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PubMed1981

[Absorption of the antibody formation to anticartilage-antiparathyroid antibodies administered into the rectum (author's transl)].

The absorption of and specific antibody formation to Artroglobina (:AG, beta and gamma-globulin fractions of anticartilage-antiparathyroid immune serum from the horse) administered into the rectum were studied in rats and guinea-pigs, an immunological tests in the "Phase I Study" were carried out using serum from volunteers. 1) When the radio-labelled AG (125I-AG) was administered into the rat rectum, the plasma level of 125I reached the maximum (3.1% of the total dosage) at 2 hour later and 0.3 per cent of the total dosage retained the reactivity with the anti-Fab antibody. 2) Gel diffusion and PCA tests gave positive reactions in the sera after the second administration of AG in a dose of 20 mg/kg, corresponding to 40 times the clinical dose, with a certain interval after the first treatment. From the results, it was confirmed that rectally-administered AG induces mainly IgG or IgE antibody formation, in the rat. 3) The administration of AG through the rectum did not induce the systemic anaphylaxic reaction in the guinea-pigs which had been administered AG into the rectum. The intravenous challenge, however, resulted in a positive anaphylaxic reaction in animals treated with AG rectally. This indicates the sensitization of the animal with AG by the rectal administration. 4) The specific antibody responses, immune complexes and complement values did not change in the sera of volunteers given AG which consisted of alternating cycles of twelve days of treatment with one suppository daily, and twelve days without treatment, in a clinical dose of 25 mg. Nevertheless, AG must be carefully prescribed as higher doses given to experimental animals induced adverse immunological effects.

Anaphylaxis↗

PubMed1984

Vascular control in the colon and rectum.

Blood flow and its intramural distribution in the large and small intestines 'at rest' appear to be quite similar, but there are some obvious differences in the regulation of the circulation in these two viscera. Autoregulation of blood flow is well developed in most regions of the gut, with the exception of the colon in which total blood flow varies greatly with arterial blood pressure. However, the colonic autoregulatory capacity can be improved by increasing the metabolic demand of the tissue, e.g. by intra-luminal placement of nutrients. Metabolic and myogenic factors seem to be mutually responsible for autoregulatory behaviour in the large intestine. Functional vasodilatation occurs in the large intestine in response to increased metabolism, a reaction which can be evoked for instance by intra-luminal placement of volatile fatty acids. Mechanical stimulation of the mucosa in the proximal colon also elicits a local hyperaemic response which is postulated to be mediated via an intrinsic nervous reflex possibly releasing 5-HT. In the distal colon and the rectum mechanical stimulation evokes a more wide-spread hyperaemia which is reported to be the result of a pelvo -pelvic reflex with vasoactive intestinal polypeptide (VIP) as a possible mediator. Activation of the sympatho-adrenal system causes constriction of the large intestinal resistance and capacitance vessels. Reflex increase in sympathetic activity, as in exercise or haemorrhage, causes a redistribution of flow and a mobilization of blood from the large intestine to other tissues, thereby, in stress situations, promoting the circulation in more vital organs such as the heart and brain. The most distal part of the large intestine, in particular the rectum, seems to have a unique extrinsic vasodilator control via the parasympathetic pelvic nerves. Activation of these nerves elicits a very pronounced and well maintained vasodilator response in the rectum but only a transient one in the distal colon. This neural vasodilator response is little affected by muscarinic blockade and, hence, largely non-cholinergic in nature. VIP is released from the colon and rectum during pelvic nerve stimulation, the rectal output being especially large and well correlated in time to the concomitant vasodilatation. The rectal vessels are very sensitive to VIP, and intra-arterial infusion of this peptide causes a vascular response which closely resembles that of pelvic nerve stimulation. Such evidence indicates that VIP might be the neurotransmitter responsible for the non-cholinergic vasodilatation in the most distal part of the large intestine.

Animals↗

PubMed1983

[Transanal endoscopic surgery of the rectum - testing a new method in animal experiments].

Surgery of the lower third of the rectum can be done without difficulty through the anus using an endoscopical approach. Polyps or tumors located in the upper two thirds of the rectum can be removed using the Mason or Kraske procedure, or by the transabdominal approach. A new endoscopic technique has been developed with the aim, to allow surgery in the whole rectum through the anus. The rectum is being dilated by mechanical means and air insufflation. An oblique angle stereoscopic endoscope as well as modified surgical instruments are used. In animals 47 excisions of mucosa were done, and the incisions were closed by continuous suture. Application of this technique in a clinical setting is planned.

Anal Canal↗

PubMed1995

[Transanal compression anastomosis in the lower rectum with a biofragmentable anastomosis ring (Valtrac). Surgical technique and initial clinical experiences].

In a pilot clinical study the practicability and postoperative course were investigated after compression anastomoses in the lower rectum using a new Valtrac application device. In all 15 patients the transanal compression anastomosis using a biofragmentable anastomosis ring was possible. Most difficult was the creation of the distal purse-string suture to fix the Valtrac ring in the rectum. Using this device the possible distal margin of the anastomosis is about two centimeters to the anal canal. There were no complications with clinical relevance for the postoperative course. Radiological leakages on day 8-10 postoperatively occurred in three patients. The new transanal application device for anastomoses in the lower rectum is a possible alternative to standard anastomoses procedure. Clinical studies hat to demonstrate a possible advantage in patients outcome after using this new operative technique in the lower rectum.

Anastomosis, Surgical↗

PubMed1996

[Proctitis of diversion on an excluded rectum in patients with hemorrhagic rectocolitis].

OBJECTIVES: Diversion colitis is characterized by inflammatory lesions affecting colon or rectum excluded from the fecal stream for varied etiologies. These lesions may mimic both ulcerative colitis and Crohn's disease. The aim of our study was to examine the excluded rectum in patients with ulcerative colitis, and to study the evolution of the pathological lesions after ileo-rectal anastomosis. METHODS: Eighteen patients with ulcerative colitis treated by total colectomy before ileo-rectal anastomosis were studied. The pathological features i.e. glandular alteration, inflammatory infiltrate and mucosal ulceration or fissure, were studied during 3 periods: initial colectomy, excluded rectum at surgery for anastomosis and rectal biopsies after anastomosis. RESULTS: We observed on the excluded rectum a follicular lymphoid hyperplasia (18 cases), granulomas with giant cells (9 cases), mucosal fissures (9 cases). The inflammation extended to the submucosa in all cases and was occasionaly transmural. These lesions disappeared after the anastomosis and then seemed to be connected with the rectal diversion. CONCLUSIONS: The pathological changes of diversion proctitis that includes mucosal fissures, granulomas with giants cells or transmural inflammation, may lead to an erroneous diagnosis of Crohn's disease. The review of the previous colectomy is then mandatory to confirm the initial diagnosis of ulcerative colitis. These lesions disappear after anastomosis.

Adolescent↗

PubMed1997

Reconstruction of the high urogenital sinus: early perineal prone approach without division of the rectum.

PURPOSE: Reconstruction of the vagina and external genitalia in the infant is quite challenging, particularly when a urogenital sinus is associated with high confluence of the vagina and urethra. Many surgeons believe that children with such a malformation should undergo staged or delayed reconstruction, so that vaginoplasty is done when the child is older and larger. Vaginoplasty early in life is thought to be difficult due to patient size and poor visualization. The posterior sagittal approach has been beneficial for acquiring exposure to high urogenital sinus anomalies but it has been thought to require splitting of the rectum and temporary colostomy. We report a modification of this technique. MATERIALS AND METHODS: In the last 5 years all patients with urogenital sinus anomalies underwent reconstruction using a single stage approach regardless of the level of confluence. In 8 patients with a high level of confluence reconstruction was performed using a perineal prone approach. Exposure was achieved without division of the rectum. The operative technique is presented in detail. RESULTS: This midline perineal prone approach has allowed excellent exposure of the high vagina even in infants. In all 8 patients reconstruction was done without difficulty and no patient required incision of the rectum or colostomy. This procedure did not preclude the use of a posteriorly based flap for vaginal reconstruction. CONCLUSIONS: While patients with low confluence can be treated with single posteriorly based flap vaginoplasty, those with higher confluence may benefit from a perineal prone approach to achieve adequate exposure for pull-through vaginoplasty. This prone approach to the high urogenital sinus anomaly can be performed without division of the rectum, provides excellent exposure of the high confluence even in small children and does not preclude the use of posterior flaps for vaginal reconstruction.

Abnormalities, Multiple↗

PubMedDate not supplied

[Complications after primary surgical management of war injuries of the colon and rectum].

War injuries of colon and rectum are real challenge for war surgeons. The aim of the study was to point out the necessity of war surgical doctrine application, considering the risk factors in the choice of primary surgical procedure and surgeon's experience in managing this kind of injuries. Postoperative complications and indications for reoperations in 216 wounded after primary surgical management of colonic and rectal war injuries in the period 1991-1995 were retrospectively analyzed. A total of 183 wounded (84.7%) were primarily surgically managed in war hospitals. Combined injuries of colon and/or rectum or more than 2 abdominal organs were found in 197 wounded (91.2%), and 29.1% of wounded were also with the combined extra-abdominal injuries. Postoperative complications were observed in 58 wounded (26.8%) and were associated with the injury and primary management of colon and rectum, with septic complications in 87.9% of cases. Reoperation was performed in 44 wounded (75.8%) and the most frequent indications, such as diffuse peritonitis and stercoral fistula, were the sequlae of dehiscence of suture or anastomosis, overlooked lesions and secondary perforations (blast) of colon or rectum. Principle of complete diversion of stool/intestinal content was used in reoperation. Mortality rate in reoperated group was 20.4% (9 wounded). Cause of death was diffuse peritonitis followed by consecutive sepsis and MOFS. The significance of surgical war doctrine and risk factors in the choice of primary surgical procedures were emphasized.

Adult↗

PubMed1997

[Gunshot wounds of rectum].

The experience of treatment of 73 wounded with gunshot injuries of the rectum is reviewed. Classification of gunshot injuries of the rectum is proposed which permits to choose rational surgical policy depending on the location of the rectal injury is proposed. Terms of closing colostomas in remote periods after operation were determined. The authors believe that because of the complicated anatomo-topographic characteristics of the rectum and frequency of the combined injuries it is advisable to perform operations bor gunshot wounds of the rectum as an urgent specialized aid.

Emergency Treatment↗

PubMed1988

A case of multiple carcinoid tumors of the rectum with extraglandular endocrine cell proliferation.

A case of multiple carcinoid tumors of the rectum with numerous proliferations of extraglandular endocrine cells is reported. The patient was 52-year-old man with five polypoid lesions in the rectum. The resected rectum contained five macroscopic carcinoid tumors, 36 microcarcinoids, and innumerous extraglandular endocrine cell proliferations. Endocrine cell microproliferations, in their early stage consisting of one to 15 micronests, were mainly located within the bundles of muscularis mucosae, having no contact with mucosal glandular structures. All of the immunohistochemically examined proliferations of extraglandular endocrine cells contained S-100 protein-positive dendritic cells, and some endocrine cells coexisted with submucosal ganglion cells. In contrast, there was no increase in intraglandular endocrine cells. The origin of rectal carcinoid tumor may be the extraglandular endocrine cells, a distinct compartment of mucosal endocrine cells of the rectum.

Carcinoid Tumor↗

PubMed1992

Declining mortality rates for cancer of the rectum in the United States: 1940-1985.

BACKGROUND AND METHODS: Age-standardized and age-specific mortality rates for cancer of the rectum and cancer of the colon were calculated according to race and gender for 1940-1985; age-standardized rates were calculated according to geographic region for 1950-1980. RESULTS: Mortality rates for cancer of the rectum decreased among white and black people of each gender, in most age categories and all regions of the country. Concurrent with this decline, mortality rates for cancer of the colon increased among all race-gender groups except white females, among whom it decreased. CONCLUSIONS: The decline in mortality rates for cancer of the rectum has been largely unappreciated. When deaths occurring from 1940 to 1985 from cancer of the rectum are combined with those from cancer of the colon, mortality rates are increased. However, this combination of sites obscures the divergent trends, which suggest that these cancers have causes that are at least somewhat different.

Black or African American↗

PubMed1982

The pelvic ileal reservoir: an experimental assessment of its function compared with that of normal rectum.

The function of the 3-loop pelvic ileal reservoir as an alternative to total proctocolectomy and ileostomy is assessed experimentally in dogs and compared with normal rectum under identical conditions. No difference was found between the pelvic ileal reservoir and normal rectum in their ability to maintain continence. The efficiency of evacuation, however, is significantly better in normal rectum (P less than 0.01). Observations made over a prolonged period of time suggest that frequency of defecation, tenesmus and incomplete evacuation are persistent problems with an ileal reservoir. The results of the experiments concur with clinical findings that satisfactory continence may be achieved by using the ileal reservoir but that it does not possess the ability of normal rectum to evacuate completely. Hence the frequent need for self-catheterization.

Animals↗

PubMed1990

Relationship between age and survival in cancer of the colon and rectum with special reference to patients less than 40 years of age.

