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PubMed2006

A comparison of methods of assessment of scintigraphic colon transit.

UNLABELLED: There is no standard method of analysis of scintigraphic colonic transit investigation. This study was designed to compare 4 techniques. METHODS: Sixteen subjects (median age, 37.5 y; range, 21-61 y), who had sustained a spinal cord injury more than a year before the study, were given a pancake labeled with 10-18 MBq of (111)In bound to resin beads to eat. Anterior and posterior images were acquired with a gamma-camera 3 h after the meal and then 3 times a day for the next 4 d. Seven regions of interest, outlining the ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, rectosigmoid, and total abdominal activity at each time point, were drawn on the anterior and posterior images. The counts were decay corrected and the geometric mean (GM), for each region, at each time point calculated. The GM was used to calculate the percentage of the initial total abdominal activity in each region, at each time point. Colonic transit was assessed in 4 ways: (a) Three independent nuclear medicine physicians visually assessed transit on the analog images and classified subjects into 5 categories of colonic transit (rapid, intermediate, generalized delay, right-sided delay, or left-sided delay). (b) Parametric images were constructed from the percentage activity in each region at each time point. (c) The arrival and clearance times of the activity in the right and left colon were plotted as time-activity curves. (d) The geometric center of the distribution of the activity was calculated and plotted on a graph versus time. The results of these 4 methods were compared using an agreement matrix. RESULTS: Though simple to perform, the visual assessment was unreliable. The best agreement occurred between the parametric images and the arrival and clearance times of the activity in the right and left colon. CONCLUSION: The different methods of assessment do not produce uniform results. The best option for evaluating colonic transit appears to be a combination of the analog images, which provide a general overview of colonic transit and a quantitative method that demonstrates segmental transit.

Adult↗
PubMed1990

Diagnosis of colorectal carcinoma--is colonoscopy superior to barium enema?

From January 1984 to December 1987, 520 pathologically proved cases of colorectal carcinomas were treated in Mackay Memorial Hospital - 272 (52.5%) were male and 248 (47.7%) were female. The distribution of carcinomas in the colorectum were caecum 27 (5%), ascending colon 49 (9.1%), transverse colon 70 (13%), descending colon 41 (7.6%), sigmoid colon 93 (17.3%), rectosigmoid colon 19 (3.5%) and rectum 239 (44.4%). Fourteen cases (3.3%) had double carcinomas. When 334 barium enema examinations (210 single contrast, 124 double contrast) and 207 colonoscopies were done, false negative results were found in 31 (14.76%) single contrast barium enema (BaE-S) and eight (6.45%) in double contrast barium enema (BaE-D) examinations, and 7 (3.38%) colonoscopic examinations failed to demonstrate cancer lesions because of incomplete examinations from technical problems. False negative in BaE were mostly due to failure to recognize or misinterpret the lesions especially in the rectum. Colonoscopy is significantly more accurate than BaE-S but not with BaE-D. BaE especially BaE-D can be complementary to colonoscopy in a nearly obstructing colon. Direct biopsy of the lesion makes colonoscopy more useful than BaE. Complete removal of a malignant polyp turns colonoscopy into a therapeutic modality. However, a well-trained endoscopist is essential in making colonoscopy a less suffering and more accurate examination. In a symptomatic patient, a confirmatory examination is always needed after positive BaE finding. Sometimes this can be avoided by having colonoscopy done first.

Adult↗
PubMed1990

Transitional mucosa of colon. A morphological, histochemical, and immunohistochemical study.

We studied alterations in the transitional mucosa of the colon in 18 cases of primary colonic adenocarcinoma (4 from the cecum; 4, the ascending colon; 5, the descending colon; 2, the sigmoid colon; and 3, the rectum). One patient had 2 separate primary tumors. Formalin-fixed, paraffin-embedded sections were studied in all cases, and tissues fixed in methacarn fixative were available in 9. Sections of tumor and transitional mucosa were compared with those of normal mucosa distant from the tumor. Sections were stained with hematoxylin-eosin, Masson's trichrome, and alcian blue at a pH of 0.9 (sulfomucin) and at a pH of 2.5 (sialomucin and sulfomucin). Immunoperoxidase stains for collagen type IV (basal lamina) were also performed. Transitional mucosa showed morphological alterations, including increase in mucosal thickness and crypt distortion. An increase in lamina propria fibrosis was noted in transitional mucosa in 3 cases. Abnormal mucin content, consisting of a predominance of sialomucin, was noted in transitional mucosa in 12 cases. In one of these, sialomucin was predominant in both transitional and normal mucosa. No alterations in the thickness of the subepithelial collagen table were noted. Collagen type IV staining was effective in demonstrating an increase in lamina propria vascularity in transitional mucosa in 11 specimens.

