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Sigmoid Colon (sigmoid + colon)
Kinds of Sigmoid Colon Selected AbstractsA CASE OF PYOGENIC GRANULOMA IN THE SIGMOID COLON TREATED WITH ARGON PLASMA COAGULATIONDIGESTIVE ENDOSCOPY, Issue 3 2005Tomoko Morita Pyogenic granuloma (PG) with hemorrhagic tendency, is often recognized in the oral mucosa and skin, but rare in the gastrointestinal tract. Only 20 cases have been reported in the gastric mucosa. There have been no reports of gastrointestinal PG treated by argon plasma coagulation (APC). We report here the first case of PG in the sigmoid colon treated by APC. The patient was a 64-year-old woman complaining of constipation who was referred to a university hospital of Kochi Medical School. She presented with easily bleeding mucosa, as revealed by a total colonoscopic study in the sigmoid colon. Magnifying colonoscopic examination showed two sessile small polyps in the sigmoid colon. Pathological examination of the biopsy specimens revealed pyogenic granuloma. We treated this lesion by endoscopic APC. No recurrence has been found as of 9 months after APC therapy. [source] PEUTZ,JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERYDIGESTIVE ENDOSCOPY, Issue 1 2003Kazuhiro Yada We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz,Jeghers (P,J) polyposis successfully treated by laparoscopic surgery. A 49-year-old woman was admitted for severe cough and edema of the extremities. Chest X-ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc-diethylene triamine penta-acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy-assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P,J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P,J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding. [source] REFRACTORY DIVERTICULAR COLITIS WITH PROGRESSIVE ULCERATIVE COLITIS-LIKE CHANGES EXTENDING TO THE RECTUMDIGESTIVE ENDOSCOPY, Issue 3 2009Tateki Yamane A 68-year-old man visited our department because of diarrhea and bloody stools. Colonoscopy revealed diverticula scattered in the sigmoid colon with localized mucosal edema and reddening. The mucosa became somewhat rough 9 months later, and had an erosive, ulcerative colitis (UC)-like appearance after a further 6 months, with these changes extending to the rectum. These findings led to a diagnosis of diverticular colitis (DC) with UC-like changes. The condition was refractory to treatment including drug therapy and was thus surgically treated. No cases of DC have been reported in Japan, and a refractory case of DC with progressive UC-like changes extending to the rectum is rare even in Europe and the USA. [source] DIAGNOSIS OF COLONIC ADENOMAS BY NEW AUTOFLUORESCENCE IMAGING SYSTEM: A PILOT STUDYDIGESTIVE ENDOSCOPY, Issue 2007Noriya Uedo Detection and removal of adenoma by colonoscopy is an important means of preventing cancer. Autofluorescence endoscopy can visualize flat or isochromatic tumor that was not detectable by white light endoscopy by the difference in tissue fluorescence properties. Recently, a new autofluorescence imaging system (AFI, Olympus Medical Systems) using a combination of autofluorescence and reflection imaging has been developed. The purpose of the present paper was to investigate its feasibility in detection of colonic adenoma in a clinical setting. A total of 64 patients were randomly assigned to AFI or white light groups, and the distal sigmoid colon and the rectum was observed under autofluorescence or white light followed by the other mode of observation by a different endoscopist. The diagnostic ability of each method for detection of neoplasms was compared in relation to the histology as a reference standard. Sensitivity and specificity of AFI for detection of neoplastic polyps was 84% and 60%, respectively, and were similar to those of white light colonoscopy: 90% and 64%. Conventional colonoscopy overlooked more flat lesions including one adenocarcinoma. AFI has the potential to detect more flat lesions but efficacy was unable to be demonstrated in the restricted population. Further investigations are needed to determine optimum usage. [source] SUCCESSFUL PLACEMENT OF SELF-EXPANDABLE METALLIC STENTS FOR DOUBLE COLORECTAL CANCERSDIGESTIVE ENDOSCOPY, Issue 4 2006Tsuyoshi Abe Stent placement for the palliation of unresectable colon cancer is an alternative to surgical treatment that has recently become popular. A dedicated stent for colorectal cancer is not available in Japan. We report a patient with two colonic obstructions who underwent a successful palliative treatment using two stents. He was admitted to Toho University Ohashi Medical Center because of ileus. A colonoscopy revealed two advanced lesions with stenosis in the sigmoid and transverse colon. Because he had multiple liver metastases and severe Alzheimer dementia, we selected palliative stent placement for the treatment of both strictures. We placed a covered stent in the sigmoid colon stricture and subsequently attempted to place a second stent in the transverse colon stricture. However, the second stent could not be placed in the transverse colon because the modified delivery system could not pass through the first stent in the sigmoid colon. This probably led to a twisting of the stent in the sigmoid colon. We next used the 24 F introducer sheath that is included in Keller-Timmermans Introducer Sets. This strategy allowed the modified delivery system to