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PubMed1992

[Concentration of selenium in serum of patients with ulcerative colitis].

Selenium deficiency may be implicated in the pathogenesis of some human diseases, including colon cancer. The incidence of carcinoma of the colon is increased in patients with ulcerative colitis. We measured the serum concentration of selenium in 22 patients with ulcerative colitis and 22 sex-, age-, height and weight-matched controls. Although no significant difference was found in mean serum selenium between patients and controls (patients: 0.92 mumol/l, controls: 0.79 mumol/l), the serum selenium level decreased with increasing extension of the disease. The differences between serum selenium concentrations in patients with proctitis-sigmoiditis, left-sided colitis and pan-colitis were statistically significant. No correlation was found between serum selenium concentrations and the sex, age, height, or weight of the patients. The inverse correlation between serum selenium concentration and the extension of the disease may be caused by a decreased absorption of selenium from the diseased colon in ulcerative colitis.

Adult↗
PubMed1992

Association of human immunodeficiency virus and anal human papillomavirus infection among homosexual men.

BACKGROUND: A previous study of men with proctitis, proctocolitis, or enteritis showed an association of anal human papillomavirus (HPV) infection with human immunodeficiency virus (HIV) infection. Because anorectal abnormalities may confound an observed association between anal HPV DNA and HIV seropositivity, the present study was undertaken among consecutive homosexual men seeking HIV serologic testing who were unselected for anorectal symptoms. METHODS: Consecutive homosexual men underwent a standardized interview, physical examination, and collection of specimens for HIV serologic testing and detection of anal HPV DNA. RESULTS: Anal HPV DNA was detected in eight (31%) of 26 HIV-seropositive men and in 10 (8%) of 119 HIV-seronegative men (odds ratio, 5.8; 95% confidence interval, 1.1 to 30.1, adjusted for history of sexually transmitted disease, current anorectal symptoms, and age). When men with anorectal symptoms were excluded from the analysis, anal HPV DNA was detected in 27% of seropositive men compared with 8% of seronegative men (odds ratio, 4.4; 95% confidence interval, 1.4 to 13.4). There was no difference between HIV-seropositive and HIV-seronegative men with respect to distribution of type of HPV DNA. Men with group II or III and group IV HIV disease were 4.1 and 10.9 times, respectively, more likely than HIV-seronegative men to have anal HPV DNA detected. CONCLUSIONS: Because HIV-seropositive men appear to be at increased risk for the detection of anal HPV DNA, the natural course of anal HPV infection should be compared among HIV-seropositive and HIV-seronegative homosexual men.

Anus Diseases↗
PubMed1960

The potentiation of radiation effects with 5-fluoro-uracil.

A preliminary study of the response of various inoperable malignant diseases to simultaneously administered 5-fluoro-uracil and orthovolt x-ray was performed. The 5-fluoro-uracil was given intravenously at a relatively nontoxic dosage level. The x-ray tumor dose was limited to 2,000 roentgens in every patient. Pronounced and rapid tumor regression occurred in 12 of 18 evaluable patients. Significant objective response was obtained in each of eight patients with epidermoid carcinoma of the lung. Toxicity occurred in half of the patients, manifested by pharyngitis, esophagitis, proctitis, leukopenia and thrombocytopenia.

Aged↗
PubMed1977

Therapeutic regimens for anorectal gonococcal infection in males.

Anorectal gonococcal infection is particularly prevalent in women and homosexual men. Although the currently recommended Public Health Service therapeutic regimens for uncomplicated gonorrhea appear to be effective also for anorectal gonorrhea in women, their efficacy for anorectal infection in men has not been adequately evaluated. We report a case of gonococcal proctitis in a homosexual man that did not respond to therapy with ampicillin plus probenecid and tetracycline, but subsequently responded to spectinomycin therapy. Currently available therapeutic regimens for anorectal gonococcal infection in males are reviewed.

