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PubMed1983

Leucocyte adherence inhibition and carcinoembryonic antigen in combination for diagnosis of colorectal cancer.

A combination of leucocyte adherence (LAI) and carcinoembryonic antigen (CEA) diagnosed colorectal carcinoma with 91% sensitivity and 68% specificity. Relative operating characteristic (ROC) analysis was used to calculate the cutoff points for optimum detectability in a group of 159 patients with bowel symptoms who were investigated by endoscopy and radiology. Combining LAI and CEA would be likely to reduce the chance of missed diagnosis of colorectal carcinoma when x-ray and colonoscopic findings are equivocal.

Adenoma↗
PubMed1983

Sulindac for polyposis of the colon.

Four members of a Gardner's syndrome family had rectal and colon polyposis treated with nonsteroid anti-inflammatory drugs. Three of these patients had had subtotal colectomy and ileoproctostomy and the residual polyps arose in the rectal mucosa. The polyps almost completely disappeared when sulindac was administered. Indomethacin therapy over the course of a preceding year was ineffective in one of these patients. One patient (case 4) had diffuse polyposis in an intact colon. After sulindac therapy for a year, only three small mucosal polyps could be identified by air contrast barium enema and colonoscopic examination. These observations confirm those of Pollard and Luckert [1,2] on rats with chemically induced polyposis of the intestinal tract.

Adolescent↗
PubMed1994

Effects of preoperative chemotherapy on DNA ploidy patterns, cell cycle, and histological findings in gastric and colonic cancer patients.

The effects of preoperative chemotherapy on gastric and colonic cancers have yet to be evaluated fully. In this study, its effects were assessed by studying DNA ploidy patterns, cell cycles, and histological findings in such patients. Thirty-nine patients with gastric or colonic cancer were given preoperative chemotherapy with UFT (an admixture of tegafur and uracil). Biopsy specimens for analysis were obtained before chemotherapy through a gastroscope or colonoscope and after chemotherapy from resected tumors. The DNA ploidy patterns and cell cycles were evaluated using a flow cytometer and the tissues were examined histologically. The DNA ploidy pattern was diploid (D) in 12 gastric and 13 colonic cancer patients and aneuploid (A) in 10 and 4 patients, respectively. After chemotherapy, the pattern changed in nine gastric (A-->D: 7, D-->A: 2) and six colonic cancer patients (A-->D: 3, D-->A: 3) and was unchanged in the remaining patients. Cell cyclic analysis showed decreased G1- and increased S-phase fractions in 10 of 12 patients with gastric and 6 of 10 patients with colonic cancer. Histologically, decreased tumor cellularity, increased fibrosis, and/or cytological changes were observed in both cancers after chemotherapy. Gastric and colonic cancers in which the DNA ploidy pattern changed from aneuploid to diploid, G1- decreased and S-phase increased, and/or histological changes were observed, were considered to have responded to preoperative UFT administration.

Adult↗
PubMedDate not supplied

Hereditary nonpolyposis colorectal cancer and colonic adenomas: aggressive adenomas?

Hereditary nonpolyposis colorectal cancer (HNPCC) results from an inherited defect in one of the genes responsible for repair of errors that occur during DNA replication. Affected individuals have high risk for cancers of the colon and certain extracolonic sites. It appears that HNPCC patients form adenomas at about the same rate s the general population and there is some circumstantial evidence that adenoma is the precursor to colorectal carcinoma in the syndrome. It is hypothesized that HNPCC features accelerated progression from colonic adenoma to carcinoma, a process theoretically driven by the inability to repair DNA mismatches. Evidence in support of the "Aggressive Adenoma" in HNPCC is provided. We discuss our recommendations for colonoscopic surveillance on an annual basis for HNPCC gene-positive individuals, and for genetic counseling.

Adenoma↗
PubMed2002

Management of large bowel obstruction in advanced ovarian cancer with intraluminal stents.

BACKGROUND: While most patients with advanced ovarian cancer can achieve prolonged remission with surgery and chemotherapy, eventually most will recur. Commonly bowel obstruction will complicate their recurrence, usually heralding the terminal phase of their disease. Standard management of bowel obstruction has involved surgical intervention after a period of conservative medical management. Unfortunately, many patients submitted for surgery do not derive benefit from such an approach, spending the majority of their remaining life in the hospital or recovering from the surgery. CASES: Two cases of patients with large bowel obstruction resulting from advanced and recurrent ovarian cancer are presented. In the first case, a rectal stent was decided upon as the appropriate management as she was failing first-line therapy, with little likelihood of recovering from a laparotomy. In the second case a large recurrent infected tumor mass had already been debulked, but was continuing to cause obstructive symptoms. In both cases immediate relief of their gastrointestinal symptoms was achieved. CONCLUSIONS: In patients with large bowel obstruction secondary to extrinsic compression, useful palliation can be achieved with a colonoscopically placed endoluminal stent.

Colonic Diseases↗
PubMed1996

Laparoscopic treatment of a sigmoid perforation after colonoscopy. Case report and review of literature.

The authors report a case of sigmoid colon perforation post colonoscopic polypectomy. Such perforation is rare and has been estimated to occur between 0.1 and 3% of the time. Surgical treatment is necessary when there is deterioration of the clinical state. In this reported case, surgical closure of the perforation was achieved by laparoscopy. We believe that this approach is effective for colonic suture, peritoneal lavage, and drainage.

Aged↗
PubMed1995

Insufflation. Complications and recommendations.

This article focuses on complications in colonoscopy related to colonic insufflation. Causes of colonic insufflation complications are examined and methods that may be used to minimize complications are proposed. Testing of state-of-the-art video colonoscope systems is the basis of this analysis of insufflation complications and the resulting recommendations.

Colonoscopy↗
PubMedDate not supplied

Hereditary generalized juvenile polyposis: association with arteriovenous malformations and risk of malignancy.

A young man with hereditary juvenile polyposis, a duodenal adenoma with carcinoma in situ, and multiple arteriovenous malformations of the lungs and liver is reported. Because of the risk of malignancy, it is suggested that patients with juvenile polyposis have endoscopic or radiographic surveillance of the upper gastrointestinal tract in addition to either prophylactic colectomy or regular colonoscopic surveillance with polypectomy. In view of the serious potential complications of associated pulmonary, cerebral, and hepatic arteriovenous malformations, screening of patients with juvenile polyposis with chest radiography, magnetic resonance imaging of the brain, and sonography of the liver may be warranted.

Adenoma↗
PubMed1995

Accuracy of colonoscopy in localisation of colorectal cancer.

An audit was performed of 77 patients with a single colorectal cancer visualised and sited before surgery by colonoscopic examination. The site of the cancer described at colonoscopy was compared with the actual site found at laparotomy. Six significant errors in preoperative localisation were encountered, when a change from the preoperatively planned resection to an alternative resection was found necessary. In two of these cases, extra morbidity was encountered as a result of these siting errors. Inaccurate localisation is a potential hazard of colonoscopy, especially when the examination is incomplete.

Colonoscopy↗
PubMed1991

A simple method of infundibular retraction during laparoscopic cholecystectomy.

Laparoscopic excision of the gallbladder has rapidly become a preferable technique for treating patients with symptomatic cholelithiasis. To date, new developments in instrumentation have hardly been able to keep pace with the rising popularity of this method. The use of techniques applied to other areas of endoscopy may be useful when adapted to laparoscopic surgery. We discuss herein the use of a standard colonoscopic polypectomy snare for retraction of the gallbladder during laparoscopic cholecystectomy. This adaptation facilitates the procedure and avoids the need for an additional trocar puncture.

Cholecystectomy↗
PubMed1992

Observations on the characteristics of stimulated defaecation in severe idiopathic constipation.

A combined manometric and radioisotope study is described which was designed to investigate the motility characteristics of induced defaecation in the colon, rectum and anal canal, in patients with severe constipation. Five women with severe idiopathic constipation, aged 30-45 years, were studied. A multiple channel water-perfused manometric tube was placed colonoscopically into either the whole colon or left colon to monitor pressure activity. In two whole-colon studies, 5.5 MBq 111In DTPA and later 9 MBq 99mTc DTPA were instilled into the colon to monitor the transit of colonic contents in response to two separate stimuli. Motor activity was initiated on both occasions by intraluminal instillation of 5.5 mg bisacodyl. In the whole-colonic studies a right colonic stimulus initiated multiple high-pressure peristaltic waves which traversed the entire length of the colon. The bowel was then refractory to a second stimulus at the splenic flexure. In the five left colonic studies, a stimulus at the splenic flexure produced high-pressure peristaltic waves which proceeded distally, and which included a rise in rectal pressure. The anal canal relaxed simultaneously with the onset of peristalsis high in the left colon, and remained relaxed until the pressure wave reached the anus and bowel content had been expelled. In both types of study high-pressure waves corresponded to the effective transport of radioisotope. The constipated patients showed a coordinated motor response to the stimulus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A peroperative comparison of Western and Oriental colonic anatomy and mesenteric attachments.

It has been suggested that the Oriental colon is easier to colonoscope than its Western counterpart. The aim of this study was to investigate possible differences in colonic anatomy between Western and Oriental patients that might explain this observation. Measurements of colonic length and mesenteric attachments were taken according to a set protocol from 115 Western (Caucasian) and 114 Oriental patients at laparotomy. Sigmoid adhesions were found more frequently in Western (17%) compared to Oriental (8%) patients, P = 0.047. A descending mesocolon of > or = 10 cm occurred in 10 (8%) Western patients but only 1 (0.9%) Oriental patient, P = 0.01. The splenic flexure was more frequently mobile in Western patients (20%) compared to Oriental (9%) patients, P = 0.016. In 29% - of Western patients the mid-transverse colon reached the symphysis pubis, or lower when pulled downwards in contrast to 10% of Oriental patients, P < 0.001. There was no significant difference in total colonic length comparing Western (median = 114 cm, range 68-159 cm) to Oriental (median = 111 cm, range 78-161 cm) patients. Western patients have a higher incidence of sigmoid colon adhesions and increased colonic mobility when compared to Orientals. These findings support the observation that colonoscopy is a more difficult procedure in Western patients.

