[A rare case of coexistence of aneurysm of the abdominal aorta and sigmoid neoplasm].
A rare case is reported of coexistence of aortic abdominal aneurysm with sigmoid tumour. Emergency surgical treatment was instituted.
Adenocarcinoma↗
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Colitis proximal to obstructing colonic carcinoma.
Nonspecific colitis proximal to an obstructing colonic carcinoma has appeared in the surgical literature for over 20 years, but it remains an uncommon and difficult clinical problem. This report details the case histories of five patients with this entity who have been admitted to the surgical service of Presbyterian Hospital since 1967. The colitis described is clearly related to the obstructive lesion and does not represent chronic inflammatory colitis in association with a carcinoma. The patients may initially have symptoms secondary to the obstructing lesion or fulminant peritoneal signs secondary to the colitis. The roentgenographic appearance is typical and closely resembles that seen in colonic ischemia. The pathologic process varies from fibrosis and stricture formation to transmural necrosis and perforation.
Adult↗
Rectal stump tumor fragments in low anterior resections: a case report.
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Adenocarcinoma↗
Preoperative irradiation and surgery for certain cancers.
Failure to cure cancer by surgery is caused by inability to remove all local extensions of the lesion or from prior or synchronous dissemination of tumor cells. Laboratory evidence has suggested that preoperative irradiation of the primary tumor can increase cure rates. In the clinical realm, the efficacy of preoperative irradiation appears to vary with specific tumors. Lung cancer shows no improvement in survival. Cancers of the bladder and breast may show enhancement of cure rate. Data indicate that cancer of the rectosigmoid does benefit from preoperative therapy. Adherence to important factors of dosage and timing of operation is necessary to prevent undesirable complications. Randomized clinical trials are needed to establish the efficacy of this combined modality treatment system. This is particularly true since both these modalities can be applied on a wide-scale basis if beneficial effects are conclusively demonstrated.
Breast Neoplasms↗
Preoperative radiotherapy for adenocarcinoma of the rectosigmoid.
Ninety-seven patients with adenocarcinoma of the rectosigmoid have been treated with high dose (5000-6000 rad) preoperative irradiation from 1960 through 1972 at the University of Oregon Health Sciences Center. Fifty-seven were initially clinically resectable and 40 were initially inoperable. Forty of the 57 initially clinically resectable patients had "curative" resections and are at risk for more than 5 years. An increase in 5-year survival (from 38% to 53%) and an absence of pelvic recurrence have occurred in those patients receiving preoperative irradiation and "curative" resection. Four of the 40 initially inoperable patients are alive without tumor. Three of the four survivors had irradiation and surgery; one had irradiation only. An additional four patients had no evidence of tumor at death. Tumor was totally sterilized by irradiation and nine patients and reduced to microfocal extent in an additional three of the 97 patients. Incidence of complications was no greater than has been reported in a surgical series from the same institution.
Adenocarcinoma↗
Abdominoperineal resection following anterior resection.
A series of 11 patients undergoing abdoninoperineal resection for "suture line recurrence" following anterior resection is presented. Five-year survival is 10%. Technically, the procedure is difficult and major problems are encountered, including large blood loss and ureteral complications. These patients had an inadequate distal margin of resection at the time of anterior resection. The survival of this group of patients underscores the importance of making the correct judgment about anterior or abdominoperineal resection at the time of the initial presentation of the patient. The phrase "suture line recurrence" is a misnomer; all of these patients had advanced pelvic malignancy. If the adequacy of the distal margin is questionable or a distal margin of 5 cm cannot be obtained safely at the time of anterior resection, abdominoperineal resection should be performed, as the opportunity for cure of a recurrence should this rule be compromised is limited.
Female↗
Argyrophilic prostatic carcinoma. Case report with literature review on prostatic carcinoid and "carcinoid-like" prostatic carcinoma.
