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  • 1
    Digitale Medien
    Digitale Medien
    Ultra-low Anterior Resection and Coloanal Pouch Reconstruction for Carcinoma of the Distal Rectum (1997)
    Springer
    World journal of surgery 21 (1997), S. 721-727 
    Details
    ISSN: 1432-2323
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract. Facilitated by an enhanced appreciation for pelvic anatomy and physiology along with a better understanding of patterns of rectal cancer spread, great advances have been made in our ability to perform restorative resections for an ever-increasing proportion of mid and distal rectal cancers. Whereas oncologic results following a low anterior resection were the principal concern 20 years ago, recent efforts have focused on improving functional results as well. Aspirations for improved function need to be tempered by the realization that improved sphincter-saving rates must follow improved oncologic results rather than jeopardize them. Some crucial questions are addressed in this paper: What are the variables involved in optimizing the oncologic and functional results of a low anterior resection and a coloanal reconstruction? What are the issues involved in selecting a particular coloanal reconstruction (straight versus pouch, stapled versus handsewn, with or without fecal diversion) for a particular patient? Who is not a good candidate for a coloanal reconstruction?
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s002689900297
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  • 2
    Digitale Medien
    Digitale Medien
    Colonoscopic screening for neoplasms in asymptomatic first-degree relatives of colon cancer patients (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 523-529 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Colonoscopy ; Asymptomatic ; Adenomas ; Familial ; Prospective ; Controlled study
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Individuals with a family history of colorectal cancer are believed to be at an increased risk of developing colorectal neoplasia. To estimate this risk and the potential yield of screening colonoscopy in this population, we recruited and prospectively colonoscoped 181 asymptomatic first-degree relatives (FDR) of colorectal cancer patients and 83 asymptomatic controls (without a family history of colorectal cancer). The mean ages for the FDR and control groups were 48.2 ± 12.5 and 54.8 ± 11.0, respectively. Adenomatous polyps were detected in 14.4 percent of FDRs and 8.4 percent of controls. Although 92 percent of our FDRs had only one FDR afflicted with colon cancer, those subjects with two or more afflicted FDRs had an even higher risk of developing colonic adenomas (23.8 percent) than those with only one afflicted FDR (13.1 percent). A greater proportion of adenomas was found to be beyond the reach of flexible sigmoidoscopy in the FDR group than in the controls (48 percent vs.25 percent, respectively). Logistic regression analysis revealed that age, male sex, and FDR status were independent risk factors for the presence of colonic adenomatous polyps (RR=2.32, 2.86, and 3.49, respectively;P 〈0.001). Those at greatest risk for harboring an asymptomatic colonic adenoma are male FDRs over the age of 50 (40 percent ts.20 percent for age-matched male controls). Based on probability curves, males with one FDR afflicted with colon cancer appear to have an increased risk of developing a colonic adenoma beginning at 40 years of age. Our results document, for the first time, an increased prevalence of colonoscopically detectable adenomas in asymptomatic first-degree relatives of colon cancer patients, as compared with asymptomatic controls, and support the use of colonoscopy as a routine screening tool in this high-risk group.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02050530
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  • 3
    Digitale Medien
    Digitale Medien
    Anorectal disease in neutropenic leukemic patients (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 1095-1099 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Anorectal disease ; Leukemia ; Neutropenia ; Anorectal abscess
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: This study was designed to evaluate the spectrum, clinical presentation, management, and outcome of anorectal disease in neutropenic leukemic patients and to compare operative and nonoperative management in neutropenic leukemic patients. METHODS: A retrospective review of hospital records was performed. RESULTS: One hundred fifty-one of 2,618 (5.8 percent) patients hospitalized with leukemia had concomitant symptomatic anorectal disease. Data from 81 patients were available for analysis. Fifty-two (64 percent) were treated nonoperatively and 29 (36 percent) underwent operative treatment. Fifty-seven (70.4 percent) had absolute neutrophil counts 〈1,000/ mm 3,and 54 (66.7 percent) were severely neutropenic (absolute neutrophil count 〈500/mm 3).Management and outcomes of 54 severely neutropenic patients were analyzed. In 20 patients who underwent surgery there were 4 deaths (20 percent) and 4 recurrences (20 percent), whereas in 34 patients managed nonoperatively there were 6 deaths (18 percent) and 4 recurrences (12 percent) (P 〉0.05). CONCLUSIONS: Symptomatic anorectal disease afflicted 5.8 percent of hospitalized leukemic patients. In these patients, anorectal sepsis was a major source of mortality. Our data suggest that anorectal abscesses in neutropenic leukemic patients may be safely drained. Because we did not observe excessive morbidity or mortality (20 percent vs. 18 percent) in the operated neutropenic leukemics as compared with the nonoperated patients, selected neutropenic leukemic patients should not be denied anorectal surgery when otherwise indicated.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02049810
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  • 4
    Digitale Medien
    Digitale Medien
    Clustering of colorectal cancer in families of probands under 40 years of age (1996)
    Springer
    Diseases of the colon & rectum 39 (1996), S. 1004-1007 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Familial ; Colorectal cancer ; Clustering ; Young probands
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Although sporadic colorectal cancer (CRC) is relatively uncommon in the young, it may constitute an elevated genetic risk for CRC in these individuals. PURPOSE: This study was designed to determine extent of colorectal cancer in families of probands under 40 years of age. METHODS: Medical records of all consecutive patients, 40 years of age or younger at the time of CRC surgery, during the time period 1986 to 1994 were examined. Cases of familial adenomatous polyposis and ulcerative colitis were excluded.Via interviews of surviving probands or nearest relatives, dates of birth and death, causes of death, and diagnosis of cancer were recorded on all first-degree relatives (parents, siblings, and offspring), second-degree relatives (grandparents, aunts, and uncles), and any other relatives. RESULTS: A total of 128 patients, 40 years of age or less at time of CRC resection, were identified. Of these, 45 probands/families were reached by phone, and 45 detailed family histories were obtained. Age range of these 45 probands was 19 to 40 (mean, 33.1) years. In 25 families there was no history of CRC in first-degree, second-degree, or third-degree relatives. Eight of 45 probands (17.8 percent) had at least one first-degree relative with CRC, and three of these eight families fulfilled the Amsterdam criteria for hereditary nonpolyposis colorectal cancer (HNPCC). In all three families, inheritance of CRC appeared to segregate with the maternal side of the family. In addition, 5 of 43 non-HNPCC probands had at least one first-degree, second-degree, or third-degree relative less than 40 years of age, at time of CRC diagnosis. CONCLUSION: Ascertainment of a detailed family history in early age of onset CRC patients identifies frequent familial clustering of CRC and HNPCC in 17.8 percent of cases.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02054690
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  • 5
    Digitale Medien
    Digitale Medien
    Major 20th-century advancements in the management of rectal cancer (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 563-578 
    Details
    ISSN: 1530-0358
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Conclusions At the beginning of the century, rectal cancer was a deadly disease treated simply by perineal excision. With advances in pathologic staging, preoperative assessment, surgical technique, and CMT made in the last century, we have witnessed improved oncologic and functional results after treatment of rectal cancer. As we look to the future, the use of molecular markers may help identify patients with node-negative disease yet aggressive biology in need of adjuvant therapy. It is also anticipated that improvements in various imaging modalities may better select patients for local procedures or preoperative adjuvant therapy. Further-more, ongoing progress in our understanding of pelvic anatomy and neurophysiology should improve preservation of both genitourinary and sphincter function.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02234129
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  • 6
    Digitale Medien
    Digitale Medien
    Signet-ring cell carcinoma of the colon and rectum (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1176-1180 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Signet-ring cell ; Colorectal carcinoma ; Neoplasm
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: There is little information comparing signet-ring cell carcinoma to common non-signet-ring cell colon and rectal cancers. The aim of this study was to better define the clinicopathologic differences between these two distinct entities. METHODS: Using a prospective database of 5,350 surgical patients with rectal cancers operated on at Memorial Sloan-Kettering Cancer Center between 1986 and 1997, 46 patients with signet-ring cell carcinoma were identified. Signet-ring cell carcinoma lesions were those in which signet-ring cells constituted more then 50 percent of the tumor. Six patients who presented with recurrent disease were excluded from the study. Control patients were matched for age, gender, TNM stage, primary site, procedure, and adjuvant therapy. Age, primary site of the tumor, stage at presentation, and survival times of patients with signet-ring cell carcinoma were also compared with 3,371 patients with primary non-signet-ring cell rectal cancers. Survival was calculated using Kaplan-Meier survival estimates. RESULTS: Mean age of the signet-ring cell carcinoma group was 59±12 years and median age was 61 (range, 20–91) years. Male-to-female ratio was 1.1:1. Lymphatic and peritoneal spread was more common among the signet-ring cell carcinoma group. Approximately one-third of signetring cell carcinoma patients presented with metastatic disease. Mean survival time of the signet-ring cell carcinoma group was 45.4 months (95 percent confidence interval, 26.9–63.8) compared with 78.5 months (95 percent confidence interval, 62.0–94.9) for the control patients group;P=0.02 by the log-rank test. The cumulative survival curve of patients with signet-ring cell carcinoma resembles that of patients with poorly differentiated rectal cancers. CONCLUSIONS: Patients with signet-ring cell carcinoma of the colon and rectum have a worse prognosis compared with matched controls with the same stage of disease.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02238570
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  • 7
    Digitale Medien
    Digitale Medien
    Colonic manifestations of multiple endocrine neoplasia type 2B (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1216-1219 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Constipation ; Surgery ; Gastrointestinal tract ; Ganglioneuromatosis ; Megacolon ; Metoclopramide
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Multiple endocrine neoplasia type 2B is best known for its endocrine manifestations and typical phenotype. The gastrointestinal manifestations, however, are also an important and commonly unrecognized component of the syndrome. We present four cases that demonstrate the varied presentation of patients with colonic manifestations of multiple endocrine neoplasia type 2B. We discuss the cause, diagnostic significance, and management of the colonic disease that is a component of multiple endocrine neoplasia type 2B.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02238578
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  • 8
    Digitale Medien
    Digitale Medien
    Factors predictive of persistent or recurrent Crohn's disease in excluded rectal segments (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 768-772 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Crohn's disease ; Excluded rectum ; Anal Crohn's disease
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The fate of the excluded rectal segment after surgery for Crohn's colitis remains poorly defined. To determine prognostic factors relating to the fate of the rectal segment, records of 47 patients who underwent creation of an excluded rectal segment were studied. Disease developed in 33 patients (70 percent) in the excluded rectal segment by five years; 24 patients (51 percent) had completion proctectomy by 2.4 years; and 9 patients (19 percent) retained a rectum with disease at a median follow-up period of five years (range, 2–13 years). At a median follow-up time of six years (range, 2–21 years), 14 patients were without clinical disease. The three groups were equivalent with respect to sex, duration of preoperative disease, indication for operation, distribution of disease, and histologic involvement of the proximal rectal margin. The median age of patients in the proctectomy group at diagnosis tended to be younger than that of patients with a retained excluded rectal segment (22, 30, and 31 years for patients having proctectomy, patients with a diseased excluded rectal segment, and patients with a normal excluded rectal segment, respectively). Neither initial involvement of the terminal ileum nor endoscopic inflammatory changes seen in the rectum predicted eventual disease of the excluded rectal segment. However, initial perianal disease complicating Crohn's colitis was predictive of persistent excluded rectal segment disease and often required proctectomy. Therefore, because the presence of perianal disease and Crohn's colitis predicts persistent or recurrent excluded rectal segment disease, primary total proctocolectomy or early completion proctectomy may be indicated in this subgroup of patients.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02050327
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  • 9
    Digitale Medien
    Digitale Medien
    Decreased levels of protein kinase C enzyme activity and protein kinase C mRNA in primary colon tumors (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 913-921 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Colon cancer ; Protein kinase C ; RNA
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: We have previously reported decreased protein kinase C (PKC) enzyme activity in primary human colorectal carcinomas. The purpose of this study was to extend these findings to a larger number of cases and to also examine the levels of expression of mRNAs that encode specific isoforms of PKC in these tumors. METHODS: Colorectal carcinomas and paired grossly normal adjacent mucosal samples were collected from 39 patients. Complete histopathologic analyses were performed on all samples. PKC enzyme activity in both the cytosolic and particulate fractions was quantitated by measuring the amount of 32 P incorporated into histone Type III-S. Northern blot nucleic acid hybridization was performed using polyA + RNA extracted from both the tumor and normal tissue samples and 32 P-labeled probes for specific isoforms of PKC. The paired sample t-test was used to determine the statistical significance of tumor to normal ratios of both enzyme activity and mRNA levels. RESULTS: The mean value for cellular PKC enzyme activity in the colon tumors from 39 patients was about 60 percent of that found in the paired adjacent grossly normal mucosa samples (P〈0.001). The subcellular distribution of PKC activity was similar in normal and tumor samples (about 70 percent in the particulate fraction). The abundance of PKCα mRNAs varied considerably among 28 tumor/normal pairs, with a mean tumor to normal (T∶N) ratio of 1.0±0.6 for the 99-kb mRNA band and 1.4±0.7 for the 3.5-kb band. The abundance of PKCβ mRNAs was decreased in 30 of 39 tumors, with a mean T∶N ratio of 0.6±0.4 for both the 94- and 3.5-kb bands for all 39 samples (P〈0.001). None of the parameters measured correlated with Dukes stage or the grade of the tumor. CONCLUSIONS: These studies extend previous evidence that total PKC enzyme activity is frequently decreased in primary human colon tumors. Our finding that this is often associated with decreased levels of PKC β mRNA suggest that this is not simply due to posttranslational down-regulation of this enzyme system. Further studies are required to determine whether these changes in PKC α and PKC β mRNAs are due to altered de novo transcription or mRNA stability. It will also be of interest to examine the expression of other isoforms of PKC in colon tumors.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02050625
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  • 10
    Digitale Medien
    Digitale Medien
    All patients with small intramural rectal cancers are at risk for lymph node metastasis (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 881-885 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Rectal cancer ; Metastasis ; Lymph nodes ; Local excision
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: Although local excision can be curative in patients with early-stage rectal cancer, approximately 20 percent of patients will develop local recurrence, many as a result of unrecognized and unresected regional lymph node metastases. Our objective was to determine if standard pathologic factors can predict lymph node metastases in small intramural rectal cancers and provide a basis for patient selection for nonradical surgery. METHODS: Between June 1986 and September 1996, 318 patients with T1 or T2 rectal cancers underwent radical resection at our institution. Of these, 159 patients (48 T1 and 111 T2) were potentially eligible for curative local excision (≤4 cm in size, ≤10 cm from the anal verge, no synchronous metastases), and the prevalence of lymph node metastases based on T stage and other pathologic factors was analyzed in this group. RESULTS: The overall frequency of lymph node metastasis was 15 percent (24/159 patients). T stage (T1, 10 percent; T2, 17 percent), differentiation (well-differentiated or moderately differentiated, 14 percent and poorly differentiated, 30 percent), and lymphatic vessel invasion (lymphatic vessel invasion-negative, 14 percent and lymphatic vessel invasion-positive, 33 percent) influenced the risk of lymph node metastasis. However, only blood vessel invasion (blood vessel invasion-negative, 13 percent and blood vessel invasion-positive, 33 percent) reached statistical significance as a single predictive factor (P=0.04). Tumors with no adverse pathologic features (low-risk group) had a lower overall frequency of lymph node metastasis (11 percent) compared with the remaining tumors (high-risk group, 31 percent;P=0.008). However, even in the most favorable group (T1 cancers with no adverse pathologic features) lymph node metastases were present in 7 percent of patients. CONCLUSION: In rectal cancer patients potentially eligible for local excision, the overall risk of undetected and untreated lymph node metastases is considerable (15 percent). The use of pathologic factors alone after local excision does not reliably assure the absence of lymph node metastases.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02237095
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