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PubMed1994

The colonic neobladder: a stoma-free bladder substitute after radical cystectomy--preliminary results in six patients.

We have used a urethral colonic pouch for total bladder replacement in 6 bladder cancer patients after radical cystectomy. The distal ileum, cecum, ascending colon and the right third of the transverse colon were isolated. The cecum and colon were opened along the tenia and a detubulized pouch was created. The ureters were sutured to the terminal ileum. The maximum pressure wave measured ranged 22-58 cmH2O, and the amount of residual urine varied between 0 and 58 ml. All patients were completely continent during the day and slight incontinence at night was observed in 3. By amputating the right colonic artery, the pouch is easily moved to the urethral stump and serves as a low pressure neobladder after cystoprostatectomy.

Adult↗

PubMed1991

Coexisting tuberculosis and carcinoma of the colon.

Four cases of coexisting tuberculosis and carcinoma of the colon (CTCC) are reported. All the patients were female and the mean age was 49 +/- 11 years. The tumour involved the right colon in three patients and the distal transverse colon in the other. The two lesions coexisted at the same site in two patients. Mucinous carcinoma was the predominant type seen in three patients. The characteristics of patients with CTCC were compared with those of 54 patients who had carcinoma of the colon (CC) and 17 patients with tuberculosis of the colon (TC) seen during the same period. All the four CTCC patients were female, compared with 13 of 54 patients with CC (P less than 0.001). These two groups were similar in mean age, anatomic sites and histopathological tumour types. The CTCC patients were significantly older than the TC patients (49 +/- 11 years vs 34 +/- 10 years, P less than 0.05). The sex distribution of TC patients was similar to that of CTCC patients, 14 of 17 patients being female. All TC lesions were confined to the right colon. The present study showed a high frequency of carcinoma in patients with colonic tuberculosis, signifying the need for epidemiological and histopathological investigations into the aetiological relationship between the two diseases, the possibility of which was suggested recently by Japanese researchers. The relevant literature on 58 previously reported patients with CTCC was reviewed.

Adenocarcinoma↗

PubMed2003

[Esophagoplasty with the colon in flap patients with burn strictures of the esophagus].

Results of coloesophagoplasty in 366 patients with long burn strictures of the esophagus are presented. The lesion was total in 74 (21.2%) of them. Inefficacy of bougieurage was indication for plastic surgery in 133 (36.3%) patients, complete obliteration of esophagus--in 53 (14.5%). Left half of the colon was used in 296 (80.9%) cases, transverse colon--in 48 (13.1%), right half of the colon--in 22 (6.0%) cases. Retrosternal shunting esophagoplasty was performed in 247 (67.5%) patients. Complications were in 84 (34.0%), necrosis of the transplant--in 4 (1.6%) patients. Extirpation of the esophagus with posteriormediastinoplasty was performed in 16 (4.4%) patients, in 14 of them--transhiatally. Complications occurred in 7 patients coloesophagopharyngoplasty was carried out in 52 (14.2%) patients with combined stricture of the esophagus and the pharynx, in 23 of them--simultaneously. Complications were in 28 (53.8%) patients. Intrapleural of coloesophagoplasty was performed in 51 patients. General hospital lethality was 3.3%. Long-term results were studied in 259 patients. Good results of esophagoplasty were seen in 135 (52.1%) patients, satisfactory--in 65 (25.1%), unsatisfactory--in 59 (22.8%) patients. Dysfunction of the artificial esophagus was seen in 22.0% patients, 12.7% patients underwent repeated reconstructive surgeries.

Adolescent↗

PubMed1992

The long colic nerves in human fetuses. I. Macroscopic studies.

The long colic nerves were investigated in 50 fetuses aged 13 to 21 weeks. The long colic nerves arise from the pelvic nerves, pelvic plexuses, hypogastric nerves, and intermesenteric plexus. The nerves may take origin from two or three sources, and in most cases they arise from the pelvic nerves. They ascend along the sigmoid and descending colons reaching the left portion of the transverse colon.

Colon↗

PubMed2003

[Early esophageal replacement in patients with esophageal atresia].

INTRODUCTION: When primary anastomosis is not feasible in esophageal atresia esophageal replacement is one of the possible options. We report our experience with this approach in patients with long-gap esophageal atresia. MATERIALS AND METHODS: From 1991 to 2002 we treated 50 children with esophageal atresia. Nine required esophageal replacement because of long-gaps. Six were boys and three girls. Six had isolated atresia, and three had regular atresia with TEF. Associated malformations in 8 patients were: cardiovascular (2), anorectal (2), urogenital (5), intestinal duplication (1), and costovertebral (1). The weight at birth ranged from 1.2 to 3.95 kg (median 2.3). Patients with type I atresia had immediate gastrostomy accompanied by esophagostomy in one. Esophageal anastomosis was impossible or failed in 3 patients with type III EA, who had fistula ligation and esophagostomy. Esophageal replacement was performed at a median age of 4.95 months (range 2.3 to 18), with a median weight of 5.33 (range 2.89 to 11.5 kg.). We used gastric pull-up in 2 cases and colonic transposition in 7 with isoperistaltic left transverse colon in retromediastinal-transhiatal (6) or restrosternal (1) position. Two patients had extramucosal piloromyotomy and 4 had piloroplasty. RESULTS: All patients survive and have functional grafts. Postoperative complications were: pneumonia (1), wound dehiscence with evisceration (2) and salivary fístula (2) which closed spontaneously. In the long range, one patient was operated three times for hernia through the enlarged hiatus, one had one episode of intestinal subobstruction successfully managed with nasogastric aspiration and another one had dumping syndrome for several months. After a median follow-up of 3.15 years (range 1.6 to 6.9) all patients eat normal diets per os. CONCLUSIONS: Esophageal replacement for the treatment of infants with long-gap EA has been in our hands as good as any other option with 100% survival and good functional results. The operation can be safely performed in the first months provided that associated malformations are under control. However, like other options, this approach is not devoid of complications.

Esophageal Atresia↗

PubMed2006

The epidemiology and clinical findings of colorectal cancer in Iran.

BACKGROUND: This study was performed to evaluate the prevalence, clinical features and management of patients with colorectal cancer (CRC) in Iran. METHODS: All cases of CRC presented to a principal referral University hospital (SGH) for cancers in Teheran, Iran between June 20, 2000 and January 3, 2003 were retrospectively reviewed. RESULTS: A total of 200 patients were included. 114 patients (57%) were male and 86 were female (43%). Age ranged from 13-90 years with a mean of 55.15 +/- 14.5. Among these patients, 16.5% were less than 40 years of age. The tumors were categorized according to their distribution as appendix (n=4), cecum ( n=7), right colon (n=1), hepatic flexure (n=2), transverse colon (n=19), splenic flexure (n=3), left colon (n=6), sigmoid ( n=16), rectum (n=117), rectosigmoid and rectal lesions (n=16), and colorectal lesions without known locations (n=9). Non-mucinous adenocarcinoma (AC) was the most common histological type (n=181, 90%), followed by mucinous AC (n=15), squamous cell carcinoma (n=1), carcinoid (n=1), melanoma (n=1) and signet ring carcinoma (n=1). The most common presenting symptom was rectal bleeding (n=68, 34.5%). Younger patients had a greater preponderance of mucinous AC (p=0.008) and generally underwent more extensive chemotherapy as seen with more usage of 5-Fluorouracil (p=0.05). CONCLUSIONS: We have had few reports with reference to the epidemiology of CRC in Iran since 1977. The current data suggest a younger age distribution for CRC. We found no significant difference between age, gender and type of cancer with subsite distribution. Distal CRC was more prevalent. Among patients, 30.5% were diagnosed by screening studies.

Adolescent↗

PubMed1995

[Continent urinary diversion with the Florida pouch].

From October 1990 through June 1993, the Florida pouch, a continent urinary reservoir using the ascending colon and the dexter half of the transverse colon was constructed in 7 patients after cystectomy for invasive tumor. Concerning the length of the efferent limb, although 10 cm was adopted in the first three cases, we shortened it and finally considered 8 cm to be the adequate length. Although the capacity of the reservoir ranged from 90 ml to 180 ml immediately after operation, an increase of capacity by three times or more within three months after operation was seen. The patients performed self-catheterization 4-5 times during the day and 0-2 times at night for volumes ranging from 300 to 600 ml. Continent colonic urinary diversion did not appear to create either any significant acid-base changes or azotemia in patients with normal renal function. Every patient received both a serum value evaluation and an absorption test for vitamin B12 (Schilling test). Although there were no patients with a reduced serum vitamin B12 level, one patient showed a slightly low absorption value. Because there is a large quantity of vitamin B12 reserve in the liver, it must be emphasized that even when the entero-hepatic circulation has been injured by surgical interruption of the intestinal tract, it may be years before reduced serum vitamin B12 value become apparent. Accordingly, the vitamin B12 absorption test should be performed regardless of the ileal length incorporated into the resection.

Aged↗

PubMed1995

Colorectal carcinoma in patients 30 years of age and younger.

Thirty-seven cases of colorectal cancer in patients aged 30 years or younger have been treated at the University of Virginia Health Sciences Center from 1957 through 1992. The present series, comprising patients treated from 1978 through 1992, updates a series presented from our institution comprising patients treated from 1957 through 1977. For the 36-year series, 24 patients (65%) were female, and 13 (35%) were male. Sixteen patients (43%) were black, and 21 patients (57%) were white. Sites of tumor and their frequency were rectosigmoid, 14 (38%), left colon, five (14%), splenic flexure, two (5%), transverse colon, three (9%), hepatic flexure, two (5%), right colon, two (5%), and cecum, six (16%). Twenty-two patients (59%) presented with abdominal pain, whereas 15 (41%) presented with hematochezia or hemoccult positive stools. The average time of onset of symptoms to diagnosis was 2.3 months. Thirty-four of 37 patients (92%) presented with advanced stage disease. Only four patients had precancerous conditions: one each with Gardner's Syndrome, Turcot's Syndrome, ulcerative colitis, and villous adenoma. Twenty-five patients (68%) underwent surgery for cure, and ten (27%) received palliative procedures. Nothing could be done for two patients (5%). Twenty-one patients (57%) had mucinous histology, 13 (35%) had typical adenocarcinoma, one (3%) had small cell carcinoma, and histology was unavailable in two (6%). Nodes were negative in only 10 (27%) patients, of which only three had mucinous histology. There have been five 5-year survivors and three patients alive and disease free at last follow up, ranging from 30 months to 48 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Colonoscopy technic. Evaluation of 80 examinations].

Eighty colonoscopies were done in 77 patients with the CF-MB Olympus colonoscope. A schedule of the examination is analyzed. The bowel preparation can be done at the patient's home. If the patient is well prepared psychologically, the use of antispasmodics or sedatives is not required. The position proposed for the patient is on his back with legs flexed. The symptom most frequently found during the examination was abdominal pain related to the introduction of the colonoscope and to the colon distension; 28,7% of the patients had no symptoms. In the absence of colon obstruction the colonoscope can reach the transverse colon even though fluoroscopy was not used. There were no complications in the 80 examinations performed.

Adolescent↗

PubMed1977

Cytotoxicity of 5,6-dihydroxytryptamine in dimethylhydrazine-induced carcinomas of rat colon.

Male Sprague-Dawley rats were given weekly s.c. injections of 1,2-dimethylhydrazine (21 mg/kg) for 20 weeks. The injections were then discontinued, and, after an interval of 2 to 8 weeks, experimental animals were given i.p. injections of 5,6-dihydroxytryptamine (5,6DHT) at a dose of 40 mg/kg and sacrificed at intervals of 1, 2, 6, 16, and 48 hr later. Specimens of descending colon and carcinomas of the descending or transverse colon from sacrificed animals were examined using light microscopy and transmission electron microscopy. The results show that 5,6DHT at a dose of 40 mg/kg is cytotoxic to malignant colonic epithelial cells but not cytotoxic to adjacent nonmalignant colonic epithelial cells. In malignant colonic epithelial cells, ultrastructural changes in cytoplasmic membranes and mitochondria were evident at 1 hr after 5,6DHT treatment. At 6 hr after 5,6DHT treatment, light microscopy of sections of tumor showed areas of cell necrosis and disrupted tumor morphology. Sections of specimens taken 16 hr after treatment showed widespread destruction of malignant cells.

5,6-Dihydroxytryptamine↗

PubMed1997

Abdominal fluid collection secondary to acute pancreatitis: treated with percutaneous catheter drainage.

BACKGROUND: Complicated pancreatic inflammatory diseases are often life-threatening, multifocal, and multibacterial disorders. Untreated, these lesions often prove fatal. The purpose of the study is to describe interventional radiologic techniques for diagnosis and treatment of complicated peripancreatic fluid collections. METHODS: Between January 1994 and December 1995, 17 patients with abdominal fluid collection from complicated acute pancreatitis underwent percutaneous drainage following initial diagnosis with computed tomography (CT). These patients required multiple CT examinations, multiple catheter insertions, multiple catheter manipulations, and long-term catheter drainage. RESULTS: Twenty-five infected fluid collections among these 17 patients were percutaneously drained. Sixteen (94%) patients were successfully treated with catheter drainage alone. Surgical treatment was necessary in one patient because of segmental stricture of transverse colon caused by inflammation and adhesion of transverse mesocolon. Catheter drainage duration averaged 31 days. Patients required an average of three catheter manipulations and four abdominal CT scans. Mean hospital stay was 42 days (range, 11-95 days), and mean ICU stay was 25 days (range, 1-70 days). CONCLUSIONS: The study confirms that complicated peripancreatic fluid collections can be safely and effectively treated in most patients with percutaneous catheter technique.

Abscess↗

PubMed1976

Late results following substitution of colon for the stomach, esophagus, urinary bladder and vagina.

The transverse colon was substituted for the stomach in four patients after total gastrectomy for cancer. Three of them are alive after 21 to 23 years. They are in good condition and fully active. In six patients the esophagus was resected and the colon was interposed transthoracically. Two patients survive 13 to 15 years later. Carcinoma of the urinary bladder was resected three times and colon substituted. In a case of total vaginal aplasia, sigmoid colon was substituted for the vagina. The patient is alive after 17 years and has a normal sexual life. Sixteen patients have had colon transplantations to replace various organs. Seven of them are alive. The average time of survival thus far is 19 years.

Adult↗

PubMed1995

Differences in colonic tone and phasic response to a meal in the transverse and sigmoid human colon.

It is not yet clear whether the regional differences in the physical properties of the colon influence its motor responses. Tonic and phasic colonic motility and compliance of the transverse and sigmoid colon were therefore assessed using a combined barostat-manometry assembly in 22 healthy subjects. Measured colonic compliance was corrected by subtraction of the compliance of the closed barostat system. The mean (SEM) preprandial colonic volumes in the transverse and sigmoid colon were similar (150 (12) and 128 (13) ml, p = NS), corresponding to calculated mean (SEM) colonic diameters of 4.3 cm and 4.0 cm respectively. The mean increase in colonic tone postprandially was significantly greater in the transverse (24.1% (3.5)) than in the sigmoid colon (13.1% (3.0), p < 0.01). The mean increase in phasic contractility was significantly greater, however, in the sigmoid than in the transverse colon (1270 (210) and 425 (60) mm Hg/90 min respectively, p < 0.01). Compliance was greater in the transverse than sigmoid colon (7.6 (0.44) and 4.1 (0.15) ml/mm Hg, p < 0.001). The fasting volume of the colon was significantly correlated with the magnitude of the tonic response to the meal in the transverse and sigmoid colon (p < 0.001 for both). In conclusion, there are quantitatively different but qualitatively similar phasic and tonic responses to the meal in the two colonic regions. Differences in the viscoelastic and luminal dimensions may partly account for these differences in tonic responses.

Adult↗

PubMed2006

Gastro-colonic anastomosis--a viable option in extensive small bowel infarction.

INTRODUCTION: We have previously presented a patient with massive small and large bowel infarction and demonstrated that even with only a few inches of remaining small bowel an almost normal life-style and diet is possible. PATIENT: Recently, we have looked after a young and otherwise fit female patient who suffered mesenteric venous gangrene of the whole small bowel from the Ligament of Treitz to the caecum. In order to achieve gastro-intestinal continuity and to avoid the torrential fluid loss associated with high fistula, an anastomosis between the stomach and the transverse colon was formed. RESULTS: We are surprised to find that despite the extensive resection our patient maintains a good quality of life and is able to look after her young family.

Adult↗

PubMed1999

Collagenous colitis: a study of the distribution of morphological abnormalities and their histological detection.

In collagenous colitis, the literature is conflicting concerning where in the colon the lesions are most likely to be present and most severe. Conflicting data furthermore shed doubt on the sensitivity of the histological detection of the morphological abnormalities and the threshold criteria for diagnosis. We addressed these questions in 56 patients with collagenous colitis. Two hundred ninety-one coded biopsy specimens were analyzed according to six standardized sites from cecum to rectum. Subepithelial collagen deposits were subjectively graded in hematoxylin and eosin (H&E) sections and quantitatively measured in trichrome-stained sections, respectively. Semiquantitative grading was also done for inflammatory changes of the lamina propria and abnormalities of the surface and crypt epithelium. The transverse colon yielded the largest percentage of biopsy specimens (83%) interpreted as diagnostic of collagenous colitis and also had the largest percentage of biopsy specimens with inflammatory changes (98%). Biopsy specimens from both the rectosigmoid and the right colon (ascending and cecum) were significantly less likely to be diagnostic (P<.01). Only 66% of specimens obtained from the rectosigmoid were diagnostic, and 18% of these were interpreted as normal. Subepithelial collagen deposits proved to be significantly thicker in the transverse (median, 46.8 microm; range, 12 to 212.4) and descending (median, 49.2 microm; range, 6 to 230.4) than in the rectosigmoid (median, 33.6 microm; range, 9.6 to 178.8) and right colon (median, 35.4 microm; range, 6 to 140.4), respectively (P<.01). Almost all biopsy specimens (97%) had collagen deposits thicker than 10 microm. However, the subjective interpretation "diagnostic of collagenous colitis" proved to be most consistent with a threshold of 30 microm. Our results indicate that biopsy specimens from at least as proximal as the transverse colon should be obtained to definitely rule out collagenous colitis. Furthermore, it is evident that in a given biopsy specimen, markedly abnormal subepithelial collagen deposition had to be present for an unequivocal histological diagnosis of collagenous colitis.

Adult↗

PubMed1971

Movement of segmental constrictions in the human colon.

Changes in the segmental pattern of opaque contents in the transverse colon among patients with diverticulosis were observed by means of time-lapse cinefluorography after ingestion of barium sulphate suspension. In some of them the muscular constrictions separating the opaque masses of bowel contents were seen to relax and later to re-form in a different spatial relationship to fixed points on the bowel wall represented by the necks of diverticula. In other instances ring contractions moved progressively along the bowel wall, temporarily occluding the necks of any diverticula they passed. Bowel contents were seen to be transported ahead of the advancing constrictions at varying rates and in either direction.

Barium Sulfate↗

PubMed1979

Simultaneous double obstruction of the proximal colon: a case report.

A rare case of simultaneous obstructions of the proximal colon secondary to an obstructing carcinoma of the transverse colon and an ascending colon volvulus at the hepatic flexure is presented. Their probable interrelationship and resulting radiographic features are discussed.

Aged↗

PubMed1991

Multiple diffuse hemangiomas of the large intestine.

A 54-year-old male case with multiple, diffuse hemangiomas of the large intestine is described. Large diffuse hemangiomas were located at the rectosigmoid and the ascending colon. Some polypoid lesions were located on the transverse colon. Tiny calcifications representing phleboliths were detected in those lesions. No skin hemangiomas were present. Although he did not manifest systemic bleeding tendency, blood examinations demonstrated the presence of mild consumption coagulopathy.

Colonic Polyps↗