Anomalous venous drainage of the hypoplastic right lung and other malformations (scimitar syndrome)

Patients with lower abdominal symptoms, indicating colonic disorder, were classified into predefined clinical syndromes. Two important syndromes were colicky sigmoid syndrome and chronic diverticular disease. The first one, characterized by presence of colicky lower abdominal pains but absence of colonic diverticula, probably covers what is generally referred to as 'irritable bowel syndrome'. The second one was characterized by presence of lower abdominal colics and of colonic diverticula. The results showed a significant correlation between the presence of lower abdominal colics and a high pressure activity in the sigmoid colon after intravenous neostigmine. There was, however, no correlation between the presence of diverticula and a high pressure activity. The generally accepted theory of a high pressure activity as the dominant factor in the pathogenesis of colonic diverticula, therefore, was questioned, as was the equally accepted theory of a gradual development of chronic diverticular disease from the adiverticular colicky sigmoid syndrome.     

Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study

In a curative resection for advanced sigmoid or rectal cancer, an extensive dissection of the regional lymph nodes is generally required. This often necessitates the removal of the autonomic nerves around the inferior mesenteric artery. The present study was done in an attempt to clarify the influence of a neurectomy around the inferior mesenteric ganglion and plexus on the motility of the colon. In eight dogs, we resected the ganglion and plexus around the inferior mesenteric artery, together with an implantation of strain gauge force transducers in various parts of the colon, and 7-10 days later, colonic motility was examined. The percentage of contractile states and contractile forces increased at both the distal colon in fasting dogs, as well as at the middle colon in the late postprandial period. At the distal colon, contractile forces were noted in the early and late postprandial periods. These contractile abnormalities at the middle and distal colon may thus explain the frequent bowel movements or diarrhea often observed after extensive surgery in patients with sigmoid or rectal cancer.     

Synchronous adenocarcinoma and lymphoma of the colon

Synchronous lymphoma and adenocarcinoma of the colon are extremely rare. A 32-year-old woman was referred to us for colon cancer. Investigations revealed two primary tumors, one in the cecum and the other in the sigmoid colon. Subtotal colectomy with ileorectal anastomosis was performed. Histology revealed the cecal tumor to be non-Hodgkin's lymphoma, diffuse small cell type with plasmacytoid features. The sigmoid colon tumor was moderately differentiated adenocarcinoma. The patient received 6 cycles of chemotherapy postoperatively for lymphoma but died of recurrent disease after 17 months.     

Surgical standards in primary colon cancer

The surgical standards in the treatment of primary cancer of the colon include the radical resection of the tumor-bearing colon with truncal ligation of its vessels. Eradication of the tumor with complete dissection of the lymphatic drainage area increases the chance for cure (R0). The lymphatic dissection determines the extent of colonic resection: right hemicolectomy (ileo-transversostomy) with truncal ligation of the iliocolic and right colonic arteries for carcinomas of the cecum and ascending colon; transverse colectomy (ascendo-descendostomy) with ligation of the middle colic artery for carcinomas in the middle of the transverse colon; left hemicolectomy (transverso-rectostomy) with ligation of the inferior mesenteric artery at the aorta for cancer of the descending and sigmoid colon; extended sigmoid resection (descendo-rectostomy) with central lymphadenectomy and ligation of the inferior mesenteric artery distal to the left colic artery for cancer of the distal sigmoid colon. Carcinomas located in between two drainage areas (lateral transverse colon, hepatic or splenic flexure) are treated by extended hemicolectomies or subtotal colectomies with dissection of two lymphatic drainage areas. The monobloc no-touch isolation technique requires the ligation of vessels prior to the mobilisation of the colon. Exceptions from these standard operations (limited resections) are necessary for metastatic disease or in the acute emergency situation of perforation or obstruction. Application of these surgical principles will ensure the best possible treatment results in primary colonic cancer.     

Comparative study between corpus cavernosum-electromyography findings and electron microscopy of cavernosal muscle biopsies in erectile dysfunction patients

BACKGROUND/AIMS: The colonic response to obstruction is poorly understood. Thickening of the proximal bowel following colonic stricture may be due to increased protein synthesis. We have investigated the colonic morphology and collagen concentration during the development of left-sided colonic obstruction in an animal model. METHODS: Twelve male Wistar rats received either a silk ligature obstruction of the colon 2.5 cm above the peritoneal reflection (n = 6) or manipulation of the left colon (controls, n = 6). Twenty-four hours later, three colonic specimens from the ligature zone and from 1 cm proximal and distal to this site, or from equivalent regions in controls, were assayed for hydroxyproline concentration. RESULTS: In controls there was no difference in hydroxyproline concentration between colonic sites. In obstructed rats, the hydroxyproline concentration was greater both at the ligature and distally, when compared with the proximal region. The hydroxyproline concentration was higher (p < 0.05) than corresponding control values at the ligature site (14.95 +/- 2.76 vs. 10.97 +/- 1.95 microgram/mg of dry tissue mean +/- s.d.) but not on either side. CONCLUSION: The colonic collagen concentration is equivalent or raised near an obstruction, demonstrating that obstructed colon may possess an enhanced capacity to hold sutures.     

Arginine transferase activity in homogenates from guinea-pig hair follicles

A retrospective 10-year experience with the traditional three-stage plan (diverting colostomy, resection, colostomy closure) for perforated diverticulitis of the colon in four urban hospitals was reviewed to accurately assess the mortality rate. Only patients who were admitted in a non-elective manner with signs of an acute abdomen or who were already hospitalized with another illness and developed an acute abdomen were considered. Fecal or generalized purulent peritonitis, or pelvic peritonitis with abscess were observed at laparotomy in all instances. Two hundred and eight patients representing 211 episodes met the above stated criteria for inclusion in the study. A transverse colostomy was performed in 203 instances associated with 16 deaths, and 8 sigmoid colostomies were associated with two deaths. The overall mortality after the first stage was 8.5%. A loop colostomy was constructed most frequently and a completely divided colostomy performed in only 31 of 211 (15%) instances. Of 147 instances in which the diseased sigmoid colon was resected, 44 (30%) had the colostomy ablated at the same operation, resulting in only one death (0.7% mortality). Colostomy closure as a separate procedure in 103 instances resulted in 4 deaths (3.9% mortality). The highest mortality rate occurred in patients in the in the eighth decade. Staged procedures for perforated colonic diverticula can be carried out with a mortality rate of 11%.     

Transfusion malaria in sick neonates

A 45-year-old woman was incidentally suspected to have megacolon. Chest X-rays showed elevated left diaphragm due to colonic gas, and the heart was deviated to the midline. Barium enema revealed marked dilation of the sigmoid colon, confirming the diagnosis of megacolon. Maximal diameter of the sigmoid colon was 23 cm, but she had no gastrointestinal symptoms. During the work up for megacolon, the presence of myotonic dystrophy was suspected. She had hatchet face, but was not bald. Muscles of the neck and extremities were slightly atrophic. There was percussion myotonia of the tongue and both hands, and grip myotonia of the hands. Laboratory examinations showed impaired glucose tolerance and low level of serum IgG. EMG showed myotonic discharges and myopathic units in the limbs. Brain CT imaging revealed a thick skull. Cases of myotonic dystrophy associated with marked megacolon are rare in Japan. Megacolon presents a high risk for ileus, volvulus, and rupture, and myotonic dystrophy is associated with a high operative and anesthesic risk. Megacolon, therefore, is an important complication to look for in the management of myotonic dystrophy.     

Enhancement of experimental colon cancer by genistein

Several phytochemicals and micronutrients that are present in fruits and vegetables are known to exert cancer chemopreventive effects in several organs, including the colon. Among them, the soybean isoflavonoid genistein received much attention due to its potential anticarcinogenic, antiproliferative effects and its potential role in several signal transduction pathways. The present study was designed to investigate the effect of genistein on azoxymethane (AOM)-induced colon carcinogenesis and to study its modulatory role on the levels of activity of 8-isoprostane, cyclooxygenase (COX), and 15-hydroxyprostaglandin F2alpha dehydrogenase (15-PGDH) in the colonic mucosa and colon tumors of male F344 rats. At 5 weeks of age, groups of male F344 rats were fed control (AIN-76A) diet or a diet containing 250 ppm genistein. Beginning 2 weeks later, all animals except those in the vehicle-treated groups were given weekly s.c. injections of AOM (15 mg/kg body weight) for 2 successive weeks. All rats were continued on their respective dietary regimen for 52 weeks after AOM treatment and were then sacrificed. Colon tumors were evaluated histopathologically. Colonic mucosae and tumors were analyzed for COX, 15-PGDH, and 8-isoprostane levels. Administration of genistein significantly increased noninvasive and total adenocarcinoma multiplicity (P < 0.01) in the colon, compared to the control diet, but it had no effect on the colon adenocarcinoma incidence nor on the multiplicity of invasive adenocarcinoma (P > 0.05). Also, genistein significantly inhibited the 15-PGDH activity (>35%) and levels of 8-iosoprostane (50%) in colonic mucosa and in tumors. In contrast, genistein had no significant effect on the COX synthetic activity, as measured by the rate of formation of prostaglandins and thromboxane B2 from [14C]arachidonic acid. The results of this investigation emphasize that the biological effects of genistein may be organ specific, inhibiting cancer development in some sites yet showing no effect or an enhancing effect on the tumorigenesis at other sites, such as the colon. The inhibition of 8-isoprostane levels by genistein indicates its possible antioxidant potential, which is independent of the observed colon tumor enhancement, yet this agent may also possess several biological effects that overshadow its antioxidant potential. The exact mechanism(s) of colon tumor enhancement by genistein remain to be elucidated; it is likely that its colon tumor-enhancing effects may, at least in part, be related to inhibition of prostaglandin catabolic enzyme activities.     

Feasibility of photodynamic therapy using endogenous photosensitization for colon cancer

A novel approach to photodynamic therapy (PDT) involves endogenous photosensitization by the oral administration of delta-aminolevulinic acid (ALA), a naturally occurring substance that is the precursor of protoporphyrin IX (PpIX). A 60-year-old man with adenocarcinoma of the sigmoid colon received ALA, 60 mg/kg by mouth. Six hours later, when the plasma level of PpIX had peaked, the tumor was exposed locally to red light at 633 nm to activate PpIX. Endoscopy and biopsy findings subsequent to this treatment showed unequivocal visible changes and necrosis. Six months later, the patient again underwent successful treatment without adverse effects. This report suggests a role for PDT using endogenous photosensitization in certain circumstances involving adenocarcinoma of the large intestine.     

IgG response to pneumococcal polysaccharide-protein conjugate appears similar to IgG response to polysaccharide in bone marrow transplant recipients and healthy adults

OBJECTIVE: This study was done to determine if the detection of pericolic lymph nodes on CT scans could be used to differentiate cancer of the colon from diverticulitis. MATERIALS AND METHODS: We retrospectively evaluated 58 CT scans from 57 patients with proven diverticulitis or cancer of the colon. The CT scans were evaluated by five board-certified radiologists who were unaware of the proven diagnosis. Consensus opinions regarding the presence and size of pericolic lymph nodes were recorded. These data were correlated with the proven diagnoses to determine the correlation between the observed findings and the type of colonic abnormality. Fisher's exact test was used to determine statistical significance. RESULTS: Lymph nodes were seen in 22 (71%) of 31 cases of colonic cancer and in four (15%) of 27 cases of diverticulitis. The lymph nodes were 0.5-2.5 cm in short-axis diameter. We saw no difference in node size for patients with colonic cancer versus patients with diverticulitis. The nodes were most commonly located along the blood vessels in the mesenteric fat. Statistical analysis showed a significant difference (p < .001) in the frequency but not in the size of nodes between the two groups of patients. The detection of nodes resulted in a diagnostic sensitivity and specificity for colonic cancer of 71% and 85%, respectively. CONCLUSION: Pericolic lymph nodes are seen much more frequently in patients with colonic cancer than in patients with diverticulitis. The detection of pericolic lymph nodes in patients suspected of having diverticulitis should raise the suspicion of underlying colonic cancer that should, in turn, prompt additional evaluation.     

Adrenergic-mediated connexin43 phosphorylation in the ocular ciliary epithelium

We report a case of aneurysmal rupture of the pancreaticoduodenal artery successfully treated by transcatheter arterial embolization. A 61-year-old man with a history of hypertension underwent surgery at our hospital in November 1995 for local peritonitis caused by perforation of the sigmoid colon secondary to cancer. On the 9th postoperative day, he developed shock, with complaints of epigastric and back pain. Abdominal computed tomography showed an enhanced mass, thought to be a peripancreatic aneurysm. Emergency angiography demonstrated an aneurysm arising from the arcade of the anterior pancreaticoduodenal artery. After diagnostic angiography, transcatheter arterial embolization was performed. With steel coils, the anterior superior pancreaticoduodenal artery and anterior inferior pancreaticoduodenal artery were embolized near the origin of the aneurysm. Angiography 7 weeks later revealed no recanalization of the aneurysm and the absence of anomalous collateral vessels. The patient has been well for 19 months without re-bleeding or recurrence of sigmoid colon cancer. Transcatheter arterial embolization is an effective therapeutic approach for aneurysm of the pancreaticoduodenal artery and is the preferred initial treatment.     

Intrabiliary growth of metastatic colonic adenocarcinoma: a pattern of intrahepatic spread easily confused with primary neoplasia of the biliary tract

Because of its propensity to spread along epithelial surfaces, colonic adenocarcinoma can mimic other neoplasms. For example, colonic adenocarcinoma can grow along the surface of the urinary bladder and can simulate primary bladder neoplasia, and metastatic colonic adenocarcinoma can grow along alveolar walls and can mimic primary lung neoplasia. Intraepithelial spread along bile ducts, however, is not a well-recognized behavior of hepatic metastases. Indeed, dysplastic change in the epithelium lining the biliary tract is sometimes used to discriminate primary biliary neoplasms from metastatic adenocarcinoma. We report on eight cases of colonic adenocarcinoma metastatic to the liver that demonstrated prominent spread throughout the biliary tree along intact basement membranes. Morphologically, this pattern closely resembled high-grade dysplasia (i.e., carcinoma in situ) of the extrahepatic and intrahepatic bile ducts. Clinically, two of the tumors were mistaken for primary biliary neoplasia because of the common radiologic finding of intrabiliary masses with distended bile ducts. A definite diagnosis of metastatic carcinoma was established by careful attention to the medical history, thorough evaluation of the morphologic features, and histologic comparison with the primary colon cancer. For patients with a history of colonic adenocarcinoma, consideration of a liver metastasis is appropriate even when certain histologic and radiographic features point to a neoplasm of biliary origin.     

Laparoscopic colonic resection

We present our initial experience with laparoscopic colonic resection in 15 patients: adenocarcinoma of the colon, 10 cases, giant villous adenoma (2), arteriovenous malformation (2), and a case of benign stricture. Mean operating time was 190 minutes and there were no intraoperative complications. The margins of resection and number of resected lymph nodes in patients with malignancy were comparable to those in the conventionally operated. Mean postoperative hospital stay was 6.1 days. During a maximum follow-up of 15 months there were no wound or trocar-site recurrences. We conclude that laparoscopic colonic resection is technically feasible and safe. However, its use for treating malignant diseases of the colon needs further study.     

Abdominoinguinal incision in adenocarcinoma of the sigmoid or cecum: report of two cases

PURPOSE: This study illustrates a technique allowing resection of a sigmoid adenocarcinoma with lateral fixation and a cecal adenocarcinoma with involvement of the psoas muscle and ureter. METHODS: The abdominoinguinal incision, an incision used in the resection of a sarcoma of the lower abdominal quadrants, was applied in the case of a sigmoid adenocarcinoma with posterolateral fixation and infiltration of the anterior abdominal wall and in a case of a cecal adenocarcinoma involving the right psoas muscle and ureter. RESULTS: In the first case, resection of the tumor mass en bloc with resection of the sigmoid and lower anterior abdominal wall muscles, including the inguinal ligament, was performed. Reconstruction of the muscular fascial defect was done with the rotation of a right rectus abdominis flap. The patient was well 12 months later. In the second case, the cecal carcinoma was resected en bloc with the right psoas and ureter; a right nephrectomy was also performed. This patient was well eight months later. CONCLUSIONS: The abdominoinguinal incision may provide the exposure needed to allow the resection of a sigmoid or a cecal adenocarcinoma with posterolateral fixation, often considered unresectable with conventional abdominal incisions.     

Bladder substitutes, bile acids and the risk of colorectal cancer: an experimental study

There is a large body of evidence relating the causation of colon cancer to bile acids. Using an animal model, we attempted to address the question, i.e., the incidences of carcinogenesis in the colon as consequences of resection of different bowel segments, predominantly employed in the construction of various forms of intestinal bladder substitutes. 60 male Wistar rats were operated. Group 1 served as control, in group 2, 20 cm of terminal ileum was resected, and rats in group 3 underwent resection of the distal 10 cm of the ileum and 7 cm of the proximal colon. All rats were killed 6 months after surgery and the colon was removed. After examination under 40-fold magnification, in the absence of tumors, 3 biopsies were performed at predetermined positions and underwent histological processing. Even if no tumor was found it would be incorrect to conclude that these results would have an appeasing relevance. The complex and highly different fecal bile acid profiles of the rat compared to man makes it impossible in this context to draw analogies between the rat model and human colonic carcinogenesis. Furthermore, 6 months of observation in the rat might be too short for 'spontaneous' colonic carcinogenesis. Nevertheless, there exists evidence from epidemiological studies to implicate bile acids as an etiological factor in the development and growth of colorectal cancer. Therefore, the importance of colorectal cancer in urologic surgery patients must be kept in perspective. In this direction, further studies are required besides the application of known appropriate preventive measures.     

Urodynamics of the upper urinary tract

A 64 year old woman with a past history of panhysterectomy and oophorectomy for carcinoma of the body of the uterus (1950) and partial colectomy for carcinoma of the colon (1971), presented in 1972 with severe weakness of the proximal girdle muscles and histological evidence of polymyositis. A detailed search disclosed no tumor and she was treated with prednisone. Two years later, investigations for iron deficiency anemia revealed two polyps in the colon. Pathological examination of the resected colon disclosed two separate foci of adenocarcinoma and a number of adenomatous polyps. Three months later, further investigations for melena led to the discovery of a gastric carcinoma. Due to the extent of the tumor, she was subjected to gastrectomy. splenectomy, and excision of the tail of the pancreas, but died of postoperative complications. At autopsy, no residual cancer was detected, but a meningioma was found. The association of polymyositis with malignant tumors has been recognized for a long time, but only two previously reported patients have had more than one cancer. Although a causal relationship is difficult to establish, continued vigilance for neoplasms is advocated during the follow-up period.     

Segmental tuberculosis of the colon diagnosed by colonoscopy

Segmental tuberculosis of the colon is a rare clinical entity. In the absence of pulmonary or ileocecal involvement, colonic tuberculosis may be difficult to differentiate from neoplasm or Crohn's disease by symptomatic and radiological means. Colonoscopy and biopsy can, however, establish the diagnosis and prevent operative intervention, as indicated in the present report. A patient with a radiologically demonstrated strictured lesion of the sigmoid colon was found at colonoscopy to have several hemorrhagic transverse ulcers ranging in diameter between 1-4.5 cm. Multiple target colonoscopic biopsies, specifically from the ulcer beds, revealed necrotizing granulomas and acid-fast bacilli. Antituberculous chemotherapy produced remarkable symptomatic, radiographic and endoscopic improvements and averted exploratory laparotomy for the establishment of the diagnosis. This case report points out the importance of colonoscopic biopsy as a useful diagnostic modality in this disease.     

Unusual intestinal manifestations of tuberculosis

In an 87-year-old Swiss female referred with complaints of bloody diarrhea and weight loss, colonoscopy revealed three ulcers in the rectum and colon. Cultures from the colonic ulcers were positive for Mycobacterium tuberculosis. There was no evidence of pulmonary infection. One week after adequate therapy was begun, a perforation occurred at the rectosigmoid junction. The sigmoid was resected and left-sided colostomy was performed. Seven days after surgery the patient died. Clinical features, diagnosis and morphological changes of intestinal tuberculosis are discussed.     

Intact colonic motor response to sudden awakening from sleep in patients with chronic idiopathic (slow-transit) constipation

PURPOSE: There are few data about the relationships between colonic motor behavior and higher brain functions, such as sleep. Previous studies were done in healthy subjects, and it is unknown whether patients with functional motor disorders of the colon behave differently. This study was designed to characterize colonic motor activity in patients with constipation, both during sleep and after sudden awakening, and to compare it with that of healthy subjects. Our working hypothesis was that patients with constipation would have an impaired response to sudden awakening. PATIENTS AND METHODS: Twelve chronically constipated women, 22 to 49 years old, were recruited for the study, and their data were compared with those obtained from 12 healthy female volunteers, 21 to 38 years old. Manometric studies were performed in the descending and sigmoid colon for 30 minutes during sleep (immediately before awakening) and 30 minutes after being awakened suddenly. A motility index was calculated before and after the stimulus. RESULTS: In both groups motility in the descending and the sigmoid colon was almost absent during sleep and significantly increased after sudden awakening. No difference in postawakening values was found between patients with constipation and controls. CONCLUSIONS: In patients with chronic constipation, the brain-gut control of some fundamental mechanisms governing colonic motility is preserved. These data suggest that the alterations of colonic motility described in chronic constipation may be caused by an intrinsic dysfunction of the viscus.     

Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors

Previous studies have shown that PKC-alpha protein expression is decreased in sporadic human colon cancers, as well as in colonic tumors of rats induced by chemical carcinogens. To elucidate the potential role of PKC-alpha on several phenotypic characteristics of colon cancer cells, we have transfected cDNAs for PKC-alpha in sense or antisense orientations into CaCo-2 cells, a human colonic adenocarcinoma cell line. Transfected clones were isolated that demonstrated approximately 3-fold increases (sense transfectants) and approximately 95% decreases (antisense transfectants) in PKC-alpha expression with no significant alterations in other PKC isoforms. Transfection of CaCo-2 cells with PKC-alpha in the antisense orientation resulted in enhanced proliferation and decreased differentiation, as well as in a more aggressive transformed phenotype compared with empty vector-transfected control cells. In contrast, cells transfected with PKC-alpha cDNA in the sense orientation demonstrated decreased proliferation, enhanced differentiation, and an attenuated tumor phenotype compared with these control cells. These data show that alterations in the expression of PKC-alpha induce changes in the proliferation, differentiation, and tumorigenicity of CaCo-2 cells. Furthermore, these findings indicate that loss of PKC-alpha expression in sporadic human and chemically induced colonic cancers may confer a relative growth advantage during colonic malignant transformation.