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PubMed2004

Histological quality of polyps resected using the cold versus hot biopsy technique.

BACKGROUND AND STUDY AIMS: The monopolar hot biopsy technique is a widespread method of removing and cauterizing small colonic polyps. Due to the insulated cups of the biopsy forceps, it also allows adequate histological interpretation of the resected specimen. In our experience, polyps removed using the monopolar hot biopsy technique have been less histologically interpretable in comparison with polyps removed using cold biopsy forceps. The aim of this study was to assess and compare the diagnostic quality of polyps obtained using the hot biopsy and cold biopsy techniques. PATIENTS AND METHODS: This was a prospective study of consecutive patients undergoing colonoscopy with removal of polyps using either hot biopsy or cold biopsy techniques. One experienced endoscopist using the same techniques carried out the biopsies. An experienced gastrointestinal pathologist, blinded to the technique used, evaluated the specimens for diameter, artifacts, cautery damage, tissue fragmentation, and general histological and diagnostic quality. Statistical analysis was carried out using the chi-squared test, Fisher's exact test, and Student's t-test. RESULTS: Forty-three consecutive patients (84 % men; mean age 63.8 +/- 15 years) underwent 88 biopsies (45 hot biopsies and 43 cold biopsies). There were no statistically significant differences between the two study groups with regard to demographic data, indications for colonoscopy, endoscopic findings, or polyp size. Cautery damage, architectural distortion, and tissue fragmentation occurred more frequently in polyps resected using the hot biopsy technique ( P < 0.001). CONCLUSIONS: The quality of the specimens removed by cold biopsy was generally better than when using hot biopsy technique. Histological evaluation is more difficult in polyps resected with the hot biopsy technique in comparison with the cold biopsy technique. When the nature of polyps affects the patient's management, a biopsy may be obtained before polyp coagulation.

Aged↗
PubMed2004

Extracellular signal-regulated kinase is involved in tumor necrosis factor-alpha-induced MUC5AC gene expression in cultured human nasal polyp epithelial cells.

OBJECTIVES: Mucus secretion and inflammatory cytokines are increased in cases of chronic sinusitis with polyp. In this study we initially investigated the localization of MUC5AC protein in human nasal polyps. We then examined whether tumor necrosis factor-alpha (TNF-alpha) induces MUC5AC gene expression and whether extracellular signal-regulated kinase (ERK) plays a role in TNF-alpha-induced MUC5AC gene expression in cultured human nasal polyp epithelial cells. Finally, we investigated whether MUC5AC and activated ERK are co-expressed in goblet cells. MATERIAL AND METHODS: Human nasal polyp epithelial cells were isolated and subcultured. Passage-2 polyp epithelial cells were treated with 10 ng/ml TNF-alpha. ERK involvement was determined by Western blotting and MUC5AC gene expression by reverse transcriptase polymerase chain reaction. An ERK kinase assay and an inhibitor study using PD98059 were also performed. Immunohistochemical staining using polyclonal MUC5AC antibody and a phospho-specific ERK antibody was done in nasal polyps. RESULTS: MUC5AC was found to be expressed in the majority of goblet cells in human nasal polyp epithelium. TNF-alpha induced MUC5AC gene expression, and ERK activation was found to be essential for TNF-alpha-induced MUC5AC gene expression in cultured human nasal polyp epithelial cells. In addition, both MUC5AC and activated ERK were co-expressed in goblet cells of human nasal polyp epithelium. CONCLUSIONS: TNF-alpha induces MUC5AC gene expression via ERK in cultured human nasal polyp epithelial cells.

Blotting, Western↗
PubMed2006

Topical steroids do not downregulate expression of growth-related oncogene-alpha in nasal polyps.

CONCLUSIONS: Topical steroids did not affect expression of growth-related oncogene-alpha (GRO-alpha) in nasal polyps. The results of this study suggest roles for steroid-resistant gene expression in the pathogenesis of nasal polyps and point to the need for additional pharmacological strategies. OBJECTIVE: Infiltration of inflammatory cells is believed to play a role in the development of nasal polyps. GRO-alpha is a chemokine that recruits and activates neutrophils and also possesses growth stimulatory and angiogenetic properties. An increased presence of GRO-alpha has been demonstrated in nasal polyps compared with normal nasal tissue. In this study we evaluate the presence and expression levels of GRO-alpha in nasal polyps before and after glucocorticoid treatment. MATERIAL AND METHODS: Nasal polyps were surgically removed in patients before and 6 weeks after treatment with topically applied fluticasone. GRO-alpha gene expression and the presence of GRO-alpha peptide were detected in polyp tissue by means of in situ hybridization, quantitative real-time reverse transcriptase polymerase chain reaction and immunohistochemistry. RESULTS: Strong GRO-alpha gene expression and the presence of GRO-alpha peptide were seen in both the epithelium and stromal inflammatory cells of nasal polyps. No differences in gene expression levels in tissue homogenates were found when untreated polyp tissue was compared with polyps treated for 6 weeks with topically applied steroids.

Administration, Topical↗
PubMed2005

Mucin gene expression in nasal polyps.

CONCLUSIONS: A large set of mucin genes is expressed in nasal polyps. The expression pattern is complex and may reflect the wide spectrum of variables involved in polyp formation and progression. Prospective studies including subgroups of nasal polyps and involving substantial numbers of cases in each subgroup will be required to elucidate these variables and to understand how they affect mucus secretion. OBJECTIVE: At present, 15 of the 19 known mucin genes are expressed in the human airways. Nasal polyps might be expected to have a mucin expression pattern comparable to that of the airways. The aim of this study was to investigate mucin expression in nasal polyps. MATERIAL AND METHODS: Nasal polyp samples were obtained from 20 patients during functional endoscopic sinus surgery. Normal (control) sphenoid sinus mucosa was obtained from patients undergoing trans-sphenoid hypophysectomy. The expression of eight mucin genes (MUC1-4, -5AC, -5B, -6 and -7) was studied by in situ hybridization utilizing digoxigenin-labelled oligonucleotide probes. RESULTS: MUC6 and -7 were not expressed in sphenoid sinus mucosa, while all the studied mucin genes were expressed in nasal polyps. Expression patterns varied widely between individual polyps. The predominant epithelial mucin genes were MUC4, -5AC and -3, while MUC5B and -7 were mainly of glandular origin. MUC1, -2 and -6 were weakly expressed. The major alteration in gene expression in nasal polyps was found in the submucosal glands. MUC4 and -5AC represent a major component of both submucosal glands and epithelial cells in nasal polyps.

Biomarkers, Tumor↗
PubMed1998

Polypoid dysplasia and adenomas in inflammatory bowel disease: a clinical, pathologic, and follow-up study of 89 polyps from 59 patients.

Dysplasia in inflammatory bowel disease (IBD) is categorized as either flat or associated with a raised lesion or mass (dysplasia-associated lesion or mass [DALM]). One specific subtype of a dysplasia-associated lesion or mass consists of isolated discrete nodules or polyps that are difficult to distinguish from sporadic adenomas. Because the clinical management of these two lesions is different, we performed this study to (1) evaluate the clinical presentation, pathologic features, and natural history of polypoid dysplastic lesions and sporadic adenomas in patients with IBD and (2) determine whether there are clinical, endoscopic, or pathologic findings useful in differentiating between these two lesions. The morphologic features of 89 benign polypoid epithelial neoplasms from 59 patients with IBD (51 with ulcerative colitis, 8 with Crohn's colitis) were evaluated and correlated with the clinical, endoscopic, and follow-up data. In a separate analysis, patients were categorized arbitrarily as having (1) a probable sporadic adenoma if the polypoid epithelial neoplasm was not located within areas of histologically proven colitis, (2) a probable IBD-associated polypoid dysplasia if the lesion developed within an area of colitis, and associated flat dysplasia or an adenocarcinoma was detected during follow-up evaluation or (3) an indeterminate polyp, which was seen in the remainder of the cases. The clinical, endoscopic, and histologic data were compared among these three patient and polyp subgroups. There were 35 males and 24 females (median age, 57 years; range, 27-85 years). Median duration of disease was 10 years. Forty-nine percent of the patients had pancolitis; 66% had histologically active disease at the time of presentation. Nearly 70% of patients had only one polyp; the majority occurred in either the left colon or the rectum (66%). Most polyps were described as a sessile nodule, whereas only 7 (7.8%) were pedunculated. Polyps ranged from 2 mm to 50 mm (median, 5 mm); most had a tubular architecture (84.3%) and contained low-grade dysplasia (64%). In addition, most polyps had mildly increased lamina propria and intraepithelial neutrophilic and mononuclear inflammation. At follow-up evaluation (40 patients; median follow-up time, 13 months; range, 1-78 months), a further neoplastic lesion developed in 20%; low-grade flat dysplasia was seen in 5 (12.5%), and adenocarcinoma developed in 3 (7.5%). However, dysplasia or adenocarcinoma did not develop in the patients who had polyps located outside of areas of histologically proven colitis. In addition, at least one more benign polypoid epithelial neoplasm developed in 15 of 40 patients (37.5%). Patients with probable IBD-associated polypoid dysplasia had a statistically significant (p < 0.05), longer disease duration than patients with probable sporadic adenoma. A statistically significant, higher proportion of polyps with tubullovillous or villous architecture, an admixture of normal and dysplastic epithelium at the surface of the polyps, and increased lamina propria mononuclear inflammation was noted in probable IBD-associated polypoid dysplastic lesions compared with those considered to be sporadic adenomas. Several clinical and pathologic features may be useful to help categorize a polypoid dysplastic lesion as a sporadic adenoma or an IBD-related neoplasm in a patient with IBD. This distinction is important because the natural history of these two lesions (as shown by the results of this study) and their subsequent management are quite different.

Adenoma↗
PubMed1988

Colon adenomas in patients with hyperplastic polyps.

Although hyperplastic polyps are generally believed to have no malignant potential, recent work has suggested that they might be more common in patients with adenomas. We evaluated whether hyperplastic polyps could serve as a marker for patients who might benefit from colonoscopy. We retrospectively reviewed 1,588 consecutive colonoscopy reports and hospital charts on 1,407 different patients examined between May 1983 and August 1985: 242 patients had adenomas, and 94 had hyperplastic polyps. Of patients with hyperplastic polyps 93.6% had concomitant adenomas, as compared with 35.7% of those without, p less than 0.001. Adenomas proximal to the rectosigmoid were found in 61.7% of patients with hyperplastic polyps and in 25.3% of those without, p less than 0.001. Patients with hyperplastic polyps in the rectosigmoid had proximal adenomas more frequently (64.7%) than did those without rectosigmoid hyperplastic polyps (29.4%), p less than 0.001. We conclude that patients with hyperplastic polyps are more likely to have adenomas, and patients with rectosigmoid hyperplastic polyps are more likely to have proximal adenomas. Based on these preliminary data, we believe that the finding of hyperplastic polyps in the rectosigmoid might justify full colonoscopy and that this should be studied further.

Adenoma↗
PubMed1992

Are tiny polyps important when found on sigmoidoscopy in asymptomatic people?

To determine the occurrence of synchronous large bowel polyps located proximal to the sigmoid, in persons undergoing screening flexible sigmoidoscopy, we examined those who had diminutive polyps (less than or equal to 0.5 cm) as the only finding in the distal colon by further colonoscopy. One hundred one asymptomatic persons (mean age 61 +/- 13 years) had 143 diminutive polyps; a single polyp was found in 76%, and 64% of all polyps were located in the rectum. Thirty (21%) were hyperplastic and 86 (60%) were neoplastic, including 14 with moderate and one with severe dysplasia. The others were inflammatory (five) or unclassified (hot biopsy changes or normal mucosa, 14 polyps), and eight were lost before processing. Colonoscopy revealed that 16 (16%) of the 101 patients had 21 additional polyps proximally, mostly less than 1 cm in diameter. These included one hyperplastic and 18 neoplastic polyps, and two specimens showed hot biopsy changes. Age, histological type, number or location of the index diminutive polyps, were not associated with proximal lesions. We question whether immediate colonoscopy is justified in asymptomatic patients with only diminutive polyps at flexible sigmoidoscopy.

Adult↗
PubMed2004

Significance of nasal polyps in chronic rhinosinusitis: symptoms and surgical outcomes.

PURPOSE: To demonstrate the significance of nasal polyps on the symptoms of chronic rhinosinusitis (CRS) and their influence on surgical outcomes. METHODS: Retrospective analysis of prospectively collected data comparing two groups of patients diagnosed with CRS with and without nasal polyps that underwent surgical management with a minimum 1-year follow-up period. Subjective scoring was performed using the Sino-Nasal Outcome Test (SNOT-20) questionnaire. Computed tomography (CT) scans were compared using the Lund-Mackay scoring system. The two groups were analyzed for the need of revision surgery. RESULTS: Two hundred one patients underwent surgical management of CRS over a 3-year period. One hundred four were male, 97 were female, and the average age was 49 (range 18-80) years. Polyps were present in 78 patients with CRS, whereas 123 patients did not have polyps. The average CT score was 18 for the polyp group and 9.5 for the patients without polyps (P = .0000). Nonpolyp group SNOT-20 scores were 26.5 preoperatively with improvement to 5.1 at 6 months and 5.0 at 12 months postoperatively (85% improvement). Polyp group SNOT-20 preoperative scores averaged 32.2 with improvement to 9.2 at 6 months and 9.1 at 12 months postoperatively (81% improvement, P = .003). Nine patients required revision surgery (4.5%), eight (10%) who had polyps and one (0.8%) who did not (P = .002). CONCLUSION: The presence of nasal polyps has a significant negative impact on patients with CRS. Patients with nasal polyps have more severe symptoms with less improvement after operative intervention, higher CT scores at presentation, and a significantly higher need for revision surgery.

Adolescent↗
PubMedDate not supplied

Oral contrast adherence to polyps on CT colonography.

Although oral contrast agents are known to improve the accuracy of CT colonography (CTC) by tagging fluid and stool, it is not well recognized that oral contrast also adheres to the surface of polyps. The authors' objective was to quantitate the frequency of contrast adhering to polyps. Three hundred thirty-eight optical colonoscopy-proven polyps were identified on CTC of all of the 216 patients with polyps in a larger cohort of screening patients. CT scans of polyps were analyzed for adherent contrast (ie, a thin coat/adherent drops) in at least one view (prone/supine). Forty-six percent of the 312 polyps not touching a contrast pool had adherent contrast. Polyps with villous histology were significantly more likely to have adherent contrast (77% [20/26] vs. 43% [124/286], P<0.001). Oral contrast agents often tag polyp surfaces in a pattern that is distinct from internal tagging of adherent stool, which must be recognized during CTC interpretation. Polyps with villous histology show a higher rate of contrast adherence than nonvillous polyps.

Administration, Oral↗
PubMed2006

Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy.

BACKGROUND: It is controversial whether proton pump inhibitor use leads to fundic gland polyp development. AIM: To determine whether fundic gland polyp development is due to proton pump inhibitor use and to investigate mechanisms involved. METHODS: Proton pump inhibitor use and the presence of fundic gland polyps were assessed in consecutive patients undergoing oesophagogastroduodenoscopy. Biopsies from fundic gland polyps and gastric mucosa were taken. Dysplasia was graded as negative, low or high grade. Prevalence of parietal cell hyperplasia and parietal cell protrusions and the proportional cystic area were assessed. RESULTS: 599 patients participated, 322 used proton pump inhibitors, 107 had fundic gland polyps. Long-term proton pump inhibitor use was associated with an increased risk of fundic gland polyps (1-4.9 years use: OR 2.2, 95% CI: 1.3-3.8; > or =5 years: OR 3.8, 95% CI: 2.2-6.7) while short-term therapy (<1 year) was not (OR 1.0, 95% CI: 0.5-1.8). Low-grade dysplasia was found in one fundic gland polyp. Fundic gland polyps associated with long-term proton pump inhibitor use had a larger proportional cystic area and higher frequency of parietal cell hyperplasia and parietal cell protrusion. CONCLUSIONS: Long-term proton pump inhibitor use is associated with an up to fourfold increase in the risk of fundic gland polyps. Risk of dysplasia is negligible. Aetiologically, these polyps seem to arise because of parietal cell hyperplasia and parietal cell protrusions resulting from acid suppression.

Adolescent↗
PubMed2006

Fibroblastic polyp of the colon: clinicopathological analysis of 10 cases with emphasis on its common association with serrated crypts.

AIMS: To describe the clinical and pathological features of 10 further cases of fibroblastic polyps (FP), a recently described, distinctive type of colorectal mucosal polyp. METHODS AND RESULTS: The patients were seven women and three men with ages ranging from 44 to 63 years. The lesions ranged in size from 2 to 4 mm. Eight of the polyps were located in the sigmoid colon. Five cases were associated with hyperplastic polyps. Histologically, FP displayed bland, plump spindle cells with oval nuclei arranged as bundles parallel to the surface or as haphazardly orientated sheets with a focal periglandular or perivascular concentric arrangement. Eight polyps represented mixed fibroblastic/hyperplastic polyps as they contained serrated (hyperplastic) crypts. Immunohistochemically, all cases were positive for vimentin and negative for desmin, smooth-muscle actin, h-caldesmon, S100 protein, c-Kit, epithelial membrane antigen, cytokeratin AE1/3, CD34, CD68, COX-2, and factor XIIIa. Ultrastructural examination supported the fibroblastic nature of the tumour cells. CONCLUSIONS: FP is a distinctive type of benign mucosal colorectal polyp characterized by its distal location, small size, frequent association with hyperplastic polyps, distinct morphological appearance and typical immunonegativity for markers of specific differentiation. FP with serrated crypts (mixed fibroblastic/hyperplastic polyp) represents a frequent variant of this lesion. Pathologists should recognize FP and discriminate it from other types of colorectal polyps.

Adult↗
PubMed2001

Experience with juvenile polyps in North American children: the need for pancolonoscopy.

We report a recent experience with juvenile polyps (JP) in a large cohort of North American children to determine if a pancolonoscopy (PC) is needed in all children with suspected polyps. We reviewed hospital charts of all patients with JP seen over a 9-yr period (January, 1990-October, 1998). A total of 331 JP were encountered during 195 procedures in 184 patients (64% males, 88% white, mean age 5.93 yr [range 0.42-15.5 yr], median age 4.84 yr). Painless rectal bleeding was the commonest symptom. PC was performed in 42% (82/195) of procedures, and 177 JP were encountered: 54% (97/177) were in the rectosigmoid colon, 14% (24/177) were in the descending colon, and 32% (56/177) were proximal to the splenic flexure (i.e., proximal polyps). Overall, proximal polyps were seen in 37% (31/82) of PC. Only proximal polyps were noted in 12% (10/82) of PC. Five patients were re-endoscoped after an initial limited examination because of continuing symptoms from proximal polyps. All but one of the polyps had typical features of a JP on histological examination. Though most JP are located in the left colon, a PC should be the initial procedure because: 1) 37% of PC revealed proximal polyps, 2) 32% of polyps were located proximal to splenic flexure, 3) persistence of symptoms from missed proximal polyp(s) necessitates a repeat study with attendant risks, and 4) there is a possibility of malignant transformation in an unidentified JP.

Adenomatous Polyposis Coli↗
PubMed2004

Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy.

BACKGROUND AND OBJECTIVES: Multiple factors influence the yield of colonoscopy for the detection of neoplasia. Few studies have addressed the impact of colonoscopy duration on procedure yield. The aim of our study was to determine whether endoscopist-specific procedure times correlate with the number and clinical significance of polyps detected at screening or surveillance colonoscopy. METHODS: Procedural data from screening or surveillance colonoscopies performed at Mayo Clinic, Rochester MN, between January 1, 1996 and June 30, 2000, were reviewed. Individual endoscopists were characterized by their personal endoscopist procedure mean time (EPMT) to perform a negative colonoscopy. Procedure time included patient's consent and sedation. EPMT was then correlated with individual polyp detection rates. RESULTS: Overall, 10,159 colonoscopies were reviewed of which 4,312 (42.4%) yielded polyps. Polyp detection varied among endoscopists between 19.0% and 62.3%. There was a close correlation between EPMT and polyp yield (all sizes), r = 0.64, although correlation was weaker for polyps >10 mm (r = 0.42) and polyps >20 mm (r = 0.20). On multivariate analysis, longer mean endoscopist time was associated with colonic lesion detection, OR = 1.54 (95% CI 1.37-1.62). Longer mean procedure duration demonstrated a looser association with identification of polyps >10 mm, OR = 1.40 (1.19-1.64) and polyps >20 mm, OR = 1.03 (0.74-1.43). CONCLUSIONS: There is a direct correlation between colonoscopy procedure time and yield, with a three-fold variation of polyp detection rates. These results should prompt future prospective studies assessing the impact of colonoscopic withdrawal time on lesion detection.

Colonoscopy↗
PubMed2006

Polyp miss rate determined by tandem colonoscopy: a systematic review.

BACKGROUND AND AIMS: Colonoscopy is the best available method to detect and remove colonic polyps and therefore serves as the gold standard for less invasive tests such as virtual colonoscopy. Although gastroenterologists agree that colonoscopy is not infallible, there is no clarity on the numbers and rates of missed polyps. The purpose of this systematic review was to obtain summary estimates of the polyp miss rate as determined by tandem colonoscopy. METHODS: An extensive search was performed within PUBMED, EMBASE, and the Cochrane Library databases to identify studies in which patients had undergone two same-day colonoscopies with polypectomy. Random effects models based on the binomial distribution were used to calculate pooled estimates of miss rates. RESULTS: Six studies with a total of 465 patients could be included. The pooled miss rate for polyps of any size was 22% (95% CI: 19-26%; 370/1,650 polyps). Adenoma miss rate by size was, respectively, 2.1% (95% CI: 0.3-7.3%; 2/96 adenomas > or =10 mm), 13% (95% CI: 8.0-18%; 16/124 adenomas 5-10 mm), and 26% (95% CI: 27-35%; 151/587 adenomas 1-5 mm). Three studies reported data on nonadenomatous polyps: zero of eight nonadenomatous polyps > or =10 mm were missed (0%; 95% CI: 0-36.9%) and 83 of 384 nonadenomatous polyps <10 mm were missed (22%; 95% CI: 18-26%). CONCLUSIONS: Colonoscopy rarely misses polyps > or =10 mm, but the miss rate increases significantly in smaller sized polyps. The available evidence is based on a small number of studies with heterogeneous study designs and inclusion criteria.

Colonic Polyps↗
PubMed2006

Retroflexion in the colon: a useful and safe technique in the evaluation and resection of sessile polyps during colonoscopy.

OBJECTIVE: Endoscopic polypectomy has become the standard management approach for colon polyps. Three factors can make endoscopic resection of colonic polyps difficult: size, configuration, and location. We describe the use of retroflexion in the colon as a useful and routine technique using a standard colonoscope for the resection of difficult sessile polyps. METHODS: Fifteen patients in whom the retroflexion technique was used for polyp removal were prospectively identified. Each polyp was visualized and resected using both a forward and retroflexed view. RESULTS: Nine women and six men were identified between the ages of 49 and 81 years. The 15 polyps were located in the cecum (3), ascending colon (3), hepatic flexure (3), splenic flexure (2), descending colon (2), and sigmoid colon (2). All the polyps were sessile and their largest diameter ranged from 20 mm to 50 mm. Retroflexion combined with forward viewing allowed for a better assessment of the size and extent of all the polyps compared with forward viewing alone. All polyps, except two, were completely resected during the first session, using both the prograde and retroflexion approaches. No complications from retroflexion of the colonoscope, including perforation or bleeding, occurred. CONCLUSION: Retroflexion complements the conventional prograde inspection of sessile polyps that are only partially visualized on prograde view alone. Retroflexion allows a complete assessment of the lesions' size and extent and aid in their complete removal.

Aged↗
PubMed1991

Colorectal neoplasia in juvenile polyposis or juvenile polyps.

Juvenile (retention) polyps are usually solitary lesions in the colorectum but may be multiple in juvenile polyposis. The association between juvenile polyps and colorectal neoplasia is controversial. We present three patients with juvenile polyposis who had colorectal adenomas or adenomatous epithelium in juvenile polyps at ages 3, 4, and 7 years. In a retrospective study of 57 additional patients with one or more juvenile polyps, 10 patients (18%) had colorectal neoplasia including three with adenocarcinoma, two with tubular adenoma, and six with adenomatous epithelium in a juvenile polyp (one had both adenomatous epithelium and an adenocarcinoma). Nine of these 10 patients had juvenile polyposis defined by the presence of at least three juvenile polyps; and eight of the nine had a family history of juvenile polyps. Colorectal neoplasia occurred at young age (mean (SEM) 37 (5) years). Our findings suggest that patients with juvenile polyps who have three or more juvenile polyps or a family history of juvenile polyps should undergo surveillance for colorectal neoplasia.

Adenocarcinoma↗
PubMed2006

Upregulation of COX-1 and COX-2 in nasal polyps in cystic fibrosis.

BACKGROUND: Since abnormalities in prostanoid metabolism occur in the lower airway of patients with cystic fibrosis (CF), it is likely that they could also be detected in the nose. METHODS: The degree of mRNA and protein expression of cyclo-oxygenase (COX) enzymes 1 (COX-1) and 2 (COX-2) was examined using quantitative reverse competitive polymerase chain reaction (RT-PCR) and Western blot analysis in the nasal polyps from 10 patients with CF, nasal polyps from 10 non-CF patients and 11 nasal mucosa specimens. The results are presented as 10(6) cDNA molecules/mug total RNA and the densitometric ratio between protein and beta-actin. RESULTS: COX-1 mRNA levels were significantly higher in CF nasal polyps (median 2.34, 25-75th percentiles 1.6-3.2) than in the nasal mucosa (0.78, 0.11-1.21), while there was no difference with non-CF nasal polyps (1.11, 0.80-3.15). COX-1 protein levels were significantly higher in CF nasal polyps (3.63, 2.71-4.27) than in nasal mucosa (1.55, 0.66-2.33) and non-CF nasal polyps (2.19, 1.72-3.68). COX-2 mRNA was significantly higher in CF nasal polyps (3.34, 2.42-7.05) than in nasal mucosa (1.69, 0.19-3.50). No differences were found in COX-2 mRNA expression between CF and non-CF polyps (1.38, 0.12-6.07). COX-2 protein levels were also significantly higher in CF nasal polyps (0.23, 0.04-0.34) than in non-CF nasal polyps (0.011, 0.009-0.016) or nasal mucosa (0.014, 0.014-0.016). CONCLUSIONS: Upregulation in the expression of COX-1 and COX-2 could explain the high production of prostanoids reported in CF. These findings raise questions regarding the potential use of selective or non-selective COX-2 non-steroidal anti-inflammatory treatment in CF.

Adolescent↗
PubMedDate not supplied

Computer-aided diagnosis scheme for detection of polyps at CT colonography.

Colon cancer is one of the leading causes of cancer deaths in the United States. However, most colon cancers can be prevented if precursor colonic polyps are detected and removed. An advanced computer-aided diagnosis (CAD) scheme was developed for the automated detection of polyps at computed tomographic (CT) colonography. A region encompassing the colonic wall is extracted from an isotropic volume data set obtained by interpolating CT colonographic scans along the axial direction. Polyp candidates are detected with computation of three-dimensional (3D) geometric features that characterize polyps, followed by extraction of polyps with hysteresis thresholding and fuzzy clustering using these geometric features. The number of false-positive findings is reduced by extracting 3D texture features from polyp candidates and applying quadratic discriminant analysis to the candidates. This CAD scheme was applied in 71 patients who underwent CT colonography, 14 of whom had colonoscopically confirmed polyps (n = 21). At by-patient analysis, sensitivity was 100%, with an average false-positive rate of 2.0 per patient. At by-polyp analysis, the scheme detected 90% of the polyps at the same false-positive rate. This CAD scheme permits accurate detection of suspicious lesions and thus has the potential to reduce radiologists' interpretation time and improve their diagnostic accuracy in the detection of polyps at CT colonography.

Adult↗