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Three cases are reported of bleeding angioma of the caecum. The wider use and improved technique of selective arteriography have led to an increase in frequency of diagnosis of this condition, and facilitate the management.
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A total of 519 patients presenting with carcinoma of the caecum in the Plymouth Health District between 1975 and 1987 were reviewed. The clinical course was determined in relation to patients with and without a history of previous appendicectomy. There was no difference in the incidence of previous appendicectomy between patients with carcinoma of the caecum and an age and sex matched control group. The presence of synchronous carcinomas and/or adenomas was unrelated to previous appendicectomy. Ten patients presented with appendicitis and 11 with a mucocele of the appendix as the first sign of carcinoma of the caecum. Previous appendicectomy was associated with a higher incidence of local fixity, invasion of the abdominal wall, metastatic spread and poor differentiation. These differences were reflected in a significantly lower resection rate for carcinomas in patients who had previously undergone appendicectomy. The survival of patients who had previously had appendicectomy was significantly reduced. Four independent prognostic factors for survival were identified using multivariate discriminant analysis. These were Dukes' classification, local invasion, tumour differentiation and previous appendicectomy. Local recurrence was more common in patients who had previously had appendicectomy and was often in the old appendicectomy wound itself. Appendicectomy does not increase the risk of carcinogenesis in the caecum. In this study a history of appendicectomy was an independent risk factor for survival and significantly worsened the prognosis for patients who subsequently developed carcinoma of the caecum.
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The impact of intraoperative ultrasonography (IOUS) on treatment strategy was studied in 122 patients with primary colorectal cancer. All patients underwent preoperative liver imaging by ultrasonography and computed tomography (CT). After curative resection of the primary tumour patients were eligible for adjuvant chemotherapy. The findings on IOUS were assessed by ultrasonography 6 months after laparotomy. Of 34 patients with suspected liver metastases on ultrasonography or CT, the diagnosis was confirmed by IOUS in 21. In the remaining 13 patients the suspect lesions were shown to be benign. Of the 88 patients with normal preoperative imaging results, suspect lesions were detected in five; in four the lesion was found by IOUS only. One of these four also had an extrahepatic metastasis. At follow-up the diagnosis of metastasis proved to be wrong in two of the remaining three patients, so IOUS was helpful in only one patient. Surgical management was not markedly influenced by findings on IOUS in any patient. However, IOUS correctly changed the stage of the disease, and consequently postoperative treatment, in 14 patients (11 per cent). Two patients were erroneously excluded from the adjuvant protocol following an incorrect diagnosis based on IOUS.
An important element of the evaluation of patients with infective endocarditis is the determination of an infectious source. In approximately 20-45% of cases, no source is identified. Often the specific organism involved implicates the source, as is classically described by the association of S. bovis with colonic neoplasia. Other gut organisms have been reported to infect heart valves when colorectal pathology is present, but at far less frequency than S. bovis. This report deals with the case of a 75-year-old man with Enterococcus faecalis endocarditis of an unusual source--a cecal carcinoma that was causing intermittent appendiceal obstruction and infection. This case adds to previous case reports which suggest that the occurrence of enterococcal endocarditis in the absence of a classic infectious source should lead to a search for occult colorectal pathology.
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Clinical and histopathological features were correlated with cytogenetic banding studies on direct preparations from 31 large-bowel tumors. An interesting relationship between the site and the karyotypes of the tumors was observed. There appears to be a progressive increase in chromosomal number and/or structural rearrangement as one progresses from proximal to distal large bowel. We suggest that these observations may be related to differences in function and micro-environment within different areas of the colon. Although it is not known what factors favor cytogenetic variability and instability on the left side or the presence of fewer abnormalities on the right side of the colon, it is evident that clonal karyotypic evolution may be important in the progression of large-bowel cancer. The brevity of follow-up precludes conclusions regarding the influence of karyotype on survival.
The results of this multicentre autopsy study emphasize the relationship between the prevalence of adenomas and the incidence of large-bowel cancer. The highest proportion of autopsies with adenomas was observed in the area with the highest incidence of large-bowel cancer. The segmental distribution of adenomas within the colon was found to be similar to the site distribution of cancer. However, the lowest proportion of adenomas was found in the rectum, the segment in which cancer is most frequent. The latter finding suggests that either the adenoma-carcinoma sequence is a less important pathway in the pathogenesis of rectal cancer, or that more rectal than colonic adenomas become malignant. The high proportion of hyperplastic polyps in the rectum, and statistically significant regional differences following the same patterns as the incidence of rectal cancer suggest that there could be at least an indirect relationship between hyperplastic polyps and cancer of the rectum. Adenomas of both colon and rectum were more frequent in men than in women, contrary to findings with colon cancer. However, as for colon cancer, the sex ratio of adenomas changed with age, from slightly below unity in persons under 65, to above unity for those aged 65 and over. A major difficulty that emerged was the histological identification of "polyps" because of the degree of autolysis of epithelial cells in the mucous membrane, and this difficulty largely contributed to the poor consistency of histological reporting. Regular consistency surveys of histological preparations should be recommended in any type of multicentre study in which histological examination is included.
Register and census data for complete cohorts of Norwegian men and women born between 1935 and 1969 have been used to examine the relationship between reproductive factors and the incidence of colorectal cancer. Among 1.1 million men and 1.1 million women under observation, 491 male and 859 female cases of colorectal cancer were diagnosed during the period of follow-up. Our hazard model estimates clearly show that in these young cohorts, women with 2 or more children run a lower risk of having a malignant tumor in the cecum or ascending colon than do other women of the same age and in the same birth cohort. No association with parity is found with respect to cancer in the transverse or descending colon, whereas a downward trend in the effect estimates, followed by an upturn, appears for the rectum, sigmoid colon and rectosigmoid junction. Such correlations, which also hold when we control for education and place of residence, are not found for men. The observed relationship between parity and cancer incidence is not likely to be exclusively explained by life-style differentials. Presumably, there is a biological effect of the number of pregnancies and deliveries, net of age at first birth and other reproductive factors, on the development of colorectal cancer.
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A 55-year-old Japanese man presented with a fist-sized, nonremovable mass in the right lower abdomen. Transabdominal sonographic examination revealed extensive wall thickening without stratification in the distal ileum and cecum, whose echogenicity was homogeneous and extremely low. Some compressibility of the affected bowel was retained. Diagnostic findings obtained with other conventional modalities were consistent with intestinal malignant lymphoma. At surgery, 3 tumors were found in the ileocecal region and the ileum. Histopathological, immunophenotypic, and molecular cytogenetic analysis of resected specimens showed a diffuse Burkitt-like type of B-cell lymphoma.
BACKGROUND AND OBJECTIVES: We performed a retrospective analysis to assess the influence of different prognostic factors, including the International Prognostic Index (IPI), that can predict the outcome in patients with primary large bowel lymphoma (Stage IE) treated with combined therapy (surgery followed by chemotherapy). METHODS: All patients were treated with radical surgery followed by six cycles of combined chemotherapy: CHOP-Bleo (cyclophosphamide, doxorubicine, vincristine, prednisone, and bleomycin) or variants (epirubicin instead of doxorubicin). In all cases, an multivariate analysis was performed to identify prognostic factors (if any), including IPI, that can influence outcome. RESULTS: According to the IPI, event-free survival (EFS) and overall survival were 85% and 87%, respectively, in patients with low and low-intermediate clinical risk that was not statistically significant when compared to patients at high and high-intermediate clinical risk: 69% and 76% (P = 2). Multivariate analysis failed to demonstrate the influence of multiple prognostic factors that were analyzed. CONCLUSIONS: Combined therapy appears to be an excellent therapeutic approach in this group of patients with prolonged EFS and survival, and without late toxicity. However, no prognostic factors, including IPI, could be identified to define the best therapy, probably because the number of patients, even in large series, is limited. Multicentric studies are necessary to identify prognostic factors to define therapy and outcome in this rare clinical presentation of malignant lymphoma.
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We describe here a novel technique of isoperistaltic side-to-side ileocolic anastomosis following right hemicolectomy with minimal use of linear cutter (GIA-80) in 16 of our patients. Compared to the traditional standard technique, we found our new technique to be simple, safe, and cost-effective. It probably also helped in faster and uncomplicated recovery of our patients.