ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

BACKGROUND:Suture line recurrence continues to be an important cause of failure following curative resection for colorectal carcinoma. Our aim was to determine whether the nature of the suture material used affected the proliferative activity of colonic crypt cells at the anastomosis. METHODS ANDMATERIALS:Sprague‐Dawley rats were randomized into one control and three experimental groups. In each experimental group the proximal 2 cm of rectum were resected and anastomoses constructed with titanium clips, interrupted 6‐0 VicrylTM(Ethicon, Inc., Somerville, NJ), and interrupted 6‐0 silk. Control animals had a sham operation. One‐quarter of each group of rats were killed at 14, 30, 60, and 90 days. Each animal received intraperitoneal tritiated thymidine 30 minutes before death. Each anastomosis was harvested, and longitudinally oriented crypts were analyzed for the total number and position of labeled cells at five equal distances from the anastomosis. Random crypts were studied in the control group.RESULTS:Labeling indices were increased in almost all experimental groups at days 14, 30, 60, and 90. There were no persistent, statistically significant differences in labeling indices among the various suture materials.CONCLUSION:The type of suture material used did not significantly affect the proliferative rate in this animal model.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Toxic megacolon is a rare complication of pseudomembranous enterocolitis. We reviewed our recent experience with this complication.METHODS:The first five patients of the series were studied retrospectively, and six others were followed prospectively.RESULTS:Between June 1992 and May 1994, 11 patients (8 male, 3 female) developed toxic megacolon secondary to pseudomembranous enterocolitis. Mean age was 60.7 ±11.8 (range, 40‐79) years. Presenting symptoms and signs included diarrhea, 100 percent; malaise, 91 percent; abdominal pain, 82 percent; abdominal distention, 82 percent; white blood cell count greater than 10.5, 82 percent; abdominal tenderness, 72 percent; anemia less than 12 gm, 72 percent; albumin less than 3 gm, 64 percent; tachycardia greater than 100, 55 percent; fever greater than 38.5° Celsius, 45 percent; shock or hypotension, 45 percent. Predisposing factors included antibiotics, 64 percent; immunosuppressants or chemotherapy, 36 percent; antidiarrheals, 27 percent; and barium enema in one patient. Five patients (45 percent) had more than one predisposing factor. X‐rays showed transverse colon dilation and loss of haustrations in eight patients (72 percent), with a mean diameter of 99 ±3.4 cm. Flexible proctosigmoidoscopy showed pseudomembranes in all scoped patients, and toxin assay forClostridium difficilewas positive in all patients. One patient had emergency surgery. Ten patients were initially treated medically with nasogastric suction and intravenous resuscitation (90 percent) and antibiotics (100 percent), usually in the intensive care unit (80 percent). Four patients did not respond and underwent surgery; two others improved, then deteriorated, and also underwent surgery. Altogether, 7 of 11 patients (64 percent) underwent surgery. Three patients (27 percent) responded well to medical treatment. One patient was deemed too ill to undergo surgery and died. Mean delay to surgery was 3.0 ±1.3 days. No sealed or overt perforation was found at laparotomy. All patients who underwent surgery had a subtotal colectomy, with either a Hartmann's stump (71 percent) or a mucous fistula (29 percent). Eventually, five of seven patients who were operated on and two of four medically treated patients died (overall mortality, 64 percent). Only one patient underwent closure of ileostomy and anastomosis.CONCLUSION:Toxic megacolon complicating pseudomembranous enterocolitis is a serious problem that carries a high morbidity and mortality rate, regardless of treatment.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

BACKGROUND:The length of the rectosigmoid stump left after subtotal colectomy and ileostomy is believed to affect postoperative complications, including sepsis, success of future restorative proctocolectomy, and long‐term functional outcome.METHODS:We reviewed the charts of 60 patients with toxic ulcerative colitis who were treated with subtotal colectomy leaving either a short (25) or long (35) rectosigmoid stump and who eventually underwent restorative proctocolectomy between 1983 and 1992 at a large tertiary care center. Data were collected on preoperative disease duration and steroid use, operative time, blood loss, transfusion requirements, length of stay, stool frequency, fecal incontinence, and sexual dysfunction.RESULTS:There were no statistically or clinically significant differences between groups.CONCLUSIONS:Rectosigmoid stump length does not appear to affect complications or long‐term outcome in patients with toxic ulcerative colitis treated with subtotal colectomy and restorative proctocolectomy.