SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Four cases of Crohn's disease of the colon are presented in order to illustrate some of the difficulties which may arise in making a correct diagnosis. A combination of a high index of suspicion and suggestive clinical, sigmoidoscopic, radiological and histological features is necessary if the disease is not to be missed or misdiagnosed.
Two hundred and fifty-eight patients with juvenile polyps were reviewed. Ten patients less than 20 years of age were found to have adenomas. The points to be presented can, therefore, be emphasized. Juvenile polyps are a distinct pathologic entity and can occur at any age and in either sex. Adenomas do exist in pediatric patients. We should not assume that every polyp in patients less than 20 years of age is automatically a juvenile polyp and, therefore, benign. Barium enema is recommended for any child or adolescent in whom one or more polyps are found. In multiple polyposis, the finding that one polyp is of the juvenile type does not necessarily rule out the presence of adenoma. Any patient with a solitary adenoma who has multiple polyps, whether adenoma or juvenile polyps, should be observed at appropriate intervals by sigmoidoscopic, roentgenographic and, possibly, colonoscopic examination. Finally, we hope that this study will inspire others to investigate further this interesting pathologic condition.
To determine the epidemiologic features of Clostridium difficile in Halifax, Nova Scotia, the authors studied two groups of hospitalized patients, one group of outpatients and a fourth group of 54 healthy subjects. The first group consisted of 29 patients with diarrhea, whose stool was found to contain C. difficile or its cytotoxin, or both. Twenty-two underwent sigmoidoscopic examinations; of these, 18 had abnormal colonic mucosa and 6 of the 18 had pseudomembranous colitis. In the second group of 127 patients on general medical wards, 22 (17%) carried C. difficile. Thirteen of the 22 had diarrhea, and 3 had pseudomembranous colitis. Clustering of patients with C. difficile was evident. In vitro production of toxin by isolates of C. difficile from these patients was more likely if antibiotics had been given. Only 1 (4.5%) of the 22 outpatients with various gastrointestinal disorders (group 3) and none of the 54 healthy subjects (group 4) carried C. difficile. The clinical spectrum of infection with C. difficile extended from asymptomatic patients to those with nonspecific colitis and pseudomembranous colitis.
We report a case of necrotizing amebic colitis with the sigmoidoscopic finding of a confluent, grayish pseudomembrane. The patient was referred from a chronic mental institution, which represents the patient population most susceptible to fulminant amebic dysentery in the United States. The pseudomembrane was a reflection of extensive mucosal necrosis and resolved with amebicidal therapy.
Based upon experiments on animals, an anastomotic apparatus, consisting of two magnetic rings of polymer bonded, rare earth cobalt magnets embedded in polyester, was developed. There are three types of polyester device with diameters of 25, 28, and 30 millimeters, respectively. The force between the magnets varied between 2.5 Newtons at 4 centimer separation and 11.8 Newtons at union. For the low colorectal anastomosis, a magnet holder, connecting rod and spherical cap were developed. The aim of the technique is a quick restoration of the underbroken submucosal intestinal cylinder by optimal circular apposition of the submucosal layer. The working mechanism is based upon progressive compression, leading to necrosis of the intermediate mucosal and submucosal layers by increasing the magnetic force while intestinal healing takes place. After seven to 12 days, the magnets cut through the disappear from the anastomotic region by intestinal peristalsis. From the initial series of 21 patients, 11 resections of the sigmoid colon and nine low anterior resections were performed. Dehiscence of the suture line was noted in two instances. One patient required reoperation. The other patient had a small area of dehiscence at the suture line after evacuation of an infected hematoma with a further uncomplicated course. One patient died on the third postoperative day of recurrent myocardial infarction. In the other 18 patients, primary intestinal healing was demonstrated roentgenologically and sigmoidoscopically.
Campylobacter fetus ss. jejuni has been recently recognized as a common human enteric pathogen; however, the pathology and pathophysiology of the enteritis caused by this agent are still largely obscure. We report 4 patients who presented with acute abdominal pain and bloody diarrhea and who had C. fetus ss. jejuni isolated from fecal cultures. Each patient showed a fourfold rise in serum IgG titer to the organism isolated. In all 4 patients colonic involvement was noted on sigmoidoscopic examination. Biopsy specimens showed acute colitis with inflammatory infiltrates of the lamina propria and crypt abscesses. Clinical improvement was complete in all patients after therapy with erythromycin. These results suggest that clinicians should consider Campylobacter enteritis in the differential diagnois of acute colitis.
We have developed an anastomosis technique for resection of the distal colon based on the principle of submucosal layer apposition. The anastomosis apparatus consists of two rings of Ertalyte (polyester-polyethyleneterephtalate) containing two magnetic rings of polymer bonded rare earth cobalt. For low anastomoses we developed a magnetic ring holder, protecting cap and hexagonal connecting rod. The working principle is based on progressive compression leading to necrosis of the intermediate mucosal and submucosal layers by increasing magnetic force while bowel healing takes place. After 7 to 17 days the magnets cut through and are propelled by peristalis out of the anastomotic region. From our initial series of five patients we performed three sigmoid resections and two low anterior resections. There were no postoperative complications. Sigmoidoscopic and radiological investigations two weeks postoperatively, showed no evidence of leakage or anastomotic narrowing. The technique and the special advantages of the apparatus are discussed.
In its first 4 1/2 years of operation in the Long Beach Community Hospital Cancer Detection Center, among the 5,595 persons examined, 16 cases of colorectal cancer were discovered. Fourteen of the 16 had symptoms referable to neoplasms. Eight had lesions found on proctosigmoidoscopic examination. Nine had positive findings for occult blood in stool samples, a 7.5% cancer detection rate among the 120 with positive stool sample findings. Six patients with cancer submitted one to four stool specimens that showed negative findings on occult blood testing, and one patient submitted no specimen. Although valuable in screening, stool testing for occult blood will not detect all colonic neoplasms. The complaints of pain, altered bowel habits, or tenesmus warrant sigmoidoscopic examination, barium enema studies, or both, whether findings in stool samples are positive or negative.
Crohn's disease and lymphoma limited to the small bowel may have similar clinical and radiologic features. This diagnostic dilemma was encountered in 5 adolescent patients with an eventual diagnosis of Crohn's disease, all of whom had normal sigmoidoscopic and radiographic evaluations of the colon. Rectal and colonic biopsies in 3 revealed granulomas and focal colitis supportive of the diagnosis of Crohn's disease and prevented laparotomy. A careful search for occult colonic involvement in similar patients with Crohn's disease may obviate the need for diagnostic surgery.
Early experiences and results with the EEA stapling instrument for colorectal anastomosis are reported. 39 patients underwent anterior resection or left hemicolectomy with end-to-end anastomosis performed by means of the EEA stapler. Two patients had a clinically recognizable anastomotic leakage, both of which healed spontaneously. One patient died from pulmonary embolism, but at autopsy the anastomosis was intact. No significant problems in the control of anorectal function developed. On follow-up sigmoidoscopic examinations two patients showed a distinct narrowing of the anastomotic site, but both of these stenoses were spontaneously dilated by six months. It seems that an anastomosis performed with the EEA stapler is at least as reliable as a hand sutured one and apparently more so. With this instrument an anastomosis can be achieved at a lower level than would be feasible with conventional hand suture techniques. In addition, it is much more easily and rapidly performed, especially in patients with a narrow pelvis or other anatomical difficulties.
Portal hypertension diffusely affects the gastrointestinal tract. The frequency and profile of distinct colonic mucosal lesions (portal colopathy) and rectal varices (RV; veins > 4 cm above the anal verge) is not well studied. Fifty consecutive patients with portal hypertension (25 with cirrhosis, 10 with noncirrhotic portal fibrosis [NCPF], and 15 with extrahepatic portal vein obstruction [EHPVO]) were assessed clinically and by upper and lower gastrointestinal (GI) endoscopy. Colorectal lesions were seen in 35 (70%) patients, significantly more often in bleeders than in nonbleeders. Rectal varices were detected in 22 (44%) patients; larger and more often seen in EHPVO (80%) than in cirrhosis (28%) and NCPF (30%) (P < .01) patients. Portal colopathy was seen in 26 (52%) patients, with nearly similar frequency in cirrhotics, NCPF, and EHPVO patients. Previous sclerotherapy or presence of gastric varices had little influence on the development of these lesions. An association (P < .01) was, however, seen between the presence of colopathy and portal gastropathy. Overt bleeding was seen in 8% and 4% of patients with RV and colopathy, respectively. In conclusion, our results demonstrate that colorectal lesions are present in about two thirds of patients with portal hypertension. Patients with portal hypertension and lower GI bleeding should be colonoscoped. Patients with extrahepatic portal vein obstruction may in turn benefit from baseline sigmoidoscopic examination to define the presence and size of rectal varices.
The morphological features of 62 anorectal malignancies diagnosed on sigmoidoscopic biopsy were studied. On haemotoxylin and eosin staining the tumours were diagnosed as adenocarcinomas (43), squamous cell carcinoma (12), malignant melanoma (3), carcinoid (2), clear cell carcinoma (1) and poorly differentiated carcinoma (1). PAS Alcian blue, Grimelius silver stain, AgNOR and immunohistochemical stain for carcinoembryonic antigen (CEA) and human papilloma virus (HPV) were done to further categorise these tumours. The ages of the patients varied from 18 to 77 yr (mean 43.7 yr) and the male: female ratio was 2:1. PAS Alcian blue staining was helpful in differentiating mucinous from non-mucinous adenocarcinomas and reclassifying one poorly differentiated carcinoma as mucin secreting adenocarcinoma. Also, it clearly identified pagetoid spread in two cases of adenocarcinomas. Grimelius silver stain was strongly positive in melanomas and neuroendocrine tumours. Basal silver staining was visualised in metaplastic foci but was absent in dysplastic epithelium. AgNOR counts may be considered useful in differentiating melanomas (high counts) from spindle cell variant of squamous carcinomas (low counts). High AgNOR counts and strong Grimelius positivity in clear cell carcinoma suggested its melanotic origin. Immunostaining for CEA and HPV were of limited value. CEA was positive in the majority of the adenocarcinomas while HPV could only be demonstrated in two squamous cell carcinomas.
BACKGROUND: Recent screening studies with fecal occult blood testing (FOBT) report that one of three patients with colorectal cancer (CRC) can be cured of the disease; minimal attention has been given to the two of three patients who despite repeated screening go on to die of silent CRC. We report the known "miss rate" (known false negatives) of our 14-year ongoing program of FOBT that was organized in 1979 to detect early CRC. METHODS: From October 1979 through December 1993, 36,034 FOBT kits were distributed to patients who were without gastrointestinal complaints at Hines Veterans Affairs Hospital. The test was considered positive if at least one result of the six tests was positive and negative if the test result was equivocal. Patients with negative FOBT received a new test kit each year by mail. A positive test was followed by full colonoscopy or an air contrast barium enema if a full colonoscopy was not possible. RESULTS: The overall return rate was 47.8%. CRC was detected in 115 patients: 94 had a favorable and 21 had an unfavorable Duke's C or D or lymphoma prognosis. Of 21 patients 13 (62%) had initially tested FOBT negative (missed lesion). Of the 21 cases of advanced CRC 15 (71.43%) were in the descending, sigmoid, or rectosigmoid colon or rectum. CONCLUSIONS: (1) The majority (82%) of all CRC detected by FOBT screening are diagnosed at a favorable stage. (2) The majority of known advanced CRC (62%) escape early detection with FOBT. (3) Five (62.5%) of eight of the advanced CRC cases discovered on initial FOBT and 10 (76.9%) of 13 of advanced CRC cases missed on initial FOBT but detected in subsequent years were in the left colon and most likely in the range of the flexible sigmoidoscope. (4) FOBT as a sole screening test may provide a false sense of security, especially in patients with advanced left-side CRC.
BACKGROUND: The efficacy of screening flexible sigmoidoscopy in patients with a prior history of a negative screening sigmoidoscopy has not been previously studied. METHODS: Charts from 866 consecutive asymptomatic patients undergoing baseline or rescreening flexible sigmoidoscopy were reviewed. Any previously screened patient with a history of polyps was excluded from the study. Findings on sigmoidoscopy, including size, location, and histopathology of lesions and number of prior examinations, if any, were recorded. RESULTS: Polyps were found in only 12 of 866 patients (1.4%). The effect of prior screening was significant. Ten of 414 (2.4%) patients who had not undergone prior screening sigmoidoscopy were found to have polyps. In contrast, only two of 452 (0.4%) patients who had undergone prior screening were found to have polyps. CONCLUSIONS: Screening flexible sigmoidoscopic examinations provided a low positivity yield in this study, a finding that is likely explained by the exclusion of previously screened patients with a history of polyps and by the significant number of previously screened patients. The relation between the prevalence of lesions and the patients' previous examination statuses suggests that multiple screenings for asymptomatic, low-risk patients at 3- to 5-year intervals as recommended by the American Cancer Society may be unnecessary.
Solitary rectal ulcer syndrome (SRUS) is an unusual disorder which is seldom seen in our hospital. Considerable uncertainly remains concerning the cause, natural history, and management of this condition. During 1980-1992 period, 7 patients were seen at the Instituto Nacional de la Nutrición and the diagnosis was established on histological, sigmoidoscopic and clinical grounds. Most of the patients suffered rectal bleeding, abdominal pain, straining at defecation, tenemus and rectal mucus discharge. Laboratory results were non specific. Eighty-five percent has macroscopic ulcerations and these were found within 5.2 cm of the anal margin and usually situated anteriorly. Neither medical nor local surgical treatment consistently achieved relief of symptoms or healing of the lesion.
OBJECTIVES: To provide a proctosigmoidoscopic review of a very large set of unselected control subjects, providing an unbiased view of colonic polyps in the general population. METHODS: Sigmoidoscopic data from 406 sequentially recruited subjects were analyzed. Participation rates were over 85%, and subjects were thus free of the usual selection bias. RESULTS: Thirty-eight percent of screened individuals were found to have distal colonic polyps. Adenomas were found in 12%, and hyperplastic polyps were found in 30% of screened individuals. Adenomas were more prevalent in males and in older individuals. Hyperplastic prevalence did not differ significantly by gender or age. Synchronous adenomatous and hyperplastic polyps occurred in 3% of screened individuals, but these lesions were not associated. CONCLUSIONS: Distal colonic adenomatous and hyperplastic polyps are very common in the general population and are not associated. The high frequency of these polyps raises questions about the feasibility of biopsy for all polyps, and suggests that further study is needed to determine the appropriate indications for subsequent colonoscopy.
OBJECTIVES: To assess the diagnostic yield of the 1-yr follow-up flexible sigmoidoscopy examination for the detection of colonic neoplasia in a colorectal cancer screening program. METHODS: Data were prospectively collected for flexible sigmoidoscopies performed between July 1991 and July 1992 as part of the University of South Alabama Colon Cancer Registry. RESULTS: A total of 217 subjects with an age-related risk of colon carcinoma and no evidence of occult blood by stool examination were enrolled. One hundred and sixteen underwent initial sigmoidoscopic examination, and 101 had a 1-yr surveillance examination. Ten of the 116 patients (8.6%) undergoing initial surveillance sigmoidoscopy were found to have neoplastic lesions. In contrast, only 1/101 (1%) patients undergoing 1-yr follow-up surveillance sigmoidoscopy was found to have a neoplastic lesion. Neoplastic lesions in both groups were adenomas. No carcinomas were found. CONCLUSIONS: These data suggest that the 1-yr surveillance sigmoidoscopy adds little to the diagnostic yield of colon cancer screening.
The efficacy of three lower bowel preparations in 96 patients undergoing rigid sigmoidoscopy was studied. The maximal length of insertion and clarity of view were assessed in each group and compared to patients without bowel preparation. Blood per rectum and diarrhoea were the main indications for sigmoidoscopy. The maximal insertion of the instrument was similar for all groups and the rectosigmoid junction was examined in the majority. The clarity of view was good in 71% of patients receiving Fleet enema, 68% of those receiving Dulcolax micro-enema, 36% in the Dulcolax suppository group and 16% in the group without bowel preparation. There were no adverse effects or complications arising from bowel preparation or sigmoidoscopy. Bowel preparation significantly improves the number of satisfactory sigmoidoscopic examinations, and the use of simple disposable enemas is safe and effective.