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Analysis of length and surface area of each segment of the large intestine according to age, sex and physique.

Length, diameter and surface area of each of 6 segments of the large intestine were determined and calculated in 920 Japanese patients who underwent barium enema. Of the length and surface area measurements obtained, those of the transverse colon were the largest, followed by those of the sigmoid colon. The diameter of the ascending colon was the largest, while those of the descending colon and sigmoid colon were the smallest. There were various sex differences in size of the large intestine. Length and surface area of the entire large intestine in males were shorter and smaller respectively than those in females. Lengths of the cecum, ascending colon, transverse colon and rectum in males were shorter than those in females. Diameters of the descending colon, sigmoid colon and rectum in males were larger than those in females. Total surface areas of the ascending colon and transverse colon in males were smaller than those in females, while total surface areas of the descending colon, sigmoid colon and rectum in males were larger than those in females. Length of the entire large intestine tended to be increased with age. Length and surface area of the entire large intestine tended to be increased with an increase in physical dimensions in females.

Adolescent↗

S-methyltransferases in human intestine: differential distribution of the microsomal thiol methyltransferase and cytosolic thiopurine methyltransferase along the human bowel.

1. The activities of the microsomal thiol methyltransferase and the cytosolic thiopurine methyltransferase were measured with 2-mercaptoethanol and 6-mercaptopurine as substrates in human ileum, ascending colon, transverse colon, descending colon and liver. 2. Thiol methyltransferase activity (pmol/min per mg) (mean +/- SD) was 495 +/- 280 (ileum), 786 +/- 454 (ascending colon), 1791 +/- 233 (transverse colon), 964 +/- 484 (descending colon) and 4800 +/- 1194 (liver). 3. Thiopurine methyltransferase (pmol/min per mg) (mean +/- SD) was 53.5 +/- 15.4 (ileum), 34.6 +/- 11.4 (ascending colon), 64.3 +/- 12.1 (transverse colon), 57.0 +/- 10.1 (descending colon) and 106 +/- 20.4 (liver). 4. Transferase in intestinal mucosa followed non-Michaelis-Menten kinetics, and two phases representing high and low affinity forms, for the acceptor methyl substrates were observed. 5. Comparison of intestinal with hepatic activities showed that thiopurine methyltransferase is better expressed than thiol methyltransferase in the human intestine, at least with the substrates studied.

Adult↗

Colorectal transport in normal defaecation.

OBJECTIVE: Colorectal luminal transport during defaecation can be assessed by means of scintigraphy. However, normal values remain to be established and inter- and intra-subjective variation is unknown. The aim of the study was to describe colorectal transport during normal defaecation by means of a new method for colorectal scintigraphy and to determine inter- and intrasubjective variation. METHODS: Thirty healthy volunteers (18 men and 12 women, age 22-46 years; median 31) took 2 MBq 111In on two consecutive days (days 0 and 1). On days 1 and 2 an abdominal scintigraphy was done before and after defaecation. Changes in colorectal contents were computed in two ways: firstly, assuming ordered evacuation, the extent of colorectal emptying was computed; secondly, antegrade and retrograde transport within the colorectum was computed for each colorectal segment. RESULTS: Median colorectal emptying during normal defaecation was 99% of the rectosigmoid (range: 60% of the rectosigmoid to complete emptying of the rectosigmoid, descending colon, transverse colon and 19% of the caecum/ascending colon). There was no difference between men (median 99% of the rectosigmoid) and women (98% of the rectosigmoid). Day to day variation was large (dispersion=52%) with a trend towards larger defaecation on day 2 than on day 1 (P = 0.09). Large antegrade and retrograde movements of colorectal contents were observed within the colorectum during defaecation. Antegrade transport involved the rectosigmoid (median 99%), the descending colon (median 53%), the transverse colon (median 46%), and the caecum/ascending colon (median 11%). Retrograde transport was mainly from the transverse colon and the descending colon. Colorectal emptying was significantly correlated to the subjective description (P < 0.01) but not to total gastrointestinal or segmental colorectal transit times determined by means of radioopaque markers. CONCLUSIONS: Colorectal scintigraphy before and after defaecation provides detailed information about colorectal emptying and intracolonic antegrade or retrograde transport during defaecation. Inter- and intraindividual variations are large and antegrade and retrograde transport within the colorectum is common.

Adult↗

APC gene mutations and colorectal adenomatosis in familial adenomatous polyposis.

Correlations between germline APC mutation sites and colorectal pathophenotypes, as evaluated by the direct count of adenomas at colectomy, were investigated analysing colectomy specimens from 29 FAP patients carrying one mis-sense (codon 208) and 14 frame-shift or non-sense APC mutations (codons 232, 367, 437, 623, 876, 995, 1061, 1068, 1075, 1112, 1114, 1309, 1324, 1556). The mis-sense mutation at codon 208 was associated with a relatively mild colorectal pathophenotype. The mutation at codon 367, subject to alternative splicing, was associated with attenuated FAP. The mutation at codon 1309 was associated with the profuse colorectal adenomatosis. For 13 mutations, predicted to result in null alleles or truncated APC proteins, we correlated density and distribution of colorectal adenomas with the predicted functional effects of the mutation. The most severe colorectal pathophenotype was significantly associated with the truncating mutation at codon 1309, which is located downstream to the I beta-catenin binding domain but upstream II beta-catenin-binding domain. Mutations between codons 867 and 1114, which affect the I beta-catenin binding domain, as well as mutations occurring in exons 6 and 9, predicted to result in null alleles, were associated with a less severe colorectal pathophenotype. Overall, the highest number of adenomas was detected in the right colon, followed by the left colon, transverse colon sigma and rectum. However, the highest density of adenomas was observed in the left colon, followed by the right colon, sigma, transverse colon and rectum. Colorectal carcinomas, observed in only five patients, were all in the left colon.

Adenoma↗

Morphological properties of zero-stress state in rat large intestine during systemic EGF treatment.

Systemic treatment with epidermal growth factor (EGF) induce growth of the large intestine. The aim of this study was to investigate the morphological properties early in the course of EGF-induced large intestinal growth. The effects of systemic EGF treatment on the morphological properties at the zero-stress state along the large intestine were investigated. EGF-treated rats and control rats were allocated into group with EGF treatment for 2, 4, 7, and 14 days (N = 6 for each EGF treatment group except N = 4 for the 14-day group). The controls had saline injected (N = 3 for each group). The excised large intestine was subdivided into four segments: the ascending colon, transverse colon, descending colon, and rectum. The length and weight of each segment was measured. The zero-stress state was obtained by cutting rings of the large intestine radially, and the opening angle was measued on video images. The thickness and cross-sectional area of the mucosa and muscle layers, and the inner and outer circumference were measured. The total colon length did not increase, whereas the weight of the large intestine, muscosal thickness and mass, and inner and outer circumference increased significantly (P < 0.05). The increase was most prominent in the proximal colon after 7 days of EGF treatment. Later no further morphological changes were observed, except for a decrease in mucosal thickness in most segments and in mucosal cross-sectional area in the descending colon. In the controls and during the first week of EGF treatment, the opening angle was approximately 100 degrees. After 14 days the opening angle increased significantly in the ascending and transverse colon to approximately 172 and 135 degrees (P < 0.05). In conclusion, this study demonstrates that systemic EGF treatment caused remodeling of the morphology of the zero-stress state in the large intestine in a time-dependent manner. The growth was most pronounced in the ascending and transverse colon and involved mainly the mucosal layer.

Analysis of Variance↗

Normal colon of Sprague-Dawley rats. An immunohistochemical study.

The patterns of expression of the human-tumor-associated antigens, CO17-1A, GA73-3, BR55-2, GICA19-9, CA50 and carcino-embryonic antigen (CEA) were studied in the normal colonic mucosa (the last three also in the serum) of Sprague-Dawley rats. Four immunohistochemically different segments were identified: caecum, ascending colon, transverse colon and descending colon. The immunohistochemical reactions of the cells at the lower part of the crypt were essential for the distinction of the four segments. In the caecum, the MAbs 17-1A, 73-3 and 19-9 stained the glycocalyx of the cells of the lower part of the crypts and the Golgi apparatus of the intercalated cells (IC). MAb55-2 stained very weakly the goblet-like cells (GLC) of the lower part of the crypt of transverse colon, in addition to a nearly complete lack of reaction in the upper part of the crypts. In the ascending colon, the lower part of the crypts showed a characteristic diffuse staining of the intercalated cells with MAb55-2. The perinuclear and mucosal staining observed in the GLC of the transverse colon with MAbs 17-1A, 73-3 and 19-9 as against the supranuclear and Golgi zone staining observed in the GLC/goblet cells (GC)/columnar cells (CC) of the lower part of crypts of the descending colon with the same MAbs, distinguished the former segment from the latter. The IC demonstrated by immunohistochemistry in the lower parts of the crypts of caecum and ascending colon appear to correspond to the replicating cells of the colonic crypts.

Animals↗

Bowel wall fat halo sign in patients without intestinal disease.

OBJECTIVE: Stratification with a fat layer in the intestinal wall is thought to be a reliable marker for inflammatory bowel disease. We evaluated the presence and frequency of the bowel wall fat halo sign in patients undergoing abdominal CT for clinical indications unrelated to the gastrointestinal tract. MATERIALS AND METHODS: We performed a retrospective review of 100 consecutive abdominal and pelvic CT examinations in 61 men and 39 women (mean age, 56 years) with clinical suspicion of renal stone disease. Two radiologists experienced in abdominal imaging performed qualitative and quantifiable assessment of the images. Five segments of the colon (ascending colon, transverse colon, descending colon, sigmoid colon, and rectum) and the terminal ileum (for approximately 1 ft [30 cm]) were evaluated for the presence of the fat halo sign. If the fat halo sign was present, fat density and total wall-thickness assessments were made. Presence or absence of clinical and radiologic signs of inflammatory bowel disease was determined. The Student's t test was used to evaluate the statistical significance, correlating body weight and presence of the halo sign. RESULTS: The fat halo sign was seen in 21 (21%) of 100 patients. Of the 21 patients with the fat halo sign, six (29%) had renal stone disease and 15 (71%) had no stone disease. The density value of the halo sign ranged from -18 to -64 H (mean, -41 H). The distribution of the fat halo sign was as follows: the terminal ileum, 4%; the ascending colon, 28%; the transverse colon, 34%; the descending colon, 36%; the sigmoid colon, 14%; and rectum, 10%. No patient with this sign had any remote, recent, or subsequently recorded history of inflammatory bowel disease. A statistically significant relationship (p < 0.001) was seen between the presence of the fat halo sign and body weight distribution, with 16 of 21 patients weighing over 200 lb (90 kg). CONCLUSION: In the absence of clinical or radiologic evidence of inflammatory bowel disease, the presence of the fat halo sign may represent a normal finding that is possibly related to obesity.

Adipose Tissue↗

Cytomegalovirus colitis in AIDS: CT features.

OBJECTIVE: The purpose of this study was to determine the CT features of cytomegalovirus colitis in patients with AIDS. MATERIALS AND METHODS: Abdominal CT scans of 24 patients with biopsy-proved cytomegalovirus colitis (colonoscopy, n = 14; sigmoidoscopy, n = 8; surgery, n = 2) were jointly reviewed by two observers. Patients were men 26-68 years old (mean age, 39 years; SD, 9 years) with CD4 counts of 3-129 mm3 (mean, 32 mm3; SD, 34 mm3). The mean interval between CT and biopsy was 6 days (range, 0-20 days; SD, 6 days). Scans were assessed for colonic wall thickening (> or = 4 mm), ulceration, mural edema, pericolonic stranding, ascites, lymphadenopathy, and thickening of the small-bowel wall. Mural involvement was recorded as asymmetric or circumferential. Disease location was recorded as ascending colon, transverse colon, descending colon, rectosigmoid colon, or pancolonic. RESULTS: Colonic wall thickening of 8 to 33 mm (mean, 15 mm; SD, 6 mm) was seen in 22 patients. One patient had pancolonic involvement. The ascending colon was involved in 13, the transverse colon in five, the descending colon in 10, and the rectosigmoid colon in 16. Circumferential colonic thickening was seen in 17 patients. Deep mural ulceration was seen in 15 patients, mural edema in 15, pericolonic stranding in 23, ascites in 10, lymphadenopathy in four, and small-bowel involvement in 10. Two patients had appendicitis. Three patients had perforations (two rectal, one cecal). One patient had a giant rectal ulcer. CONCLUSION: Although many of the CT features of cytomegalovirus colitis are nonspecific, the diagnosis should be suggested when CT shows colonic wall thickening, particularly if the thickening is associated with mural ulceration in patients with AIDS and CD4 counts of less than 200 mm3.

AIDS-Related Opportunistic Infections↗

[Surgical standards in primary colon cancer].

The surgical standards in the treatment of primary cancer of the colon include the radical resection of the tumor-bearing colon with truncal ligation of its vessels. Eradication of the tumor with complete dissection of the lymphatic drainage area increases the chance for cure (R0). The lymphatic dissection determines the extent of colonic resection: right hemicolectomy (ileo-transversostomy) with truncal ligation of the iliocolic and right colonic arteries for carcinomas of the cecum and ascending colon; transverse colectomy (ascendo-descendostomy) with ligation of the middle colic artery for carcinomas in the middle of the transverse colon; left hemicolectomy (transverso-rectostomy) with ligation of the inferior mesenteric artery at the aorta for cancer of the descending and sigmoid colon; extended sigmoid resection (descendo-rectostomy) with central lymphadenectomy and ligation of the inferior mesenteric artery distal to the left colic artery for cancer of the distal sigmoid colon. Carcinomas located in between two drainage areas (lateral transverse colon, hepatic or splenic flexure) are treated by extended hemicolectomies or subtotal colectomies with dissection of two lymphatic drainage areas. The monobloc no-touch isolation technique requires the ligation of vessels prior to the mobilisation of the colon. Exceptions from these standard operations (limited resections) are necessary for metastatic disease or in the acute emergency situation of perforation or obstruction. Application of these surgical principles will ensure the best possible treatment results in primary colonic cancer.

Anastomosis, Surgical↗