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PubMedDate not supplied

[Endoscopic dilatation of benign colon and rectum stenosis].

AIM: To determine the usefulness of endoscopic dilatation in dealing with benign stenosis of the anus, rectum and colon. PATIENTS AND METHODS USED: Thirty six (36) patients with stenosis, anus (8), rectum (22) and colon (6) were given endoscopic treatment using hydroneumatic balloons, electro incision (radiated cuts) or a combination of both. Rigid equipment (metal) was used for distal stenosis. Age ranged between 30 and 82 years. Twelve (12) patients were male and 24 female. The diameter of the stenosis was less than 13 mm in 18 of the patients and 11 patients carried colostomy. RESULTS: All 36 patients were subjected to a total of 113 dilatation sessions. The average number of sessions per patient for patients with anal stenosis was 2.5 and for patients with colorectal stenosis, 3.32. One patient with rectal stenosis required 21 sessions to achieve final objective. The result achieved was good in 31 patients, less than satisfactory in 3 patients and bad in one patient, who presented a stenosis which was over 5 cm long. We lost track of a patient in the follow up stage. Success in closing the colostomy was achieved in 9 patients, while one presented a complication due to the procedure (cervical emphysema) which remitted with medical attention. CONCLUSIONS: Endoscopic dilatation offers, through its different techniques, a safe and efficient method for the treatment of benign stenosis of the anus, rectum and colon and must be considered as a first class tool for the treatment of this kind of pathologies.

Adult↗
PubMed2002

Tissue microarray molecular profiling of early, node-negative adenocarcinoma of the rectum: a comprehensive analysis.

PURPOSE: Early-stage adenocarcinoma of the rectum treated with curative intent has a favorable overall prognosis; however, 20%-30% of the patients recur, and the majority ultimately die of disease. Recurrence and tumor-related mortality may be attributable to molecular abnormalities in primary tumors accounting for their more aggressive biological behavior. This study evaluates such molecular phenotypes with regard to cell cycle regulation and proliferation and determines their significance for patient outcome. EXPERIMENTAL DESIGN: One hundred patients with primary T(2-3), N(0) adenocarcinoma of the rectum uniformly treated by surgery alone were studied. Core biopsies of pathological specimens were assembled on tissue microarrays, and expression of p53, mdm-2, p21, Bcl-2, p27, cyclin D1, and Ki-67 was analyzed by immunohistochemistry. Molecular profiles were correlated with disease-free (DFS) and disease-specific survival (DSS). RESULTS: Despite previously described prognostic relevance of some of the investigated molecules in analyses where different stages of colorectal cancer were included, none of the cell cycle-regulatory or proliferation-related markers was associated with recurrence or survival. However, patients with tumors demonstrating down-regulation of p27, a cyclin-dependent kinase inhibitor and tumor suppressor gene associated with development of metastases, showed a trend toward reduced DFS and DSS (P = 0.06 and P = 0.07, respectively). CONCLUSIONS: In this homogeneous group of patients with early-stage, node-negative adenocarcinoma of the rectum uniformly treated by surgery alone, the investigated cell cycle-regulatory and proliferation-associated proteins appear to have no prognostic significance. However, down-regulation of p27 appears to be associated with a trend toward reduced DFS and DSS, which suggests further investigation of other p27-related pathways potentially relevant for metastatic disease.

Adenocarcinoma↗
PubMedDate not supplied

Compositional and structural alterations of proteoglycans in human rectum carcinoma with special reference to versican and decorin.

