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PubMed1990

Long-duration stress. Immediate and late effects on small and large bowel motility in rat.

No extensive information exists in literature concerning the late or residual effects of stress on motility of small bowel and colon. Moreover, the duration and magnitude of the intestinal motor response to stress are still ignored. Therefore, the aim of our work was to determine, in rat, the effect of long-duration stress induced by restraint on the motility of small bowel and colon. Observations were made during physical restraint and 60 h later. Bipolar electrodes were implanted on the gastrointestinal serosa from the pylorus to the sigmoid colon in male Wistar rats. Electromyographic (EMG) recordings were made during fasting state, and a control EMG recording session was performed during 12 hr, followed by a 12-hr recording during restraint stress. After a 60-hr resting period, another EMG recording session was performed during 3 hr. During stress in the pylorus and small bowel, the recurrence of migrating myoelectrical complexes (MMCs) was immediately interrupted and replaced by a continuous and irregular activity. The motility index (number of spike bursts/10 min) was augmented rapidly on the jejunum and ileum, but it increased only gradually on the pylorus. Only on the transverse colon were the number of spike bursts/hour and their relative duration increased after 7 hr of physical restraint. In contrast, the sigmoid colon displayed a gradual decrease in the relative duration of contractile activity during the first 6-7 hr of stress. At 60 hr after stress in the pylorus and small bowel, a normal control motor activity was restored (MMC, motility index) on the jejunum and on the ileum, but the motility index on the pylorus was decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[Cerebellar syndrome and myoclonus in a patient with adenocarcinoma of the colon].

INTRODUCTION: Neurological paraneoplastic syndromes (NPS) are usually found in association with bronchogenic and gynecological tumors. Any part of the central or peripheral nervous system may be involved, and the clinical presentation may therefore take any of a large number of forms. Intestinal tumors rarely lead to NPS. We present the case of a patient with adenocarcinoma of the colon, in whom the first clinical sign was NPS. CLINICAL CASE: A 72 year old man presented with subacute onset of generalized myoclonus, predominantly of action, ataxia on walking and changes in speech associated with a constitutional syndrome. There were no ocular changes. Laboratory investigations including immunology, serology and tumour markers were normal. Anti-Hu, Yo and Ri antibodies were negative. Study of the CSF showed the blood-brain barrier to be damaged. Cranial MR, EEG, thoraco-abdominal CT and osseous gammagraphy showed no significant changes. On colonoscopy there was a tumour in the medial zone of the transverse colon (an adenocarcinoma). Treatment was started with high dose steroids and the condition progressively improved. After right hemicolectomy steroid treatment was stopped, and there was complete recovery of the condition. CONCLUSIONS: The presence of cerebellar syndromes and myoclonus of unknown aetiology should lead one to the diagnosis of a paraneoplastic syndrome. Adenocarcinoma of the colon should be included in the differential diagnosis.

Adenocarcinoma↗
PubMed1981

Carcinoma-related alterations of glycosyltransferases in human tissues.

The glycosyltransferases responsible for catalyzing additions of A, B, and H sugars to cellular acceptors were studied in 23 cases of primary carcinoma. The carcinomas were derived from mouth, tongue, larynx, lung, cervix, esophagus, stomach, and colon. Comparisons of A, B, and H enzymes were made between mucosal extracts from tumor and from normal adjacent tissue and, in the case of gastrointestinal tract, extracts derived from mucosae of individuals free of disease. The most prevalent finding was that of alpha-2-fucosyltransferase (H enzyme) deficiency in tumor extracts from Group A, B, and O patients in relation to the normal tissue counterpart (20 cases). Exceptions were observed in one case of carcinoma of the stomach and in two of seven cases of carcinoma of rectum or sigmoid. In four of nine Group A patients (carcinoma of the mouth, tongue, ascending and transverse colon), N-acetylgalactosaminyltransferases (A enzymes) were demonstrated but were deficient in relation to the normal adjacent counterpart. A enzymes were not demonstrable in normal and tumor extracts from distal colon in five cases. Differences between tumor extracts and normal adjacent tissue were noted in D-galactosyltransferase (B enzyme) derived from carcinomas of larynx and esophagus, but B enzyme was not demonstrated in tumor or normal tissue derived from the sigmoid colon. Study of the normal distribution of H enzyme in gastrointestinal mucosa indicated the presence of relatively high enzyme levels in stomach and upper intestine but low levels in distal colon.

