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PubMed1993

Glycosylation and sulphation of colonic mucus glycoproteins in patients with ulcerative colitis and in healthy subjects.

Studies have been made of mucus glycoprotein biosynthesis in different regions of the lower gastrointestinal tract in normal patients and those with ulcerative colitis (UC), active or inactive, by means of 3H-glucosamine (3H-GlcNH2)--35S-sulphate double labelling of epithelial biopsy specimens under culture conditions. The time based rate of 3H-GlcNH2 labelling of mucus in rectal tissue was similar to that in active or inactive UC whereas the rate of 35SO4(2) labelling was significantly increased in active disease. The 3H specific activities measuring the amount of isotopic incorporation into surface and tissue mucus glycoproteins were increased in patients with active UC compared with normal or inactive subjects. The 35S specific activities did not differ significantly between patients with active UC and those in remission. In the rectum, glycosylation of mucus glycoproteins decreases with the increasing age of the patient. Regional differences in 3H-labelling of mucus components are reported for ascending colon, transverse colon, sigmoid colon, and rectum. Sulphation (35S-labelling) was higher in all parts of the colon in left sided UC. Results point to accelerated glycosylation of core proteins in the active phase of UC.

Adult↗

PubMed2004

MR colonography in patients with incomplete conventional colonoscopy.

PURPOSE: To assess dark-lumen magnetic resonance (MR) colonography for the evaluation of colonic segments in patients in whom conventional colonoscopy could not be completed. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Within 24 hours of incomplete conventional colonoscopy, 37 patients (22 women, 15 men; age range, 25-63 years) underwent MR colonography. Contrast material-enhanced T1-weighted three-dimensional images were collected after rectal administration of water for colonic distention. Data from MR colonography were evaluated by two radiologists. With a three-point scale, image quality was characterized in terms of colonic distention (1 = good; 2 = moderate, diagnostic; and 3 = poor, nondiagnostic) and presence of artifacts (1 = none; 2 = moderate, diagnostic; and 3 = extensive, nondiagnostic). Depiction of colorectal disease was assessed according to the following colonic segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. RESULTS: Four patients had history of colorectal cancer, and each had undergone partial colonic resection of two segments. Hence, 214 segments were evaluated. Conventional colonoscopy failed in assessment of 127 of 214 potentially visible colonic segments in the 37 patients. MR image quality was rated diagnostic in 35 patients and permitted assessment of 206 of 214 potentially visible segments. Nondiagnostic image quality in two patients was attributed to inadequate distention of prestenotic colonic segments owing to high-grade tumor stenosis. All inflammation- and tumor-induced stenoses and all five polyps identified at conventional colonoscopy in poststenotic segments were correctly detected at MR colonography. However, MR-based assessment of prestenotic segments revealed two lesions suspected of being carcinoma, five polyps, and four segments affected by colitis. CONCLUSION: MR colonography proved reliable in evaluating the majority of colonic segments inaccessible with conventional colonoscopy. The identification of additional disease at MR colonography underscores the need for a second diagnostic step in the setting of incomplete conventional colonoscopy.

Adult↗

PubMed1987

Histologic and colonoscopic assessment of disease extension in ulcerative colitis.

A comparison between histologic and colonoscopic extension of ulcerative colitis was made in 107 examinations (83 patients). During colonoscopy signs of inflammation were registered, and biopsy specimens were taken from the following gut segments: rectum, left colon, transverse colon, and right colon. Inflammatory activity in the specimens was graded in accordance with severity in a scale from one to five. Endoscopically, total colitis was seen in 40 examinations but was present in 70 examinations histologically. In 34 of 107 examinations the extension of disease was underestimated at colonoscopy. A slight inflammation existed in those segments that appeared normal colonoscopically. Our conclusion is that the extension of ulcerative colitis often is underestimated endoscopically and that inflammatory activity can be present in mucosa assessed as normal on colonoscopy.