This study indicated that human normal rectum (HNR) and human rectum carcinoma (HRC) contained three populations of proteoglycans (PGs). About 63% of the HNR PGs, in terms of uronic acid, were heparan sulfate proteoglycans (HSPGs) of M(r) 500,000 with HS side-chains of M(r) 35,000. The other two populations were versican (29%) and decorin (8%) of M(r) 715,000 and 90,000, respectively, bearing mainly dermatan sulfate (DS) (73%) and chondroitin sulfate (CS) (27%) chains of M(r) 24-26,000 and 20-22,000, respectively. In contrast, in terms of uronic acid, HRC contained 2-fold amounts of PGs. The majority of these PGs (87%) were versican and decorin of lower hydrodynamic size (500,000 and 70,000, respectively) than in HNR, with CS as prominent GAG (70%) in both types of PG. The M(r) of CS and DS chains in these PGs was 12-14,000 and 14-16,000, respectively. The remaining portion (13%) of PG was HSPGs of lower hydrodynamic size (300,000) with smaller HS chains (29,000) than HSPGs of HNR. Moreover, the molar concentrations of versican and decorin estimated from PG-derived protein contents represented a significant, but disproportionate increase, about 5-fold and 8-fold, respectively. The sulfation pattern of rectum carcinoma-associated versican and decorin was significantly altered mainly in containing (62%) 6-sulfated disaccharides and a significant proportion (10%) of non-sulfated disaccharides. DS chains of the tumor-associated versican and decorin contained decreased amounts of iduronic acid. On the metabolic level, the abnormally high production of versican and decorin in this malignant tumor suggests a dramatic modification in their biosynthetic steps at both translational and posttranslational levels.

Aged↗
PubMed2003

[Early surgical complications after treatment of malignant diseases of the colon and rectum].

Operations malignity on the colon and rectum belong into a group of risky operational treatment, which has a high percentage of early postoperational complications in comparison to the other operational treatments in digestive surgery. To determine the precentage of the postoperational complication of the resectional treatment on the colon and rectum, obtained results compare with the experience of the other authors. Analysed 439 patients operated from malignity on the colon and rectum in five year period (1998-2002). Bleeding after the postoperation had 8 patients (1.82%). Dehiscentio anastomosis has been evident in 21 patient (4.78%). Interintestinal apscess has been evident in 4 patients (0.91%). The infection of operational would of the 45 patients has been (10.25%). Dehiscentia of the operational wound of 10 patients has been (2.27%). Ileus in early postoperational stage has been evident in 16 patients (3.64%). The Total number of reoperation based on the analysed complications has been evident in 50 patients (11.38%). As e conclusion we can see that ours results coincides with the experience of the other authors.

Colorectal Neoplasms↗
PubMedDate not supplied

[Comparative results of ganglion dissection in cancer of the rectum with and without prior treatment of the adipose tissue].

BACKGROUND: The aim of this study is to describe the result obtained through two techniques of isolation of lymphatic lymph nodes in surgical pieces of anterior resection due to adenocarcinoma of the rectum. MATERIAL AND METHODS: We carried out a search in a series of 30 consecutive cases of patients operated on for adenocarcinoma of the rectum for lymph nodes first in a manual conventional way and second after 24 hours in a degreasing solution at room temperature. RESULTS: In the first search 335 lymph nodes were lymph nodes isolated, with an average that oscillated between 6.46 and 17.58, with the lower values corresponding to the groups that had received prior adjuvant treatment. In the second inclusion, following the action of the clearing solution, we found new lymph nodes (85) in some 75% of the cases, appreciably lower in number and smaller in size than the initial search. CONCLUSIONS: Manual lymph nodes dissection of the adipose tissue is a reliable method for the isolation of lymphatic lymph nodes in pieces of resection due to adenocarcinoma of the rectum. The search for lymphatic ganglions following the action of a clearing solution should be reserved for cases in which the minimum recommended in the TNM staging is not reached

Adenocarcinoma↗
PubMed2004

Adenosquamous carcinoma of the rectum: a case report.

Adenosquamous carcinoma is defined as a tumor with well defined malignant glandular and squamous components and the potential for both components to metastases. This tumor is extremely rare in colon and rectum with an incidence of less than 0.2%. Adenosquamous carcinoma of rectum should be distinguished from collision tumor with exemption of all lesions located distal to a level of 7 cm above the dentate line. Here we present a case of rare type adenosquamous carcinoma in rectum in a 29 year old female.

Adult↗
PubMedDate not supplied

[Colon and rectum signet-ring cell carcinoma in the National Institute of Neoplastic Diseases].

OBJECTIVE: Primary signet ring cell carcinoma of the colon and rectum is a rare form of adenocarcinoma of the large intestine. The purpose of this study was define the incidence, natural history and relation with hereditary nonpolyposis colorectal cancer (HNPCC). METHODS: We reviewed the medical records and pathology of 28 patients with primary signet ring cell carcinoma of the colon and rectum seen at the Instituto de Enfermedades Neoplasicas (INEN), between 1991 and 2002. RESULTS: In the present study the incidence was 5.09% of large bowel adenocarcinoma. Most patients present with late stage disease (Dukes stage C and D). In most cases the signet ring cells diffusely infiltrated through all layers of the intestinal wall (Borrmann IV). Male to female ratio was of 1 : 1.5, mean age was 55.5 and median age was 57 years (range 11 - 83 years). CONCLUSIONS: Comparison of our data with the literature showed some differences that could be related with biological characteristics of our people and different applied inclusion criteria. We couldn't define the relation between HNPCC and primary signet ring cell carcinoma of the colon and rectum.

Academies and Institutes↗
PubMed2004

[Laser palliative destruction of rectum carcinoma--case reports].

The palliative treatment of developed primary or recurrent rectum carcinoma is still an important issue in treatment of this disease. The aim of the surgery is in such case to remove the tumorous obstacle and to prevent the development of ileus, to reduce pain, to limit the volume of tumorous tissue, to prevent bleeding and possible incontinence or mucous secretion. The transanal laser thermodestruction of the tumor represents one of the possible ways of palliative treatment of rectum carcinoma. The method is very considerate even for the high risk patients. On the other hand it requires a short-term hospitalization. The method of transanal laser evaporisation of carcinoma is also important from the ethical point of view: in many cases it may prevent the creation of palliative derivative colostomy. This fact is very important especially in patients with the terminal stage of the malign carcinoma because they live the rest of their lives in acceptable conditions. The important benefits are described in three case histories. The method is presented as an urgent surgery in solution of ileus which is based on tumorous rectum stenosis.

Adult↗
PubMed2005

Preoperative diagnosis of urinary bladder involvement in adenocarcinoma of colon and rectum.

OBJECTIVE: Objective of the study was to compare urinary symptoms, urinalysis, computed tomography, intravenous pyelography, ultrasonography between colorectal adenocarcinoma with urinary bladder involvement and without urinary bladder involvement. MATERIAL AND METHOD: Patients with adenocarcinoma of the colon and rectum who had the first operation between January 1999 and October 2004 were included in the present study. All patients were divided into the bladder adhesion group and nonadhesion group. Sex, sites of tumor, urinary symptoms and preoperative investigations were compared. RESULTS: 453 patients were included in the present study with 264 males and 189 females (sex ratio M:F = 1.4:1). 26 cases (5.7%) had bladder adhesion. Males had more chance of having bladder involvement. Sigmoid and rectum were the most common sites of bladder adhesion. All cases with urinary symptoms had bladder involvement. Urinalysis and computed tomography had a sensitivity of 59% and 61%, respectively. All cases whose computed tomography showed bladder involvement had bladder adhesion during surgery. Cystoscopy had a sensitivity of 75%. Ultrasonography and IVP did not help in detection of bladder invasion. CONCLUSION: History of urinary symptoms, urinalysis, computed tomography should be routinely performed in patients with adenocarcinoma of the sigmoid and rectum to detect urinary bladder involvement and to inform modes of urinary tract diversion to patients before surgery.

Adenocarcinoma↗
PubMed1992

Patterns of recurrence after curative resection of carcinoma of the colon and rectum.

Data on 818 patients who had undergone curative resection for Dukes' B2 or Dukes' C carcinoma of the colon and rectum were analyzed to determine the timing and patterns of recurrence based on such tumor characteristics as location, Dukes' stage, grade, ploidy and the presence of obstruction, perforation or adherence to adjacent organs or tissues. Three hundred and fifty-three patients (43 per cent) had recurrent disease. There was recurrence in 52 per cent of patients with carcinoma of the rectum and in 40 per cent of patients with carcinoma of the colon. The median time to recurrence for all patients was 16.7 months, with a range from 1 month to 7.5 years. Dukes' C lesions and the presence of adhesion or invasion, or both, or perforation were associated with significantly earlier recurrence. Among patients with recurrence, the most frequent sites were hepatic in 33 per cent, pulmonary in 22 per cent, local or regional, or both, in 21 per cent, intra-abdominal in 18 per cent, retroperitoneal in 10 per cent and peripheral lymph nodes in 4 per cent. Rectal primary sites, when compared with colonic, had proportionally more local or regional, or both, recurrences (p = 0.00003) and fewer involving retroperitoneal nodes (p = 0.022). Both primaries of the rectum and colon at stage C, when compared with stage B, had fewer local or regional recurrences, or both (p = 0.01), but a greater tendency to involve retroperitoneal or peripheral nodes. Primaries of the colon with adhesion to, or invasion of, adjacent organs had a lesser tendency to pulmonary metastasis (p = 0.036). Whereas the grade of anaplasia and ploidy had a strong influence on the rate of recurrence, they did not influence timing or patterns of recurrence. Patterns of recurrence based on the characteristics of the tumor may facilitate selection of the most appropriate adjuvant procedures, particularly those directed toward local or regional recurrence, or both, and also may guide efforts at early recognition of recurrence.

Adenocarcinoma↗
PubMedDate not supplied

Hypercalcemia associated with adenocarcinoma of the rectum. A case report and review of the literature.

Hypercalcemia is a well described complication of cancer both in solid tumor and hematologic malignancies. Metastatic adenocarcinoma of the rectum has not been reported to be associated with hypercalcemia. We report a case of a patient with metastatic adenocarcinoma of the rectum to the liver with hypercalcemia. Evaluation for other causes of hypercalcemia was negative. We suggest that adenocarcinoma of the rectum can lead to the development of hypercalcemia.

Adenocarcinoma↗
PubMed1991

[Internal intussusception of the rectum. An analysis of 62 cases].

In 62 cases of internal intussusception of the rectum, 21 were treated surgically. Their clinical features included serious dyschesia demanding longer time and strength, tenesmus, and slender stool. Digital examination of the rectum, proctoscopy, and colonoscopy usually showed no abnormalities, while defecography could show the presence and severity of internal intussusception. Parenchymal diseases of the rectum such as carcinomas should be ruled out before surgical correction. Operative measures included rectal suspension raising of the pelvic floor, resection of the redundant sigmoid colon, and the pathogenesis of the disease.

Adult↗
PubMed1991

Anastomotic recurrence of carcinoma of the colon and rectum. The value of endoscopy and serum CEA levels.

The early diagnosis of anastomotic recurrence after surgery for carcinoma of the colon and rectum is difficult. Whether repeat colonoscopy and serial serum CEA measurements were useful in diagnosing early anastomotic recurrence was examined. A total of 112 patients with carcinoma of the colon and rectum who had undergone resection and anastomosis were followed with frequent colonoscopy and serum CEA measurements. Seventeen patients developed anastomotic recurrence. Fourteen patients had elevated serum CEA levels, and 15 patients had endoscopic evidence suggesting recurrence at the anastomotic site. CT scans of the abdomen and pelvis demonstrated metastatic disease in seven patients, localized anastomotic disease in six patients, and no evidence of disease in four patients. Laparotomy was then carried out in 10 patients. In eight of 10 patients, it was possible to resect localized disease. In a 3-year follow-up study, eight patients were alive, four without any evidence of recurrent disease. Repeat colonoscopy and serum CEA measurements are recommended as postoperative surveillance for carcinoma of the colon and rectum. In select cases laparotomy and resection may prolong survival.

Abdominal Neoplasms↗
PubMed1990

Surveillance strategies after resection of carcinoma of the colon and rectum.

The primary aim of postoperative surveillance of patients with carcinoma of the colon and rectum is to detect recurrent tumor when cure is still possible. Most recurrences are detected within 30 months after the initial operation. Patients who have had carcinoma of the colon and rectum must be observed not only because of the risk of recurrence or metastatic disease but also because of the increased risk of subsequent primary carcinomas of the colon and rectum as well as of other sites. Careful history-taking and thorough physical examination provide the first indication of tumor recurrence in as many as 48 per cent of instances. Although the liver is the most common site of metastases from carcinoma of the colon, liver chemistry tests are seldom the first to indicate recurrent disease. Fecal occult blood testing, roentgenography with barium enema and colonoscopy are useful surveillance tools, not for detecting recurrences but for detecting second primary carcinomas. Imaging techniques, such as intravenous pyelography, CT and scintigraphy of liver and spleen are generally not cost-effective in surveillance, but MRI and ultrasonography have shown some promise in detection of recurrence without exposing patients to ionizing radiation. The most effective indicator of recurrent disease is a progressive increase in serial levels of CEA. When CEA levels rise and other methods of imaging cannot account for the change, second-look operation is generally appropriate.

Biomarkers, Tumor↗
PubMedDate not supplied

[Villous tumors of the rectum. Endoscopic treatment using monopolar coagulation].

UNLABELLED: Many methods are used to treat villous adenomas of the rectum. The best choice between these methods is not well established. Ninety-six patients (47 men, 49 women) treated with endoscopic monopolar coagulation were studied. The mean age was 66 years (range 37-84). The lesions were located in the lower third of the rectum in 27 cases, in the middle third in 35 cases and in the upper third in 34 cases. The circumferential extent of the lesions was less than 1/3 in 70 cases (C1), greater than 1/3-less than 2/3 in 23 (C2) and greater than 2/3 in 3 cases (C3). The follow-up of 2 patients (1 C1 and 1 C2) was not sufficient. Healing was not achieved in 8 of the 94 evaluated patients. Eighty-six patients were totally healed: 68 C1, 16 C2 and 2 C3 with a follow-up of 2 to 132 months (median: 36 months). The treatment was achieved after a mean of 2.1 sessions per patient (range 1-13). CONCLUSIONS: 1) Endoscopic monopolar coagulation of villous adenoma of the rectum is a simple and efficient treatment. 2) This method is complementary to surgery for extensive lesions (C3).

Adenoma↗
PubMed1986

Squamous cell carcinoma of the colon and rectum.

Squamous cell carcinoma of the colon and rectum is a relatively rare entity. Although much of this disease entity remains enigmatic, treatment tenets are the same as those accepted for adenocarcinoma of the colon and rectum. Although prognosis of squamous cell carcinoma of the colon and rectum appears to be worse than that of adenocarcinoma, an aggressive approach to this neoplasm is indicated in order to improve survival rates.

Adult↗
PubMed1979

Sacrofixation with Marlex mesh in massive prolapse of the rectum.

Rectal fixation to the sacrum is considered the most rational operation in the surgical treatment of massive or complete prolapse of the rectum, since it eliminates the anatomic defect which is fundamental in the pathogenesis of this disease. Many techniques have been used to join the posterior wall of the rectum to the sacrum, ranging from the use of simple sutures with nonabsorbable material to prosthetic materials, such as Teflon sheets or Ivalon, polyvinyl, sponges which are placed around the rectum and attached to the sacrum. A variant consists of using Marlex mesh instead of Teflon. In an experience with 24 patients, only one patient died postoperatively. In a follow-up period of ten years, no recurrences have been observed in any of the remaining patients.

Adolescent↗
PubMed1985

Changing attitudes toward management of cancer of the colon and rectum.

Changes in the attitudes of surgeons toward the management of cancer of the colon and rectum over a 5-year period were assessed by analysis of responses of general surgeons to a 21-item questionnaire on colon cancer from 1978 and 1983. Comparisons of the responses revealed that the use of routine preoperative liver scans has decreased from 57 to 45 per cent. Transanal resection of villous adenoma of the rectum is used more often (44% in 1983 versus 34% in 1978). For obstructing carcinoma of the colon, a two-stage procedure is used more often, with 46 per cent of the respondents in favor of this approach in 1983 compared with 29 per cent in 1978. The use of staplers for colon anastomoses following resection has also increased with 44 per cent surgeons in 1983 using this technique always or frequently compared with 21 per cent in 1978. Following anterior resection, 66 per cent of respondents in 1983 seldom or never use a transverse colostomy (54% in 1978). The number of surgeons closing the perineal wound over suction drains following an abdominoperineal resection has increased from 46 per cent (1978) to 63 per cent in 1983. Sphincter-saving procedures for carcinoma of the rectum are used by a large number of surgeons in 1983 (29% versus 9% in 1978). An increase is noted in the use of preoperative radiation therapy for selected cases of rectal cancer (53% in 1978 to 68% in 1983).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