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PubMed1986

Ethiodized oil emulsion enhanced computerized tomography in the preoperative assessment of metastases to the liver from the colon and rectum.

Selective reticuloendothelial (RE) cell uptake of ethiodized oil emulsion 13 (EOE-13), an emulsion of Ethiodol (ethiodized oil) roentgenographic contrast material in a phosphate buffer, permits detection of small metastatic lesions of the liver and spleen through enhancement of roentgenographic density differences on computerized tomography (CT) between tissues containing and not containing RE cells. To determine the efficacy of this contrast material in the assessment of patients with metastatic disease of the liver, routine CT and emulsion enhanced tomography (EOE) were performed in a series of 15 patients prior to surgical exploration for treatment of carcinoma of the colon and rectum. All patients were suspected of harboring hepatic metastasis on the basis of clinical examination, liver function tests or radionuclide scans. EOE consistently demonstrated the nature and location of hepatic defects. Surgical exploration failed to locate one metastasis that was judged to be real because of progressive enlargement on EOE and CT over a period of two years. CT scans detected metastases in three patients subsequently shown to have normal livers and failed to detect disease in one patient subsequently shown to have metastases. EOE contrast material provides a more sensitive and accurate picture of metastatic liver involvement from carcinoma of the colon and rectum than is available on routine CT. The information provided by the results of this test can be useful in preoperative planning when treatment of disease of the liver is considerable feasible.

Adenocarcinoma↗
PubMed1978

[Malignant polyps and early recognized carcinomas of the rectum. Morphological aspects and selective surgical treatment (author's transl)].

The lymphatic drainage of the colon and rectum originates in the submucosal layer. Therefore metastases do not arise from carcinomas confined to the mucosa, and for the same reason the WHO lately recommended to call these lesions severe atypism. The term adenocarcinoma should be reserved in the case of infiltration of the carcinoma into the submucosa. According to the features outlined above adenomas of the rectum showing severe atypism can be removed by careful excision of the mucosa. Even adenomas containing an early diagnosed adenocarcinoma up to 2.5 cm in diameter often can be cured by a local resection of the rectal wall, if no metastases have occurred. From 1971--December 1, 1977, 12 rectal adenomas with severe atypism and 14 rectal adenomas with adenocarcinoma had been removed locally without complications. After 6 years there was no recurrence of carcinoma.

Aged↗
PubMed1987

Identification of insulin receptors in epithelial cells from duodenum, jejunum, ileum, caecum, colon and rectum in the rat.

Specific insulin binding was demonstrated in isolated epithelial cells of rat intestine, from the duodenum to the rectum. In every segment tested, insulin binding exhibited similar properties relating to kinetics and specificity and could be interpreted in terms of two populations of receptors possessing different affinities and binding capacities. Insulin receptors were unequally distributed along the intestinal tract, suggesting that the hormone may have varying importance at different points along the intestinal axis. These observations together with previous data on insulin regulation of a number of intestinal epithelial activities suggest that the pancreatic hormone may play an important role in gut physiology from the duodenum to the rectum.

Animals↗
PubMed1987

Obesity and cancer. A review of epidemiological studies on the relationship of obesity to cancer of the colon, rectum, prostate, breast, ovaries, and endometrium.

Cancer of the colon, rectum, prostate, breast, ovaries and endometrium may be associated with obesity. The present paper reviews both prospective and retrospective studies of the potential associations between obesity and these cancers. This research is especially difficult because of the complex interrelations between weight and diet, physical activity, cigarette smoking, and other conditions. Epidemiological studies of body weight are subject not only to biases of sampling, selection, and confounding but also to marked difficulties in definition and measurement. Bearing in mind the methodological shortcomings, there is a distinct and reproducible association between obesity and cancer of the endometrium and postmenopausal breast cancer. The studies of cancer of the colon, rectum, prostate, and ovaries are too inconclusive to elucidate whether obesity implies an increased risk. It is recommended that future studies in this field include a standardised assessment of the distribution of fat tissue, the onset and duration of the condition, and the associated confounding factors. It is concluded that obesity, especially in females, should be avoided as a part of the general cancer preventive effort.

Breast Neoplasms↗
PubMed1988

[Treatment of cancer of the rectum by electrocoagulation].

The destruction of rectum carcinoma by electrocoagulation can be used for the treatment of patients of older age groups with high operative risk having exophite tumors of the inferior ampular part not more than 3 cm in size. When observing the conditions concerned and careful dispensary examination, the efficiency of immediate and long-term results of this operation are not inferior to generally used routine methods of treatment. Electrocoagulation of rectum carcinoma must be fulfilled but at oncological and specially equipped oncoproctological units.

Age Factors↗
PubMedDate not supplied

[The value of vaginoplasty in perineal cicatrization following amputation of the rectum via abdomino-perineal approach].

Advantage of vaginoplasty in perineum healing following abdominoperineal amputation of the rectum. Healing of the perineal wound following abdominoperineal amputation of the rectum is achieved by secondary intention within 6 to 12 weeks. To improve the tedious dressings and to minimise the duration of healing, resorting to primary healing of the perineum in the females is facilitated by a technique of vaginoplasty. Our observations through personal experience dealing with 24 patients matched those described by Johnston in 1969 and 1979. Perineal healing was obtained within 10-14 days. The vaginal floor epithelialization was obtained after a median duration of 32.7 days. No important complications were noticed in relation to this technique.

Aged↗
PubMed1978

[The operative treatment of prolapse of the rectum (author's transl)].

Different kinds of mucosal prolapse at the rectum are differentiated. True and prolapse with protrusion of considerable portions of the rectum principally occur in later life. For younger patients several rather complicated operative procedures for the elimination of anal prolapse come into consideration, but usually they cannot be reasonably accepted by older patients. For this reason a simple method is recommended which carries little risk and yet promises satisfactory result--such as the insertion of a Thiersch ring. Whereas with this technique, if correctly carried out, improvement of the condition is almost certain to be expected, the longterm result over several years is limited, as a followup examination showed. Insertion of a Thiersch ring can, howeever, be repeated without difficulty. This procedure will retain its indication because of its simplicity.

Anesthesia, Local↗
PubMed1987

Trends and ethnic variation in incidence and mortality from cancers of the colon and rectum in Singapore, 1968 to 1982.

Data collected by the population-based Singapore Cancer Registry show rapidly increasing incidence for both cancer of the colon (annual average of 3-6%) and rectum (annual average of 3-5%) over the period 1968 to 1982. The cancer incidence rates were generally highest among the Chinese in whom the latest age-adjusted rates (1978-82) for colon were 14.3 per 100,000 in males and 14.9 in females, and for rectum 12.5 in males and 10.0 in females. The rates were intermediate for Indians and lowest in Malays. In both sexes, foreign-born Singapore Chinese (mostly born in China) had significantly lower risks for colon cancer compared to local-born Chinese (RR 0.71 in males, RR 0.72 in females, both p less than 0.05). There were no discernible differences between the two groups for rectal cancer. Internationally, Singapore's incidence rates for both sites rank roughly midway between the lows of Asia and Eastern Europe and the highs of Western Europe, North America and New Zealand. Among Chinese populations worldwide, the Singapore rates are also intermediate between the low rates in Shanghai and the high rates in Hawaii and California. The rates among Singapore Indians are generally higher than those in Bombay, Madras and Bangalore. These findings strongly suggest the importance of environmental lifestyle related risk factors among which, on current knowledge, dietary intakes feature prominently. The per capita food availability in Singapore especially in meat and animal fat, has also increased markedly over the last two decades.(ABSTRACT TRUNCATED AT 250 WORDS)

Colonic Neoplasms↗
PubMedDate not supplied

[Carcinoid tumors of the rectum. Apropos of 2 cases with metastases].

We are reporting two cases of carcinoid tumors of the rectum treated surgically. In both cases, there were nodes metastases and in one case liver metastases without carcinoid syndrome. Carcinoid tumors of the rectum are rare and usually asymptomatic; metastases are essentially located in the lymph nodes and the liver.

Carcinoid Tumor↗
PubMed1986

Urodynamic investigation predicts bladder dysfunction at an early stage after abdominoperineal resection of the rectum for cancer.

In a prospective study, 25 consecutive patients (14 men and 11 women) who underwent abdominoperineal resection of the rectum were urodynamically investigated before surgery and 10 days, one month, and three months after the operation. Nine men and three women (48% and 95% confidence limits; range 28% to 69%) developed voiding disturbances 10 days after the operation. One man and one woman developed incomplete lower motor neuron lesion (8% and 95% confidence limits; range 1% to 26%). At follow-up 3 months after surgery, five patients (20% and 95% confidence limits; range 7% to 41%) had still voiding disturbances: two patients with lower motor neuron lesion and three men with bladder outlet obstruction caused by prostatic hypertrophy. The three men underwent transurethral resection of the prostate 6 months after excision of the rectum. It is concluded that the risk of neurogenic bladder and voiding dysfunction is a minor problem. Cystometry performed before removal of the vesical catheter around the tenth postoperative day will diagnose patients with neurogenic bladder dysfunction. If voiding symptoms persist beyond 3 months after the operation, further urodynamic investigations should be undertaken to find patients with bladder dysfunction not due to lesion of the peripheral parasympathetic nerves to the bladder, which could demand surgery.

Abdomen↗
PubMed1986

The role of preoperative intravenous pyelogram in operations performed for carcinoma of the colon and rectum.

The relationship between preoperative intravenous pyelogram (IVP) and urologic complications after potentially curative operations for carcinoma of the colon and rectum was studied in 511 patients who underwent operation from 1976 to 1983. Forty per cent of the patients had preoperative IVP and these patients were significantly more likely to have undergone resection distal to the transverse colon than patients without preoperative IVP. Sex, age, urologic history, physical findings, abnormal urinalysis, elevated blood urea nitrogen (BUN) or serum creatinine levels and identity of the surgeon did not appear to influence whether or not an IVP was obtained before operation. Postoperative urologic complications were noted in 9.4 per cent of the patients; 87 per cent of the complications were retention or infection. Complications were significantly more common in male patients, particularly those with preoperative symptoms of retention, patients with elevated preoperative BUN or serum creatinine levels and patients who had resections distal to the transverse colon. Age, urologic history, physical findings, abnormal urinalysis results and the identity of the surgeon were not associated with postoperative urologic complications. The incidence of complications was the same in patients with normal and abnormal IVP results as well as for patients who did not undergo IVP. The findings of this study do not support the routine use of preoperative IVP for patients who undergo potentially curative resection for carcinoma of the colon and rectum.

Colonic Neoplasms↗
PubMed1986

Posterior trans-sphincteric resection for small tumours of the lower rectum.

In the period 1977-1983, 21 patients with small tumour of the lower two-thirds of the rectum were treated with local excision, using the posterior trans-sphincteric approach. The operative and postoperative course was uneventful, with no mortality, septic complications, fistula or anal incontinence. In 14 cases the tumour was an adenocarcinoma. These tumours had been preoperatively classified as carcinoma or suspected carcinoma with limited superficial growth. In 12 of them there was no invasion beyond the rectal wall. In follow-up averaging 44 months there has been no local recurrence, but liver metastasis has appeared in two patients. In our experience, local tumour excision via posterior trans-sphincteric rectotomy is a safe alternative for removal of adenoma or small, localized carcinoma of the lower two-thirds of the rectum.

Adenocarcinoma↗
PubMed1986

[Surgical treatment of villous tumors of the rectum and sigmoid. Apropos of 79 cases].

The authors analyse a series of 79 villous tumors of the rectum and sigmoid. These tumors are observed more often in men at an average age of 65. They distinguish benign tumors (44 cases), premalignant (21 cases) and malignant tumors (14 cases). The histology of the whole piece has a greater value than a preoperative biopsy. There are many clinical symptoms and the forms with electrolyte depletion are not rare (6 cases). Tumors with wide implantation need a surgical treatment. It will be conservative in benign cases, but the excision will be wide in cases of invasive malignancy. The indication are based upon the localisation of the tumor on the rectum. Mortality of wide excision is quite important (10) because of the bad general feature of the patients. Recurrences must be detected early by regular endoscopic follow-up.

Adult↗
PubMed1986

Recurrence and survival after anterior resection of the rectum using the end to end anastomotic stapler.

With the introduction of the end to end anastomotic stapler there has been an increase in the number of sphincter saving resections for carcinoma of the middle and distal part of the rectum. The results of earlier reports have indicated an increasing number of local recurrences possibly due to less extensive dissection of the lower pelvic area. Ninety-six patients, 46 males and 50 females, with a median age of 68 years (a range in age of 33 to 86 years) were operated upon between 1978 and 1981 for carcinoma of the rectum with anterior resection and stapled anastomosis have been analyzed. All patients were observed for more than three years (a median of 65 months and a range of 36 to 82 months). The hospital mortality rate was 5 per cent. The median distal margin was 2.5 centimeters (a range of 1 to 10 centimeters). Local recurrences occurred in 17 patients. No correlation between the grade of malignant disease and classification according to Dukes' staging and local recurrence was found. The median time between operation and the diagnosis of a local recurrence was 14 months (two to 62 months). Distant metastases developed in 14 of 83 patients who underwent operation for cure. The over-all five year survival rate was 64 per cent. The survival rate for 83 patients who underwent operation for cure was 71 per cent (96 per cent of Dukes' A, 72 per cent for Dukes' B, 45 per cent for Dukes' C and zero per cent for Dukes' D). It is concluded that the use of stapling devices has not been followed by a higher rate of local recurrence or a decreased five year survival rate and that this new technique can be used whenever technically possible.