Colitis, Ulcerative↗

PubMed2006

Comparative study of two bowel preparation regimens for colonoscopy: senna tablets vs sodium phosphate solution.

AIM: To compare the efficacy and acceptance of senna tablet and sodium phosphate solution for bowel preparation before colonoscopy. METHODS: One hundred and thirty four patients, who needed elective colonoscopy, were randomly allocated to take 180 mg senna tablet or 95 mL sodium phosphate solution on the day before colonoscopy. The efficacies of both laxatives were compared using the mean difference of colon-cleanliness score of the rectum, sigmoid segments, descending colon, transverse colon and cecum. The scores were rated by two observers who were blinded to the laxatives administered. The higher score means that the colon is cleaner. The efficacy of both laxatives were equivalent if the 95% confidence interval of the mean difference of the score of colon lie within -1 to +1. RESULTS: On intention-to-treat analysis, the mean cleanliness scores in the four segments of colon except the cecum were higher in the sodium phosphate group than those in senna group (7.9 +/- 1.7 vs 8.3 +/- 1.5, 8.0 +/- 1.8 vs 8.5 +/- 1.4, 7.9 +/- 2.0 vs 8.5 +/- 1.3, 7.9 +/- 2.0 vs 8.2 +/- 1.4 and 7.2 +/- 1.7 vs 6.9 +/- 1.4, respectively). The 95% confidence intervals (95% CI) of mean difference in each segment of colon were not found to lie within 1 point which indicated that their efficacies were not equivalent. The taste of senna was better than sodium phosphate solution. Also, senna had fewer side effects. CONCLUSION: The efficacy of senna is not equivalent to sodium phosphate solution in bowel preparation for colonoscopy, but senna may be considered an alternative laxative.

Adult↗

PubMed1995

[Improving the effect of orthograde colonic lavage with golytely solution by adding dimethicone].

The effectiveness of an additional application of Simethicone during an orthograde lavage with Golytely solution in preparation for colonoscopy was tested in a prospective, randomized, placebo-controlled double blind study on 152 patients 78 Simethicone, 74 placebo). The colon regions were separated into rectosigmoid, descending colon, transverse colon and ascending colon and interpreted according to the criteria formation of foam and contamination with feces. By the endoscopic examination of the colon we found a statistically significant improvement in visibility in the patients treated with Simethicone in contrast to placebo both in the individual scores, separated according to each of the colon regions, and in the total scores (p < 0.01). Furthermore, the time needed for the colonoscopy could be significantly shortened in the Simethicone group (p < 0.05). Adverse effects were not observed. We conclude that the additional application of Simethicone during the orthograde colon lavage with Golytely solution results in an improvement in the preparation for the colonoscopy as well as visibility of the colon mucosa.

Adolescent↗

PubMed1994

Morphometric analysis of enteric lesions in C3H/HeN mice inoculated with Serpulina hyodysenteriae serotypes 2 and 4 with or without oral streptomycin pretreatment.

The segmental distribution and sequential progression and the role of the indigenous bacterial flora in the development of enteric lesions associated with Serpulina hyodysenteriae infection in laboratory mice have not been defined. We examined the distribution and sequential morphometric changes in the large intestine of mice orally inoculated with S. hyodysenteriae serotypes 2 and 4. To determine the role of colonization resistance conferred by the indigenous bacterial flora, 40 female C3H/HeN mice were administered water alone or water containing 5 mg/mL streptomycin sulfate ad libitum for seven days prior to orogastric inoculation either with S. hyodysenteriae or sterile trypticase soy broth (TSB). Clinical signs were monitored daily and three mice per group were necropsied on postinoculation days (PID) 7 and 14 for pathological assessment of the cecum, proximal colon, transverse colon, and descending colon, and bacteriological culture of the cecum for S. hyodysenteriae. Weekly pooled fecal samples were collected from each group for determination of total numbers of anaerobe bacteria. Gross examination revealed soft fecal pellets on PID 7 and 14 and catarrhal typhlitis on PID 14, irrespective of streptomycin pretreatment. The recovery rates of S. hyodysenteriae from the ceca of serotype 2- and serotype 4-inoculated mice was 100 and 91.7%, respectively. Statistically significant differences in morphometric changes between TSB- and S. hyodysenteriae-inoculated mice were present on PID 7 and 14 and were restricted to the cecum. Although oral administration of streptomycin for seven days prior to S. hyodysenteriae inoculation resulted in a significant reduction in the numbers of fecal anaerobes, it did not affect the colonization, distribution, severity, or progression of cecal lesions.

Animals↗

PubMed1977

Fibrous foreign body impaction colic in young horses.

OF 207 horses with colic seen over a 36-month period, 10 were determined to have impaction colic caused by ingestion of synthetic fencing material. In 6 cases, there was history of exposure to rubberized fencing products. All horses affected were less than or equal to 3 years of age, had signs of mild to moderate abdominal pain, and were unresponsive to usual symptomatic therapy. At surgery, each horse was found to have an impaction involving the distal right dorsal colon, transverse colon, or small colon, and in some cases, all 3 bowel segments. In 9 cases, the involved segment of bowel could not be brought out of the abdominal cavity, and in each of these cases, the foreign bodies were removed through one or more enterotomies. Five of the 10 horses survived.

Animals↗

PubMed1997

[Hereditary nonpolyposis colonic carcinoma with primary extra-colic manifestation].

A 62-year-old woman presented with nausea, weakness, and vasovagal attack. She had a history of a carcinoma of the endometrium 19 years prior to admission, and adenocarcinomas of the cecum, ascending colon, transverse colon, rectum and sigmoid during the subsequent years. Due to the typical history, including family history, hereditary nonpolyposis colorectal cancer (HNPCC) was diagnosed 6 months prior to admission. Physical examination was normal with the exception of pallor of the skin and the palpebral conjunctivas. Laboratory values showed hypochromic, microcytic anemia (hemoglobin: 6.5 g/dl; MCV 70.1 fl; MCH 22.8 micrograms). Esophagogastroduodenoscopy revealed an exophytic mass protruding into the lumen of the inferior part of the duodenum. Carcinoma of the duodenum as a manifestation of HNPCC was diagnosed and partial duodenectomy performed. Macroscopic and microscopic examination revealed two adenocarcinomas--next to one another--7.0 cm and 2.5 cm in diameter. HNPCC is often overlooked and its relevance underestimated. Since diagnosis of this disease has major implications, all patients with colorectal cancer, and also young women with carcinoma of the endometrium, should be screened for HNPCC.

Adenocarcinoma↗

PubMed1999

The northern exposure sign: a newly described finding in sigmoid volvulus.

OBJECTIVE: Previous studies of sigmoid volvulus have focused on the migration and dilatation of the sigmoid with respect to both fixed and mobile landmarks in the abdomen. None has specifically referred to the relationship of this colonic segment to the more proximal large intestine. We analyzed findings on abdominal radiographs, all of which had been obtained with the patient supine, of sigmoid volvulus, with particular attention to the juxtaposition of the sigmoid colon with the transverse colon. MATERIALS AND METHODS: The abdominal radiographs of 30 patients with clinically confirmed sigmoid volvulus were obtained from the teaching files of four hospitals and were retrospectively reviewed. These radiographs were compared with abdominal radiographs of 28 individuals, each of whom had a dilated colon but not sigmoid volvulus. All radiographs had been obtained with the patient in the supine position. RESULTS: The transverse colon was identified in 26 of the 30 patients with sigmoid volvulus. In each of these 26 patients, the sigmoid colon was cephalad to the transverse colon. Of the patients in the control group, the transverse colon was identified in 24 of the 28 patients. In none of these control group patients did the sigmoid colon extend rostral to the transverse colon. Thus, this sign had a sensitivity of 86% and a specificity of 100%. CONCLUSION: A dilated sigmoid colon that ascends cephalad to the transverse colon is a newly described and accurate finding of sigmoid volvulus on abdominal radiographs obtained with the patient supine.

Case-Control Studies↗

PubMed1995

Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications.

OBJECTIVES: Our objectives in this study were to determine diminutive colonic polyp histology, distribution, frequency of significant synchronous neoplastic lesions, and treatment complications. METHODS: We evaluated consecutive colonoscopic examinations in which one or more diminutive polyps were detected over a 36-month period; these examinations had been entered into an endoscopy database at the time of colonoscopy. RESULTS: A total of 1964 diminutive polyps were found and removed in 753 colonoscopies; 1525 were removed by hot biopsy, 436 were removed by cold biopsy, and three were removed by snare. Of the diminutive polyps, 40.7% were adenomatous, 37.2% were hyperplastic, 17.9% were mucosal tags or lymphoid aggregates, and 4.3% were mixed; 0.26% contained atypia, and none were cancerous. In the right colon and transverse colon, diminutive polyps were more likely to be neoplastic (p < 0.0001), but in the left colon they were more likely to be nonneoplastic (p < 0.0001). The prevalence of synchronous neoplastic lesions was 21.5%. No perforations were seen; however, significant hemorrhages occurred in six cases in which hot biopsy was used. The risk of a significant hemorrhage from hot biopsy of diminutive polyps was 0.39%. The risk of hot biopsy-induced hemorrhage was significantly higher in the right colon than in the transverse colon and left colon (p < 0.05). The risk in the cecum was 1.33%; in the ascending colon it was 1.03%, and for the remainder of the colon it was 0.24%. CONCLUSIONS: Most diminutive polyps proximal to the left colon are neoplastic. The decision to use the hot biopsy or cold biopsy technique to eradicate diminutive polyps should take into account the location of the polyp because of the significantly increased risk of hemorrhage with hot biopsies in the right colon.

Adenoma↗

PubMed1986

The leading cord method of colonofiberscopy.

Although the colonofiberscope has undergone various modifications and improvements, the insertion principle remains unchanged; that is, pushing and rotation and the elasticity of the scope itself are inevitable. It often is difficult to maintain proper balance among these dynamic factors; imbalance prevents deep insertion. Over-elongation of the scope leads to insertion failure, particularly if there are adhesions of the sigmoid colon, overextension of the colon, or transverse colon ptosis. Our "leading cord" method is an excellent aid to colonofiberscopy. It can be inserted from the clamp hole of a conventional fiberscope and hardened to straighten the scope, thereby permitting deep insertion. With this technique the region from the rectum to the descending colon, as well as a ptosed transverse colon, can be straightened. Our clinical experience indicates that the rate of successful insertions in colonofiberscopy will be increased considerably with this complementary device.

Colonoscopes↗

PubMed1979

Colonic myoelectrical activity in man: comparison of recording techniques and methods of analysis.

Both monopolar and bipolar recordings of human colonic myoelectrical activity have been made on 29 occasions from implanted serosal electrodes attached to either the ascending colon or transverse colon. Visual and computer analysis of the signals were made and the incidences of the two electrical rhythms present in the colon were compared for the two recording techniques, recording sites, and methods of analysis. The percentage incidence of both rhythms was similar for the mono and bipolar recording techniques in both parts of the colon. The incidence of the two rhythms in the transverse colon was approximately twice that recorded in the ascending colon, this being true for both recording techniques and methods of analysis, but neither was detected for more than 50% of the time. It is concluded that the methods of data analysis probably account for the differing incidences of electrical activity in the human colon that have been reported previously.

Adult↗

PubMed2002

Relationship between degree of cellular differentiation in colorectal cancer and topographical distribution.

OBJECTIVES: To demonstrate the relationship between degree of cellular differentiation in colorectal cancer and topographical distribution in 215 patients diagnosed with colorectal cancer from 1997 to 2000. MATERIAL AND METHODS: 215 patients (129 men and 86 women) were studied prospectively with a mean age of 64 years (range: 23-84 years). In all patients we performed a full colonoscopy with several biopsies (in patients with colon stenosis we used barium enema), radiographic studies (CT, abdominal ultrasounds), and laboratory tests for serum tumour markers (CEA, Ca 19-9, alpha-fetoprotein). The topographic location of colorectal cancer was: rectum 35%, sigmoid colon 31%, descending colon 10%, transverse colon 6%, ascending colon 9%, caecum 5%, and we included anorectal cancer 4%. RESULTS: According to histological differentiation we found: A) well-differentiated tumours 101/215 (47%); B) moderately-differentiated tumours 98/215 (45.5%), and C) poorly-differentiated tumours 16/215 (7.5%). We found no significant association among histological differentiation, topographic location, stage according to the Astler-Coller classification, sex or age (p = ns). The prevalence of well-differentiated tumours in men was 49% and 43% in women; of moderately-differentiated cancers in men was 43%, and 49% in women; for poorly-differentiated tumours in men was 7.5%, and 7.2% in women. Regarding tumour location, 165 cancers were found in the left colon: 80 were well differentiated, 77 moderately differentiated and 8 poorly differentiated. In the transverse colon we found 12 tumours: 7 well differentiated, 3 moderately differentiated and 2 poorly differentiated. 30 cancers were localized in the right colon: 11 well differentiated, 15 moderately differentiated and 4 poorly differentiated. In the anorectum 8 tumours were found: 3 well differentiated, 3 moderately differentiated and 2 poorly differentiated. According to staging classification, well differentiated tumours (101/215) were more common in Dukes' C2 (20.7%) and B1 (32.6%), moderately differentiated cancers (98/215) were in B1 (28.5%) and C2 (20.4%), and poorly differentiated tumours (16) were more common in Dukes' C2 (25%), without differences among other stages (p = ns). CONCLUSIONS: According to our results we have found that histological differentiation of colorectal cancer has no association with topographic location, and it is independent of sex or age. We have not found any relationship either between histological differentiation and stage in the Astler-Coller classification, but well differentiated cancers were more common at any location, age or sex.

Adult↗

PubMed1992

Esophageal reconstruction for esophageal strictures or resection after corrosive injury.

A total of 75 esophageal reconstructions were performed for caustic esophageal strictures (65 patients) or postcaustic resection (10 patients) at Naval General Hospital and National Cheng-Kung University Hospital from September 1976 to April 1991. Reconstructive procedures included bypass in 61 patients, replacement of the esophagus through the substernal route in 10, and replacement of the esophagus through the posterior mediastinum in 4. Esophageal substitutes used for reconstruction were a long segment of the ileum and the ascending colon in 42 patients; a short segment of the ileum and the ascending colon in 18; the ascending colon and transverse colon in 3; the ascending, transverse, and left colon in 1; the transverse and left colon in 6; the jejunum in 2; and the stomach in 3. All but two of the esophageal substitutes were isoperistaltic. There were 28 postoperative complications in 24 (32%) of the 75 patients. Cervical anastomotic leakage occurred in 5 patients (6.7%). There were no operative deaths. Postoperatively, swallow function was considered good in 67 patients (89.3%). In this experience, isoperistaltic transposition of the transverse and left colon provided the best results.

Adolescent↗

PubMed2006

Comparison between ureteral replacements using a transverse tubularized colonic tube or ileal ureter: experimental study in dogs.

INTRODUCTION: We report the comparison between ureteral replacements using a transverse tubularized colonic tube or ileal ureter in dogs. MATERIALS AND METHODS: Ten canines were studied. Four underwent ureteral substitution with an ileal ureter; 5 with a single transverse tubularized colonic tube and 1 with a double colonic transverse tubularized tube. The animals were observed for a predetermined interval of 30 days. At 30 days, the animals underwent an intravenous pyelogram, cystogram, urine analysis, and serum electrolyte sampling, and the kidney, ureteral conduit, and bladder were examined grossly and histologically. RESULTS: The pyelograms of both the ileal ureter and the transverse tubularized colonic tube showed prompt bilateral renal excretion. Grade 1 hydronephrosis was seen in 3 of 4 animals that received the ileal ureter and with 1 of 5 animals that received the colonic tube. Histological exam of the kidneys showed small focal areas of pyelonephritis in both groups without significant injury to the collecting tubules or glomeruli. DISCUSSION: The transverse tubularized colonic tube is an effective form of ureteral replacement in the animal model. The advantages of using the colon include its proximity to the ureters, the minimal mobilization needed, position outside the radiation portals, and the short colonic segment necessary.

Animals↗

PubMed1994

Pseudomembranous colitis: diagnostic sensitivity of the abdominal plain radiograph.

We performed a retrospective study to determine the incidence of plain radiographic abnormalities in patients with pseudomembranous colitis (PMC). One hundred and fifty-two plain radiographs of the abdomen (taken within 3 days of pseudomembranous colitis diagnosis) from 152 patients with pseudomembranous colitis were reviewed. Forty-eight of 152 (32%) plain radiographs were abnormal, demonstrating: colonic ileus in 48/152 (32%), small bowel ileus in 31/152 (20%), ascites in 10/152 (7%), and nodular haustral thickening in 28/152 (18%). The distribution in 48 patients with colonic ileus included: right colon, 41/48 (86%), transverse colon, 35/48 (72%), and left colon, 26/48 (55%). Distribution in 28 patients with nodular haustral thickening included: right colon, 5/28 (18%), transverse colon, 15/28 (54%), and left colon, 14/28 (50%). Radiographic changes were non-specific in 32% of patients with changes more specific to PMC in only 18%.

Adolescent↗

PubMed2002

Internal hernia of the transverse colon-Chilaiditi syndrome in a child.

A redundant loop of transverse colon was herniated symptomatically behind the right liver to a suprahepatic, subdiaphragmatic position in an 11-year-old girl (Chilaiditi Syndrome). Constipation from birth, partial obstruction, and recurrent severe right upper quadrant pain unresponsive to nonoperative management warranted transverse colectomy.

Abdominal Pain↗

PubMed1987

Age-dependent shift-to-the-right in the localization of colorectal adenomas.

The age-dependent prevalence and topographical distribution of colorectal adenomas was investigated in 1006 unselected autopsies (554 males and 452 females) in Mainz, FRG. In 200 out of 1006 autopsies (19.8%) a total of 498 adenomas of the large intestine were detected. The percentage of patients with adenomas increased continuously with age. Only 6% of all adenomas were localized in the caecum and 8% in the rectum, whereas all the other adenomas were distributed rather evenly throughout the ascending colon (23%), the transverse colon (25%), the descending colon (15%) and the sigmoid colon (23%). Analyzing the topographical distribution of adenomas for definite age groups (40-59, 60-69, 70-79 and 80-99 years of age), it became evident that the topographical distribution is not constant, but shows an age-dependent shift-to-the-right, i.e. with advancing age an increase in the relative frequency of adenomas in the proximal colonic segments (from caecum to transverse colon) and a decrease in the distal segments (from descending colon to rectum). This shift to the right, which evolves continuously from the youngest to the oldest age group, results from a disproportionate increase in the absolute number of adenomas in the proximal colonic segments when compared with the distal segments. The age-dependent shift-to-the-right of colorectal adenomas provides an important confirmation of the adenoma-carcinoma sequence, but cannot be explained by current concepts concerning the aetiology of colorectal adenomas and carcinomas.

Adenoma↗