be easily passed through the initial stent in the sigmoid colon and then advanced into the transverse colon stricture, enabling both stents to be positioned properly. [source] THERAPEUTIC FISTULOSCOPY FOR THE MANAGEMENT OF PROLONGED POSTOPERATIVE INTRA-ABDOMINAL ABSCESS CAUSED BY SMALL INTESTINAL PINHOLE PERFORATIONDIGESTIVE ENDOSCOPY, Issue 4 2005Yoshihisa Saida Fistuloscopy is an effective treatment for intractable fistula, a sometimes difficult to manage postoperative intra-abdominal complication. A case of a 69-year-old male with an abdominal abscess after he underwent right hemi-colectomy for cecum cancer with invasions into the ileum and sigmoid colon is reported. A re-operation for lavage and drainage was performed 2 weeks after surgery. However, no obvious origin for the pus was located. Although physiological saline lavage was repeatedly performed, the effusion of pus persisted in the drain at the midline incision about 7 months after surgery. Then, fistuloscopy with an upper gastrointestinal endoscope was performed through the hole of the tube. A pinhole that produced a bubble just below the midline incision was observed. Then, an endoscopic retrograde cholangiopancreatography (ERCP) tube was inserted to obtain images of the small intestine by fluorography and findings suggested a diagnosis of perforation of the small intestine, which appeared to explain why resolution of the abscess was prolonged. After direct drainage to the small intestine with a 40-cm-long 7 Fr percutaneous transhepatic cholangio drainage (PTCD) balloon catheter, pus from the tube notably decreased. After confirming that the abscess cavity had disappeared by abdominal computed tomography scan, the PTCD catheter was extracted about 8 months after primary surgery. Since then, no recurrence of cancer or abscess has been observed. In cases of intractable postoperative intra-abdominal abscess, fistuloscopy using smaller diameter gastrointestinal endoscopy appears to be a valuable diagnostic tool. [source] A CASE OF PYOGENIC GRANULOMA IN THE SIGMOID COLON TREATED WITH ARGON PLASMA COAGULATIONDIGESTIVE ENDOSCOPY, Issue 3 2005Tomoko Morita Pyogenic granuloma (PG) with hemorrhagic tendency, is often recognized in the oral mucosa and skin, but rare in the gastrointestinal tract. Only 20 cases have been reported in the gastric mucosa. There have been no reports of gastrointestinal PG treated by argon plasma coagulation (APC). We report here the first case of PG in the sigmoid colon treated by APC. The patient was a 64-year-old woman complaining of constipation who was referred to a university hospital of Kochi Medical School. She presented with easily bleeding mucosa, as revealed by a total colonoscopic study in the sigmoid colon. Magnifying colonoscopic examination showed two sessile small polyps in the sigmoid colon. Pathological examination of the biopsy specimens revealed pyogenic granuloma. We treated this lesion by endoscopic APC. No recurrence has been found as of 9 months after APC therapy. [source] PEUTZ,JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERYDIGESTIVE ENDOSCOPY, Issue 1 2003Kazuhiro Yada We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz,Jeghers (P,J) polyposis successfully treated by laparoscopic surgery. A 49-year-old woman was admitted for severe cough and edema of the extremities. Chest X-ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc-diethylene triamine penta-acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy-assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P,J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P,J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding. [source] CONCURRENT GASTRIC AND COLONIC LOW-GRADE MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMATA IN A PATIENT WITHOUT HELICOBACTER PYLORI INFECTIONDIGESTIVE ENDOSCOPY, Issue 1 2003HIROYUKI OKADA Mucosa-associated lymphoid tissue (MALT) lymphomata observed simultaneously in the stomach and colon are rare. We report concurrent gastric and colonic low-grade MALT lymphomata that originated from the same clone in a 58-year-old Japanese man without Helicobacter pylori infection. Endoscopy showed multiple erosive lesions in the gastric body and antrum, and a single flat elevation with an irregular margin in the sigmoid colon. Histopathological findings of both lesions suggested low-grade MALT lymphoma. Lymphoepithelial lesions were evident in the gastric lesions, but not in the colonic lesion. Southern blot analysis of lymphoma cells revealed the same immunoglobulin heavy-chain rearrangement pattern. The chromosomal translocation t(11;18)(q21;q21) was also observed. After six courses of cyclophosphamide, doxorubicin, vincristine and predonisolone, the gastric lesions disappeared endoscopically, while the colonic lesion persisted. A sigmoidectomy was consequently performed. The chromosomal translocation may be related to the pathogenesis of the present MALT lymphoma case without H. pylori infection. It is interesting that the gastric and colonic lesions differed in response to treatment and in their endoscopic and histologic features, despite having the same origin. [source] Obstructing sigmoid cancer in a patient with a large, tender, non-reducible inguinal hernia: the obvious diagnosis is not always the correct oneEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2008G.H. SAKORAFAS md We present a 85-year-old patient with intestinal obstruction and a large, tender, non-reducible right inguinal hernia. He was operated with the presumed diagnosis of strangulated inguinal hernia. At surgery, a perforated obstructing sigmoid colon was diagnosed. A sigmoidectomy (Hartman procedure) and hernia repair (Bassini technique) was performed. [source] Preserved Na+/H+ exchanger isoform 3 expression and localization, but decreased NHE3 function indicate regulatory sodium transport defect in ulcerative colitis,INFLAMMATORY BOWEL DISEASES, Issue 7 2010Sunil Yeruva PhD Abstract Background: A major causative factor of diarrhea in ulcerative colitis (UC) patients is the loss of Na+ absorptive capacity of the inflamed colonic mucosa. Potential contributing mechanisms include reduced driving force for active transport, and impaired expression, mislocalization, or defective transport function of Na+ absorptive proteins. We therefore studied the expression, brush border membrane (BBM) localization, and transport capacity of the major intestinal Na+ absorptive protein, the Na+/H+ exchanger isoform 3 (NHE3) in biopsies from UC patients. Methods: In UC and control biopsies, inflammation was graded histologically, NHE3, tumor necrosis factor alpha (TNF-,), villin, as well as other housekeeping genes were analyzed by quantitative real-time polymerase chain reaction (PCR), BBM localization of NHE3 determined by immunohistochemistry, and confocal microscopy. Na+ absorptive capacity was assessed by 22Na+ isotope fluxes and NHE3 transport activity measured microfluorometrically in BCECF-loaded surface colonocytes within isolated crypts. Results: In mildly, moderately, and severely inflamed sigmoid colon of UC patients, neither NHE3 mRNA expression nor the abundance of NHE3 in the BBM was significantly altered compared to other structural components of the BBM. However, Na+ absorption was strongly reduced by ,80% and acid-activated NHE3 transport activity was significantly decreased in the surface cells of sigmoid colonic crypts even in moderately inflamed mucosa. Conclusions: In the colonic mucosa of patients with active UC, NHE3 transport capacity was found significantly decreased despite correct NHE3 location and abundance in the brush border, independent of current treatment. These findings suggest functional NHE3 transport as a novel factor for inflammatory diarrhea in UC patients. (Inflamm Bowel Dis 2010) [source] Risk factors and characteristics of extent progression in ulcerative colitisINFLAMMATORY BOWEL DISEASES, Issue 9 2009María Josefina Etchevers MD Abstract Background: The main objective was to identify risk factors for extent progression in distal ulcerative colitis. The secondary objective was to determine clinical characteristics of disease at the time of progression. Methods: Data were obtained from a prospective database. Distal colitis was defined as disease limited to rectum and sigmoid colon (n = 178), extensive colitis as involvement of at least the descending colon (n = 179), and colitis with progression when there was a change of category from distal to extensive (n = 63). To study clinical characteristics at the time of progression, a nested case,control study was performed. Results: Compared to distal colitis, colitis with progression was associated to significantly higher prevalence of extraintestinal manifestations (42.9% versus 15.5%) steroid-refractory course (28.0% versus 2.2%), requirement of thiopurines (44.3% versus 17.3%), cyclosporine (25.4% versus 1.9%), infliximab (9.5% versus 1.2%), surgery (20.6% versus 0.6%), and incidence of neoplasia (6.3% versus 0%). However, these differences appeared after disease progression. Regression analysis demonstrated that preexisting independent predictive factors for progression were younger age at diagnosis (hazard ratio [HR] 0.979 95% confidence interval [CI] 0.959,0.999) and presence of sclerosing cholangitis (HR 12.83, 95% CI 1.36,121.10). The nested case,control study showed that at the time of progression the flare was more severe in cases than in matched controls, with significant differences in markers of disease severity, therapeutic requirements, hospitalizations, and surgery. Conclusions: Patients with distal ulcerative colitis diagnosed at a younger age or with associated sclerosing cholangitis are at higher risk for progression. Disease flare associated with progression follows a severe course with high therapeutic requirements. (Inflamm Bowel Dis 2009) [source] A new oral delivery system for 5-ASA: Preliminary clinical findings for MMxINFLAMMATORY BOWEL DISEASES, Issue 5 2005Cosimo Prantera MD Abstract Background: Multi-matrix (MMx), a new delivery system for mesalazine, seems to release 5-aminosalicyclic acid (5-ASA) preferentially in the sigmoid colon. This study had 2 objectives: (1) to evaluate the therapeutic response to MMx in patients with active left-sided disease and (2) to gain additional insights as to how the therapy would compare with topical 5-ASA. Methods: Patients received either 1.2 g of 5-ASA MMx three times per day plus placebo enema or 4 g of 5-ASA enema plus placebo tablets for 8 weeks. The primary endpoint was clinical remission (clinical activity index ,4) at 8 weeks. Secondary endpoints were endoscopic and histologic remissions. Results: Seventy-nine patients were enrolled. Clinical remission rates at 4 and 8 weeks were 57.5% and 60.0% for patients treated with MMx and 68.4% and 50.0% for patients randomized to 5-ASA enemas, respectively (95% confidence interval for the difference at 8 weeks, ,12 to +32). Endoscopic remission was achieved by 45.0% of patients on 5-ASA MMx and by 36.8% of those on enema, whereas 15.0% and 8% of patients, respectively, showed histologic remission. Compliance was 97.0% for oral and 87.5% for topical therapy. In the enema group, compliance was 88.0% for the patients in remission and 65.5% for those with active disease. Conclusions: Preliminary studies suggest that similar rates for induction of remission can be expected from 5-ASA enemas and MMx for patients with left-sided ulcerative colitis. [source] Demography and clinical course of ulcerative colitis in a multiracial Asian population: A nationwide study from MalaysiaJOURNAL OF DIGESTIVE DISEASES, Issue 1 2009I HILMI OBJECTIVE: To establish the clinical course of ulcerative colitis (UC) in the Malaysian population, comparing the three major ethnic groups: Malay, Chinese and Indian. METHODS: Patients who were diagnosed with UC from seven major medical referral centers in Malaysia were recruited. Their baseline characteristics, and the extent of the disease, its clinical course and complications were recorded. RESULTS: A total of 118 patients was included. The extent of disease was as follows: proctitis alone in 22 (18.6%), sigmoid colon in 23 (19.5%), descending colon in 16 (13.6%), transverse colon in 11 (9.3%), ascending colon and pancolitis 46 (39%). Most patients had chronic intermittent disease. Extra-intestinal complications were seen in 27 (22.9%) patients and fulminant colitis was seen in four (3.4%). None developed colorectal cancer. The overall cumulative colectomy rates at 1, 5 and 10 years were 3.4% (CI: 0.9,8.5), 5.9% (CI: 1.9,13.2) and 15.6% (CI: 6.5,29.4), respectively. There was a higher prevalence of extra-intestinal manifestations and a trend towards more extensive disease among Indian patients. However, no significant differences were seen in the age of onset, the severity of disease (fulminant colitis, refractory disease) and the colectomy rate. CONCLUSION: As in developed countries, most of our patients have a remitting and relapsing pattern of disease but the clinical course appears to be milder, with lower rates of colectomies. There are differences in clinical presentation among the three major ethnic groups, with Indians having a higher prevalence of extra-intestinal manifestations and a trend towards more extensive disease. [source] Comparison of malignant potential between serrated adenomas and traditional adenomasJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 11 2007Sang Yong Song Abstract Background:, Serrated adenoma is a discrete colorectal epithelial neoplastic lesion that can evolve into colorectal cancer. However, the degree of malignant potential has not been firmly established as yet. The purpose of the present paper was to compare the malignant potential and clinicopathological features between serrated and traditional adenomas. Methods:, A total of 124 serrated adenomas from 116 patients were assessed, and 419 traditional adenomas from 200 were randomly selected. The combination of nuclear dysplasia and serration of ,20% of crypts was regarded as serrated adenoma. The clinicopathological features of serrated and traditional adenomas were compared, and multivariate analysis performed to confirm whether the malignant potential of serrated adenoma was similar to that of traditional adenoma. Results:, The differences in age, sex, total number of adenomas, and synchronous lesions including adenoma with high-grade dysplasia and carcinoma between subjects with and without serrated adenoma were not significant. Serrated adenomas were more frequently located in the rectum and sigmoid colon (P < 0.001), and the average size of serrated adenomas was greater than that of traditional adenomas (P < 0.05). The incidence of malignant lesions including high-grade dysplasia and carcinoma in serrated adenomas was found to be lower than in traditional adenomas (3.2% vs 9.3%, P < 0.05). In the multivariate analysis, adenoma type and polyp size constituted the risk factors for the incidence of high-grade dysplasia and carcinoma. Conclusions:, Serrated adenoma is a premalignant lesion, but it has a lower potential for the development of malignancy than traditional adenomas. [source] CLINICAL CHARACTERISTICS and PROGNOSIS OF COLORECTAL SIGNET-RING CELL CARCINOMAJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2001Kook Lae Lee Background/aims, Colorectal signet-ring cell carcinoma (SRCC) is uncommon tumor. The aim of this study was to evaluate the clinical characteristics of primary and metastatic colorectal SRCC. Methods, We retrospectively examined the records of patients who had undergone surgery for colon cancer and was diagnosed pathologically as colorectal SRCC from 1988 to 2000. Results, Among 1812 patients with colorectal cancer examined, the number of patients with SRCC was 28 (1.5%); eight patients (28.6%) were metastatic and 20 patients (71.4%) were primary. Male to female ratio was 19:9 and mean age was 44.2 (primary, 42.5; metastatic, 48.3). Mean age of primary SRCC of rectosigmoid area was lower than that of ascending colon (37.4 vs. 54.5). The topographic incidences of primary SRCC were nine patients in rectum; five patients in sigmoid colon; six patients in ascending colon. Metastatic SRCC's were mostly found in splenic flexure and rectosigmoid area. Biopsy positive rate at first was 13 of 18 in primary SRCC, and 3 of 5 in metastatic SRCC. Five cases (55.6%) of primary rectal SRCC showed linitis plastica type. The stage of primary SRCC showed a preponderance of Astler,Coller C2 lesions; 3 (15%) were in B2, 1 (5%) was in C1, 14 (70%) were in C2, 2 (10%) were in D. One and two years survival of primary SRCC were 62.7 and 45.7%, respectively. Conclusions, Colorectal SRCC is rare among colon cancer and common in young age group especially which is primary or occurs in rectosigmoid area. The primary SRCC's were mostly found in advanced stage, and the prognosis might be poor. [source] Effect of alosetron on left colonic motility in non-constipated patients with irritable bowel syndrome and healthy volunteersALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2002C. H. M. Clemens Background: Alosetron is a 5-hydroxytryptamine-3 receptor antagonist reducing symptoms in female patients with diarrhoea-predominant irritable bowel syndrome, and is known to increase the colonic transit time. Aim: To study the effect of alosetron on left colonic phasic motility in ambulant non-constipated patients with irritable bowel syndrome and healthy volunteers. Methods: In a double-blind, randomized, crossover design, 10 patients with irritable bowel syndrome and 12 sex- and age-matched volunteers were treated for two 7-day periods with alosetron, 4 mg b.d., or placebo b.d. On day 6 of each treatment period, a six-channel solid-state manometric catheter was positioned in the left colon and 24 h motility was studied on day 7. The periprandial phasic motility around dinnertime was evaluated in the descending and sigmoid colon. The high-amplitude propagated contraction frequency and characteristics were calculated. Results: Alosetron appeared to increase the overall periprandial frequency in the sigmoid colon (P=0.043) and the mean amplitude of colonic contractions in the descending colon (P=0.007). The high-amplitude propagated contraction frequency was higher on alosetron during the second half of the day for patients with irritable bowel syndrome (P=0.002), with increased mean propagation length of high-amplitude propagated contractions (P=0.001). The stool frequency (P=0.024) and stool consistency score (P=0.002) were decreased by alosetron. Conclusions: The 5-hydroxytryptamine-3 receptor antagonist alosetron marginally increased left colonic periprandial phasic motility. Alosetron increased the number and propagation length of high-amplitude propagated contractions, which were paradoxically accompanied by a decrease in stool frequency and a firming of stool consistency. [source] Effect of otilonium bromide on contractile patterns in the human sigmoid colonNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2010D. Gallego Abstract Background, The mechanism of action of the spasmolytic compound otilonium bromide (OB) on human colonic motility is not understood. The aim of our study was to characterize the pharmacological effects of OB on contractile patterns in the human sigmoid colon. Methods, Circular sigmoid strips were studied in organ baths. Isolated smooth muscle cells from human sigmoid colon were examined using the calcium imaging technique. Key Results, Otilonium bromide inhibited by 85% spontaneous non-neural rhythmic phasic contractions (RPCs), (IC50 = 49.9 nmol L,1) and stretch-induced tone (IC50 = 10.7 nmol L,1) with maximum effects at micromolar range. OB also inhibited by 50% both on- (IC50 = 38.0 nmol L,1) and off- contractions induced by electrical stimulation of excitatory motor neurons. In contrast, the inhibitory latency period prior to off -contractions was unaffected by OB. OB inhibited acetylcholine-, substance P-, and neurokinin A-induced contractions. The L-type Ca2+ channel agonist BayK8644 reversed the effects of OB on RPCs, on- and off -contractions. Hexamethonium, atropine, the NK2 antagonist, or depletion of intracellular Ca2+ stores by thapsigargin did not prevent the inhibitory effect of OB on RPCs and electrical contractions. KCl-induced calcium transients in isolated smooth muscle cells were also inhibited by OB (IC50 = 0.2 ,mol L,1). Conclusions & Inferences, Otilonium bromide strongly inhibited the main patterns of human sigmoid motility in vitro by blocking calcium influx through L-type calcium channels on smooth muscle cells. This pharmacological profile may mediate the clinically observed effects of the drug in patients with irritable bowel syndrome. [source] Distribution of serotonin receptors and interacting proteins in the human sigmoid colonNEUROGASTROENTEROLOGY & MOTILITY, Issue 5 2009N. Chetty Abstract, This study aimed to examine the distribution of 5-HT receptors in the human colon. 5-HT induces desensitization of the circular muscle and as this is facilitated by G-protein coupled receptor kinases (GRKs) and other proteins, we also examined their distribution. Human sigmoid colon samples were dissected into three separate layers (mucosa, taeniae coli and intertaenial strips) and RNA was amplified by RT-PCR. The 5-HT2B receptor and all 5-HT7 receptor splice variants were expressed in all tissues. 5-HT4 a,b,c and n splice variants were also expressed in all tissues and 5-HT4d, 5-HT4g and 5-HT4i were only detected in some samples. The 5-HT2A receptor was seen predominantly in the intertaenial strips of the colon. Only one transcript of the serotonin transporter (SERT) was detected in the muscle layers. Variation was seen in GRK expression with GRK2 and 3 predominantly expressed in the mucosa, while GRK5 and 6 were found more commonly in the taeniae coli. PDZ (named after postsynaptic density protein, Drosophila disc large tumour suppressor and tight junction protein ZO-1) domain containing proteins, which may be involved in 5-HT receptor trafficking, were also detected throughout the sigmoid colon. The 5-HT3A subunit was expressed in all tissues, whereas the 5-HT3E subunit was mainly found in the mucosa layer while the 5-HT3B subunit was more common in the muscle layers. Receptor interacting chaperone (RIC-3), which is involved in transporting 5-HT3 receptor subunits, is expressed less in mucosa compared to muscle layers. In conclusion, these results show that there is variation in distribution of 5-HT receptors and interacting proteins within the sigmoid colon that may contribute to colonic function. [source] Colorectal carcinoma among Indigenous people: a public hospital-based study in Townsville and Cairns, North Queensland, AustraliaANZ JOURNAL OF SURGERY, Issue 11 2005Ping-Yan Lu Introduction: There are very little clinical and pathological data on colorectal cancer among Indigenous people in Australia. Methods: A retrospective study on Indigenous patients treated for colorectal cancer at the Townsville and Cairns Base Hospitals from 1999 to 2004 was carried out in order to better characterise this disease in the Indigenous population. Results: There were 25 patients (12 M, 13 F) with a median age of 57.3 years. The majority (56%) of the tumours were left-sided, being in the sigmoid colon, rectosigmoid junction and rectum. Of the patients, 60% had American Joint Committee on Cancer (AJCC) staging system Stage I and II disease at presentation. There was a relatively high proportion of poorly differentiated adenocarcinomas (40%). Six patients died of the disease. The median follow-up was 20.5 months (range 2,51). Conclusions: Comparisons were made with available data on colorectal cancer in the general Australian population. The limitations and deficiencies of the study, as well as problems of data collection on Indigenous people were discussed. [source] Multiple extragenital adenomatoid tumors in the mesocolon and omentum,APMIS, Issue 11 2008CHI-JU YEH Adenomatoid tumors are benign mesothelial neoplasms most commonly found in the male and female genital tracts. Extragenital adenomatoid tumors are rare, most of them being solitary tumors. To our knowledge, only one case of multiple extragenital adenomatoid tumors, involving the liver and peritoneum, has been reported to date. Here we report another case of multiple extragenital adenomatoid tumors involving the mesocolon and omentum. A 47-year-old woman presented with a delayed menstrual period. Ultrasonography revealed a left adnexal mass, and surgical resection was attempted at a local hospital. The patient was transferred to our hospital without resection due to the intraoperative finding of multiple peritoneal tumors. At our hospital, an 8.0×7.5×6.0 cm tumor at the mesocolon of the sigmoid colon and three omental nodules measuring up to 2.5×2.0×1.7 cm were resected. Grossly, they were well circumscribed, gray-tan and elastic with small cystic spaces. Microscopically, they were composed of tubules and anastomosing channels lined by flattened or cuboidal cells with bland nuclei. Immunohistochemically, the tumor cells were positive for pan-cytokeratin AE1/AE3, vimentin, cytokeratin 5/6 and calretinin. The postoperative course was uneventful, and the patient was well 10 months after the operation. Despite their rarity, adenomatoid tumors should be included in the differential diagnosis of multiple intra-abdominal tumors. [source] Colorectal xanthomas with polypoid lesion: Report of 25 casesAPMIS, Issue 1 2004MASAHIKO NAKASONO Little attention has been paid to colorectal xanthoma. To clarify the clinical and pathological features of colorectal xanthoma, we report 28 colorectal xanthomas biopsied from 25 patients. All were composed of typical xanthoma cells and showed polypoid configuration. Median age of the patients was 64 years and there were 15 men and 10 women. Diabetes mellitus, constipation, and hyperlipidemia were found in two, one, and seven patients, respectively. Seventeen (60.7%) of the 28 polyps were located in the sigmoid colon and the remaining 11 in the rectum. Twenty-three polyps (82.1%) were sessile. Twelve (60.0%) of twenty polyps that were recorded were reddish in color. Only two polyps revealed a yellowish tone. Microscopically, foamy cells were present in the lamina propria, but the submucosa did not contain foamy cells. Immunohistochemically, the foamy cells invariably expressed extensive positivity for CD68. The colonic glands showed a deformity in the case with moderate to intense density of the foamy cells. The surface epithelium showed a hyperplastic change in 22 (78.6%) xanthomas. The colonic glands in four xanthomas were also associated with hyperplastic changes. The basement membrane of the surface epithelium was often thickened. Cell debris and proliferation of the capillaries were observed just below the surface epithelium in 19 (67.9%) and 22 (78.6%) xanthomas, respectively. Previous mucosal minute injury was suggested as the pathogenesis of colorectal xanthomas. Colorectal xanthomas were not identical to gastric and esophageal xanthoma, endoscopically or microscopically. We prefer the term "xanthomatous polyp" rather than xanthoma in the colorectal region. They may be regarded as a novel type of colorectal non-neoplastic polyp. [source] Natural orifice surgery: applications in colonic surgeryASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 2 2010J. Leroy Abstract Natural orifice transluminal endoscopic abdominal surgery, or NOTES, allows invasive operations to be performed through a single or multiple natural-orifice approach either in isolation ("pure") or in combination with a transparietal ("hybrid") access format. Therefore, to facilitate a colonic or rectal resection, the transgastric, transrectal or transcolonic routes, as well as the transvaginal route in women, can all be used either alone or in combination. We are now performing resectional colonic techniques on our patients that have been inspired by this revolutionary concept, carefully planned with storyboarding and validated in porcine models with survival analysis. Adaptation of existing equipment along with the use of new instruments and some simple ideas, such as magnetic fields to retract and mobilize the colon, have allowed us to simplify and standardize the operative technique (the first steps to ensuring procedural reproducibility). Initial potential applications can easily be imagined for partial colonic resections for voluminous benign polyps and for small early cancers, but these applications may extend to incorporate inflammatory bowel diseases such as diverticular disease of the sigmoid colon. For these techniques to further improve and the concept to become a concrete reality, a change in current surgical practice is required, and conventional laparoscopic techniques must be understood to represent a point along the evolutional development of surgery and not considered the final destination. However, as important as technical capacity is, due consideration and assurance of oncological and immunological propriety is essential, as is the issue of clarifying precise patient harm:benefit risk ratios. [source] Long-term results of orthotopic neobladder reconstruction after radical cystectomyBJU INTERNATIONAL, Issue 6 2003J.N. Kulkarni Objective To assess, in a retrospective study, the long-term results of neobladder reconstruction after radical cystectomy, as this is the standard of care for muscle-invasive bladder cancer. Patients and methods Data were retrieved for all patients with muscle-invasive transitional cell carcinoma of the bladder treated by radical cystectomy and orthotopic neobladder substitution between 1988 and 1998. All perioperative and long-term complications were recorded. The voiding pattern, frequency of micturition and continence were assessed, and a complete urodynamic profile recorded. Results In all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36,144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH2O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twenty-four patients had recurrence of disease, of whom 20 died. Conclusions Orthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates. [source] Diversion colitis in children with colovaginoplastyBJU INTERNATIONAL, Issue 9 2001H.A. Syed Objective To highlight the occurrence of diversion colitis and its effects in colovaginoplasty. Patients and methods The records of 18 children who had undergone colovaginoplasty were reviewed retrospectively. Nine patients had androgen-insensitivity syndrome and three each had congenital adrenal hyperplasia, vaginal agenesis and Mayer,Rokitansky syndrome. Through an abdominoperineal approach a segment of sigmoid colon was isolated on its vascular pedicle and brought to the perineum in the plane between the urethra and rectum, as a blind pouch or as an interposition between the proximal vagina and the perineum. The mean (range) follow-up was 5 (1.5,8) years. Results There were no major complications during the early follow-up. Three patients developed severe vaginal discharge with bleeding 2,7 years after colovaginoplasty; examination showed erythema, oedema, ulceration and bleeding. Histology confirmed the classic features of diversion colitis in all three patients. One child responded to vaginal irrigation with a solution of short-chain fatty acids, and the other two were treated with steroid enemas and mesalazine after a poor response to short-chain fatty acids. One of these patients has required surgical reduction of an excessively long neovagina. Conclusion Symptomatic diversion colitis can occur after colovaginoplasty. The severity of the symptoms raises concerns about the use of colovaginoplasty in children and alternative techniques of vaginal replacement should be considered in the first instance. [source] Effects of excitatory and inhibitory neurotransmission on motor patterns of human sigmoid colon in vitroBRITISH JOURNAL OF PHARMACOLOGY, Issue 7 2008M Aulí Background and purpose: To characterize the in vitro motor patterns and the neurotransmitters released by enteric motor neurons (EMNs) in the human sigmoid colon. Experimental approach: Sigmoid circular strips were studied in organ baths. EMNs were stimulated by electrical field stimulation (EFS) and through nicotinic ACh receptors. Key results: Strips developed weak spontaneous rhythmic contractions (3.67±0.49 g, 2.54±0.15 min) unaffected by the neurotoxin tetrodotoxin (TTX; 1 ,M). EFS induced strong contractions during (on, 56%) or after electrical stimulus (off, 44%), both abolished by TTX. Nicotine (1,100 ,M) inhibited spontaneous contractions. Latency of off-contractions and nicotine responses were reduced by NG -nitro- L -arginine (1 mM) and blocked after further addition of apamin (1 ,M) or the P2Y1 receptor antagonist MRS 2179 (10 ,M) and were unaffected by the P2X antagonist NF279 (10 ,M) or ,-chymotrypsin (10 U mL,1). Amplitude of on- and off-contractions was reduced by atropine (1 ,M) and the selective NK2 receptor antagonist Bz-Ala-Ala-D-Trp-Phe-D-Pro-Pro-Nle-NH2 (1 ,M). MRS 2179 reduced the amplitude of EFS on- and off-contractions without altering direct muscular contractions induced by ACh (1 nM,1 mM) or substance P (1 nM,10 ,M). Conclusions and implications: Latency of EFS-induced off-contractions and inhibition of spontaneous motility by nicotine are caused by stimulation of inhibitory EMNs coreleasing NO and a purine acting at muscular P2Y1 receptors through apamin-sensitive K+ channels. EFS-induced on- and off-contractions are caused by stimulation of excitatory EMNs coreleasing ACh and tachykinins acting on muscular muscarinic and NK2 receptors. Prejunctional P2Y1 receptors might modulate the activity of excitatory EMNs. P2Y1 and NK2 receptors might be therapeutic targets for colonic motor disorders. British Journal of Pharmacology (2008) 155, 1043,1055; doi:10.1038/bjp.2008.332; published online 1 September 2008 [source] 5-HT4 receptors on cholinergic nerves involved in contractility of canine and human large intestine longitudinal muscleBRITISH JOURNAL OF PHARMACOLOGY, Issue 5 2000N H Prins 5-HT4 receptors mediate circular muscle relaxation in both human and canine large intestine, but this phenomenon alone can not explain the improvement in colonic motility induced by selective 5-HT4 receptor agonists in vivo. We set out to characterize 5-HT4 receptor-mediated effects in longitudinal muscle strips of canine and human large intestine. Electrical field stimulation (EFS) was applied providing submaximal isotonic contractions. L -NOARG (0.1 mM) was continuously present in the organ bath to preclude nitric oxide-induced relaxation to EFS. The selective 5-HT4 receptor agonist prucalopride (0.3 ,M) enhanced EFS-evoked contractions, that were antagonized in both preparations by the selective 5-HT4 receptor antagonist GR 113808 (0.1 ,M). The prucalopride-induced increase was present in canine ascending and descending colon, but absent in rectum. Regional differences in response to prucalopride were not observed in human ascending and sigmoid colon and rectum. Incubation with atropine (1 ,M) or tetrodotoxin (0.3 ,M) inhibited EFS-induced contractions, which were then unaffected by prucalopride (0.3 ,M) in both tissues. In the presence of methysergide (3 ,M; both tissues) and granisetron (0.3 ,M; only human tissues), 5-HT (0.3 ,M) enhanced EFS-induced contractions, an effect that was antagonized by GR 113808 (0.1 ,M). In the presence of atropine or tetrodotoxin, EFS-induced contractions were inhibited, leaving 5-HT (0.3 ,M) ineffective in both preparations. This study demonstrates for the first time that in human and canine large intestine, 5-HT4 receptors are located on cholinergic neurones, presumably mediating facilitating release of acetylcholine, resulting in enhanced longitudinal muscle contractility. This study and previous circular muscle strip studies suggest that 5-HT4 receptor agonism facilitates colonic propulsion via a coordinated combination of inhibition of circumferential resistance and enhancement of longitudinal muscle contractility. British Journal of Pharmacology (2000) 131, 927,932; doi:10.1038/sj.bjp.0703615 [source] Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery (Br J Surg 2006; 93: 609,615)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2006D. Pandey No abstract is available for this article. [source] Authors' reply: survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery (Br J Surg 2006; 93: 609,615)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2006Y. Kanemitsu No abstract is available for this article. [source] Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2006Y. Kanemitsu Background: The aim of this study was to assess the impact of inferior mesenteric artery (IMA) root nodal dissection before high ligation of the artery on survival in patients with sigmoid colon or rectal cancer. Methods: Data on 1188 consecutive patients who underwent resection for sigmoid colon or rectal cancer, with high ligation of the IMA, were identified from a prospective database (April 1965 to December 1999). Survival of patients with involvement of nodes along the IMA proximal to the origin of the left colic artery (root nodes, station 253) through the bifurcation of the superior rectal artery (trunk nodes, station 252) was determined. Results: Twenty patients (1·7 per cent) had metastatic involvement of station 253 lymph nodes and 99 (8·3 per cent) had metastases to station 252. The 5- and 10-year survival rates of patients with metastases to station 253 were 40 and 21 per cent, and those for patients with metastases to station 252 were 50 and 35 per cent, respectively. Conclusion: High ligation of the IMA allows curative resection and long-term survival in patients with cancer of the sigmoid colon or rectum and nodal metastases at the origin of the IMA. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||