ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The diagnosis of inflammatory bowel disease (IBD) in a proband increases the probability of a parallel IBD diagnosis in a family member. In this study, we were able to confirm the IBD diagnosis in 35 (9.9 percent) of the relatives of 352 registry probands. To confirm a proband's report of a positive family history of IBD, efforts were made to directly contact all first‐degree relatives regardless of their IBD status (parents, siblings, and children). Consent to contact family members was obtained from the proband, who furnished the registry personnel with names, addresses, and phone numbers. We then attempted to contact each identified relative by phone. After verbal consent was obtained, family members were asked if they had been diagnosed with IBD. This diagnosis was confirmed by contacting the relative's physician. A McNemar (&KHgr;2Mc) matched‐pair analysis was used to analyze concordance between the proband and the affected family member. Within the CD/CD (Crohn's disease) concordant pairs, sex was a significant risk factor. Sex was not a significant risk factor within the UC/UC (ulcerative colitis) concordant pairs. In the condordant surgery pairs, no surgical procedure was a significant risk factor for the prediction of a similar surgical procedure for the affected relative. In concordant extraintestinal complications, only the appearance of a skin rash was significantly related to the appearance of a skin rash in the affected relative.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;We describe the clinical and pathologic features in four extended kindreds that are consistent with the hereditary flat adenoma syndrome (HFAS). This colon cancer susceptibility disorder is believed to be inherited as an autosomal dominant. The principal phenotypic marker is multiple colonic adenomas (usually less than 100), with a tendency for proximal location. The majority of these adenomas are flat or slightly raised and plaquelike, as opposed to polypoid. Colon cancers have typically developed in middle age and show no unusual histologic features. There are a variety of extracolonic manifestations, including adenomas and carcinomas of the small bowel and fundic gland polyps. The HFAS is contrasted with hereditary nonpolyposis colorectal cancer and familial adenomatous polyposis (FAP) and shown to be distinct from both in the numbers and distribution of colonic adenomas and the typical age of cancer diagnosis. The clinical implications of these findings are discussed. Given its linkage to the FAP locus on 5q and the phenotypic parallels between HFAS and FAP, we conclude that HFAS is a variant of FAP.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The study of 54 patients treated curatively by irradiation with or without surgery is reported. The crude and cancer‐specific five‐year survival rates are 59.2 percent and 79.7 percent. Three patients were treated palliatively. The great variation in histologic type, clinical appearance, disease stage, and patient status justifies the definition of a treatment strategy using radiotherapy, surgery, or a combination of the two methods. T1 and T2 squamous‐or basal‐cell carcinomas are suitable for local excision followed by irradiation or for irradiation alone. T3 tumors and Bowen's disease should be treated by irradiation first. Verrucous carcinoma is suitable for local surgery followed by irradiation. Mucoepidermoid carcinoma and T4 tumors are suitable for preoperative irradiation and delayed surgery. The optimal radiation technique consists of delivering a dose of 40 Gy in 17 days by cobalt‐60 with bolus and in combination with concomitant chemotherapy (5‐fluorouracil and mitomycin C). Prophylactic irradiation of the inguinal area is recommended in all NO tumors except for T1 lesions and basal‐cell carcinomas.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;This study was performed to determine the correlation of tumorrasand c‐myconcogene expression with clinical and prognostic variables in patients prone to develop colorectal cancer. One hundred eighteen patients with colorectal cancer were studied; mean age was 40 years. Fifty‐three were young patients (age 40 or less), 49 had ulcerative colitis, and 16 had multiple polyposis coli. Immunoperoxidase stains of paraffin‐embedded cancer sections were performed for the c‐mycandrasproteins.rasstaining was found to correlate with Dukes stage and prognosis. Patients with tumors negative forrasprotein stain had an actuarial five‐year survival of 61 percent versus 44 percent for those tumors with a positive stain(P<0.05). This correlation was not seen with the c‐mycstain. Positiverasoncogene stain appears to be a useful indicator of advanced stage and poor prognosis in colorectal cancer occurring in cancer‐prone patients.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;In 68 patients the DNA content of tumor cells was measured by image cytometry after resection of the rectum because of cancer. In the DNA histogram a differentiation between diploid (n=19), polyploid (n=24), hypotriploid (n=17), and hypertriploid (n=8) tumors was possible. The best relapse‐free survival time was found in patients with diploid tumors. The prognosis worsened from polyploid to hypotriploid and was worse in hypertriploid tumors. Testing for a prognostic advantage of diploid over aneuploid tumors without adjustment for additional factors simply by means of the log‐rank statistic gave a (one‐sided)Pof 0.1013. In a multivariate analysis the degree of differentiation turned out most important. Again, an appropriate test for prognostic relevance of DNA content failed to be significant(P=0.3264).

