[Contributions to the study of gastric polypi; description of a case].
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Provided examination conditions are optimal, we are now able to detect changes of the wall of the colon from about 5 mm diameter upwards and thus to further clarify the diagnosis and to initiate appropriate treatment. Hence, the demand for early or timely diagnosis can be met by means of x-ray diagnosis in respect of processes of the colon.
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From August 1976 till the end of February 1979 158 polyp in 83 patients (48 male and 35 female) were removed by means of the rectocoloscopic polypectomy with the high frequency diathermy loop. 66% of the polypi had a diameter of less than 1 cm. Most the polypi were with about 70% in the sigma and in the rectum. With 60.7% the adenomas appeared most frequently, followed by the hyperplastic polypi in 20% and by the inflammatory ones in 13.3% of the cases. With the increase of size of the polypi the proportion of the adenomas clearly increased in comparison to the other kinds of polypi. Severe epithelial atypias (altogether 23.1%) were more frequently in adenomas larger than 2 cm than in smaller ones. An invasive carcinoma was found in no polypus. Thus the endoscopic polypectomy in every case meant a curative therapy with great economic use. In patients a haemorrhage appeared as a complication of the coloscopic polypectomy. Only the removal of the polypi in toto allows an exact histological classification and the answer of the decisive question, whether in one adenoma only severe epithelial atypias are present and thus the polypectomy is therapeutically sufficient or whether there exists an adenocarcinoma, for the removal of which an operation according to the principles of the carcinoma surgery must be carried out. The endoscopic ablation of the adenomas thus means a genuine prophylaxis of cancer.
A survey is presented on the incidence of colorectal carcinomas in the GDR, exogenous causes possibly being responsible for the increase in incidence, common screening methods, macro-anatomy and micro-anatomy of colorectal carcinoma, staging, prognosis, and pathways of metastases. The correlation between intestinal polypi and colorectal carcinoma as well as the frequency of their degeneration are also referred to. Adenomatous polypi (polypous adenoma), villous polypi (villous adenoma), and certain rare intestinal polypi, such as familial polyposis coli, multiple polyposis of the entire gastro-intestinal tract, as well as the Gardner- and Turcot-syndromes, are some of those polypi which depending on their size tend to malignant degeneration. Histological information provided by the pathologist is discussed in its value and importance for surgical practice.
By fibrocolonoscopy, fibrocolonoscopic biopsy, polypectomy, operation resp., one hundred and eight true polypi in the colon of 75 patients were studied, grouped according to localization: in caecum -- 2.8 per cent, in ascending colon -- II. I per cent, transverse colon -- 13.9 per cent, descending colon -- 19.4 per cent, in sigmoid colon -- 40.8 per cent and in rectum -- 12 per cent. Endoscopically they were grouped as follows: adenomatous -- 91.7 per cent and villous -- 8.3 per cent and after the pathohistological examination as: adenomatous 73.3 per cent, adenovillous -- 17.2 per cent and villous -- 9.5 per cent. In 40 (52.8%) of the cases, well differentiated polypi were concerned (I grade); in 30 (38%) -- moderately differentiated polypi (II grade) and in 5 (6.5%) -- poorly differentiated polypi (III grade). The studies revealed that the pathohistological examination was a method, specifying the morphological structure of polypus, determining the therapeutic behaviour of the clinicists. Fibrocolonoscopic polyrectomy solves the problem of diagnostics and treatment of the true polypi, contributing to the prophylaxis of colon carcinoma.