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PubMed2003

Various techniques of contouring the rectum and their impact on rectal dose-volume histograms.

Late rectal bleeding resulting from radiotherapy has been correlated with rectal dose-volume histograms (DVHs). The techniques of contouring the rectum have been inconsistent within the literature, making interpretations of DVHs difficult. This study was conducted to investigate the impact on rectal DVHs when using different ways of contouring. Ten prostate cancer patients were treated with a 4-field box-technique and received 70 Gy. Six different ways of contouring the rectum were implemented by using 3 different cross-sections and 2 different lengths. The 3 different cross sections were (1) anterior rectal wall (arw): only the anterior half of the rectal wall was contoured; (2) whole rectal wall (wrw): the entire rectal wall was contoured but excluding the rectal contents; and (3) the rectum (rec): including the rectal contents. Two different lengths were used for the above 3 volumes: (1) long (Lg): cranial border starting at where the rectum turned horizontally into the sigmoid and the caudal border 2 cm below the prostatic apex; (2) short (Sh): from 2 cm above to 2 cm below the prostate. Therefore, a total of 6 different volumes (Sh arw, Lg arw, Sh wrw, Lg wrw, Sh rec, and Lg rec) were generated. DVHs of all 6 volumes were compared with the y-axis being percentage volume as well as absolute volume (cc). When using percentage volume as the y-axis, Sh arw gave an impression that a large portion of rectum (median of 41.8%) received high dose (greater than 90% prescribed dose), while the Lg wrw and Lg rec revealed a smaller portion of rectum (median of 17.1% and 14.7%, respectively) received high dose. The other contours were somewhere in-between. When using absolute volume as the y-axis, the DVHs of the 4 rectal volumes, excluding the rectal content (Sh and Lg arw, Sh and Lg wrw), merged at doses greater than 80% to 85% prescription, therefore providing similar information within these high-dose regions. Configurations of rectal DVHs varied drastically with different techniques of contouring and may lead to different interpretations. By using absolute volume (cc) as the y-axis, the shape of the 4 rectal DVHs, excluding the rectal content, were similar in the high-dose region. Reporting rectal toxicities in relations to DVHs using absolute volume, as well as percentage volume, may eliminate inconsistencies secondary to different methods of contouring.

Humans↗
PubMed1987

Nerve pathways involved in adrenergic regulation of electrical and mechanical activities in the chicken rectum.

Peripheral nerve pathways responsible for adrenergic inhibition of mechanical and electrical activities in the chicken rectum and receptors mediating the adrenergic inhibition were investigated in isolated extrinsically-innervated rectum of the chicken. Electrical stimulation of the anal end (Ra) or the ileal cut end (Ri) of Remak's nerve, or perivascular nerves (P) elicited relaxation of the rectum pretreated with atropine (0.5 microM) and hexamethonium (0.3 mM) to block the cholinergic and non-cholinergic, non-adrenergic excitatory innervations. Ri stimulation was much less effective than Ra and P stimulations. The relaxation was shown to be related to cessation of spontaneous spike discharge of the longitudinal muscle which was accompanied by membrane hyperpolarization. The inhibitory effects elicited by Ra and P stimulations, which were prolonged beyond the period of the stimulation, were converted to transient ones by propranolol (3.4 microM). Phentolamine (2.6 microM) reduced effectively the residual effects. In contrast, the effects of Ri stimulation were little affected by these drugs. The present results provide evidence for the existence of two nerve pathways responsible for direct adrenergic inhibitory innervation to the chicken rectum, one running orally in Remak's nerve trunk, leaving it and descending in the branches to the rectum, and the other running as the perivascular nerves along the arterial supplies of the rectum. The direct innervation is mediated predominantly by beta-adrenoceptors.

Animals↗
PubMed1983

Neural vasodilator control in the rectum of the cat and its possible mediation by vasoactive intestinal polypeptide.

