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1

PROLAPSO DO RETO ASPECTOS CLÍNICOS E CIRÚRGICOS  

Microsoft Academic Search

RESUMO: O prolapso retal é um transtorno da estática do reto e se manifesta pela invaginação oculta ou visível, quando há saída de segmento variável do reto pelo ânus. Trata-se de uma anomalia relativamente incomum, incapacitante e de etiologia pouco conhecida, para que concorre uma multiplicidade de fatores de diferentes patogenias. É mais freqüente na mulher idosa, com pico acima

2

Morphine Rectal  

MedlinePLUS

Rectal morphine is used to relieve moderate to severe pain. Morphine is in a class of medications called opiate ( ... Rectal morphine comes as a suppository to insert in the rectum. It is usually inserted every 4 hours. Use ...

3

Rectal Prolapse  

MedlinePLUS

... out of the anus. Weakness of the anal sphincter muscle is often associated with rectal prolapse at ... pelvis as well as weakening of the anal sphincter muscle. Sometimes rectal prolapse results from generalized pelvic ...

4

Rectal prolapse  

Microsoft Academic Search

Introduction  Rectal prolapse, or procidentia, is defined as a protrusion of the rectum beyond the anus. It commonly occurs at the extremes\\u000a of age. Rectal prolapse frequently coexists with other pelvic floor disorders, and patients have symptoms associated with\\u000a combined rectal and genital prolapse. Few patients, a lack of randomized trials and difficulties in the interpretation of\\u000a studies of anorectal physiology

Stavros Gourgiotis; Sotirios Baratsis

2007-01-01

5

Rectal lymphoscintigraphy  

Microsoft Academic Search

Regional lymph nodes of the rectum are not demonstrable by pedal lymphoscintigraphy. We have evaluated the technique of rectal\\u000a lymphoscintigraphy, using a technique similar to that which has been used in the assessment of lymph nodes in breast and prostatic\\u000a cancer. Thirty-five patients were studied: ten normal subjects and 25 patients with rectal cancer. In normal subjects, the\\u000a lymph nodes

Luigi Bucci; Raffaele Salfi; Francesco Meraviglia; Francesco Mazzeo

1984-01-01

6

Rectal Resection  

Microsoft Academic Search

The frequency of fecal incontinence (FI) in patients submitted to rectal resection (RR) for cancer ranges between 2% and 40%\\u000a [1-6]. In fact, despite the significant improvements registered over the last few decades in the treatment of rectal cancer,\\u000a not only in the control of the neoplasm itself and sparing of the anal sphincters but also in the preservation of

Giovanni B. Doglietto; Carlo Ratto; Angelo Parello; Lorenza Donisi; Francesco Litta

7

Rectal lymphoscintigraphy  

SciTech Connect

Regional lymph nodes of the rectum are not demonstrable by pedal lymphoscintigraphy. The authors have evaluated the technique of rectal lymphoscintigraphy, using a technique similar to that which has been used in the assessment of lymph nodes in breast and prostatic cancer. Thirty-five patients were studied: ten normal subjects and 25 patients with rectal cancer. In normal subjects, the lymph nodes accompanying the superior hemorrhoidal artery and the inferior mesenteric artery are demonstrable in succession; after three hours the aortic lymph nodes are demonstrable. The 25 patients with rectal cancer underwent resection of their primary tumor and the stage was defined according to Dukes (1932). In five patients (stage A) no alteration was demonstrable. In 11 patients (stage B) the demonstration of regional lymph nodes was delayed vs. the control group. In nine cases (stage C) the demonstration of regional lymph nodes was delayed and defective versus the control group.

Bucci, L.; Salfi, R.; Meraviglia, F.; Mazzeo, F.

1984-06-01

8

Rectal lymphoscintigraphy.  

PubMed

Regional lymph nodes of the rectum are not demonstrable by pedal lymphoscintigraphy. We have evaluated the technique of rectal lymphoscintigraphy, using a technique similar to that which has been used in the assessment of lymph nodes in breast and prostatic cancer. Thirty-five patients were studied: ten normal subjects and 25 patients with rectal cancer. In normal subjects, the lymph nodes accompanying the superior hemorrhoidal artery and the inferior mesenteric artery are demonstrable in succession; after three hours the aortic lymph nodes are demonstrable. The 25 patients with rectal cancer underwent resection of their primary tumor and the stage was defined according to Dukes (1932). In five patients (stage A) no alteration was demonstrable. In 11 patients (stage B) the demonstration of regional lymph nodes was delayed vs. the control group. In nine cases (stage C) the demonstration of regional lymph nodes was delayed and defective versus the control group. PMID:6734361

Bucci, L; Salfi, R; Meraviglia, F; Mazzeo, F

1984-06-01

9

Solitary Rectal Ulcer Syndrome  

MedlinePLUS

Solitary rectal ulcer syndrome Basics Multimedia Resources Reprints A single copy of this article may be reprinted for personal, noncommercial use only. Solitary rectal ulcer syndrome By Mayo Clinic staff Original Article: http:// ...

10

Understanding Minor Rectal Bleeding  

MedlinePLUS

... Hemorrhoids Anal fissures Proctitis (inflammation of the rectum) Polyps Colon or anal cancer Rectal ulcers Understanding Minor Rectal ... appropriate course of action with you. What are colon polyps? Polyps are benign growths within the lining of ...

11

Rectal balloon for CT of rectal cancer  

Microsoft Academic Search

The use of a balloon catheter to distend the rectum for pelvic CT in patients with rectal cancer is described. The 20-cm long balloon, inserted over a 12F catheter and inflated with 180-200 ml of water, is simple to use, well tolerated by patients and allows high-quality CT scans. Preliminary results of the presurgical staging of rectal cancer by CT

M. Bellomi; A. Severini; E. Leo; S. Andreola; A. Marchiano; G. Cozzi; M. Salvetti

1995-01-01

12

Laparoscopy for rectal cancer.  

PubMed

Several large case series and single-institution trials have shown that laparoscopy is feasible for rectal cancer. Pending the results of the UK CLASICC, COLOR II, Japanese JCOG 0404, and ACOSOG Z6051 trials, the oncologic and long-term safety of laparoscopic rectal cancer surgery is unclear and the technique is best used at centers that can effectively collect and analyze outcomes data. Robotic and endoluminal techniques may change our approach to the treatment of rectal cancer in the future. Training, credentialing, and quality control are important considerations as new and innovative surgical treatments for rectal cancer are developed. PMID:20883954

Nandakumar, Govind; Fleshman, James W

2010-10-01

13

Physiology of rectal sensations  

Microsoft Academic Search

PURPOSE: The first awareness of balloon inflation (first sensation (FS)), flatus sensation (constant sensation (CS)), urge to defecate (UD), and maximum tolerated threshold (MTT) are the four commonly evaluated rectal sensations. The traditional view that these sensations are attributable to pelvic floor mechanoreceptor stimulation is challenged by current evidence in favor of rectal wall mechanoreceptors. The aim of this study

G. N. Rao; P. J. Drew; J. R. T. Monson; G. S. Duthie

1997-01-01

14

Advanced rectal cancer  

Microsoft Academic Search

The best treatment of advanced rectal cancer remains uncertain. The aim of this study was to determine the outcome after palliative\\u000a procedures in patients with advanced rectal cancer. One hundred and three patients treated over a seven-year period were identified,\\u000a including 30 with local invasion, 18 with local metastases, and 55 with distant metastases. Patients were grouped into two\\u000a groups:

Walter E. Longo; Garth H. Ballantyne; Anton J. Bilchik; Irvin M. Modlin

1988-01-01

15

Effect of rectal distension on rectal electromechanical activity.  

PubMed

The rectum possesses electric activity in the form of pacesetter potentials (PPs) and action potentials (APs). The latter are associated with rectal pressure elevation and share in the rectal motile activity. A recent study has shown that electric waves are transmitted by the longitudinal but not the circular rectal muscle fibers. Rectal motile activity under normal physiologic conditions was suggested to be induced by the electric waves, that effect longitudinal muscle contraction, as well as by circular muscle stretch resulting from rectal distension. The current study investigated the effect of rectal overdistension on the rectal electromechanical activity aiming at assessing the effect of stool accumulation in the rectum on rectal motile activity. Under general anesthesia, the abdomen of 16 mongrel dogs was opened, the rectum exposed, and 3 electrodes were sutured to the rectal serosa. The rectal pressure was measured by a 10-F catheter connected to a pressure transducer. Rectal distension was achieved by a balloon inflated with carbon dioxide (CO2). Simultaneous recording of the electric activity and rectal pressure was performed during rectal inflation in increments of 10 mL CO2. There was significant increase of rectal pressure as well as of frequency, amplitude, and conduction velocity of PPs and APs on rectal distension. The more the rectal balloon was distended, the more was the increase in rectal pressure and waves variables; the increase was maximal just before balloon expulsion at 40 mL distension. Upon rectal overdistension (50 and 60 mL), no PPs or APs were recorded and the rectal pressure was 0; no balloon expulsion occurred. Rectal overdistension (pathologic distension) appears to abort the electromechanical activity of the rectum and lead to failure of the rectum to expel the balloon. This effect is suggested to be due to overstretch of rectal musculature with a resulting loss of the rectal electric waves and noncontraction of the muscle fibers. These findings appear to explain the cause of rectal atony, which occurs in rectal inertia and leads to constipation. PMID:11700922

Shafik, A; El-Sibai, O

16

Local Excision of Rectal Tumors  

Microsoft Academic Search

Background: In endoscopically non-resectable benign rectal tumors, local excision is the treatment of choice. Furthermore, patients with early rectal carcinomas can be cured by a transanal excision. A transanal approach may also be justified considering the higher morbidity and mortality rates of a transabdominal procedure. Patients and Method: 57 patients with rectal tumors were treated with a transanal excision. In

Heinz Wykypiel; Friedrich Conrad; Anton Klingler; Reinhard Mittermair; Jörg Tschmelitsch

2002-01-01

17

Rectal manifestations of pellagra  

Microsoft Academic Search

Twenty (44%) of 45 patients with cutaneous pellagra had diarrhoea. Inflammation was seen on sigmoidoscopy in 42 and was severe in 5 (11%), moderate in 4 (9%) and mild in 33 (73%). Six patients (13%) had perianal excoriation. Rectal biopsies taken in all cases showed extensive ulceration in 1 case, moderate to severe inflammation in 16 (36%) and mild inflammation

I. Segal; L. Ou. Tim; A. Demetriou; A. Paterson; M. Hale; M. Lerios

1986-01-01

18

Rectal prolapse in children.  

PubMed

Rectal prolapse in children is nowadays a rare anomaly. Potty training in young children is the common cause and the resulting prolapse can be treated conservatively. In children with refractory prolapse, sclerosing injections may be used. Operative treatment by posterior rectopexy is only indicated in the very few cases of long-standing prolapse. PMID:2694022

Severijnen, R; Festen, C; van der Staak, F; Rieu, P

1989-12-01

19

Digital rectal exam  

MedlinePLUS

... physical examination in both men and women. In men, the test is used to examine the prostate, looking for abnormal enlargement or other signs of prostate cancer . In women, a digital rectal exam may be performed during a routine gynecologic examination. ...

20

Rectal pharmacokinetics of budesonide  

Microsoft Academic Search

The pharmacokinetics and systemic availability of budesonide after rectal administration of two single enema doses (2 mg in 100 ml fluid of almost identical composition) were compared in 15 healthy volunteers. In 11 of these subjects, 2 mg oral budesonide in a gelatine capsule was given on a separate occasion. An intravenous administration (0.5 mg) was given as reference. With

K. Dahlström; S. Edsbäcker; A. Källén

1996-01-01

21

Abnormal per rectal bleed.  

PubMed

A 3-year old girl presented to our A&E with a complaint of an acute event of per rectal bleed. The parent had given a history of a visit to a nearby waterfall one day ago. Upon admission she developed hypotension and had a fainting episode due to the excessive passing of blood per rectum. The case report shows how the appropriate investigations were carried out and the twist behind the cause. PMID:21515535

Singh, Arvinder Harbaksh Singh

2011-02-01

22

Solitary rectal ulcer syndrome  

Microsoft Academic Search

Background  Although the clinicopathologic features of solitary rectal ulcer syndrome (SRUS) are well documented, the heterogeneous endoscopic appearance of lesions that the syndrome produces and its rare incidence may make for clinical confusion.Methods  Together with a literature review, we describe the variety of lesions experienced in our hospital with a series of endoscopic and histological illustrations and emphasize the diagnostic dilemma both

Jy-Ming Chiang; Chung-Rong Changchien; Jim-Ray Chen

2006-01-01

23

Surgical management of rectal prolapse  

Microsoft Academic Search

This article reviews the pathogenesis, clinical presentation and surgical management of rectal prolapse. Full-thickness prolapse of the rectum causes significant discomfort because of the sensation of the prolapse itself, the mucus that it secretes, and because it tends to stretch the anal sphincters and cause incontinence. Treatment of rectal prolapse is primarily surgical. Perineal surgical repairs are well tolerated, but

Eric L Marderstein; Conor P Delaney

2007-01-01

24

Endosonographic staging of rectal carcinoma  

Microsoft Academic Search

Transrectal ultrasonography (US) scanning facilitates the ultrastructural differentiation of the various histologic layers of the rectal wall. In particular, the muscularis propria is represented by the 4th sonographic layer. Rectal carcinoma appears on US as a low echogenic area that suddenly interrupts the regular sequence of parietal layers.

Giulio Di Candio; Franco Mosca; Alessandro Campatelli; Andrea Cei; Mauro Ferrari; Fulvio Basolo

1987-01-01

25

Rectal prolapse in children.  

PubMed Central

Some of the factors thought to be responsible for rectal prolapse in children are reviewed. In the United Kingdom management has in the past been conservative. It is suggested that children should be treated at an early stage by means of an injection of phenol in almond oil, in order to reduce the discomfort of recurrent manipulative reductions of the prolapse in the child and alleviate the anxiety of the parents. In 18 cases treated during the past 3 years a single injection performed under general anaesthesia, as a day case, was successful in preventing further prolapse of the rectum. Images Figure 1. Figure 2. Figure 3. Figure 4.

Freeman, N V

1984-01-01

26

Rectal compliance as a routine measurement  

Microsoft Academic Search

PURPOSE: The clinical impact of rectal compliance and sensitivity measurement is not clear. The aim of this study was to measure the rectal compliance in different patient groups compared with controls and to establish the clinical effect of rectal compliance. METHODS: Anorectal function tests were performed in 974 consecutive patients (284 men). Normal values were obtained from 24 controls. Rectal

Richelle J. F. Felt-Bersma; Cornelius E. J. Sloots; Alexander C. Poen; Miguel A. Cuesta; Stephan G. M. Meuwissen

2000-01-01

27

Intraspinal schwannoma presenting solely with rectal pain.  

PubMed

A cauda equina schwannoma presented solely with rectal pain. The tumor was found to have infarcted and hemorrhaged. A discussion of rectal pain is included, and it is speculated that some forms of rectal pain, especially those classified as proctalgia fugax or rectal neuralgia, may be due to cauda equina tumors. PMID:3352894

Kornel, E E; Vlahakos, D

1988-02-01

28

The trigger for rectal filling sensation  

Microsoft Academic Search

In order to evaluate whether rectal volume, weight or pressure is the main trigger for rectal sensation, their respective values were determined at each of the rectal filling sensation thresholds (first, constant, urge, maximum) in 12 adult control subjects. The rectal balloon was filled at 60 ml\\/min in sitting position using water (twice), air and mercury consecutively. Pressure values were

P. M. A. Broens; F. M. Penninckx; B. Lestfir; R. P. Kerremans

1994-01-01

29

Laparoscopic rectal resection with anal sphincter preservation for rectal cancer  

Microsoft Academic Search

Background  Total mesorectal excision (TME) is the surgical gold standard treatment for middle and low third rectal carcinoma. Laparoscopy\\u000a has gradually become accepted for the treatment of colorectal malignancy after a long period of questions regarding its safety.\\u000a The purposes of this study were to examine prospectively our experience with laparoscopic TME and high rectal resections,\\u000a to evaluate the surgical outcomes

J.-L. Dulucq; P. Wintringer; C. Stabilini; A. Mahajna

2005-01-01

30

Presentations of Localized Rectal Cancer  

Cancer.gov

Rectal Cancer: Advanced Technologies Chris Willett, M.D. Department of Radiation Oncology Duke University Medical Center Durham, NC Gastric Intergroup 0116: RT Considerations 35% of initially submitted RT plans: Major deviations (2/3 undertreatment) 2

31

Effect of rectal dilation in fecal incontinence with low rectal compliance  

Microsoft Academic Search

PURPOSE: This study was undertaken to determine the effect of rectal dilation in a patient with urge-type fecal incontinence and frequent bowel movements associated with low rectal compliance and capacity. METHOD: Daily rectal balloon dilation was performed for a period of four weeks. RESULTS: The patient regained complete fecal continence with one to two daily bowel movements. Rectal compliance, capacity,

Nis I. Alstrup; Ole Ø. Rasmussen; John Christiansen

1995-01-01

32

Preoperative MRI of Rectal Cancer With and Without Rectal Water Filling: An Intraindividual Comparison  

Microsoft Academic Search

OBJECTIVE. The purpose of our study was to determine if a rectal distention using warm water may improve the accuracy of MRI for the preoperative staging of rectal carcinoma. SUBJECTS AND METHODS. Sixty-two patients with surgically proven rectal carcino- mas underwent pelvic MRI before and after a rectal distention by warm water. Four radiolo- gists, who were blinded to the

Myeong-Jin Kim; Joon Seok Lim; Young Taik Oh; Joo Hee Kim; Jae-Joon Chung; Seung Ho Joo; Nam Kyu Kim; Kang Young Lee; Won Ho Kim; Ki Whang Kim

33

ACR Appropriateness Criteria on Resectable Rectal Cancer  

SciTech Connect

The American College of Radiology (ACR) Appropriateness Criteria on Resectable Rectal Cancer was updated by the Expert Panel on Radiation Oncology-Rectal/Anal Cancer, based on a literature review completed in 2007.

Suh, W. Warren [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States)], E-mail: wsuh@lroc.harvard.edu; Blackstock, A. William [Department of Radiation Oncology, Wake Forest University, School of Medicine, Winston Salem, NC (United States); Herman, Joseph [Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD (United States); Konski, Andre A. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Mohiuddin, Mohammed [Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, KY (United States); Department of Radiation Oncology, Wake Forest University, School of Medicine, Winston Salem, NC (United States); Poggi, Matthew M. [Inova Alexandria Cancer Center, Alexandria, VA (United States); Regine, William F. [Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD (United States); Cosman, Bard C. [VA Medical Center, San Diego, CA (United States); Saltz, Leonard [Department of Medical Oncology, Memorial-Sloan Kettering Cancer Center, New York, NY (United States); Johnstone, Peter A.S. [Radiation Oncology Department, Emory University School of Medicine, Atlanta, GA (United States)

2008-04-01

34

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5450 Rectal dilator. (a) Identification. A rectal dilator is a...

2013-04-01

35

Colonoscopy for rectal bleeding in childhood.  

PubMed

Undiagnosed rectal bleeding can pose a significant problem in the pediatric patient. A systematic and logical approach to the work-up of the child with rectal bleeding is necessary for prompt and accurate diagnosis. It is our impression that the addition of colonscopy in carefully selected patients will decrease the number of children with undiagnosed significant rectal bleeding. PMID:305476

Holgersen, L O; Mossberg, S M; Miller, R E

1978-02-01

36

Piriformis muscle metastasis from a rectal polyp.  

PubMed

Rectal cancers constitute over a quarter of all colorectal cancers. Spread of rectal cancer is usually to liver, lung and brain from high risk rectal cancers. Cases have rarely been reported of spread to soft tissue structures. Here we present a case of metastatic spread of a previously excised, early invasive adenocarcinomatous polyp to piriformis. PMID:23087286

Salar, Omer; Flockton, Helen; Singh, Rajeev; Reynolds, Jonathan

2012-10-19

37

Transanal endoscopic microsurgery in rectal cancer  

Microsoft Academic Search

In rectal cancer total mesorectal excision (TME) is the gold standard. However, driven by the aim to avoid major morbidity and stoma formation, local excision (LE), preferrably with transanal endoscopic microsurgery (TEM), is considered a curative alternative in selected rectal cancer patients. In this thesis the role of TEM in T1 rectal cancer is studied. It was shown that compared

Pascal Gabriël Doornebosch

2010-01-01

38

Imaging and management of rectal cancer  

Microsoft Academic Search

Local staging and management of rectal cancer has evolved during the past decade. Imaging modalities used for staging rectal cancer include CT, endoscopic ultrasound, pelvic phased-array coil MRI, endorectal MRI, and PET. Each modality has its strengths and limitations. Evidence supports the use of both endoscopic ultrasound and CT in staging rectal cancer. MRI is the only reliable tool for

Julia K LeBlanc

2007-01-01

39

Rectal prolapse associated with bulimia nervosa  

Microsoft Academic Search

PURPOSE: Rectal prolapse is a condition in which, when complete, the full thickness of the rectal wall protrudes through the anus. Bulimia nervosa is an eating disorder characterized by periodic food binges, which are followed by purging. Purging usually takes the form of self-induced vomiting, laxative abuse, and\\/or diuretic abuse. We report seven cases of rectal prolapse associated with bulimia

Michael Malik; James Stratton; W. Brian Sweeney

1997-01-01

40

Diagnosis and outcome of isolated rectal tuberculosis  

Microsoft Academic Search

PURPOSE: Segmental colonic tuberculosis commonly involves the ascending, transverse, or sigmoid colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. This study describes the clinical presentation, endoscopic features, and outcome of isolated rectal tuberculosis. METHODS: Isolated rectal tuberculosis was defined as focal lesions of the rectum in the absence of radiologically demonstrable lesions in the small and large bowel

A. S. Puri; J. C. Vij; A. Chaudhary; Nirmal Kumar; A. Sachdev; V. Malhotra; V. K. Malik; S. L. Broor

1996-01-01

41

Intermittent rectal motor activity: a rectal motor complex?  

PubMed Central

Prolonged nocturnal recordings from multiple sites in the anorectum and duodenum were performed in 12 healthy volunteers to investigate the presence and determine the characteristics of nocturnal rectal motor activity and assess any synchronicity with phase III of the small intestinal migrating motor complex. Runs of phasic contractions of two contractile frequencies (3 or 6/minute), sustained for more than three minutes, and preceded and followed by motor quiescence were observed in 10 of the 12 subjects. This phenomenon is similar to that described by other investigators and termed the 'rectal motor complex'. The runs of contractions showed considerable inter- and intrasubject variation, with a duration of 3-30 minutes (median 9.0), amplitude of 10-55 mm Hg (median 20.0), and periods of 10-420 minutes (median 55.5) between contractile activity. There was no propagation through the rectum, the phasic motor activity rarely occurred simultaneously at more than one rectal recording site. No consistent relation with phase III of the small intestinal migrating motor complex was observed in any subject. In view of these findings, we question whether this intermittent motor activity merits the term 'rectal motor complex'.

Prior, A; Fearn, U J; Read, N W

1991-01-01

42

Sleeping position and rectal temperature.  

PubMed

The effects of sleeping position upon body temperature were assessed by continuous monitoring of rectal temperature in 137 babies sleeping at home under conditions chosen by their parents. There were three groups of subjects: (1) normal babies aged 12-22 weeks whose temperature rhythms were developed, (2) normal babies aged 6-12 weeks who were developing their night time temperature rhythms, and (3) babies the night after diphtheria, pertussis, and tetanus immunisation, whose temperature rhythms were disturbed. Sleeping in the prone position was not associated with higher rectal temperatures at any time of night in young babies, nor did it exaggerate the disturbance of rectal temperature rhythm after immunisation. In older normal babies the prone position did not disturb rectal temperature in the first part of the night, though prone sleepers warmed a little faster prior to walking, especially in warm conditions. Prone sleepers were, however, born earlier in gestation and tended to be of lower birth weight. Normal babies can therefore thermoregulate effectively whatever their sleeping posture, even in warm conditions, though the prone position may make it slightly more difficult to lose heat. It is difficult to see how the prone position, even interacting with warm conditions, could induce lethal hyperthermia in otherwise normal babies. Perhaps the prone position is associated with other risk factors for sudden infant death syndrome. PMID:1929494

Petersen, S A; Anderson, E S; Lodemore, M; Rawson, D; Wailoo, M P

1991-08-01

43

Origin of rectal electric waves  

Microsoft Academic Search

PURPOSE: The rectum possesses electric activity in the form of pacesetter and action potentials. In a recent study we suggested that the waves are not initiated by the extrarectal autonomic innervation but might be triggered by a “rectosigmoid pacemaker.” It was postulated that the electric signals are transmitted in the rectal wall through either the muscle bundles or enteric nerve

Ahmed Shafik

1999-01-01

44

Rectal neutropenic enteropathy of children  

Microsoft Academic Search

Neutropenic enteropathy is a rare condition that involves commonly the ileocecale region of neutropenic patients. We report a case of 8 years old girl undergoing chemotherapy complicated by rectal neutropenic enteropathy. To our knowledge this location is the first case reported in the literature.

Assmae Sqalli Houssaini

2009-01-01

45

Approach to Rectal Cancer Surgery  

PubMed Central

Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.

Chua, Terence C.; Chong, Chanel H.; Liauw, Winston; Morris, David L.

2012-01-01

46

The trigger for rectal filling sensation.  

PubMed

In order to evaluate whether rectal volume, weight or pressure is the main trigger for rectal sensation, their respective values were determined at each of the rectal filling sensation thresholds (first, constant, urge, maximum) in 12 adult control subjects. The rectal balloon was filled at 60 ml/min in sitting position using water (twice), air and mercury consecutively. Pressure values were corrected for the elastic properties of the balloon, while the volume of inflated air was recalculated taking into account the prevalent rectal pressure and temperature. The results obtained using water, air and mercury demonstrated a constant relationship between a given rectal sensation level and the pressure recorded in the distending balloon, but not its volume or weight. Pressure values recorded at each sensation level were constant during repeated determinations of rectal sensation, the volume of rectal distension increased, probably because the rectum had already been dilated by previous testing. Balloon distension using air with the patient in the lateral position were found to be most practical for routine evaluation of rectal sensation. It is therefore concluded that any disturbance of rectal sensation will be reflected by changes in pressure and not by changes in the volume needed to produce a given sensation level. The location of the receptors involved has to be elucidated, but it seems that the pelvic floor can be excluded since the weight of the rectal contents was not related to sensation. PMID:8027617

Broens, P M; Penninckx, F M; Lestár, B; Kerremans, R P

1994-04-01

47

Rectal bleeding: prevalence and consultation behaviour.  

