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PubMed2005

Rectosigmoid findings are not associated with proximal colon cancer: analysis of 6 196 consecutive cases undergoing total colonoscopy.

AIM: To review the risk of proximal colon cancer in patients undergoing colonoscopy. METHODS: We estimated the risk of advanced proximal adenomas and cancers in 6 196 consecutive patients that underwent colonoscopy (mean age 60 years, 65% males, without prior history of colorectal examination). Neoplasms were classified as diminutive adenoma (5 mm or less), small adenoma (6-9 mm), advanced adenoma (10 mm or more, with villous component or high-grade dysplasia) and cancer (invasive adenocarcinoma). The sites of neoplasms were defined as rectosigmoid (rectum and sigmoid colon) and proximal colon (from cecum to descending colon). RESULTS: The trend of the prevalence of advanced proximal adenoma was to increase with severe rectosigmoid findings, while the prevalence of proximal colon cancer did not increase with severe rectosigmoid findings. Among the 157 patients with proximal colon cancer, 74% had no neoplasm in the rectosigmoid colon. Multivariate logistic-regression analysis revealed that age was the main predictor of proximal colon cancer and existence of rectosigmoid adenoma was not a predictor of proximal colon cancer. CONCLUSION: Sigmoidoscopy is inadequate for colorectal cancer screening, especially in older populations.

Adenoma↗
PubMed1999

[Enterohemorrhagic colitis: comparison of clinical and CT findings].

Abdominal precontrast CT was performed in 12 patients (5 males, 7 females, 29-81 years, mean age; 57.5 years) with enterohemorrhagic colitis due to Escherichia coli O157:H7. Mural thickening was recognized in the terminal ileum (11/12), cecum (12/12), ascending colon (11/12), transverse colon (7/12), descending colon (2/12), and rectosigmoid colon (1/12). Dirty fat sign, lymphadenopathy, and peritoneal fluid collection were seen in 11, 7, and 5 of the 12 cases, respectively. The CT appearance of enterohemorrhagic colitis is one of moderate to severe circumferential thickening. The bowel wall is heterogeneous because of submucosal edema and hemorrhage. The CT appearance is nonspecific, but the condition is mainly seen in the right colon. Precontrast CT is useful in the screening of enterohemorrhagic colitis, especially in mass outbreaks.

Adult↗
PubMed2002

Relationship between degree of cellular differentiation in colorectal cancer and topographical distribution.

OBJECTIVES: To demonstrate the relationship between degree of cellular differentiation in colorectal cancer and topographical distribution in 215 patients diagnosed with colorectal cancer from 1997 to 2000. MATERIAL AND METHODS: 215 patients (129 men and 86 women) were studied prospectively with a mean age of 64 years (range: 23-84 years). In all patients we performed a full colonoscopy with several biopsies (in patients with colon stenosis we used barium enema), radiographic studies (CT, abdominal ultrasounds), and laboratory tests for serum tumour markers (CEA, Ca 19-9, alpha-fetoprotein). The topographic location of colorectal cancer was: rectum 35%, sigmoid colon 31%, descending colon 10%, transverse colon 6%, ascending colon 9%, caecum 5%, and we included anorectal cancer 4%. RESULTS: According to histological differentiation we found: A) well-differentiated tumours 101/215 (47%); B) moderately-differentiated tumours 98/215 (45.5%), and C) poorly-differentiated tumours 16/215 (7.5%). We found no significant association among histological differentiation, topographic location, stage according to the Astler-Coller classification, sex or age (p = ns). The prevalence of well-differentiated tumours in men was 49% and 43% in women; of moderately-differentiated cancers in men was 43%, and 49% in women; for poorly-differentiated tumours in men was 7.5%, and 7.2% in women. Regarding tumour location, 165 cancers were found in the left colon: 80 were well differentiated, 77 moderately differentiated and 8 poorly differentiated. In the transverse colon we found 12 tumours: 7 well differentiated, 3 moderately differentiated and 2 poorly differentiated. 30 cancers were localized in the right colon: 11 well differentiated, 15 moderately differentiated and 4 poorly differentiated. In the anorectum 8 tumours were found: 3 well differentiated, 3 moderately differentiated and 2 poorly differentiated. According to staging classification, well differentiated tumours (101/215) were more common in Dukes' C2 (20.7%) and B1 (32.6%), moderately differentiated cancers (98/215) were in B1 (28.5%) and C2 (20.4%), and poorly differentiated tumours (16) were more common in Dukes' C2 (25%), without differences among other stages (p = ns). CONCLUSIONS: According to our results we have found that histological differentiation of colorectal cancer has no association with topographic location, and it is independent of sex or age. We have not found any relationship either between histological differentiation and stage in the Astler-Coller classification, but well differentiated cancers were more common at any location, age or sex.

Adult↗
PubMed1992

Colorectal polyps in autopsy material. Part I. Adenomatous polyps.

In prospective studies specimens of the large bowel were obtained from 733 autopsy cases. After fixing they were examined under illuminated magnifying lens and all polypous lesions were excised for histological analysis and classified according to Correa's criteria (8). Adenomatous polyps were found in 280 cases (38.2%) and their prevalence increased with age in both sexes. Adenomatous polyps, also multiple were found most frequently in the transverse colon, and then ascending colon, sigmoid, descending colon and rectum. The mean number of adenomatous polyps per positive specimen was 2.33 for men and 2.60 for women. In 6.8% their diameter was > or = 10 mm. The prevalence of polyps with severe degree of dysplasia (III degree) increased from proximal to distal segments of the colon in both sexes and their prevalence is significantly higher in the ascending colon in women. In the whole series there were 6 adenocarcinomas of 5-18 mm in size, all in women over 80 years of age. The results of the present study were compared with the data concerning other populations of the world. In the light of a repeatedly confirmed a generally accepted relationship between adenoma and adenocarcinoma of the large intestine the results of our study seem to underestimate the prevalence of colon adenocarcinoma in the population of Cracow and Cracow district.

Adenocarcinoma↗
PubMed2004

Clinical characteristics of colorectal polyp in Thai children: a retrospective study.

BACKGROUND: It was believed that more than 90 per cent of children with colorectal polyp had a single lesion, located in the rectosigmoid colon, therefore, sigmoidoscopy with polypectomy was the treatment of choice. After a wide use of pediatric colonoscopy, this concept has been changed. MATERIAL AND METHOD: This study was aimed to describe clinical characteristics of colorectal polyp in Thai children. Medical records of children with colorectal polyp were retrospectively reviewed. Comparison between polyposis coli and children with less than 5 polyps were also analyzed. RESULTS: There were 93 patients, 43 females and 50 males. The average age was 5.1 years. Lower GI bleeding and prolapse of rectal polyp comprised the two most common presentations, 93.5 and 39.8 per cent, respectively. The mean duration of symptoms was 5.6 months. Only 50.6 per cent had rectal polyp noted by digital examination. Investigations included sigmoidoscopy (n = 77), colonoscopy (n = 16), and barium enema (n = 16). Eight per cent of the cases had more than 5 polyps. Location of the polyps was noted in the rectosigmoid colon (88.2%), descending colon (4.3%), right-sided colon (4.3%), and pancolonic (3.2%). Of all the patients, 11.8 per cent had the polyp above the rectosigmoid region, whereas 50 per cent of those who underwent colonoscopy (n = 16) had the polyps noted proximal to this region. Older age, lower hematocrit, and more frequent right-sided polyps were significantly associated with polyposis coli (p < 0.05). Only 2 patients with polyposis coli were treated by colectomy. Histopathology included juvenile polyp (95%), inflammatory pseudopolyp (2.5%), and hyperplastic polyp (2.5%). CONCLUSION: Most of the children with colorectal polyp had juvenile polyp that is commonly found in the rectosigmoid colon. However, a significant number of patients had carrying polyps proximal to the rectosigmoid region, which would be easily missed by sigmoidoscopy. With the concern of malignancy change particularly in children with polyposis coli, routine colonoscopy should be considered as an initial investigation in children with colorectal polyp.

Adenomatous Polyposis Coli↗
PubMed1991

Submucous large-bowel lipomas--presentation and management. An 18-year study.

Gastrointestinal lipomas are rare, but commonest in the colon and rectum, characteristically submucosal and seldom subserosal. An 18-year analysis revealed 17 cases of large-bowel lipoma, 13 presenting with colicky pain, abdominal discomfort, blood-stained feces or rectal bleeding and altered bowel habits and four asymptomatic. The 17 patients had totally 21 lipomas, all submucosal. No patients with multiple lipoma had evidence of lipoma at other sites. The ileocecal valve and cecum were most commonly affected, followed by the rectum, sigmoid colon and descending colon. Tumor size (largest diameter) was 0.5-10 cm, averaging 3.1 cm (3.5 cm in symptomatic, and 1.8 cm in asymptomatic patients). The primary diagnosis (with barium enema, colonoscopy and CT) was lipoma in only five cases, but CT gave the correct diagnosis in all three cases in which it was used. Two lipomas were found in surgical specimens from colorectal malignancy, while nine were misinterpreted as polyps and one as angiodysplasia. In symptomatic patients unnecessary colotomy or colonic resection may be avoidable by colonscopic removal of lipoma.

Adult↗
PubMed1988

The laser: an alternative for palliative treatment of obstructing intraluminal lesions.

Twenty nine patients with carcinoma obstructing the colon, six obstructing the gastroesophageal junction, six obstructing the tracheobronchial tree, and one patient with recurrent transitional cell cancer of the bladder invading the rectum, not amenable to surgical resection, were treated by laser photocoagulation. Forty were treated with the Nd:YAG laser and two with the CO2 laser. There were 26 men and 16 women with an average age of 73.8 years. The locations of the tumors were 17 rectal, six rectosigmoid, one transverse colon, two descending colon, four ascending colon, six gastroesophageal, and six in the tracheobronchial tree. Symptoms consisted of obstruction and/or bleeding. Seventeen patients were poor surgical candidates, 25 were unresectable due to widespread disease, two had recurrence at the anastomosis, and three patients had another primary site not controlled by their previous surgical procedure. There were seven complications--three perforations, a rectovaginal fistula, two failures in therapy, and lower GI bleeding. Nineteen patients have died of their disease. Tumors were eradicated in two patients. Forty patients had remained free of referring symptoms of obstruction and bleeding.

Adenocarcinoma↗
PubMed1988

[Total and segmental colonic transit times. Measurements by radio-opaque markers].

Measurement of the transit time by addition of a marker to the natural alimentary bolus permits an overall evaluation of colonic motricity. Bismuth and barium salts, dyes and radioactive compounds have been used, each of these methods having its own drawbacks, such as insufficient or impossible quantification, influence on transit or partial intestinal absorption. Radio-opaque pellets do not modify transit, are not absorbed, provide quantification readily and measure transit selectively in the ascending colon, the descending colon, the sigmoid colon and the rectum. The progression of pellets is followed by radiography of the abdomen. The number of radiograms can be reduced to 3 or even 1 by graded administration of the pellets over 3 consecutive days. The results obtained in normal subjects are similar in different studies; they are not influenced by age or by the amount of fibrous material present in food. Total and right segmental transit times are longer in women than in men. Measurement of the colonic transit time is indicated in severe constipation to differentiate between colonic inertia and terminal obstruction which have different mechanisms and treatments. Such measurements are also useful for an objective evaluation of constipation.

Colon↗
PubMed1985

[Colonic cancers. Results of surgical treatment and prognosis. 579 cases].

Between 1964 and 1981, 579 patients were operated upon for carcinoma of the colon. Hepatic and/or peritoneal metastases were present in 17.3%. Excision was performed in 530 cases (91.5%). Carcinomas of the left colon were usually treated by segmental resection. The peritoneum and lymph nodes were involved in 21.7% and 31% respectively of the patients who underwent resection. There were 6 post-operative deaths: 2 after exploratory or derivative surgery and 4 after excision of the tumour. All but 8 of the 395 patients operated upon before 1978 were followed up; 229 survived for more than 5 years, 58% of all operated patients and 63.6% of those who had their tumour excised. The 5-year survival rate was 6% after palliative excision and 73.6% after curative excision (caecum and ascending colon: 81%; transverse colon: 83%; descending colon: 65%; sigmoid flexure: 70.7%). Tumoral invasion in depth and lymph node involvement had a significant influence on prognosis. Based on Dukes' classification, the 5-year survival rates for stages A, B, C and D tumours were 89%, 75.4%, 54% and 6% respectively. The time elapsed between the first symptoms and the operation did not alter the prognosis which was slightly better in women and in young patients.

Adult↗
PubMed1986

[The importance of the mesocolon in the occurrence of liver metastasis from primary colorectal carcinomas].

The frequency of liver metastasis was analyzed in 1,558 patients with primary colorectal carcinomas. The highest frequency of liver metastasis occurred in carcinomas of the transverse colon (17%) and the sigmoid colon (15%), when compared to the other segments, such as the cecum (10%), ascending colon (9%), descending colon (6%), rectum (9%) and anal canal (0%). It would appear that carcinoma located in those segments of the human colorectum containing any portion of the mesocolon are more prone to metastasize into the liver.

Colonic Neoplasms↗
PubMed1994

Morphometric analysis of enteric lesions in C3H/HeN mice inoculated with Serpulina hyodysenteriae serotypes 2 and 4 with or without oral streptomycin pretreatment.

The segmental distribution and sequential progression and the role of the indigenous bacterial flora in the development of enteric lesions associated with Serpulina hyodysenteriae infection in laboratory mice have not been defined. We examined the distribution and sequential morphometric changes in the large intestine of mice orally inoculated with S. hyodysenteriae serotypes 2 and 4. To determine the role of colonization resistance conferred by the indigenous bacterial flora, 40 female C3H/HeN mice were administered water alone or water containing 5 mg/mL streptomycin sulfate ad libitum for seven days prior to orogastric inoculation either with S. hyodysenteriae or sterile trypticase soy broth (TSB). Clinical signs were monitored daily and three mice per group were necropsied on postinoculation days (PID) 7 and 14 for pathological assessment of the cecum, proximal colon, transverse colon, and descending colon, and bacteriological culture of the cecum for S. hyodysenteriae. Weekly pooled fecal samples were collected from each group for determination of total numbers of anaerobe bacteria. Gross examination revealed soft fecal pellets on PID 7 and 14 and catarrhal typhlitis on PID 14, irrespective of streptomycin pretreatment. The recovery rates of S. hyodysenteriae from the ceca of serotype 2- and serotype 4-inoculated mice was 100 and 91.7%, respectively. Statistically significant differences in morphometric changes between TSB- and S. hyodysenteriae-inoculated mice were present on PID 7 and 14 and were restricted to the cecum. Although oral administration of streptomycin for seven days prior to S. hyodysenteriae inoculation resulted in a significant reduction in the numbers of fecal anaerobes, it did not affect the colonization, distribution, severity, or progression of cecal lesions.

Animals↗
PubMed1997

[Delayed traumatic hernia diagnosed with magnetic resonance imaging].

A 30-year-old man was admitted to the hospital 7 years after an automobile accident during which a lumbar vertebra was fractured. Immediately after the accident he had neither thoracic nor abdominal symptoms. An X-ray film obtained 4 years after the accident showed elevation of the left side of the diaphragm. That elevation progressed over the next 3 years, although the patient had no symptoms. On admission, a chest X-ray film showed blunting of the left costo-phrenic angle and mobility of the shadow, which simulated a pleural effusion. A chest CT scan and barium studies showed that portions of the small intestine, transverse colon and descending colon were in the left side of the thorax, but the diaphragm was not seen. The patient was given a diagnosis of delayed traumatic diaphragmatic hernia after T1-weighted sagittsal magentic resonance images revealed the whole diaphragm and the hernial orifice. Magnetic resonance imaging can be very useful in the evaluation of diaphragmatic hernia.

Adult↗
PubMed1989

The role of the pelvic nerves in the realization of the reservoir function of the colon.

In situ experiments were made on a group of dogs and in vivo experiments on another group of dogs with implanted electrodes for recording the electrical activity of the colonic muscle wall. A bipolar platinum electrode implanted in the pelvic nerve entering into the distal area of descending colon was used for electrical stimulation of the nerve (1 ms impulse duration, frequency of 2, 8, 10 and 15 Hz and amplitude of 10, 15 or 20 V). Electrical stimulation of the pelvic nerve with a frequency of 2 Hz resulted in inhibition of the spike activity. However, groups of spike potential burst in the distal part of the descending colon in response to electrical stimulation with frequencies of 8, 10 or 15 Hz. Repeated stimulation caused spreading of the spike activity of the descending colon in oral direction until the transverse colon. These antiperistaltic waves probably prevented the propulsion of the content of the descending colon. Thus, in addition to the inhibitory effect exercised by the sympathetic and noncholinergic nonadrenergic inhibitory part of the intrinsic nervous system, the reservoir function of the colon is influenced by these orally spreading waves of spike activity (antiperistaltic waves), which are caused by impulses along the pelvic nerves.

Animals↗
PubMed1996

NHE2 and NHE3 are human and rabbit intestinal brush-border proteins.

Rabbit NHE2 and NHE3 are two epithelial isoform Na+/H+ exchangers (NHE), the messages for which are found predominantly and entirely, respectively, in renal, intestinal, and gastric mucosa. The current studies used Western analysis and immunohistochemistry to identify and characterize the apical vs. basolateral membrane distribution of NHE2 and NHE3 in intestinal epithelial cells. Based on Western analysis, NHE2 and NHE3 both are present in brush-border but not basolateral membranes of small intestine. Both NHE2 and NHE3 are 85-kDa proteins. Consistent with Western analysis, NHE2 and NHE3 are immunolocalired to the brush-border but not basolateral membranes of villus epithelial cells, but not goblet cells, in human jejunum and ileum and in surface epithelial cells in the ascending and descending colon and rectum. In addition, NHE2 and NHE3 are present in small amounts in the crypt cell brush border of human jejunum, ileum, ascending and descending colon, and rectum. In rabbit jejunum, ileum, and ascending colon, NHE2 and NHE3 are present in the brush border of epithelial and not goblet cells, again much more in the villus (small intestine)/ surface cells (colon) than the crypt. NHE2 but not NHE3 is present in the brush border of rabbit descending colon surface cells and in small amounts in crypt cells. NHE2 and NHE3 are both human and rabbit small intestinal and colonic epithelial cell brush-border Na+/H+ exchanger isoforms that colocalize in all intestinal segments except rabbit descending colon, which lacks NHE3.

Animals↗
PubMed1995

Adjuvant radiotherapy and anastomosis in rectal cancer--disturbing evidence from animal studies.

PURPOSE: Adjuvant radiotherapy is used increasingly in the management of rectal cancer. However, ionizing radiation is mutagenic, and, superimposed on a background of increased cellular proliferation as seen around anastomoses and in colorectal cancer patients, there is the potential for enhanced metachronous cancer risk. METHOD: The influence of preoperative irradiation on both carcinogenesis and cellular proliferation at colonic anastomoses was explored in 180 adult male F344 rats. Orthovoltage x-rays were delivered to the distal descending colon by parallel opposed fields. Ninety rats received 16 Gy in one fraction; the remainder received 36 Gy in two fractions one week apart. In each irradiation group 18 rats either acted as controls or one week after radiotherapy underwent distal colotomy and repair. RESULTS: We found the descending colon susceptible to radiation carcinogenesis; 26 colorectal tumors developed in the low-dose irradiation group and 47 in the high-dose group (P = 0.0008; Mann-Whitney U test, 16 vs. 36 Gy). Preferential tumor development was seen in the anastomotic region. In those animals that underwent surgery and irradiation, among the low-dose irradiation group only 3 of 72 had tumors within the descending colon compared with 21 of 72 at the anastomotic site (McNemar's test chi-squared = 40.9; P < 0.001), and in the high-dose irradiation group 5 of 72 had tumors within the descending colon compared with 36 of 72 at the anastomotic site (McNemar's test chi-squared = 22.0; P < 0.001). Anastomotic crypt cell production rates were increased for at least three months following exposure to irradiation (16 Gy: f = 15.1, P < 0.005; 32 Gy: f = 9.4, P < 0.005). CONCLUSIONS: Radiation carcinogenesis is greatly enhanced at colonic anastomoses and may result from altered anastomotic proliferation. This has potentially disturbing implications in view of the increasing use of adjuvant radiotherapy for rectal carcinoma.

Adenocarcinoma↗
PubMed2004

The development of large intestine during the fetal period.

OBJECTIVE: The aim of this study is to determine the colon types, developmental change of the colon morphology during the fetal period. METHODS: The study was realised on 131 human fetuses (male 69, female 62) ages between 10 and 40 weeks, which have no external pathology and anomalies. The colon types were evaluated in two parts. As the first part, the colon part between the ileal orifice and sigmoid colon was typed. The sigmoid colon was typed as the second part. The macroscopic diameters of parts of the colon and the thicknesses of wall layers of ascending and descending colons were measured under the light microscope. RESULTS: For the proximal part of the colon, there were seven types of colon, and there were five types for the sigmoid colon. For the first part, transverse type colon was a rare type during the fetal period (3%). The oblique type colon was observed mostly in the first and second trimester during the fetal period. Adult type colon was the most common type in the third trimester and full-term groups. The pendulous type colon was observed mostly in the third trimester. The development of the haustra and tenia coli in the first trimester was quite slow, but later the development increased more and more, and during the full-term period, the haustra and tenia coli could be seen clearly. CONCLUSION: The percentage distribution of the colon types between the trimesters was significant. It was observed that the maturation of haustra and tenia coli started from the ascending colon and progressed towards the sigmoid colon. The thickness of the tunica mucosa layer both in the ascending and in descending colon part increased considerably in the middle of the second trimester.

Cecum↗
PubMed2006

[A case of Non-Hodgkin's lymphoma in a patient with Crohn's disease].

Although adenocarcinoma is a well known complication of chronic inflammatory bowel disease, primary gastrointestinal lymphoma occurring in Crohn's disease is rare. A 40-year-old man with 10 year-history of Crohn's disease had multiple longitudinal ulcerative lesions on descending colon in follow-up colonoscopic examination. Microscopic examination of proximal descending colon revealed peripheral T cell lymphoma and other site of the descending colon was consistent with Crohn's disease. The patient reached complete remission of malignant lymphoma after three cycles of combined chemotherapy. He has been well for 10 months with sulfasalazine maintenance therapy but was admitted to the hospital due to spontaneous bowel perforation of ascending colon. Right hemicolectomy was done, but the patient died of post-surgical recurrent mesenteric abscess and sepsis. To the best of our knowledge, this is the first case of Non-Hodgkin's lymphoma complicating Crohn's disease in Korea which was confirmed by immunohistochemical studies.

Adult↗
PubMed1990

Colonic sodium-potassium adenosine triphosphate subunit gene expression: ontogeny and regulation by adrenocortical steroids.

Mineralocorticoids and glucocorticoids exhibit overlapping but distinct effects on transepithelial sodium transport in the descending colon. Na,K-ATPase, the major sodium pump, has been variously reported to be regulated by one or both classes of steroids. The present studies explore the ontogeny and steroidal regulation of Na,K-ATPase alpha- and beta-subunit mRNA levels in the descending colon. In descending colon, subunit mRNA levels are low before birth, increasing to reach adult levels at approximately day 25. Dexamethasone treatment caused a rapid dose-dependent increase in colonic Na,K-ATPase subunit mRNA levels. The specific glucocorticoid RU26988 also increased subunit mRNA levels. Aldosterone administration, at doses adequate to yield a profound antinatriuresis, did not alter subunit mRNA levels. Carbenoloxone sodium produced an approximately 3-fold increase in subunit mRNA levels in intact but not adrenalectomized rats. We have demonstrated that Na,K-ATPase subunit gene expression is: 1) low in the fetal colon but achieves plateau levels by day 25; 2) acutely regulated by corticosteroids via type II rather than type I receptors; and 3) increased by carbenoxolone sodium, presumably as a result of increased occupancy of the type II receptor by corticosterone.

Adrenal Cortex Hormones↗