Blood Group Antigens↗
PubMed2001

Study of the mechanism underlying the difference in motility between the large and small intestine: the "single" and "multiple" pacemaker theory.

The common movement of the small intestine (SI) is peristalsis and of the large intestine (LI) are giant migrating contractions. The mechanism underlying the difference in the type of motility between the SI and LI is yet to be elucidated; the current communication investigated this point. 7 pigs (4 male) were anesthetized, abdomen opened and a balloon-ended catheter was introduced into the right colon through ileotomy. Balloon was filled in increments of 10 ml of saline and the EMG activity of the colonic longitudinal and circular muscle layers was recorded before and after myotomy performed between 2 of the 3 electrodes fixed to the colon. The balloon was then withdrawn, located in the terminal ileum and distended in increments of 2 ml; the ileal EMG activity was registered before and after myotomy done between 2 of the 3 electrodes applied to the ileum. The LI showed slow waves or pacesetter potentials (PPs) and action potentials (APs) which had the same frequency, amplitude and conduction velocity from the 3 electrodes of the same animal. The waves were recorded from the longitudinal and not the circular muscle coat. Upon LI distension, the electric activity increased and was recorded also from the circular muscle. At 40-50 ml distension, the balloon was dispelled to the transverse colon. Electric activity from SI was similar to that of the LI, but was not the same from the 3 electrodes; it diminished aborally. It increased with increasing balloon distension until, at 8-10 ml distension, the balloon moved slowly aborally. Electric waves were recorded proximally but not distally to colonic myotomy, and the balloon moved up to the cut. In the SI, waves were recorded both proximally and distally to the ileal myotomy, and the balloon moved across the cut. The fact that the colonic electric waves displayed the same variables from the 3 electrodes and that they were not recorded distally to the colonic myotomy, would suggest the presence of a "single" colonic pacemaker, probably situated in the cecum. This is in contrast to the hypothesis of the "multiplicity" of the small intestinal pacemakers, which is based on the fact that the electric activity diminished as the waves propagated aborally and on the existence of slow waves distal to the ileal myotomy. The concept of "single" and "multiple" pacemakers explaining the difference in the motility of small from that of large gut needs further studies.

Animals↗
PubMed2004

Prospective comparison of air-contrast barium enema and colonoscopy in patients with fecal occult blood: a pilot study.

BACKGROUND: The utility of air-contrast barium enema and colonoscopy for evaluation of the colon has been debated. Air-contrast barium enema is less expensive and invasive than colonoscopy, but it also is less sensitive and specific. Further, although air-contrast barium enema may be less painful than colonoscopy, it often is poorly tolerated by patients. Thus, this study compared the sensitivity and the specificity of air-contrast barium enema and colonoscopy for detection of colonic lesions in patients with fecal occult blood. METHODS: Over a 30-month period, patients with fecal occult blood were recruited. Patients underwent standard air-contrast barium enema, followed by colonoscopy 7 to 14 days later. Colonoscopists were blinded to the results of air-contrast barium enema until the colonoscopy was completed, after which the results were disclosed. If the findings were discrepant, colonoscopy was repeated. RESULTS: A total of 100 patients were evaluated. Nine air-contrast barium enemas were reported to be inadequate, and the cecum was not intubated at colonoscopy in two patients. In the remaining patients, 5 cancers were identified (1 each cecum, transverse colon, descending colon, sigmoid colon, and rectum) by both studies. Sixty-six polypoid lesions were identified in 30 patients. Diverticula were identified in 42 patients by air-contrast barium enema and in 18 patients by colonoscopy. Air-contrast barium enema detected 3 of 36 polypoid lesions 5 mm or less in diameter, 5 of 15 adenomas 6 to 9 mm in size, and 4 of 15 adenomas 10 mm or greater in diameter (sensitivity 8%, 33%, and 27%, respectively). After excluding patients with diverticula, air-contrast barium enema detected 3 of 7 adenomas 10 mm or greater in size. Overall, 12 polypoid lesions or filling defects were identified by air-contrast barium enema that could not be verified by colonoscopy. The specificity of air-contrast barium enema for lesions 1.0 cm or greater in size was 100%; for those 6 mm or greater, it was 97%. CONCLUSIONS: Air-contrast barium enema accurately detects colon cancer and diverticula. Its sensitivity for detection of polypoid lesions or adenomas is poor and was confounded by the presence of diverticula.