PubMed Central

OBJECTIVES--To determine prevalence of rectal bleeding in the community and to examine factors that lead some patients to consult their general practitioner about rectal bleeding while others do not. DESIGN--Questionnaire survey followed by semistructured interviews of sample of respondents with rectal bleeding. SETTING--Two general practices on Tyneside. SUBJECTS--2000 adult patients registered with the general practices were sent a validated questionnaire. Respondents with rectal bleeding were divided into consulters and non-consulters, and 30 patients from each group (matched for age, sex, and characteristics of bleeding) were interviewed. MAIN OUTCOME MEASURES--Prevalence of rectal bleeding, proportion of subjects with rectal bleeding who sought medical advice, and reasons for consulting or not consulting a doctor about rectal bleeding. RESULTS--287 of the 1200 respondents to the questionnaire had noticed rectal bleeding at some time in their lives, and 231 had noticed it within previous 12 months. Only 118 (41%) of all respondents with rectal bleeding had ever sought medical advice for the problem. Those aged over 60 were most likely to have consulted, as were those who reported blood mixed with their stools. Main difference between those who had sought medical advice and those who had not was that consulters were more likely than non-consulters to perceive their symptoms as serious. CONCLUSIONS--Although rectal bleeding is common, only minority of patients seek medical of symptoms seems to be most important factor in deciding whether to consult a doctor for rectal bleeding.

Crosland, A.; Jones, R.

1995-01-01

48

Rectal balloons: complications, causes, and recommendations.  

PubMed

Nine previously unreported rectal injuries caused by barium-enema examinations have been reviewed. In each case, the injury occurred in conjunction with inflation of a rectal balloon. Analysis of the clinical material suggested that certain mechanical properties of balloon catheter tips might transfer mechanical stress to the rectal wall and contribute to the observed injuries. Careful manometric evaluation of in vivo rectal balloons suggest that significant anatomic differences in patients may be clinically important. Further experimental bench studies revealed undesirable mechanical properties in many commercially available rectal balloon catheters. These mechanical problems include low compliance, asymmetrical inflation, strong lateral and anterior displacement of a firm catheter tip into the restraining wall, and self-obstruction of the balloon deflation outlet by the inflated baloon. Many of these problems were clinically confirmed by careful in vivo observations and by evidence collected from the nine cases of rectal injury. A series of practical prophylactic procedures are recommended. PMID:478796

Nelson, J A; Daniels, A U; Dodds, W J

49

Physiological variation in rectal compliance.  

PubMed

The volume (V) of air inflated in a latex balloon placed in the rectum and the corresponding pressures (P) were measured in 48 subjects (24 men and 24 women) at three points: (1) earliest defaecation urge; (2) constant defaecation urge; and (3) maximum tolerable volume (MTV). The rectal pressures in all three cases were higher in men than in women. Woman aged over 60 years had higher rectal compliance (delta V/delta P) than men in the same age group, while no difference was found between men and women below the age of 60 years. Day-to-day variation of the measurements was tested in ten subjects. Reproducibility was good only for MTV (95 per cent confidence interval 57-183 per cent). Reproducibility of rectal compliance decreased with increasing values for this parameter. No such trend was found for the other parameters. In conclusion, MTV is a reproducible parameter and suitable for clinical use in evaluation of patients with faecal incontinence or constipation. PMID:1422734

Sørensen, M; Rasmussen, O O; Tetzschner, T; Christiansen, J

1992-10-01

50

Rectal Ischemia Mimicked Tumor Mass  

PubMed Central

Ischemic proctitis is a rare disease which is usually encountered in elderly with comorbidities. We present a case of an 80-year old man with severe coronary disease who presented with severe hematochezia and hypotension. Endoscopy revealed a rectal mass 3-4?cm above the dental line and rectosigmoid mucosal inflammation compatible with ischemic colitis. The rectal insult was so intense that it resembled a neoplasmatic lesion. We discuss the causes, the prognostic factors, and the clinical and therapeutic challenges of this rare, albeit life-threatening entity, and we review the relative literature. A percentage of 10%–20% of patients with ischemic colitis usually have a distal potentially obstructing lesion or disorder such as cancer, diverticulitis or fecal impaction. Ischemic colitis, when mucosal and submucosal edema is severe and hemorrhagic nodules are large enough, can mimic a neoplasmatic lesion. The best treatment approach is a conservative management initially with a close clinical followup and after stabilization a repetition of rectal endoscopy with new biopsies. Early recognition of this clinical entity is of paramount importance to implement appropriate therapy (conservative or surgical) and avoid potentially fatal treatment of presumed inflammatory or infectious bowel diseases.

Zikos, Nicolaos; Aggeli, Panagiota; Louka, Evangelia; Pappas-Gogos, George

2013-01-01

51

Robotic rectal surgery: what are the benefits?  

PubMed

Robotic rectal surgery is not a rare event for colorectal surgeons any more. Even patients with colorectal diseases obtain information through the mass media and are asking surgeons about robotic surgery. Since laparoscopic rectal surgery has proved to have some benefits compared to open rectal surgery, many surgeons became interested in robotic rectal surgery. Some of them have reported the advantages and disadvantages of robotic rectal surgery over the last decade. This review will report on the outcomes of robotic rectal surgery. Robotic rectal surgery requires a longer operation time than laparoscopic or open surgery, but many authors reduced the gap as they were accustomed to the robotic system and used various additional techniques. The high cost for purchasing and maintaining the robotic system is still a problem, though. However, except for this reason, robotic rectal surgery shows comparable and even superior results in some parameters than laparoscopic or open surgery. They include pathologic and functional outcomes as well as short-term outcomes such as complication rates, length of hospital stay, time to recover normal bowel function or first flatus, time to start diet, and postoperative pain. Moreover, studies on oncologic outcomes show acceptable results. Robotic rectal surgery is safe and feasible and has a number of benefits. Therefore, it can be an alternative option to conventional laparoscopic and open surgery with strict indications. PMID:24101003

Kim, C W; Baik, S H

2013-10-01

52

Die Glandulae rectales (Proctodaealdrüsen) beim Kaninchen  

Microsoft Academic Search

The rabbit rectal gland consists of tubuli. The secretory cells are columnar elements with prominent apical cytoplasmic caps and protrusions extending into the glandular lumen. The cells contain relatively large lipid droplets but no mucosubstances. Intercellular canaliculi are absent from the rabbit rectal gland epithelium. The glands were also investigated histochemically. The following enzymes were demonstrated and localized: Oxydo-reductases of

Wolfgang Kühnel

1971-01-01

53

Treatment of locally advanced rectal cancer  

Microsoft Academic Search

Historically, locally advanced rectal cancer is known for its dismal prognosis. The treatment of locally advanced rectal cancer is subject to continuous change due to development of new and better diagnostic tools, radiotherapeutic techniques, chemotherapeutic agents and understanding of the subject. It is clear, that a multimodality approach is the only way to achieve satisfactory local recurrence and survival rates

René A. Klaassen; Grard A. P. Nieuwenhuijzen; Hendrik Martijn; Harm J. T. Rutten; Geke A. P. Hospers; Theo Wiggers

2004-01-01

54

Rectal compliance in females with obstructed defecation  

Microsoft Academic Search

PURPOSE: This study was designed to investigate whether rectal compliance is altered in females with obstructed defecation. METHODS: Eighty female patients with obstructed defecation and 60 control subjects were studied. Rectal compliance was measured with an “infinitely compliant” polyethylene bag. This bag was inserted in the rectum and inflated with air to selected pressure plateaus (range, 0–60 mmHg; cumulative steps

M. J. Gosselink; W. C. J. Hop; W. R. Schouten

2001-01-01

55

Stapled Rectal Mucosectomy vs. Closed Hemorrhoidectomy  

Microsoft Academic Search

INTRODUCTION: We compared the safety and clinical outcome between stapled rectal mucosectomy and closed hemorrhoidectomy for the surgical treatment of noncomplicated hemorrhoidal disease. METHODS: Eighty-four patients with Grade III and IV hemorrhoidal disease were randomly assigned to two groups: 1) stapled rectal mucosectomy group (n = 42) and 2) closed hemorrhoidectomy group (n = 42). Postoperative pain, analgesic use, symptoms,

José Manuel Correa-Rovelo; Oscar Tellez; Leoncio Obregón; Adriana Miranda-Gomez; Segundo Moran

2002-01-01

56

Cellulite nécrosante périnéale révélant un adénocarcinome rectal  

Microsoft Academic Search

We report one case of rectal cancer disclosed by a perineal cellulitis in a diabetic woman. This infrequent association has a bad prognosis. Diagnosis is mainly clinical. Treatment is urgent with large spectrum antibiotic therapy, surgical debridement, colostomy and hyperbaric oxygen if available. Surgical treatment of the rectal cancer can be done immediately or delayed.

A Lamy; B Tissot; F Pigot

2003-01-01

57

Bevacizumab, Fluorouracil, Leucovorin Calcium, and Oxaliplatin Before Surgery in Treating Patients With Stage II-III Rectal Cancer  

ClinicalTrials.gov

Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Rectum; Stage IIA Rectal Cancer; Stage IIB Rectal Cancer; Stage IIC Rectal Cancer; Stage IIIA Rectal Cancer; Stage IIIB Rectal Cancer; Stage IIIC Rectal Cancer

2013-07-31

58

PET-MRI in Diagnosing Patients With Colon or Rectal Cancer  

ClinicalTrials.gov

Recurrent Colon Cancer; Recurrent Rectal Cancer; Stage IIA Colon Cancer; Stage IIA Rectal Cancer; Stage IIB Colon Cancer; Stage IIB Rectal Cancer; Stage IIC Colon Cancer; Stage IIC Rectal Cancer; Stage IIIA Colon Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

2013-10-10

59

Evaluating the effect of rectal distension and rectal movement on prostate gland position using cine MRI  

Microsoft Academic Search

Purpose: To evaluate the dynamic interrelationship between rectal distension and rectal movements, and to determine the effect of rectal movement on the position of the prostatic gland using cine magnetic resonance imaging (MRI).Methods and Materials: Fifty-five patients with biopsy-proven or suspected prostate cancer were examined in the axial plane using repeated spoiled gradient-echo sequences every 10 seconds for 7 minutes.

