Extended lymphadenectomy in carcinoma of the right colon

The Authors report on a retrospective study concerning 49 patients treated for a modified Dukes' stage B, C or D right colon cancer. A potentially curative right hemicolectomy with extended lymphadenectomy was performed. Locally advanced disease was treated by "en bloc" resection. Two (4.1%) patients died after surgery, in other 2 (4.1%) cases major postoperative complications were registered. Microscopic examination of the surgical specimens showed lymph node metastases in 44.9% of the cases: in this subgroup a metastatic involvement of the main (III level) nodal groups was detected in 22.7% of the patients. The Authors conclude that extended lymph node dissection does not increase postoperative complications and may play a role in the treatment of right colon cancer. A not negligible group of patients may be understaged or receive inadequate surgical treatment when submitted to traditional right colectomy.     

Duodeno-colic fistula due to cancer of the right colon]

The author presents a case of duodeno-colic fistula revealing carcinoma of the right hepatic flexure showing the difficulty of surgery. A right hemi-colectomy enlarged to the duodenum and pancreas is the ideal operation from a curative point of view, but rarely possible owing to the age of the patient and the constitutional background. The risk of breakdown of duodenal sutures, which is sometimes technically difficult after colonic removal, is far from negligible. The results of by-pass operations, with or without exclusion of the fistula, are poor and uncertain.     

The clinicopathological characteristics and outcome of patients with right colon cancer

We compared the characteristics between the 281 cases with right colon cancer (RCC) and 438 cases with left colon cancer (LCC) who underwent a resection for the disease at our hospital between 1972 and 1995. The mean patient age was significantly higher for RCC than for LCC (62.5 years vs 60.4 years). The mean tumor size was also significantly larger in RCC than in LCC (6.1 cm vs 4.8 cm). The type of recurrence or survival was similar between RCC and LCC. Elderly patients were also found to be more likely to develop RCC than younger patients. This cancer often grows to a large size before being diagnosed. These findings, therefore, suggest the need for targeted examinations for the early detection of RCC, especially in the elderly.     

Angiodysplasia in a jejunal diverticulum as an unusual cause of lower gastrointestinal bleeding

Recent findings of indoor exposure studies of chlorpyrifos indicate that young children are at higher risks to the semivolatile pesticide than had been previously estimated [Gurunathan et al., Environ Health Perspect 106:9-16 (1998)]. The study showed that after a single broadcast use of the pesticide by certified applicators in apartment rooms, chlorpyrifos continued to accumulate on children's toys and hard surfaces 2 weeks after spraying. Based on the findings of this and other research studies, the estimated chlorpyrifos exposure levels from indoor spraying for children are approximately 21-119 times above the current recommended reference dose of 3 microg/kg/day from all sources. A joint agreement reached between the U.S. Environmental Protection Agency and the registrants of chlorpyrifos-based products will phase out a number of indoor uses of the pesticide, including broadcast spraying and direct uses on pets. While crack and crevice treatment of insects (such as cockroaches and termites) by chlorpyrifos will still continue, it appears prudent to explore other insect control options, including the use of baits, traps, and insect sterilants and growth regulators. To ensure global protection, adequate dissemination of appropriate safety and regulatory information to developing regions of the world is critical, where importation and local production of chlorpyrifos-based products for indoor uses may be significant.     

Actinomycosis of the colon

A 44-year-old woman with severe pain in the right upper quadrant, simulating acute cholecystitis, was found to have a large tumour in the transverse colon. Cultures from the mass grew Actinomyces israelii. Actinomycosis may often be missed; involvement of the large bowel is not confined to the appendiceal and cecal areas and may simulate other intra-abdominal conditions.     

Pseudo-obstruction of the colon

"Pseudo-obstruction of the colon" refers to a condition in which physical and radiological findings identical to those associated with mechanical obstruction of the large bowel are found but in which no organic cause for the colonic distention is present. These cases may involve progressive proximal large bowel dilatation to the point of cecal perforation or necrosis. We have collected eight cases of our own which will be presented. The various etiologic factors reported in the literature will be discussed and analyzed and we will offer an anatomicophysiologic explanation of a possible mechanism, based on sympathetic-parasympathetic neurostimulatory imbalance.     

The right drug for the right patient.

In chemotherapy, the problem of finding the right drug for the right patient is based upon the premise that drugs have specific actions and that a particular agent may be beneficial for certain patients but not for others. The drug of choice in this study was defined in terms of the best prediction from multiple regression equations developed on groups that had received 3 different tranquilizing drugs, using pretreatment symptomatology as the predictors. Cross-validation of these assignments on an independent sample confirmed the hypothesis that patients respond best if assigned to their drug of choice. Simple random assignment of patients to the different drugs would have led to an acceptance of the null hypothesis. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Myoelectric activity of the ileum, cecum, and right ventral colon, and cecal emptying of radiolabeled markers in clinically normal ponies

1. The activities of the two key enzymes involved in glutamine metabolism, glutaminase and glutamine synthetase, were measured in mucosal biopsies taken from different sites throughout the human gastrointestinal tract, from oesophagus to rectum. 2. The specific activity of glutamine synthetase was highest in the stomach (4.5 nmol glutamine formed per minute per mg of protein), but both small and large intestine and the oesophagus had little synthesizing capacity (less than 0.3 nmol of glutamine formed per minute per mg of protein). 3. Glutaminase specific activity was highest in the small intestine (53 nmol glutamate formed per minute per mg of protein by duodenal mucosa), intermediate in the large intestine and lowest in the oesophagus and stomach (less than 13 nmol of glutamate formed per minute per mg of protein). 4. The glutamine concentration in the mucosa was lower in the duodenum than in the colon (0.62 and 0.95 mmol/kg wet weight respectively), but both were much lower than the measured K(m) values of glutaminases obtained from these sites (3.8 and 4.0 nmol/kg wet weight respectively). 5. The concentration of glutamine in saliva, stomach juice, bile and duodenal juice suggests that very little glutamine passes into the gastrointestinal tract via these secretions. 6. The study provides the most complete information on the distribution of glutamine synthetase and glutaminase along the human gastrointestinal tract, and suggests that (i) both the small and large intestines have a high potential for glutamine metabolism, but little synthesizing capacity, thus both must derive their glutamine from other sources, and (ii) neither the stomach nor the oesophagus have a high glutaminase activity, although the stomach has substantial capacity to synthesize glutamine. The distribution of the enzymes along the gastrointestinal tract may help rationalize the use of glutamine for treating diseases that affect different parts of the gastrointestinal tract.     

Volvulus of the sigmoid colon

The clinical presentation and treatment of 31 consecutive patients with sigmoid volvulus are reviewed. Nearly half of these patients had a history of mental illness and one-third of all patients were chronically constipated. The main clinical features of abdominal pain and gross abdominal distension had been present for an average of 8 days before presentation of the patient to hospital. The clinical diagnosis of sigmoid volvulus was not difficult but the presence of non-viable bowel was more difficult to establish. A silent abdomen was the most valuable indication of the presence of gangrenous bowel. Conservative measures, including sigmoidoscopy and therapeutic barium enema, successfully reduced the volvulus in half of the cases so treated. In those patients undergoing surgery the procedure associated with the lowest mortality was sigmoid resection with end-to-end anastomosis. The overall mortality was 35%.     

Valuable nuggets for those in the right place at the right time

It was by no means a vintage conference for hardmetals interests, says Ken Brookes, but there was gold dust to be found for those who panned the waters of the conference…