Biomedical subjects

J J DeCosse

Publications and source records attributed to J J DeCosse.

At least 19 recordsLinked to original sources

PubMed1992

Treatment options for the patient with colorectal cancer.

Treatment decisions for patients with colorectal cancer depend on the site and extent of the cancer. Medical factors rarely preclude appropriate treatment. For colonic and upper rectal cancer, curative treatment is almost entirely operative. Even patients with disseminated colon cancer merit a limited palliative resection to abort bleeding and prevent obstruction. When surgery is elective, colostomy is rarely necessary, although it may be required in patients who have obstructed or perforated colon cancer. For distal rectal cancer, various treatment options, including radiation therapy, have reduced the need for a colostomy, although maintaining comparable cure rates. Currently, only about one in seven patients with rectal cancer requires a permanent colostomy.

Colorectal Neoplasms↗

PubMed1992

Loss of colonic HLA antigens in familial adenomatous polyposis.

The loss of HLA antigens by neoplastic cells is considered important for tumor growth and metastasis, since it may allow tumors to escape immune surveillance. We studied the expression of HLA class I and II antigens in the colons of 10 patients with familial adenomatous polyposis (FAP), a condition which leads inevitably to colorectal cancer. Expression of HLA class antigens was studied by immunohistochemistry in (a) adenomas from patients with FAP, (b) histologically normal mucosa distant from the adenomas, and (c) histologically normal colonic mucosa from normal subjects. The expression of HLA class I and II antigens was decreased in histologically normal mucosa from FAP patients compared to normal controls. Adenomas showed a similar but quantitatively more pronounced reduction (or loss) of HLA antigen expression. The reduction of HLA expression in adenomas was comparable to that observed in sporadic colon carcinomas. This generalized suppression of HLA gene expression in the colon of FAP patients, which precedes the onset of overt histological manifestations of neoplasia, may be an important early event in colon carcinogenesis.

Adenomatous Polyposis Coli↗

PubMed1992

Clostridial septicemia in an urban hospital.

The records of 56 patients at an urban hospital who had positive blood cultures for clostridia were reviewed. Each patient was classified as immunologically normal or immunosuppressed. Data were collected on clinical history, type of clostridial bacteremia, physical and laboratory determinants of infection, therapeutic intervention, clinical course and outcome. Of the 56 patients, 22 were determined to be immunosuppressed. Among all 56 patients, 28 had a malignancy, usually gastrointestinal or hematologic in origin. Fever, leukocytosis and abdominal pain were common in both groups. Clostridial bacteremia almost always heralded clostridial septicemia. A gastrointestinal source of infection, particularly carcinoma of the colon or rectum or enterocolitis, was evident or presumed in 43 of the 56 patients. Clostridium perfringens was the most frequently isolated microorganism, but C. septicum was associated with more complications and a higher mortality rate. Septic complications and mortality were higher among the patients with immunosuppression.

Adolescent↗

PubMed1992

Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon.

Eighty consecutive patients presenting with complete large intestinal obstruction from primary carcinoma were evaluated. A multivariate analysis was performed to evaluate perioperative morbidity and mortality. There were five deaths in the immediate postoperative period (30 days). Extensive and lesser complications occurred in eight and 11 patients, respectively. There were 25 lesions of the right colon, whereas in 55 patients, the lesion was located distal to the left branch of the middle colic artery. Females were more likely to present with obstructed carcinomas of the left colon than males. Patients with an obstruction of the left colon more frequently presented with dehydration than those with a tumor of the right colon (p less than 0.05). Most carcinomas of the right colon were resected, whereas lesions of the left colon were managed with diverting colostomy in 33 patients and by primary resection in 22. Thirteen patients with carcinomas of the left colon had an immediate anastomosis without mortality. Preoperative severe cardiopulmonary disease, Acute Physiology and Chronic Health Evaluation score and advanced carcinoma (Dukes' C or D) were statistically related to early hospital morbidity and mortality, while individual physiologic parameters, site of lesion or operation performed were not. Primary resection may be performed safely in selected patients. Multivariate assessment and clinical staging may allow for appropriate patient selection and improve immediate outcome.

Aged↗

PubMed1991

Ploidy in invasive colorectal cancer. Implications for metastatic disease.

A retrospective study was performed to determine the ploidy of superficial (above muscularis propria) and deep (below muscularis propria) biopsy specimens from the primary colorectal cancer of 88 patients with Dukes Stage C2 and D colorectal tumors. The ploidy of lymph node and liver metastases was compared with that of the superficial and deep specimen from the corresponding primary tumor. Among the tumors studied, 78% exhibited nondiploid stemlines. In 19% of the tumors, the ploidy of the superficial biopsy differed from that of the deep biopsy. Among these discordant tumors, all of the deep biopsy specimens corresponded in ploidy to the liver metastases, whereas most of the superficial specimens were similar in ploidy to the lymph node metastases. Our observations suggest that measurement of a single site may not be sufficient to detect nondiploid stemlines within a tumor. They also suggest that measurement of deeper parts of invasive tumors may be more reflective of the phenotype of distant metastases than measurement of superficial specimens.

Colorectal Neoplasms↗

PubMed1991

Familial polyposis coli: the spectrum of ocular and other extracolonic manifestations.

Familial polyposis coli (FPC) is hereditary condition that conveys a virtual 100% risk for the development of colon cancer in the untreated patient. A total of 56 patients with FPC underwent complete ophthalmic examination. Highly pleomorphic pigmented retinal lesions were identified bilaterally in 52% (n = 29) and unilaterally in 14% (n = 8) of our subjects. In all, 33 patients had one or more extracolonic expressions associated with FPC, including desmoids, osteomas, epidermoid cysts, lipomas, fibromas, and upper gastrointestinal tract polyps. In 15 patients, pigmented fundus lesions were the only extracolonic manifestations. No significant association between eye findings and other extracolonic manifestations could be established. The presence or absence of pigmented fundus lesions was found to cluster within families. Pigmented fundus lesions are probably a variably penetrant expression of the polyposis gene and do not appear to be specifically associated with subgroups of inherited polyposis syndromes such as Gardner's syndrome.

Adenomatous Polyposis Coli↗

PubMed1991

Sphincter-sparing surgery.

Since World War II, a variety of technical innovations have been introduced to preserve the anal sphincter in patients with chronic ulcerative colitis or tumors of the rectum. Studies of anorectal physiology have yielded guidelines for preserving continence and minimizing morbidity. For example, preservation of the anal rectal angle is essential; the rectal mucosa can be removed without impairing neural mechanisms; construction of a reservoir increases rectal compliance. Following these guidelines, surgeons have introduced new techniques and applications benefiting a larger and more varied patient population. Some technical problems remain, however, and patient selection criteria for restorative rectal surgery need to be refined.

Colitis, Ulcerative↗

PubMed1990

Reduced expression of HLA class I and II antigens in colon cancer.

The expression of HLA class I and II antigens was studied by immunohistochemistry in (a) specimens of colon cancer from 25 patients, (b) normal colonic mucosa obtained 5-10 cm away from each tumor, and (c) colonic mucosa from 13 normal individuals. Thirteen of the tumor specimens had normal epithelium adjacent to the cancer, which thus served as an internal control. The expression of HLA class I antigens in colon cancer was dramatically reduced compared to control (P less than 0.0001): undetectable in 28%, diminished in 68%, normal in 4%. The expression of class II antigens was also reduced in cancer (P less than 0.0001 for all when compared to normal), being undetectable in most (HLA-DP 64%, HLA-DQ 72%, HLA-DR 68%). In 44% of the cancers all three HLA class II antigens were undetectable; in 92% at least one class II antigen was undetectable; and in 20% both class I and class II antigens were undetectable. No cancer specimen had a completely normal HLA phenotype. The expression of other surface antigens was preserved in cancer tissues and, therefore, loss of HLA antigens was not due to a nonspecific decline in surface molecules. When glands of normal mucosa immediately adjacent to cancer were compared to those of normal controls, significantly reduced expression of only HLA class I antigens (P = 0.0149) and HLA-DP (P = 0.034) was found. The expression of the HLA antigens in colonic mucosa remote from the cancer was no different from that of normal controls. Our data show extensive and significant reduction in the expression of HLA antigens in colon cancer; its potential relationship to immunosurveillance in cancer is discussed.

Colon↗

PubMed1990

Abnormal DNA ploidy and proliferative patterns in superficial colonic epithelium adjacent to colorectal cancer.

Superficial colonic cells were taken from normal-appearing mucosa at 2, 5, and 10 cm proximal and distal to colorectal cancer margins in 37 patients. The DNA ploidy and proliferative pattern of each sample were determined using flow cytometry. In 11 patients, histology of mucosal sections from the same sites also was analyzed. We found a higher frequency of aneuploidy than previously reported in mucosa up to 10 cm from a colorectal cancer; 62% (23/37) of the primary cancers were aneuploid, and of these, 48% (11/23) were associated with adjacent aneuploid mucosa. The mucosa adjacent to the 14 diploid cancers had only diploid characteristics. The proliferative activity (as reflected by synthetic (S) phase fraction) of aneuploid cancers (21.1 +/- 2.0% SEM) and aneuploid mucosa as far as 10 cm away (21.2 +/- 2.1% SEM) was higher than in normal controls (10.2 +/- 0.7% SEM) (P less than 0.0005). Parallel cytology excluded shed cancer cells as an explanation for these findings. Histology showed diffuse, generally mild and reactive, mucosal abnormalities in eight of 11 patients. Ploidy did not correlate with histologic abnormalities. The findings of aneuploidy and high S-phase fraction in uninvolved superficial mucosa provide evidence for a field defect in mucosa adjacent to colorectal cancer and support the concept that the large bowel mucosa behaves as a unit in carcinogenesis.

Adult↗

PubMed1990

Effect of flurbiprofen and 16,16-dimethyl prostaglandin E2 on gastrointestinal tumorigenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine in rats: glandular epithelium of stomach and duodenum.

The effect of an exogenous synthetic prostaglandin analogue, 16,16-dimethyl prostaglandin E2 (16,16-dm-PGE2), as well as the effect of endogenous prostaglandin synthesis inhibition by a cyclooxygenase inhibitor, flurbiprofen, on chemically induced gastric carcinogenesis has been investigated in rats. Carcinogenesis was induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG; CAS:70-25-7). Animals were divided into six groups: Group I, treatment with MNNG alone; Group II, treatment with 16,16-dm-PGE2 plus MNNG; Group III, treatment with flurbiprofen plus MNNG; Group IV, treatment with 16,16-dm-PGE2 alone; Group V, treatment with flurbiprofen alone; and Group VI, controls. Treatment with high doses of MNNG resulted in rapid development of malignant tumors originating from the glandular epithelium of the stomach and duodenum in animals of all groups receiving the carcinogen. The first gastric adenocarcinoma infiltrating the muscularis proper was detected after 139 days in an animal treated with a combination of MNNG and flurbiprofen. The incidence of infiltrating adenocarcinoma and the incidence of all neoplastic lesions of the glandular stomach were both significantly higher in animals treated with a combination of MNNG and flurbiprofen compared with treatment by MNNG alone or in combination with 16,16-dm-PGE2 (P less than 0.05 and P less than 0.001). The difference in tumor incidence between the last two groups was not significant. The first duodenal adenocarcinoma was detected on Day 114 in another animal of the group treated with MNNG plus flurbiprofen. When compared with the group treated with MNNG plus 16,16-dm-PGE2, significantly more animals developed duodenal adenocarcinoma when treated with MNNG plus flurbiprofen (P less than 0.005) or with MNNG alone (P less than 0.05). Results of this study indicate that inhibition of endogenous prostaglandin synthesis favors development of adenocarcinoma in the glandular stomach of rats. Vice versa, the addition of an exogenous prostaglandin analogue inhibits the development of duodenal adenocarcinoma. This protective effect of prostaglandins may be due to an increase of the thickness of the mucus gel covering the glandular epithelium, thereby preventing access of carcinogen to the mucosa.

16,16-Dimethylprostaglandin E2↗

PubMed1990

Surveillance strategies after resection of carcinoma of the colon and rectum.

The primary aim of postoperative surveillance of patients with carcinoma of the colon and rectum is to detect recurrent tumor when cure is still possible. Most recurrences are detected within 30 months after the initial operation. Patients who have had carcinoma of the colon and rectum must be observed not only because of the risk of recurrence or metastatic disease but also because of the increased risk of subsequent primary carcinomas of the colon and rectum as well as of other sites. Careful history-taking and thorough physical examination provide the first indication of tumor recurrence in as many as 48 per cent of instances. Although the liver is the most common site of metastases from carcinoma of the colon, liver chemistry tests are seldom the first to indicate recurrent disease. Fecal occult blood testing, roentgenography with barium enema and colonoscopy are useful surveillance tools, not for detecting recurrences but for detecting second primary carcinomas. Imaging techniques, such as intravenous pyelography, CT and scintigraphy of liver and spleen are generally not cost-effective in surveillance, but MRI and ultrasonography have shown some promise in detection of recurrence without exposing patients to ionizing radiation. The most effective indicator of recurrent disease is a progressive increase in serial levels of CEA. When CEA levels rise and other methods of imaging cannot account for the change, second-look operation is generally appropriate.

Biomarkers, Tumor↗

PubMed1990

Cytoreductive surgery.

The results of experimental studies suggest that cytoreduction has important potential benefits. In the laboratory setting, reduction of tumor burden increases the sensitivity of remaining tumor to chemotherapy and radiation therapy by increasing the proportion of proliferating tumor cells, by decreasing the number of necessary chemotherapeutic cycles necessary to eradicate the tumor, by improving cellular distribution of oxygen and nutrient within the tumor and by reducing the likelihood that resistant clones will develop. The evidence for clinical benefit seems much more limited. In general, a benefit of cytoreduction in extending the survival or disease-free interval appears likely only if there is effective chemotherapy or radiation therapy. Hence, benefits of cytoreduction have been acknowledged in pediatric solid tumors, lymphoma and carcinoma of the ovary, for which effective adjuvant treatments exist. Patients with certain tumors that exhibit biologically favorable characteristics may benefit from cytoreduction, even though the usefulness of other treatment modalities may be minimal. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

DNA content of rectal scrapings from individuals at low and high risk for the development of colorectal cancer. A feasibility study.

Scrapings of superficial rectal mucosa were collected from 31 patients with colorectal carcinoma, 66 patients with sporadic adenoma, and 53 control subjects with no personal or family history of colorectal cancer. The DNA ploidy level and proliferative patterns of each specimen were analyzed by flow cytometry (FCM). A GMS index, calculated as the ratio of G2 + M:S, was found to be significantly lower in control subjects than in any of the high-risk groups studied. Aneuploidy was more prevalent in rectal scrapings from cancer patients and adenoma patients than in those from control subjects. Aneuploid cell populations were detected in apparently normal rectal scrapings from two control subjects. Some high-risk individuals (i.e., cancer patients and patients with adenomas and a family history of cancer) exhibited higher proportions of tetraploid (designated G2/M) cells and a higher G2/M:S phase ratio than control subjects. The results accumulated thus far show that the rectal scraping procedure is safe and easy to perform. Our limited findings give hope that the DNA content analysis of cells obtained by rectal scraping may eventually prove useful in mass screening for colorectal cancer risk. However, definitive evaluation will require further refinement and elaboration of analytic technique and testing on more patients at various levels of predetermined risk.

Adenoma↗

PubMed1989

Effect of wheat fiber and vitamins C and E on rectal polyps in patients with familial adenomatous polyposis.

Over a 4-year period in a chemoprevention trial on large bowel neoplasia, 58 patients with familial adenomatous polyposis were treated with 4 g of ascorbic acid (vitamin C)/day plus 400 mg of alpha-tocopherol (vitamin E)/day alone or with a grain fiber supplement (22.5 g/day). In this randomized, double-blind, placebo-controlled study, we determined the effects of these supplements on rectal polyps in these patients. Analysis by intent to treat suggested that the high-fiber supplement had a limited effect. Analysis adjusted for patient compliance showed a stronger benefit from the high-fiber supplement during the middle 2 years of the trial. The results provide evidence for inhibition of benign large bowel neoplasia by grain fiber supplements in excess of 11 g/day in this study population. The findings are consistent with the hypothesis that dietary grain fiber and total dietary fat act as competing variables in the genesis of large bowel neoplasia.

Adenomatous Polyposis Coli↗

PubMed1989

Conservative treatment of distal rectal cancer by local excision.

From 1954 through 1982, 57 patients with invasive, distal rectal cancer had a full-thickness local excision with curative intent. Prognostic criteria and need for further treatment were based on the histopathologic results of the operative specimen. The overall 5-year survival rate was 83.4%. The rectal cancer-specific mortality rate was 10.5%. None of the 27 patients without adverse prognostic factors died from rectal cancer, and for this group local excision alone was sufficient treatment. The only single factors associated with an adverse outcome were mucinous characteristics and full-thickness invasion. Ulceration alone and penetration into the muscularis propria alone were not adverse factors. In the presence of multiple adverse prognostic factors, mucinous characteristics or full-thickness penetration, local excision was inadequate treatment and an abdominal perineal resection was necessary.

Adenocarcinoma↗

PubMed1989

Early gastric cancer.

Thirty-six patients with early gastric cancer were studied. In 15 patients, malignancy was restricted to the mucosa; in 21 patients, submucosal invasion was noted. Lymph node involvement was found in four patients. Kaplan-Meier estimates for 5-year survival were 92 percent for mucosal lesions and 65 percent for submucosal lesions (overall 5-year survival rate 73 percent). Mucosal lesions were significantly larger than were submucosal lesions (3.7 +/- 0.6 cm versus 2.5 +/- 0.4 cm, mean +/- SE; p less than 0.005). Associated malignancy was recorded in 13 of 36 patients. When compared with data from a large Japanese study, early gastric cancer in the United States tends to develop more distally in the stomach and in patients approximately one decade older. Survival was not as favorable as in Japan. This may be related to patient age and the high incidence of associated nongastric malignancy.

Adenocarcinoma↗

PubMed1989

Abdominal actinomycosis: evaluation by computed tomography.

Actinomycosis causes disease in multiple organ systems and involves the abdomen approximately 20% of the time. We report a case of a 48-yr-old woman with a large abdominal mass secondary to actinomycosis. The patient demonstrates the clinical and pathologic features of this disease, as well as the role of evaluation by barium examination and computed tomography (CT). A discussion of abdominal actinomycosis is included.

Actinomycosis↗

PubMed1988

Early cancer detection. Colorectal cancer.

Persons with symptoms or signs suggestive of colorectal cancer require complete exam of the large bowel either by sigmoidoscopy, preferably flexible, with barium enema, or by total colonoscopy. A test for fecal occult blood (FOBT) is not necessary here. In asymptomatic persons at average risk for colorectal cancer, the following screening recommendations are made: from age 40, annual digital rectal exam and FOBT; and, from age 50, sigmoidoscopy, preferably flexible, every 3 to 5 years after two negative annual exams. If there is a family history of colorectal cancer in one or more first-degree relatives, annual digital rectal exam and FOBT should begin at age 40, with either barium enema and sigmoidoscopy or total colonoscopy every 3 to 5 years. Persons with a history of chronic ulcerative colitis, polyposis syndromes, or prior colorectal adenomas or cancer merit special attention.

Colonoscopy↗