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PubMed1992

Prevention and early detection of colorectal cancer.

Adherence to a low-fat, high-fiber diet and regular screening to detect and identify polyps at an early, more treatable stage may reduce deaths from colorectal cancer. Patients should be told that they can reduce their risk of colorectal cancer by increasing their intake of fruits, vegetables and whole grain cereals and decreasing their intake of fat. Although scientific controversy exists regarding the specific methods and intervals of screening for colorectal cancer, family physicians should adopt a regular approach to screening in their patients. In adults 50 years of age or older, annual fecal occult blood testing is recommended. If positive results are obtained, follow-up examination should be performed with either colonoscopy or flexible sigmoidoscopy plus air-contrast barium enema. Persons between 50 and 75 years of age may also benefit from screening with flexible fiberoptic sigmoidoscopic examination every three to five years.

Aged↗
PubMedDate not supplied

[Colonic polyps: an analysis of the endoscopic and histopathological aspects].

The present study is a retrospective analysis of the endoscopic and histologic features of 728 polyps resected from 422 patients during the years 1980 to 1991. Mean age of the patients was 52 years (5 to 87), 63% male and 37% female. The histology of the lesions showed: adenoma: 60.3%, hyperplastic: 31.7; juvenile: 2.3% and miscellaneous: 5.7%. The 439 adenomas where found in 270 patients of which 151 (55.9%) were male and 119 (44.1%) female. The 231 hyperplastic polyps where found in 113 patients: 66 (58.4) male and 47 (41.6) female. All the hyperplastic polyps where less than 20 mm in diameter. Of the adenomas, 385 (87.7%) where less than 20 mm in diameter and had macroscopic appearance similar to the hyperplastic polyps. Of the 439 adenomas, 218 (49.6) where pediculated and 221 (50.4%) sessile. Of the hyperplastic polyps 53 (22.9%) where pediculated and 178 (77%) sessile. Of the adenomas, 351 (80%) where tubular and 88 (22%) had a villous component, most of the tubular adenomas where less than 15 mm in diameter and the villous component was more frequent as the polyps increased in size. Of the adenomas, 139 (30%) had dysplasia and of these 10% had cancer which represents a total of 3% of all the adenomas in this series. The grade of dysplasia was more severe as the adenomas was larger in size or had villous component. The polyps were located: 69.6 in the distal colon at the reach of the flexible sigmoidoscope and 30.4% in the proximal colon.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1963

COLON AND RECTAL POLYPS. RELATIONSHIP TO CARCINOMA.

A review of certain significant contributions to the literature was undertaken to evaluate evidence for and against the proposition that there is positive relationship of adenomatous polyps to carcinoma of the colon and rectum. The overwhelming evidence would seem to indicate that some adenomatous polyps are disposed to develop into invasive carcinomas. Since there is no way of determining which polyp has this tendency, it would seem prudent to remove all polyps that can be removed safely with a sigmoidoscope and remove any in the colon that are more than 1 to 1.5 cm in diameter, the criterion as to size depending upon other factors in each case. It is established that colon and rectal carcinomas may also arise from the mucosa without first appearing in a polyp. Such lesions may clinically appear as shallow ulcerations.

Adenoma↗
PubMed1992

Solitary rectal ulcer syndrome.

Solitary rectal ulcer syndrome (SRUS) clinically presents with rectal bleed. Twenty three cases of SRUS are described highlighting that it is a distinct clinicopathological entity which can be diagnosed in the presence of typical clinical features, sigmoidoscopic findings and histopathological appearance of mucosal biopsy.

Adolescent↗
PubMed2003

Retained rectal foreign bodies.

