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PubMed2000

Diagnosis of colorectal neoplasms at double-contrast barium enema examination.

The double-contrast barium enema examination has been recognized as an option for colorectal cancer screening in Americans with average risk who are greater than 50 years of age. The purpose of this article is to review the principles for diagnosing colorectal neoplasms on double-contrast images and the spectrum of findings associated with these lesions. Colonic polyps can be sessile or pedunculated; their appearance depends on whether they are located on the dependent or nondependent wall of the bowel. Villous tumors may be flat, lobulated lesions, also known as "carpet" lesions, that are characterized by a finely nodular or reticular surface pattern, without a discrete mass. Colonic carcinomas may manifest as plaquelike, polypoid, semiannular ("saddle") or annular lesions. Colonic neoplasms sometimes are more difficult to detect in the region of the ileocecal valve or the distal rectum or in patients with severe diverticulosis. Careful double-contrast technique and meticulous scrutiny of the images therefore are required to optimize detection of these lesions.

Barium Sulfate↗
PubMed1996

Genetic counseling in an extended attenauted familial adenomatous polyposis kindred.

OBJECTIVES: To provide DNA-based genetic counseling to family members in the direct genetic lineage of a family fulfilling phenotypical criteria for the autosomal, dominantly inherited, attenuated familial adenomatous polyp (AFAP) syndrome. This enabled highly targeted cancer risk estimation based on cancer phenotype in concert with the presence or absence of the adenomatous polyposis coli (APC) germline mutation. Management recommendations could then be fully responsive to this syndrome's natural history. METHODS: Detailed family history with pathology verification of colonic polyps and cancer was performed on an extended AFAP kindred. Endoscopic gastrointestinal examinations enabled detailed knowledge of the syndrome's upper and lower gastrointestinal tract phenotype. Molecular genetic evaluation of DNA led to the identification of the APC germline mutation which co-segregated with the phenotype. RESULTS: Forty-two members of this extended AFAP family underwent DNA testing, wherein 27 were found to harbor the APC germline mutation,thereby enabling precision in their genetic counseling. Anecdotal examples of this counseling experience, with particular attention to psychological reactions, as well as concerns about such issues as insurance and employer discrimination, have been described. CONCLUSIONS: When DNA-based testing is offered to AFAP family members, genetic counselors must compassionately consider patients' psychological concerns when providing detailed risk status and available surveillance and management programs.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

[Lymphoscintigraphic localization of sentinel lymph nodes in colorectal carcinoma in early stage: results of a single center study and proposal of a multicenter protocol].

In colorectal cancer the sentinel node dissection may help to identify any unusual mesenteric lymphatic drainage pattern from the primary tumor site (ex/skip metastases); assuming that accurate pathological staging is critical for therapeutic decisions we are conducing a study to evaluate the feasibility of the sentinel node technique in colorectal neoplasms and its overall accuracy in predicting regional lymph nodes metastases for appropriate staging. From February 2001 to September 2004 we included in this study 30 patients with rectal lesions or degenerate colonic polyps not radically excised by endoscopy. Lymphatic mapping was performed with low molecular weight albumin colloid labelled with 500Mci of 99mTc in a 2 ml volume and injected submucosally by an endoscopic route at the four cardinal points around the tumor, the afternoon before the surgical procedure, both in case of colonic or rectal lesions. Scintigraphic images were obtained with a gamma camera fitted with a general purpose collimator. The day of the intervention, a hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect the "hot" nodes, in vivo and ex vivo. These lymph nodes were tagged with a stitch in vivo; the specimen was removed by a standard resection and SLN were dissected ex vivo and sent separately for pathological examination. In case of rectal lesions, the sentinel nodes were searched ex vivo into mesorectal fat in case. All lymph nodes, including blue or hot ones, were embedded separately for preparation of paraffin sections and haematoxylin and eosin staining. Sentinel lymph node were submitted to multi-seriate sections in order to look for micrometastases. Using the radioactive tracer, sentinel lymph nodes were successfully identified in 27 out of 30 patients. Concordance between SLNs and nodal status was observed in 23 out of 27 cases (85%); two patients (7.4%) were upstaged, as SLN was the only site of metastases. In another two cases we observed no concordance between negative sentinel node and non sentinel nodes (false negative rate, 7.4%). Starting from this experience we are proposing a multicentric trial concerning the value of sentinel node technique in rectal cancer and in early colorectal cancers detected by screening programs.

Clinical Protocols↗
PubMed1995

Recurrent intussusception reduced by the patient: a case report.

A case of recurrent acute intussusception associated with a palpable abdominal mass which patient reduces with relief of symptoms is presented. Surgery revealed multiple colonic polyps and a total colectomy with ileorectical anastomosis was done and the patient has remained well after 3 years of follow up.

Acute Disease↗
PubMed1981

Electron microscopy of polyps of the colon. II. Inclusion bodies of Leuchtenberger.

The electron-microscopic characteristics of the LEUCHTENBERGER'S inclusion bodies were studied in adenomatous, papillary and adeno-papillary polyps of the colon. According to them, formation of intracellular inclusions is due to focal cytoplasmic degradation, and that of intercellular inclusions to the herniation of the cytoplasmic part of epithelial cells. The formation of inclusions is believed to be connected with the low stage of development of the plasma membrane of rapidly proliferating undifferentiated colonic epithelial cells. During malignant transformation of polyps, the frequently occurring inclusions are considered an important morphological sign.

Colonic Neoplasms↗
PubMed1987

Relative growth of adenomatous polyps of the colon. Stereology and allometry of multiple polyposis.

The volume of the adenomatous mucosa (V), the area of the surface epithelium (Ss), the area of the glandular epithelium (Sg), and the Sg: Ss ratio were calculated in a series of 14 adenomatous polyps (APs) of a case of multiple polyposis of the colon. The equation of simple allometry was used to study the relative growth of the four series of values. Ss grew isometrically with size; Sg overgrew Ss and accounted for most of the increase in V. The Sg:Ss ratio increased with Sg and V.

Colonic Polyps↗
PubMed2002

[Prevention without radiation--a strategy for comprehensive early detection using magnetic resonance tomography].

Recent advances in hardware technology, noninvasiveness, lack of radiation and high diagnostic accuracy combine to allow the usage of magnetic resonance imaging (MRI) for disease screening in asymptomatic people. 175 volunteers were examined by means of a comprehensive 60-minute MR-screening-protocol covering four organ systems: the brain, the arterial vasculature, the heart and the colon. In 28% of the cases vascular pathology (cerebral, peripheral or cardiovascular) was detected. In up to 17% of the single examination parts relevant incidental findings were seen. The outlined comprehensive MR-protocol is an accurate and patient-friendly imaging tool for the detection of vascular pathology as well as colonic polyps. The socio-economic relevance of this screening exam has to be further investigated in larger patient cohorts.

Adult↗
PubMed1994

Nifedipine (Procardia XL) as a cause of false-positive results on barium enema study.

There are a number of potential causes for false-positive results on a barium enema study. We report three cases in which patients had to have colonoscopy because a nifedipine slow-release tablet (Procardia XL) was misinterpreted as a colonic polyp on a barium enema study. The pill did not move with abdominal compression, further suggesting that it was a polyp. Patients in whom similar lesions are identified during barium enema examination should be questioned as to whether they are taking these medications.

Aged↗
PubMed1988

Conceptual developments through colonoscopy.

Fiberoptic colonoscopy is 25 years old this year. Improvement in instruments led rapidly to wide acceptance of colonoscopy in diagnosis and therapy of colorectal diseases. The diagnosis of benign and malignant neoplasms was revolutionized by colonoscopy. The differential diagnosis of inflammatory bowel disease, assessment of its extent and severity, response to treatment, and potential for development of cancer are all made easier by colonoscopy. Colonoscopy has improved the diagnosis of diverticular disease, rectal bleeding, identification of ischemia, and other problems. Therapeutic colonoscopy has radically changed the management of colonic polyps, and colonoscopic polypectomy is now the standard form of treatment for most of these lesions. Treatment of bleeding lesions, decompression of obstruction, and removal of foreign bodies are other examples of therapeutic colonoscopic procedures.

Colonic Diseases↗
PubMed1994

Expression of mRNA for the gap-junctional protein connexin43 in human colonic tissue is variable in response to beta-carotene supplementation.

Increased expression of the gap-junctional protein connexin43 (Cx43) is reported to be increased in mouse and human dermal fibroblasts in vitro in response to beta-carotene treatment. In the present study, we determined the level of Cx43 mRNA expression in colonic mucosa from normal subjects and subjects with a prior history of colonic polyps or cancer before and after three months of administration of a placebo or beta-carotene. RNA was reverse transcribed and used in a polymerase chain reaction assay employing primers selected from the human Cx43 gene sequence. Cx43 mRNA expression was normalized on the basis of beta 2-microglobulin mRNA expression. The beta-carotene concentration in colonic mucosa, as well as serum and diet, was also determined to establish a correlation between Cx43 expression and beta-carotene concentration. In an initial analysis of samples collected from 10 subjects before supplementation, the quantity of Cx43 mRNA was variable and did not correlate with beta-carotene intake or the concentration of beta-carotene in tissue or serum. In samples collected at zero and three months from eight subjects who were controls or received a placebo, there was no correlation between Cx43 mRNA level and tissue or serum beta-carotene concentration. In samples collected from subjects before and after three months of beta-carotene supplementation, there was a significant increase in tissue and serum beta-carotene concentration in all subjects and an increase in Cx43 mRNA expression after supplementation relative to baseline in four of six samples. The high variability in Cx43 expression indicates that induction of Cx43 mRNA expression is not solely dependent on the concentration of beta-carotene in diet, serum, or tissue. However, the results from subjects supplemented with beta-carotene suggest that induced expression may occur in colonic tissue of some individuals. some individuals.

Base Sequence↗
PubMedDate not supplied

[The importance of Streptococcus bovis systemic infections].

Streptococcus bovis is relatively common cause of bacteremia and endocarditis, especially in older persons, or in patients that have some kind of chronic disease. These infections are frequently connected with malignant, potentially malignant, or benign colorectal neoplasia. Hematogenous dissemination of Streptococcus bovis could result with various clinical manifestations, namely purulent meningitis, brain abscess, osteomyelitis, spondylodiscitis, and many different kinds of infections in AIDS patients are reported. In this report, two patients hospitalized at the Departement of Infectious Diseases at the General Hospital "Dr. Josip Bencević" in Slavonski Brod are presented. The first patient was addmited to the hospital because of fever of unknown origin, and in his blood cultures, Streptococcus bovis was isolated. He was an older man, who had undergone prostatectomy due prostatic adenoma several years before. The other patient, previously completely healthy younger man, suffered purulent meningitis caused by the same microorganism. Colon endoscopy was performed in both patients and it revealed colon polyps. Histologically, in both cases, those were benign neoplasia. In Croatia, until this report, there have been no other reports about patients suffering systemic Streptococcus bovis infections. At the same time, this report describes Streptococcus bovis purulent meningitis in a previously healthy adult, which is also extremely rare in the medical literature. Since Streptococcus bovis infections are associated with colon carcinoma, it is imperative to perform colonoscopy in each patient suffering infection with this germ, and to consider him as a high risk patient for developing colon cancer.

Adult↗
PubMed1990

The effect of preoperative endoscopy on recurrence and survival following surgery for colorectal carcinoma.

Numerous studies have elucidated the benefits of endoscopy before surgery for carcinoma of the colon and rectum. In patients with known colon cancer, the incidence of synchronous colon cancers is 1.5 to 7.6 per cent and synchronous colon polyps is 25 to 40 per cent. Standard barium contrast studies are inferior to endoscopic examination in detecting these synchronous lesions. Endoscopy has been shown to alter the planned surgical procedure in 11 to 13 per cent of patients with colorectal cancer. Nevertheless, some authors avoid preoperative endoscopy because of concern that neoplastic cells may be seeded throughout the colon during the examination. They fear that manipulation of the tumor may promote hematogenous or lymphatic spread. Our study seeks to demonstrate whether this concern is valid by comparing rates of local recurrence, distant metastases, and survival between patients who have undergone preoperative endoscopy with those who have not.

Adult↗
PubMed1994

Gardner's syndrome. Case report and discussion of the manifestations of the disorder.

Extracolonic manifestations of Gardner's syndrome are common and may precede the detection of colonic polyps. Tc-MDP bone scintigraphy performed on a patient with Gardner's syndrome demonstrated intense uptake of radiotracer within the maxilla and mandible as a result of the dental anomalies associated with this disorder. Nuclear scintigraphy has a role in the imaging of these patients for skeletal anomalies, the detection of thyroid carcinoma, and for skeletal metastases when colon carcinoma is detected.

Adult↗
PubMed1978

Polyposis coli. The clinical spectrum in adults.

Four patients are reported, to illustrate the wide spectrum of colonic polyps which may occur in multiple form in adults. Included are unusual cases of metaplastic and juvenile polyposis. The subject is reviewed, and the need for accurate histological diagnosis is stressed. The possibility that the difference between familial adenomatous polyposis and Gardner's syndrome may lie merely in the degree of expressivity of the associated extracolonic features is discussed. Surveillance of these patients for peri-ampullary neoplasms in the duodenum is considered. The interrelationship between familial adenomatous polyposis, juvenile polyposis and colorectal cancer is discussed.

Adenocarcinoma↗
PubMed1998

Diagnostic failure in colonoscopies for malignant disease.

BACKGROUND: While colonoscopy has become established as more accurate than double contrast barium enema for detecting colonic polyps and cancers, as well as offering the opportunity for therapy, there are occasional instances where colonoscopy is misleading. The present study is to determine what problems occur, with a view to finding a solution. METHODS: The records of the Colorectal Project at the Princess Alexandra Hospital indicate retrospectively that 346 patients have been correctly diagnosed with cancer of the colon and rectum by colonoscopy in the 5 years up to October 1996. During the same time eight patients (2.3%) were recorded at the same hospital as being misdiagnosed by colonoscopy, the lesion being either missed completely or misplaced. RESULTS: In five of these patients there was failure to recognize that the whole colon had not been examined endoscopically, thereby missing a more proximal lesion. In two patients the lesion was missed although the entire colon was examined. In one patient the lesion was discovered but inaccurately sited. Six of these mistakes would have been obviated by the routine use of fluoroscopy to confirm the totality of the colonoscopy and to site any lesions found. The other two cases occurred because of failure to remember that colonic examination during withdrawal should be performed meticulously back as far as the anal canal. Failure to diagnose a colon cancer on the initial colonoscopy led to an average delay of 6 months for definitive care. CONCLUSIONS: It is recommended that fluoroscopy be used routinely during colonoscopy to site accurately any lesions found, and to confirm the completeness of insertion if reliable landmarks, including terminal ileum, are not clearly identified.

Aged↗
PubMed1994

Obesity and adenomatous polyps of the sigmoid colon.

The relation between obesity and adenomatous polyps of the sigmoid colon was investigated in male self-defense officials who received a retirement health examination at three hospitals of the Self-Defense Forces in Japan between January 1991 and December 1992. Body mass index (BMI) and waist-hip circumference ratio (WHR) were used as indices of obesity. A total of 228 adenoma cases and 1484 controls with normal sigmoidoscopy were identified in 2228 men: cases having small adenomas (< 5 mm in diameter) and those with large adenomas (5 mm or greater) numbered 115 and 102, respectively. Smoking, alcohol use, physical activity, rank, and hospital were controlled for by multiple logistic regression analysis. BMI and WHR were classified into four levels using the 30th, 60th, and 90th percentiles of each distribution in the control as cut-off points. There was a significant two-fold elevation in the overall adenoma risk among men at the highest BMI level (> or = 26.95) compared with those at the lowest level (< 22.48), but the risk did not linearly increase: a similar increase was also noted for large adenomas. While WHR was only weakly related to the overall adenoma risk, the risk of large adenomas progressively increased with increasing levels of WHR; odds ratio (OR) 2.9 (95% confidence interval (CI) 1.4-5.9) for the highest (> or = 0.958) versus lowest (< 0.878) levels. BMI was not materially associated with adenoma risk after additional adjustment for WHR, but a positive association between WHR and large adenomas was independent of BMI: OR 3.4 (95% CI 1.5-7.6) for the highest versus lowest levels. These findings suggest that obesity is associated with an increased risk of colon adenomas, probably with adenoma growth.

Adenoma↗
PubMed1981

A comparison of tube leukocyte adherence inhibition assay and standard physical methods for diagnosing colorectal cancer.

In vitro antitumor immunity, measured by means of a tube leukocyte adherence inhibition (LAI) assay, was able to demonstrate early colorectal cancer in cases yet undiagnosed. Testing 106 patients attending a colonoscopy clinic, we found that nine of 15 (60%) patients with colorectal cancer were LAI-positive. The nine included: five of six with Dukes' A and B; one of two with Dukes' C; and three of seven with Dukes' D lesions. Of 58 patients without colon neoplasia, one had a positive test. By contrast, barium enema results were diagnostic for 13 of 15 (87%) cases and colonoscopy for 11 of 15 (73%). There were 32 colon polyps discovered by means of barium enema and colonoscopy. Of 13 adenomas removed, four had stimulated positive LAI responses. Of another 19 polyps not removed two incited positive LAI responses. Two patients with histories of recurrent adenomas were LAI-positive, though only one had a new polyp that could be detected by means of barium enema. For a procedure to be of diagnostic value for a given disease, sensitivity and specificity must be at least 1.0. If this sum is 2.0, the test is ideal. The sum of sensitivity and specificity for the tube LAI assay, barium enema, and colonoscopy were 1.58, 1.87, and 1.73, respectively, for colorectal cancer; 1.81, 2.0, and 2.0, respectively, for early colorectal cancer; and 1.42, 1.77, and 1.55 respectively, for advanced colorectal cancer. In this limited series of patients, the barium enema seems to be superior to the tube LAI assay for diagnosing colorectal cancer, but the difference in sensitivity and specificity is not statistically valid by the paired chi square test. The results of this study shows conclusively, that the tube LAI is of diagnostic value and suggest its use for evaluating suspected cases, especially early ones, of colorectal cancer.

Adenoma↗