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[Clinical and cytogenetic investigation of a family with high predisposition for intestinal polyps].

A medico-genetic investigation of a family, consisting of 25 members, revealed high predisposition to malignant pathology of the gastrointestinal tract: rectal cancer was diagnosed in 2, malignant polyposis of the large intestine--1, diffuse polyposis of the large intestine (DPLI)--3, and uterine fibromyoma--in 1 patient. Six members underwent a cytogenetic examination using the metaphase method for peripheral blood lymphocytes and G-banding of chromosomes. Two patients with DPLI carried 8.7 and 16.7% of hyperaneuploid cells and one--20% of cells with double minute chromosomes (DMS). It is suggested that formation and subsequent significant increase in hyperaneuploid and DMS cells could have been responsible for DPLI development in the family.

Adult↗

[Application of metal hemoclip for endoscopic polypectomy in children with thick-pedunculated intestinal polyps].

OBJECTIVE: With the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety. METHODS: Between October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed. RESULTS: Six polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared. CONCLUSION: Mechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.

Child↗

[Intraoperative imaging of the small intestine for the endoscopic removal of small intestine polyps in Peutz-Jeghers syndrome].

The hamartomas in Peutz-Jeghers syndrome lead to various complications that are frequently followed by small-bowel resections and the development of a short-bowel syndrome. In order to prevent such complications an intraoperative endoscopic exploration of the entire small bowel with multiple polypectomies of hamartomas was carried out. Although a further growth of presently unrecognisable hamartomas is possible, such a procedure permits total polypectomy in Peutz-Jeghers syndrome, and complications are thus put off to a later time.

Adult↗

[The association of skin fibromas and intestinal polyps: an age-related effect].

To test the association between skin tags and colorectal polyps, 157 consecutive patients (60 men and 97 women, mean age 61.2 [17-92] years) who during their hospitalization had a coloscopy for gastro-enterological indications, underwent independently medical and dermatological examinations. 61 patients (38%) had colorectal polyps, 83 (53%) skin tags; 39 had both (24.8%). Thus the probability of having colorectal polyps was significantly higher for a person with than without skin tags (P = 0.033). But this relationship was entirely age-dependent. Discriminant analysis indicated that in addition to age (F = 15.1) the presence of skin tags (F = 1.2) was only a small additional factor in the recognition of those with colorectal polyps. Skin tags are thus of little help in the diagnosis of polyps in elderly patients.

Adenocarcinoma↗

[Treatment of polyps and villous tumors of the large intestine].

Polyps and villous tumors were found in 1525 of 10624 patients (14.3%) aged from 40 to 60. In 82% of the cases they were in combination with ulcer disease of the stomach and duodenum, with inflammatory diseases of the gastro-intestinal tract, diverticulitis, tumors of the colon. 1519 polypectomies and dissection of villous tumors both via the fibroscope, rectoscope and by transanal access were made. Complications were obtained in 5 patients, recurrent disease was noted in 3 patients (0.9%).

Adolescent↗

Epidemiology of polyps in the rectum and sigmoid colon. Size, enzyme levels, DNA distributions, and nuclear diameter in polyps of the large intestine.

Enzyme activity and cell cycle variables were measured in 38 adenomas and 9 hyperplastic large-intestinal polyps equal to or larger than 5 mm in diameter. The polyps were resected endoscopically from patients 50-59 years old. A significantly higher activity of lactate dehydrogenase (LD) was found in polyps from women than in those from men. A higher LD and activity was also observed in adenomas with moderate to severe dysplasia than in those with mild dysplasia. A significantly higher activity was found for LD and glucose-6-phosphate dehydrogenase (G6PD) in adenomas greater than or equal to 10 mm than in adenomas less than 10 mm in diameter. DNA flow cytometry showed that all hyperplastic polyps were diploid and that two of the adenomas had an aneuploid DNA stemline in addition to the diploid one. The S-phase fraction varied from 3.5% to 26.5% and the G2 fraction from 0.4% to 6.7%. Two overlapping populations were found, based on nuclear size measurements. Hyperplastic polyps had almost only small nuclei, whereas adenomas had both small and large nuclei in various ratios. No statistical correlations were found between the S-phase or G2-phase fractions and polyp size or the presence of dysplasia. The number of adenomas with aneuploidy was too small to disclose a relationship to polyp size or enzyme activity. The increased enzyme activity in larger polyps and in polyps from women may point to certain risk factors in these special groups. The results indicate a further need for studies of combination of markers for prognostic evaluation of large-intestinal adenomas.

Adenoma↗

[Diagnostic importance of colonoscopy in patients operated on previously for cancer of the large intestine].

Polyps, new malignant tumors and recurrent tumors along the line of anastomosis were frequently revealed in patients who had been previously operated upon for colon carcinoma. The authors examined 93 patients subjected to radical operations for carcinoma of te colon 6 months - 10 years before. In 37 of them there were polyps, 3 patients had metachronous tumors and 6 patients had recurrent carcinomas along the anastomosis line. A conclusion was made that the patients previously operated for carcinoma of the colon should be referred to a group of patients previously operated for carcinoma of the colon should be referred to a group of patients with the increased oncological risk. They must be dynamically observed.

Adult↗

[Expression and significance of oncoprotein p53, rasp21 and p185 in carcinomas and polyps of the large intestine].

Seventy eight cases of carcinoma and 14 cases of poly of large intestine were examined to observe the expression of p53, rasp21 and p185 oncoproteins with immunogold silver staining method. The positive expressions for p53, rasp21 and p185 were 53.9%, 46.2% and 51.3% respectively. But only poorly positive expression was found in large intestine polyps for p185 staining. The difference between the carcinomas and polyps for p185 staining was significant (P < 0.01). The normal mucoepithelium near the cancer region expressed positive staining for p53, rasp21 and p185 were 0%, 2.6% and 5.1% respectively. These results were also significantly different when compared to cancer tissue (P < 0.01). In addition, of these 78 cases, 33 cases (42.3%) gave coordinately positive expression for p53 and rasp21 oncoprotein; p53 positive expression was obviously stronger in poorly differentiated carcinoma and mucoadenocarcinoma than in highly and moderately differentiated adenocarcinoma (P < 0.01).

Adenocarcinoma↗