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PubMed2006

[A case of relapsed ischemic colitis with colon cast-like stripped mucosa].

An 82-year-old woman who had 5 relapses of ischemic colitis was admitted with sudden lower abdominal pain. Colonoscopic examination performed on the 2nd day revealed colon cast-like stripped colonic mucosa in the lower portion of the descending colon. She was treated conservatively. After 2 weeks, ischemic colitis healed, with slight residual stenosis. Most reports of colon cast indicated that colon cast was caused by abdominal aneurysm, operation, or external wound. The only predisposing conditions in this case were arteriosclerosis of abdominal aorta and chronic constipation. Arteriosclerosis and chronic constipation might be the important risk factors of ischemic colitis with colon cast and relapsing of ischemic colitis.

Aged, 80 and over↗
PubMed1983

[Crohn disease. Results of surgical treatment].

The aim of this study was to describe and to analyze the results of surgery for Crohn's disease in a retrospective series of 155 operations performed in 124 patients from 1949 to 1981 by the same surgical team. Indications for surgical treatment were as follows: acute complications (25 p. 100), intestinal obstruction (35 p. 100), systemic inflammatory manifestations (40 p. 100). Three patients died postoperatively and complications necessitated a reintervention in 10 other subjects. Surgical indications and late postoperative prognosis were significantly different in patients with right-sided bowel lesions (i. e. terminal ileitis, ileocolitis of the ascending colon) and in those with left colonic involvement (i.e. colitis of the whole or descending colon, rectitis and anoperineal lesions). Surgery was required because of failure of medical treatment in 73 p. 100 of Crohn's disease affecting the left colon and in 17 p. 100 of the right-sided lesions (p less than 0.001). After resection a recurrence rate after 1 year and 3 years of respectively 50 and 62 p. 100 was observed in the left colonic disease group and in 5 and 23 p. 100 of the cases respecting the left colon. Finally 31 reoperations were necessary; no surgical mortality occurred in 12 patients with right-sided lesions whereas 5 among 19 patients with involvement of the left colon died postoperatively. These results: a) confirm the high postoperative rate of recurrence (or relapse) after surgical bowel resection for Crohn's disease (especially when the left colon is affected), b) emphasize the need for the surgeon to be very cautious when determining the extent of resection.

Adolescent↗
PubMed1994

[Regulating effect of electro-acupuncture on dysrythmia of gastro-colonic electric activity induced by erythromycine in rabbits].

The myoelectric activity of gastro-colon was recorded in 20 rabbits. The model of gastro-colonic disorder was produced by vena injection of erythromycine (EM) (7 mg/kg). We investigated regulating effect of electro-acupuncture (EA) on the disorder of gastrocolonic electric activity (GEA). After the vagotomy the effect of EA was observed. In fasting and anaesthetic rabbits, the frequency and amplitude of GEA were 4.47 +/- 1.23 cmp, 1.90 +/- 0.27 mV at antrum, 8.33 +/- 2.61 cpm, 0.51 +/- 0.12 mV at ascending colon, 6.74 +/- 2.68 cpm, 0.35 +/- 0.10 mV at descending colon. After injection of EM, the frequency and amplitude of GEA were increased, the latency and duration of EM effect were 36.5 +/- 4.5 min and 3.8 +/- 1.4 min, the great contraction wave was showed. EA could shorten the duration and latency, decrease the frequency, amplitude and variation coefficient of GEA. After vagotomy the effect of EA disappeared. These results indicate that vagus nerve plays an important role in regulating effect of EA on gastro-colonic disorder.

Animals↗
PubMed1996

[Colorectal metachronous tumors].

INTRODUCTION: The metachronous colorectal carcinoma is defined as a primary carcinoma which arises after surgical removal of a previous carcinoma of the large bowel. The incidence of metachronous colorectal cancer has been reported to be 1-8 per cent. THE AIM: The purpose of the present study was to determine the incidence of metachronous colorectal carcinoma and, on this basis, to propose a follow-up programme after primary resection for cure in this patient group of patients. PATIENTS AND METHODS: Twenty-eight patients with metachronous colorectal malignancies underwent surgery, 16 (57.1%) male and 12 (42.9%) female. These metachronous cancers were discovered at intervals ranging from eight months to seven years (range 28 +/- 10 months). Nine (32%) metachronous lesions were detected two years of more after the original cancer. Six of the metachronous cancers appeared in the right colon, eight were distributed throughout the transverse and descending colon, and fourteen in the rectosigmoid region. Histological examination revealed a high proportion of early stage lesions (82.1% Duke's A more B). CONCLUSION: A set of patients surviving their initial colorectal cancer should be followed for the rest of their life because of the risk of developing a second primary. In the light of our experience, a full examination of the colon in these patients is mandatory, and colonoscopy is the best diagnostic procedure.

Adult↗
PubMed1998

A case of ischemic colitis associated with pheochromocytoma.

A 40-year-old woman was admitted because of abdominal pain and diarrhea. She sometimes experienced paroxysmal hypertension, sweating, headache, and palpitation. Sigmoidoscopic findings showed well-demarcated diffuse mucosal edema, hyperemia, and easy touch bleeding from distal descending colon up to the splenic flexure area. Barium x-ray showed loss of haustral marking, thumb printing appearance, and diffuse luminal stenosis in the transverse, descending, and sigmoid colon. On the abdominal computed tomogram, a 3.8-cm sized well-enhanced right adrenal mass was incidentally found. Twenty-four hour urinary excretion of vanillyl mandelic acid, norepinephrine, and normetanephrine were increased. Iodine131 metaiodobenzylguanidine scan showed hot uptake on the right adrenal gland compatible with pheochromocytoma. Exploratory laparotomy was done under the impression of ischemic colitis associated with pheochromocytoma. Adrenalectomy and resection of the stenotic left colon were performed. After surgery, pain subsided, blood pressure fell gradually, blood sugar and catecholamine level became normal, and bowel habit returned to normal.

Adrenal Gland Neoplasms↗
PubMed1982

Carcinoma of the colon and rectum: the natural history reviewed in 1704 patients.

For 1704 patients with large bowel cancer compiled by the Armed Forces Central Medical Registry, selected prognostic factors were related to five-year or longer survival. The majority of late deaths (those occurring after five years) resulted from cancer in the descending colon, sigmoid colon or rectum rather than from cancer in the right or transverse colon. For example, among all patients with cancer of the rectum, 15.4% of those with Dukes' B tumors and 10.9% of those with Dukes' C tumors died of rectal cancer between five and ten years after diagnosis. When late survival rates were compared, patients with right and transverse colon cancer (8 deaths/93 at risk) fared significantly better than those with left colon and rectal cancer (33 deaths/171 at risk; P = 0.01). Among patients with left-sided colon and rectal carcinoma, a further significant difference in late survival was found when stage of disease was considered: patients with Dukes' A cancers (3 deaths/47 at risk after five years) fared better than those with Dukes' C cancers (21 deaths/74 at risk) (P = 0.002). For Dukes' B and C stages of disease, patients with left colon and rectal cancer fared worse than those with right and transverse colon lesions after 60 months. Of all patients who died of large bowel cancer after five years, 69% had a recurrence of cancer by 60 months, and most late recurrences were located in the descending and sigmoid colon and in the rectum. These results show differences in survival after five years with respect to both site of cancer in the colon and stage of initial disease. Our findings indicate that many left-sided large bowel cancers have a slowly progressive natural history.

Adenocarcinoma↗
PubMed1986

Familial heterogeneity of colon cancer risk.

The authors have assembled detailed family histories of cancer on 857 cancer probands, of whom 180 manifested colorectal carcinoma. This study determines if some families had a greater risk for colorectal cancer than others, and if so, what factors were associated with an increase in risk. To test for the possibility of heterogeneity of risk, a parameter called the Z-score, was calculated for each family. The Z-score is a measure of the number of cancer cases in the family adjusted for the number of expected cases. A permutation test was employed to test whether or not the variance of Z-scores from the sample was greater then expected by random chance. The variance for families ascertained through colon cancer probands, but not in any of the other groups, was significantly increased. Of the colon group, 10.6% fell into a high-risk category, as did 5.56% of the rectal cancer families, but only 3.95% of the other groups combined were at high risk. Anatomic sites (in the proband) with the highest Z-score variances were sigmoid and transverse colon, whereas lower variances were seen for cecum and descending colon. Risk status therefore may be partially dependent upon exact anatomic sites within the colon. The effect of proband's age of diagnosis was not significant, but did show the possibility of an effect on heterogeneity of risk for both the younger and older groups.

Age Factors↗
PubMed1985

Total pelvic exenteration for advanced carcinoma of the lower colon.

Thirteen patients with advanced carcinoma of the lower colon and no evidence of extrapelvic metastasis were submitted to total pelvic exenteration. Nine of the 13 patients had ureteral urinary diversion by the ileal segment conduit. Three had colonic conduit bladder using the terminal portion of the descending colon. One patient had bilateral uretero colonic anastomosis. The operative mortality rate was 7.7%. Determinate 5-year survival rate of 38.5% was achieved. Histological examinations of the surgical specimen revealed associated abscesses adjacent to the tumor in six cases, although the cancer extended to the bowel wall and adhered to the surrounding structures in all specimens. Total pelvic exenteration assures a better quality of life, lessening of symptoms, disease control and, in selected patients, a cure.

Adenocarcinoma↗
PubMed1994

Site distribution of colonic adenomas and carcinomas in relation to colonic flexures.

To minimize the chance of overlooking colonic tumours, 'short segments' of the colon were defined and examined on barium enema films in relation to the distribution of colonic tumours. Films of 299 histologically proven adenomas and carcinomas from 265 consecutive patients were used. No significant differences in distribution were noted between the adenomas and carcinomas. The distance of tumours from distal minor flexures was within seven centimetres in 80% of lesions in the transverse colon, five centimetres in 80% of lesions in the descending colon, and four and six centimetres respectively for 80 and 95% of sigmoid colon lesions. In the cecum plus ascending colon 75% of the lesions were located within seven centimetres from the cecal pole.

Adenoma↗
PubMed1987

Late development of metachronous colorectal cancer.

The incidence of metachronous colorectal cancer has been reported to be 1 to 5 percent, with most of the cases being discovered within ten years of the initial cancer. A retrospective review of all colorectal cancer patients was conducted at the Southern Illinois University Affiliated Hospitals to determine the incidence of metachronous colorectal cancer at the authors' institution. In this study, a metachronous cancer was defined as a second colorectal primary occurring at least three years following discovery of the initial lesion. Between 1978 and 1984, there were 24 patients with metachronous colorectal cancer identified in an operative series of 707 patients for a frequency of 3.4 percent. These metachronous cancers were discovered at intervals ranging from 3 to 35 years. Sixteen (67%) metachronous lesions occurred 11 years of more after the original cancer. Synchronous or interval adenomatous colorectal polyps were noted in 17 (71 percent) of the patients. Thirteen of the metachronous cancers appeared in the right colon, while six were distributed throughout the transverse and descending colon, and five were in the rectosigmoid region. The incidence of late-appearing metachronous colorectal cancers and the propensity to occur in the right colon underscores the need for evaluation of the entire colon as part of lifelong follow-up of the colorectal cancer patient.

Adult↗
PubMed1994

Hodgkin's disease of the gastrointestinal tract.

Hodgkin's disease (HD) is rarely considered in the differential diagnosis of gastrointestinal (GI) disorders. We report eight cases of GI HD. The patients, ages 16-64, all with stage IV disease of varied histologic subtypes and GI symptoms including pain, upper or lower GI bleeding and/or obstruction. There was diffuse gastric fold thickening in one case, a large submucosal mass along the proximal greater curvature in another case, and a large ulcerating mass along the lesser curvature in the third case. Two cases of jejunal disease manifested as either a short or long segment of luminal narrowing with prominent mucosal nodularity. Another case exhibited a short area of complete mucosal destruction, irregular cavitation and intraluminal filling defect. In one additional case there was diffuse jejunal nodularity. Colonic involvement (two cases) presented as a solitary polypoid mass in transverse colon in one patient and severe narrowing of the descending colon with adjacent mesenteric mass on CT in another. We conclude that although rare in Hodgkin's disease, GI involvement should be considered, particularly in patients with stage IV disease.