BACKGROUND: Retained rectal foreign bodies have been encountered more frequently and present a dilemma for management. Most of the reports on these cases were documented in the form of case report and from Western countries. The present study was a review on the authors' experiences in such cases. METHODS: Data from January 1979 to January 2000 were extracted from a computerized database of Taipei Veterans General Hospital. The clinical features, treatment strategies and outcomes were analyzed. RESULTS: Ten male patients (mean age: 57.0 years) with 12 presentations of retained rectal foreign bodies were collected. Glass bottles and vibrators were the most common objects encountered, while anal eroticism was reported as the reason for insertion in 50% of the cases. The majority of the objects were extracted by non-surgical methods through either anoscope (n = 4), rigid sigmoidoscope (n = 2) or colonoscope (n = 1). Obstetric forceps was utilized to remove an incarcerated bowling bottle. Emergent laparotomies were performed in cases with overt peritonitis (n = 2), pelvic sepsis (n = 1) and an impacted high-lying glass bottle. Minor complications, such as mucosal abrasion or superficial tear, were found in 62.5% of the non-surgically treated cases. Delayed bleeding was found in 2 of them. There was no mortality in our series. CONCLUSIONS: Despite its rarity, the retained rectal foreign body had varying clinical features. Most of the uncomplicated rectal foreign bodies could be simply extracted transanally under adequate anesthesia. Fiberoptic colonoscopic extraction provided an alternative choice. Open surgery should be reserved only for those patients with overt peritonitis or pelvic sepsis.

Adult↗
PubMed1992

Solitary rectal ulcer syndrome and colitis cystica profunda--a clinico-pathological review.

Twenty cases of solitary rectal ulcer syndrome (SRUS) and three cases of colitis cystica profunda (CCP) diagnosed between 1985 to 1990 were studied retrospectively. Clinical features, sigmoidoscopic findings and histopathology of the above lesions were reviewed. Haematoxylin and Eosin, Masson's Trichome, and high iron diamine Alcian blue staining was done in all the cases. Histopathologic examination helps in diagnosing the benign condition of the rectum viz. SRUS and CCP which are considered malignant clinically. Since an overlap of histopathological features were seen in SRUS and CCP, both can be considered as one entity, which has been highlighted in our study. Fibromuscular obliteration of lamina propria is the hallmark of the lesion.

Adolescent↗
PubMed1992

Phase II study of the safety and efficacy of a 5-lipoxygenase inhibitor in patients with ulcerative colitis.

We examined the effects of an inhibitor of 5-lipoxygenase (A-64077) in 11 patients with mild to moderately active ulcerative colitis (UC). Treatment was a daily oral dose of 800 mg for 28 days. Physicians global rating (scale 1-50) included stool characteristics, rectal bleeding, abdominal and rectal pain, urgency, and general well being; sigmoidoscopic evaluation (scale 1-15) included mucosal vascular pattern, erythema, granularity/ulcerations, friability, and exudate. All of the patients experienced a decrease in discomfort of their disease, and the gross appearance in the sigmoidoscopy improved in eight of them, but were not accompanied by histologic improvement. No significant side effects occurred. A long-term controlled double-blind and dose-effect trial using 5-lipoxygenase inhibitors is needed which may lead to a new therapeutic approach in UC.

Administration, Oral↗
PubMed1992

Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study.

Arachidonic acid metabolites formed by both the cyclooxygenase and lipoxygenase pathways may contribute to the clinical diarrhea and colitis of inflammatory bowel disease. Patients with active ulcerative colitis have increased levels of leukotriene B4 in their rectal mucosa, and these levels tend to correlate with severity of the disease. In this study, we evaluated the efficacy of ingestion of fish oil n-3-omega-fatty acids, inhibitors of leukotriene synthesis, in the treatment of ulcerative colitis. Eleven patients with ulcerative colitis of mild to moderate severity were studied in a 8-month, double-blind, placebo-controlled, crossover trial of dietary supplementation with fish oil, which provided about 4.2 g of omega-3- fatty acids per day. A disease activity index based on patient symptoms and sigmoidoscopic appearance was used to assess efficacy. Mucosal leukotriene B4 production was measured by radioimmunoassay. Mean disease activity index declined 56% for patients receiving fish oil and 4% for patients on placebo (p less than 0.05). There were no statistically significant differences in histopathologic scores or colonic mucosal leukotriene B4 levels. All patients tolerated fish oil ingestion and showed no alteration in routine blood studies. No patient worsened; anti-inflammatory drugs could be reduced or eliminated in eight patients (72%) while receiving fish oil. We conclude that fish oil dietary supplementation results in clinical improvement of active mild to moderate ulcerative colitis but is not associated with significant reduction in mucosal leukotriene B4 production, compared with placebo therapy. Further studies are needed to elucidate the mechanism of action and optimal dose and duration of fish oil supplementation in ulcerative colitis.

Adult↗
PubMed1992

[Lower digestive hemorrhage. Its etiology and the diagnostic efficacy of different explorations. A study of 2646 patients].

Lower gastrointestinal bleeding (LGB) is more frequent than upper gastrointestinal bleeding (UGB) with a better course and a more difficult diagnosis. We reviewed retrospectively 8544 cases from patients who were admitted at the Coloproctology Unit of Hospital de la Princesa. Those with the diagnosis of LGB with visible blood in stools (2646-31%) were outpatients, with a mean age of 43 years (range 9-91). Males represented 56.4% and females 43.6. All of them underwent at least sigmoidoscopic examination. The more frequent disorder was hemorrhoids (48.5%) and the bleeding source was found in the anus in 61%. Most of lesions (86%) could be reached with the short colonoscope and 92.7% of the bleeding sources were found with total colonoscopy. In 7.3% colonoscopy was not diagnostic and fiber gastroscopy identified the bleeding spot in 1.5% of the total. Barium studies were diagnostic in 0.5%, arteriography in 0.25% and radionuclide bleeding scan in 0.1%. Finally in 130 patients the bleeding source could not be found. We conclude that most of hemorrhagic lesions occur in the descending colon and that total colonoscopy can localize more than 92%. When total colonoscopy fails only 33% of the lesions can be found (2.35% from total) and 19% (1.5% from the total number) with UGB are identified with the fiber gastroscopic examination.

Age Factors↗
PubMed2005

Management of sigmoid volvulus in Polokwane-Mankweng Hospital.

OBJECTIVE: To evaluate the outcome of treatment of patients with sigmoid volvulus in the Polokwane-Mankweng Hospital and to identify the best management options for these patients. METHODS: A retrospective study was undertaken of 85 patients with sigmoid volvulus treated in Polokwane-Mankweng Hospital during the period July 1997-May 2004. RESULTS: In total, 85 patients were evaluated (77 males and 8 females, male/female ratio 9:1). The age range was 7-80 years (mean 42 years). Sigmoidoscopic derotation was attempted in 17 patients, and was successful in 10 patients. Laparotomy was done in 84 patients, viz. 75 emergencies and 9 electives. During laparotomy, gangrenous sigmoid colon was found in 30 patients and viable sigmoid in 54 patients. Resection with primary anastomosis was done in 44 patients. Hartmann's procedure was performed in 33 patients. Sigmoidopexy was done in 7 patients. Total hospital mortality was 6% (5 deaths). Mortality in the 84 operated cases was 5% (4 deaths). CONCLUSIONS: There was no mortality in patients undergoing elective resection and primary anastomosis after successful preoperative deflation and in patients with viable sigmoid volvulus who underwent an emergency Hartmann's procedure. There was low mortality in those patients with resection and primary anastomosis on viable sigmoid (3%, 1:39). The highest mortality (1:5) occurred in cases of resection and primary anastomosis of gangrenous sigmoid colon.

Adolescent↗
PubMed1992

Endoscopic diagnosis of anorectal melanoma.

Symptoms of anorectal melanoma commonly are attributed to hemorrhoids. The authors believe recognition of the sigmoidoscopic appearance will allow the physician to distinguish this condition from the more common anorectal disorders.

Aged↗
PubMed2005

[Transient intestinal obstruction due to stool impaction in the elderly].

BACKGROUND/AIMS: Acute intestinal obstruction is an urgent disease to be diagnosed and treated promptly. In elderly, fecal impaction may be an important and preventable cause of colonic obstruction. We investigated the clinical features of patients presenting with identical features of intestinal obstruction transiently due to fecal impaction. METHODS: From February 2001 to March 2004, nineteen patients were diagnosed as transient intestinal obstruction due to fecal impaction. We evaluated clinical characteristics, radiologic findings, sigmoidoscopic or colonoscopic findings and managements. RESULTS: Male and female ratio was 1:1.1. Mean age was 79.3 years. All 19 patients had abdominal pain and distension. On digital rectal examination, the hard feces was palpable in only 8 patients (42%) while others showed empty rectum. The abnormal laboratory findings included leukocytosis in 5 patients (26%), anemia in 10 patients (53%) and electrolyte abnormalities in 7 patients (37%). Simple abdominal X-rays showed diffuse small and/or large bowel dilatations. In only 3 patients (16%) air-fluid levels were definite, but most patients showed abundant feces in the rectum and colon. During emergency sigmoidoscopy, abdominal pain and distension were relieved and there were Bristol type 1 hard stool in the recto-sigmoid junction in 7 patients (37%) and multiple rectal ulcers in 1 patient. On colonoscopy, there were no mass or pathologic obstruction in all patients. Patients were discharged after the adequate medication and toilet training. CONCLUSIONS: In elderly patients, fecal impaction is odd and preventable cause of intestinal obstruction. It is often significant to differentiate fecal impaction from other pathologic conditions in patients with chronic constipation.

Aged↗
PubMed1991

[Pseudomembranous colitis: a clinical analysis and review of literatures].

Clostridium difficile has been well known to be a pathogen of pseudomembranous colitis. It is characterized by the formation of elevated plaques and pseudomembranes which result in varying degree of diarrhea. This series analysed 20 cases of pseudomembranous colitis diagnosed at Chang Gung Memorial Hospital between January 1985 and December 1989. The male to female ratio was 1:3. Their ages ranged between 13 and 81 years, with a mean of 53.7 years. Sixteen of our patients claimed to have taken antibiotics for upper respiratory tract infection, pneumonia, cellulitis or acute pelvic inflammatory disease within six weeks before onset of symptoms. The antibiotics were mainly in the penicillin group and cephalosporin group. Clinical presentations included diarrhea of varying degree, fever, and abdominal pain. The diagnosis was made by the typical colonic mucosal changes under sigmoidoscopic or colonoscopic examination and pathological findings. The lesions were prominent in the rectum and sigmoid colon. Eleven cases were treated with vancomycin. Of these, one failed and died, and two recurred. The two recurrences were again treated with the same dose of vancomycin and with complete remission. Three of our patients responded to metronidazole. The other six cases with milder symptoms were successfully controlled by using cholestyramine (2 cases) or by supportive treatment (4 cases).

Adolescent↗
PubMed1991

The value of colonoscopic surveillance following a diagnosis of colorectal cancer or adenomatous polyp.

Conventional follow-up of patients with colonic neoplasia will at best only identify symptomatic lesions and those visible with a sigmoidoscope, and will therefore fail to identify new malignant lesions in time for effective treatment. In 1980 we began a prospective study of the efficacy and feasibility of replacing conventional outpatient follow-up with annual colonoscopic surveillance. One hundred and fifty-eight patients, attending one surgeon, have been entered: 74 patients who had a curative resection for colorectal carcinoma and 84 patients who had endoscopic or local resection of an adenoma. In the carcinoma group (mean follow-up 4.3 years, range 1-21), 40 of 237 colonoscopies were positive (17%) in 27 patients (36%). Forty-eight polyps were removed endoscopically and two asymptomatic recurrent carcinomas identified. In the adenomatous polyp group (mean follow-up 4 years, range 1-11), 40 of 252 colonoscopies were positive (16%) in 29 patients (34%). Fifty polyps were removed endoscopically, including two which had become malignant. All patients were also screened by Haemoccult stool testing, in the hope that it would identify these lesions and allow the frequency of colonoscopy to be reduced. Unfortunately, Haemoccult testing failed to identify many lesions, including one carcinoma and one malignant polyp. Our experience suggests that colonoscopic follow-up of all patients with colonic neoplasia attending one surgeon is a feasible exercise which can and should replace outpatient appointments for clinical examination.

Aged↗
PubMed1991

[Staging of rectal carcinoma by endorectal ultrasonography].

Staging of rectal carcinoma is essential for its management. 23 patients with rectal lesions were examined by endorectal ultrasonography. Of these 19 had rectal carcinoma and in 4 there was an abscess of the rectal wall, previously diagnosed by sigmoidoscopic biopsy. 10 of those with carcinoma were examined by computerized tomography as well, and 10 were operated on. In most cases the staging of rectal carcinoma by endorectal ultrasonography was accurate and compared well with the operative histological results. We conclude that endorectal ultrasonography is the method of choice for staging of rectal carcinoma prior to treatment.

Carcinoma↗
PubMedDate not supplied

Teaching lower gastrointestinal endoscopy: a comparison of family medicine and internal medicine residencies.

Lower gastrointestinal endoscopy (LGIE) is an important procedure in primary care for detecting colorectal cancer. This survey of family practice (FP) and internal medicine (IM) residency directors in the southeastern United States shows that 100 percent of FP and 92 percent of IM programs provide training in LGIE. Less than half of all programs had certification criteria, and both disciplines showed a clear preference for the 60-cm flexible sigmoidoscope. LGIE procedures in IM programs were more frequently supervised by gastroenterologists, and in FP programs they were more frequently supervised by FP faculty. Only 55 percent of FP and 56 percent of IM residents were predicted to suggest screening LGIE to their patients, and 80 percent of FP and 63 percent of IM residents were predicted to include sigmoidoscopy in the evaluation of hematochezia.

Certification↗
PubMed1975

Responses to drug therapy in ulcerative colitis. Evaluation by rectal biopsy and histopathological changes.

To evaluate responses to medical therapy in ulcerative colitis, rectal biopsies of patients with active untreated disease, individuals with positive and negative sigmoidoscopic findings treated with salicylazosulfapyridine, prednisone and 6-mercaptopurine, alone and in combinations and noncolitis controls were compared histologically. Predominant histological observations were analyzed statistically. There were fewer crypt abscesses but more mucosal edema after all forms of therapy. Quantitative histopathological analysis failed to demonstrate that the response to one drug was significantly different from another.

Biopsy↗
PubMed1991

Factors affecting compliance with screening sigmoidoscopy.

BACKGROUND: A retrospective, qualitative study in a university setting was undertaken to better understand factors influencing patient compliance with screening sigmoidoscopy. METHODS: Individuals who completed screening sigmoidoscopy were interviewed to learn about the physician-patient relationship, general knowledge of cancer, family experience with cancer, exposure to the media, and specific reasons why sigmoidoscopy was completed. RESULTS: Respondents reported that their physician's recommendation had a strong positive influence on their decision to have sigmoidoscopic screening, as did their family and personal experiences with cancer. In all cases, the patients stated that they would not have had a sigmoidoscopy without the recommendation of their physician. Respondents were little influenced by exposure to the media or by famous personalities. CONCLUSIONS: The importance of the physician's recommendation for the patient to have sigmoidoscopy and demonstration of concern with early cancer detection may represent the primary motivating factors in completion of screening sigmoidoscopy.

Attitude to Health↗