[Infection of the abdominal cavity after radical operations in diffuse polyposis of the large intestine].
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Biomedical subjects
Publications and source records attributed to A M Nikitin.
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Morphologic characteristics of multiple colonic polyps from 155 patients were analysed. In 23.5% of cases the polyps were proximally localized. The histologic structure in 98.1% out of 316 polyps showed them to be adenomas with different atypical changes of the epithelium, including carcinoma in situ, or invasive cancer. With the increase in adenoma size its histologic structure became more complicated and atypical changes more prominent. Different forms of colonic mucosa multiple adenoma are reviewed, the incidence of malignancy being 11.6%. It is concluded, that thorough examination of the colon and active surgery is indicated in this group of patients.
An analysis of results of examination and surgical treatment of 500 patients with diffuse polyposis coli for the recent 30 years has shown that one fourth of the patients have polyps in the stomach. They have structure of adenoma with different degree of epithelialdysplasia. The incidence of polyps and their structure do not change after operation on the colon. Carcinoma of the stomach in such patients can develop in 0,4% of the cases while the malignization index of colon polyps is 150 times higher. Hence, the conclusion is made of the first and foremost importance of operation on the colon.
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In patients with proliferative and mixed forms of total polyposis of the digestive tract the intestinal polyps are mainly localized in the duodenum, with hamartomal polyposis--in the jejunum and ileus. The endoscopic polypectomy from the small intestine may be performed intraoperatively and during endoscopy under narcosis. 174 polyps with the diameter of 0.5-5 cm were removed in 27 patients. There were 3 complications (bleedings) after polypectomy.
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An attempt has been made to estimate the correlation of oncological illnesses in the families within the limits of segregational and correlational analyses, considering the fact of accumulation in the families of probands with autosomal-dominant polyposes of colon of the cases of primary (without preceding polyposes) colon cancer. Significant correlation was found between the hereditary polyposes and primary colon cancer in the families studied. Based on these data, a hypothesis is discussed of the main gene and its modifications on the phenotypical version in the form of primary benign (polyposes) and malignant (cancer) pathology. No significant correlation was found between colon polyposes and cancer of stomach in the families.
An experience with the surgical treatment of 505 patients with incomplete fistulas of the rectum is analyzed. Preoperative methods of diagnosis are shown to be not very informative. Of determining importance for the selection of the method of surgery is the relationship of the fistula passage to the sphincter fibres. Data of the operation performed and of the nearest postoperative complications are presented.
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Based on the study carried out, we have suggested a populational-genetical model of hereditary polyposes with frequencies of some parameters, such as frequency of mutation, gene's (allele's) frequency, frequency of heterozygotes (general and for separate groups), fertility, fittnes and selection efficiency.
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The prevalence of hereditary autosomal dominant gastrointestinal adenomatosis in the Moscow population was estimated on the basis of elaboration of an indirect method. This estimate was found to be 1:48000. The prevalence observed is discussed in terms of ascertainment problems and peculiarities of the method of calculation proposed.
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