Adult↗
PubMed1994

Laparoendoscopy (laparoscopy assisted enteroscopy) and partial resection of small bowel.

We investigated laparoendoscopy (laparoscopy-assisted small bowel enteroscopy) as an aid in managing the challenging diagnostic problem of occult small bowel hemorrhage. We performed laparoendoscopy on five nonconditioned dogs and five conditioned dogs. In each case, we laparoscopically inspected the small bowel from the ligament of Treitz to the ileocecal valve. Small bowel was exteriorized, an enterotomy was performed, and an Olympus CL-100L colonoscope was inserted and advanced proximally to the stomach and distally to the ileocecal valve. A segment of small bowel was arbitrarily designated as the site of bleeding, was exteriorized, and was resected. Bowel continuity was restored with a stapled anastomosis. The animals were euthanized and autopsied immediately after the procedure (n = 5) or a week following the procedure (n = 5), at which time the anastomoses were tested for leakage and patency. The entire small bowel was visualized in all animals. There were no anastomotic leaks. Laparoendoscopy may be of value in identifying and treating hemorrhagic origin of small bowel. Clinical trials are warranted.

Anastomosis, Surgical↗
PubMed1987

The 'malignant colon polyp'. A critique and opinion.

There is some controversy about the indications for surgical resection above the distal rectum following colonoscopic removal of a polyp which proves to be malignant. Sessile, villous adenomas are generally considered to carry greater risk of spreading malignancy than pedunculated, tubular or villous adenomas. Resection is usually recommended in the presence of carcinomatous invasion beyond the muscularis mucosae and/or insufficient tumor-free margin of the stalk if the patient's condition permits.

Carcinoma in Situ↗
PubMed1993

Report of colon cancer detection in mass surveys using immunological occult blood test (Latex method).

Occult blood test for the screening of colon cancer has been made by immunological method using latex agglutination for 4 years since 1988. A total of 35,139 persons have received the screening test and out of 1886 persons, that is, 5.4% showed positive. Five hundred seventy of the positive result subjects (30.2%) underwent barium enema examination. Three hundred fifty nine subjects (62.8%) showed some abnormal findings. They underwent colonoscopic examination and 45 of them (7.9%) had colon cancer. Twenty six of these were of early stage type and 19 persons were of advanced stage.

Adenocarcinoma↗
PubMed1975

Evaluation of endoscopic examination of colon tumors in rats.

This study is an evaluation of the use of endoscopic examination to detect MNNG-induced large-bowel tumors in rats. The smallest human fiberbronchoscope was used as a colonoscope for the rats and the full length of the distal large bowel was visualized. The correct diagnosis rate in all rats with and without large-bowel tumors was 94%. Of rats with colon tumors, 85% were correctly diagnosed endoscopically. Even tumors 1 or 2 mm in diameter were detected. The examination was easy and reliable. This procedure may be an adjunct in experimental work with this and other animal models of colon cancer.

Animals↗
PubMed1977

Cancer in chronic ulcerative colitis. Diagnostic role of segmental colonic lavage.

Saline colonic lavage in 74 patients with chronic ulcerative colitis was performed utilizing a commercially available dental irrigating unit through a polyethylene catheter in the biopsy channel of a colonoscope or through a sigmoidoscope via a lavage-aspirating double-lumen probe. Six patients were found with colonic carcinoma. Two diagnoses of malignancy were established by cytologic smears and cell block alone. Two patients had positive mucosal biopsies and cell block. One patient with a hepatic flexure carcinoma and a second patient with a malignancy proximal to the left colon stricture were missed by these techniques. Considering the established proclivity for carcinoma in these patients, it is felt that segmental lavage in areas of stricutre, grossly dostorted mucosa, or endoscopically inaccessible areas represents a valuable adjunct in the diagnosis of carcinoma in chronic ulcerative colitis.

Adenocarcinoma↗
PubMed1977

Idiopathic proctitis. I. The morphology of proximal colonic mucosa and its clinical significance.

A group of 31 patients with idiopathic proctitis were colonoscoped while they were symptomatic. Multiple mucosal biopsies were taken from the transverse, descending, and sigmoid colon and from the rectum. While visualization by colonoscopy revealed abnormalities limited to the most distal 18-20 cm of the colon, microscopic abnormalities were frequently seen in more proximal locations. Analysis of clinicopathological data indicates that there is good correlation between the extent of microscopic mucosal abnormalities and the clinical course. Patients with abnormalities limited to the rectum generally responded well to conventional treatment while patients with more proximal involvement were refractory to such therapy.

Adult↗