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PubMed2007

Quantitative evaluation of adhesion of lactobacilli isolated from human intestinal tissues to human colonic mucin using surface plasmon resonance (BIACORE assay).

AIMS: To isolate lactobacilli from the mucus layer of the human intestine and evaluate their adhesion abilities using a BIACORE assay. METHODS AND RESULTS: Thirty strains of lactobacilli were isolated from the mucus layer of normal human intestinal tissues using conventional plate culture. The strains were identified using homology comparisons of the 16S rDNA sequence to databases as Lactobacillus salivarius (26%), Lactobacillus fermentum (13%), Lactobacillus gasseri (10%), Lactobacillus paracasei (7%), Lactobacillus casei (3%), Lactobacillus mucosae (3%) and Lactobacillus plantarum (3%). Lactobacillus plantarum LA 318 shows the highest adhesion to human colonic mucin (HCM) using the BIACORE assay at 115.30 +/- 12.37 resonance unit (RU). The adhesion of cell wall surface proteins from strain LA 318 was significantly higher to HCM than to bovine serum albumin (BSA; P < 0.05). CONCLUSIONS: We isolated 30 strains of lactobacilli. Lactobacillus salivarius was the predominant species of lactobacilli isolated in this study. The adhesion of strain LA 318 isolated from human transverse colon to its mucin was shown. The adhesion could be mediated by lectin-like components on the bacterial cell surface. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study where lactobacilli were isolated from human intestinal tissues and shown to adhere to HCM.

Bacterial Adhesion↗
PubMed2002

Use of a variable-stiffness colonoscope allows completion of colonoscopy after failure with the standard adult colonoscope.

BACKGROUND AND STUDY AIMS: Experts fail to reach the cecum in 2 - 10% of colonoscopies. The purpose of this case series was to evaluate the efficacy of a small-caliber, variable-stiffness colonoscope in patients with incomplete colonoscopy. PATIENTS AND METHODS: The variable-stiffness colonoscope (Olympus America XPCF-140AL) was used by the same examiner to reattempt colonoscopy immediately in all patients in whom colonoscopy to the cecum with the standard colonoscope was incomplete. RESULTS: Sixteen of 385 attempted colonoscopies (4.2%) did not reach the cecum with the standard colonoscope due to looping (n = 12), fixed angulation of the sigmoid colon (n = 3), and diverticulosis (n = 1). The procedures were deemed a failure after a mean of 28 min, despite the use of abdominal pressure and positional change in all patients. Fifteen of the 16 patients (94 %) had a complete colonoscopy with the variable-stiffness colonoscope. One patient had an incomplete colonoscopy with the variable-stiffness colonoscope due to an obstructing mass in the transverse colon that was not reached by the standard colonoscope. With the variable-stiffness colonoscope, the mean time to cecal intubation was 10.3 min; four patients (25 %) required a change in patient position, and six patients (37.5 %) required abdominal pressure. CONCLUSIONS: A variable-stiffness colonoscope allowed completion of colonoscopy in all patients without obstruction who had an incomplete colonoscopy with the standard colonoscope. Further study is needed to determine whether the variable-stiffness colonoscope should be used routinely for colonoscopy.

Adult↗
PubMed1986

Giant and symptomatic inflammatory polyps of the colon in idiopathic inflammatory bowel disease.

Four cases of giant inflammatory polyps were found in a series of 86 consecutive colectomies for inflammatory bowel disease. Two presented a distinctive clinical syndrome of abdominal pain and chronic iron-deficiency anemia due to blood loss. Secondary ulceration of the heads of the polyps accounted for the bleeding and anemia, and the size of the polyps accounted for the abdominal pain. In both cases unusually long portions of colon were involved by the giant polyps. The third and fourth cases had rare complications--reactivation of an enterocutaneous fistula and perforation of an acquired diverticulum. These cases demonstrate that giant inflammatory polyps may produce symptoms independently of the underlying inflammatory bowel disease. In reported cases of giant inflammatory polyps, approximately two-thirds had Crohn's disease and one-third had ulcerative colitis. The transverse colon was the commonest location, pain was the commonest symptom, and the polyps were localized to a short segment of colon in the majority of cases. More than 50% of cases mimicked neoplasm on barium enema. Giant inflammatory polyps may produce a variety of distinctive signs and symptoms and deserve independent recognition.

Adult↗
PubMed1979

Colonic complications of acute pancreatitis.

Colonic complications of acute pancreatitis include "pseudo-obstruction," necrosis, hemorrhage, fistula, and ischemic colitis. With the ten cases reported in this article, there are now 75 cases reported in the literature to our knowledge. The fulminating lesions (necrosis and hemorrhage) are usually associated with pancreatic abscess and/or pseudocyst and may occur because of a direct pressure effect with secondary vascular compromise. The lesions are predominant in the transverse colon and at the splenic flexure. Because the risk factor for a colonic complication from pancreatitis is highest in those patients with inflammatory masses in the body and tail of the gland due to colon contiguity, such masses require individualized treatment, including frequent clinical examination with sequential ultrasonography, and probably early surgical intervention.

Adult↗
PubMed1975

Studies on the fibercolonoscopy: with special reference to the latest procedures.

The Machida type fibercolonoscope, or FCS, devised by us is an anterior direct vision type of fiberscope. The most important feature of this new fiberscope consists of a tip of 5 cm size which is capable of being directed by flection up to 120 degrees in any direction and the tip up to 30 cm possessing a fishing-rod-like flexibility and elasticity by means of a special spiral spring. This angle-regulating mechanism makes it possible to insert this instrument along the course of the intestine under direct visual control. The fishing-rod-like construction where the maximal flexibility is greatest at the tip makes it considerably easier to pass sites of marked flexure in the colon. At examination the insertion of the instrument is guided by direct observation and by roentgenoscopy. The results in 200 cases in 1970 and thereafter, when operative techniques No. I, II and III devised previously by us were used, showed that successful insertion into the cecum was possible in 139 out of 173 cases (80%) except 27 cases of pathological stenosis due to cancer and other reasons. Thus fibercolonoscopy now enables the direct observation of the colon beyond the reach of the signoidoscope, providing a useful diagnostic procedure. Furthermore, a medium-long fibercolonoscope or FCS-M has been produced by us for examination of the lower portion of the large intestine. This is used in the inverted position without roentgenoscopic guidance as in conventional sigmoidoscopy. When this method, fibersigmoidoscopy, was used in 120 cases, it was possible to examine up to the transverse colon in 19 cases, the splenic flexure in 22 cases and the descending colon in 39 cases without the use of special techniques I, II and III. Thus in the majority of cases it is possible to carry out the examination of the left colon in this manner. The usefulness of fibersigmoidoscopy in the practical clinic is, therefore, rather larger than that of fibercolonoscopy.

Adenoma↗
PubMedDate not supplied

Volvulus of the colon--a continuing surgical problem.

Twenty-six cases of colonic volvulus from the University of Kentucky Medical Center and the Lexington Veterans Administration Hospital, covering a ten-year period, are presented. Overall mortality was 19 per cent (5 of 26 patients). Cecal volvulus carried the greatest mortality, 30 per cent (3 of 10 patients), whereas sigmoidal volvulus had relatively low mortality rate of 7 per cent (1 or 15). A single patient who had volvulus of the transverse colon died. The most significant factor leading to death was not necrotic bowel but the necessity for emergency operation in these generally debilitated patients. A plan of management with the major aim to convert emergency situations into elective or urgent ones is presented with the expectation that the mortality rate can be improved.

Adult↗
PubMed1998

Juvenile polyposis in a tropical country.

The clinical profile, malignant potential, and management of 17 children with juvenile polyposis (more than five juvenile polyps) were evaluated clinically and endoscopically. Colonoscopy and polypectomy were done three weekly until colonic clearance was achieved, and thereafter two yearly. All polyps were subjected to histological examination. Mean age was 7.7 years, with a male preponderance (3:1). Presentation was with rectal bleeding (94%), pallor (65%), stunted growth (53%), and oedema (47%), and the mean (SD) duration of symptoms was 33 (27) months. None had a positive family history or any congenital anomaly. Two children had six polyps up to the transverse colon; the rest had numerous polyps all over the colon. All children had juvenile polyps on histology and 10 (59%) had adenomatous changes (dysplasia). Total colectomy was done in six for intractable symptoms. Colon clearance was achieved in eight after an average 3.4 polypectomy sessions, and three were still on the polypectomy programme. In conclusion, juvenile polyposis is commonly associated with low grade dysplasia. Serial colonoscopic polypectomy is effective but colectomy is required for intractable symptoms and when clearance of the colon is not possible.

Adenomatous Polyposis Coli↗
PubMed2004

[A cavernous haemangioma of the colon as the cause of rectal bleeding in childhood].

A 13-year-old girl presented with rectal bleeding, abdominal pain and a palpable mass in the lower right abdomen. The history mentioned a chronic anaemia since she was 2 years old. Further examination did not give any indications for inflammation as etiological factor and showed a thickening of (apparently) the small intestine. A laparotomy was performed, since the age and presentation made a malignant lymphoma a probable diagnosis. The combination of chronic anaemia and rectal bleeding also suggested a benign vascular malformation. A large cavernous haemangioma of the transverse colon was found. This was resected and the patient fully recovered. Although a haemangioma of the colon is rare, it is important to keep this possibility in mind in the case of rectal bleeding in childhood, especially when other causes of rectal bleeding are excluded. Usually haemangiomas show spontaneous regression, but this is rare in intestinal haemangiomas. Surgical resection is the therapy of choice in the case of a solitary haemangioma.

Adolescent↗
PubMed1997

Retrograde colonic spread of a new mesalazine rectal enema in patients with distal ulcerative colitis.

BACKGROUND: Rectal treatment with mesalazine enemas is the first-line therapy for distal ulcerative colitis. In order to improve the benefits of rectal therapy, a new 60 mL 5-ASA rectal gel enema preparation has been developed using a device which excludes direct contact of the inert propellant gas with the active drug. The purpose of the present study was to assess by scintigraphy the colonic distribution of this new mesalazine rectal gel enema. METHODS: Twelve patients with active ulcerative colitis were administered 4 g of the mesalazine rectal enema labelled with 100 MBq technetium sulphur colloid (99mTc-SC). Anterior scans of the abdomen were acquired at intervals for 4 h. Scans were analysed to evaluate the extent of retrograde flow and homogeneity of distribution of the radiolabelled enema in the rectum, sigmoid, descending and transverse colon. In addition, plasma levels of 5-ASA and Ac-5-ASA were measured for 6 h. RESULTS: All patients retained the entire rectal gel throughout the course of the study without reporting adverse events. In 11 out of 12 patients (92%) the gel had spread homogeneously beyond the sigmoid colon and had reached the upper limit of disease in all cases. The maximum spread (splenic flexure) was observed in 6 out of 12 patients (50%) within the first 2 h. The systemic absorption of mesalazine and its metabolite Ac-5-ASA was low. CONCLUSIONS: The new mesalazine enema represents an adequate alternative and a further technological improvement in the topical treatment of distal ulcerative colitis.

Adult↗
PubMedDate not supplied

Perioperative care protocols for a canine model of a new gastrocolonic pouch for continent urinary diversion.

Traditionally, in continent urinary diversion (CUD), the ileum, ascending colon, or sigmoid colon is utilized to construct a urinary reservoir with a continence mechanism. When CUD was performed in women who had undergone extensive pelvic irradiation therapy for gynecologic cancer, the complication rate was exceedingly high due to the poor vascularity of the irradiated bowel incorporated in the reservoir. In order to avoid this very high complication rate, an animal study was conducted to test the feasibility of constructing a CUD utilizing nonradiated stomach, transverse colon, and proximal ureters. The development of this model in the canine necessitated prolonged abdominal surgery involving both the gastrointestinal and urinary systems. The immediate postoperative challenge included the need for continuous intravenous fluid infusion, maintenance of patent renal stents and neobladder stomal catheters, prevention of hypothermia and hypokalemia, and reduction of postoperative discomfort. Re-establishing an adequate plane of nutrition, preventing colonic ulceration from gastric secretions in the pouch, monitoring renal function, maintaining a patent stoma during healing, and managing the gradual expansion of the pouch were among the chronic care considerations. This procedure required the institution of unique and intensive perioperative care protocols. Using the methods discussed in this paper, three of four dogs in a pilot study survived the procedure and were included in an ongoing study of the new gastrocolonic continent urinary diversion.