An unusual prostatic neoplasm characterized by a carcinoid-like light microscopic pattern together with argyrophilia of tumor cells is described. Immunoperoxidase stain for prostatic specific antigen, however, was positive, indicating that this neoplasm was an argyrophilic prostatic carcinoma. Although the clinical significance of a carcinoid-like pattern and/or argyrophilia in prostatic carcinoma is currently unknown, pathologic recognition of these features is of paramount importance because prostatic carcinoma with these features has to be distinguished from true primary prostatic carcinoid tumor or, in areas of metastasis, from metastatic carcinoid originating from other sites such as the gastrointestinal or respiratory tracts. The value of the immunoperoxidase technique for prostatic specific antigen as well as prostatic acid phosphatase in this differentiation is stressed.
Adenocarcinoma↗
Preoperative prediction of outcome in patients with rectal and rectosigmoid cancer.
This study evaluated the possibility of dividing patients with primary rectal carcinoma into prognostic groups before surgery based on preoperative serum levels of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), and an antigen defined by the monoclonal antibody C-50 (CA-50), as well as on some easily available clinical characteristics providing prognostic information. The evaluation was made both for patients who were "potentially curable" by surgery and, among those, for patients who were "potentially cured." Using the Cox regression model, the serum levels of the three tumor markers, together with the knowledge of whether or not the tumor was polypoid were combined to make up the set of variables that best predicted patient outcome. These variables and their associated regression coefficients were used to classify the patients according to prognosis. The cancer-specific mortality rate for the 24% of potentially curable patients with the best prognosis was 15%; for the 26% of potentially curable patients with the worst prognosis, the cancer-specific mortality rate was 57%. For potentially cured patients among those who were potentially curable, the cancer-specific mortality rates for patients with the best and worst prognoses were 14% and 47%, respectively. The information provided by these preoperatively available variables together was comparable with that given by Dukes' staging system, but the latter system was more informative. On the other hand, some of the preoperative variables provided information not provided by Dukes' staging system.
Adult↗
Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma.
A multimodality approach of moderate-dose to high-dose preoperative radiation therapy, surgical resection, and intraoperative electron beam radiation therapy (IORT) has been used for patients with locally recurrent rectal or rectosigmoid carcinoma. The 5-year actuarial local control and disease-free survival for 30 patients undergoing this treatment program were 26% and 19%, respectively. The most important factor predicting a favorable outcome was complete resection with negative pathologic resection margins. The determinant local control and disease-free survival for 13 patients undergoing complete resection were 62% and 54%, respectively, whereas for 17 patients undergoing partial resection these figures were 18% and 6%, respectively. There did not appear to be a difference in local control or survival based on the original surgical resection (abdominoperineal resection versus low anterior resection). However, the likelihood of obtaining a complete resection after preoperative radiation therapy was higher in patients who had previously undergone a low anterior resection than patients undergoing prior abdominoperineal resection. For the 30 patients undergoing external beam irradiation, resection, and IORT, the most significant toxicities were soft tissue or sacral injury and pelvic neuropathy. Efforts to further improve local control are directed toward the concurrent use of chemotherapy (5-fluorouracil with and without leucovorin) as radiation dose modifiers during external beam irradiation and the use of additional postoperative radiation therapy.
Adult↗
Preoperative high-dose leucovorin/5-fluorouracil and radiation therapy for unresectable rectal cancer.
Twenty patients with primary or recurrent unresectable rectal cancer limited to the pelvis were entered on a Phase I trial of preoperative pelvic radiation therapy (RT) (5040 cGy) and two cycles of combined high-dose leucovorin (LV) and 5-fluorouracil (5-FU), followed by surgery and ten cycles of postoperative LV/5-FU (sequential). Maximum tolerated doses (MTD) were determined for preoperative combined LV/5-FU and RT and for postoperative sequential LV/5-FU. 5-FU was escalated 50 mg/m2 while the LV remained constant at 200 mg/m2. The initial doses of 5-FU were combined LV/5-FU and RT (200 mg/m2) and sequential LV/5-FU (325 mg/m2). The median follow-up time was 14 months. The resectability rate was 89%, and the pathologic complete response rate was 21%. The MTD for combined LV/5-FU and RT was 300 mg/m2; therefore, the recommended dose of 5-FU is 250 mg/m2. The recommended dose of 5-FU for sequential LV/5-FU is 375 mg/m2. The dose-limiting toxicities in this trial were diarrhea, tenesmus, increased bowel movements, dysuria, and myelosuppression. For the six patients who received 5-FU at the recommended dose level, the median low counts were leukocyte count, 3.7/microliters (range, 2.4 to 4.9/microliters); hemoglobin, 9.0 g/dl (range, 8.2 to 11.9 g/dl); and platelet count (X1000), 146/microliters (range, 89 to 182/microliters). The incidence rate of any Grade 3 toxicity was 17% (diarrhea and frequent bowel movements). The recommended doses of 5-FU used in this protocol were well tolerated. Because there was a long delay before optimal doses of 5-FU could be delivered, the authors do not recommend that high-dose LV be used in conjunction with combined 5-FU and RT with the treatment regimen as currently designed. However, because the resectability and complete response rates were higher than those previously reported for preoperative RT alone, the authors are encouraged by the combined technique approach. New trials are currently being undertaken to determine if the use of a low-dose LV regimen is more tolerable.
Antineoplastic Combined Chemotherapy Protocols↗
Use of fibrinogen to enhance the antitumor effect of OK-432. A new approach to immunotherapy for colorectal carcinoma.
OK-432 (5 KE), an immunomodulatory agent prepared from an attenuated strain of Streptococcus pyogenes, was dissolved in 1 ml of aprotinin (1000 KIE) and mixed with 80 mg of fibrinogen containing Factor XIII. A single intratumoral injection of the mixture was performed preoperatively under endoscopy in 20 patients with colorectal carcinoma. Postoperative histopathologic examinations revealed the formation of fibrin fibers at the site of injection and marked infiltration of inflammatory cells into the tumor stroma on the day after injection; the formation of granulomas containing many giant cells after 4 to 7 days; and extensive regression of tumor tissue after 14 days. This study suggests that the high concentration of exogenous fibrinogen gelatinized enough to trap OK-432 in tumor stroma and that OK-432 induced granulomatous hypersensitivity to degenerate tumor stroma, thereby causing regression of the tumors.
Adenocarcinoma↗
Parameters affecting laser palliation in patients with advanced digestive cancers.
Ninety-nine nonsurgical patients (group I) with esophagogastric cancer were referred to the laser center for palliation of dysphagia, and another 142 nonsurgical patients (group II) with a rectosigmoid cancer were referred for palliation of abnormal rectal discharge (125 patients) or occlusion (17 patients). The immediate success rate was 83% in group I and 90% in group II. Patients were retreated monthly. The average duration of palliation was 4.3 months +/- 0.5 (+/- standard error) in group I and 9.3 months +/- 0.95 in group II. Complication rate was 4% in group I and 3.4% in group II. Parameters affecting results were found only in group I. Factors that could negatively affect the immediate success rate included annular size of the tumor basis more than two thirds of the circumference, tumor localization at the upper third of the esophagus, and recurrence after a nonlaser treatment. The average duration of improvement after initial success was affected only by the circumferential extension.
Aged↗
[The evaluation of the cyclophosphamide sensitivity of human tumours by determining the incorporation of tritiated uridine and thymidine into the nucleic acids of human tumor cells in vitro in presence of 4-hydroxycyclophosphamide (author's transl)].
A new in vitro assay for screening the sensitivity of human tumour cells against Cyclophosphamide has been developed. While biologically activated Cyclophosphamide was unsuitable because of unpurities in the material, synthetic 4-Hydroxycyclophosphamide was shown to inhibit the incorporation of tritiated uridine and thymidine into the nucleic acids of human tumour cells in vitro. 29 tumours including 14 mammarial carcinomas, 8 ovarial carcinomas and 7 other malignant tumours were tested. While 12 tumours showed a significant and 5 only a slight inhibition of the 3H-uridine incorporation in vitro. 12 tumours showed no effect. Histologically none-differentiated tumours were more sensitive against 4-Hydroxycyclophosphamide as compared with the more differentiated ones. First observations point to 4-Hydroperoxycyclophosphamide instead of 4-Hydroxycyclophosphamide as a more suitable form of activated Cyclophosphamid for the in vitro assay of Cyclophosphamide sensitiveness because of the higher stability and better availability of this compound.
Antineoplastic Agents↗
A new detachable snare for hemostasis in the removal of large polyps or other elevated lesions.
In cooperation with Olympus Optical Co. (Tokyo, Japan) the author developed a detachable snare that enables the endoscopic ligation of the base of an elevated lesion. This apparatus surrounds the base of a large polyp or other elevated lesions with a specially manufactured loop, which is then tightened. This detachable snare enables the removal of large polyps and other elevated lesions without bleeding. The loop is made of nylon because the removal of an elevated lesion required high-frequency current. At Sakura National Hospital between May 1989 and October 1990, the detachable snare was used in 11 patients, including 4 with elevated gastric lesions, 2 with elevated duodenal lesions, and 5 with elevated colonic lesions. All of these elevated lesions were pedunculated or semi-pedunculated and measured greater than or equal to 20 mm in maximal diameter. In all cases, the lesions were removed effectively, resulting in a temporary, residual shallow ulcer.
Adult↗
Unusual involvement of the rectum by carcinoma of the prostate.
The authors present three cases in which carcinoma of the prostate simulates a primary carcinoma of the rectum. Direct invasion by prostatic carcinoma should be included in the differential diagnosis of mass lesions of the rectum in males.
Aged↗
Laser palliation for rectosigmoid cancers.
Lasers are now used in the rectum an colon for treatment of vascular telangiectasia [1], and benign and malignant sessile tumours [2,3]. This paper will describe the results of a 7 years experience with treatment of sessile rectosigmoid cancers.
Adult↗
Preoperative prediction of late cancer-specific deaths in patients with rectal and rectosigmoid carcinoma.
The possibility of predicting late cancer-specific deaths from (a) the preoperative serum levels of three tumour markers, carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and an antigen defined by the C-50 antibody (CA-50), from (b) one clinical factor of independent prognostic relevance, polypoid tumour growth, and from (c) Dukes' stage was evaluated in 276 patients with rectal carcinoma operated upon with curative intent ("potentially curable"), and in the 251 of those patients who were considered to be "potentially cured" after surgery. Using the Cox regression model, the preoperative serum levels of the tumour markers strongly predicted the cancer-specific mortality within the first year after surgery. This ability of S-CEA and S-CA-50 diminished for the mortality during the second year after surgery, and virtually disappeared thereafter. The ability of S-TPA to predict cancer-specific deaths did not change as dramatically with time as that of the other two markers, particularly in the group of "potentially cured" patients. Patients with polypoid tumour growth had a good prognosis which did not appear to change with time. Similarly, the prognostic information provided by Dukes' staging system was valid at all studied time intervals after surgery, although it declined after the second year. The importance of these results in relation to the selection of patients for adjuvant treatment is discussed.
Adenocarcinoma↗
Effectiveness of a long intestinal tube in a one-stage operation for obstructing carcinoma of the left colon.
Five consecutive patients with obstructing carcinoma of the left colon were successfully managed by long intestinal tube decompression. The tube was introduced pernasal into the duodenum on the day of admission. The tube advanced spontaneously into the ascending colon with marked abdominal decompression within several days. Thereafter, preoperative colonic irrigation through this tube was performed. In three of five patients, segmental colectomy was accomplished without intraoperative cleansing. In two patients, fecal residue was removed by intraoperative colonic irrigation using the long tube. Proximal colostomy was avoided in all patients. This treatment protocol enabled: 1) both preoperative and intraoperative colonic irrigation and cleansing; 2) elective surgery instead of emergency; 3) safe one-stage operation with secure colonic anastomosis; and 4) segmental resection rather than subtotal resection of the colon.
Adult↗