) but no significant difference in selenium level.CONCLUSIONS:These results support the hypothesis of an association between low selenium level and advanced tumor disease. From our data, it cannot be decided whether this phenomenon is more likely to be a consequence or a causative factor for development and course of the disease.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Assessment of sustained voluntary contraction of the external sphincter is helpful in evaluating the patient who has a defecation disorder on presentation. A new index of external sphincter function is described.METHOD:A prospective registry of patients referred for computerized anal manometry using standard protocols was reviewed. Patients were grouped by primary symptoms; those with overlapping complaints were excluded. The rate of fatigue, defined as the change in stationary squeeze over a 40‐second period of voluntary contraction, was calculated by linear regression analysis. Fatigue rate index, a calculated measure of time necessary for the external sphincter to become completely fatigued, was determined to permit comparison of external sphincter fatigue in patients with different complaints.RESULTS:Twenty‐six healthy volunteers (15 women; mean age, 45 years), 33 patients with a primary complaint of anal seepage (13 women; mean age, 53 years), 75 patients with gross incontinence (61 women; mean age, 53 years), and 49 patients with severe constipation (41 women; mean age, 45 years) were evaluated. Mean resting and squeeze pressures were 55 mmHg and 107 mmHg for volunteers, 37 mmHg and 97 mmHg for patients with seepage, 30 mmHg and 49 mmHg for incontinent patients, and 56 mmHg and 93 mmHg for constipated patients. Pudendal neuropathy, as evidenced by a prolonged pudendal nerve terminal motor latency (>2.4 ms), was identified in 13 percent of volunteers, 32 percent of patients with seepage, 54 percent of incontinent patients, and 38 percent of constipated patients. Mean fatigue rate index was 3.3 minutes for volunteers, 2.3 minutes for seepage patients, 1.5 minutes for incontinent patients, and 2.8 minutes for constipated patients. Compared with volunteers and patients with seepage, the incontinent patients had a significantly shorter fatigue rate index (P<0.05; Student'st‐test), which was independent of the variations in resting pressure (P<0.05; two‐way analysis of variance).CONCLUSION:The external anal sphincter is normally subject to fatigue. Patients with worsening degrees of incontinence have a predictably lower fatigue rate index. Fatigue rate index is a simple measure of external sphincter integrity, which may be used in assessment of sphincter function and future treatment protocols.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID