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Gene expression patterns distinguish colonoscopically isolated human aberrant crypt foci from normal colonic mucosa.

Aberrant crypt foci (ACF) are considered the earliest identifiable preneoplastic colonic lesions; thus, a greater understanding of the nature of genetic changes underlying the transformation of normal colonic mucosa (NM) into ACF may provide insight into the mechanisms of carcinogenesis. ACF were identified by indigo carmine spraying onto colonic mucosa during colonoscopy and isolated as standard pinch biopsies of the mucosal areas containing the ACF. RNAs isolated from ACF and matched NM biopsies from the ascending and descending colons of 13 patients were analyzed on arrays containing 9128 cDNAs. Thirty-four differentially expressed (P < 0.001) genes were found in a paired comparison of the ACF and NM samples, and 25 of 26 matched pairs of ACF and NM could be correctly classified in leave-one-out cross-validation. Differential expression for seven of eight genes was confirmed by real-time reverse transcription-PCR. Furthermore, ACF and NM samples, including six pairs of ACF and NM samples that had not previously been analyzed by array hybridization, can be correctly classified on the basis of the overexpression in ACF of three selected genes (REG4, SRPN-B5, and TRIM29) evaluated by real-time reverse transcription-PCR. In a separate analysis of 13 biopsy pairs from either ascending or descending colon, ACF and NM samples could also be correctly classified by the gene expression patterns. Analysis of gene expression differences in ACF from the ascending and descending colon versus NM samples indicates that ACF from these distinct colonic locations are converging toward similar gene expression profiles and losing differences in gene expression characteristic of NM from the ascending versus descending colon.

Adult↗

Primary colorectal T-cell lymphoma.

We report here a case of primary colorectal T-cell lymphoma in a 49-year-old man. Eighteen years previously, he was diagnosed as having ulcerative colitis based on the findings of colonoscopy and a barium enema. Since then, he had been treated with salicylazosulfapyridine until the most recent episode. He was refered to our clinic with the chief complaint of abdominal pain and excretion of mucus, and for a workup of bowel lesions. Physical examination results were not remarkable, except for the presence of low-grade fever. Total colonoscopy showed multiple shallow ulcers and aphthoid erosions through the entire colon and rectum, except for the descending colon. Endoscopic findings of the descending colon were normal, which was different from the findings of the active stage of ulcerative colitis. Biopsy specimens from the colon and rectum with ulcerations and aphthoid erosions showed a diffuse proliferation of medium-sized to large atypical lymphoid cells with irregular and indistinct nucleoli, thus revealing malignant lymphoma, diffuse pleomorphic type. The lymphoma cells were positive for CD2, CD3, CD5, CD8, and T-cell receptor (TCR) beta F1, but negative for CD4, CD19, CD20, CD103, and CD56. Southern blotting revealed rearrangement of TCR. Based on these findings, the patient was diagnosed as having high-grade T-cell lymphoma. The findings of computerized tomography of the chest and abdomen, gallium scintigraphy, and abdominal ultrasonography were all normal. There were no abdominal lesions throughout the esophagus, stomach, duodenum, and small intestine. As the patient refused total proctocolectomy, he was treated with one course of CHOP (cyclophosphamide, vincristine, adriamycin, and prednisolone) and subsequently with three courses of ProMACE-CytaBOM (consisting of cyclophosphamide, adriamycin, etoposide, cytarabine, bleomycin, vincristine, methotrexate, and prednisolone). After the therapy, improvement of the colorectal lesions was observed, though lesions clearly still remained. To our knowledge, this is the first case report of primary colorectal T-cell lymphoma with cytotoxic/suppressor T-cell phenotype.

Antineoplastic Combined Chemotherapy Protocols↗

Colorectal transport in normal defaecation.

OBJECTIVE: Colorectal luminal transport during defaecation can be assessed by means of scintigraphy. However, normal values remain to be established and inter- and intra-subjective variation is unknown. The aim of the study was to describe colorectal transport during normal defaecation by means of a new method for colorectal scintigraphy and to determine inter- and intrasubjective variation. METHODS: Thirty healthy volunteers (18 men and 12 women, age 22-46 years; median 31) took 2 MBq 111In on two consecutive days (days 0 and 1). On days 1 and 2 an abdominal scintigraphy was done before and after defaecation. Changes in colorectal contents were computed in two ways: firstly, assuming ordered evacuation, the extent of colorectal emptying was computed; secondly, antegrade and retrograde transport within the colorectum was computed for each colorectal segment. RESULTS: Median colorectal emptying during normal defaecation was 99% of the rectosigmoid (range: 60% of the rectosigmoid to complete emptying of the rectosigmoid, descending colon, transverse colon and 19% of the caecum/ascending colon). There was no difference between men (median 99% of the rectosigmoid) and women (98% of the rectosigmoid). Day to day variation was large (dispersion=52%) with a trend towards larger defaecation on day 2 than on day 1 (P = 0.09). Large antegrade and retrograde movements of colorectal contents were observed within the colorectum during defaecation. Antegrade transport involved the rectosigmoid (median 99%), the descending colon (median 53%), the transverse colon (median 46%), and the caecum/ascending colon (median 11%). Retrograde transport was mainly from the transverse colon and the descending colon. Colorectal emptying was significantly correlated to the subjective description (P < 0.01) but not to total gastrointestinal or segmental colorectal transit times determined by means of radioopaque markers. CONCLUSIONS: Colorectal scintigraphy before and after defaecation provides detailed information about colorectal emptying and intracolonic antegrade or retrograde transport during defaecation. Inter- and intraindividual variations are large and antegrade and retrograde transport within the colorectum is common.

Adult↗

Laparoscopic cryptorchid castration in standing horses.

OBJECTIVE: This article describes a new technique for laparoscopic cryptorchid castration in standing horses. STUDY DESIGN: Prospective study. ANIMALS OR SAMPLE POPULATION: Eight horses aged 11 months to 3 years and weighing between 300 and 643 kg. METHODS: Food was withheld for 24 to 36 hours, and then horses were sedated with detomidine HCl (0.02 to 0.03 mg/kg) and butorphanol tartrate (0.02 mg/kg). The paralumbar fossa region was desensitized with 2% mepivacaine in an inverted "L" pattern and caudal epidural anesthesia was administered with either xylazine (0.18 mg/kg diluted to 10 to 15 mL with 0.9% sodium chloride) or a combination of 2% mepivacaine and xylazine (0.18 mg/kg). Initial laparoscopic exploration was performed from the left flank; in three horses, right flank laparoscopy was needed to complete the procedure. The spermatic cord was ligated within the abdomen with one or two sutures of 0 polydioxanone suture, and the testis or testes removed through a flank incision. RESULTS: In five horses with no palpably descended testes, standing laparoscopy was the only procedure performed, whereas in two horses, the abdominal testis was removed laparoscopically, and the descended testis was removed under short acting anesthesia. In one horse, with nonpalpable testes, it was determined by laparoscopic observation that the testes were in the inguinal canal, and castration was performed under general anesthesia. No surgical or postoperative complications were noted. The right side of the abdomen, and especially the right vaginal ring, could be easily observed from the left side by passing the laparoscope through a small perforation in the mesocolon of the descending colon or by elevating the descending colon with an instrument or by use of an arm in the rectum. CONCLUSIONS: The standing laparoscopic approach combined with or without short-acting anesthesia to remove the descended testis is easily performed. CLINICAL RELEVANCE: This approach will provide surgeons with another option to castrate cryptorchid stallions.

Anesthesia, General↗

Gastrointestinal and segmental colonic transit times in patients with acute and chronic spinal cord lesions.

STUDY DESIGN: Longitudinal study among patients with acute and chronic spinal cord injuries (SCI). OBJECTIVES: To compare total gastrointestinal transit times (GITT) and segmental colorectal transit times (CTT) in SCI patients with acute and chronic lesions to those of healthy volunteers. Furthermore, to examine the impact of time elapsed since injury on GITT and CTT, and finally to compare the pattern of colorectal dysfunction in patients with supraconal versus conal/cauda equina lesions. SETTING: Surgical Research Unit and Department of Neurosurgery, University Hospital of Aarhus, Denmark. METHODS: Patients took 10 radioopaque markers on six consecutive days and an abdominal X-ray was taken on day 7. GITT and CTTs were computed from the number of markers in the entire colorectum and in each colorectal segment respectively. We studied 26 patients with acute spinal cord lesions (15 supraconal and 11 conal/cauda equina lesions; time since injury=11 - 24 days) and 18 patients were available for follow-up 6 - 14 months later. Results were compared to 24 healthy volunteers. RESULTS: In patients with acute supraconal or conal/cauda equina lesions GITT and CTTs of the ascending, transverse, and descending colon were significantly prolonged, but rectosigmoid transit time was only significantly prolonged in patients with conal/cauda equina lesions. In patients with chronic supraconal lesions GITT and CTTs of the transverse colon and the descending colon were significantly prolonged. In patients with chronic conal/cauda equina lesions GITT and CTT of the transverse, the descending colon and the rectosigmoid were significantly prolonged. Thus, supraconal SCI resulted in generalized colonic dysfunction whereas chronic conal/cauda equina lesions resulted in severe rectosigmoid dysfunction. CONCLUSION: SCI results in severely prolonged colonic transit times both in the acute and chronic phase. However, the type of colorectal dysfunction depends on the level of SCI.

Acute Disease↗

Blood pressure changes in the marginal artery of the colon following occlusion of the inferior mesenteric artery.

The perfusion pressure in the marginal artery of the descending colon was measured continuously at laparotomy in eight patients and the effect of sudden occlusion of the inferior mesenteric artery recorded. Three patients with ulcerative colitis, all in their early 30s, and five elderly patients with colonic or rectal carcinoma were studied. In all patients occlusion caused an initial and marked pressure drop, which remained reduced at a critically low level in two of the elderly patients. Such a reduction in perfusion pressure is probably still insufficient to interfere with the nourishment of the terminal part of the colon provided that the systemic pressure is kept at a normal level. However, since in many patients there is a sharp drop in systemic blood pressure during the recovery phase after surgery, it appears likely that the perfusion pressure in the marginal artery may in those cases be insufficient to maintain an adequate blood flow to the colon despite the inherent tendency of "auto-regulation" in this vascular bed. The results of the present study indicate that, contrary to previous belief, ligation of the inferior mesenteric artery may increase the risk of ischaemia in the terminal part of the descending colon, leading to anastomotic dehiscence after anterior resection, or sloughing after a "pull-through" operation. This complication could probably be prevented by a more generous resection of the sigmoid and descending colon, thus reducing the length of the anastomosis formed by the arc of Riolan and by careful maintenance of an adequate blood pressure during the recovery phase.

Adult↗

Short chain fatty acids in human large intestine, portal, hepatic and venous blood.

Evidence for the occurrence of microbial breakdown of carbohydrate in the human colon has been sought by measuring short chain fatty acid (SCFA) concentrations in the contents of all regions of the large intestine and in portal, hepatic and peripheral venous blood obtained at autopsy of sudden death victims within four hours of death. Total SCFA concentration (mmol/kg) was low in the terminal ileum at 13 +/- 6 but high in all regions of the colon ranging from 131 +/- 9 in the caecum to 80 +/- 11 in the descending colon. The presence of branched chain fatty acids was also noted. A significant trend from high to low concentrations was found on passing distally from caecum to descending colon. pH also changed with region from 5.6 +/- 0.2 in the caecum to 6.6 +/- 0.1 in the descending colon. pH and SCFA concentrations were inversely related. Total SCFA (mumol/l) in blood was, portal 375 +/- 70, hepatic 148 +/- 42 and peripheral 79 +/- 22. In all samples acetate was the principal anion but molar ratios of the three principal SCFA changed on going from colonic contents to portal blood to hepatic vein indicating greater uptake of butyrate by the colonic epithelium and propionate by the liver. These data indicate that substantial carbohydrate, and possibly protein, fermentation is occurring in the human large intestine, principally in the caecum and ascending colon and that the large bowel may have a greater role to play in digestion than has previously been ascribed to it.

Acetates↗

Rectodynamic and radiological assessment in modified mainz pouch II cases.

OBJECTIVE: To evaluate the radiologic findings and to measure the pressure changes in a modified sigmoidorectal pouch (Mainz pouch II procedure). METHODS: A total of 26 patients who had a radical cystectomy because of muscle-invasive bladder tumor underwent a Mainz pouch II procedure between 1993 and 1998. The differences from the original definition was a reverse ureteral anastomosis and a detubularized segment at least 30 cm in length. In all cases, sigmoidoscopy was done and sigmoidal pressure and capacity were measured preoperatively and at the 3rd and 6th months postoperatively besides the colon X-rays. The 24-hour pouch pressure changes called 'natural pouch pressure' was measured using a handmade system with a central venous pressure (CVP) manometer at the 3rd month postoperatively. RESULTS: Preoperative colon X-rays showed a passage of opaque substance through the descending colon at an average volume of 150 ml (average sigma capacity), whereas postoperative anteroposterior and oblique pouch X-rays showed no passage up to an average volume of 520 ml (270-650) though the descending colon. The sigmoidal colon pressure that was on average 20 cm H(2)O at the preoperative evaluation was measured as 6 cm H(2)O at the 3rd month and 6.5 cm H(2)O at the 6th months during the postoperative period. 24 hour natural pouch pressure was found to be 8.7 cm H(2)O on average while the pressure was found to be 13.8 cm H(2)O on average when the patient felt abdominal discomfort, in other words the desire to defecat (miction). CONCLUSIONS: A modified sigmoidorectal pouch procedure not only provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and descending colon with lower metabolic acidosis problem, but it is also a good alternative diversion procedure that whould be preferable especially in Muslim countries as it does not cause any difficulties in terms of Islamic worship.

Anastomosis, Surgical↗

Low anterior resection with anastomosis by endorectal pull-through. Another look at Black's operation.

The type of endorectal pull-through described by Black was evaluated as an alternative method of anastomosis in 11 anterior resections in which anastomosis from above was impossible. The method is attractive from the standpoint of function because it preserves the distal rectum and leaves the anus intact. Technical points important to success are complete mobilization of the descending colon to allow the distal descending colon to be used for the pull-through and prophylactic dilatation of the early stenosis, which is characteristic of this type of anastomosis.

Adenocarcinoma↗

Carotenoids are decreased in biopsies from colorectal adenomas.

UNLABELLED: A lower intake of carotenoids is associated with an increased risk of colorectal cancer. In order to take advantage of the chemopreventive properties of carotenoids, it is necessary to determine carotenoid concentration at the target tissue. As early stages in the adenoma-carcinoma sequence of colorectal cancer might be susceptible to chemoprevention, we sought to determine carotenoid concentrations in biopsies from colorectal adenomas. METHODS: Biopsies from colorectal adenomas and non-involved mucosa were taken from seven patients. For controls, biopsies were obtained from the ascending and descending colon of patients without polyps (n = 5). Concentration of carotenoids (alpha-, beta-carotene, lutein, lycopene, zeaxanthin, beta-cryptoxanthin) were determined by optimizing gradient HPLC-analysis. Results are expressed as pmol/microg DNA. RESULTS: Except for alpha-carotene, all carotenoids could reliably be detected in all specimens. In control patients carotenoid concentrations were highest in the ascending colon, being followed by the descending colon and non-involved mucosa from polyp-carriers. In colorectal adenomas all carotenoids were significantly reduced as compared to-non-involved mucosa (beta-carotene: 0.37 vs 0.19, P<0.03; lycopene: 0.34 vs 0.21, P<0.06, beta-cryptoxanthin: 0.14 vs 0.09, P<0.03, zeaxanthin: 0.18 vs 0.09, P<0.02; lutein: 0.18 vs 0.13,P <0.02). CONCLUSION: All carotenoids investigated are reduced in colorectal adenomas, suggesting that mucosal carotenoids could serve as biomarkers for predisposition to colorectal cancer. Moreover, anti-tumor activity exerted by carotenoids is limited due to mucosal depletion. We speculate that supplementation of a larger array of carotenoids might be beneficial for patients with colorectal adenoma.

Adenoma↗

Isolation of a rat amiloride-binding protein cDNA clone: tissue distribution and regulation of expression.

Sodium transport across high-resistance epithelia involves both an apical amiloride-sensitive sodium channel and the basal Na(+)-K(+)-ATPase pump. Aldosterone regulates sodium transport by increasing the sodium permeability of the sodium channels. To study further the regulation of gene expression in sodium-transporting epithelia by corticosteroids, we have cloned an amiloride-binding protein (ABP) cDNA from rat descending colon and kidney. Identical 311 nucleotide cDNAs were amplified from both rat descending colon and kidney, and the predicted amino acid sequence exhibited 83% homology to the equivalent region of the human peptide sequence. Use of this cDNA as a probe resulted in detection of a transcript in both the small and large bowel, thymus, and seminal vesicle. The latter tissue exhibited the highest level of rat ABP expression. Low to undetectable levels of rat ABP were expressed in the descending colon and kidney. No regulation of rat ABP by either class of corticosteroids was observed. Levels of ABP were low at birth and increased gradually to adult levels just before weaning in the bowel. The distribution of rat ABP is not as would be predicted for an aldosterone-induced gene and is thus unlikely to be a component of the amiloride-sensitive electrogenic sodium channel.

Adrenal Cortex Hormones↗

[Intestinal occlusion caused by malignant neoplasia of the colon: surgical strategy].

Malignant tumors of the large bowel become often clinically evident as an obstruction in 8-29% cases, specially the neoplasms at the splenic flexure (50%) or descending colon (25%). Different factors (urgency, age, colonic distension and lack of adequate bowel preparation) influence therapeutic choice, specially about the bowel resection and one stage anastomosis. Twenty-six patient with neoplastic stenosis of the large bowel (8 of ascending colon and proximal transverse, 5 of splenic flexure or descending colon, 12 of the sigma, 1 of the rectum) have been surgically treated. 4 patient have been subjected to right emicolectomy and ileo-transverse anastomosis; 2 to Hartman's operation; 1 to anterior resection of the rectum; 3 to left hemicolectomy and 2 to resection of the sigma with colic on table irrigation and one-stage anastomosis; 13 to colostomy; 1 to palliative ileo-colic bypass. Two patients (7.5%) died in post-operative period. In patients subjected to one-stage procedures for left colic stenosis, the Authors haven't observed major complications, but one patient developed an anastomic leakage (4%), conservative treated. In stenosis localized to ascending colon or hepatic flexure standard surgical operation is right emicolectomy. In patients affected by cancer of descending colon, the Hartmann's operation is considered the more rational procedure, even if 50% of the patients aren't reoperated on for reconstruction. The one-stage anastomosis is indicated only in selected cases, specially subjected to TPN before surgery or balancing of the metabolic parameters and to antibiotic prophylaxis. The subtotal or total colectomy is indicated when signs of colic perforation are found or when the colon is massively dilatated or there are signs of colonic necrosis or in case of other lesions of the large bowel preoperatively known.

Aged↗

Non-invasive electrocologram: non-invasive recording of the human colonic electrical activity.

The electrical activity of the descending colon of fifteen healthy volunteers was recorded non-invasively by cutaneous electrodes sticked on the abdominal wall along the descending colon projection--electrocologram (EColG). The electrical activity of the colon and stomach was recorded by an original electrogastrograph. The means, S.E.M. of the frequency of the colonic and gastric waves were calculated. Parallel studies of the EColG and the changes in the intracolonic pressure were performed on 10 patients with balloon inflated in the colon. Two kinds of EColG waves according to their frequency were identified: i) Type A waves with a frequency of 5.86 +/- 0.59 cpm and ii) Type B waves with a frequency of 2.35 +/- 0.25 cpm. There was a significant difference between the frequencies of the EColG waves and the frequency of the EGG waves -3.35 +/- 0.31 cpm. The type A waves were of low amplitude and corresponded to type A dog colonic waves i.e. they characterized the quiescent period of colonic motility. Type B waves were with a high amplitude, corresponded to type B dog colonic waves and characterised the activity periods of colonic motility. This was confirmed by the correspondence between type B waves and the changes in the intracolonic pressure. Thus the proposed non-invasive electrogastrographic method proved to be suitable for non-invasive registration of the electrical activity of the human colon.

Adult↗

Crohn's disease associated with giant inflammatory polyposis.

We found shallow serpiginous, longitudinal ulcerations in the descending colon at the first examination of a 17-year-old female patient with Crohn's disease. Four months later at the second examination, we observed that a polypoid lesion had formed longitudinally in the region of the healed ulcers. The third examination, one year later, showed the presence of pedunculated and semi-pedunculated giant polyps in the descending colon. The lesion of the descending colon was removed surgically to cure the crampy abdominal pain caused by colonic obstruction. The segmental colectomy specimen showed longitudinally aligned pedunculated polyps of various sizes. The pathological diagnosis was inflammatory polyposis. To the best of our knowledge, there have been very few reports on the appearance of a number of pedunculated polyps such as in this case. This reports shows, through endoscopic pictures, the evolution of the polyp and discusses its formation.

Adolescent↗

Ileal and colonic epithelial metabolism in quiescent ulcerative colitis: increased glutamine metabolism in distal colon but no defect in butyrate metabolism.

Previous studies have shown that butyrate is an important energy source for the distal colon, and that its metabolism may be defective in ulcerative colitis (UC). A similar metabolic defect in the ileum might account for the occurrence of 'pouchitis' in UC patients after colectomy. A method has been developed that allows the measurement of metabolism in ileocolonoscopic biopsy specimens, and this has been used to assess butyrate and glutamine metabolism in quiescent UC and controls. Preliminary experiments showed optimal metabolism of butyrate at 1 mmol/l. In controls glutamine metabolism was greater in the ascending (mean (SD)) (4.9 (3.2) nmol/h/micrograms protein) than in the descending colon (1.4 0.7)) (p < 0.05, Mann-Whitney U test), but butyrate metabolism was similar in the two regions (ascending 62.6 (44.2), descending 51.5 (32.0)). Consequently ratios of butyrate/glutamine metabolism were higher in the descending colon (20.6 (14.3)) than in the ascending colon (14.3 (9.6)) (p < 0.05). In UC, rates of butyrate metabolism were similar in the ascending (92.5 (58.3) nmol/h/micrograms protein) and descending (93.3 (115)) colon, and these were not significantly different from controls. In UC, glutamine metabolism was similar in the ascending (6.2 (7.7) nmol/h/micrograms protein) and descending colon (7.8 (7.9)); the metabolism in the descending colon was significantly greater than in controls (p < 0.01). Butyrate (135 (56) nmol/h/microgram protein) and glutamine (24.1 (16.2)) metabolism in the ileum in UC, were not significantly different from control values (butyrate 111 (57), glutamine 15.5 (15.6)). These results confirm that there is regional variation of nutrient utilisation throughout the colon, but they do not support the hypothesis that UC is caused by a deficiency of butyrate metabolism.

Adolescent↗

[Colonic transit time in patient with liver cirrhosis].

BACKGROUND/AIMS: The colonic transit time in patients with liver cirrhosis has not been studied extensively in South Korea. Thus, the authors investigated the differences of colonic transit time between cirrhotic patients and normal controls with attention to factors that affect this change. METHODS: Fifteen cirrhotic patients and 15 controls were included in this study. To exclude any organic diseases, colonoscopy was preceded. The colonic transit time was measured by taking plain abdominal films on the 4th and 7th days after ingestion of radiographic non-absorbable colon markers for 3 days. RESULTS: The colonic transit time was 10.7 +/- 2.6 hours and 24.0 +/- 4.1 hours for cirrhotic patients and controls, respectively, indicating that the transit time in cirrhotic patients is much faster (p<0.05). The transit time for each segment of the colon was also measured. For the ascending colon, average transit time of the cirrhotic patients and controls were 5.60 +/- 1.93 and 6.88 +/- 1.77 hours respectively. For the descending colon, those were 2.80 +/- 1.04 and 10.80 +/- 2.59 hours (p<0.05), while those in the rectosigmoid portion were 2.32 +/- 0.81 and 4.96 +/- 1.19 hours, respectively. These results indicated that a significant difference is present in the descending colon. Additionally, the transit time is correlated with age and albumin level (B=0.760, p<0.05 and B=7.498, p<0.01, respectively). CONCLUSIONS: The colonic transit time of cirrhotic patients is faster than that of control, especially in the descending colon.

Colon↗

Segmental gut transit in diabetes mellitus: effect of cisapride.

Gut transit using radiopaque markers was assessed in 5 healthy subjects and 24 diabetic patients. In the diabetics, various parameters including duration of the disease and diabetic complications, such as neuropathy, retinopathy and nephropathy, were determined, and the relationships between gut transit times and these complications were evaluated. The effect of cisapride on gut transit was studied in 10 diabetic patients. Large intestinal, descending colon, distal colon, and whole gut transit times were delayed in diabetics with autonomic neuropathy compared to controls and to diabetics without autonomic neuropathy (P less than 0.01). There was no difference in proximal colon transit times among them. An inverse correlation was observed between CVRR and the transit times for descending colon, distal colon, large intestine and whole gut. Large intestinal and whole-gut transit times were delayed in diabetics with retinopathy or with nephropathy compared to diabetics without those complications (P less than 0.01). In the diabetics, oral administration of 7.5 mg/day of cisapride for 2 weeks significantly accelerated descending colon transit (P less than 0.05) and partially accelerated distal colon, large intestinal and whole-gut transit. It is concluded that diabetics with autonomic neuropathy have delayed transits for the whole gut and that this finding is apparent to some extent in the distal colon but not in the proximal colon. Chronic oral administration of cisapride, a gastrointestinal prokinetic drug, was effective to improve these gastrointestinal motility disorders in diabetics with autonomic neuropathy.

Administration, Oral↗

Sex differences in the changing anatomic distribution of colorectal carcinoma.

The anatomic site distribution of large bowel cancer was studied in 2079 patients between 1967 and 1980. To measure the trend in the localization of the carcinomas, the slope of the regression line of the proportions at each site over the years was computed. The large bowel was divided into five segments: cecum, ascending colon and hepatic flexure, transverse and descending colon, sigmoid and rectosigmoid junction, and rectum. A significant decrease in the proportions of cancer in the sigmoid for both sexes (slope parallel b = -0.89; P less than 0.001) and an increase of cecal cancer (b = 0.54; P less than 0.004) was observed. Sex-specific results indicated the diminishing proportion of sigmoid cancer in men (b = -1.04; P less than 0.004) with an increase in transverse and descending colon cancer proportions (b = 0.52; P = 0.012). In women, a negative slope of -0.74 was not significant for sigmoid cancer, but cancer of the cecum showed an increase in proportions (b = 0.80; P = 0.01). The age distribution indicated a significant decrease in proportion of men older than 80 years and of women in the age group of 40 to 49 years and an increase in women older than 80 years. However, age adjustment did not change any of the previous conclusions. The observed sex differences in the changing distribution within the large bowel over a 14-year period cannot be explained by the improvement of diagnostic tools in the last years. In view of these findings, it is important to evaluate the possible sex-related bias in the application of screening and preventive measures as well as the changes in the ecologic features of the large intestine.

Adult↗