Gastrointestinal endoscopy (2)
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Biomedical subjects
Publications and source records attributed to J F Morrissey.
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Tissue activity levels of ornithine decarboxylase (ODC) have been suggested to be a marker of colonic epithelial cell proliferation and risk for colorectal cancer. Supplemental dietary calcium has been hypothesized and reported to suppress colonic epithelial-cell proliferation. We measured sigmoid and rectal mucosal ODC activity levels in 45 healthy, disease-free subjects with strong family histories of colorectal cancer before and after 2 months, during which daily dietary supplementation with calcium carbonate (to provide 600 mg calcium base) was taken. Although the mean ODC activity levels decreased in both sigmoid and rectal specimens, these changes were small in relation to the standard deviation and were not statistically significant. These data suggest that the magnitude of dietary calcium intake does not significantly influence sigmoid-rectal mucosal ODC activity levels and that ODC measurements may not be a useful intermediate endpoint for interventions designed to interrupt the colon carcinogenic sequence.
Ornithine decarboxylase (ODC) catalyzes the formation of putrescine from ornithine, which is the first step in the pathway of mammalian polyamine biosynthesis. Tissue activity levels of ODC have been suggested to be a marker of risk for colorectal cancer in hereditary polyposis and in adenoma formers. We analyzed ODC activity in rectal and sigmoid colon mucosal biopsies obtained at 10 cm and at 30 cm in 40 healthy, colon cancer risk factor-free adults following three endoscopic preparation regimens: 1) no special preparation; 2) two phosphate enemas; and 3) "Colyte" lavage preparation 12 hr previously. Levels of ODC, measured in fresh tissue, were approximately twofold higher for enema preparation vs. no preparation (for log-transformed data: sigmoid, P less than 0.0001; rectum, P = 0.0001) and for enema preparation vs. lavage (sigmoid, P = 0.0002; rectum, P = 0.008). Lavage and no preparation ODC levels were not significantly different. ODC activity levels ranged from 0.00 to 352.96 pmol/mg/hr.
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In a retrospective analysis, we evaluated our results with endoscopic dilation of enterostomy stenoses that complicated gastric procedures performed for the treatment of morbid obesity. Of 541 patients who underwent a gastric procedure for treatment of morbid obesity, we found 19 patients in whom endoscopic dilations of stenoses had been attempted. We also include three patients who had surgery elsewhere but who underwent dilations at our institution. Fourteen had stenoses complicating gastric bypass with Roux-en-Y anastomoses, and eight had stenoses complicating a gastroplasty (gastrogastrostomy). Two different types of dilation were attempted during the interval reviewed--Fogarty balloon dilations and Grüntzig balloon dilations. None of the eight patients with gastroplasties benefited from the attempted dilation, but 10 of the 14 patients with stenoses complicating gastric bypasses have done well. We found no significant difference between Fogarty and Grüntzig balloon dilations. We conclude that balloon dilation is an effective means of treating stenosis that complicates gastric bypass performed with Roux-en-Y anastomoses in cases of morbid obesity.
Four patients were found with patches of gastric fundal type epithelium just distal to the cricopharyngeus, separated from the gastroesophageal junction by 15-20 cm of normal squamous epithelium. Three of the four had symptoms of dysphagia localized to the area of the esophagus containing the epithelium. Congo red dye (a pH indicator) applied to the mucosa during endoscopy revealed acid production by the mucosa after stimulation with pentagastrin. Interestingly, the patients' symptoms decreased during treatment with cimetidine only to return on cessation of therapy.
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Histochemical and histopathologic changes have been described in mucosa adjacent to and overlying neoplasms and non-neoplastic conditions of the large bowel. These changes are considered by some investigators to be preneoplastic changes. We studied mucosal biopsy specimens obtained at colonoscopy from all sections of large bowel in 34 asymptomatic subjects. Every subject had a documented family history of colorectal cancer (Cancer Family Syndrome of Lynch); in addition, two had previous colorectal cancers and two had cancers diagnosed at the time of colonoscopy. Consistent interpretations of mucin species secretion were not obtained. Microscopic mucosal abnormalities were not detected. Mucin histochemical and histopathologic changes are not promising markers for colorectal cancer in the Cancer Family Syndrome of Lynch.
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A prevalence screening program with colonoscopy was undertaken in four kindreds manifesting the cancer family syndrome. Forty-five percent of counseled patients underwent colonoscopy, providing 42 asymptomatic individuals. Seven patients (17%) were found to have adenomatous or villous polyps; two of these were malignant and one showed epithelial atypia. Three of the seven patients with polyps had multiple lesions. Only two patients had rectosigmoid polyps. From these limited data, colonoscopy is recommended as a useful screening procedure in individuals at high risk for colorectal cancer.
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