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PubMed2004

[Haemorrhoids are too often assumed and treated. Survey of 548 patients with anal discomfort].

BACKGROUND AND OBJECTIVE: Anal complaints, caused not by haemorrhoids but by anal folds, fissures or perianal thrombosis, are probably too often and wrongly attributed to haemorrhoids by patients and self-treated. It was the aim of this study to find out how frequently patients with anal complaints make this false assumption and how successful their self treatment is. PATIENTS AND METHODS: 458 consecutive patients referred between May and November 2001 with unclear abdominal and/or anal symptoms were investigated by a standardized questionnaire/interview, including any experience with wet compresses, haemorrhoidal ointments or results of a doctor's treatment of haemorrhoids. They were then examined by procto-coloscopy. The findings were documented on the questionnaire and the data stored in an computer. RESULTS: 344 of the 548 patients (63 %) believed that they had haemorrhoids, 184 (34 %) did not think so, and 20 (3 %) left the question unanswered. Haemorrhoids were found to be present in 18 % and 13 %, respectively. Bleeding, pain, itching and burning sensation around the anus were the most common symptoms in both groups. 151 of the 184 patients who did not think they had haemorrhoids (82 %) had been previously treated by a doctor for "haemorrhoids". 28 % of this group of patients and 36 % of those thought to have haemorrhoids had similar results with wet compresses, creams or ointments, and the two groups were also similar regarding the number found to have anal disease. CONCLUSION: Since many patients who had wrongly thought to have haemorrhoids had "treated" them successfully with wet compresses, creams or ointments, their complaints cannot be relied upon diagnostically. Doctors should not be misled by patients' complaints into assuming the presence of haemorrhoids and treat them, because this would incur unnecessary cost and bring little success.

Adult↗
PubMed2005

[Options for quality improvement in the treatment of rectum carcinoma].

By means of a prospective multi centre study, 13 419 cases of surgically treated patients with rectum carcinomas were registered between 1.1.2000 and 31.12.2003 and assessed in regard to possible problems concerning indications and operative procedures. Beside a high rate of non-local resective procedures in T1-low risk carcinomas, unnecessary extirpations in cases of tumour localisation over 8 cm from the anal verge were found. Tumours of the lower two-thirds of the rectum were treated by incomplete TME in 20 % of the patients. In addition, there seems to be too low a rate of neo-adjuvant therapy procedures. Protective stomata were frequently foregone after low anterior resection. Endoscopic interventional methods were still used reluctantly in inoperable situations.

Germany↗
PubMed2006

[Staging of prostate cancer: value of the combined information of endorectal MRI, biopsy Gleason score, and preoperative PSA level].

PURPOSE: To evaluate the predictive value of MR imaging criteria, the biopsy Gleason score, and preoperative PSA levels for differentiating between T2 and T3 prostate carcinomas. MATERIALS AND METHODS: Endorectal MR images of 81 patients (median age: 65 years, range: 48 to 81 years) who had biopsy-proven prostate cancer and underwent a radical prostatectomy were analyzed retrospectively. The existence of different imaging features were recorded for each patient. A radiological analysis comprising all used imaging criteria was also performed for every patient. Optimal cut-off levels for the biopsy Gleason score and preoperative PSA levels were obtained using ROC analyses. Subsequently, a logistic regression analysis was performed to identify features which make a significant contribution to the prediction of the tumor stage. RESULTS: Histological examination showed that 24 patients (29.6 %) had a T3 tumor and 57 patients (70.4 %) had a T2 tumor. The mean preoperative PSA level was 9.4 ng/ml (+/- 7 ng/ml), and the median Gleason score was 6 with a range of 4 to 8. The radiological judgment comprising all imaging criteria led to a sensitivity of 54.2 % and specificity of 79 % for the detection of a T3 tumor. The obliteration of the rectoprostatic angle (regression coefficient B = 2.30; standard error (se) = 0.80; p = 0.002) and the biopsy Gleason score (B = 1.16; se = 0.3; p = 0.001) were the parameters with the highest independent predictive value for the diagnosis of an extracapsular tumor spread. The other radiological criteria and the preoperative PSA level were not statistically significant. A combination of the parameters "obliteration of the rectoprostatic angle" and "biopsy Gleason score" led to a sensitivity and specificity of 75 % and 79 %, respectively (existence of one parameter sufficient). The optimal cut-off value was a Gleason score of 7 for the differentiation between T2 and T3 prostate carcinomas. CONCLUSION: In our study, only the criteria "obliteration of the rectoprostatic angle" and "biopsy Gleason score" were of predictive value for the diagnosis of a T3 prostate carcinoma. The other MR imaging criteria and the preoperative PSA levels had no additional benefit.

Aged↗
PubMed2006

[Local excision with transanal endoscopic microsurgery (TEM) after endoscopic R1/R2-polypectomy of pT1 "low-risk" carcinomas of the rectum].

The transanal endoscopic microsurgery (TEM) is an adequate method for the local full-thickness excision of large rectum polyps and pT1 "low-risk" rectal carcinomas. We studied prospectively the relevance of this surgical technique concerning complete tumour excision after R1/R2-polypectomy of malignant rectal polyps. 16 patients with pT1 "low-risk" rectal carcinoma and macroscopic (R2) or microscopic (R1) incomplete endoscopic polypectomy were locally resected by TEM. In 12 patients (75 %) no residual tumour was found. In the remaining four cases (25 %), one adenoma with high-grade atypia, two pT1 "low-risk" carcinomas and one tumour infiltration in the mesorectal fat were diagnosed. The patient with the mesorectal infiltration was immediately operated on with radical resection. No further tumour cells were found in this specimen. The median follow-up was 21 months. One patient with a pT1 "low-risk" carcinoma developed a local recurrence and a single hepatic metastasis in the left liver lobe after TEM. Both were completely resected. Currently, all patients are living without evidence of tumour recurrence. Transanal endoscopic microsurgery is a suitable method for the treatment of pT1 "low-risk" rectal carcinomas after incomplete endoscopic polypectomy. In cases of a "high-risk" tumour or deeper tumour infiltration (pT> 1) after TEM radical resection must be carried out.

Adult↗
PubMed1995

Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients.

BACKGROUND AND STUDY AIMS: Laser therapy is often the only alternative to palliative surgery for elderly patients with advanced rectal carcinoma. In order to reduce the number of laser sessions required, we tried to insert metal stents after initial relief of the obstruction. PATIENTS AND METHODS: In 12 patients (seven female, five male, aged 77-91 years) with rectal or rectosigmoid carcinomas, metallic self-expanding stents (length 5-10 cm, internal diameter 1-2 cm) were introduced. Initial treatments were performed with Nd:YAG laser (mean number of sessions 3.1) in order to allow free passage of an adult colonoscope. Endoscopic and clinical follow-up was carried out at regular intervals. RESULTS: Stent insertion was possible in 11 of the 12 patients. Failure occurred in one patient with sigmoid carcinoma with a distorted loop and diverticulosis. In three patients, the prostheses migrated due to the opening of the lumen being too large; after stent removal, a second stent was successfully placed. Seven patients have died since the beginning of the study, all from the initial disease, without symptoms of stent occlusion. Stenting allowed the number of laser sessions to be reduced. The interval between the laser sessions was extended from 5.1 weeks in a historical control group of 65 patients to the 9.7 weeks in these 11 patients with additional stenting. CONCLUSION: Stenting for rectal carcinoma is technically feasible and safe, and probably reduces the number of laser sessions required. However, better materials are required.

Aged↗
PubMed1994

Photodynamic therapy for villous adenomas of the colon and rectum.

Endoscopic thermal laser therapy of colorectal villous adenomas is associated with a high recurrence rate due to incomplete tumor ablation, as treatment over carries a risk of perforation. Photodynamic therapy has been shown to be a promising in the treatment of small malignant tumors, and may be useful for benign adenomas. Eight patients with nine colosigmoid villous adenomas measuring 1-5 cm in length were treated with photodynamic therapy using either haematoporphyrin derivative or Photofrin as photosensitizer and multiple (4-16) applications of interstitial photoirradiation with red light (630 nm, 100 mW x 500 s per application). All but one adenoma had previously been incompletely treated with Nd-YAG laser therapy. Some skin sensitivity to light was seen in one patient. Seven adenomas were eradicated (follow-up 9-56 months, median = 12) as judged by follow-up endoscopy and biopsy. No local complications were seen. Substantial necrosis was produced in the other two adenomas, but they were not completely destroyed, probably due to inadequate light. PDT holds promise in the non-surgical management of villous adenomas, particularly after initial tumour debulking with the Nd-YAG laser.

Adenoma, Villous↗
PubMed1988

[The value and limits of endorectal sonography in the preoperative stage classification of rectal cancer].

The article deals with the valuation of endorectal and abdominal sonography in preoperative staging of rectal carcinoma. Data processing of 40 patients suffering from tumours of the rectum examined rectoscopically, by biopsy and via sonography showed that endorectal sonography can achieve preoperative staging (T) with a sensitivity of 89%, a specificity of 100%, a positive predictive value of 89% and a negative predictive value of 100%, the overall accuracy being 81%. Identification of pararectal adenopathies can be performed with a sensitivity of 16% and a specificity of 100%. Liver metastases were determined with a sensitivity and specificity of 100%. Hence, endorectal sonography is a valuable method for preoperative staging of carcinoma of the rectum.

Adenocarcinoma↗
PubMed1985

Screening for colorectal cancer in a Hungarian county.

An initial screening for colorectal cancer in asymptomatic adults was performed with Haemoccult in 26,357 persons, rigid rectoscopy in 10,673 and flexible sigmoidoscopy in 3,963 persons. The rate of cancer detection was 4.4% in screenees with a positive Haemoccult test, 0.08% using rigid rectoscopy and 0.28% using flexible sigmoidoscopy. The respective frequency of patients discovered to have polyps was 16.2%, 1.32% and 8.49%. 77% of the 36 colorectal cancers detected due to the Haemoccult test program were either Dukes A or B. A comparison of these screening results indicates that Haemoccult screening markedly increases the yield of colorectal neoplasms when asymptomatic persons are examined. This screening should be repeated annually to reduce the morbidity and mortality of colorectal cancer.

Adenoma↗
PubMed1985

Follow-up of patients with colorectal adenomas.

With the aim of establishing suitable follow-up intervals, we examined the probability for the recurrence of relevant adenomas in the colorectum. A total of 592 adenoma patients in whom colonoscopy up to the caecum had reliably excluded relevant findings, were admitted to the study. Relevant findings were considered to be 1) colorectal carcinoma, 2) an adenoma with severe cellular atypia, 3) an adenoma of at least 5 mm in diameter, 4) a histologically unclassified polyp of at least 5 mm in diameter. We were able to show that the use of a dose-effect relationship is statistically justified for the follow-up results of the 592 patients. Thus, the probability for renewed relevant findings at any given time can be computed on the basis of the follow-up results. Renewed relevant findings were presented by 6.0% of patients with single adenomas after 4 years (confidence level 4.8-7.3%), while 5.7% of patients with multiple adenomas had relevant findings after 2 years (confidence level 4.5-7.0%). These follow-up intervals are, thanks to the adequate detection rate, economical and, at the same time, safeguard adenoma patients with a high level of reliability, against cancer of the colorectum.

Adenoma↗
PubMed1980

Carcinoids of the gastrointestinal tract.

Thirteen cases of carcinoid of the GI tract during eleven years seen in our hospital are presented. Prior to surgery, the clinical diagnosis of our 9 cases of gastric carcinoid was as follows: 7 cases were diagnosed as advanced gastric cancer, one case as perforated gastric ulcer, while a minute lesion of less than 1 cm in diameter was correctly diagnosed as a carcinoid. The tumors were all larger than 2 cm in the largest diameter with the exception of a minute lesion that appeared as a submucosal tumor and was diagnosed correctly before operation. Only one case of rectal carcinoid was diagnosed as a carcinoid endoscopically. The other two were diagnosed as rectal polyp and rectal cancer respectively. The lesion arising in the cecum was diagnosed as cecum tumor. The biopsy specimens of most carcinoids revealed adenocarcinoma pre-operatively, and only two cases were diagnosed correctly as carcinoid. In our series, we were unable to detect any symptom or sign of carcinoid syndrome, even in the case with widespread liver metastasis. We have not encountered any case of carcinoid in the appendix, which lesion has been very frequently reported in the Western countries.

Adult↗