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At least 361 records · Page 20Linked to original sources
PubMed2006

Straight and colonic J-pouch reconstruction after low anterior resection.

PURPOSE: A complication after restorative rectal surgery with a straight anastomosis is low-anterior resection syndrome with a postoperatively deteriorated anorectal function. The colonic J-reservoir is sometimes used with the purpose of reducing these symptoms. An alternative method is to use a simple side-to-end anastomosis or a coloplasty. MATERIAL AND METHODS: Three-hundred fiftyseven patients with rectal cancer undergoing total mesorectal excision (TME). Three-hundred (84.0%) received a low anterior resection with primary anastomosis and colo-rectal n = 194 (64.6%) or colo-anal anastomosis n = 106 (35.3%). A colonic pouch using the descending colon was created in 24 patients and in 75 patients respectively. Surgical results and complications were recorded. Patients were followed with a functional evaluation at 6 and 12 months postoperatively. RESULTS: Patient characteristics in both groups were very similar regarding gender, age, tumor level, and Dukes' stages. A large proportion of the patients received short-term preoperative radiotherapy (72%). There was no significant difference in surgical outcome between the 2 techniques with respect to anastomotic height, perioperative blood loss, postoperative complications, reoperations, hospital stay or pelvic sepsis rates except the anastomotic stricture rate in the colonic J-Pouch group after coloanal anastomosis (p < 0.02). CONCLUSIONS: These data show that either a colonic J-pouch or a straight anastomosis performed on the descending colon in low-anterior resection with TME are methods that can be used with similar expected surgical and functional results.

Anal Canal↗
PubMed1988

Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide.

To investigate the reported association between idiopathic chronic constipation and morphologic abnormalities of enteric nerves, we measured the concentrations of six neuropeptides, vasoactive intestinal peptide, peptide histidine-methionine, substance P, methionine5-enkephalin, neuropeptide Y, and the bombesinlike intestinal peptides, in descending colon from 4 patients with idiopathic chronic constipation. Decreased concentrations of vasoactive intestinal peptide (707 +/- 112 ng/g wet tissue) and peptide histidine-methionine (543 +/- 58 ng/g) were found in the muscularis externa obtained from constipated patients compared with normal concentrations (40 patients) of vasoactive intestinal peptide (1199 +/- 47 ng/g) and peptide histidine-methionine (815 +/- 45 ng/g). Vasoactive intestinal peptide was identified by immunocytochemistry in nerve fibers within the circular smooth muscle layer of descending colon obtained from 6 control patients, but not in nerve fibers within the circular smooth muscle of descending colon obtained from 3 patients with idiopathic chronic constipation. By contrast, the distribution of immunoreactive met5-enkephalin was similar in normal descending colon and in descending colon obtained from patients with idiopathic chronic constipation. Decreased colonic concentrations of vasoactive intestinal peptide (a candidate nonadrenergic, noncholinergic inhibitory neurotransmitter) may be associated with diminution of inhibitory innervation of colonic circular smooth muscle in some patients with idiopathic chronic constipation.

Adult↗
PubMed2003

In-utero development of the fetal colon and rectum: sonographic evaluation.

OBJECTIVE: To construct a normal range for the internal diameter of the fetal descending colon and rectum during gestation. SUBJECTS AND METHODS: This was a prospective, cross-sectional study including 379 healthy pregnant women with normal singleton pregnancies at 19-40 weeks of gestation. Measurements of the fetal descending colon (maximum internal diameter) and the fetal rectum (at the level of the bladder, measuring the anteroposterior diameter), were performed by high-resolution transabdominal sonography. RESULTS: Adequate bowel measurements were obtained in all 379 fetuses. The diameter of the descending colon and rectum plotted as a function of gestational age had a sigmoid curve; the curve estimation was expressed by a cubic regression equation with R(2) of 0.848 and 0.831, respectively (P < 0.0001). The normal mean and the 95% prediction limits were defined. CONCLUSION: The present data provide a normal range of fetal bowel (descending colon and rectum) diameters from the early second trimester of pregnancy onwards. They may allow intrauterine assessment of the development of the fetal colon and may serve as reference values in the detection of anomalies of the fetal bowel.

Adult↗
PubMed1992

Analysis of length and surface area of each segment of the large intestine according to age, sex and physique.

Length, diameter and surface area of each of 6 segments of the large intestine were determined and calculated in 920 Japanese patients who underwent barium enema. Of the length and surface area measurements obtained, those of the transverse colon were the largest, followed by those of the sigmoid colon. The diameter of the ascending colon was the largest, while those of the descending colon and sigmoid colon were the smallest. There were various sex differences in size of the large intestine. Length and surface area of the entire large intestine in males were shorter and smaller respectively than those in females. Lengths of the cecum, ascending colon, transverse colon and rectum in males were shorter than those in females. Diameters of the descending colon, sigmoid colon and rectum in males were larger than those in females. Total surface areas of the ascending colon and transverse colon in males were smaller than those in females, while total surface areas of the descending colon, sigmoid colon and rectum in males were larger than those in females. Length of the entire large intestine tended to be increased with age. Length and surface area of the entire large intestine tended to be increased with an increase in physical dimensions in females.

Adolescent↗
PubMed1981

Trends in the anatomical distribution of colorectal carcinoma in Hawaii, 1960-1978.

The incidence of colorectal adenocarcinoma increased in the five major ethnic groups in Hawaii, but more in men than women. The highest rates were in the Chinese and Japanese. The site-specific time trend patterns revealed that the greatest increase occurred in rectosigmoid cancer, followed by cancer of the sigmoid colon and the transverse descending colon. Rectal cancer had minimal changes in rates over time. The comparison of site-specific rates between the Japanese in Hawaii and Miyagi Prefecture, Japan, showed that the occurrence of cancer of the rectosigmoid, sigmoid, and transverse descending colon was far greater in Hawaii than Miyagi with minimal differences in the rates of rectal cancer. The findings from this study indicate that the separate anatomical locations of colorectal cancer probably have some distinct etiologies that need further investigation.

Adenocarcinoma↗
PubMed1967

Transport of sodium and secretion of potassium and bicarbonate by the colon of normal and sodium-depleted rats.

1. Ascending and descending colonic segments of normal and Na-depleted rats were perfused in vivo with isotonic solutions of varying Na concentration and the unidirectional Na fluxes and secretion rate of K and bicarbonate and the transmucosal electrical p.d. were measured.2. Potential difference was greater in Na-depleted rats, especially towards the distal end of the descending colon. With reduction of luminal Na concentration, p.d. was reduced.3. The ascending and descending segments were similar in regard to Na transport except that the latter had lower passive permeability. Na depletion caused an increase of Na influx rate, Na net flux rate and Na exchange diffusion whilst the mucosal passive Na permeability decreased. These changes resulted in a reduction in the critical luminal Na concentration, i.e. the concentration at which the unidirectional fluxes were equal.4. K secretion rate was similar in the ascending and descending colon and was increased by Na depletion. In all rats, it was reduced when the luminal Na concentration was low.5. Bicarbonate secretion rate was unaffected by the Na depletion and all solutions remained isotonic during perfusion.6. The results confirmed that active Na transport was stimulated by Na depletion but indicated that this was probably not the only factor in the elevation of transmucosal p.d.

Journal Article↗
PubMed1992

Incidence and mortality of carcinoids of the colon. Data from the Connecticut Tumor Registry.