Animals↗
PubMed1989

[Continent urostomy using a hydraulic ileal valve. Apropos of 160 cases].

We report our experience of continent urostomy about 160 cases. This study described the continence mechanism by the hydraulic valve. This one is made by isolating of 14 cm long ileal loop which is invaginated. It was adapted to six reservoirs: 142 ileocecums, 9 ileal pouchs, 4 bladders, 3 sigmoids, 1 rectum and 1 colonic transverse segment. The follow-up was few months to 14 years. 145 patients are continent, the continent urostomy was well tolerated by the upper urinary tract. The complications of the valve and their management are analysed.

Cecum↗
PubMed1995

Leiomyosarcoma of colon: report of two cases.

Leiomyosarcoma of the colon is a rare tumor, with fewer than 45 cases being reported by 1980. Wide resection, 10 cm margin, and adjacent mesentery will decrease chances of locoregional relapse. We recently encountered two leiomyosarcomas in the colon in the past two years. One is a 63-year-old female who was seen with rectal bleeding, pain, and was found to have a large intraluminal leiomyosarcoma in the descending colon. Biopsy revealed leiomyosarcoma, grade III. She underwent a wide subtotal colectomy with ileosigmoid anastomosis, with metastases to three of the nodes in the mesentery, and remains well. The second is a 69-year-old female with general weakness who had previously undergone a hysterectomy and cholecystectomy. On examination she was found to have an abdominal mass. This proved to be a large leiomyosarcoma arising in the proximal portion of the transverse colon. There were no metastatic areas to the liver, chest, or any other areas. She has undergone extended right colectomy and remains well. Because of the rarity of this type of cancer, there is no established protocol concerning its treatment.

Aged↗
PubMed2001

Laparoscopic right hemicolectomy with radical lymph node dissection using the no-touch isolation technique for advanced colon cancer.

The treatment of advanced right-sided colon cancer presents numerous challenges for the surgeon who must aim to minimize the invasiveness of surgery, achieve curative resection, and prevent port-site recurrences. To overcome these issues, we performed a totally intra-abdominal laparoscopic right hemicolectomy with radical lymph node dissection based on a no-touch isolation technique. To perform this no-touch technique, we initially dissected the lymph nodes along the surgical trunk, then transected the transverse colon, terminal ileum, and mesentery without tumor manipulation. Finally, the right side of the colon was freed retroperitoneally. We performed this surgical technique on three patients and no intraoperative complications were encountered. Curative resection was achieved in all three patients, as curability A according to the Japanese Classification of Colorectal Carcinoma, and their postoperative courses were uneventful. Therefore, this novel technique proved to be both feasible and safe. Furthermore, it enabled us to minimize the invasiveness of surgery, while providing clear access to resect the right-sided advanced colon cancer.

Carcinoma↗
PubMed1991

Colonic motility and transit in health and ulcerative colitis.

Preprandial and postprandial colonic motility and transit (scintigraphy), with respect to the splenic flexure, were studied in 10 patients with ulcerative colitis and in 9 healthy subjects. The healthy subjects had a postprandial increase in intraluminal pressure that was significantly (P less than 0.03) greater in the descending colon than in other regions of the colon. In ulcerative colitis, the pressure was decreased in all regions compared with healthy subjects, with no significant pressure gradient among different regions. In normal subjects, transit was quiescent during fasting; eating stimulated both antegrade and retrograde transit. In ulcerative colitis, transit was variable before as well as after the meal. Both healthy subjects and patients with ulcerative colitis had more rapid emptying from the splenic flexure into the sigmoid than into the transverse colon. More frequent, low-amplitude, postprandial propagating contractions occurred in ulcerative colitis (P less than 0.05) than in healthy subjects. Propagating contractions were always antegrade and caused a rapid movement of the tracer into the sigmoid. In conclusion, ulcerative colitis is characterized by (a) decreased contractility, (b) increased low-amplitude propagating contractions, and (c) variable transit. These disturbances may accentuate the diarrhea in ulcerative colitis.

Adult↗
PubMed1988

Adenocarcinoma of the colon and rectum: a report on 624 cases.