Anwar R Padhani; Vincent S Khoo; John Suckling; Janet E Husband; Martin O Leach; David P Dearnaley

1999-01-01

60

Treatment of Rectal Hemorrhage by Coil Embolization  

SciTech Connect

Four patients, aged 54-84 years, presenting with life-threatening rectal bleeding from the superior hemorrhoidal artery, underwent percutaneous fibered platinum coil embolization via coaxial catheters. Pre-procedure sigmoidoscopy had failed to identify the source of hemorrhage, because the rectum was filled with fresh blood. Embolization was technically and clinically successful in all four patients. Subsequent sigmoidoscopy confirmed the diagnoses in three patients as a solitary rectal ulcer, iatrogenic traumatic ulceration following manual evacuation, and a rectal Dieulafoy's lesion. The other case was angiographically seen to be due to a rectal angiodysplasia. Embolization is an effective procedure in life-threatening superior hemorrhoidal arterial bleeding when endoscopic treatment fails, and should be preferred to rectosigmoid resection.

Dobson, Craig Charles; Nicholson, Anthony A. [Department of Radiology, Hull Royal Infirmary, Anlaby Road, Hull, East Yorkshire HU3 2JZ (United Kingdom)

1998-03-15

61

Treatment of rectal hemorrhage by coil embolization  

SciTech Connect

Four patients, aged 54-84 years, presenting with life-threatening rectal bleeding from the superior hemorrhoidal artery, underwent percutaneous fibered platinum coil embolization via coaxial catheters. Preprocedure sigmoidoscopy had failed to identify the source of hemorrhage, because the rectum was filled with fresh blood. Embolization was technically and clinically successful in all four patients. Subsequent sigmoidoscopy confirmed the diagnoses in three patients as a solitary rectal ulcer, iatrogenic traumatic ulceration following manual evacuation, and a rectal Dieulafoy's lesion. The other case was angiographically seen to be due to a rectal angiodysplasia. Embolization is an effective procedure in life-threatening superior hemorrhoidal arterial bleeding when endoscopic treatment fails, and should be preferred to rectosigmoid resection.

Dobson, Craig Charles; Nicholson, Anthony A. [Hull Royal Infirmary, Department of Radiology (United Kingdom)

1999-03-15

62

Advances in Radiotherapy in Operable Rectal Cancer  

Microsoft Academic Search

Aims: Radiotherapy (RT) reduces local recurrence in rectal cancer but the optimal treatment schedule is unknown. Relevant questions in designing optimal therapy are set out. This review identifies evidence that influences current practice and shapes future trials in treatment of operable rectal cancer. Methods: PubMed and MEDLINE search. Results: RT reduces local recurrence and pre-operative treatment is superior to post-operative

Aravind Suppiah; John E. Hartley; John R. T. Monson

2009-01-01

63

Colorectal Cancer or Colon and Rectal Cancer?  

Microsoft Academic Search

Aims: The aim of this study was to compare features of colon and rectal cancers such as prognosis, clinicopathological features and tumor markers, namely carcinoembryonic antigen (CEA), matrix metalloproteinase (MMP)-2 and p27kip1. Methods: Two hundred and thirty patients with stage I–III colon or rectal cancer were retrospectively assessed with the endpoint of recurrence or metastasis after curative operation. CEA, MMP-2

M. Li; J. Y. Li; A. L. Zhao; J. Gu

2007-01-01

64

Solitary rectal ulcer: ultrasonographic and magnetic resonance imaging patterns mimicking rectal cancer.  

PubMed

The objective of this study was to analyze a series of solitary rectal ulcer syndrome (SRUS) cases initially diagnosed as rectal cancer. We analyzed all the patients (1996-2008) initially referred to our colorectal unit with a diagnosis of rectal cancer but with a final diagnosis of SRUS. Demographic data, the diagnostic work-up, and treatment details were collected in a prospective database and analyzed retrospectively. Out of the 5035 patients registered in the colorectal unit database, 14 (0.28%) had a final diagnosis of SRUS. Nine of them had an initial diagnosis of rectal cancer. Out of these, six were preoperatively staged with endorectal ultrasound and/or magnetic resonance and were therefore analyzed for this study. Endorectal ultrasound was performed in all six patients and rectal cancer was diagnosed in five of them; MRI was performed in four patients and a diagnosis of rectal cancer was assessed in three of them; rectal cancer was finally ruled out in all cases by deep-forceps macrobiopsies. The incidence of misdiagnosis between SRUS and rectal cancer does not decrease with the regular use of imaging methods. Clinical judgment and deep-forceps macrobiopsies are essential in avoiding an erroneous diagnosis. PMID:21971372

Blanco, Francisco; Frasson, Matteo; Flor-Lorente, Blas; Minguez, Miguel; Esclapez, Pedro; García-Granero, Eduardo

2011-11-01

65

Rectal Hypersensitivity Worsens Stool Frequency, Urgency, and Lifestyle in Patients With Urge Fecal Incontinence  

Microsoft Academic Search

PURPOSE  Rectal sensory mechanisms are important in the maintenance of fecal continence. Approximately 50 percent of patients with urge incontinence have lowered rectal sensory threshold volumes (rectal hypersensitivity) on balloon distention. Rectal hypersensitivity may underlie the heightened perception of rectal filling; however, its impact on fecal urgency and incontinence is unknown. This study was designed to investigate the impact of rectal

Christopher L. H. Chan; S. Mark Scott; Norman S. Williams; Peter J. Lunniss

2005-01-01

66

Parents' perceptions of taking babies' rectal temperature.  

PubMed Central

OBJECTIVE--To explore the attitudes of parents to measuring their babies' rectal temperature. DESIGN--Qualitative study using unstructured interviews of parents given "Baby Check," a scoring system designed to assess severity of illness in babies that includes measurement of rectal temperature. SETTING--One inner city general practice in Newcastle upon Tyne. SUBJECTS--42 parents of 34 babies under 6 months old. RESULTS--Parents were reluctant to measure rectal temperature in their babies; 37 parents spontaneously raised concerns. Fifteen did not undertake measurement, 16 did so once only, and 11 did so more than once. Parents' concerns included a fear of hurting their child, anxieties about sexual intimacy and abuse, difficulty in comforting their child, and concern for their child's feelings. Most (33) substituted axillary measurement. CONCLUSIONS--Parents' preference for the axillary method of measuring temperature and resistance to using a rectal method in their children was based on several concerns. If parents are to be encouraged to use the rectal method of measuring temperature in sick babies any benefits must be set against the generation of considerable parental anxiety and the resources that would be necessary to negotiate with parents and change their views.

Kai, J

1993-01-01

67

Transanal endoscopic microsurgery for rectal cancer.  

PubMed

If curation is intended for rectal cancer, total mesorectal excision with autonomic nerve preservation (TME) is the gold standard. Transanal resection is tempting because of low mortality and morbidity rates. However, inferior tumour control, provoked by the limitations of the technique, resulted in its cautious application and use mainly for palliation. Transanal endoscopic microsurgery (TEM) is a minimal invasive technique for the local resection of rectal tumours. It is a one-port system, introduced transanally. An optical system with a 3D-view, 6-fold magnification and resolution as the human eye, together with the creation of a stabile pneumorectum, and specially designed instruments allow full-thickness excision under excellent view and a proper histological examination. The technique can also be applied for larger and more proximal tumours. Mortality, morbidity as well as incomplete excision rates are minimal. Local recurrence and survival rates seem comparable to TME in early rectal cancer. TEM is the method of choice when local resection of rectal cancer is indicated. Results justify a re-evaluation of the indications for the local excision of rectal cancer with a curative intent. PMID:11978515

de Graaf, E J R; Doornebosch, P G; Stassen, L P S; Debets, J M H; Tetteroo, G W M; Hop, W C J

2002-05-01

68

Civilian Extraperitoneal Rectal Gunshot Wounds: Surgical Management Made Simpler  

Microsoft Academic Search

Background  Rectal injuries are associated with significant morbidity and mortality. Controversy persists regarding routine presacral\\u000a drainage, distal rectal washout (DRW), and primary repair of extraperitoneal rectal injuries. This retrospective review was\\u000a performed to determine the outcome of rectal injuries in an urban trauma center with a high incidence of penetrating trauma\\u000a where a non-aggressive surgical approach to these injuries is practiced.

Pradeep H. Navsaria; Sorin Edu; Andrew J. Nicol

2007-01-01

69

Prostatic sarcoma after treatment of rectal cancer  

PubMed Central

Background The relationship between radiation exposure for treatment of cancer and occurrence of a second primary cancer at the irradiated site is well known. This phenomenon is however rare in prostate. Case presentation A 75-year-old farmer was treated for rectal cancer with preoperative 45 Gy of radiotherapy and abdominoperineal resection. Four years later he developed symptoms of bladder outlet obstruction and acute urinary retention. He underwent a transurethral resection of the prostate. Histological examination of the removed prostate tissue and immunohistochemistry revealed it to be a poorly differentiated sarcoma. Conclusion We believe this to be the first reported case of radiation-induced sarcoma following radiotherapy treatment for rectal cancer. Since radiotherapy plays a pivotal role in the contemporary treatment of rectal adenocarcinoma, it is relevant to be aware of the potential long-term carcinogenic complications of radiotherapy of the pelvis.