Adolescent↗
PubMed1980

The colonic epithelium in ulcerative colitis: an energy-deficiency disease?

Suspensions of colonocytes (isolated colonic epithelial cells) were prepared from mucosa of the descending colon from 6 patients with quiescent ulcerative colitis (UC), 4 with acute UC, and 7 control subjects. In each group metabolic performance was investigated by assessing utilisation of n-butyrate, the main respiratory fuel of the colonic mucosa, as well as utilisation of glucose and glutamine. In both acute and quiescent UC oxidation of butyrate to CO2 and ketones was significantly lower than in the control tissues, and the decrease correlated with the state of the disease. Enhanced glucose and glutamine oxidation compensated for decreased butyrate oxidation in UC, indicating that colonocytes in colitis were not metabolically degenerate cells. Failure of butyrate oxidation reflects a variable yet definite metabolic defect in the mucosa in UC. Diminished oxidation of butyrate can explain the characteristic distribution of colitis along the colon, especially the frequency of UC in the distal colon. It is suggested that failure of fatty-acid (n-butyrate) oxidation in UC is an expression of an energy-deficiency disease of the colonic mucosa.

Acute Disease↗
PubMed2006

Pancreatic cancer initially presenting with a pseudocyst at the splenic flexure.

Pancreatic cancer and pancreatitis associated pseudocyst are not uncommon disorders. However, occurrence of the cancer with an initial manifestation of pseudocyst has been rarely reported. Surgery was performed on a 44-year-old male patient for an abscess-like cavity situated at the mesenteric side of the colon and extending from the splenic flexure to the descending colon. The lesion was verified as a pseudocyst with fat necrosis due to leakage of pancreatic fluid. When further surgery was carried out 1 month later in order to manage the drainage site of the pancreatic fluid, cancer of the pancreas body was detected proximal to the drainage site. The cancer was a moderately differentiated ductal adenocarcinoma with wide peripancreatic infiltration. It is thought that the cancer-associated duct obstruction caused a local pancreatitis resulting in a large communicating pseudocyst, although the exact mechanism remains unresolved. The present case may be instructive in showing physicians that a pseudocyst may obscure the presence of pancreatic cancer.

Adult↗
PubMed1996

Alcohol dehydrogenase in the human colon and rectum.

Alcohol dehydrogenase (ADH) activities were measured in rectal biopsies from 55 patients (28 males, 27 females aged 22-81 years), in colonic biopsies from 19 patients (10 males, 9 females aged 21-81 years) and in three surgical specimens. All patients had normal mucosa as determined by light microscopy. The activity of rectal ADH was comparable to gastric ADH activity and did not exhibit any significant gender effect (5.5 +/- 1.1 vs. 6.7 +/- 1.0 nmol/mg protein x min; nonsignificant). No significant correlation was found between age and rectal ADH activity. Compared to ADH activities in other colonic segments, rectal ADH activity was found to be significantly increased (ascending colon: 3.9 +/- 0.7 nmol/mg protein x min; p < 0.05; transversal colon: 3.4 +/- 1.1 nmol/mg protein x min; p < 0.05; descending colon 2.3 +/- 0.4 nmol/mg protein x min; p < 0.001; rectum 6.1 +/- 0.8 nmol/mg protein x min). This higher activity of ADH in the rectum could result in increased acetaldehyde levels after alcohol administration and could therefore play a role, at least in part, in the ethanol-associated rectal cocarcinogenesis.

Adult↗
PubMed1991

Treatment of postoperative paralytic ileus with cisapride.

The effect of cisapride on postoperative colonic motility was studied in 40 patients undergoing cholecystectomy under randomized, double-blind conditions. The patients received 10 mg of cisapride or placebo by intravenous injection starting on the day of surgery and repeated every 12 h until the 3rd postoperative day. The return of propagative motility in the colon was visualized by means of radiopaque markers and serial abdominal radiographs. Cisapride induced a significantly earlier return of propulsive motility in the right colon, as indicated by the propagation of markers from the ascending colon to the transverse colon (p less than 0.05). Radiopaque markers reached the descending colon (p less than 0.05) and the rectosigmoid colon (p less than 0.05) significantly earlier in the cisapride group than in controls. The first passage of feces occurred significantly earlier in cisapride-treated patients than in controls (p less than 0.05). The first passage of gas after surgery did not differ significantly between the groups. Our results suggest that cisapride can be used to induce earlier return of propagative motility in the colon after major abdominal surgery.

Cholecystectomy↗
PubMedDate not supplied

[The surgical treatment of obstructive cancers of the left colon. Apropos of a series of 66 cases].

From 1977 to 1989, 66 patients were operated on in emergency, without any bowel preparation, for acutely obstructing left-sided colon cancer. Two synchronous cancers were diagnosed and the 68 tumours were located as follows: 13 on the left transverse colon or at the splenic flexure, 7 on the descending colon, 37 on the sigmoid, and 11 at the rectosigmoid junction or below. According to Astler-Coller staging, 15 patients were classified as B, 17 as C and 25 as D. Initial treatment was a colostomy in 58 patients (88%), or a resection with or without anastomosis in 2 and 6 cases respectively. Most patients underwent a two- or more rarely a three-stage resection and 44 patients left the hospital without either tumour or stomy. Cumulative operative mortality was 12%. Five-year survival rates were 21% for the patients with a minimal potential follow-up of 5 years, and 39% for curative resections (disease-free survival of 33%). From these results, we think that two-staged resection, with close proximal colostomy followed by resection and anastomosis, remains an appropriate approach for most obstructing left-sided colon cancers; more tempting procedures such as resection with primary anastomosis or subtotal colectomy are probably indicated in selected patients.

Adult↗
PubMed1983

Use of technetium-labeled autologous red blood cells in detection of gastrointestinal bleeding.

Twenty patients with occult gastrointestinal bleeding underwent diagnostic evaluation with autologous TcRBC imaging, which identified a locus of bleeding in 19. Bleeding was demonstrated in the esophagogastroduodenal area in four patients, the cecum in four patients, the ascending colon or hepatic flexure in nine patients and the descending colon in two patients. In the six patients who underwent surgical intervention, the source of bleeding had been correctly located by imaging. The advantages of imaging over those of conventional arteriography included its minimally invasive nature and its ability to detect areas of intermittent minimal bleeding for a period of 30 hours. The major disadvantages of the technique were that localization of the site of bleeding was not as precise as that obtained with arteriography, imaging could not be used as a treatment modality and the nature of the lesion could not be defined. However, we believe that, as an adjunct to conventional angiography and other techniques, autologous TcRBC imaging will improve the localization of obscure foci of gastrointestinal bleeding. Studies are underway to determine the proper place of TcRBC imaging in the gastroenterologic armamentarium. Its noninvasive nature and sensitivity to intermittent hemorrhage suggest that it may become the initial investigative modality of choice in many instances.

Adult↗
PubMed1980

Lysozyme activity in gastrointestinal and lymphoreticular tissues of rabbits genetically deficient in lysozyme.

Lysozyme activities in gastrointestinal and lymphoreticular tissues and in macrophage culture products of normal and genetically lysozyme-deficient rabbits were measured and compared. The supernatants of homogenates of 18 gastrointestinal and lymphoreticular tissues were assayed for lysozyme. In the gastrointestinal tract, there were no major differences in lysozyme activities between the two groups of rabbits. Ascending colon and orad gastrointestinal tissues had low activities, whereas descending colon and rectum had very high lysozyme activities in both types of rabbits. In the lymphoreticular tissues, lysozyme-deficient rabbits had graded lysozyme deficiencies: slight or no deficiency was present in thymus, partial deficiency in gut-associated lymphoid tissues, and near total deficiencies in secondary lymphoid tissues and bone marrow. Both macrophage culture cells and fluids from lysozyme-deficient rabbits were completely deficient in lysozyme. The results indicate that in the lysozyme-deficient rabbits there is tissue-specific lysozyme activity expressed and when considered along with other observations suggest that the lysozyme-deficient condition may be due to a deficiency of an isozyme or isozymes of lysozyme.

Animals↗