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Large Bowel (large + bowel)
Selected AbstractsGastric adenocarcinoma metastatic to the skin: a reportEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2002C. CHARALAMBOUS MBCHB, FRCS SURGICAL SENIOR HOUSE OFFICER Metastases to the skin from internal tumours are uncommon, yet they may be the first presentation of such malignancies. They usually arise from the breast, lung and large bowel. Skin metastases from gastric adenocarcinoma are extremely rare. We report a case of a patient with gastric adenocarcinoma who at presentation had multiple, clinically benign-looking skin nodules. Biopsy of these revealed metastatic deposits. [source] Imaging the large bowel in the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2004Aza Abdulla Diseases of the large bowel are common in older patients and many of these, notably polyps, cancer, diverticular disease and ischemia, increase in incidence with age. A variety of imaging modalities are available in clinical practice but the choice of investigation should take into consideration not only its diagnostic yield but also the ability of the older patient to undergo the procedure with minimal discomfort. Perhaps more important is whether that investigation is likely to have an effect on the overall management of the patient. [source] MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: Diagnostic accuracy and patient acceptanceINFLAMMATORY BOWEL DISEASES, Issue 8 2007Jost Langhorst MD Abstract Background: The purpose of this pilot study was to assess the diagnostic accuracy of MR colonography (MRC) without bowel cleansing regarding its ability to quantify inflammatory bowel disease (IBD). In addition, patient acceptance was compared with conventional colonoscopy (CC). Methods: In all, 29 patients with IBD (17 ulcerative colitis; 12 Crohn's disease) were included. While CC was performed after bowel cleansing as the gold standard, MRC was based on a fecal tagging technique and performed 48,72 hours prior to CC. The presence of inflammation in each of 7 ileocolonic segments was rated for every procedure. Patients evaluated both modalities and dedicated aspects of the examination according to a 10-point-scale (1 = good, 10 = poor acceptance). Furthermore, preferences for future examinations were investigated. Results: Inflammatory segments were found by means of CC in 23 and by MRC in 14 patients. Overall sensitivity and specificity of MRC in a segment-based detection were 32% and 88%, respectively. Concerning severely inflamed segments, sensitivity increased to 53% for MRC. Overall acceptance of CC was significantly higher compared to MRC (mean value (mv) for MRT = 6.0; CC = 4.1; P = 0.003). For MRC, the placement of the rectal tube (mv = 7.3), and for CC bowel purgation (mv = 6.5), were rated as the most unpleasant. A total of 67% of patients voted for CC as the favorable tool for future examinations. Conclusions: The presented data indicate that ,fecal tagging MRC' is not suitable for an adequate quantification of inflammatory diseases of the large bowel. Furthermore, overall acceptance of endoscopic colonoscopy was superior to MRC. (Inflamm Bowel Dis 2007) [source] Impact of elemental diet on mucosal inflammation in patients with active Crohn's disease: Cytokine production and endoscopic and histological findingsINFLAMMATORY BOWEL DISEASES, Issue 6 2005Takayuki Yamamoto MD Abstract Background: The aim of this study was to examine the impact of elemental diet on mucosal inflammation in Crohn's disease (CD), mainly by cytokine measurements. Methods: Twenty-eight consecutive patients with active CD were treated with an elemental diet (Elental) for 4 weeks. The mucosal biopsies were obtained from the terminal ileum and large bowel before and after treatment. As a control group, mucosal biopsies were obtained from 20 patients without inflammation. Mucosal cytokine concentrations were measured by enzyme-linked immunosorbent assay. Results: After treatment, clinical remission was achieved in 20 patients (71%). Endoscopic healing and improvement rates were 44% and 76% in the terminal ileum and 39% and 78% in the large bowel, respectively. Histologic healing and improvement rates were 19% and 54% in the terminal ileum and 20% and 55% in the large bowel, respectively. Before treatment, the mucosal concentrations of interleukin (IL)-1,, IL-1 receptor antagonist (IL-1ra), IL-6, IL-8, and tumor necrosis factor-, in the ileum and large bowel were significantly higher than in controls. These cytokine concentrations decreased to the levels of control after treatment. IL-1ra/IL-1, ratio in the ileum and large bowel was significantly lower than in controls before treatment. The ratio increased to the level of controls after treatment. The endoscopic and histologic healing of the mucosal inflammation was associated with a decline of the mucosal cytokines and an increase of the IL-1ra/IL-1, ratio. Conclusions: The elemental diet (Elental) reduced mucosal cytokine production and corrected an imbalance between proinflammatory and anti-inflammatory cytokines in CD. [source] Changing cancer incidence in Kampala, Uganda, 1991,2006INTERNATIONAL JOURNAL OF CANCER, Issue 5 2010Donald Maxwell Parkin Abstract Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for a 16-year period (1991,2006). This period coincides with continuing social and lifestyle changes and the peak and subsequent wane of the epidemic of HIV-AIDS. There has been an overall increase in the risk of cancer during the period in both sexes, with the incidence rates of cancers of the breast and prostate showing particularly marked increases (4.5% annually). Prostate cancer is now the most common cancer in men. The incidence of cancer of the esophagus, formerly the most common cancer in men and second in frequency in women, has remained relatively constant, whereas the incidence of cancer of the cervix, the most common malignancy in women, continues to increase. Since the early 1990s the incidence of Kaposi sarcoma (KS) in men has declined, and while remaining relatively constant in women, it has been diagnosed at progressively later ages. The rates of pediatric KS have declined by about 1/3rd. The incidence of squamous cell cancers of the conjunctiva has also declined since the mid 1990s. Cancer control in Uganda, as elsewhere in sub-Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate); although the incidence of cancers associated with poverty and infection (liver, cervix, esophagus) shows little decline, the residual burden of the AIDS-associated cancers remains a major burden. [source] Dietary acrylamide and human cancerINTERNATIONAL JOURNAL OF CANCER, Issue 2 2006Claudio Pelucchi Abstract Low levels of acrylamide have been found in several foods cooked at high temperatures. While there is sufficient evidence for the carcinogenicity of acrylamide in experimental animals, the few epidemiologic studies conducted to date on occupational and dietary exposure to acrylamide have found no consistent evidence of association with human cancer risk. Using data from an integrated network of Italian and Swiss hospital-based case-control studies, we analyzed the relation between dietary acrylamide intake and cancers of the oral cavity and pharynx (749 cases, 1,772 controls), esophagus (395 cases, 1,066 controls), large bowel (1,394 cases of colon, 886 cases of rectal cancer, 4,765 controls), larynx (527 cases, 1,297 controls), breast (2,900 cases, 3,122 controls), ovary (1,031 cases, 2,411 controls) and prostate (1,294 cases, 1,451 controls). All the studies included incident, histologically confirmed cancer cases and controls admitted to the same network of hospitals for acute nonneoplastic conditions. We calculated odds ratios (ORs) using multivariate logistic regression models, adjusted for energy intake and other major covariates of interest. The ORs for the highest versus the lowest quintile of acrylamide intake were 1.12 (95% CI = 0.76,1.66) for cancer of the oral cavity/pharynx, 1.10 (95% CI = 0.65,1.86) for esophageal, 0.97 (95% CI = 0.80,1.18) for colorectal, 1.23 (95% CI = 0.80,1.90) for laryngeal, 1.06 (95% CI = 0.88,1.28) for breast, 0.97 (95% CI = 0.73,1.31) for ovarian and 0.92 (95% CI = 0.69,1.23) for prostate cancer. None of the trend in risk was significant. This uniquely large and comprehensive data set does not show any consistent association between intake of acrylamide and the risk of breast and several other common cancers. © 2005 Wiley-Liss, Inc. [source] Dextran sodium sulfate strongly promotes colorectal carcinogenesis in ApcMin/+ mice: Inflammatory stimuli by dextran sodium sulfate results in development of multiple colonic neoplasmsINTERNATIONAL JOURNAL OF CANCER, Issue 1 2006Takuji Tanaka Abstract The mouse model for familial adenomatous polyposis, ApcMin/+ mouse, contains a truncating mutation in the Apc gene and spontaneously develops numerous adenomas in the small intestine but few in the large bowel. Our study investigated whether dextran sodium sulfate (DSS) treatment promotes the development of colonic neoplasms in ApcMin/+ mice. ApcMin/+ and Apc+/+ mice of both sexes were exposed to 2% dextran sodium sulfate in drinking water for 7 days, followed by no further treatment for 4 weeks. Immunohistochemistry for cyclooxygenase-2, inducible nitric oxide synthase, ,-catenin, p53, and nitrotyrosine, and mutations of ,- catenin and K- ras and loss of wild-type allele of the Apc gene in the colonic lesions were examined. Sequential observation of female ApcMin/+ mice that received DSS was also performed up to week 5. At week 5, numerous colonic neoplasms developed in male and female ApcMin/+ mice but did not develop in Apc+/+ mice. Adenocarcinomas developed in ApcMin/+ mice that received DSS showed loss of heterozygosity of Apc and no mutations in the ,- catenin and K- ras genes. The treatment also significantly increased the number of small intestinal polyps. Sequential observation revealed increase in the incidences of colonic neoplasms and dysplastic crypts in female ApcMin/+ mice given DSS. DSS treatment increased inflammation scores, associated with high intensity staining of ,-catenin, cyclooxygenase-2, inducible nitric oxide synthase and nitrotyrosine. Interestingly, strong nuclear staining of p53 was specifically observed in colonic lesions of ApcMin/+ mice treated with DSS. Our results suggest a strong promotion effect of DSS in the intestinal carcinogenesis of ApcMin/+ mice. The findings also suggest that strong oxidative/nitrosative stress caused by DSS-induced inflammation may contribute to the colonic neoplasms development. © 2005 Wiley-Liss, Inc. [source] Yield from colonoscopic screening in people with a strong family history of common colorectal cancerJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2000Damian J Dowling Abstract Background and Aims: People with a strong family history of common (so-called ,sporadic') colorectal cancer are generally advised to undergo colonoscopic screening, but the starting age for this is unclear. An audit was performed to study the age-related yield of screening colonoscopy in this risk group. Methods: A prospective audit of the outcome of screening colonoscopy was performed on a cohort of 232 people with a strong family history of common colorectal cancer. All were registrants in a familial bowel cancer service solely because of their family medical history. They had no bowel symptoms and no prior endoscopic investigation of the large bowel. Results: Neoplastic lesions were detected by using colonoscopy in 33 participants. In 27 participants, the major lesion was a small tubular adenoma, four had an advanced adenoma and two had cancer. More neoplastic (P = 0.02) and advanced neoplastic (P = 0.03) lesions were found in those patients aged , 50 years. Only one advanced adenoma was detected in a participant below the age of 50 years. Conclusion: The yield from screening colonoscopy in young people (< 50 years) with a strong family history of common colorectal cancer is low, placing doubt on the need for colonoscopic screening before the age of 50 years. [source] The role of gene,environment interaction in the aetiology of human cancer: examples from cancers of the large bowel, lung and breastJOURNAL OF INTERNAL MEDICINE, Issue 6 2001L. A. Mucci Abstract. Mucci LA, Wedren S, Tamimi RM, Trichopoulos D, Adami H.-O. (Harvard School of Public Health, Boston, MA, USA; and Karolinska Institutet, Stockholm, Sweden) The role of gene,environment interaction in the aetiology of human cancer: examples from cancers of the large bowel, lung and breast. J Intern Med 2001; 249: 477,493. It has become increasingly clear that cancer can be considered neither purely genetic nor purely environmental. A relatively new area of cancer research has focused on the interaction between genes and environment in the same causal mechanism. Primary candidates for gene-environment interaction studies have been genes that encode enzymes involved in the metabolism of established cancer risk factors. There are common variant forms of these genes (polymorphisms), which may alter metabolism and increase or decrease exposure to carcinogens, thus impacting the risk of cancer. We present an overview of enzymes involved in carcinogen metabolism, present epidemiological tools to evaluate gene-environment interactions, and provide examples from cancers of the breast, lung and large bowel. [source] The Shigella dysenteriae serotype 1 proteome, profiled in the host intestinal environment, reveals major metabolic modifications and increased expression of invasive proteinsPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 22 2009Rembert Pieper Abstract Shigella dysenteriae serotype 1 (SD1) causes the most severe form of epidemic bacillary dysentery. We present the first comprehensive proteome analysis of this pathogen, profiling proteins from bacteria cultured in vitro and bacterial isolates from the large bowel of infected gnotobiotic piglets (in vivo). Overall, 1061 distinct gene products were identified. Differential display analysis revealed that SD1 cells switched to an anaerobic energy metabolism in vivo. High in vivo abundances of amino acid decarboxylases (GadB and AdiA) which enhance pH homeostasis in the cytoplasm and protein disaggregation chaperones (HdeA, HdeB and ClpB) were indicative of a coordinated bacterial survival response to acid stress. Several type III secretion system effectors were increased in abundance in vivo, including OspF, IpaC and IpaD. These proteins are implicated in invasion of colonocytes and subversion of the host immune response in S. flexneri. These observations likely reflect an adaptive response of SD1 to the hostile host environment. Seven proteins, among them the type III secretion system effectors OspC2 and IpaB, were detected as antigens in Western blots using piglet antisera. The outer membrane protein OmpA, the heat shock protein HtpG and OspC2 represent novel SD1 subunit vaccine candidates and drug targets. [source] Nonsteroidal anti-inflammatory drugs-associated colopathyANZ JOURNAL OF SURGERY, Issue 1-2 2010Yazan A. Masannat Abstract Background:, Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used worldwide, and their complications in the upper gastrointestinal tract are well described in the literature and well known to clinicians. However, complications in the large bowel are being increasingly recognized and reported. This review aims to address the different aspects of NSAIDs-associated colopathy. Methods:, This is a review article addressing NSAIDs colopathy. A Medline-based search was performed for articles published between 1950 and 2008 on this condition. Keywords detailed were colonic disease, ulcers, strictures and/or diaphragm strictures. Only articles in the English language were considered. Results:, The articles identified included letters to the editors, case reports, case series, review articles and few original research papers. The review was structured in a narrative style in different sections addressing pathophysiology, clinical presentation and management. Conclusions:, NSAIDs colopathy is a rare benign condition. Current evidence only suggests an association with prolonged use of the NSAIDs, however, there are no studies to support the direct causation. The presentation is non-specific, and the commonest findings on endoscopy are ulceration and diaphragm-like strictures. The importance of identifying this condition is to prevent complications and also to be able to differentiate it from other conditions such as inflammatory bowel disease (IBD) and malignancy. [source] Changes of the total antioxidative status of blood cells in the progression of stomach and large bowel cancers in patients subjected to primary radical treatmentBIOFACTORS, Issue 1-4 2004Z. Kopañski Abstract The analysis included 53 patients (32 men and 21 women) aged 43 to 66 years, who were subjected to radical treatment (surgical or combined) because of stomach (22 patients) or large bowel (31 patients) cancer. All the patients were included in the same model of control examinations, which considered evaluation of the erythrocytes TAS and of the Ca19,9, CEA and AFP concentrations in serum. It was confirmed that in all the patients in whom the recurrence and/or the dissemination occurred of the cancer, the average erythrocytes TAS value increased 5.5 times by comparison with the period before progression and 7 times in comparison with the patients without recurrence and/or dissemination of the cancer. Moreover it was shown that statistically significantly higher TAS values were associated with the progression of the large bowel cancer in comparison with the stomach cancer and that the blood cells TAS positively correlated with the changes of the Ca19,9, CEA and AFP concentrations in patients with progression of the cancer after radical treatment. [source] Strategy for the surgical management of patients with idiopathic megarectum and megacolon,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2001C. B. Ó Súilleabháin Background: Several surgical procedures have been used to treat idiopathic megabowel. A structured approach to the surgical management of megarectum/colon is reported. Methods: Twenty-eight consecutive patients with megabowel referred for surgery were reviewed. All patients had conservative treatment for 6 months. Those failing to improve underwent full-thickness biopsy of the anorectal junction, anorectal physiology studies, colonic transit studies and evacuation proctography. Surgery involved excision of the abnormal large bowel and formation of an anastomosis (coloanal or ileoanal) using ,normal' bowel identified either by a defunctioning stoma or colonic motility studies. Results: Eight patients responded to conservative management. Two patients were lost to follow-up and one died from unrelated causes. Two of the 17 patients who underwent full-thickness biopsy were cured by the procedure. Anorectal physiology, colonic transit and evacuation studies did not aid selection of the surgical procedure performed in 15 patients: proctectomy and coloanal anastomosis (six), restorative proctocolectomy (three), panproctocolectomy (one) and defunctioning stoma (five). At a median follow-up of 3·6 years, 13 of 15 evaluable patients had a satisfactory outcome. Conclusion: Approximately 40 per cent of patients with megabowel referred for surgery responded to conservative treatment. The remaining patients may be treated successfully by surgery. The use of either a ,diagnostic' defunctioning stoma or colonic motility studies may aid in the choice of surgical procedure. © 2001 British Journal of Surgery Society Ltd [source] Numerical distribution of lymphoid nodules in the human sigmoid colon, rectosigmoidal junction, rectum, and anal canalCLINICAL ANATOMY, Issue 2 2006Ivan L. Cameron Abstract There is little information on the numerical distribution of lymphoid nodules (LN) in distal segments of the human large bowel. A novel approach was therefore developed to assess the number of LN in the sigmoid colon, the rectosigmoid segment, the rectum, and the anal canal in humans. The distal large bowel from five cadavers was selected for quantitative study. The number of LN was scored macroscopically from the proximal sigmoid colon to the distal anal canal. A numerical distribution, previously unreported, consisting of two circular bands of LN was observed in each of the five cadavers. One band was located 3 cm proximal from the pectinate line and the other was located at the rectosigmoid segment. Significantly more LN occurred 3,5 cm proximal to the pectinate line compared to areas distal or proximal to this band of LN. This band of LN has not been reported previously in humans. Clin. Anat. 19:164,170, 2006. © 2006 Wiley-Liss, Inc. [source] Frequency of constitutional MSH6 mutations in a consecutive series of families with clinical suspicion of HNPCCCLINICAL GENETICS, Issue 3 2007B Roncari A large majority of constitutional mutations in hereditary non-polyposis colorectal cancer (HNPCC) are because of the MHL1 or MSH2 genes. In a lower fraction of cases, another gene of the mismatch repair (MMR) machinery, MSH6, may be responsible. Families with MSH6 mutations are difficult to recognize, as microsatellite instability (MSI) may not be detectable and immunohistochemistry (IHC) may give ambiguous results. In the present study, we proposed (i) to determine the frequency of MSH6 mutations in a selected population of colorectal cancer patients obtained from a tumor registry, (ii) to assess whether IHC is a suitable tool for selecting and identifying MSH6 mutation carriers. One hundred neoplasms of the large bowel from suspected HNPCC families were analyzed for MSI (BAT25 and BAT26 markers) and immunohistochemical expression of the MSH6 protein. We found on 12 tumors (from different families) showing instability or lack of MSH6 expression. Among these, four potentially pathogenic MSH6 mutations were detected (del A at 2984; del TT at 3119; del AGG cod 385; and del CGT cod 1242) by direct gene sequencing. These represented 12.9% of all families with constitutional mutations of the DNA MMR genes. Thus, some 5% of all HNPCC families are featured by constitutional mutation of the MSH6 gene. This appears, however, as a minimum estimate; routine use of IHC and the study of large numbers of individuals and families with little or no evidence of Lynch syndrome might reveal that mutation of this gene account for a large fraction of HNPCC. [source] Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer , a prospective trial of 150 patientsCOLORECTAL DISEASE, Issue 2 2009T. J. White Abstract Objective, Virtual colonoscopy (VC)/CT colonography has advantages over the well-documented limitations of colonoscopy/barium enema. This prospective blinded investigative comparison trial aimed to evaluate the ability of VC to assess the large bowel, compared to conventional colonoscopy (CC), in patients at high risk of colorectal cancer (CRC). Method, We studied 150 patients (73 males, mean age 60.9 years) at high risk of CRC. Following bowel preparation, VC was undertaken using colonic insufflation and 2D-spiral CT acquisition. Two radiologists reported the images and a consensual agreement reached. Direct comparison was made with CC (performed later the same day). Interobserver agreement was calculated using the Kappa method. Postal questionnaires sought patient preference. Results, Virtual colonoscopy visualized the caecum in all cases. Five (3.33%) VCs were classified as inadequate owing to poor distension/faecal residue. CC completion rate was 86%. Ultimately, 44 patients had normal findings, 44 had diverticular disease, 11 had inflammatory bowel disease, 18 had cancers, and 33 patients had 42 polyps. VC identified 19 cancers , a sensitivity and specificity of 100% and 99.2% respectively. For detecting polyps > 10 mm, VC had a sensitivity and specificity (per patient) of 91% and 99.2% respectively. VC identified four polyps proximal to stenosing carcinomas and extracolonic malignancies in nine patients (6%). No procedural complications occurred with either investigation. A Kappa score achieved for interobserver agreement was 0.777. Conclusion, Virtual colonoscopy is an effective and safe method for evaluating the bowel and was the investigation of choice amongst patients surveyed. VC provided information additional to CC on both proximal and extracolonic pathology. VC may become the diagnostic procedure of choice for symptomatic patients at high risk of CRC, with CC being reserved for therapeutic intervention, or where a tissue diagnosis is required. [source] | |||||||||||||