Abbas, Salah M; Hill, Andrew G

2007-01-01

70

Colonscopy for investigation of unexplained rectal bleeding.  

PubMed

215 colonsocopic examinations were performed on patients with rectal bleeding whose cause had not been determined by barium enema. The probable or definite source of the bleeding was diagnosed in 41% of cases. 13% had a carcinoma, 14% had one or more colonic polyps, 7% had previously unrecognised inflammatory bowel disease. The remainder had various other colonic conditions. The source of bleeding was twice as likely to be found by colonoscopy in patients presenting with frank rectal blood-loss as in those with occult blood. A carcinoma was found twice as often in those patients with diverticular disease as in those without this condition. A lesion was discovered in the majority of patients who had had two or more negative barium enemas. These results emphasise the importance of rectal bleeding as a symptom of colonic abnormality and the value of colonscopy in its investigation in patients where the results of radiology are negative. PMID:78109

Teague, R H; Thornton, J R; Manning, A P; Salmon, P R; Read, A E

1978-06-24

71

Rectal hypersensitivity in the irritable bowel syndrome.  

PubMed

Studies of rectal sensory thresholds and compliance in patients with the irritable bowel syndrome have produced conflicting results though there is persistent evidence of rectal hypersensitivity particularly in those with diarrhoea-predominant symptoms. This study examined rectal sensation and compliance in 31 patients with constipation-predominant irritable bowel syndrome (mean age 41 years, 27 female) and 17 healthy volunteers (mean age 45 years, 17 female). A rectal balloon was inflated with fluid at a constant rate and the volume and intrarectal pressure at sensory threshold was recorded. The volumes at first (129 +/- 8 vs 229 +/- 24 ml, P < 0.001 Mann-Whitney-U test), constant (159 +/- 12 vs 286 +/- 21, P < 0.001) and maximum tolerated sensation (290 +/- 13 vs 509 +/- 19, P < 0.001) were all significantly less in the irritable bowel group. There was no significant difference in intrarectal pressures at any of these volumes (29.0 +/- 2.2 cmH2O vs 29.0 +/- 2.5, 35.0 +/- 2.5 vs 34.0 +/- 2.8, 71 +/- 2.5 vs 65.0 +/- 3.0 respectively). Rectal compliance was significantly less in the irritable bowel group (3.6 +/- 0.2 ml/cmH2O vs 8.7 +/- 0.4, P < 0.001). Twenty two patients complained of abdominal pain on balloon inflation, mimicking that experienced as part of their symptoms. Patients with constipation-predominant irritable bowel syndrome have rectal hypersensitivity and reduced compliance. PMID:9112147

Slater, B J; Plusa, S M; Smith, A N; Varma, J S

1997-01-01

72

Abdominosacral resection for primary irresectable and locally recurrent rectal cancer  

Microsoft Academic Search

PURPOSE: The purpose of this study was to present a technique of abdominosacral resection and its results in patients with locally advanced primary or locally recurrent rectal cancer with dorsolateral fixation. METHODS: Between 1994 and 1999, 13 patients with locally advanced primary rectal cancer and 37 patients with locally recurrent rectal cancer underwent abdominosacral resection as part of a multimodality

Guido H. H. Mannaerts; Harm J. T. Rutten; Hendrik Martijn; Gerbrand J. Groen; Patrick E. J. Hanssens; Theo Wiggers

2001-01-01

73

Curative Surgery for Local Pelvic Recurrence of Rectal Cancer  

Microsoft Academic Search

Background\\/Aims: Local pelvic recurrence of rectal cancer after radical resection has been associated with morbidity and cancer-related death. This study retrospectively evaluated outcome following curative resection for rectal cancer recurring after surgery on the basis of prognosis, type of procedure and perioperative morbidity. Methods: A total of 85 consecutive patients with local pelvic recurrence of rectal cancer were evaluated. Of

Norio Saito; Keiji Koda; Nobuhiro Takiguchi; Kenji Oda; Masato Ono; Masanori Sugito; Kiyotaka Kawashima; Masaaki Ito

2003-01-01

74

Esophago-rectal reflex. Description and clinical significance.  

PubMed

The present communication describes the "esophago-rectal reflex" and its clinical significance. The study was performed in 19 healthy volunteers and 14 constipated subjects. The technique comprised the introduction into the esophagus of a balloon-tipped tube so that the balloon lay within the lower esophageal sphincter (LES). The rectal and rectal neck pressures were measured by means of perfused open-ended tubes. The esophageal balloon was inflated with 2, 4 and 6 ml water and the responses of the rectal and rectal neck pressures were recorded. Distension of the LES was accompanied by significant rectal pressure increase (P < 0.001); the pressure increased with increasing LES distension. Anesthetized LES mucosa did not evoke the rectal pressure response. The rectal neck pressure did not show significant change with LES distension (P > 0.05). Both the rectal and rectal neck pressures showed insignificant response to LES distension in constipated subjects (P > 0.05). The esophago-rectal reflex seems to be conducted through the myenteric plexus from the esophagus down along the gut wall to the rectum, initiating rectal contractions. It is likely that these signals alarm the rectum for the entrance of new contents in the gut so that the rectum may evacuate its contents. PMID:8473093

Shafik, A

75

Massive zosteriform cutaneous metastasis from rectal carcinoma.  

PubMed

A 44-year-old man presented with a large and rapidly growing skin lesion approximately six months after resection of a rectal carcinoma. The lesion measured 40 cm in size, extended from the suprapubic area to the proximal half of the left groin, and showed a particular zosteriform aspect. Biopsy confirmed a metastatic skin adenocarcinoma. Cutaneous metastases from rectal cancer are very uncommon. Their gross appearance is not distinctive, although the skin tumors are usually solid, small (less than 5 cm) and painless nodules or papules. Early biopsies for suspicious skin lesions are needed in patients with a history of colorectal cancer. PMID:14605930

Damin, D C; Lazzaron, A R; Tarta, C; Cartel, A; Rosito, M A

2003-07-01

76

Intersphincteric resection for low rectal cancer  

Microsoft Academic Search

Intersphincteric resection (ISR) is regarded as the most extreme form of resection of ultralow rectal cancers.\\u000a \\u000a ISR for low rectal carcinoma is a demanding operation, whose outcome in terms of morbidity, mortality, local recurrence rates,\\u000a survival, functional results and patients’ quality of life can vary greatly.\\u000a \\u000a \\u000a \\u000a Postoperative morbidity and mortality rates, as well as oncological results, are relatively acceptable, with

V. A. Komborozos

2011-01-01

77

Features of pathological assessment in rectal cancer.  

PubMed

Rectal cancer diagnosis is established by collaboration between oncological surgeons, oncologists, pathologists and imaging specialists. By examining the macroscopic and microscopic aspect of the surgical specimen, the pathologist could provide the surgeon with information regarding the surgical procedure. Staging represents the clinical or pathological assessment of the extent of tumour spread. The clinical staging is a preoperative evaluation based on clinical and radiological information being used to determine the appropriate treatment for each case. The pathological staging permits the postoperative assessment that brings prognostic information. The aim of this paper is to present the suggestions of our multidisciplinary team for an accurate pathology assessment of rectal cancer. PMID:17571550

Scripcariu, V; Dajbog, Elena; Lefter, L; Danciu, M; Ferariu, D; Pricop, Adriana; Grigora?, M; Negru, D; Volov??, C; Miron, L; Drug, V; Dragomir, C

78

Functional outcome following restorative rectal cancer surgery.  

PubMed

The trend towards preoperative adjuvant and neoadjuvant therapies in selected patients with rectal cancer has led to increases in sphincter preservation with a limited understanding of the factors governing unsatisfactory functional outcomes. Data would suggest the need for a more selective use of standard radiotherapeutic fields in low- to intermediate-risk cases where there appears to be limited survival or locoregional recurrence benefit and where there is under-reported toxicity. This article discusses the complex factors which impact on functional outcome following open rectal cancer surgery particularly when it is accompanied by adjuvant therapy. PMID:19780324

Zbar, A P; Kennedy, P J; Singh, V

2009-01-01

79

Laparoscopic Total Mesorectal Excision for Rectal Cancers  

Microsoft Academic Search

\\u000a Introduction  More and more colorectal surgeons believe that total mesorectal excision can achieve favorable oncologic results for the treatment\\u000a of rectal cancers. The present study is a feasibility study aiming to evaluate if total mesorectal excision can be safely\\u000a performed by laparoscopic approach with beneficial functional recovery.\\u000a \\u000a \\u000a \\u000a Methods  A total of 44 patients (from January 2004 to February 2005) with middle rectal

Jin-Tung Liang; Horng-Shiee Lai; Po-Huang Lee

2006-01-01

80

Hyperglycemia-Induced Attenuation of Rectal Perception Depends upon Pattern of Rectal Balloon Inflation  

Microsoft Academic Search

This study investigated the effects of acutehyperglycemia on conscious rectal perception in responseto two different rectal distension paradigms. Elevenhealthy males were studied in random order on two separate days during euglycemia andhyperglycemia with blood glucose concentrations clampedto 3.8 ± 0.6 and 14.8 ± 0.86 mmol\\/liter,respectively. In order to evoke sensory responses, rapidphasic and ramplike distensions were applied to anintrarectal balloon.

Erol Avsar; Onder Ersoz; Esat Karisik; Yalcin Erdogan; Nural Bekiroglu; Roger Lawrance; Sema Akalin; Nefise B. Ulusoy

1997-01-01

81

Differences in microbial signatures between rectal mucosal biopsies and rectal swabs.  

PubMed

There is growing evidence the microbiota of the large bowel may influence the risk of developing colorectal cancer as well as other diseases including type-1 diabetes, inflammatory bowel diseases and irritable bowel syndrome. Current sampling methods to obtain microbial specimens, such as feces and mucosal biopsies, are inconvenient and unappealing to patients. Obtaining samples through rectal swabs could prove to be a quicker and relatively easier method, but it is unclear if swabs are an adequate substitute. We compared bacterial diversity and composition from rectal swabs and rectal mucosal biopsies in order to examine the viability of rectal swabs as an alternative to biopsies. Paired rectal swabs and mucosal biopsy samples were collected in un-prepped participants (n = 11) and microbial diversity was characterized by Terminal Restriction Fragment Length polymorphism (T-RFLP) analysis and quantitative polymerase chain reaction (qPCR) of the 16S rRNA gene. Microbial community composition from swab samples was different from rectal mucosal biopsies (p = 0.001). Overall the bacterial diversity was higher in swab samples than in biopsies as assessed by diversity indexes such as: richness (p = 0.01), evenness (p = 0.06) and Shannon's diversity (p = 0.04). Analysis of specific bacterial groups by qPCR showed higher copy number of Lactobacillus (p < 0.0001) and Eubacteria (p = 0.0003) in swab samples compared with biopsies. Our findings suggest that rectal swabs and rectal mucosal samples provide different views of the microbiota in the large intestine. PMID:23060016

Araújo-Pérez, Félix; McCoy, Amber N; Okechukwu, Charles; Carroll, Ian M; Smith, Kevin M; Jeremiah, Kim; Sandler, Robert S; Asher, Gary N; Keku, Temitope O

2012-10-11

82

Endoscopic palliative management of rectal cancer.  

PubMed

Laser ablation and bipolar coagulation have been used to palliate rectal cancer and avoid surgery. Indications are distal metastatic disease, extensive local invasion, obstruction and bleeding from nonresectable rectal tumor, or refusal of surgery. From Jan 1, 1986, to Jan 1, 1989, I saw 26 patients who met those criteria; 19 already had metastatic disease and three repeatedly refused abdominoperineal resection. A two-laser approach using both CO2 and Nd:YAG lasers was used in patients with low-lying lesions; others were treated by the Nd:YAG laser only. For rectal tumors, bipolar esophageal tumor probes were used via the rigid sigmoidoscope. The number of laser sessions averaged three per patient, and the number of bipolar coagulation sessions averaged five per patient. Bleeding followed bipolar coagulation in one patient. There were no perforations in either treatment group, and no patient has required colostomy. Of the 19 patients who already had metastatic disease, 12 are still alive, the longest survival being 20 months. Of those medically unfit for surgery, three have died of coincidental disease, and one is alive with controlled rectal cancer after 16 months. All three patients who refused surgery are alive; the longest survival is 13 months. PMID:1707555

O'Connor, J J

1991-04-01

83

Rectal diversion without colostomy in Fournier's gangrene.  

PubMed

Fournier's gangrene is a potentially fatal necrotizing fasciitis affecting the perineum and genital area. The usual treatment includes prompt surgical debridement and, in many cases, a diverting colostomy. We present two cases of Fournier's gangrene that were treated with extensive local debridement and rectal diversion with a new device for faecal matter management, avoiding the need for a colostomy. PMID:19484342

Estrada, O; Martinez, I; Del Bas, M; Salvans, S; Hidalgo, L A

2009-05-29

84

Rectal Cancer: Adjuvant Therapy and New Directions  

Microsoft Academic Search

Cancers of the colon and rectum are a leading cause of cancer-related death in the United States and worldwide. The 5-year survival rates, in general, have improved over time for patients with colon cancer due to evolving preventative strategies, improved screening techniques and the recent development of more effective therapeutic agents. Unfortunately, the treatment for patients with locally advanced rectal

Kevin P. McMullen; Charles Matthews; A. William Blackstock

2007-01-01

85

Diagnosis and therapy of rectal cancer  

Microsoft Academic Search

Summary  BACKGROUND: Rectal cancer poses a formidable challenge to surgical treatment due to a technically difficult access in the pelvis with close proximity to functionally important structures such as the anal sphincters and autonomic nerves, which coordinate urinary bladder and sexual functions. Management therefore aims both at maximising local cure rates and minimising functional consequences of treatment. METHODS: Review of the

F. Herbst; J. Widder; A. Maier

2006-01-01

86

Transanal endoscopic microsurgery for rectal cancer  

Microsoft Academic Search

If curation is intended for rectal cancer, total mesorectal excision with autonomic nerve preservation (TME) is the gold standard. Transanal resection is tempting because of low mortality and morbidity rates. However, inferior tumour control, provoked by the limitations of the technique, resulted in its cautious application and use mainly for palliation. Transanal endoscopic microsurgery (TEM) is a minimal invasive technique

E. J. R de Graaf; P. G Doornebosch; L. P. S Stassen; J. M. H Debets; G. W. M Tetteroo; W. C. J Hop

2002-01-01

87

[Rectal prolapse repair using transanal endoscopic surgery].  

PubMed

Rectal prolapse repair techniques using laparoscopic abdominal surgery are the treatments of choice. However, in patients with increased morbidity, perineal surgical techniques are indicated. Transanal endoscopic surgery is presented as a possible alternative option in groups with increased experience in it. PMID:22854204

Serra-Aracil, Xavier; Alcántara, Manel; Corredera, Costanza; Mora, Laura; Navarro, Salvador

2012-07-30

88

[Rectal cancer: diagnosis, screening and treatment].  

PubMed

Rectal cancer is one of the primary malignant neoplasms occurring in Mexican patients of reproductive age. Unfortunately, randomized studies in rectal cancer do not exist as they do with well-recognized colon cancer. We must individualize the epidemiology, risk factors, diagnostic approach, staging and treatment because management is different in rectal cancers affecting the mid- and lower third of the rectum than in the upper third and in colon cancers. Histological staging is the primary prognostic factor. TNM staging (tumor, node, and metastasis) is used internationally by the American Joint Committee on Cancer (AJCC). Staging is done with the assistance of endorectal ultrasound, which is best used in early-stage cancer; however, there are certain disadvantages in detecting node involvement. Magnetic resonance, on the other hand, allows for the evaluation of stenotic tumors and node involvement. Once the correct diagnosis and staging have been made, the next step is correct treatment. Neoadjuvant treatment has demonstrated to be better than adjuvant treatment. Abdominoperineal resection is rarely practiced currently, with sphincter preservation being the preferred procedure. Laparoscopic approach has conferred the advantages of the approach itself when performed by experts in the procedure but there is insufficient evidence to make it the "gold standard." Rectal cancer is a complex pathology that must be considered totally different from colon cancer for diagnosis and treatment. The patient must be staged completely and appropriately for individualizing correct treatment. More long-term studies are needed for optimizing treatment modalities. PMID:22385771

Decanini-Terán, César Oscar; González-Acosta, Jorge; Obregón-Méndez, Jorge; Vega-de Jesús, Martín

89

Digital Rectal Exam (DRE): What to Expect  

MedlinePLUS

A digital rectal exam (DRE) is a screening test that allows a doctor to check the prostate gland in men or the lower colon/rectum in men and women for cancer or other abnormalities. In addition, in association with a vaginal examination, a DRE can check for cancer of ...

90

Rectal motility studies in faecally incontinent geriatric patients.  