The aims of this study were to calculate the true incidence of colonic carcinoids in Connecticut from 1976 to 1986 and to determine the outcome of patients with these lesions. Fifty-four patients with carcinoids of the colon were identified (23 male and 31 female patients). Their average age was 64.1 +/- 2.1 years, with a range of 12 to 83 years. The age-adjusted incidence was 0.31 cases/100,000 population/year. Forty-eight percent of the carcinoids were located in the cecum; 16%, ascending colon; 6%, transverse colon; 11%, descending colon; 13%, sigmoid colon; and 6%, not assigned. Follow-up information was available in all cases. The crude 2-year survival rate was 63%, whereas the 5-year survival rate was 37%. Only one of six (16.6%) lesions that were 2 cm or smaller metastasized, whereas 23 of 31 lesions larger than 2 cm metastasized (74%). Six patients have survived an average of 43.5 months after local excision of their carcinoids. Fourteen patients died of their carcinoids. Metachronous gastrointestinal malignant neoplasms developed in six patients. These results suggest that, when found at an early stage, carcinoids of the colon (2 cm or smaller) can be treated by local excision. The vast majority of colonic carcinoids, however, are discovered at an advanced stage and should be treated aggressively with standard colonic resection. In addition, surveillance of the entire gastrointestinal tract should be initiated in these patients because of a high rate of other gastrointestinal malignant neoplasms.

Adolescent↗
PubMedDate not supplied

Colitis in Behçet's disease: characteristics on double-contrast barium enema examination in 20 patients.

We performed a retrospective review of double-contrast barium enema examinations of 20 patients with clinically proven Behçet's colitis. Main lesion was ovoid or geographic ulcers with a mean diameter of 2.7 cm. The number of ulcers was single in 15 cases and multiple in five. On six resected specimens, ulcers involved submucosa in three, muscle layer in one, and serosa in two cases with an undermining tendency and transmural inflammation. Aphthous ulcers were present in three cases. Neither perforation nor fistula was demonstrated. In all 20 patients, the ulcer was localized in the ileocecal area, with extension to the ascending colon in seven. Skip lesions were observed in the transverse colon and descending colon in three cases. Destruction of surrounding mucosa resulted in cecal contraction in 19 cases, widening of the ileocecal valve in 19, and fold thickening in the terminal ileum in 12. Six cases (30%) manifested as ileocecal mass accompanied by ulcer, fold thickening, and adjacent mucosal deformity. The appendix was visualized in only three (20%) of the 15 patients with no history of appendectomy. On follow-up study of 15 cases, the ulcers disappeared or decreased in size in 13 cases (86%) and the mucosal deformity was not improved in all cases. On the basis of our results, we believe that the characteristic findings of colitis in Behçet's disease in barium enema examination are ovoid or geographic, relatively large, and deep ulcerations with persistent surrounding deformity which tend to localize in the ileocecal area.

Adolescent↗
PubMedDate not supplied

Sonographic assessment of the normal and abnormal bowel wall in nondiverticular ileitis and colitis.

BACKGROUND: To assess the value of high resolution sonography (HRS) in identifying normal and inflammatory bowel wall in nondiverticular ileitis and colitis by using a segment-by-segment analysis. METHODS: Thirty-five HRS were performed in patients with nondiverticular inflammatory bowel disease, without knowledge of clinical, endoscopic, and radiologic data. HRS evaluated separately five intestinal segments (terminal ileum, cecum/ascending colon, transverse, descending colon, and sigmoid colon) and was considered positive for inflammation when wall thickness during compression exceeded 3 mm. We compared HRS findings with results of endoscopy or enteroclysis performed within 8 days of HRS; endoscopic and radiologic results were classified into two subgroups: mild inflammatory lesions and frank inflammatory lesions. RESULTS: Segment-by-segment analysis resulted in an accuracy of 81%, a sensitivity of 70%, and a specificity of 93%. Sensitivity was significantly lower for mild lesions (52%) than for frank lesions (87%, p < .001). Of the 32 patients having an inflammatory bowel condition, 29 (91%) had at least one segment correctly identified as inflammatory by HRS. CONCLUSION: Even if relatively insensitive for minor lesions, HRS is a promising, minimally invasive method for assessing normal and inflammatory bowel wall in nondiverticular ileitis and colitis.

Adolescent↗
PubMed2005

Right- and left-sided colorectal cancers display distinct expression profiles and the anatomical stratification allows a high accuracy prediction of lymph node metastasis.

Accurate preoperative prediction of lymph node metastasis and degree of tumor invasion would facilitate an appropriate decision of the extent of surgical resection of cancers to reduce unnecessary complication or to minimize the risk of recurrence in patients. We analyzed gene expression profiles characteristic of the invasiveness of colorectal carcinoma in a total of 89 cases, using a cDNA array and pattern classification algorithms. We set binary classes for a panel of clinicopathologic parameters, each of which was divided at different levels for categories (discrete) or values (continuous). We searched an optimal combination of genes to discriminate the classes by using of a feature subset selection algorithm, which was applied to a set of genes preselected on the basis of statistical difference in expression (two-sided t test, P < or = 0.05). We used a sequential forward feature selection which additively searched a combination of genes, giving a minimal leave-one-out classification error rate of a k-nearest neighbor classifier. In the process of gene preselection, we found a remarkable difference in the expression pattern of genes according to the anatomical location of cancers. The difference was most prominent when the classes were set for cecum, ascending colon, transverse colon, and descending colon (CATD) versus sigmoid colon and rectum (SR). By stratifying these two locations, we were able to extract gene expression profiles characteristic of the classes of the presence versus absence of lymph node metastasis, lymphatic invasion, vascular invasion and degree of mural invasion, and pathological stages, with an accuracy of more than 90%. These results suggest that colorectal cancers harbor distinct molecular pathophysiological statuses according to their right-to-left locations, of which stratification is important for pattern classification of cDNA array data.

Adult↗
PubMed1998

Surgical management of left colon obstruction: the University of Minnesota experience.

BACKGROUND: Management of left-sided colonic obstruction is a surgical challenge. This study was performed to review our management of patients with left colon obstruction presenting to the University of Minnesota Hospitals over a 10-year period, 1985 to 1994. STUDY DESIGN: We did a retrospective chart review of 143 patients (48 male and 95 female; mean age 70 years). RESULTS: Sites of obstruction were rectosigmoid, 40%; sigmoid colon, 47%; descending colon, 5%; and splenic flexure, 8%. Fifty-two percent of patients had obstructing colorectal cancer. Two patients presented with generalized peritonitis secondary to colonic perforation. The majority (n = 121, 85%) of patients underwent resection (subtotal in 39 [32%], and segmental in 82 [68%]) and anastomosis in a single stage after appropriate resuscitation. Intraoperative colonic cleansing was undertaken in 40 patients (28%). Morbidity within 30 days of operation was 11%, including 1 anastomotic leak, and mortality was 3%. The 4 deaths occurred in patients over 75 years of age and were not from anastomotic complications. CONCLUSIONS: A single stage resection and an anastomosis facilitated by intraoperative colonic cleansing in one-third of cases was performed in 85% of patients presenting with left colon obstruction. One anastomotic leak occurred. Our current policy of strongly favoring a single stage, definitive operation for patients presenting with left colon obstruction appears reasonable on the basis of this retrospective review of our experience.

Adult↗
PubMed1974

Glycosidases heterogeneity among dimethylhydrazine induced rat colonic tumours.

Activities of N-acetyl-β-D-glucosaminidase, N-acetyl-β-D-galactosaminidase, β-D-galactosidase and α-L-fucosidase were measured in rat colonic tumours induced by 1,2-dimethylhydrazine. Tumours varied considerably in their enzyme content, not only from different animals but also from the same animals. Enzymatic heterogeneity among tumours appeared to be related to their site of origin in the colon. The descending colon, which after the DMH treatment showed a significant increase in the levels of glycosidases, also gave rise to a larger number of adenocarcinomata than other parts of the colon. The relative changes in the activities of four glycosidases seemed to show a good correlation.

Animals↗
PubMed2003

Identification of a novel type IV pilus gene cluster required for gastrointestinal colonization of Citrobacter rodentium.

Citrobacter rodentium is used as an in vivo model system for clinically significant enteric pathogens such as enterohaemorrhagic Escherichia coli (EHEC) and enteropathogenic E. coli (EPEC). These pathogens all colonize the lumen side of the host gastrointestinal tract via attaching and effacing (A/E) lesion formation. In order to identify genes required for the colonization of A/E-forming pathogens, a library of signature-tagged transposon mutants of C. rodentium was constructed and screened in mice. Of the 576 mutants tested, 14 were attenuated in their ability to colonize the descending colon. Of these, eight mapped to the locus of enterocyte effacement (LEE), which is required for the formation of A/E lesions, underlying the importance of this mechanism for pathogenesis. Another mutant, P5H2, was found to have a transposon insertion in an open reading frame that has strong similarity to type IV pilus nucleotide-binding proteins. The region flanking the transposon insertion was sequenced, identifying a cluster of 12 genes that encode the first described pilus of C. rodentium (named colonization factor Citrobacter, CFC). The proteins encoded by cfc genes have identity to proteins of the type IV COF pilus of enterotoxigenic E. coli (ETEC), the toxin co-regulated pilus of Vibrio cholerae and the bundle-forming pilus of EPEC. A non-polar mutation in cfcI, complementation of this strain with wild-type cfcI and complementation of strain P5H2 with wild-type cfcH confirmed that these genes are required for colonization of the gastrointestinal tract by C. rodentium. Thus, CFC provides a convenient model to study type IV pilus-mediated pathogen-host interactions under physiological conditions in the natural colonic environment.

Amino Acid Sequence↗
PubMed1985

Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency.

In a prospective study, the occurrence of angiodysplasia was investigated by total colonoscopy in 1938 patients. Angiodysplasia was found in 59 patients, i.e. 3%. 12 out of 59 patients were admitted for acute or chronic peranal hemorrhage or anemia. 47 out of 59 patients were asymptomatic. The site of the lesions was as follows: cecum 37%, ascending colon 17%, transverse colon 7%, descending colon 7%, sigmoid colon 18% and rectum 14%. Histological confirmation was obtained in 15 out of 37 biopsies. The endoscopic appearance was variable, most of the vascular dilatations being smaller than 5 mm (n = 47), with a homogeneous (n = 35) or inhomogeneous (n = 24) structure and a regular (n = 34) or irregular (n = 25) border. The lesions were single (n = 34) as well as multiple (n = 25), they were usually flat (n = 54), seldom slightly prominent (n = 5). Concomitant pathological findings in the bowel were diagnosed in 33 out of 59 patients: diverticula in 32%, adenomas in 24% and carcinomas in 8.5%. Right hemicolectomy for bleeding angiodysplasia is indicated only if endoscopic therapy has failed and other colorectal sources of bleeding, and especially angiodysplasia in the left colon and rectum have been excluded by endoscopy or angiography.

Adolescent↗
PubMed2002

Malakoplakia in association with colorectal carcinoma: a series of four cases.

AIMS: Malakoplakia is a characteristic inflammatory condition which is usually seen in the urogenital tract. Gastrointestinal malakoplakia is seen in association with a variety of conditions such as ulcerative colitis, diverticular disease, adenomatous polyps and carcinoma. The purpose of this paper is to report four additional cases of colorectal cancer associated with malakoplakia and review the literature on this association. METHODS: All specimens were colectomies for cancer. Routine handling of the specimen with lymph node harvesting was performed. In addition to H&E stains, PAS, Perls' Prussian Blue and von Kossa stains were performed. RESULTS: Three of the cases were encountered in males and the patients ranged in age from 55 to 64 years. One case each occurred in the caecum/ascending colon and descending colon, while the remaining two were located in the rectum. All four cases were Dukes' stage B tumours. Furthermore, all four cases had spread to pericolic fat and two had perforated. Microscopic examination showed the malakoplakia to be present at the infiltrating edge of the tumours. The draining lymph nodes were involved by malakoplakia to varying degrees in all cases. CONCLUSIONS: From this series and the literature review, malakoplakia associated with colorectal cancer tends to occur in elderly males in the rectum. The malakoplakia is found at the infiltrating front of the tumour and is not admixed with the neoplastic glands. Although lymph node involvement by malakoplakia has been reported only once previously, all four cases in this series showed evidence of involvement. The association does not appear to have any prognostic significance.

Carcinoma, Ductal, Breast↗
PubMedDate not supplied

Radiographic contrast gastrointestinal study of the neonatal llama.

