Primary diffusely infiltrative adenocarcinoma of the colon and rectum

In this study, patient opinion on oral rehabilitation by means of Br?nemark implants was investigated. All patients were referred to a periodontal clinic for implant installation and treated by one and the same operator. Prosthetic restorations were performed by dentists, who had no previous experience with prostheses on implants, but had completed a postgraduate training course. Patient opinion was obtained through questionnaires, pertaining to satisfaction and oral function. A comparison was made between pre-implant situation, short-term (< 4 months) and long-term functioning (3 years) with the implant-restorative rehabilitation. In total, 61 patients participated in the study; 23 received a full lower arch bridge and 18 a full upper arch bridge, while 20 patients got partial bridges. Of 298 installed implants, 7 failed at abutment connection (2.3%) and 1 during the 3-year follow-up interval (0.3%). The study results indicated that a great majority of patients were very satisfied with the treatment. Comfort with eating, aesthetics, phonetics and overall satisfaction improved significantly and nearly all patients said that they would undergo the treatment again or recommend it to others. Patients experienced their implants as "natural" teeth. The conclusion is that rehabilitation ad modum Br?nemark, even in the hands of non-specialized dentists, can be of high quality, improving oral function and satisfying the needs and demands of patients.     

Treatment of recurrence of adenocarcinoma of the colon and rectum at the anastomotic site

Resection of recurrent adenocarcinoma of the colon and rectum at the anastomotic site was performed in 30 patients. In the majority of the patients, the recurrence was apparent within two years of the initial operation. In 27 patients, the recurrence was diagnosed based upon persistent signs and symptoms or if the tumor was clinically palpable. In 15 patients, complete resection of the recurrent tumor was feasible, and the median survival time was 59 months, with a five year survival rate of 49 per cent. In ten other patients, minimal tumor was left behind. The median survival time was 17 months and 12 per cent survived five years.     

Polyps of the colon and rectum

The uptake and metabolism of [14C]- or E[3H] adenosine have been studied in suspensions of washed platelets and in platelet rich plasma. The appearance of radioactivity in the platelets and the formation of radioactive adenosine metabolites have been used to determine the uptake. Adenosine is transported into human blood platelets by two different systems: a low Km system (9.8 muM) which is competitively inhibited by papaverine, and a high Km system (9.4 mM) which is competitively inhibited by adenine. Adenosine transported via the low Km system is probably directly incorporated into adenine nucleotides, while adenosine transported through the high Km system arrives unchanged inside the platelet and is then converted into inosine and hypoxanthine or incorporated into adenine nucleotides.     

Chemical burns of the colon and rectum

From the experimental data obtained in 104 animals and clinical observation of 270 cases of digestive tract chemical burns the authors have found that in response to the effect of a corrosion substance, got into the stomach, a complex of protective secretory motor reactions preventing in the most cases from the injury to the intestinal tract occur. In contaminations incompatible with life only, a superficial burn of the colon associated with injuries to the upper portions of gastrointestinal tract, does occur. This was found at the analysis of 62 postmortem protocols of the cases who died ater taking some chemical liquids.     

Carcinoid tumors of the colon and rectum

The article gives a review of the literature concerning carcinoid tumours of the colon and rectum. Carcinoid tumours of the rectum are more common than of the colon, although these tumours are rarities. The carcinoid tumour grows slowly and the patients can survive for years with the disease. Treatment of the rectal carcinoid depends on the size and invasiveness of the primary tumour, as a non-invasive tumour less than 2 cm in diameter can be locally excised. For carcinoids of the colon, the treatment of tumours of less than 2 cm and without invasion will be local excision. For larger and/or invasive tumours in both colon and rectum the treatment is resection. The prognosis for colonic carcinoids is worse than for rectal carcinoids. Adjuvant treatment forms are briefly described. Follow-up programmes for these patients are generally long (over five years) and include recto-/colonoscopy, and search for metastatic spread.     

Adrenalectomy for metastatic disease to the adrenal glands

A policy of supportive treatment is frequently adopted for patients with metastatic disease to the adrenal glands. This study reports an experience with adrenalectomy for adrenal metastasis. Between 1983 and 1993, adrenalectomy was performed in 52 patients for metastasis to the adrenal glands. Survival was calculated by the Kaplan-Meier method and compared with the log rank test. Primary tumour sites included kidney (n = 15), lung (n = 11), colon (n = 7), unknown (n = 5), stomach (n = 3), melanoma (n = 3) and other (n = 8). Adenocarcinoma (69 per cent) was the most common histological cell type. Thirty-two patients were asymptomatic on initial evaluation. Symptomatic adrenal pain relief was achieved in 11 of 13 patients. Overall survival rates were 73 per cent at 1 year and 40 per cent at 2 years. Patients with potentially curative resection had better survival than those who had a palliative procedure. Patients with adrenal metastases due to adenocarcinoma had improved survival compared with that in those with other histological cell types. Although long-term survival is generally poor, highly selected patients with adrenal metastasis (symptomatic disease or adenocarcinoma) may benefit from surgical resection.     

Surgical treatment of adenocarcinoma of the rectum

OBJECTIVE: The authors' aim was to determine survival and recurrence rates in patients undergoing resection of rectal cancer achieved by abdominoperineal resection (APR), coloanal anastomosis (CAA), and anterior resection (AR) without adjuvant therapy. SUMMARY BACKGROUND DATA: The surgery of rectal cancer is controversial; so, too, is its adjuvant management. Questions such as preoperative versus postoperative radiation versus no radiation are key. An approach in which the entire mesorectum is excised has been proposed as yielding low recurrence rates. METHODS: Of 1423 patients with resected rectal cancers, 491 patients were excluded, leaving 932 with a primary adenocarcinoma of the rectum treated at Mayo. Eighty-six percent were resected for cure. Surgery plus adjuvant treatment was performed in 418, surgery alone in 514. These 514 patients are the subject of this review. Among the 514 patients who underwent surgery alone, APR was performed in 169, CAA in 19, AR in 272, and other procedures in 54. Eighty-seven percent of patients were operated on with curative intent. The mean follow-up was 5.6 years; follow-up was complete in 92%. APR and CAA were performed excising the envelope of rectal mesentery posteriorly and the supporting tissues laterally from the sacral promontory to the pelvic floor. AR was performed using an appropriately wide rectal mesentery resection technique if the tumor was high; if the tumor was in the middle or low rectum, all mesentery was resected. The mean distal margin achieved by AR was 3 +/- 2 cm. RESULTS: Mortality was 2% (12 of 514). Anastomotic leaks after AR occurred in 5% (16 of 291) and overall transient urinary retention in 15%. Eleven percent of patients had a wound infection (abdominal and perineal wound, 30-day, purulence, or cellulitis). The local recurrence and 5-year disease-free survival rates were 7% and 78%, respectively, after AR; 6% and 83%, respectively, after CAA; and 4% and 80%, respectively, after APR. Patients with stage III disease, had a 60% disease-free survival rate. CONCLUSIONS: Complete resection of the envelope of supporting tissues about the rectum during APR, CAA, and AR when tumors were low in the rectum is associated with low mortality, low morbidity, low local recurrence, and good 5-year survival rates. Appropriate "tumor-specific" mesorectal excision during AR when the tumor is high in the rectum is likewise consistent with a low rate of local recurrence and good long-term survival. However, the overall failure rate of 40% in stage III disease (which is independent of surgical technique) means that surgical approaches alone are not sufficient to achieve better long-term survival rates.     

Changes in the adrenal glands in menigococcemia

Post-mortem morphological, histochemical, and morphometric investigations of the adrenals in 46 deceased patients who suffered from meningococcemia with and without lesions of the meninges were carried out. The control group was composed of 7 practically healthy persons who had perished suddenly as a result of craniocerebral trauma. It was shown that the adrenals might often be seriously damaged in meningococcemia without clinical and morphological signs of meningitis. Hemodynamic disorders, in particular, involvement of the vessels of the microcirculatory bed, contributed considerably to the lesions of the adrenals. However, even in meningococcemia free from signs of meningitis, in a number of cases individual areas of the cortex retained a high functional activity. In meningococcemia combined with lesions of the meninges, despite considerable damage of the cortical layer, in the majority of cases there were evidences of the tense functioning of the adrenal cells.     

Venous infarction of the adrenal glands

An investigation of 78 cases of adrenal haemorrhage and necrosis disclosed that 32 were examples of adrenal venous infarction. In all these cases there was thrombosis of the main adrenal vein and in most there was also thrombosis of the capsular veins, a finding which has not been well established. In a number of cases with venous infarction there was clinical and pathological evidence that disseminated intravascular coagulation (DIC) had occurred, but it appears that it was not the direct cause of venous thrombosis. The majority of cases of venous infarction occur in patients with severe infection, frequently of the respiratory tract. Venous infarction was found in five cases with hypothermia an association which had rarely been described, and in three of these there was evidence of DIC. This is apparently the first occasion on which DIC has been demonstrated in cases of hypothermia in man. The cause of venous thrombosis in the adrenal glands is obscure in most cases of venous infarction, although in three it was due to involvement by metastatic carcinoma. It is suggested that the factors responsible for the initiation of thrombosis in the adrenal veins are catecholamines, thrombin, fibrin and endotoxin. Localisation of the thrombi to the adrenal vein is due to the unique anatomical structure of the vein which, under certain circumstances, results in the local stasis of blood.     

Bilateral non-Hodgkin's lymphoma of the adrenal glands with adrenal insufficiency

A 66-year-old female presented with anorexia, fatigue, skin pigmentation, weight loss and low grade fever. Imaging studies demonstrated bilateral bulky masses confined to the adrenal glands. Ultrasonography guided needle biopsy of the mass showed findings of diffuse large B-sell lymphoma. Low levels of serum cortisol, urinary 17-OHCS and 17-KS, a high level of ACTH and a non-reactive pattern on the rapid ACTH test led to a diagnosis of Addison's disease. Only a partial regression was achieved by the first chemotherapy. She died due to disease progression, while the next course of chemotherapy had been postponed because of interstitial pneumonitis due to methotrexate.     

Pseudocysts of the adrenal glands in newborn infants

With diagnostic aims the author used direct laryngeal tomography in patients with median stenosis of the larynx. Tomography made it possible to define the width of the lumen of the sumplica area. Depending on the change of the subplica area the author varied the extent of surgical intervention. He used the extralaryngeal method of vocal plica laterification in all patients. With narrow subglottis he practiced complete mobilization of the elastic cone and its subsequent laterification; with wide subglottis he mobilized only the uper edge of the elastic cone. He succeeded in obtaining good functional results concerning respiration in all patients.     

Colonoscopy in the management of diseases of the colon and rectum

This report covers a 2.5-year experience with colonoscopy in the management of 208 patients (104 men and 98 women, average age 58 years). Colonic bleeding of unknown cause and abnormal barium-enema findings were the most common indications for colonoscopic examination. During this period, 110 colonoscopic polypectomies were performed. Among the few complications was one case of perforation of the sigmoid from transcolonoscopic removal of a small carcinoma; the perforation was incidentally discovered at the time of subsequent laparotomy. Bleeding occurred in 6 patients, but only one of them required surgical intervention to arrest the hemorrhage. Colonoscopy is a safe, effective and reliable diagnostic and therapeutic procedure. Its use can reduce expense for the patient and obviate a long painful postoperative period.     

Adjuvant radiation therapy for adenocarcinoma of the rectum

The potential for electron transfer quenching of rose bengal triplet (3RB2-) to compete with energy transfer quenching by oxygen was evaluated. Rate constants for oxidative and reductive quenching were measured in buffered aqueous solution, acetonitrile and in small unilamellar liposomes using laser flash photolysis. Biologically relevant quenchers were used that varied widely in structure, reduction potential and charge. Radical ion yields (phi i) were measured by monitoring the absorption of the rose bengal semireduced (RB.3-) and semioxidized (RB.-) radicals. The results in solution were analyzed as a function of the free energy for electron transfer (delta G) calculated using the Weller equation including electrostatic terms. Exothermic oxidative quenching was about 10-fold faster than exothermic reductive quenching in aqueous solution. The quenching rate constants decreased as delta G approached zero in both aqueous and acetonitrile solution. Exceptions to these generalizations were observed that could be rationalized by specific steric or electrostatic effects or by a change in mechanism. The results suggest that electron transfer reactions with some potential quenchers in cells could compete with formation of singlet oxygen [O2(1 delta g)]. Values of phi i were generally greater for reductive quenching and, for oxidative quenching, greater in acetonitrile than in buffer. Electron transfer quenching of 3RB2- in liposomes, below the phase transition temperature was slower than in solution for both lipid-soluble and water-soluble quenchers indicating that these reactions may not compete with formation of O2(1 delta g) during cell photosensitization.     

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.     

Contrast-enhanced MR imaging of the kidneys and adrenal glands

Technical developments including motion artifact compensation and the use of paramagnetic contrast agents have substantially improved the performance of MR imaging of the kidneys and adrenal glands. MR imaging allows one to assess morphologic alterations of the kidneys as well as perfusion and functional derangements. MR imaging is the best noninvasive method for distinction of benign from malignant adrenal masses.