Adenomatous Polyps↗
PubMed1977

[Surgical management of left colon and rectal radiation injuries (author's transl)].

A. First of all, we can affirm after the analysis of 132 records: the predominance of gynecologic cancers and the frequent responsibility of medical associations in the determinism of advanced radiation injuries of colon and rectum; the typically variable appearence of these injuries with an usual delay going from 6 months to a year and limits from 2 months to 35 years; the difficulty of diagnosis between radiation injurie and recurrence of cancer especially in case of fistula and the severe forecost in case of cancer radiation injurie association. B. The surgical management exist only for non-indications and failures of medical treatment; the one stage resection with end to end anastomosis will be made exclusively on advanced, therefore non evolving and limited injuries; in most cases, the multiple stage resection must be preferred: first derivation in selected part (sigmoid or transverse colon) and secondary resection in healthy area; as regards the closure of colostomy, it must never occur before a 6 months delay and anastomosis radiologic check.

Abdominal Neoplasms↗
PubMed1981

Colon perforation during attempted barium enema reduction of intussusception.

In reviewing the records of almost 1000 infants and children with intussusception in two children's hospitals over the last 25 yr, there have been seven bowel perforations during attempted hydrostatic barium enema reduction of an intussusception. Except for one instance, these have all occurred during the last 6 yr. The infants were all 6 mo old or less and most had a preceeding viral illness. Only 4 of the 7 had pain, all vomited, in only 2 was a mass felt and all but 1 had rectal bleeding. The duration of these signs and symptoms was longer than 36 hr with most ill for 3 or 4 days. All seven infants had abdominal x-rays that showed complete small bowel obstruction. Once the intussusception was suspected, barium enema reduction was attempted without excessive hydrostatic pressure and not for a prolonged time; all the ileocolic intussusceptions were met in the transverse colon with only a minimal reduction produced. It was at this time that a perforation was suddenly noted. All infants required immediate right hemicolectomy for the area (s) of colonic necrosis. Postoperatively, there were two wound infections, a volvulus which left the child with a short gut and another infant suffered severe brain damage. These babies seem to fit a pattern in which they are younger and sicker longer than the average infant with an intussusception, and have a complete small bowel obstruction. These facts may be a warning that such infants are at increased risk for a barium enema bowel perforation.

Barium Sulfate↗
PubMed2004

[Pleural involvement in the course of chronic myelomonocytic leukemia and the development of multiple colonic perforation due to leukemic infiltration in the acute leukemia phase].