This is a description of the radiographic appearance of the normal gastrointestinal tract of neonatal crias with survey and contrast radiography, including transit times for the various segments of the gastrointestinal tract. Radiographs of the abdomen of six healthy neonatal llama crias positioned in right lateral and dorsal recombency were obtained initially then at various intervals post barium administration. Portions of the gastrointestinal tract that could be identified included the stomach with first, second and third compartments, the duodenal ampulla, small intestine, proximal loop of the ascending colon, spiral colon and descending colon. Barium given by orogastric intubation rapidly entered all three compartments of the stomach and the proximal small intestine. Overall the transit time through the intestinal tract of the crias was longer than expected with no emptying of the ascending colon and beyond though studies were carried to 48-72 hours. Recommendations are made for frequency of radiographs.

Ampulla of Vater↗
PubMed1996

Intimin from enteropathogenic Escherichia coli restores murine virulence to a Citrobacter rodentium eaeA mutant: induction of an immunoglobulin A response to intimin and EspB.

The formation of attaching and effacing (A/E) lesions is central to the pathogenesis of enteropathogenic Escherichia coli (EPEC)-mediated disease in humans and Citrobacter rodentium (formerly C. freundii biotype 4280)-mediated transmissible colonic hyperplasia in mice. Closely related outer membrane proteins, known as intimins, are required for formation of the A/E lesion by both EPEC (Int(EPEC)) and C. rodentium (Int(CR)). A secreted protein, EspB (formally EaeB), is also necessary for A/E-lesion formation. Here we report that expression of a cloned Int(EPEC), encoded by plasmid pCVD438, restores murine virulence to an intimin-deficient mutant of C. rodentium DBS255. Replacement of Cys937 with Ala abolished the ability of the cloned EPEC intimin to complement the deletion mutation in DBS255. Ultrastructural examination of tissues from wild-type C. rodentium and DBS255(pCVD438)-infected mice revealed multiple A/E lesion on infected cells and loss of contact between enterocytes and basement membrane. Histological investigation showed that although both wild-type C. rodentium and DBS255(pCVD438) colonized the descending colon and induced colonic hyperplasia in orally infected 21-day-old mice, the latter strain adhered to epithelial cells located deeper within crypts. Nonetheless, infection with the wild-type strain was consistently more virulent, as indicated by a higher mortality rate. All the surviving mice, challenged with either wild-type C. rodentium or DBS255(pCVD438), developed a mucosal immunoglobulin A response to intimin and EspB. These results show that C. rodentium infection provides a relevant, simple, and economic model to investigate the role of EPEC proteins in the formation of A/E lesions in vivo and in intestinal disease.

Adhesins, Bacterial↗
PubMed1989

Epidemiological evidence for distinguishing subsites of colorectal cancer.

The registry of digestive tract tumours established for the department of Cote d'Or (France) was used to study the epidemiological characteristics of large bowel cancer subsites for the period 1976-1983. Age standardised incidence rates for colon cancers were 18.9/100,000 for men and 14.2/100,000 for women. The corresponding rates for rectal cancers were 18.4/100,000 and 10.2/100,000. The sex ratio for right colon cancer (caecum, ascending colon, hepatic flexure, transverse, splenic flexure) was close to 1 and did not change with advancing age, while that for the left colon (sigmoid, descending colon) showed a male excess after 65. For rectal cancer (rectosigmoid junction, rectal ampulla) the male predominance was more marked and occurred earlier, after 55 years of age. There was no significant variation in incidence between rural and urban areas for the different sublocalisations. In males the risk was high in the highest social classes for left colon cancer (p less than 0.01), and among farmers for rectal cancer (p less than 0.01). The risk of left colon cancer in males increased with the comfort of housing (p less than 0.01), but this marker of social class had little influence on incidence for the other localisations in males, or for any localisation in females. No significant variation was found with education. The incidence of colon cancer tended to increase over the 8 years of study. The variations were significant for left colon cancer. For rectal subsites cancer incidence decreased in women (p less than 0.05). The observed differences suggest differences in the aetiological factors within large bowel cancers. Therefore right colon cancer, left colon cancer and rectal cancer should be considered separately in epidemiological analytical investigations.

Aged↗