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PubMedDate not supplied

[Colonic tuberculosis].

General improvement of life standard normally reduces tuberculous morbidity. However, the general surgeon is confronted with a significant rise of abdominal tuberculosis, especially the colonic form. Between 1990 and 1995, 6 patients with ileo-colonic tuberculosis were operated in the Surgical Department N. Gh. Lupu, of which 3 presented also the peritonitis form, and 2 patients had also a liver involvement. The clinical symptoms, the palpable abdominal mass in the right lower quadrant and the intraoperative aspect suggested usually a right colonic neoplasm. The diagnosis was established by histology. The management was right (ileo) hemicolectomy, followed by tuberculostatic treatment over one year. In conclusion, the diagnosis is still a matter of concern whenever a palpable abdominal mass is found, even in the absence of evolutive pulmonary tuberculosis. A frozen section from the resection piece is very important, because it enables early beginning of the tuberculostatic treatment.

Adult↗
PubMed1987

Optimizing single- and double-contrast colon examinations.

Recent technical advances have greatly increased the effectiveness of barium enema examinations for detection of common diseases of the colon. As documented in the literature, the double-contrast enema may equal or exceed colonoscopy in detection of colonic neoplasms and, with proper technique, the single-contrast enema may also closely approach these results. This presentation reviews recent technical improvements in the areas of radiographic-fluoroscopic equipment, fluoroscopic images, film-screen combinations, barium suspensions, examination techniques, filming sequences, and quality controls. These are employed to optimize both the double- and single-contrast barium enemas to where their sensitivities are competitive with endoscopy.

Air↗
PubMed1989

Colorectal neodymium-YAG photoablative therapy. Comparing applications and complications on both sides of the peritoneal reflection.

Laser photoablative therapy has seen wide application in the esophagus, stomach, and rectum. Its use in the supraperitoneal colon has been less extensive because of fear of complications. One hundred fifteen patients who presented during a four-year period and underwent neodymium-YAG laser treatment on both sides of the peritoneal reflection (rectum, 47 patients; colon, 68 patients) were reviewed. The various lesions treated with laser therapy included 32 malignant tumors that presented with bleeding or obstruction, 44 large broad-based villous adenomas, six carcinoid tumors, and 33 patients with arteriovenous malformations or radiation proctitis who presented with acute hemorrhage or chronic blood loss. Overall treatment efficiency was 83% in the rectal group vs 87% in the colonic group. There was no significant difference in complication frequency or severity between the two groups, even though 45% of the colonic lesions were located in the thin-walled cecum. There was no laser-related mortality in this series. Laser photoablative therapy is safe and effective treatment for a wide variety of colorectal lesions. In experienced hands, it can be used on either side of the peritoneal reflection with equal efficiency and no increased risk of complications.

Adenoma↗
PubMed2004

Expression of Sonic hedgehog pathway genes is altered in colonic neoplasia.

The Hedgehog (Hh) signalling pathway is crucial for normal development and patterning of numerous human organs including the gut. Hh proteins are also expressed during gastric gland development and gastric epithelial differentiation in adults. Recently, dysregulation of these developmentally important genes has been implicated in cancer, leading to the present study of the expression of Hh signalling proteins in colon cancer. In this study, normal colon and colonic lesions (hyperplastic polyp, adenoma, and colonic adenocarcinoma) were examined by immunohistochemistry using antibodies against Hh signalling molecules: the secreted protein Sonic hedgehog (SHH), its receptor Patched (PTCH), and the PTCH-associated transmembrane protein Smoothened (SMOH). The study shows that Hh signalling pathway members are expressed in normal colonic epithelium. SHH was expressed at the top of the crypts and in a few basally located cells, while PTCH was detected in the neuroendocrine cells and SMOH at the brush border of superficial epithelium. RT-PCR analysis of laser-microdissected crypts from normal human colon confirmed that mRNAs encoding these proteins were expressed in colonic epithelium. Expression of SHH, PTCH, and SMOH was up-regulated in hyperplastic polyps, adenomas, and adenocarcinomas of the colon, and SHH expression correlated with increased expression of the proliferation marker Ki-67 in all lesions examined. To address whether the Hh signalling pathway is functional in the gut, the effect of Shh on epithelial cells in vitro was explored by treating primary murine colonocytes with either Shh peptide or neutralizing anti-Shh antibody. The proportion of cells in the S-phase was assessed by bromodeoxyuridine (BrdU) incorporation. It was found that exogenous Shh promotes cell proliferation in colonocytes, while anti-Shh inhibits proliferation, suggesting that Shh is required during proliferation of epithelial cells in vitro. It is suggested that SHH is required during epithelial proliferation in the colon and that there is a possible role for Hh signalling in epithelial colon tumour progression in vivo.

Adenocarcinoma↗
PubMed1988

A prospective, randomized trial of perioperative prophylactic cefamandole in elective colorectal surgery for malignancy.

The impact on wound infection of the addition of perioperative cefamandole to a mechanical bowel preparation with oral antibiotics was studied in a prospective randomized series of patients undergoing elective colectomy for biopsy-proven carcinoma or adenomatous polyps. Seventy patients were randomized, all underwent mechanical bowel preparation and received oral neomycin and erythromycin base. Thirty-four patients also received a preoperative and four postoperative doses of cefamandole, while 36 patients were randomized to receive no parenteral antibiotics. The two groups were well stratified for age, sex, and risk factors. The Dukes stage was similar and the surgical procedures were equally distributed in the two groups. There were no wound infections in the 34 patients receiving cefamandole and only one wound infection (2.8 percent) in the 36 control patients. Therefore, the addition of perioperative intravenous cefamandole to a good mechanical bowel preparation with oral antibiotics was of no benefit in reducing wound infections following resection of colorectal malignancies in this select group of patients.

Carcinoma, Squamous Cell↗
PubMed2002

Secondary prevention: screening and surveillance of persons at average and high risk for colorectal cancer.

Secondary prevention of colorectal cancer with FOBT and endoscopy with polypectomy decreases cancer deaths. Other available modalities include genetic tests and imaging studies, but outcomes data are not yet available. Issues remain concerning the most appropriate test, the optimal intervals, and cost-efficacy. Patients may be stratified by personal and family risk, and specific strategies may be used. Newer developments in genetic tests and imaging, including virtual colonoscopy, hold promise for the future. The most important issue at present is to have people screened or surveilled by any of the recommended modalities.

Adenoma↗
PubMed2004

Small early tubular adenomas and mixed colonic polyps found on screening flexible sigmoidoscopy do not predict proximal neoplasia in males.

BACKGROUND & AIMS: Distal colonic adenomas found on flexible sigmoidoscopy are associated with proximal neoplasias, thus requiring a complete colonoscopic examination, but data regarding the association of distal mixed polyps with proximal neoplasia are lacking. We conducted this study to elucidate the significance of distal mixed colonic polyps in predicting proximal neoplasia. METHODS: We retrospectively analyzed data from patients who underwent a flexible sigmoidoscopic examination for colorectal cancer screening and a follow-up colonoscopic examination because of distal colonic polyps. Distal index polyps were classified by a pathologist as early tubular adenoma (ETA), serrated, or true mixed categories. Index polyps also were immunostained with a monoclonal antibody, Adnab-9, a marker for the colorectal adenoma carcinoma sequence. RESULTS: In 636 patients with distal index polyps, 6% were malignant, 55% were adenomas, 13% were ETAs, 6% were serrated, 4% were true mixed, and 17% were hyperplastic. Compared with distal hyperplastic index polyps, distal malignant polyps (P = 0.0006) and adenomas (P = 0.001) were associated with a significantly increased number of synchronous proximal neoplasia, but the small distal mixed, serrated, or ETA did not predict the increased incidence of proximal neoplasia. Large distal polyps of each category were significantly associated with an increased number of synchronous proximal neoplasias. In support of these findings, immunostaining of distal polyps with Adnab-9 showed predictability for proximal neoplasia only in the adenoma category (P < 0.05). CONCLUSIONS: Small ETAs, serrated, or mixed polyps found on flexible sigmoidoscopic examination do not increase the probability of synchronous proximal neoplasia.

Adenomatous Polyps↗
PubMed2003

Cdx1 homeobox gene during human colon cancer progression.

The Cdx1 homeobox gene encodes an intestine-specific transcription factor with a pro-oncogenic function in vitro. Here we have analysed the pattern of Cdx1 in human colon cancer progression. Cdx1 expression remains at a high level in the majority of the polyps and it is even overexpressed in more than one-third of the specimens, consistent with the fact that the gene is an intestine-specific target of oncogenic pathways. However, Cdx1 decreases in one-fifth of the polyps, which is reminiscent of the loss of expression previously reported in the majority of carcinomas. Allelic imbalance analysis demonstrates that the Cdx1 locus located on chromosome 5q is a major site of genomic rearrangement in colorectal cancers, and that the frequency of the rearrangements increases during polyps to carcinoma progression. Allelic imbalance at the Cdx1 locus occurs in relation to, although not invariably in association with, the rearrangements at the APC locus on the same chromosomal arm. Xenografts of primary human colon carcinomas indicate that the level of Cdx1 mRNA correlates with the intensity of allelic imbalance. Together, these data show that Cdx1 exhibits a complex pattern during colorectal cancer progression. Given that Cdx1 has a pro-oncogenic function in vitro, the maintenance of a high level of expression in polyps, and even its overexpression in one-third of the specimens, suggest that this homeobox gene may be an important factor in the process toward malignant transformation during the first steps of tumorigenesis.

Adenomatous Polyposis Coli Protein↗
PubMed2005

The association of calcium and vitamin D with risk of colorectal adenomas.

The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber, high-fruit and vegetable, low-fat diet on the recurrence of adenomatous polyps in the large bowel. Detailed dietary intake and supplement use data were collected at baseline and at each of 4 annual study visits. Adenoma recurrence was ascertained by complete colonoscopy at baseline and after 1 and 4 y. Recurrence was found in 754 of the 1905 trial participants. We evaluated the association between calcium and vitamin D intake and adenomatous polyp recurrence after adjusting for intervention group, age, gender, nonsteroidal anti-inflammatory drug use, total energy intake, and the interaction of gender and intervention group. Vitamin D models were also adjusted for the location of the clinic site. Dietary variables were adjusted for total energy intake via the residual method. There were no overall significant associations between adenoma recurrence and dietary calcium intake [odds ratio (OR) for the 5th compared with the lowest quintile = 0.91; 95% CI = 0.67-1.23; P-trend = 0.68], total calcium intake (OR = 0.86; 95% CI = 0.62-1.18; P-trend = 0.20), or dietary vitamin D intake (OR = 0.93; 95% CI = 0.69-1.25; P-trend = 0.43) averaged over follow-up. Total vitamin D intake was weakly inversely associated with adenoma recurrence (OR = 0.84; 95% CI = 0.62-1.13; P-trend = 0.03). Supplemental calcium and vitamin D use during follow-up also were inversely associated with adenoma recurrence (OR for any compared with no use = 0.82; 95% CI = 0.68-0.99; and OR = 0.82; 95% CI = 0.68-0.99; for calcium and vitamin D, respectively). Slightly stronger associations were noted for the prevention of multiple recurrences. Our analyses did not suggest a significant effect modification between total calcium and total vitamin D intake (P = 0.14) on risk for adenoma recurrence. This trial cohort provides some evidence that calcium and vitamin D may be inversely associated with adenoma recurrence.

Adenoma↗
PubMed1995

Egg consumption and risk-markers for colorectal neoplasia.

A strong positive relationship between dietary intake of eggs and risk of colorectal cancer has been observed in a number of epidemiological surveys. In this study we investigated the relationship between egg consumption and intermediate biomarkers of crypt cell proliferation in the colon and rectum of 75 patients who had adenomatous polyps or no evidence of bowel disease. Biopsies of normal flat mucosa were obtained at colonoscopy, and microdissected crypts were used to measure crypt length, frequency of mitosis per crypt and spatial distribution of mitoses within the crypt. There was no significant difference in the consumption of eggs by patients with adenomatous polyps (n = 53) and those without (n = 22). There was no significant positive correlation between frequency of egg consumption and any of the parameters of crypt cell proliferation in the group as a whole, nor when the patients with polyps were analysed separately. This study provides no biological evidence of any relationship between egg consumption and abnormal cell proliferation among patients at relatively high risk of colorectal neoplasia.

Abdominal Pain↗
PubMed1999

32/67-kD laminin receptor expression in human colonic neoplasia: elevated transcript levels correlate with the degree of epithelial dysplasia.

OBJECTIVE: The 32/67-kD laminin receptor is thought to be involved in tumor cell migration and metastasis formation, and enhanced expression was observed in human colorectal carcinoma. Our objective was to investigate further the expression of the 32/67-kD laminin receptor RNA in human colonic carcinogenesis. METHODS: We obtained sections of human colonic tissues in various stages of malignant transformation and analyzed them by in situ hybridization. RESULTS: Normal colonic mucosa displayed a gradient between crypt base and surface epithelium with lowest receptor RNA levels in superficial epithelial cells. Increased laminin receptor RNA expression was observed in epithelial cells of adenomas with positive correlation between transcript levels and the degree of epithelial dysplasia. At variance with published results, we did not observe significant differences in 32/67-kD laminin receptor transcripts between adenomas with high-grade dysplasia and invasive adenocarcinoma. However, adenocarcinoma metastases displayed significantly higher laminin receptor RNA levels than high-grade adenomas and primary carcinomas. CONCLUSIONS: We propose a two-step mechanism which controls first, upregulation of laminin receptor RNA before the acquisition of an invasive phenotype in dysplastic epithelial cells, and second, a further upregulation in metastatic cells during the adenoma-carcinoma sequence of the colon.

Adenocarcinoma↗
PubMed2001

Fas ligand upregulation is an early event in colonic carcinogenesis.

BACKGROUND/AIMS: Fas ligand (FasL) is a mediator of apoptosis via the Fas receptor (Fas/CD95/APO-1). Normal colonic epithelium expresses Fas, and appears to be relatively sensitive to Fas mediated apoptosis. Colonic adenocarcinomas coexpress FasL and Fas without undergoing widespread apoptosis. This study investigates the expression of FasL in colonic carcinogenesis from the earliest stages of the adenoma-carcinoma sequence. METHODS: FasL expression was determined in colonic adenomas (n = 38) of varying degrees of dysplasia and histological type by immunohistochemistry. Adenomas that contained areas of carcinomatous change were included (n = 12 of 38). Normal colonic epithelium (n = 10), hyperplastic polyps (n = 8), and serrated adenomas (n = 3) from patients without colonic adenocarcinomas were used for comparison. Cell death was detected in situ in adenomas using TUNEL (terminal transferase mediated dUTP nick end labelling). RESULTS: In normal colonic epithelium and hyperplastic polyps, FasL expression was restricted to the luminal surface of the crypts, where Fas-FasL coexpression was coincident with a high frequency of TUNEL positive epithelial cells. All adenomas (n = 38) had an altered distribution of positive FasL staining; FasL expression was found in most cells (> 70% of neoplastic cells). Expression of Fas was also detected throughout the adenomas, but coexpression of FasL and Fas was not associated with TUNEL positivity in most cells. CONCLUSIONS: FasL upregulation occurs early in the adenoma-carcinoma sequence of colon carcinogenesis, and is evident at the level of mild dysplasia. The lack of pronounced apoptosis in areas of adenomas coexpressing Fas and FasL suggests that colonocytes acquire resistance to Fas mediated apoptosis early in the transformation process.

Adenoma↗
PubMed2006

Sessile serrated adenomas of the large bowel. Clinicopathologic and immunohistochemical study including comparison with common hyperplastic polyps and adenomas.

Sessile serrated adenoma (SSA) is a newly characterized type of the large bowel adenoma. It arises in hyperplastic polyp (HP) and represents a precursor lesion of colorectal carcinoma with microsatellite instability. SSAs differ from common HPs by abnormal proliferation of the crypt epithelium and by nuclear atypia. We examined 15 SSAs from 15 patients. The age range was 25-80 years (average 60 years). Six patients were females and 9 were males. For comparison, we examined 10 conventional tubular adenomas and 10 common HPs with vesicular cells. The sites of SSAs were as follows: 8 in rectum, 4 in rectosigmoid colon, 1 in transverse colon, 1 next to mucinous carcinoma of ascending colon, 1 in anastomosis after resection of the transverse colon adenocarcinoma. The diameter of the lesions ranged from 5 to 12 mm. Histologically, SSAs showed asymmetrical proliferation of the epithelium, irregular shape of the crypts with their branching and some crypt dilatations especially in the basal parts of the crypts. Cellular atypia (dysplasia) was usually low. In 5 cases the nuclei were focally stratified and localized in the lower part of the cells. High-grade dysplasia was found only in SSA adjacent to mucinous adenocarcinoma. Immunohistochemically, SSAs showed secretion of gastrointestinal mucin expressing MUC2 and MUC5A. Both MUC2 and MUC5A were also positive in mucinous carcinoma. In previous studies these expressions were considered specific for serrated type of carcinogenesis. However, our study found positivity of MUC2 and MUC5A also in conventional adenomas. Expression of p53 in SSAs was minimal. SSAs have malignant potential comparable with conventional adenomas and for this reason they must be distinguished from HPs.

Adenoma↗
PubMed1988

[Endoscopic and surgical therapy of malignant colorectal polyps].

87 malignant colorectal polyps were removed in 81 patients by endoscopic polypectomy from 1972 until 1987. Thereafter 34 of these patients had a surgical resection of the colon. Surgical resection was performed for incomplete excision of the polyp (20 x), for tumor invasion of the lymphics in the polyp stalk and for moderately/poor differentiated carcinoma. In 6 patients a residual carcinoma was detected in the removed colon specimen, but lymph-node metastasis only in one with moderate-differentiated carcinoma. Our results demonstrate that colorectal polyps with invasive well-differentiated carcinoma and tumor free base do not need a surgical resection. Patients of the high-risk-group (moderately/poor-differentiated carcinoma, invasion of blood vessels and lymphatics, incomplete excision), should be referred to further surgical resection. With regard to the low rate of metastatic spread even in patients with high-risk-polyps accurate differentiation seems to be necessary. In 19 out of 52 (36.5%) patients endoscopic control examinations after surgical or endoscopic resection revealed recurrent pathological findings. On the base of the presented data we conclude that there is a need for short-term endoscopic controls over a period of five years.

Adenocarcinoma↗
PubMed1987

A basic audit: knowledge and attitudes of teaching and nonteaching surgeons towards colorectal cancer.

In order to determine surgeons' knowledge of colorectal cancer in New Zealand and to see whether this knowledge was related to clinical practice a questionnaire was sent to all general surgeons on the New Zealand Medical Register. One hundred and twenty-three responses were received and analysed. Surgeons involved in student teaching had a better knowledge of this cancer than their nonteaching colleagus. There was a significant association between knowledge and attitudes towards screening, polyp removal and occult blood testing.

Adult↗
PubMed1987

[Does prolonging the test period improve screening for colorectal cancer?].

Prolongation of Haemoccult-screening from 3 to 6 days in 3540 out-patients resulted in a rise of the positivity rate from 4.1 to 6.75%. This was accompanied by an increase of the detection rate by 10% in cancers and 25% in large adenomas. The predictive value of a positive test for colorectal neoplasia (carcinoma and large polyps together) dropped from 26.7 to 20.9%. More data are needed before general recommendation for change from the standard 3-day-test period can be given.

Colonic Neoplasms↗
PubMed1986

Familial polyposis coli.

Familial polyposis coli is a syndrome of autosomal dominant inheritance that ultimately causes colonic cancer if untreated. Diagnosis at the presymptomatic stage is imperative. Patients with the disease, as well as family members at risk, need intense support, education, surveillance and follow-up. Benign and malignant extracolonic manifestations, such as osteomas, desmoid tumors, medulloblastomas and glioblastomas, may appear even before the polyposis is clinically evident. When symptoms of the polyps are present, two-thirds of the patients already have colonic cancer.

Adult↗