Home About us Contact
|
Home About us Contact | ||
|
|
||
Splenic Flexure (splenic + flexure)
Selected AbstractsIncidence and Prognosis of Colorectal Dysplasia in Inflammatory Bowel Disease: A Population-based Study from Olmsted County, Minnesota,INFLAMMATORY BOWEL DISEASES, Issue 8 2006Tine Jess MD Abstract Background and Aims: The risk, fate, and ideal management of colorectal dysplasia in inflammatory bowel disease (IBD) remain debated. We estimated the incidence, long-term outcome, and risk factors for progression of colorectal dysplasia (adenomas [adenoma-associated lesions or masses (ALMs)], flat dysplasia, and dysplasia-associated lesions or masses [DALMs]) in a population-based IBD cohort from Olmsted County, Minnesota. Materials and Methods: The Rochester Epidemiology Project was used to identify cohort patients with colorectal dysplasia. Medical records were reviewed for demographic and clinical characteristics. Histology slides were reviewed by a pathologist blinded to previous pathology reports. The cumulative incidence of dysplasia was estimated, and the association between patient characteristics and recurrence/progression of dysplasia was assessed using proportional hazards regression. Results: Twenty-nine (4%) IBD patients developed flat dysplasia (n = 8), DALMs (n = 1), ALMs in areas of IBD (n = 18), or ALMs outside areas of IBD (n = 2). Among 6 patients with flat low-grade dysplasia (fLGD) who did not undergo colectomy, none progressed during a median of 17.8 (range 6,21) years of observation with a median of 3 (range 0,12) surveillance colonoscopies. Four (22%) patients with ALMs in areas of IBD who did not undergo surgery developed LGD or DALMs. Primary sclerosing cholangitis and dysplasia located proximal to the splenic flexure were significantly associated with risk for recurrence/progression of dysplasia. Conclusions: This population-based cohort study from Olmsted County, Minnesota did not confirm an increased risk of cancer related to fLGD, whereas 22% of patients with ALMs in areas of IBD developed fLGD or DALMs. [source] The changing incidence and sites of colorectal cancer in the Israeli Arab population and their clinical implicationsINTERNATIONAL JOURNAL OF CANCER, Issue 1 2007Paul Rozen Abstract Israeli Arabs have been at low risk for colorectal cancer (CRC) and had mainly proximal cancer, but increasing CRC is now noted. We examined this trend and CRC site and compared them to the total Jewish population and to the low-risk Jews of Asian-African origin. Israel Cancer Registry CRC data, 1982,2002, for Arabs and Jews was computed by gender, age and site: rectal cancer included recto-sigmoid junction; "right-sided" CRC included the proximal colon up to and also the splenic flexure. During 1982,2002, Arab CRC trends increased significantly in both sexes due to left -sided CRC (women, p = 0.01; men, p = 0.02) and rectal cancers (p = 0.05). Left -sided CRC increased significantly in both men and women aged , 65 years (p = 0.02). Comparing 1982,1984 to 2000,2002, the proportion of right-sided CRC decreased in both genders (p < 0.01) from 39.4 to 27.1% of male CRC, and from 44.8 to 31.3% in females. In general, this pattern of increasing rectal and left-sided CRC had been seen over a decade earlier in Jews of Asian-African origin and then their trend reversed during the last decade. In conclusion, there is a recent trend for left-sided CRC in Israeli Arabs, probably related to their changing life style. These results should influence their cancer preventive lifestyle recommendations, and CRC screening and diagnostic methodologies used. © 2006 Wiley-Liss, Inc. [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] Oxytocin stimulates colonic motor activity in healthy womenNEUROGASTROENTEROLOGY & MOTILITY, Issue 2 2004B. Ohlsson Abstract, The effects of oxytocin in the gastrointestinal tract are unclear. The aim of this study was to examine the effect of infusion of oxytocin on colonic motility and sensitivity in healthy women. Fourteen healthy women were investigated twice. A 6-channel perfusion catheter, with three recording points (2 cm apart) proximally and three recording points distally to a barostat balloon, was inserted to the splenic flexure. An intestinal feeding tube was placed in the mid-duodenum. A 90-min duodenal lipid infusion of 3 kcal min,1 was administered. Thirty minutes after the start of the lipid infusion, the subject randomly received either 20 or 40 mU min,1 of oxytocin, or isotonic saline as intravenous infusions for 90 min. Meanwhile, the colonic motility was recorded. During the last 30 min of oxytocin and saline infusion, the visceral sensitivity to balloon distensions was examined. During lipid infusion the number of antegrade contractions per hour was 0.7 ± 0.3 after saline and 3.9 ± 1.4 after oxytocin (P = 0.03), indicating more pronounced lumen-occlusive contractile activity after oxytocin administration. Some of these consisted of high-amplitude (> 103 mmHg in amplitude) antegrade contractions. Lipid infusion evoked a decrease of the balloon volume, reflecting increased colonic tone, but there was no difference between saline and oxytocin. Sensory thresholds did not differ significantly between saline and oxytocin. Infusion of oxytocin stimulates antegrade peristaltic contractions in stimulated colon in healthy women. The effects of oxytocin on colonic motor activity deserve to be further explored, especially in patients with colonic peristaltic dysfunction. [source] Review of the Lynch syndrome: history, molecular genetics, screening, differential diagnosis, and medicolegal ramificationsCLINICAL GENETICS, Issue 1 2009HT Lynch More than one million patients will manifest colorectal cancer (CRC) this year of which, conservatively, approximately 3% (,30,700 cases) will have Lynch syndrome (LS), the most common hereditary CRC predisposing syndrome. Each case belongs to a family with clinical needs that require genetic counseling, DNA testing for mismatch repair genes (most frequently MLH1 or MSH2) and screening for CRC. Colonoscopy is mandated, given CRC's proximal occurrence (70,80% proximal to the splenic flexure). Due to its early age of onset (average 45 years of age), colonoscopy needs to start by age 25, and because of its accelerated carcinogenesis, it should be repeated every 1 to 2 years through age 40 and then annually thereafter. Should CRC occur, subtotal colectomy may be necessary, given the marked frequency of synchronous and metachronous CRC. Because 40,60% of female patients will manifest endometrial cancer, tailored management is essential. Additional extracolonic cancers include ovary, stomach, small bowel, pancreas, hepatobiliary tract, upper uroepithelial tract, brain (Turcot variant) and sebaceous adenomas/carcinomas (Muir-Torre variant). LS explains only 10,25% of familial CRC. [source] Quality assurance in colonoscopy: role of endomucosal clipsCOLORECTAL DISEASE, Issue 7 2010S. Maslekar Abstract Objective, Quality assurance in colonoscopy is important, and subjective assessment of completion based on endoscopic signs can be inaccurate leading to missed lesions. We aimed to determine the technique of endomucosal clips with follow-up X-rays in objectively documenting completion and correlation with pathology miss rates. Method, A total of 82 patients undergoing colonoscopy by trained colonoscopists had an endomucosal clip applied to the most proximal bowel reached. A plain abdominal X-ray was performed while there was still a pneumocolon, and the clip position was assessed by a blinded radiologist to determine objective completion rates. Repeat colonoscopies were performed in patients with incomplete procedures. Pathology and endoscopy database were also reviewed to identify missed lesions at a median follow-up of 6 years. These were correlated with colonoscopy completions. Results, The clip was found in caecum of 76 (93%), ascending-colon in three (3.6%), hepatic flexure in one (1.2%) and splenic flexure in two (2.4%) patients. The endoscopist opinion was incorrect in six incomplete colonoscopies. A total of 33 patients underwent repeat colonoscopies over the median 6-year follow-up. Three adenomas and one carcinoma were missed in the incomplete group and were subsequently picked up in repeat endoscopies. Only one adenoma was truly missed in complete colonoscopies, providing an overall miss rate of 1.3%. Conclusion, Use of endomucosal clips with follow-on abdominal X-ray is a safe and effective method of determining completion of colonoscopy. This technique is also an excellent objective measure of quality assurance of completion and miss rates in colonoscopy, especially when combined with an audit to determine the missed lesions at two years postprocedure. [source] Retrospective analysis of pre- and peri-operative imaging in confirmed proximal colonic cancers , possible implications for screening flexible sigmoidoscopyCOLORECTAL DISEASE, Issue 2 2009R. Peravali Abstract Objective, Faecal occult blood testing is being introduced for population screening in the United Kingdom. Flexible sigmoidoscopy may provide a viable alternative. The outcomes of the flexible sigmoidoscopy trial are awaited but the most obvious disadvantage is that only the lower third of the colon is examined and proximal pathology cannot be excluded. The relationship between proximal pathology and distal findings at flexible sigmoidoscopy is uncertain. The aim of this study was to determine the incidence of distal neoplasia in patients with confirmed proximal cancers of the colon. Method, All confirmed proximal colonic cancers (defined as those proximal to the splenic flexure) were identified from a database of pathology specimens at a single centre between January 1999 and August 2006. A retrospective analysis of preoperative and peri-operative mucosal imaging (contrast enema, colonoscopy and CT colonography) was conducted to identify any distal neoplasia in these patients. Results, A total of 348 patients were identified. Pre- or peri-operative mucosal imaging was identified in 231 (66%) and 49 (21%) had distal neoplasia. Nineteen (8%) of these patients would have gone on to have a colonoscopy based on the UK flexible sigmoidoscopy trial protocol and 92% of the cohort would not have had a colonoscopy. Conclusion, Nearly 80% of confirmed proximal cancers in our series did not have any demonstrable distal neoplasia. Only 8% of our cohort would have proceeded to colonoscopy. A very significant number of proximal cancers would not have been detected. [source] Tumour location is a prognostic factor for survival in colonic cancer patientsCOLORECTAL DISEASE, Issue 1 2008O. H. Sjo Abstract Objective, To evaluate survival and prognostic factors in a consecutive series of colon cancer patients from a defined city population in Norway. Method, All patients with adenocarcinoma of the colon diagnosed between 1993 and 2000 were registered prospectively. Five-year actuarial survival and 5-year relative survival rates were calculated. Cox regression analyses were used to study the effect of prognostic factors on survival. Results, In the study period 627 patients were admitted. Overall 5-year relative survival was 50% in females and 52% in males. Five-year relative survival in 410 (65%) patients operated with curative intent, was 74% for females and 79% for males. Tumour location in the transverse colon, splenic flexure and descending colon (OR = 1.8), emergency operation (OR = 1.7), TNM stage (OR = 1.8,2.9), blood transfusion of more than two units (OR = 1.8) and age (OR = 4.0,7.1) were independent negative prognostic factors. Conclusion, Colon cancer located in the transverse and descending colon is associated with poor prognosis. Comparison of results from different centres is difficult due to selection and classification differences, and different methods used for calculation of survival. [source] | ||||||||||