[Morphogenesis of adenomatous polyps of the large intestine].
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By fibrocolonoscopy, fibrocolonoscopic biopsy, polypectomy, operation resp., one hundred and eight true polypi in the colon of 75 patients were studied, grouped according to localization: in caecum -- 2.8 per cent, in ascending colon -- II. I per cent, transverse colon -- 13.9 per cent, descending colon -- 19.4 per cent, in sigmoid colon -- 40.8 per cent and in rectum -- 12 per cent. Endoscopically they were grouped as follows: adenomatous -- 91.7 per cent and villous -- 8.3 per cent and after the pathohistological examination as: adenomatous 73.3 per cent, adenovillous -- 17.2 per cent and villous -- 9.5 per cent. In 40 (52.8%) of the cases, well differentiated polypi were concerned (I grade); in 30 (38%) -- moderately differentiated polypi (II grade) and in 5 (6.5%) -- poorly differentiated polypi (III grade). The studies revealed that the pathohistological examination was a method, specifying the morphological structure of polypus, determining the therapeutic behaviour of the clinicists. Fibrocolonoscopic polyrectomy solves the problem of diagnostics and treatment of the true polypi, contributing to the prophylaxis of colon carcinoma.
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Two hundred and twenty-two patients with Peutz-Jeghers syndrome were ascertained in Japan between 1961 and 1974 through two nationwide surveys, medical literature, and personal examinations. Genetic analysis was made of this group as well as 102 follow-up cases. The average age at diagnosis was 23 in males and 26 in females, with male to female ratio of 1:1.13. Presenting complaints of 170 patients included obstruction (42.8 per cent of patients), abdominal pain (23.4 per cent), rectal bleeding (13.5 per cent), extrusion of polyp (7.2 percent). Diagnosis of 52 patients was based on melanin pigmentation. Intussusception occurred in 46.9 per cent of the patients, most often in the small intestine. Polyps occurred in the stomach in 108 patients (48.6 per cent), small intestine, 142 patients (64 per cent), colon, 118 patients (53.2 per cent) and rectum, 71 patients (32 per cent). Among the 222 patients, cancer was histologically verified in 28. Fifteen early cancers occurred (3 gastric, 8 small intestine, 4 colon), and 11 advanced cancers (3 gastric, 1 small intestine, 6 colon, and 1 both colon and small intestine). Mortality was lower than in patients with familial polyposis coli but higher than in the general population. Conservative surgical management, planned medical follow-up, and the need for a national registration system are stressed.
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Polyps in the large intestine is a frequent disease in children. It is more often observed in boys than in girls aged 4 to 9. In most cases solitary polyps are observed (in 73,35%). Two-three polyps are met in 21,62% of cases. Polyposis is a rare disease--0,91%. The main symptom of polyps in children is hemorrhage from the anal orifice. The method of treatment is dependent on the amount, size, height of the situs and spread of the polyps. Dissection of polyps through the rectal speculum is used more frequently, rectoromanoscope is used in rarer cases (electroexcision and coagulation). Resection of the large intestine or colotomy and ablation of polyps can be successfully used in polyposis and high situs of polyps.