The relative survival of all patients (n = 61,769) in the entire Swedish population reported to have a malignant tumour of the colon and rectum between 1960 and 1981 was analysed with special reference to patients under 40 years of age. The 5-year relative survival rate of patients with a tumour of the colon, irrespective of histopathological diagnosis, was 62.0 per cent below the age of 40 years and 44.4 per cent in those 40 years of age or older (P less than 0.05). The corresponding figures for patients with a tumour of the rectum were 46.6 per cent and 39.1 per cent, respectively. When the relative survival was analysed separately for patients with a histopathologically demonstrated adenocarcinoma, the 5-year survival rate among patients with a cancer of the colon was 50.9 per cent in patients below 40 years of age and 48.6 per cent in those 40 years of age or older. In patients with adenocarcinoma of the rectum, the 5-year relative survival rate was 41.1 per cent in patients younger than 40 years of age and 40.7 per cent in patients 40 years of age or older. Thus, patients below the age of 40 years with an adenocarcinoma of the colon and rectum as a group appear to have the same or even a better prognosis than older patients if all tumours are considered, irrespective of histopathological diagnosis.

Adenocarcinoma↗

PubMed1996

Perianal extramammary Paget's disease associated with primary linitis plastica of the rectum: report of a case.

We report herein a case of perianal extramammary Paget's disease associated with primary linitis plastica of the rectum. An 82-year-old woman was admitted to our hospital for investigation and treatment of a perianal eczematous lesion. A skin biopsy of the lesion revealed perianal extramammary Paget's disease and a barium enema demonstrated diffuse narrowing with an irregular contour at the ampulla recti. Under a suspected diagnosis of linitis plastica of the rectum, an abdominoperineal resection was performed to resect both the rectal and perianal lesions with regional lymphadenectomy. Grossly, marked narrowing and wall thickness were observed at the lower rectum, and a histological diagnosis of signet ring cell carcinoma was confirmed. The perianal eczematous lesion revealed many atypical cells with clear cytoplasm, being Paget cells, throughout the entire epidermis. Sparse distributions of signet ring cells were also observed in the subcutaneous tissue beneath the perianal eczematous lesion. The pathogenesis of perianal extramammary Paget's disease in this patient was therefore considered to be an intraepidermal extension of primary linitis plastica of the rectum.

Aged↗

PubMed2001

Adenosquamous and squamous carcinoma of the colon and upper rectum: a clinical and histopathologic study.

PURPOSE: Squamous and adenosquamous carcinoma of the colon and proximal rectum are rare neoplasms in which the clinicopathologic behavior and the most appropriate management are unknown. The purpose of this study was to review the histology and clinical course of the largest series of cases ever reported from a single center on this rare condition. METHOD: The Mayo Clinic tissue registry was searched for all primary cases of squamous and adenosquamous carcinoma of the colon or rectum proximal to 8 cm from the dentate and presenting before December 31, 1992. Of the 52 identified cases there was adequate histologic material for review in 44 cases. These cases were divided into pure squamous-cell carcinoma (n = 11), mixed adenosquamous carcinoma (n = 31), and adenocarcinoma with benign-appearing squamous metaplasia (adenoacanthoma; n = 2). Squamous-cell carcinomas were examined for evidence of human papilloma virus by in situ hybridization. A retrospective review of medical records was undertaken in all 52 cases with respect to predisposing factors, clinicopathologic behavior, prognostic features, and treatment with adjuvant therapy. RESULTS: The charts of 52 patients (20 females), with a mean age of 58.6 (range, 19-90) years, were reviewed. Right-sided lesions were the most common (43 percent). Metastatic disease was evident at presentation in 49 percent of patients, the most common sites in order being liver, peritoneal, and lung. The five-year overall survival rate was 34 percent, Stage I to III disease had a 65 percent five-year survival rate, and Stage IV mean survival time was 8.5 months. For node-positive and node-negative disease, 23 and 85 percent, respectively, survived five years. There was no evidence of human papilloma virus in the six squamous-cell carcinomas examined. CONCLUSION: Squamous and adenosquamous carcinomas of the colon and rectum are rare neoplasms. Although a poor prognosis can be expected for node-positive disease, patients with negative nodes do generally the same as patients with adenocarcinoma histology. Based on advances made with multimodality therapy of squamous-cell cancer of the anus and adenocarcinoma of the rectum, further studies should define the role of postoperative therapies for these lesions.

Adenocarcinoma↗

PubMed1999

Adenosquamous carcinoma of the colon, rectum, and anus: epidemiology, distribution, and survival characteristics.