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Using Northern and dot‐blot analysis we examined normal and tumor tissue from 29 patients with colorectal carcinomas for the expression and amplification of c‐myc,c‐fosand c‐Ha‐rasproto‐oncogenes. Overexpression of c‐myc(6/24), c‐fos(4/24), and c‐Ha‐ras(9/23) was found. For the c‐fosproto‐oncogene we also have observed decreased levels of expression in 13 percent (3/24) of the cases analyzed. Gene amplification appeared to be a rare event in these tumors and was found in 3/29 (10 percent) tumors for c‐mycand in 1/29 (3 percent) for c‐fosprotooncogene.Curves for overall survival and for disease‐free survival failed to show a significant tendency in these parameters to be poorer in tumors with alterations of gene expression for any of the proto‐oncogenes analyzed. Despite the biologic importance of these genetic alterations in the etiology of colorectal tumors, levels of c‐myc,c‐fos,and c‐Ha‐rasgene expression separately or together cannot be considered as prognostic factors for clinical outcome of the disease.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Transient mucosal ischemia may cause oxygen‐derived free radical production by xanthine oxidase, precipitating pouchitis after ileal pouch‐anal anastomosis. Our aim, therefore, was to determine the effect of allopurinol, a xanthine oxidase inhibitor, in patients with acute and chronic pouchitis. Acute pouchitis was characterized clinically by sporadic episodes of increased frequency and decreased viscosity of stools, hematochezia, fever, malaise, and pelvic pain, which resolved promptly with treatment. Chronic pouchitis patients required continuous treatment to remain asymptomatic and invariably developed the signs and symptoms of pouchitis within one week following cessation of therapy. Eight patients with acute pouchitis were treated with allopurinol (300 mgp.o. b.i.d.)during the episode. Fourteen patients with chronic pouchitis had their standard antibiotic therapy discontinued while still asymptomatic; they were then given allopurinol (300 mgp.o. b.i.d.)for 28 days. Acute pouchitis resolved promptly in four of eight patients. Seven of the 14 patients with chronic pouchitis responded completely with no recurrence of symptoms during treatment. Allopurinol either terminated an episode of acute pouchitis or prevented pouchitis from recurring in 50 percent of patients. These data support a role for mucosal ischemia and oxygen free radical production in the etiology of pouchitis.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The clinical characteristics of 152 patients diagnosed with two primary metachronous tumors—one or both of them in the colon—were studied. Nineteen patients had both primary tumors in the colon (Group I), 59 had the first primary tumor in the colon and the second tumor elsewhere (Group II), and 74 had the second primary tumor in the colon and the first primary tumor elsewhere (Group III). The group in which the second primary tumor was in the colon included significantly more female patients than did the other two groups, with a younger median age at diagnosis of first tumor. The median time interval between the two primary tumors was 44, 57, and 62 months in Groups I, II, and III, respectively. The number of clinic visits during the year before diagnosis of the second primary was similar in all groups, but only 60 percent of the patients kept their follow‐up appointment. In most instances, the diagnosis was made after the patients' symptoms, although only a small percentage of the second primary tumors (15‐30 percent) were diagnosed during routine follow‐up. The second primary tumor occurred in the field of radiotherapy of the first primary tumor in 27 of 35 patients who received radiotherapy. To increase the number of patients diagnosed in an earlier stage of disease, they should be urged to keep their follow‐up appointment, and physicians following patients with single tumors should be aware of the increased likelihood of a second tumor. To increase the cure rate of those tumors, efforts toward early diagnosis are warranted. This includes physical examination and mammography to detect breast cancer in women, annual occult blood tests and rectal examination, and sigmoidoscopy or colonoscopy at three‐year intervals to detect colon cancer early

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;It has been postulated that reduction in anal resting pressure following low anterior resection is due to intraoperative injury to the internal anal sphincter during transanal passage of the stapling device or damage to its nerve supply in the course of rectal mobilization. The aim of this study was to assess the relative importance of either mechanism. Fourteen dogs had a standard segment of colon and distal rectum excised. Colorectal reconstruction was performed using either a low stapled EEA®(U.S. Surgical Corporation, Norwalk, CT) colorectal anastomosis (n=7) or a handsewn anastomosis (n=7). Anorectal manometry was performed preoperatively and again on the 10th postoperative day. Resting anal pressure was significantly reduced after EEA®anastomosis (mean±SEM: before, 49±3 mm Hg; after, 20±4 mm Hg; P <0.001) and handsewn anastomosis (mean±SEM: before, 46±4 mm Hg; after, 35±4 mm Hg; P<0.01). Postoperative resting pressures were also significantly reduced (P<0.05) following EEA®anastomosis when compared with the handsewn group. This study suggests that damage to the innervation of the internal anal sphincter during rectal mobilization and further direct injury to the sphincter during transanal instrumentation both contribute to the fall in anal resting pressure observed following low anterior resection.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID