[Relationship between intestinal polyps and cancer].
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Biomedical subjects
Publications and source records attributed to T Muto.
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Recent reports have noted a high frequency of elevated mucosal lesions of the stomach in patients with familial adenomatosis coli. This paper describes an additional 10 cases from six different families. Nine patients had sessile polyps in various portions of the stomach. Six of these have been examined histologically; two were adenomatous and four hyperplastic. The need for meticulous examination of the stomach in patients with multiple colonic polyposis is emphasized.
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Pathophysiological and nutritional conditions were compared after esophageal reconstruction in 15 patients with a gastric tube and in 12 patients with a pedicled colon segment for the treatment of esophageal cancer. There was no significant difference in the postoperative nutritional index, iron and vitamin B12 metabolisms. On the other hand, the long gastric tube from the greater curvature of the stomach used as an esophageal substitute retained some secretory functions of both exocrine and endocrine although the effect of truncal vagotomy may have to be taken into consideration.
The malignant potential of adenomas of the colon and rectum varies with size, histological type and grade of epithelial atypia. The adenomatous polyp is usually small and has a low malignant potential, whereas tumors with a villous structure are usually larger and have a much higher cancer rate. Severe atypia is more common in villous adenomas than in adenomatous polyps. Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp-cancer sequence although the majority of adenomas do not becoma cancerous during a normal adult life span. The slow evolution of the polyp-cancer sequence is stressed. The implications of the polyp-cancer sequence for the design of cancer prevention programmes and the study of the aetiology of large bowel cancer are discussed.
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By using a colonoscope diathermy snare a total of 75 polyps have been removed from sites throughout the colon in 43 patients. There was some haemorrhage in four cases but no other morbidity, and all patients were discharged home within 24 hours. The ease of this procedure suggests that it should replace colotomy and surgical polypectomy in the management of polyps inaccessible to the rigid sigmoidoscope.
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