Adult↗
PubMedDate not supplied

Flow cytometric DNA characteristics of radiation colitis--a preliminary study.

The DNA status of 12 rectal biopsies, taken during the investigation of radiation proctitis, was investigated. Of these six were in the acute phase and six in the chronic phase. All of the acute biopsies had diploid DNA, despite bizarre histological epithelial cell appearances. Two of the chronic phase biopsies were to have aneuploid DNA profiles. This finding may be relevant to the increased risk of malignancy in irradiated tissues.

Acute Disease↗
PubMed1992

Flexible sigmoidoscopy screening in an industrial setting.

Little is known about the yield of colorectal cancer screening programs in an industrial setting. We therefore established a flexible sigmoidoscopy screening program at a chemical manufacturing plant and offered testing to all employees over the age of 40. After a Fleet enema preparation had been administered, a digital rectal examination and sigmoidoscopy were performed on each volunteer worker in the medical office of the plant. The plant had an average census of about 650 workers; 202 were screened during a 2-yr period. The mean (+/- SEM) age of participants was 52 +/- 0.4. Sixty-four employees had polyps (31.7%); data on follow-up colonoscopy were available in 69%. Colonoscopy revealed adenomatous polyps in 23 workers (53.5%), hyperplastic polyps in 10 (23%), and no evidence of neoplasia in 10 (23%). Seven workers did not arrange for follow-up colonoscopy and 12 individuals could not be contacted. No cancers were detected. In the 40- to 50-yr age group, polyps were detected in 19.5% of employees (25% adenomatous). Incidental findings were common, and included prostatic nodules, hemorrhoids, diverticulosis, and proctitis, among others. We conclude that screening sigmoidoscopy can be conveniently and economically performed at the workplace, with a high yield and good worker acceptance. The high yield suggests a possible association between polyp formation and work in a chemical plant. The finding of adenomatous polyps in the younger patients suggests that the threshold for flexible sigmoidoscopy at age 50 needs to be reassessed.

Adult↗
PubMed2003

[Epidemiology of inflammatory bowel diseases in Veszprém county of Western Hungary between 1977 and 2001].

INTRODUCTION: An epidemiological study of inflammatory bowel disease (IBD) in Veszprém county (located in western part of Hungary) was carried out from 1977 to 2001. METHODS: Both hospital and outpatient records of IBD patients were collected reviewed carefully. Most patients have been followed up regularly. RESULTS: The number of population has decreased during the observed period from 386,000 to 376,000. The county has both industrial and agrarian parts. 560 new ulcerative colitis (UC) cases, 212 Crohn's disease (CD), and 40 indeterminate colitides (IC) were diagnosed in the investigated period. Incidence rate increased from 1.66 (1977-1981) to 11.01 (1997-2001) in UC, and from 0.41 to 4.68 in CD, respectively. The incidence rate in IC rose from 0.26 to 0.74. The M/F ratio in UC was 1.06, in CD: 1.03, respectively, 41 UD patients and 13 CD patients died, the cause of death was disease related in 6 UC and in 6 CD patients. The average age at death in UC was not different from that observed in general population (66.4 years) but in CD (50.1 years) it was much earlier. The disease related mortality was low, 0.06/100,000 both in UC and CD. The prevalence rate at the end of 2001 was 142.6 for UC and 52.9/100,000 inhabitants for CD. Mean age at onset in UC was 38.9 +/- 15.5 years, in CD 31.7 +/- 12.8 years. We observed only one peak onset of the diseases, in UC it was between 30 and 40 years, in CD between 20 and 30 years. People living in towns were more liable to acquire the disease (ORUC = 1.27, ORCD = 1.13). The rate of smokers at the onset was 14.3% (OR = 0.25) in UC and 50.5% (OR = 1.98) in CD. Ex-smokers were 18.4% and 6.4%. Family history of IBD was present in 3.4% in UC and 9.9% in CD. The location of UC (according to the known largest extent) was proctitis in 112 cases, proctosigmoiditis in 162 cases, left sided colitis in 117 and subtotal or pancolitis in 169 cases. The location of CD was only ileal in 68 cases, ileocolonic in 87 cases, colonic in 57 cases. The behaviour of CD was non-stricturing-non-penetrating in 63 cases, stricturing in 54 cases, penetrating in 95 cases. 59.4% of the CD patients had at least one operation, 6.1% had more than 3 operations. CONCLUSION: The incidence and prevalence rates have increased steadily in Veszprém County, now it reaches that of most western European countries. There were no gender differences either in UC or CD. Smoking seemed to be a risk factor for CD, but it was preventive for UC. The rapid increase in incidence supports a role for environmental (e.g. diet, lifestyle changes) risk factors.

Adolescent↗
PubMed2004

[A cluster of lymphogranuloma venereum among homosexual men in Rotterdam with implications for other countries in Western Europe].

In mid-December 2003, a cluster of 15 cases of lymphogranuloma venereum (LGV) among male homosexuals was reported to the Municipal Health Service in Rotterdam by the Erasmus Medical Centre's outpatient clinic for sexually transmitted infections (STI). Most patients presented with proctitis and some with constipation. All were Caucasian and between 26 and 48 years of age. Thirteen of them were HIV-positive and eight had a concomitant STI. All men reported having had unprotected insertive and receptive anal sexual contact. Many sexual contacts were anonymous and were reported to have taken place in Germany, Belgium, the United Kingdom and France. This outbreak of LGV may extend through a large part of western Europe. In view of the patients' international contacts, international warnings and alertness are needed. Concerted action of professionals in infectious disease control and curative care is called for.

Adult↗
PubMedDate not supplied

Retrospective comparison of clinical outcome between radiotherapy alone and surgery plus postoperative radiotherapy in the treatment of stages IB-IIB cervical squamous cell carcinoma.

PURPOSE: To determine retrospectively whether radical surgery plus postoperative radiotherapy (RT) is superior to definitive RT from the standpoint of disease control and adverse events in the treatment of stages IB-IIA and stage IIB cervical squamous cell carcinoma. MATERIALS AND METHODS: The study included 143 patients treated by definitive RT (stages IB-IIA, n = 15; stage IIB, n = 27) or postoperative RT (stages IB-IIA, n = 67; stage IIB, n = 34). Cause-specific survival (CSS) and recurrence-free rate (RFR) were estimated. Late adverse events (proctitis, cystitis, lymphedema, and ileus) were graded, and the incidences were estimated. RESULTS: Overall, 5-year CSS and RFR did not differ significantly between patients treated with definitive RT (80.4% and 69.7%, respectively) and those treated with postoperative RT (80.6% and 79.1%, respectively). Rates according to clinical stage also did not differ significantly between the two types of treatment. Grades 1-3 adverse events occurred. Grades 2-3 lymphedema and Grades 2-3 ileus, but not Grades 2-3 cystitis, occurred significantly often with postoperative RT. CONCLUSION: Despite no difference in survival or patterns of recurrence, adverse events were significantly more frequent with postoperative RT than with definitive RT for both stages IB-IIA and stage IIB disease.

Adult↗
PubMed2004

[The large intestine--literature review of recent years].

Diagnose of the idiopathic inflammatory bowel disease depends on the set of clinical, radiological, endoscopic and histological criteria. Proctitis, proctosigmoiditis, and the left-sided colitis represent 60 to 80 percent of newly diagnosed cases of colitis. For the medical management of the inflammatory bowel diseases aminosalicylates, corticosteroids, topical corticosteroids, immunosuppressants are used. The complication of highest risk represents the toxic magacolon or periannal fistulas in patients with Crohn's disease. Pre-neoplastic epithelial changes (dysplasia) are diagnosed by pathologists according sets of cytological and architectonic markers. Indeterminate diarrhea related to the antibiotics administration is comparatively common. Roman criteria II classify functional intestinal disorders, represented by a set of isolated symptoms or various combinations of symptoms without identifiable organic, biochemical, sonographic or endoscopic abnormalities of the intestinal or biliary system, lasting minimally 12 weeks (not necessarily continuously) during the preceding year, as a persisting or recurrent distress. About 20 percent of patients with diverticular disease of the colon have some clinical manifestations.

Humans↗
PubMed1992

Radical radiotherapy for carcinoma cervix--preliminary experience with the microSelectron high dose rate machine.

Radiotherapy for uterine cervix carcinoma is an accepted treatment for all stages of invasive malignancy. The radiation modality is usually a combination of brachytherapy and external beam therapy for all except the most extensive tumours (stage IV--FIGO). Satisfactory results have been obtained in the Singapore General Hospital using low dose-rate radium applications in combination with cobalt teletherapy. Five year actuarial survival rates of 86.7% were obtained for FIGO stage I, 65.0% for stage II, 41.4% for stage III, 4.9% for stage IV with an overall rate of 54.0% for all stages. Corresponding 10-year rates were: 79.6%, 60.2%, 35.2%, 0% and 48.2%. Preliminary results of primary radiotherapy in 36 patients with cervical carcinoma treated by high dose-rate brachytherapy (microSelectron HDR) combined with 6MVP photons from a Siemens linear accelerator are presented. The patients were registered at the Mount Elizabeth Oncology Centre from November 1989 to December 1990 inclusive. The morbidity from high dose-rate therapy appears lower (9.1% for vaginal stenosis, 6.1% for non-severe proctitis) than for the radium series (4.1% and 20.8%) although the major complication rate appears similar (3% vs 2.8% respectively). The total failure rate is also lower at 19.4% for the HDR patients compared to 33.5% for the radium group. However, these rates are not strictly comparable as the HDR series consists of a small number of patients with limited follow-up. In the light of the data indicating acceptable morbidity with significant rate of early failure, the HDR brachytherapy doses have been increased whilst keeping within the limits set by other centres.

Adult↗
PubMedDate not supplied

Refractory proctosigmoiditis probably caused by inferior mesenteric vein ligation at sigmoidectomy.

A case of refractory proctosigmoiditis is reported in a 65-year-old female post-sigmoidectomy patient. She had bloody diarrhea and abdominal pain 2 years after sigmoidectomy, in which the inferior mesenteric vein was ligated close to the inferior mesenteric artery root during the lymph node dissection, while the inferior mesenteric artery trunk and the last branch of the sigmoid arteries was preserved. The biopsied specimen obtained by a fiber optic colonoscopy was diagnosed as proctitis. Antidiarrheals, 5-aminosalicylic acid and steroid enemas showed only limited therapeutic effects. An angiography revealed a mild degree of rectal artery dilatation and tiny venous angiogenesis detected on the delayed phase images. Because the inferior mesenteric vein had been ligated, collateral veins developed to drain the blood on the distal side of the anastomosis to bilateral internal iliac veins. The venous blood of the descending colon (oral side of anastomosis) drained to left colic vein. The cause of rectosigmoiditis was considered to be venous congestion due to the inferior mesenteric vein ligation. A rectosigmoidectomy with reanastomosis using a double-stapling technique was performed, and the patient was discharged without symptoms.

Aged↗
PubMed2004

[Benign form of idiopathic biliary ductopenia in an adult woman].

Idiopathic adult ductopenia is a rare disease characterized by chronic cholestasis related to an unexplained loss of the interlobular bile ducts. We report on a 43-year-old woman, whose clinical course of cholestatic disease was indolent and non-progressive, and laboratory abnormalities occurred intermittently. Histological examination of liver specimen showed absence of interlobular bile ducts, intensive proliferation of peripheral bile ductules and only minimal inflammatory portal response. Given the presence of microscopic non-specific chronic proctitis, hypothyroidism and antinuclear antibodies in serum we hypothesize that idiopathic adult ductopenia could be a variant of primary sclerosing cholangitis affecting exclusively small bile ducts.

Adult↗
PubMed2005

Accuracy and reliability of the endoscopic classification of chronic radiation-induced proctopathy using a novel grading method.

GOALS: To assess a novel grading method of radiation proctitis for intraobserver and interobserver agreement among endoscopists. BACKGROUND: There are no established criteria for the endoscopic classification of chronic radiation-induced proctopathy. We introduce a classification system based on telangiectasia density and vascular coalescence. Accuracy and reproducibility of this system were examined. STUDY: A total of 131 endoscopic images of the rectum in 74 consecutive patients undergoing lower endoscopy who had received pelvic radiation therapy were analyzed. Each image was duplicated, reversed, and rotated 90 degrees for a total of 262 images. These were shown in random order to 13 endoscopist evaluators (6 attending physicians, 7 gastroenterology fellows) using an online computer testing program. Each image was scored from grade 0 to 3 using criteria from the rectal telangiectasia density (RTD) classification we developed. Kappa (kappa) statistics and percent agreement were used to quantify the reproducibility and level of agreement. RESULTS: Intraobserver agreement: The mean (SD) for kappa among the 13 raters was 0.58 (0.09); 95% confidence interval [CI] = 0.527-0.636. Interobserver agreement: The estimated kappa across all 13 raters was 0.518 (95% CI = 0.506-0.530). For the 7 trainees, kappa was 0.547 (95% CI = 0.523-0.571). For the 6 attending physicians, the kappa was 0.481 (95% CI = 0.453-0.509). As another indicator of agreement, all 13 evaluators agreed on 30 (22.9%) of images, differed by no more than 1 grade on 60 (45.8%) images, no more than 2 grades on 33 (25.2%) of images, and no more than 3 grades on 8 of the images (6.1%); 73% of patients referred for bleeding control were RTD grade 2 or 3. CONCLUSIONS: The RTD grading scale for radiation proctopathy is reproducible among endoscopists. Hematochezia is associated with high RTD grade.

Chronic Disease↗
PubMed2005

[Drug therapy for ulcerative colitis: salazosulfapyridine and 5-ASA].

Aminosalicylates have a wide range of anti-inflammatory and immunomodulatory effects. Oral salazosulfapyridine (SASP) and 5-aminosalicylic acid (5-ASA) are the 'first-line' therapy for induction of remission in mild to moderate active ulcerative colitis (UC). SASP, which is consisted of 5-ASA and sulfapyridine, has greater incidence of side effects. 5-ASA is a therapeutically active compound, while sulfapyridine is related to adverse effects. For this reason, 5-ASA formulas exclusive of sulfapyridine were developed and they enabled higher dose of 5-ASA administration without adverse effects. Topical treatment by 5-ASA enema or SASP suppository should be considered for the treatment of proctitis or distal type of UC. Oral aminosalicylate therapy is also effective for the maintenance of remission in UC. Therefore, aminosalicylates are key drugs for the treatment of UC.

Administration, Oral↗
PubMed2005

Clinical presentation of inflammatory bowel disease: a hospital based retrospective study of 379 patients in eastern China.

BACKGROUND: Numerous studies from Europe and North America have provided a wealth of information regarding the epidemiological and clinical characteristics of inflammatory bowel disease (IBD) in Caucasians. Previous studies in mainland China have been limited by small patient numbers or by lack of detailed information about clinical subgroups of the disease. This study was carried out to assess the demographic and clinical characteristics of IBD in Chinese patients. METHODS: In the Sir Run Run Shaw Hospital between 1994 and 2003, 379 patients were diagnosed as IBD. Demographic and clinical data were collected and analysed. RESULTS: Of 379 patients, 317 had ulcerative colitis (UC) (83.6%, 168 male, 149 female, male-female ratio 1.13:1, age range at diagnosis 14-79 years, mean age 44 years) and 62 had Crohn's disease (CD) (16.4%, 39 male and 23 female, male-female ratio 1.70:1, age range at diagnosis 13-70 years, mean age 33 years). In UC, 11.4% of patients had proctitis, 25.2% had proctosigmoiditis, 18.6% were diseased to the splenic flexure and 44.8% had extensive colitis. Nine patients with UC (2.8%) had arthritis, three patients (0.9%) had iritis or conjunctivitis. Of the 62 CD patients, 16 (25.8%) had diseases restricted to the terminal ileum; 15 (24.2%) had colonic diseases; 20 (32.3%) had ileocolonic disease and 11 (17.7%) had disease involving the upper gastrointestinal tract. CONCLUSIONS: This study shows similar characteristics of IBD to that in the West but there are some differences with respect to severity and extraintestinal manifestations. The ethnic and geographic differences may give important clues to the aetiology of IBD.

Adolescent↗
PubMed2005

[Combination of external beam radiotherapy and 252Cf neutron intracavitary brachytherapy for cervical cancer].

OBJECTIVE: To evaluate the curative effect of 252Cf brachytherapy on advanced cervical cancers. METHODS: A total of 77 cervical cancer patients were staged into IIa-IVa according to the standard of International Federation of Gynecology and Obstetrics (FIGO), including 13 cases of stage IIa, 32 of stage IIb, 18 of stage IIIa, 10 of stage IIIb, and 4 of stage IVa. 252Cf brachytherapy was delivered at 8-11 Gy/fraction per week, the total dose of reference point A was 36-45 Gy in 4-5 fractions. The whole pelvic cavity was irradiated with 6 MV X-ray, 200 cGy/fraction, 4 times per week. The total dose of external beam radiotherapy was 45-50 Gy (the center of whole pelvic field was blocked by 4 cm in width after 20-36 Gy), the total treatment course was 5-6 weeks. The 3-year survival rate and late complication rate in bladder and rectum were evaluated. RESULTS: The local control rate of all patients after 3-year was 94% (72/77); the overall survival rate was 82% (63/77). In particular, the 3-year survival rate was 85% (11/13) for stage IIa, 94% (30/32) for stage IIb, 78% (14/18) for stage IIIa, 70% (7/10) for stage IIIb, 25% for stage IVa cancers. The late complication rate was 3% for cystitis, 5% for proctitis. CONCLUSIONS: Combination of 252Cf brachytherapy and external beam radiotherapy can be well-tolerated by cervical cancer patients. The 3-year survival rate for stage II and III patients is high and late complication rate in bladder and rectum is low.

Adult↗
PubMed2005

Hyperbaric oxygen and malignancies: a potential role in radiotherapy, chemotherapy, tumor surgery and phototherapy.

Over the past 40 years, hyperbaric oxygen (HBO2) therapy has been recommended and used in a wide variety of medical conditions. In the 1950s, HBO2 was first used as a treatment, in addition to radiation, for head and neck cancers and cervical cancer. Many studies have been conducted to investigate possible therapeutic effects HBO2 as part of cancer management. Evidences showed that HBO2 improved tumor oxygenation, and treatment with HBO2 during irradiation has been shown to improve the radiation response of many solid tumors. It was used for delayed radiation injuries for soft tissue and bony injuries, for symptomatic radiation reactions of the urinary bladder and the bowel, for laryngeal radionecrosis, for radiation-induced optic neuropathy, for radiation-induced proctitis and for radiation-induced necrosis of the brain. HBO2 also increases sensitivity to chemotherapy. A significant improvement in tumor response was obtained when photodynamic therapy (PDT) was delivered during hyperoxygenation. These studies were extensively reviewed and rational scientific basis for further investigations was discussed. The possibility of combining HBO2, PDT and photosensitizers to overcome primary and secondary carcinoma deserve extensive laboratory and clinical research works. HBO2 is a relatively benign with few contraindications, even for active cancer patients.

Anemia↗