Adenocarcinoma↗
PubMed1986

The effect of surgical procedures on monocyte function in patients with carcinoma of the colon and rectum.

The whole blood monocyte count (WBMC), migratory response (MMR), phagocytic index (MPI), chemiluminescence (MCL) and serum opsonic activity (SOA) were measured in a group of 31 patients before and after undergoing elective operation for carcinoma of the colon and rectum (group 1). In the early postoperative period, there was a reduction of the WBMC (preoperatively: 54.1 +/- 41.8, 24 hours; 38.4 +/- 24.8, 48 hours, and 39.1 +/- 24.2 X 10(4) per milliliter, both p less than 0.05), impairment of MMR (preoperatively, 72.2 +/- 34.4; 24 hours, 56.7 +/- 28.6, and 48 hours, 54.7 +/- 30.8 cells per high power field [HPF], both p less than 0.01), enhancement of the MPI (preoperatively, 208.1 +/- 44.1, 24 hours, 225.9 +/- 45.6, p less than 0.05, and 48 hours, 242.0 +/- 48.0, p less than 0.01) and an increase of the MCL (preoperatively, 26,091 +/- 14,419; 24 hours, 30,896 +/- 13,741, and counts per minute [CPM], not significant and 48 hours: 33,576 +/- 18,167 CPM, p less than 0.02). There was also a small reduction in monocyte SOA during this period (preoperatively, 89.4 +/- 13.9; 24 hours, 83.0 +/- 20.1, and 48 hours, 78.3 +/- 29.3 per cent control, both p less than 0.05). At one week after operation, monocyte function tended to return to the normal range in patients who had undergone uncomplicated curative resection. These functions tended to be increased in those patients with complications. The administration of the immunostimulant levamisole (5 milligrams per kilogram) preoperatively to a group of 20 patients with carcinoma of the colon and rectum (group 2) did not result in any significant differences of the postoperative monocyte functions when compared with the patients in group 1.

Aged↗
PubMed1986

New upper and lower clamps for use in anterior resection of the rectum by hand suture or stapling techniques.

New occlusive clamps have been designed to facilitate anterior resection of the rectum. A T shaped upper occlusive clamp with centrally placed arms, curved transverse end and its total length and light weight provide more secure control of the intestine and allows the surgeon a less obstructed view of the distal site of section than the traditional L shaped rectal clamps. A lower occlusive clamp has been designed to obviate many of the inherent problems of controlling and suturing a rectal stump in the depths of the pelvis. Main concerns and technical troubles are retraction of the stump, loss of control of the flabby rectal remnant and difficulty handling the anterior and posterior walls as the surgeon attempts to make the anastomosis. The lower clamp keeps the rectum from retracting and the proximal cut end is held open by four stay sutures to wings on the right and left blades of the clamp. It is used to facilitate the placement of a purse-string suture in the EEA stapling technique or in a hand sutured anastomosis.

Humans↗
PubMed1986

Hepatic resection for metastases of the colon and rectum.

Hepatic resection is the treatment of choice for a solitary metastatic deposit from a primary carcinoma of the large intestine in the absence of extrahepatic disease. This study was done to evaluate hepatic resection in the treatment of multiple hepatic metastases from carcinoma of the colon and rectum. Sixty-two patients underwent hepatic resection with an over-all operative mortality of 10 per cent, but a recent (1968-1981) mortality of 2 per cent. Three, five and ten year survival rates were 50, 34 and 21 per cent, respectively. No significant differences in survival patterns were noted comparing site (colon versus rectum), time interval from diagnosis of the primary to diagnosis of metastases (synchronous versus metachronous), sex (male versus female), size of the metastatic lesion (less than 5 centimeters versus greater than or equal to 5 centimeters) or number of metastatic lesions (single versus multiple). The pathologic stage of the primary carcinoma of the large intestine significantly (p less than 0.05) influenced survival patterns after hepatic resection with Dukes' B primary tumor having a median survival time of 123 months versus 27 months for patients with Dukes' C primary tumor. Sixty-seven per cent of those with a recurrence did so within the liver. Adjuvant chemotherapy had no demonstrable effect on survival patterns. Further improvement in survival statistics will require more sensitive staging procedures and effective adjuvant therapy, particularly for patients with Dukes' C primary carcinoma of the large intestine.

Adult↗