Vascular and motor responses in the rectum to pelvic nerve stimulation are described in the anaesthetized cat and compared with corresponding effects observed in the colon. The responses comprise a cholinergic and a non-cholinergic component, and an attempt has been made to elucidate the latter. Pelvic nerve stimulation evoked a pronounced and well maintained vasodilator response in the rectum whereas that in the colon was transient. Maximal vasodilatation occurred at much lower stimulus frequencies in the rectum (2-4 Hz) than it did in the colon (8-16 Hz) and maximal blood flow under these conditions was also greater in the rectum (greater than 200 ml 100 g-1 min-1) than the colon (less than 150 ml 100 g-1 min-1). Muscarinic blockade further curtailed the colonic vasodilator response to pelvic nerve stimulation, whereas the rectal dilatation was only slightly reduced in the presence of atropine. Pelvic nerve stimulation caused a substantial release of vasoactive intestinal polypeptide (VIP) from the rectum, which was related both in magnitude and duration to the vasodilatation. Intra-arterial infusions of VIP, which reproduced this rise in rectal venous VIP concentration, caused a rectal vasodilator response which closely resembled that during pelvic nerve stimulation after cholinergic blockade. The rectal vasculature was estimated to be 50-100 times more sensitive to VIP than the colonic vasculature. VIP therefore seems to be the most likely putative neurotransmitter responsible for non-cholinergic rectal vasodilatation. Stimulation of the pelvic nerves also caused rapid contractile motor responses before, and more gradual motor responses after, muscarinic blockade in both the colon and rectum, in the latter preceded by a non-cholinergic relaxation. These patterns of motor activity largely confirm previous results. Infusions of substance P effectively mimicked the non-cholinergic contractile motor responses but failed to demonstrate significant release of this peptide during pelvic nerve stimulation in the present experiments. However, substance P is rapidly inactivated and might possibly be involved in these responses. Stimulation of the pelvic nerves in bursts at high frequencies (up to 80 Hz), simulating a discharge pattern observed electrophysiologically in vivo, was effective in eliciting all the above responses, with the exception of the colonic contraction.

Animals↗
PubMed2003

Comparative analyses of the dynamic properties of the rectum studied by cryo-sections of human cadavers and pelvic CT scans of patients.

Optimization of radiotherapy treatment plans based on dose-volume histograms relies on accurate organ delineation. Hollow organs, such as the rectum, are difficult and time-consuming to delineate owing to unclear visualization of the border between wall tissue and filling. Automated hollow organ delineation would be a valuable tool, but its development depends upon improved understanding of the dynamics of the rectum in response to filling. Two reasonable assumptions proposed in the literature are that (1) the rectal wall tissue along a constant length of the rectal cylinder is preserved over time and (2) the rectal wall tissue is distributed homogeneously along the cylinder. Therefore, variations in wall thickness can be explained by variable rectal filling. To investigate these assumptions, transversal cross-sectional areas enclosed by the outer contour (A(out)) and inner contour (A(in)) of the rectum were recorded from digital photographs of cadaver cryo-sections from the U.S. National Library of Medicine's Visible Human Project. In addition, A(out) and A(in) were recorded from 19 CT scans of 5 of our own patients. The transversal cross-sectional area of the wall of the rectum, A(wall)=A(out)-A(in), was calculated. The data derived both from cryo-sections and repetitive CT scans of patients, revealed that there was a significant correlation between A(wall) and A(out), in contradiction to assumption (1) stated above (male cryo-sections: p<0.001, female cryo-sections: p=0.03, repetitive CT scans p<0.001). Moreover, the mean A(wall) calculated from one CT scan differed significantly from the mean A(wall) from other CT scans and was correlated with the mean A(out), i.e. rectal filling (p<0.001). This finding was confirmed by careful analysis of another study (p=0.001) and opposes assumption (2). Hence, the amount of wall tissue within a constant length of rectum is not preserved over time, but increases with increased filling. This implies that the longitudinal length of the rectum decreases in response to distension of the organ.

Cadaver↗
PubMed1998

[Phantom rectum after Miles' operation].

The authors observed symptoms relating to the existence of a phantom rectum, a phenomenon about which little is still known, in 233 cases (32.1%) in a series of 724 patients undergoing amputation of the abdomino perineal rectum due to malignant neoplasm. The genesis of this phenomenon is attributed to an abnormal reactivity of the cortical and thalamic projection areas with greater response to stimuli from the stump or aspecific visceral stimuli, or even stimuli from the adjacent cortical regions. The psychodynamic aspects linked to the patient's need to develop a different body awareness should not be underestimated; this has to integrate a new anatomic reality, such as colostomy in the place of the anorectum, entailing the relinquishment of the previous body scheme. Prevention and treatment of phantom rectum, which is painful in 27% of cases, is essential for a correct operating technique, adequate psychotherapeutic support, the patient's active participation in a reeducation programme for colostomy management. It should not be forgotten that painful phantom rectum, especially with late onset, may be diagnostically significant as an indicator of the recurrence of neoplastic pathology, sometimes allowing diagnosis to be anticipated by several months. This underlines the importance of carrying out a careful postoperative clinical, biohumoral and radiological control in these patients, including pelvic CT. In the authors' experience of 233 patients suffering from phantom rectum, it was possible to document the presence of neoplastic recidivation in 30 cases (12.8%) using pelvic CT. In these cases, symptoms appeared after a disease-free interval of 26.3 months (range 3-75 months), whereas the presence of phantom rectum without recidivation is usually described in the first 2 months after surgery.

Abdomen↗
PubMedDate not supplied

[Extensive lymphadenectomy in the therapy of cancer of the left colon and rectum: an analysis of the anatomicopathological data].

In the last 12 years in our surgical service, radical resection was performed in 142 patients with cancer of left colon and in 145 patients with rectal cancer. Extended lymphadenectomy was always realized: preaortocaval lymphadenectomy in colonic cancer; preartocaval and pelvic lymphadenectomy in rectal cancer. The incidence of C stage was 40.14% in cancer of left colon and 40.68% in rectal cancer. Neoplastic diffusion in preaortocaval lymph nodes was only in a patient with colonic cancer, never in patients with rectal cancer. The incidence of neoplastic diffusion in pelvic nodes was 3.12% (0 in superior rectum; 6.25% in medium rectum; 2.4% in inferior rectum). In 1 of 90 patients with tumour of medium or inferior rectum, we relieved tumoural involvement of pelvic nodes without neoplastic diffusion in regional nodes. These anatomo-pathological data subline: a) the low incidence of neoplastic diffusion in preaortocaval nodes in cancer of left colon and rectum; b) the importance of pelvic lymphadenectomy in cancer of medium and inferior rectum.

Adult↗
PubMed1989

Non-cholinergic neural excitation of the human rectum induced by acetorphan, an inhibitor of enkephalinase.

We have studied the effects of acetorphan, an inhibitor of enkephalinase, on the electrical activity of human rectum. Acetorphan activated the rectum of healthy volunteers by inducing bursts of spike potentials, this activation might become cyclical. In contrast, this drug failed to modify the motility of the aganglionic portion of the rectum in one case of Hirschsprung's disease, indicating that the effect of acetorphan involves the intramural plexuses. Activation of the rectum persisted in spite of the blockade of the cholinergic excitatory pathways by atropine, which confirms the existence of an excitatory non-cholinergic mechanism for the rectum. Our results also suggest that the neurotransmitter responsible for this effect is continuously released by the nervous structures implicated in the control of rectal motility. Immunohistochemical data show that the rectum is supplied by a rich enkephalinergic innervation.

Adult↗
PubMed1987

Transsacral approach to the rectum.

While the proximal or upper third of the rectum is readily accessible through the lower abdomen, lesions of the distal rectum are difficult to reach both from abdomen and the perineum. The transsacral approach (Kraske) gives excellent exposure of the mid and lower rectum. The experience using this approach in sixteen cases for various indications which include local excision of benign tumours, segmental excision, repair of recto-vesical fistula, perineal excision of rectum and abdominal excision of rectal carcinoma and low colo-rectal anastomosis with preservation of ano rectal sphincters is reported. In some cases where wider exposure of the rectum is required, this was easily achieved by excising the last three pieces of sacrum and/or extending below by dividing the external sphincter. While incontinence is not a long term problem, attention to technical details and creation of a temporary colostomy are necessary for all cases of excision and end-to-end anastomosis to prevent leakage and septic complications. Temporary colostomy is not required for excision of part of the circumference of the rectum as in the treatment of most benign lesions.

Adult↗
PubMed1979

Ultrastructure of the rectum of infective-stage Wuchereria bancrofti (Nematoda: Filarioidea).

The authors have examined the ultrastructure of the rectum of infective-stage Wuchereria bancrofti by transmission electron microscopy. Our observations show that the rectum is divided into anterior and posterior segments. The cells of the anterior rectum appear to be derived from the microfilarial R (rectal) cells described by other authors. In both stages, these cells show voluminous nuclei, abundant mitochondria, and small cytoplasmic processes which contain fibrillar components. Amorphous material associated with these processes appears throughout the larval rectum and may protrude from the anus as the rectal plug. In the specimens examined, a patent lumen could not be traced completely through the anterior rectum. The posterior rectum has no counterpart in published accounts of microfilarial ultrastructure and probably arises during larval morphogenesis; it is lined with invaginated body cuticle, overlaid by a single layer of epithelial cells which may be of hypodermal origin.

Animals↗
PubMed2000

Cancer of the colon and rectum in California: trends in incidence by race/ethnicity, stage, and subsite.

BACKGROUND: Incidence and mortality from cancer of the colon and rectum have declined in recent years in the United States and California, but reasons for the decline are unknown. METHODS: Age-adjusted site-specific and stage-specific incidence rates were calculated for approximately 9,000 cases of in situ cancer and 120,000 cases of invasive cancer of the colon and rectum diagnosed between 1988 and 1996 among California residents and reported to the California Cancer Registry. Trends in incidence over time were measured using the estimated annual percent change. RESULTS: Among non-Hispanic whites there was a decline in all sites and stages, but the decrease was most pronounced for rates of in situ and regional/distant tumors in the rectum and sigmoid which declined by about 4 to 7% a year. For tumors in the proximal colon, the decrease was statistically significant only for regional/distant tumors which declined about 2% a year. Among blacks, there was an approximately 7% annual decline in the incidence of regional/distant tumors of the rectum in women and a nearly 3% a year decrease in regional/distant tumors of the proximal colon in men. The decline in rates for Hispanics and Asian/Pacific Islanders was smaller and less consistent than for non-Hispanic whites. CONCLUSIONS: The results confirm a overall decline in all stages of cancer of the colon and rectum in California, particularly among non-Hispanic white men and women. The decrease was most pronounced for tumors in the rectum and sigmoid colon and may be attributable to screening.

California↗
PubMed1986

Malignant lymphoma of the rectum.

Malignant lymphoma involving the rectum is rare. Of 61 patients with malignant lymphoma involving the rectum seen at the Mayo Clinic between 1950 and 1977, 49 had extensive lymphoma with secondary involvement of the rectum, and 12 had lymphoma confined to the rectum. Patients with widespread lymphoma were treated with radiation, chemotherapy, or both. Of the 12 patients with lymphoma confined to the rectum, five had surgical excision and seven were treated nonoperatively; the overall five-year survival was 20 percent. Patients with widespread lymphoma had a five-year survival of 15 percent. Patients with lymphoma confined to the rectum had a five-year survival of 50 percent, and patients who had surgical excision did better than those treated nonoperatively.

Adolescent↗
PubMed2005

Giant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM).

BACKGROUND: Large sessile adenomas of the rectum, with a diameter greater than 5 cm, have a high risk to undergo malignant transformation. Transanal endoscopic microsurgery (TEM) offers an alternative operation method to low-anterior rectum resection in this potentially benign tumor situation. PATIENTS: We retrospectively investigated patients with giant adenomas of the rectum (>5 cm) who were treated by TEM over the last 10 years. A total of 33 patients met the criteria and were analyzed for postoperative complications, histology, and incidence of occult adenocarcinoma; residual tumor status; and tumor recurrence. RESULTS: Partial suture-line insufficiency (n=5, 15%) was the major postoperative complication, but could be managed conservatively in four cases. The residual adenoma status was 18% (n=6), especially in patients with tumors sizes more than 30 cm2. In case of adenoma recurrence (n=4, 12%), a conventional transanal excision (Parks) was applicable, as these tumors were mostly located within the suture-line region of the lower rectum. Incidentally, five carcinomas were found in the specimens. In case of advanced tumors (1xpT2, 1xpT3), anterior rectum resection was carried out, whereas for the early tumors (2xpT1 low risk, 1x1 pTis), no further therapy was added. All patients (adenomas and carcinomas, n=33) were without recurrence during follow-up. CONCLUSION: TEM is an alternative method for the resection of large benign rectal tumors located in the mid- and upper third of the rectum. The main postoperative complication is suture-line insufficiency, which generally heals by conservative treatment.

Adenoma↗
PubMed2004

Long-term survival after local excision for T1 carcinoma of the rectum.

PURPOSE: Many authors have reported high rates of local recurrence after local excision for early carcinoma of the rectum, which raises the question of whether oncologic resection gives better results. This study was designed to compare the long-term recurrence rate, long-term survival, and risk factors for T1 adenocarcinoma of the rectum treated with local excision or oncologic resection. METHODS: We identified 144 patients who had T1 sessile adenocarcinoma in the lower third or middle third of the rectum. Patients who received adjuvant therapy or who had pedunculated lesions were excluded. Data included age, gender, size of lesion, histologic type of carcinoma, grade, presence of lymphovascular invasion, and depth of invasion. Outcomes were defined as five-year and ten-year cumulative probabilities of local recurrence, distant metastasis, overall survival, and cancer-free survival. The mean follow-up was 9.2 years; median follow-up was 8.1 years. RESULTS: We compared 70 patients who underwent local excision with 74 patients who underwent oncologic resection. Among patients with lesions in the middle or lower third of the rectum, 1) the five-year and ten-year outcomes were significantly better for overall survival and cancer-free survival in the oncologic resection group, but there were no significant differences in local recurrence or distant metastasis; 2) the multivariate risk factors for long-term, cancer-free survival were invasion into the lower third of the submucosa, local excision, and older than aged 68 years; and 3) for lesions with invasion into the lower third of the submucosa, the oncologic resection group had lower rates of distant metastasis and better survival. Among patients with lesions in the lower third of the rectum, 1) the five-year and ten-year outcomes showed no significant differences in survival, local recurrence, or distant metastasis between the two groups; and 2) for lesions with invasion into the lower third of the submucosa, the oncologic resection group showed a trend of improved survival, which was not statistically significant, possibly because of low statistical power from the small sample size. CONCLUSIONS: Patients who undergo local excision or oncologic resection for T1 carcinoma in the lower two-thirds of the rectum have a high incidence of local recurrence and distant metastasis. To improve the cure rate, the rate of recurrence must decrease. A randomized, controlled study is needed to determine whether adjuvant therapy may be beneficial.

Adenocarcinoma↗
PubMed2004

Impact of volume and location of irradiated rectum wall on rectal blood loss after radiotherapy of prostate cancer.

PURPOSE: To identify dose-volume parameters related to late rectal bleeding after radiotherapy for prostate cancer. MATERIALS AND METHODS: Clinical complication data from a randomized trial were collected and linked to the individual dose-volume data. In this trial, patients with prostate cancer were treated with either conventional (with rectangular fields) or three-dimensional conformal radiotherapy to a dose of 66 Gy. Patient complaints, including rectal blood loss, were collected for 199 patients, using questionnaires. Absolute and relative dose-volume histograms (DVHs) of the rectal wall (with and without the anal region) were calculated with and without rectal filling. A proportional hazard regression (PHR) model was applied to estimate the probability of any rectal blood loss within 3 years, as a function of several DVH parameters. In a multivariable analysis, dose-volume parameters were tested together with patient- and treatment-related parameters (age, smoking, diabetes, cardiovascular disease, tumor stage, neo-adjuvant androgen deprivation, conformal vs. conventional and rectal bleeding during treatment). RESULTS: The estimated incidence of any and moderate/severe rectal bleeding at 3 years was 33% and 8%, respectively. Differences between the conventional and conformal technique were small and not significant. The analysis of relative DVHs of the rectal wall (with and without the anal region), showed significant (p < 0.01) relations between the irradiated volume and the probability of rectal blood loss within 3 years for dose levels between 25 Gy and 60 Gy. This relationship was shown in subgroups defined by dose-volume cutoff points as well as in the PHR model, in which a continuously rising risk was seen with increasing volumes. For absolute DVHs and DVHs of the rectum including filling, less or no significant results were observed. The most significant volume-effect relation (p = 0.002) was found at 60 Gy for the rectum wall excluding the anal region. The probability of rectal bleeding increased from 10% to 63% when the irradiated rectum volume at 60 Gy increased from 25% to 100%. Other factors. including age, smoking, diabetes, cardiovascular disease, tumor stage, neo-adjuvant androgen deprivation, conformal vs. conventional, rectal bleeding during treatment, rectum length. and whole rectum volume. did not have a significant effect in the multivariable analysis. When controlling for the volumes at 60 Gy, the volumes at lower dose levels (25-55 Gy) were no longer significant (p = 0.5). CONCLUSIONS: For any rectal bleeding within 3 years, an overall incidence of 33% was observed for patients treated to 66 Gy. For this endpoint, a volume-effect relation was found for DVH parameters of the relative rectal wall volume. This relationship appeared to be most significant for the rectum without the anal region and for the higher dose levels (50-60 Gy).

Aged↗
PubMed2001

Correlation of rectum-associated lymph nodules with the development of experimentally induced acute colonic inflammation in rats.

BACKGROUND AND AIMS: The mechanisms of inflammation in ulcerative colitis occurring initially in the rectum and then extending throughout the colon are still unknown. The aim of this study is to investigate the correlation of rectum-associated lymph nodules (RALN) and the development of a dextran sulfate sodium-induced experimentally acute colonic inflammation in rats. METHODS: We immunohistochemically analyzed the lymph nodules in the rectal region of rats using monoclonal antibodies to specific markers. RESULTS: Rectum-associated lymph nodules resembled the Peyer's patches, where CD4+, CD8+ lymphocytes and Mar 1+ macrophages were observed. After the administration of dextran-sulfate sodium (DSS), RALN showed hypertrophy with an increase in the number of CD4+, CD8+, and interleukin (IL)-2R+ lymphocytes in the periphery, as well as Mar 1+ macrophages in the entire region. Concurrently, platelet/endothelin cell adhesion molecule-1 (PECAM-1+) blood vessels, including high-endothelial venules (HEV), were increased in number in the interfollicular areas. Furthermore, a number of small lymph nodules varying in size were observed in the upper region of the rectum. Some of them were initially confined to the lamina propria mucosae, and became large enough to extend deeper into the tela submucosa. These DSS-induced lymph nodules contained large numbers of CD4+ lymphocytes, IL-2R+ lymphocytes, and Mar 1+ macrophages. CONCLUSIONS: The pathological changes of ulcerative colitis were well correlated with the development of both RALN and DSS-induced lymph nodules. The immunological reaction that occurred in DSS-induced lymph nodules is significantly associated with the expansion of colitis from the lower region of rectum to the upper region of rectum and colon.

Animals↗
PubMed2001

[A case of gastrointestinal stromal tumor of rectum, difficult to differentiate from leiomyosarcoma of prostate].

A 70 year-old male was seen at the hospital with the chief complaints of frequent miction and incomplete urinary retention. A hen's egg-sized firm mass was palpable in anterior wall of rectum by digital rectal examination. Intravenous urography showed severe bilateral hydronephroureter. Transrectal ultrasound, CT scan and MRI revealed a mass with 5 cm in diameter between prostate and rectum, and the margin of them were unclear. On needle biopsy of the tumor, leiomyosarcoma of the prostate was suspected. We performed radical cytectomy and created continent urinary reserver. Because the tumor and rectum could not be lysed, part of the rectum was resected. Histological examination showed gastrointestinal stromal tumor (GIST) of rectum. GIST of rectum is a rare entity, and in case of contact with the prostate, it is difficult to differentiate from leiomyosarcoma of prostate.

Aged↗
PubMed2001

[The significance of nuclear factor kappa Bp65 (NF kappa Bp65) expression on the vascular endothelial cells of rectum adenocarcinoma of human].

OBJECTIVE: This study inquired into the mechanism of cancer vascular metastasis. METHODS: The immunohistochemical method was adopted in determining the expression of intercellular adhesion molecule-1 (ICAM-1) and nuclear factor kappa B (NF kappa Bp65) on the peritumoral rectum tissues and metastatic lymph nodes of 8 patients and on the rectum tissues and lymph nodes of 5 normal human subjects. Also, the method of in situ hybridization was employed in detecting the binding site of NF kappa Bp65 on vascular endothelial cells. RESULTS: It was found that the proteins of ICAM-1 and NF kappa Bp65 were expressed on the vascular endothelial cells of the rectum adenocarcinoma patients, and there was a NF kappa B binding consensus sequences on ICAM-1 promoter in the vascular endothelial cells of the rectum adenocarcinoma patients. When DIG-AKP labeled 38-bp oligonucleotide probe was used, there was no expression of ICAM-1 and NF kappa Bp65 on the vascular endothelial cells of the normal human lymph node and rectum tissues. CONCLUSION: The above data suggest that the activation of ICAM-1 promoter may critically depend on NF kappa Bp65 homodimers or heterodimers binding to a variant kappa B site on the vascular endothelial cells of human rectum adenocarcinoma. These may indicate the potential roles of NF kappa B in cancer metastasis, thus giving clues to the development of a novel anti-metastasis strategy.

Adenocarcinoma↗
PubMed1992

The role of prophylactic subtotal colectomy in metachronous carcinoma of the colon and rectum.

The risk of metachronous carcinoma of the colon and rectum at 40 year follow-up evaluation is as high as 30 percent. Because of this risk, we reviewed a series of 767 patients treated surgically for carcinoma of the colon and rectum to define a possible prophylactic role for subtotal colectomy. Patients being treated for metachronous carcinoma of the colon and rectum represented 1.6 percent of all patients undergoing surgical treatment for carcinoma of the colon and rectum during this period. There was an early group (less than 2.5 years) and a late group (greater than eight years); with respect to time interval between lesions, the early group possibly representing missed synchronous lesions. Forty-six percent of the patients had associated adenomas. Evaluation of the colon with preoperative colonoscopy may eliminate the "early" metachronous lesions that are probably missed synchronous lesions. The presence of adenomas in a younger patient with a primary carcinoma of the colon and rectum represents a high risk of future carcinoma. Subtotal colectomy should be considered in these patients and may also improve the life-long follow-up evaluation required by allowing proctosigmoidoscopy alone to evaluate effectively the remaining colon and rectum.

Aged↗