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The normal response to rectal distention is a relaxation of the proximal anal canal (PAC). We hypothesized that this mechanism would require a gradient of pressure and time to preserve continence.METHODS:Sixteen volunteers (10 male), mean age, 41.5 (range, 24‐60) years, were studied using an eight port axial catheter with a compliant balloon at its tip. Relaxation was induced by a small volume of rectal distention (15‐30 ml of air) and was recorded until recovery of resting anal pressure (RAP). Duration of relaxation was measured until recovery of RAP. Amplitude of relaxation was determined between RAP before rectal distention (RAP‐BR) and pressure at the point of maximum relaxation (RAP‐PMR). Gradient of pressure was determined by comparing RAP‐PMR in the high‐pressure zone (HPZ) and PAC. Contraction in the distal anal canal was interpreted as external anal sphincter contraction (EASC) and was compared with RAP‐PMR in the HPZ.RESULTS:Relaxation was significantly greater in PAC than in HPZ (50vs.36 percent;P=0.001). RAP‐PMR was significantly higher in HPZ than in PAC (30.7vs.12.6 mmHg;P= 0.001). EASC was observed in six patients and did not show significant difference with RAP‐PMR in HPZ (39.7vs.36.3 mmHg; not significant). Relaxation began at the same time in all levels but lasted significantly longer in PAC compared with HPZ (13.5vs.9.4 sec;P=0.003).CONCLUSION:Anal relaxation induced by small volume rectal distention involves a gradient in the pressure and time of relaxation between PAC and the HPZ.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:A preoperative evaluation of the lateral lymphatic spread is essential to decide the indication of autonomic nerve preserving operation for rectal cancer. For this evaluation, we used common ultrasonographic examination of the lower abdomen. We also performed this examination on postoperative patients in whom local recurrence had been suspected. Results and effectiveness of examination were evaluated.METHOD:First, we identified arteries in the pelvic cavity (common, external, and internal iliac arteries), and then we sought lymph nodes in the spaces between these arteries, urinary bladder, and rectum.RESULTS:We performed this examination on 40 preoperative patients with rectal cancer and could detect lymph nodes in 12 patients. By the size and features of these lymph nodes, five patients were considered lateral lymphatic spreadpositive. After the operation, resected specimens revealed three patients were pathologically positive, and the two others were false‐positive. Only one patient was false‐negative. Total accuracy of the examination was 92.5 percent; however, the positive lymph node around middle rectal artery and obturator artery had been overlooked. We also performed this examination on postoperative patients in whom local recurrence had been suspected. In one postoperative patient, a recurrent lesion of 30 × 3.5 cm in size was detected along the right external iliac artery and could be resected by the retroperitoneal surgical approach.CONCLUSION:We consider this examination very effective for detecting lymph node metastasis preoperatively and recurrent lesions in the pelvic cavity.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The purpose of this study was to assess risk of developing multiple primaries after a diagnosis of colon cancer and to determine the impact that having a family history of cancer has on cancer risk.METHODS:Data from the Utah Cancer Registry and the Utah Population Database were used. A cohort of 2,236 first primary colon cancers were observed for the subsequent development of additional primary cancers.RESULTS:We observed a greater than expected incidence of colon, rectal, and pancreatic cancers among the cohort. The standardized incidence ratios were 2.77 (95 percent confidence interval (CI), 2.07‐3.70), 2.26 (95 percent CI, 1.34‐3.81), and 2.38 (95 percent CI, 1.32‐4.30), respectively. Having a family history of colon or rectal cancer did not greatly influence risk of having a multiple primary. However, there was a trend toward increased risk of pancreatic cancer (hazard rate ratios, 1.99; 95 percent CI, 0.67‐5.90) and bladder cancer (hazardrate ratios, 2.35; 95 percent CI, 0.77‐7.18) among patients with a family history of rectal cancer. We also observed that risk of uterine cancer in the cohort was positively associated with family history of uterine cancer, risk of breast cancer was positively associated with family history of breast cancer, and risk of prostate cancer was positively associated with family history of prostate cancer.CONCLUSIONS:People with colon cancer are at a greater risk of developing colon, rectal, and possibly pancreatic cancer. Although a family history of colon or rectal cancer did not have a large impact on developing other cancers, a family history of other primary cancers did influence risk of other cancers.