PURPOSE: There have been 49 cases of adenosquamous carcinoma of the colon, rectum, and anus reported in the English literature. We have reviewed 145 cases of adenosquamous carcinoma to better define epidemiologic and survival characteristics of this extremely rare colon carcinoma. METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results program public use CD-ROM file for the years 1973 through 1992 were reviewed. This represents approximately 9.5 percent of the United States population. Adenosquamous carcinomas arising in the colon, rectum, and anus were identified using the International Classification of Diseases-O codes. The Astler-Coller tumor classification was used for staging. Two-tailed Student's t-test, Mantel-Haenszel chi-squared tests, and generalized Wilcoxon's tests were used for comparisons of means, proportions, and actuarial survival rates, respectively. Survival curves were calculated by the Kaplan-Meier method. RESULTS: One hundred forty-five cases of adenosquamous carcinoma were identified, representing 0.06 percent of all colorectal malignancies. The mean age of patients was 67 years. Eighty-four percent of patients were Caucasians, 15 percent were Afro-Americans, and 1 percent were other races. Afro-Americans were diagnosed at a significantly younger age (median age, 62 years; P = 0.03). Fifty-three percent of the carcinomas were located in the sigmoid colon, rectum, and anus, 28 percent in the right colon, and the rest in the middle segment. Seventy-four percent of distal cases were staged A through C, compared with 44 percent of proximal cases. Patients with adenosquamous carcinoma of the sigmoid colon, rectum, and anus survived longer than all other patients (P = 0.001). Patients with adenosquamous carcinoma Stages A and B1 had survival rates similar to patients with comparably staged adenocarcinomas. Fifty percent of the patients, including most of the patients with D stage, died in the first year. Patients with Stages B2, C, and D adenosquamous carcinomas had a significantly shorter survival than the comparably staged adenocarcinomas (P < or = 0.02). The overall adjusted five-year survival rate was 30.7 percent. In those patients who survived more than 24 months, the five-year survival was 84 percent. CONCLUSIONS: The survival rates for patients with adenosquamous carcinoma Stages A and B1 are similar to patients with comparably staged colorectal adenocarcinomas. However, we found that patients with colorectal and anal adenosquamous carcinomas staged B2 through D have significantly poorer survival than patients with comparably staged adenocarcinomas, supporting the previous reports of a poor prognosis associated with adenosquamous carcinomas.

Aged↗

PubMed1985

Small-cell carcinoma of the rectum.

Small-cell carcinoma of the rectum is a rare tumor. We treated a patient with small-cell carcinoma of the rectum with radiation and multidrug regimen being used for small-cell carcinoma of the lung. Within two months of chemotherapy, the primary lesion, as evaluated by rectoscopy, biopsy, and CT scan, had resolved completely. The patient was in complete remission for 12 months after initiation of chemotherapy and died of widespread metastases. At autopsy, no residual tumor was found in the rectum. This case stresses the importance of ultrastructural study in the differential diagnosis of small-cell cancer of the rectum and the fact that this tumor can be treated in the same fashion as for small-cell carcinoma of the lung with multidrug chemotherapy and radiation therapy to achieve local control.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1985

Small-cell carcinoma of the rectum. Clinicopathologic study.

Three cases of small-cell carcinoma of the rectum are presented. Our conclusions are as follows: small-cell carcinoma and carcinoid tumor of the rectum might have a common origin; indications for surgical intervention for small-cell carcinoma of the rectum should be considered seriously; small-cell carcinoma of the rectum should be classified as an aggressive type of rectal tumor that metastasizes easily to distant organs.

Adult↗

PubMedDate not supplied

Carcinoma in the retained rectum after colectomy for ulcerative colitis.

A carcinoma arising in an excluded rectal stump 18 years after ileostomy and 14 years after subtotal colectomy has been described. Extent of involvement of the colon, age of the patient at onset of colitis, and duration of symptomatology are factors whcih have been shown to influence the incidence of carcinoma complicating ulcerative colitis. Fifty-eight similar cases of carcinoma developing in a retained rectum were collected from the literature. The incidence of this complication is approximately 3 per cent. Rectum-sparing operations do not appear to decrease the incidence of malignant transformation in ulcerative colitis. A decision to retain the rectum after colonic resection for ulcerative colitis must take into account both the significant incidence of malignant transformation associated with all rectum-sparing procedures and also the significant incidence of recurrent symptoms following this procedure.

Adenocarcinoma↗