A 68-year-old man with chronic myelomonocytic leukemia (CMML) was initially treated with hydroxyurea with subsequent stable disease. In the time course, he developed bilateral pleuritis accompanied by leukocytosis and spiking fever. Cytologic analysis of the pleural effusion revealed abundant mature granulocytes and monocytes. He was treated with intravenous or oral etoposide with consequent resolution of the pleuritis, indicating the pleural involvement of CMML. Three months later, he developed hepatomegaly and became febrile. One month thereafter, the CMML transformed to acute myeloid leukemia, and the patient developed massive bloody stools associated with epigastric pain and leukocytosis. A gastrofiberscopic examination showed multiple bleeding gastric ulcers. The bleeding ulcers were treated with the clipping procedure; however, the bloody stools continued. Although intravenous etoposide was effective for the leukocytosis and hepatomegaly, the treatment did not improve the bloody stools. The patient finally died of panperitonitis. The autopsy showed multiple ulcers of the transverse colon, some of which were perforated. Microscopically, the ulcerated areas were densely infiltrated with leukemic cells predominantly consisting of immature monocytes and granulocytes. This patient may be the first reported case of CMML complicated by colonic perforation due to leukemic infiltration.

Aged↗
PubMed1992

Distribution of mesalamine enemas in patients with active distal ulcerative colitis.

Mesalamine (5-aminosalicylic acid), a topically administered anti-inflammatory agent, is effective treatment by enema for distal ulcerative colitis; it lacks many of the side effects of orally administered sulfasalazine. In this study, we determined the colonic distribution of a 60-ml mesalamine enema in eight patients (five women and three men, 18 to 48 years old) with active distal ulcerative colitis that ranged from 12 to 40 cm proximal to the anal verge. On 3 consecutive days, each patient self-administered a 4-g (60-ml) 5-aminosalicylic acid enema that contained 3.7 MBq of [99mTc]technetium-sulfur colloid. Anterior and posterior images were obtained at 0, 30, 60, 120, and 240 minutes. During the 4-hour study period, all patients retained the enemas. The enemas spread to the sigmoid region in 24 of 24 studies, to the splenic flexure region in 22 of 24, and to the transverse colon in 1 of 24. Most of the enema was retained in the sigmoid colon. Therefore, we conclude that a 60-ml enema, when administered as recommended clinically, routinely flows retrograde as far as the splenic flexure but rarely spreads beyond this point. These results support the use of intrarectally administered 5-aminosalicylic acid for segmental colitis of the descending colon.

Adolescent↗
PubMed1978

[Characteristics of the course of peritonitis in oncological patients].

Among 16 patients admitted into the Volynsk oncological dispensary with far-advanced tumors of the stomach and colon, the tumor perforation was recognized prior to surgery only in a half of the cases. Despite marked local proliferation and distant metastases there may be a pronounced pain syndrome. The absence of parallelism between the moment of intestinal content getting into the abdominal cavity and the protective reaction of the anterior abdominal wall musculature was characteristic of these patients. While the symptoms of peritoneal irritation in perforated gastric cancer can be recognized within the period up to 2 hours, the perforation of rectal cancer is frequently not accompanied with peritoneal signs. Among gastric cancer patients the perforation was diagnosed within 6 hours in six cases. The time of recognition of perforated cancer of the transverse colon and rectum was 15--16 hours.

Adult↗
PubMed1991

Prognostic implications of proliferative activity and DNA aneuploidy in Astler-Coller Dukes stage C colonic adenocarcinomas.

Paraffin-embedded surgical specimens from 69 patients who underwent resections of otherwise untreated Dukes stage C adenocarcinoma of the colon were examined for proliferative activity, DNA aneuploidy, DNA index, and proportion of aneuploid cells by flow cytometry. Results were correlated to clinical characteristics of the patients and to overall survival times. DNA aneuploid tumors were identified in 60 cases (87%), diploid tumors in 9 cases (13%). The mean S-phase fraction for all cases was 17.6%, with a standard deviation (SD) of 7.8. In univariate statistical analysis, younger patient age, lower tumor proliferative activity, DNA index less than or equal to 1.2, and presence of only 1-4 lymph nodes with tumor involvement were found to be significant predictors of improved patient survival. In multivariate Cox regression analysis, low tumor proliferative activity, younger patient age, and location of the tumor in the right or transverse colon were found to be significant independent predictors of increased patient survival. When tumor proliferative activity was stratified into statistically defined subgroups, patients with tumors of low proliferative activity (S-phase less than mean - 0.5 SD) had significantly longer survival than patients with tumors of moderate proliferative activity (S-phase value greater than mean - 0.5 SD and less than mean +0.5 SD) or high proliferative activity (S-phase greater than mean +0.5 SD). These results suggest that tumor proliferative activity in Dukes C colon carcinoma may be an important biological factor in determining patient prognosis.

Adenocarcinoma↗
PubMed2006

Malignant colo-duodenal fistula; case report and review of the literature.

BACKGROUND: Colo-duodenal fistula is a rare complication of malignant and inflammatory bowel disease. Cases with malignant colo-duodenal fistulae can present with symptoms from the primary, from the fistula or from metastatic disease. The fistula often results in diarrhoea and vomiting with dramatic weight loss. Upper abdominal pain is usually present as is general malaise both from the presence of the disease and from the metabolic sequelae it causes. The diarrhoea relates to colonic bacterial contamination of the upper intestines rather than to a pure mechanical effect. Vomiting may be faeculant or truly faecal and eructation foul smelling but in the case reports this 'classic' symptomatology was often absent despite a fistula being present and patent enough to allow barium through it. Occasionally patients will present with a gastro-intestinal bleed. CASE PRESENTATION: We present an unusual case of colorectal carcinoma, where a 65 year old male patient presented with diarrhoea and vomiting secondary to a malignant colo-duodenal fistula near the hepatic flexure. Adenocarcinoma was confirmed on histology from a biopsy obtained during the patient's oesophageogastroduodenoscopy, and the fistula was demonstrated in his barium enema. Staging computed tomography showed a locally advanced carcinoma of the proximal transverse colon, with a fistula to the duodenum and regional lymphadenopathy. The patient was also found to have subcutaneous metastasis. Following discussions at the multidisciplinary meeting, this patient was referred for palliation, and died within 4 months after discharge from hospital. CONCLUSION: We present the case, discuss the management and review the literature. Colo-duodenal fistulae from colonic primaries are rare but early diagnosis may allow curative surgery. This case emphasises the importance of accurate staging and repeated clinical examination.

Journal Article↗
PubMed2004

[Application of metal hemoclip for endoscopic polypectomy in children with thick-pedunculated intestinal polyps].

OBJECTIVE: With the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety. METHODS: Between October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed. RESULTS: Six polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared. CONCLUSION: Mechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.

Child↗
PubMedDate not supplied

Pelvic exenteration for carcinoma of the colon and rectum.

Carcinoma of the colon and rectum is one of the most common causes of cancer deaths in the United States. The mortality of patients treated by surgery alone is 55% within 5 years of surgery. Despite efforts to decrease local recurrence and their concomitant problems of pain and disability, a significant number of patients will still have pelvic recurrences that carry a significant morbidity. In selected cases, pelvic exenteration may cure or provide palliation of the symptoms of colorectal carcinoma. Pre-operative evaluation is performed to detect signs of unresectability. During surgery, exploration is performed for evidence of metastases to the liver, omentum, and peritoneum, followed by an assessment of the local extent of the tumor. The margins of resection must be clear even if resection of contiguous organs or bony structures is necessary. The urinary tract is resected with an ileal loop, sigmoid or transverse colon conduits, or continent urinary diversion. Depending upon the involvement of neighboring structures, exenterative pelvic surgery can be modified for organ preservation.

Colorectal Neoplasms↗
PubMed2005

[Visualization and quantification of large bowel motility with functional cine-MRI].