Adenocarcinoma↗
PubMed1989

[Diffuse ulcerative lesions in the colon with intestinal Behçet's disease].

Ileocecal region is most commonly affected in intestinal Behçet's disease. Localized deep ulcerations which have a punched-out or undermining appearance with well-defined margin placing in this region had been noted in many cases. 41 patients with intestinal Behçet's disease were observed by colonofiberscope in Teikyo University Hospital from January 1982 to June 1988. In 10% (4 cases) of these patients, diffuse ulcerative lesions in the transverse colon and the distal colon were found. These diffuse lesions in the colon with Behçet's disease were seemed to be much like those associated with inflammatory bowel disease as ulcerative colitis and Crohn's disease in morphological characteristics. The clinical symptoms of these four cases with Behçet's disease including oral aphtha, genital ulcer, joint pain, skin eruptions, and eye involvement, preceded each colonic ulceration. The first two cases were affected with ulcerative lesion in the distal portion of the recto-sigmoid colon and the descending colon. And the last two were involved in the whole transversing colon by multiple deep ulcerations. Wide-spreading ulcerative lesion in the colon with Behçet's disease is a rare condition in the Japanese, and only two papers has been reported previously. Because clinical manifestations between Behçet's disease and inflammatory bowel disease are very similar in many points as oral aphthous ulcers, arthritis, eye involvement, skin eruptions, phlebitis, arterial occlusions, then, an overlapping field or a part of a spectrum of disease has been suggested by some authors. But, in the present circumstances, they are distinct disease entities, we think that these four cases are in an atypical condition with intestinal Behçet's disease.

Adult↗
PubMed1981

Colonic gas distribution in toxic megacolon.

To determine whether dilation of the transverse colon is a specific pathophysiologic feature in toxic megacolon, plain films of the abdomen in different positions were obtained of 6 patients with ulcerative colitis complicated by toxic megacolon. All patients were examined initially in the supine position and subsequently in the prone position. Redistribution of gas in the colon occurred in all patients when the prone position was assumed. The shift of gas was largely from the transverse colon to the descending colon. Pathological examination of the colon in 5 patients revealed the transverse colon to be no more severely involved than the remainder of the colon. The findings suggest that distribution of colonic gas in toxic megacolon is largely governed by the influence of gravity and the anatomic position of the colon in the peritoneal cavity.

Adult↗
PubMed1995

Delayed colonic transit in spinal cord-injured patients measured by indium-111 Amberlite scintigraphy.

OBJECTIVE: Constipation is a major problem for patients with chronic spinal cord injury (SCI). However, it is not clear whether abnormal colonic transit is restricted to the rectosigmoid region or involves the entire colon. We assessed regional colonic transit with emphasis on the ascending and transverse segments in patients with chronic SCI and compared the results with those of controls using scintigraphic techniques. METHODS: Seven patients with SCI below T1 and 10 control subjects were studied after oral ingestion of a capsule containing indium-111-labeled Amberlite (Sigma Chemical, St. Louis, MO) pellets. The capsule was coated with a pH-sensitive polymer that prevents disintegration until it reaches the ileocecal region. Assessments of the half-time of emptying and residence time of contents in ascending and transverse segments were made, as well as an assessment of the velocity of contents throughout the entire colon, including the descending colon. RESULTS: A significantly slower half-time of emptying was found in SCI patients (ascending: 29 +/- 27 hr in SCI, 6.81 +/- 3.03 hr in controls, p < 0.01; ascending + transverse: 42 +/- 12 hr in SCI, 15.3 +/- 7.16 hr in controls, p < 0.01). The residence time of the median position of the contents was significantly prolonged in SCI patients (ascending: 31 +/- 23 hr in SCI, 8.75 +/- 4.68 hr in controls, p < 0.05; transverse: 26 +/- 3 hr in SCI, 5.0 +/- 4.4 hr in controls, p < 0.05). Overall, the velocity of the median position of contents throughout the entire colon was significantly lower in SCI (0.63 +/- 0.33 cm/hr in SCI, 2.58 +/- 1.20 cm/hr in controls, p < 0.001). CONCLUSIONS: Patients with chronic SCI have prolonged colonic transit that involves the entire colon. Hence, treatment of constipation in these patients may need to include prokinetic agents as well as local rectal maneuvers.

Adult↗
PubMed1994

[Arteriovenous malformations of the intestine in children. Study of 8 cases and review of the literature].

Eight children with arteriovenous malformations of the gastrointestinal tract were studied during a two year period (1989-1993). The main localization of the arteriovenous malformations were: ascending colon (five cases), descending colon (five cases), terminal ileum (three cases), rectum and sigmoid (three cases). Diagnosis approach was made with colonoscopy and arteriography. Surgical resection of the affected segments was the therapeutical procedure in seven of the eight cases.

Angiography↗
PubMedDate not supplied

[Carcinoma of the splenic flexure. Nosological and therapeutic contribution].

Twenty-one patients undergoing colectomy for carcinoma of the splenic flexure from November 1996 throughout October 1993 were studied retrospectively. Clinical and prognostic features were compared with those of other colon cancers treated in the same period at the same Institution. No differences in symptoms at onset and stage distribution were found in the two groups. The complex removal of the cancer tissue was achieved with the resection of the major part of the transverse colon, splenic flexure, descending colon and its mesocolon. The splenic flexure cancer did not show a worse prognosis than other colon cancers.

Adenocarcinoma↗
PubMed2003

Decreased colonic motility in persons with chronic spinal cord injury.

OBJECTIVES: In persons with spinal cord injury (SCI), several studies have shown that large bowel transit is decreased at the level of the left colon and rectum, and that postprandial colonic response to food is absent. To define these parameters further, the effects of food on colonic motility in persons with SCI were studied and compared to those of spinally intact (SI) individuals. METHODS: The study was conducted in eight subjects with SCI (four paraplegic and four quadriplegic) and six age-matched SI subjects. After routine bowel preparation, colonoscopy was performed with the proximal end of a solid state pressure transducer catheter (four sensors each separated by 10 cm) tethered to the splenic flexure using endoclips (Olympus). The subjects were then allowed to carry out their usual daily activities. Two phases were compared: 1 h before breakfast, designated as the "resting phase," and 1 h during breakfast, designated as the "food-ingestion phase." RESULTS: Baseline colonic activity of the SCI group was significantly less than in SI subjects. During meals, the motility index, mean amplitude of the waves, percent activity, and number of waves was significantly less in the SCI group. In both the SI and SCI groups, a postprandial colonic response was observed. However, in the SCI group, the response was seen only in the descending colon and not in the rectosigmoid region. CONCLUSIONS: SCI decreases colonic motility, and this alteration may relate to difficulty with evacuation. The postprandial colonic response in SCI is present but is suboptimal and confined to the descending colon.

Adult↗
PubMed1999

Comparison of cattle and sheep colonic permeabilities to horseradish peroxidase and hamster scrapie prion protein in vitro.

BACKGROUND: Paracellular permeability to solutes across the descending colon is much higher in cattle than sheep. This is a possible route for transmission of infective materials, such as scrapie prion. AIMS: To compare the permeabilities of labelled scrapie prion protein and other macromolecules in bovine and ovine descending colons in vitro. METHODS: Using fresh slaughterhouse material, transepithelial fluxes of macromolecules across colonic mucosae mounted in Ussing chambers were measured by monitoring transport of either enzyme activity or radioactivity. RESULTS: The comparative bovine to ovine permeability ratio of the probes increased with molecular weight: from 3.1 (0.13) for PEG400 to 10.67 (0.20) (p<0.001) for PEG4000; and from 1.64 (0.17) for microperoxidase to 7.03 (0.20) (p<0.001) for horseradish peroxidase (HRP). The permeability of (125)I-labelled inactivated Syrian hamster scrapie prion protein (ShaPrP(sc)) was 7.02 (0.33)-fold higher in bovine than ovine colon (p<0.0025). In each species, the probe permeabilities decreased according to the formula: P = P(o). exp(-K.ra). The "ideal" permeabilities, P(o) are similar, however, K((ovine)) = 2.46 (0.20) cm/h/nm exceeds K((bovine)) = 0.85 (0.15) cm/h/nm (p<0.001) indicating that bovine colon has a higher proportion of wide pores than ovine. Image analysis confirmed that HRP permeated through the bovine mucosal layer via a pericryptal paracellular route much more rapidly than in sheep. CONCLUSIONS: These data may imply that scrapie prion is transmitted in vivo more easily across the low resistance bovine colonic barrier than in other species.

Animals↗
PubMed2002

The variable stiffness colonoscope: assessment of efficacy by magnetic endoscope imaging.

BACKGROUND: Variable-stiffness colonoscopes combine the flexibility of pediatric instruments for negotiation of the sigmoid colon with the ability to stiffen the insertion tube to prevent or control looping after straightening. Previous studies have found wide variation in the efficacy of the stiffening mechanism. Thus, two studies were conducted to assess the potential benefit of the stiffening device and its optimal use. METHODS: In study 1, the effect of routinely stiffening the straightened variable-stiffness colonoscopes in the mid-descending colon was determined in 82 patients. Two insertions were performed (mid-descending colon to cecum) in each patient with and without application of the stiffening device (randomized). The time to negotiate the proximal colon (mid-descending to cecum), time to pass the variable-stiffness colonoscopes across the splenic flexure into the transverse colon, time to pass the right colon, and ancillary maneuvers used were recorded for each insertion. In study 2, consecutive patients, excluding any with previous colonic resection, were examined by using standard adult variable-stiffness colonoscopes. Real-time views of the procedure with magnetic endoscope imaging were recorded for all examinations, but procedures were randomized to be done either with (n = 88), or without (n = 87) the endoscopist viewing the magnetic endoscope imaging display. Whenever stiffening was applied, the anatomic location of the colonoscope tip and stiffness efficacy were recorded. RESULTS: In study 1, time taken to negotiate the proximal colon (p = 0.0041) and time to negotiate the splenic flexure (p = 0.006) were significantly shorter and ancillary maneuvers performed were fewer (p = 0.0014) with the stiffening device activated. In study 2, stiffening was used with similar frequency in patients examined with and without the magnetic endoscope imaging view, most commonly for passing the splenic flexure (71%), but also in the transverse colon (12%), right colon (9%), and sigmoid/descending colon (8%). Stiffening was significantly more effective when used in combination with magnetic endoscope imaging (69% with imager vs. 45% without imager; p = 0.0102). CONCLUSIONS: Overall, the variable-stiffness device used was effective in controlling looping 57% of the time. Activating maximum stiffness appears to be effective once the sigmoid colon has been negotiated and the colonoscope straightened with the tip in the proximal colon, reducing the number of ancillary maneuvers and shortening the insertion time through the proximal colon. Routine magnetic endoscope imaging further enhances the efficacy of the variable-stiffness colonoscopes by helping to identify the optimal time for stiffening.

Colon↗
PubMed1993

The eae gene of Citrobacter freundii biotype 4280 is necessary for colonization in transmissible murine colonic hyperplasia.

Transmissible murine colonic hyperplasia is characterized by proliferation of anchored stem cells in the mucosa of the descending colon of laboratory mice and is caused by Citrobacter freundii biotype 4280. This bacterium produces attaching and effacing lesions in the descending colon prior to the onset of gross hyperplasia. By mutational analysis, the chromosomal eae gene of C. freundii biotype 4280 was shown to be necessary for colonic colonization. Conversely, bacteria cured of a 65-kb plasmid, which was identified in C. freundii biotype 4280, were not attenuated for colonic colonization or for the induction of colonic hyperplasia.

Adhesins, Bacterial↗
PubMed1997

The relationship between myenteric neuronal denervation, smooth muscle thickening and epithelial cell proliferation in the rat colon.

The effects of myenteric neuronal denervation on smooth muscle thickening and epithelial cell proliferation were studied in the descending colon of rats treated by serosal application of 2 mM benzalkonium chloride (BAC) for 30 min. Control animals were treated with saline (0.9% NaCl). The animals were divided into six groups of 13 animals each and killed 10, 45 and 120 days after BAC treatment. A significant reduction in neuron number was observed in the myenteric plexus of animals treated with BAC, as well as smooth muscle thickening and an increase in crypt cell population, crypt cell production per crypt and a decrease in cell cycle time. These findings permit us to conclude that a relationship may exist between the increase of epithelial cell proliferation, smooth muscle thickening and myenteric neuron denervation in the descending colon caused by BAC, the latter probably playing an important role in the integration of the other two.

Animals↗
PubMed2001

A prospective radiological anatomical study of the variations of the position of the colon in the left pararenal space.

Percutaneous puncture of the kidney allows direct access to the pyelocalicial cavities. The posterior approach of this retroperitoneal organ can be complicated of transcolic punctures due to the postrenal position of the colon. A prospective radiological anatomical study of the relationship between the left kidney and the descending colon was undertaken. One hundred computed tomograms of adult subjects were obtained from which the anatomy of the left perirenal area was determined: the descending colon is more frequently behind the kidney in the young females. Two main factors determinants of this situation are: 1) colon ontogenesis in relation to the attachment of the primitive mesocolon, permitting a 'fixed' left colon, or 'moving' left colon at the end of a long mesocolon, allowing it to pass behind the kidney; 2) a mechanical factor whereby the accumulation of perirenal fat with increasing age may be a limiting factor in lateral displacement of the colon.

Adult↗
PubMed2003

Weekly administration of paclitaxel attenuated rectal stenosis caused by multiple peritoneal recurrence 8 years after the resection of gastric carcinoma.

We report a patient with rectal stenosis caused by peritoneal recurrence 8 years after a curative resection of advanced stage gastric carcinoma; the recurrence was effectively treated with the weekly administration of paclitaxel. The patient was a 66-year-old Japanese woman who was admitted to our hospital complaining of abdominal pain and frequent bowel movements. She had undergone total gastrectomy, due to advanced-stage gastric carcinoma with extensive lymph node metastasis, 8 years before, and had taken an oral anticancer agent, fluoropyrimidine, for 4 years after the operation. Colonofiberscopy performed on admission revealed circumferential rectal stenosis located 10 cm from the anal verge. Barium enema study demonstrated extensive poor expansion of the upper and lower rectum and irregularity of the descending colon. Abdominal computed tomography (CT) scanning revealed wall thickening in the rectum and descending colon. These findings were compatible with rectal stenosis caused by the peritoneal recurrence of gastric carcinoma. Weekly administration of paclitaxel was started. The abdominal symptoms soon disappeared when the second cycle of paclitaxel was completed, and they have not appeared since then. The rectal stenosis was attenuated, as confirmed by imaging analyses. Weekly paclitaxel has been effective for more than 13 months, suggesting that the patient is in a state of tumor dormancy of recurrent gastric carcinoma.

Aged↗
PubMed2003

Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy.

BACKGROUND: The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies. METHODS: Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. RESULTS: Using the sigmoid-descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid-descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%). CONCLUSIONS: Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia.

Adenomatous Polyps↗
PubMed1990

[Renocolic fistula caused by xanthogranulomatous pyelonephritis: a case report].

Renocolic fistulas caused by typical xanthogranulomatous pyelonephritis are rare. We present a case of renocolic fistula caused by xanthogranulomatous pyelonephritis. A 58-year-old woman was admitted to the Department of Urology, Sakata City Hospital, with the chief complaint of pain in the left flank region. The plain film showed no calculi. An intravenous pyelogram showed left non-functioning kidney. A left retrograde pyelogram demonstrated a communication between the left renal calyx and the descending colon. A computed tomography done after the retrograde pyelography revealed contrast medium in the descending colon and a heterogenous left renal mass and thickness of Gerota's fascia. On the basis of the radiologic studies a diagnosis of renocolic fistula was made. The patient underwent a nephrectomy with closure of the fistula of the colon. The pelvicaliceal system of the resected kidney was distended and contained yellow fatty like tissue. Histologically xanthogranulomatous pyelonephritis was confirmed. The patient made an uneventful recovery.

Colonic Diseases↗