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:It is well known that tumor cells secrete endogenous tumor necrosis factor (en‐TNF) as a cytokine when stimulated with lipopolysaccharide (LPS). We, therefore, analyzed the biologic role of en‐TNF secreted by tumor cells themselves to learn the prognosis of patients and the susceptibility of tumors to biologic response modifiers in particular.METHODS:Patients with Dukes C colorectal tumors were studied after curative operation to determine the inducibility of en‐TNF by their primary cultured cells in response to LPS.RESULTS:Irrespective of the known clinicopathologic factors of the tumors, en‐TNF was produced in 21 of a total of 44 patients. The group of patients with clear en‐TNF production showed a significantly lower incidence of recurrence and/or metastasis and a higher survival rate than the group without en‐TNF production, suggesting a strong correlation between patient prognosis and inducibility of en‐TNF.CONCLUSION:Inducibility of en‐TNF by tumor cells themselves can be a novel prognostic factor for patients with colorectal tumor, especially of Dukes Stage C.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to assess an immunotoxin, monoclonal antibody C27‐abrin A chain conjugate (MAAC), that might be effective in the treatment of colorectal carcinoma.METHODS:The immunotoxin was prepared by a specific monoclonal antibody against carcinoembryonic antigen (CEA), monoclonal antibody C27, linked toN‐succinimidyl‐3‐(2‐pyridyldithio)propionate and then coupled covalently to the toxic abrin‐A chain to synthesize MAAC. The therapeutic role of this immunotoxin in suppressing thein vitroandin vivogrowth of CEA‐secreting human colorectal cancer cells (LS174T) was assayed by methods of protein biosynthesis inhibition, cell colony proliferation, and treatment of tumor cells before and after inoculation in nude mice.RESULTS:We found that MAAC effectively suppressed the growth of LS174T in culture medium and completely eradicated cells in inoculated nude mice. In contrast, irrelevant immunotoxin antiferritin‐abrin A chain conjugate and isotype‐matched monoclonal immunoglobin (MOPC21IgG1)‐abrin A chain conjugate did not cause such effects. Thein vitrotoxicity was highly specific because the conjugate (MAAC) inhibitedde novoprotein biosynthesis, impeded growth, and caused death of cells possessing surface CEA determinants. The 50 percent inhibition dose values of the conjugate for colonogenic survival and for protein biosynthesis in LS174T cells were 0.09 μg/ml and 0.06 μg/ml, respectively. Colony survival was inhibited 96.3 percent after prolonged MAAC treatment. MAAC showed selective cytotoxicity; the inhibitory effect of MAAC to the CEA‐secreting LS174T cells over the CEA‐nonsecreting human embryonic kidney cells was 16‐fold.CONCLUSION:These results indicate that MAAC may be of benefit in therapy during or soon after resection of colorectal carcinoma or in patients who have micrometastasis.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:In recent years, flat adenomas of the colorectal mucosa have been intensively investigated by Japanese pathologists. Results of that work indicate that flat adenomas may antedate the development of colorectal carcinomas. Because of differences in the Histologic definition of flat adenomas with severe dysplasia and with intramucosal carcinoma within the group, one single observer having both Western and Asian training in pathology reviewed the material.METHODS:A total of 287 flat colorectal lesions were reviewed: 109 from the Karolinska Hospital, Stockholm, 137 from the Tokyo Medical and Dental University (TMDU) (which included 50 cases from the Nagoya City University), and 41 from the Cancer Institute (CI), Tokyo. Lesions were histologically classified following strict Histologic criteria. Thus, flat adenomas were divided into those having lowgrade dysplasia (LGD; having dysplastic cells in the deeper half of the epithelium), high‐grade dysplasia (HGD; dysplastic cells were found even in the superficial half of the epithelium), intramucosal carcinoma (dysplastic glands displayed molding with buddings and often a cribriform pattern), and adenocarcinoma (breaking through the muscularis mucosa, with neoplastic cells in the submucosal layer or deeper).RESULTS:Whereas in Stockholm only 14.7 percent of lesions had HGD, as much as 56.9 percent and 56.1 percent, respectively, had HGD at the two Tokyo Hospitals. Intramucosal carcinomas were not found in the Stockholm material but occurred in 2.2 percent of lesions seen at TMDU and in 4.9 percent of those seen at the CI. Notably, only 2.7 percent of the specimens at Karolinska Hospital had invasive adenocarcinoma, but it was seen in as many as 4.4 percent at TMDU and 21.9 percent at the CI.CONCLUSIONS:This study indicates that there were Histologic differences between flat neoplasias of the colorectal mucosa harvested in Stockholm and Tokyo. In Japan, lesions were obviously more advanced (in terms of HGD) and more aggressive (in terms of intramucosal and submucosal invasion). The cause for the differences found in those two disparate geographic regions remains poorly understood. The results, however, may help us understand some of the unclear points and discussions appearing in the literature on this subject.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID