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At least 1,153 records · Page 64Linked to original sources
PubMed1993

Spectrum of lower gastrointestinal hemorrhage: an endoscopic study of 166 patients.

BACKGROUND: The spectrum of lesions causing lower gastrointestinal hemorrhage shows marked geographic variation. The study was aimed to determine this spectrum in our region using endoscopic examination. METHODS: 166 patients presenting with lower gastrointestinal hemorrhage were investigated using colonoscopy as the first investigation. RESULTS: Lesions responsible for bleeding could be identified in 141 patients (84.9%). In 25 patients (15.1%), the etiology of bleed could not be determined either because of failure to identify a lesion (10 patients) or because of an incomplete examination (15 patients). Major causes of lower gastrointestinal bleeding included idiopathic ulcerative colitis (19.3%), acute colitis (12.0%), colonic polyps (10.2%), radiation colitis (9.0%), solitary rectal ulcer (7.8%), colonic carcinoma (7.2%), colonic tuberculosis (4.2%) and enteric fever (3.0%). CONCLUSION: Endoscopic examination is very useful in evaluating patients with lower gastrointestinal hemorrhage. The predominant causes of lower gastrointestinal bleeding in our experience are different from those reported from western countries.

Adolescent↗
PubMed1977

Therapeutic colonoscopy.

The authors report their experience with regard to operative fibrecolonoscopy both in routine and emergency cases. After taking into consideration the use of this technique for the study and treatment of rectal and colonic polyps, they also recommend the use in emergency conditions of colonic haemorrhage and in the removal of foreign bodies. They conlcude that therapeutic colonoscopy must be recognised as one of the most useful methods of diagnosis and treatment of some lesions of the rectum and colon.

Adenocarcinoma↗
PubMed2005

Polyp detection with MDCT: a phantom-based evaluation of the impact of dose and spatial resolution.

OBJECTIVE: The objective of our study was to evaluate the impact of dose and spatial resolution on the detection of colonic polyps using a 4-MDCT scanner. MATERIALS AND METHODS: Twenty-four latex phantoms that simulate the large bowel and contain artificial polyps of different sizes and shapes were constructed. The polyps were divided into three size groups (diameter, 0-2, 2-5, and 5-10 mm) and were classified into four shape groups: pedunculated; broad-based; ulcerated or depressed; and sessile or flat. The colon phantoms were submerged in a water tank and scanned on a 4-MDCT scanner using 12 protocols with various settings of slice thickness, pitch, and tube current. The images were independently evaluated by three radiologists using axial 2D multiplanar reconstruction images and a 3D surface-rendering technique (fly-through). RESULTS: At a constant dose (i.e., dose-length product [DLP]), the polyp detection rate increased with increasing axial spatial resolution. For the standard protocol (2.50-mm slice thickness, 1.5 pitch), the detection rate for all polyp sizes decreased from approximately 70% at 100 mA to 55% at 40 mA. Between a 60- and 100-mA tube current, the detection rate for the largest polyps (> 5 mm) was almost constant, close to 90%. CONCLUSION: The detection of polyps in the large bowel using a standard protocol can be improved without dose penalty by increasing the axial spatial resolution of the image acquisition and adjusting the tube current setting. If the analysis can be restricted to polyps larger than 5 mm, the dose can be substantially reduced without compromising the detection rate.

Colonic Polyps↗
PubMed1983

Inflammatory fibroid polyp of the colon simulating malignancy.

The authors report an inflammatory fibroid polyp of the colon which simulated a tumor on the air-contrast barium-enema examination. Histological evaluation revealed the inflammatory nature of the polyp. These rare lesions can be radiographically indistinguishable from primary colon carcinoma.

Adult↗
PubMed2000

Suppression of intestinal polyposis in Apc(delta 716) knockout mice by an additional mutation in the cytosolic phospholipase A(2) gene.

Arachidonic acid is a precursor for biosynthesis of eicosanoids, including prostaglandins, thromboxanes, leukotrienes, and lipoxins. Cytosolic phospholipase A(2) (cPLA(2)) plays a key role in the release of arachidonic acid as the substrate of cyclooxygenase-1 (COX-1) or COX-2. We found that the level of cPLA(2) mRNA was markedly elevated in the polyps and correlated with the polyp size in the small intestine of the Apc(delta)(716) knockout mouse, a model for human familial adenomatous polyposis. To determine the role of cPLA(2) in intestinal tumorigenesis, we then introduced a cPLA(2) gene mutation into Apc(delta)(716) mice. In the compound mutant mice, the size of the small intestinal polyps was reduced significantly, although the numbers remained unchanged. These results provide direct genetic evidence that cPLA(2) plays a key role in the expansion of polyps in the small intestine rather than in the initiation process. In contrast, colonic polyps were not affected in either size or number. Interestingly, group X sPLA(2) was constitutively expressed in the colon at much higher levels than in the small intestine. These results suggest that in the colon, group X sPLA(2) supplies arachidonic acid in both the normal epithelium and the polyps even in the absence of cPLA(2).

Animals↗
PubMed2003

First-degree relatives of patients with advanced colorectal adenomas have an increased prevalence of colorectal cancer.

BACKGROUND & AIMS: The risk of colorectal cancer in relatives of patients with adenomatous colonic polyps is not well defined. This study assessed whether finding colonic neoplasia during screening colonoscopy was related to the family history of colorectal cancer among the participants' parents and siblings. METHODS: Self-reported family history of colorectal cancer was recorded for all participants in a screening colonoscopy study. The size and location of all polyps were recorded before their removal and histologic examination. Participants were grouped according to the most advanced lesion detected. RESULTS: Three thousand one hundred twenty-one patients underwent complete colonoscopic examination. Subjects with adenomas were more likely to have a family history of colorectal cancer than were subjects without polyps (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.09-1.70). The finding of a small (<1 cm) tubular adenoma as the most advanced lesion was associated with only a modest increase in the OR of colorectal cancer in family members (OR, 1.26; 95% CI, 0.99-1.61), but the presence of an advanced adenoma was associated with a higher OR (OR, 1.62;5% CI, 1.16-2.26). Younger age of adenoma diagnosis was not related to a higher prevalence of a family history of colorectal cancer. CONCLUSIONS: Relatives patients with advanced colorectal adenomas have an increased risk of colorectal cancer. Individuals with advanced colorectal adenomas should be counseled about the increased risk of colorectal cancer among their relatives.

Adenoma↗
PubMed1989

Significance of venous and lymphatic invasion in malignant polyps of the colon and rectum.

Three hundred and sixty seven neoplastic colorectal polyps removed at endoscopy of which 34 were complicated by invasive carcinoma, were reviewed clinically and histologically to assess the prevalence and clinical significance of venous and or lymphatic invasion. Traditional stains for histological assessment were supplemented by immunohistochemical methods. Venous and or lymphatic invasion was present in six cases (17.6%), with a statistically significant association with recurrent carcinoma or Dukes's C carcinoma in polyps otherwise regarded as completely excised. The presence or absence of venous and or lymphatic invasion in malignant polyps should be documented as if present, further treatment is indicated. A combination of haematoxylin and eosin and elastic-van Gieson stains will usually identify the presence of vascular invasion. Where a discrepancy arises, however, additional immunohistochemical stains may be of value.

Colon↗
PubMed2006

Recurring enteric peritonitis associated with non-perforating colon carcinoma.

Peritonitis of enteric origin may occur during treatment with peritoneal dialysis due to visceral perforation or injury or, in the absence of perforation, due to transmural migration of enteric bacteria across the bowel wall into the peritoneal cavity. To the best of our knowledge, peritonitis has not previously been reported associated with carcinomatous colon polyp in the absence of bowel wall perforation. We describe the case of a 31-year-old female who experienced recurring episodes of enteric peritonitis associated with a clinically occult adenocarcinoma of the colon, without having any other known risk factors for peritonitis. A 15 mm carcinomatous polyp was not visible on CT scan but was found at colonoscopy with polypectomy. She proceeded to transverse colectomy; the resected colon showed no evidence of bowel wall perforation. This case demonstrates that a non-perforating carcinomatous polyp of the colon may predispose to enteric peritonitis in the setting of peritoneal dialysis, and it emphasizes the importance of making an aggressive search for underlying pathology, in patients who present with recurring enteric peritonitis or unusual presentations of enteric peritonitis.

Adenocarcinoma↗
PubMed1997

Adrenocorticotropin-independent macronodular adrenocortical hyperplasia associated with multiple colon adenomas/carcinomas which showed a point mutation in the APC gene.

We report a male Japanese with corticotropin (ACTH)-independent macronodular adrenocortical hyperplasia (AIMAH) associated with multiple colon adenomas/carcinomas. The plasma cortisol level was elevated with no diurnal rhythm and was not suppressed with dexamethasone. Basal plasma ACTH was unmeasurable but subnormally increased after administration of metyrapone or corticotropin releasing hormone. Both adrenals were resected and weighed 90g; the histopathologic findings were similar to those of AIMAH as previously reported. At least 21 colon lesions which were adenomas or carcinomas, were resected endoscopically or surgically. This is the second reported case of the association of AIMAH with multiple colon polyps. An APC gene point mutation was detected in the colon cancer tissue by polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP)/direct sequencing analysis at the putative splice acceptor site consensus sequence. However, no abnormality of APC gene was detected in the adrenocortical hyperplastic tissue. The possible etiological coexistence of these two diseases is discussed.

Adenoma↗
PubMed1990

Sex and race are risk factors for colorectal cancer within reach of the sigmoidoscope.

There is controversy about the efficacy and feasibility of flexible fiberoptic sigmoidoscopy (FFS) as a screening test for colorectal cancer in asymptomatic adults aged 50 years and over. Some authorities recommend periodic FFS screening for all such adults, whereas other authorities do not recommend screening FFS at all. There is evidence that some physicians have adopted a policy of "selective screening" by emphasizing screening FFS for adults with ancillary risk factors such as a personal history of colon polyps or previous colorectal cancer, or a family history of colon, female genital, or breast cancer. Results of this study of the subsite distribution of colorectal cancer show that both male sex and Oriental race are risk factors for colorectal cancer within reach of FFS, and that the risk of being male and Oriental (relative risk [RR] = 1.9) is of the same magnitude as that for other ancillary risk factors known for the general population (excluding specific rare disorders). Knowledge that sex and race are risk factors for colorectal cancer detectable by screening FFS may be important to those physicians who choose the selective screening approach. Further research is necessary to determine whether selective screening for colorectal cancer is efficacious, or whether the race and sex differences noted in this study are important in the etiology of colorectal cancer.

Adult↗
PubMed1995

Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps.

BACKGROUND: Monopolar hot biopsy forceps (HBF), bipolar HBF, and cold biopsy forceps (CBF) followed by bipolar electrocoagulation are used clinically to simultaneously perform a biopsy and coagulate diminutive colon polyps and angiomata. Our purpose was to conduct a randomized, controlled study to evaluate the safety of these different techniques in the canine right colon. METHODS: After right colotomy in 8 mongrel dogs, colonic mucosa was grasped en face, tented, and biopsy performed in randomized order. The dogs were sacrificed after nine days and the biopsy sites were identified and histologically examined. RESULTS: Monopolar HBF caused an overall mean rate of acute serosal whitening of 29% compared with 0% for bipolar HBF and CBF and 6% for CBF/bipolar probe. Histologically confirmed transmural injury 9 days after biopsy occurred in 44% of monopolar HBF compared with 5% of bipolar HBF, 0% of CBF, and 50% of CBF/bipolar probe. CONCLUSIONS: Monopolar HBF had significantly higher rates of acute serosal whitening and histologic transmural damage than bipolar HBF or cold biopsy alone. On the basis of these results, monopolar HBF should be avoided for coagulation of small or flat right colon lesions such as diminutive polyps or angiomata.

Animals↗
PubMed2006

Double-contrast barium enema: use in practice and implications for CT colonography.

OBJECTIVE: This study examines the use and yield of double-contrast barium enemas (DCBEs) for colorectal polyp detection in current clinical practice outside the research setting. MATERIALS AND METHODS: My colleagues and I retrospectively reviewed adult DCBE studies performed in routine clinical practice at a single academic institution from 2001 through 2004 by reviewing the official radiology and colonoscopy reports. Data were collected on indications for a DCBE, number of positive and negative DCBE reports, results of a DCBE after failed colonoscopy, and professional profiles of the radiologists who performed the DCBEs. Correlation for colon polyp detection was made by reviewing reports of colonoscopy performed within 12 months before or after a DCBE. Polyp detection and matching analysis used a six-segment colon localization scheme. RESULTS: A total of 244 out of 665 (36.7%) barium enema studies were performed using the double-contrast technique over the 4-year period-that is, approximately one per week. The most common indication for a DCBE (109/244 or 44.6%) was to complete a failed, incomplete, or inconclusive colonoscopy. Overall, only 14 of the 244 (5.7%) studies gave positive reports for polyps, and of these, five were shown to be false-positive at later colonoscopy. Only six polyps 10 mm or larger were positively detected during the entire study, which is approximately one per 60 studies or one every 8 months. In 104 patients who had negative DCBEs after failed or inconclusive colonoscopy, more than 50 subcentimeter polyps had been detected and removed, yet not one additional polyp was detected by a DCBE. Of the 15 radiologists performing the DCBEs during the study period, 89.7% of the studies were done by four individuals. Three of these four radiologists were older than 60 years at the beginning of the study, and two of them are now either retired or no longer perform fluoroscopy. CONCLUSION: In our center, a DCBE is a low-yield procedure for detecting polyps, with a high false-positive rate, and is not likely to be performed by experienced practitioners in the future.

Adult↗
PubMed1984

Familial juvenile polyposis coli; increased risk of colorectal cancer.

Six patients from one family and one solitary patient with juvenile polyposis coli are described. The histological changes in colonic polyps formed a spectrum from juvenile polyps, through focal to extensive adenomatous change, to adenocarcinomas. One patient aged 49 years had an adenocarcinoma of the colon and in another, aged 33, with rectal polyps and metastatic cancer this was suspected although the primary tumour was not located. Two additional patients, aged 19 and 41 years, had severe adenomatous dysplasia in a juvenile polyp. Four patients also had gastroduodenal polyps. The present findings clearly contradict the previous view that juvenile polyposis coli is not premalignant and only rarely needs surgical treatment. As other recent reports also describe frequent occurrence of neoplastic changes in juvenile polyps, colectomy, and ileorectostomy at the age of about 20 years is recommended as the treatment of choice for juvenile polyposis coli, as in patients with familial adenomatosis coli. Follow up should ideally include gastroduodenoscopy and inspection of the rectal remnant at regular intervals.

Adenocarcinoma↗
PubMed2002

The CAST/Ei strain confers significant protection against Apc(Min) intestinal polyps, independent of the resistant modifier of Min 1 (Mom1) locus.

Intestinal adenoma development in Apc(Min) mice is influenced by genetic background. We generated a congenic line between the CAST and B6 inbred strains to study the effects of a resistant CAST background in the absence of a major modifier locus, Modifier of Min 1 (Mom1(R)). Progeny from a CAST.B6 Mom1(R/S) x B6 Apc(Min/+) intercross were 110 or 200 days of age and screened for intestinal polyps. There was a significant decrease (P < 0.0001) in polyp multiplicity and size in CASTB6F1 Mom1(R/S), Apc(Min/+) and CASTB6F1 Mom1(S/S), Apc(Min/+) progeny compared with B6 Mom1(S/S), Apc(Min/+) controls. A complete absence of colon polyps was observed in all mice heterozygous for the CAST background. These results demonstrate that the CAST strain carries dominant modifier loci, in addition to Mom1(R), that dramatically reduce polyp burden in the small intestine and eliminate polyp burden in the colon of Apc(Min) mice.

Adenomatous Polyposis Coli↗
PubMed2006

Jumbo biopsy is useful for the diagnosis of colonic prolapsing mucosal polyps with diverticulosis.

We report here a case of multiple prolapsing mucosal polyps with diverticulosis in the sigmoid colon. A 52-year-old man was admitted to our hospital because of bloody diarrhea. Colonoscopy and barium enema showed multiple diverticula, markedly thickened mucosal folds and polypoid lesions with mucus on the top of them in the sigmoid colon. Endoscopic ultrasonography showed thickening of the mucosal and submucosal layers. Several endoscopic biopsy specimens were taken from the polypoid lesions. Histological examination revealed only chronic inflammatory cell infiltration. In order to obtain a definite diagnosis, we performed endoscopic jumbo biopsy for the polypoid lesions after obtaining informed consent. Histological examination revealed marked lymphocyte infiltration, hemosiderin deposits and fibromuscular obliteration in the lamina propria, features similar to those of mucosal prolapsing syndrome. After anti-diarrhetic treatment, clinical findings were improved. Thus, jumbo biopsy is useful for diagnosis and treatment of prolapsing mucosal polyps.

Biopsy↗