A total of 624 patients with adenocarcinoma of the large bowel and operated between 1958 and 1978 were retrospectively studied. According to the period of operation, patients were divided into group A (1958 to 1968, n = 259) and group B (1969 to 1978, n = 365). Symptoms were closely related to tumour location. Blood loss and change in bowel habits were most frequent in patients with left-sided cancer, while anaemia, loss of body weight and abdominal pain turned out to be the predominant symptoms in patients with right-sided cancer. Patients with cancer of the transverse colon or splenic flexure showed a high incidence of ileus (19%). Resection of the primary tumour was possible in 86% of the cases. The overall morbidity was 48% and the postoperative mortality was 8%. Anastomotic dehiscence occurred in 4% of our patients. There was no significant difference in postoperative mortality between the two patient groups. The mortality is closely related to the Dukes stage (Dukes A 4%, Dukes D 19%). The overall crude survival was 45%, the corrected survival 57%. Patients with cancer of the descending colon or (recto)sigmoid had a higher corrected 5-year survival when compared to patients with cancers in other tumour sites (65% versus 52%, p less than 0.01). Dukes stage, ileus as primary symptom were also correlated with survival, while sex distribution, age and duration of symptoms were not.

Adenocarcinoma↗
PubMed1988

The laser: an alternative for palliative treatment of obstructing intraluminal lesions.

Twenty nine patients with carcinoma obstructing the colon, six obstructing the gastroesophageal junction, six obstructing the tracheobronchial tree, and one patient with recurrent transitional cell cancer of the bladder invading the rectum, not amenable to surgical resection, were treated by laser photocoagulation. Forty were treated with the Nd:YAG laser and two with the CO2 laser. There were 26 men and 16 women with an average age of 73.8 years. The locations of the tumors were 17 rectal, six rectosigmoid, one transverse colon, two descending colon, four ascending colon, six gastroesophageal, and six in the tracheobronchial tree. Symptoms consisted of obstruction and/or bleeding. Seventeen patients were poor surgical candidates, 25 were unresectable due to widespread disease, two had recurrence at the anastomosis, and three patients had another primary site not controlled by their previous surgical procedure. There were seven complications--three perforations, a rectovaginal fistula, two failures in therapy, and lower GI bleeding. Nineteen patients have died of their disease. Tumors were eradicated in two patients. Forty patients had remained free of referring symptoms of obstruction and bleeding.

Adenocarcinoma↗
PubMedDate not supplied

[Cyst duplication of the colon in an adult. Case report].

The cystic type of the enteric duplication has the same histological structure as the digestive tract and the same mucosal lining as the segment to which is attached. These are rare pathological conditions especially in an adult as they usually are diagnosed and treated in childhood. A 39 year-old women has been elective admitted in our unit complaining of upper abdominal pain and a palpable abdominal mass in epigastrium and left upper quadrant. The imagistic findings (abdominal ultrasound and CT scan) raise the suspicion of a pancreatic cystic lesion. Intraoperative we found a large cystic lesion localized in the transverse mezocolon close to the transverse colon. The resected specimen was examined histopatologically and found to be a cystic duplication of the colon. The patient made an uneventful postoperative recovery.

Adult↗
PubMed1992

Angiodysplasia of colon revisited: pathologic demonstration without the use of intravascular injection technique.

The recognition of angiodysplasia either at the time of surgery or at the time of routine gross and microscopic examination has often been difficult. Until now the primary methodology used in defining the lesion has been the intravascular injection of radiopaque dyes and other compounds. This technique, however, is prohibitively time consuming and expensive, and does not encourage routine use in surgical pathology practice. We report two cases of angiodysplasia, both occurring in unlikely areas, in which the pathologic lesion was demonstrated without the use of an intravascular injection technique. One case involved 35 cm of proximal transverse colon and the other involved 23 cm of colon distal to the ileocecal valve. A simple method of demonstrating angiodysplasia by intraluminal formalin fixation (37% concentrated, unbuffered), with tying of both resected ends for 3 hours, followed by dissection of the mucosa from the muscle wall, is described. Areas of ectatic, pericryptal, thin-walled blood vessels with adjacent dilated, engorged submucosal veins are readily seen on gross direct inspection highlighted by transillumination. Histologic sections taken from these areas show early lesions of angiodysplasia characterized by ectatic, engorged submucosal veins and some dilated venules and capillaries in the mucosal lamina propria.

Aged↗