PURPOSE: To develop and evaluate a method to visualize and quantify large bowel motility using functional cine MRI. METHODS: Fifteen healthy individuals (8 males, 7 females, 20 to 45 years old) with no history or present symptoms of bowel disorders were enrolled in a functional cine MRI examination at 6 a. m. after a starving phase for at least eight hours before and after oral administration of Senna tea (mild stimulating purgative). Two consecutive sets of repeated measurements of the entire abdomen were performed using a 1.5 T MRI system with coronal T2-weighted HASTE sequences anatomically adjusted to the course of the large bowel. A navigator technique was used for respiratory gating at the level of the right dorsal diaphragm. The changes in diameter (given in cm) were measured at 5 different locations of the ascending (AC), transverse (TC) and descending colon (DC), and assessed as parameters for the bowel motility. RESULTS: The mean values as a statistical measure for large bowel relaxation were determined. Before ingestion of Senna tea, the mean diameter measured 3.41 cm (ascending colon), 3 cm (transverse colon) and 2.67 cm (descending colon). After the ingestion of Senna tea, the mean diameter increased to 3.69 cm (ascending colon) to 3.4 cm (transverse colon) and to 2.9 cm (descending colon). A statistically significant difference was demonstrated with the Wilcoxon test (level of confidence 0.05). For the determination of dynamic increase, the changes of the statistical scatter amplitude to the mean value were expressed as percentage before and after the ingestion of Senna tea. Thereby, an increase in variation and dynamic range was detected for the AC (112.9 %) and DC (100 %), but a decrease in the dynamics for the TC (69 %). CONCLUSION: A non-invasive method for the assessment of bowel motility was developed for the first time. The use of functional cine MRI utilizing a prokinetic stimulus allowed visualisation and quantification of large bowel motility. Further studies have to determine whether this technique is clinically relevant.

Adult↗
PubMed1998

[Laparoscopic therapy of diverticulitis].

The aim of this work is a critical analysis of our results with primary laparoscopic resection and anastomosis of the colon for diverticulitis. From October 1993 to October 1997, 171 patients with a mean age of 60 years (97 males, 74 females) have been operated laparoscopically. 95 patients were operated electively after many episodes of acute diverticulitis and 76 patients in the acute phase, of whom 11 patients presented a colovesical fistula. 6 left hemicolectomies and 165 sigmoid resections were performed. Among the sigmoid resections 11 patients with simultaneous resection of a colovesical fistula are included. The operating time for elective cases was between 130 and 280 minutes with a mean of 180 minutes, for acute cases the time was between 75 and 410 minutes with a mean of 205 minutes. The conversion-rate was 10.5%: problems with the instruments n = 2, impossibility to pass the stapler n = 4, severe diverticulitis n = 7, iatrogenic lesion of the ureter n = 1, perforation of the transverse colon by the trocar n = 1, extended adhesions n = 2, hemorrhage n = 1. The morbidity was 10%: abdominal wall hematoma n = 1, intraabdominal hematomas n = 2, wound abscesses treated surgically n = 2, conservatively treated intraabdominal abscesses n = 2, anastomotic leaks treated with open procedure n = 2, anastomotic leaks with fistulization n = 4, treated once with laparotomy and 3 times conservatively, sepsis 3 times treated conservatively. As late complications (3.5%) we experienced: a bowel obstruction in 2 patients treated with open procedure, herniation at the trocar sites in 3 cases corrected surgically and an anastomotic stenosis, that had to be reoperated after an unsuccesful dilatation. Analgetic requests have been decreased to the half in comparison to the classically operated patients. The mortality: 1 patient (0.6%) died due to a fasciitis. The duration of the hospitalisation was 8.4 days in average (3-32 days). We can conclude that laparoscopic colon resection should be considered as an adequate procedure for the treatment of inflammatory processes. A large experience in laparoscopic surgery with continuous training of the surgeon is the prerequisite.

Abdominal Abscess↗
PubMed1997

Aggressiveness of colon carcinoma in blacks and whites. National Cancer Institute Black/White Cancer Survival Study Group.

Black patients with colon cancer in the Black/White Cancer Survival Study were found to have a poorer survival than white patients. More advanced-stage disease at diagnosis was the primary determinant, accounting for 60% of the excess mortality. After adjusting for stage, factors such as poverty, other socioeconomic conditions, and treatment did not further explain the remaining survival deficit. This study examined the aggressiveness of colon tumors in blacks and whites to explore its role in the racial survival differences. Tumor characteristics of 703 cases of newly diagnosed invasive colon adenocarcinoma were centrally evaluated by a gastrointestinal pathologist, blinded in regard to the age, race, and sex of the patients. Blacks were less likely to have poorly differentiated (grade 3) tumors [odds ratio (OR), 0.44; 95% confidence interval, 0.22-0.88] and lymphoid reaction (OR, 0.49; 95% confidence interval, 0.26-0.90) when compared with whites. These black/white (B/W) differences remained statistically significant after adjusting for age, sex, metropolitan area, summary stage, socioeconomic status, body mass index, and health care access and utilization. In addition, blacks were less likely to have high-grade (grade 3) nuclear atypia, mitotic activity, and tubule formation, although these ORs did not reach a statistical significance level of 0.05. Similar B/W differences were observed for patients with advanced disease but not with early stage. Comparison by anatomical subsite showed that blacks had statistically significantly better differentiated tumors for cancers of the proximal and transverse colon but not for the distal. No racial differences were found for blood vessel and lymphatic invasion, necrosis, fibrosis, and mucinous type of histology. The findings, therefore, are the opposite of those hypothesized. After adjusting for stage, more aggressive tumor characteristics do not explain the adverse survival differential in blacks. This suggests that there may be racial differences in environmental exposure, and that the intensity and mode of delivery of carcinogen insult as well as host susceptibility may differ by race and anatomical subsite. Future studies should explore the B/W differences in tumor biology using molecular markers that precede the conventional histological parameters evaluated here.

Adult↗
PubMed1988

Projections of peptide-containing neurons in rat colon.

The distribution, origin and projections of nerve fibers containing vasoactive intestinal peptide, substance P, neuropeptide Y, galanin, gastrin-releasing peptide, calcitonin gene-related peptide, somatostatin or enkephalin were studied in the midcolon of the rat by immunocytochemistry and immunochemistry. Most of these nerve fibers had an intramural origin as was established by extrinsic denervation (serving of mesenterial nerves). Extrinsic denervation eliminated neuropeptide Y-containing fibers of presumably sympathetic origin together with sensory nerve fibers containing both substance P and calcitonin gene-related peptide. Co-existence of two peptides in the same neuron was studied by double immunostaining. This revealed co-existence of neuropeptide Y and vasoactive intestinal peptide in one population of intramural neurons; an additional population of intramural neurons was found to contain vasoactive intestinal peptide but not neuropeptide Y. All somatostatin-containing neurons in the submucous ganglia were found to harbor calcitonin gene-related peptide. A much larger population of submucous neurons containing calcitonin gene-related but not somatostatin was also detected. Some perivascular calcitonin gene-related peptide-containing nerve fibers (of intrinsic origin) harbored vasoactive intestinal peptide while others (of extrinsic origin) harbored substance P. The polarities and projections of the various peptide-containing intramural neurons in the transverse colon were studied by analysing the loss of nerve fibers upon local disruption of enteric nervous pathways (myectomy or intestinal clamping). Myenteric neurons containing vasoactive intestinal peptide, galanin, gastrin-releasing peptide, calcitonin gene-related peptide, somatostatin or vasoactive intestinal peptide/neuropeptide Y gave off 5-10-mm-long descending projections while those containing substance P or enkephalin issued approx. 5-mm-long ascending projections. Submucous neurons containing calcitonin gene-related peptide, somatostatin/calcitonin gene-related peptide or gastrin-releasing peptide issued both ascending (2-6 mm) and descending (2-6 mm) projections, those containing vasoactive intestinal peptide issued ascending (approx. 2 mm) projections, while those containing galanin or vasoactive intestinal peptide/neuropeptide Y lacked demonstrable oro-anal projections. Enkephalin-containing fibers could not be detected in the mucosa and the mucosal substance P-containing nerve fibers were too few to enable us to delineate their projections.

Animals↗