PubMed

Rectal motility was assessed in three groups of geriatric patients (faecally incontinent, continent faecally impacted and control patients) to determine whether 'uninhibited' rectal contractions are a cause of faecal incontinence. The incidence of rectal contractions in response to rectal distension did not differ between the three study groups. Two-thirds of the incontinent patients were unable to retain a condom distended with water (soft-stool model) during a proctometrogram. Involuntary expulsion of this device was correlated with the presence of rectal contractions and low anal resting pressure. Involuntary expulsion of an airfilled balloon (firm-stool model) from the rectum occurred less frequently and was correlated with low resting pressure but not with rectal contractions. The contribution of 'uninhibited' rectal contractions to faecal incontinence is insignificant except for a minor role in the expulsion of liquid stool. PMID:2251964

Barrett, J A; Brocklehurst, J C; Kiff, E S; Ferguson, G; Faragher, E B

1990-09-01

91

Novel Approach to Rectal Foreign Body Extraction  

PubMed Central

Introduction: The impacted rectal foreign body often poses a management challenge. Ideally, such objects are removed in the emergency department utilizing a combination of local anesthesia, sedation, minimal instrumentation, and manual extraction. In some instances, simple manual extraction is unsuccessful and general anesthesia may be necessary. We describe a novel approach to retrieval and removal of a rectal foreign body utilizing a SILS port. Case Description: A 31-y-old male presented to the emergency department approximately 12 h after transanal insertion of a plastic cigar case. Abdominal examination revealed no evidence of peritonitis. On rectal examination, the tip of the cigar case was palpable. The foreign body, however, was unable to be removed manually in the emergency department. In the operating room, with the patient under general anesthesia, multiple attempts to remove the object were unsuccessful. A SILS port was inserted transanally. The rectum was then insufflated manually by attaching the diaphragm of the rigid sigmoidoscope to the SILS insufflation port. A 5-mm 0-degree laparoscope was placed through the SILS port. An atraumatic laparoscopic grasper was then placed through the port and used to grasp the visible end of the cigar case. The rectal foreign body was removed expeditiously. Direct visualization of the rectum revealed no evidence of mucosal injury. The patient was discharged home shortly after the procedure. Discussion: The SILS port allows minimally invasive extraction of rectal foreign bodies not amenable to simple manual extraction. It provides excellent visualization and eliminates the morbidity inherent in more invasive and traditional methods of retrieval.

Bak, Yury; Merriam, Margaret; Neff, Marc

2013-01-01

92

Re-defining rectal volume and DVH for analysis of rectal morbidity risk after radiotherapy for early prostate cancer.  

PubMed

Improved prostate cancer cure rates have been attributed to higher radiotherapy dose prescriptions delivered more safely by modern conformal/intensity-modulated radiotherapy (IMRT) methods. As the dose becomes more concentrated conformally on the prostate, the volume of the rectum "at risk" for damage becomes smaller and more focal on the anterior rectal wall between the upper and lower axial limits of the planning target volume (PTV). The rectal dose-volume histogram (DVH) traditionally studies the whole volume of the rectum, and such definition for "avoidance" planning presupposes that rectal tolerance depends on "whole organ" radiation tolerance (as might, for example, lung or kidney). However, rectal morbidity with modern prostate radiotherapy is determined by anterior rectal wall tolerance between the superior and inferior limits of the PTV; this, we argue, is not dependent on whole organ tolerance. Recent published studies attempting to improve rectal DVH definition have studied the rectal wall only and concluded that rectal wall DVH is more relevant than whole rectum. In this manuscript, it is first demonstrated that a large and more relevant difference exists when comparing whole rectal DVH to "PTV limits" rectal DVH. Secondly, when considering "PTV limits" rectal DVH, the wall vs whole perimeter comparison differs little. Furthermore, by adopting a "PTV limits" DVH, the inferior right quartile of the DVH accurately reflects the dose distribution to the most vulnerable section of the anterior rectal wall. With improving IMRT technologies, scrutiny of this part of the rectal DVH will most accurately predict rectal sparing - reflected in this manuscript by the less precipitous decline of the TomoTherapy DVH vs the three-dimensional conformal DVH towards the maximum dose point received by the rectum. PMID:18344276

O'Donnell, H E; Finnegan, K; Eliades, H; Oliveros, S; Plowman, P N

2008-04-01

93

Management of radiation-induced rectal bleeding.  

PubMed

Pelvic radiation disease is one of the major complication after radiotherapy for pelvic cancers. The most commonly reported symptom is rectal bleeding which affects patients' quality of life. Therapeutic strategies for rectal bleeding are generally ignored and include medical, endoscopic, and hyperbaric oxygen treatments. Most cases of radiation-induced bleeding are mild and self-limiting, and treatment is normally not indicated. In cases of clinically significant bleeding (i.e. anaemia), medical therapies, including stool softeners, sucralfate enemas, and metronidazole, should be considered as first-line treatment options. In cases of failure, endoscopic therapy, mainly represented by argon plasma coagulation and hyperbaric oxygen treatments, are valid and complementary second-line treatment strategies. Although current treatment options are not always supported by high-quality studies, patients should be reassured that treatment options exist and success is achieved in most cases if the patient is referred to a dedicated centre. PMID:24101202

Laterza, Liboria; Cecinato, Paolo; Guido, Alessandra; Mussetto, Alessandro; Fuccio, Lorenzo

2013-11-01

94

The evaluation of rectal bleeding in adults  

Microsoft Academic Search

BACKGROUND: Though primary care patients commonly present with rectal bleeding, the optimal evaluation strategy remains unknown.\\u000a \\u000a \\u000a OBJECTIVE: To compare the cost-effectiveness of four diagnostic strategies in the evaluation of rectal bleeding.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: Cost-effectiveness analysis using a Markov decision model.\\u000a \\u000a \\u000a \\u000a \\u000a DATA SOURCES: Systematic review of the literature, Medicare reimbursement data, Surveillance, Epidemiology, and End Results (SEER) Cancer\\u000a Registry.\\u000a \\u000a \\u000a \\u000a \\u000a TARGET POPULATION: Patients

Elizabeth Allen; Christina Nicolaidis; Mark Helfand

2005-01-01

95

Prostatic carcinoma: rectal bleeding after radiation therapy  

SciTech Connect

A 64-year-old man had a prostatic nodule on routine physical examination; per-rectal needle biopsies revealed a single focus of well differentiated adenocarcinoma. The patient had no history of urinary obstruction or of bowel difficulties. Accordingly, this was clinical stage II carcinoma of the prostate. The patient chose to receive external radiation therapy and was given small-field rotational treatment to a dose of 7000 rad (70 Gy) at a rate of 800 rad (8 Gy) weekly. Late in treatment, he experienced transitory diarrhea with flatulence, but this cleared with completion of treatment. Twenty months later he began to note frequent soft bowel movements, occasionally with red blood. At sigmoidoscopy 24 months after completion of treatment, the rectal mucosa was noted to be friable with minimal bleeding, presumably the result of radiation proctitis.

Kagan, A.R.; Steckel, R.J. (eds.)

1981-06-01

96

[Organ-sparing treatment for rectal cancer].  

PubMed

Current treatment for rectal cancer including TME surgery and pre-operative (chemo)radiotherapy is associated with functional problems. Permanent stomas, faecal incontinence and sexual dysfunction have a great impact on quality of life. Therefore, organ-preserving treatment of rectal cancer has been introduced. Transanal excision without further treatment is only indicated in pT1 tumours with good prognostic characteristics. In more advanced tumours, pre-operative chemoradiotherapy can be used for down-staging. In patients with almost complete clinical response, transanal excision of the remaining lesion or a 'wait-and-see' policy with intensive follow-up can be implemented. Although initial cohort studies are promising, well designed prospective studies still have to prove the safety of this organ-preserving approach. PMID:21262021

Tanis, Erik; Bemelman, Willem A; Tanis, Pieter J

2011-01-01

97

Surgical Management of Locally Recurrent Rectal Cancer  

PubMed Central

Developments in chemotherapeutic strategies and surgical technique have led to improved loco regional control of rectal cancer and a decrease in recurrence rates over time. However, locally recurrent rectal cancer continues to present considerable technical challenges and results in significant morbidity and mortality. Surgery remains the only therapy with curative potential. Despite a hostile intra-operative environment, with meticulous pre-operative planning and judicious patient selection, safe surgery is feasible. The potential benefit of new techniques such as intra-operative radiotherapy and high intensity focussed ultrasonography has yet to be thoroughly investigated. The future lies in identification of predictors of recurrence, development of schematic clinical algorithms to allow standardised surgical technique and further research into genotyping platforms to allow individualisation of therapy. This review highlights important aspects of pre-operative planning, intra-operative tips and future strategies, focussing on a multimodal multidisciplinary approach.

Hogan, Niamh M.; Joyce, Myles R.

2012-01-01

98

Surgical management of locally recurrent rectal cancer.  

PubMed

Developments in chemotherapeutic strategies and surgical technique have led to improved loco regional control of rectal cancer and a decrease in recurrence rates over time. However, locally recurrent rectal cancer continues to present considerable technical challenges and results in significant morbidity and mortality. Surgery remains the only therapy with curative potential. Despite a hostile intra-operative environment, with meticulous pre-operative planning and judicious patient selection, safe surgery is feasible. The potential benefit of new techniques such as intra-operative radiotherapy and high intensity focussed ultrasonography has yet to be thoroughly investigated. The future lies in identification of predictors of recurrence, development of schematic clinical algorithms to allow standardised surgical technique and further research into genotyping platforms to allow individualisation of therapy. This review highlights important aspects of pre-operative planning, intra-operative tips and future strategies, focussing on a multimodal multidisciplinary approach. PMID:22701789

Hogan, Niamh M; Joyce, Myles R

2012-06-03

99

Clinically based management of rectal prolapse  

Microsoft Academic Search

  Background: Laparoscopic repair of rectal prolapse offers the potential of lower recurrence rates for transabdominal repair\\u000a coupled with the advantages of minimally invasive colorectal surgery. There have been no direct comparisons of the laparoscopic\\u000a Wells procedure (LWP) and laparoscopic resection with rectopexy (LRR). This study is the first to make a direct comparison\\u000a of outcomes from laparoscopic LRR and LWP

K. M. Madbouly; A. J. Senagore; C. P. Delaney; H. J. Duepree; K. M. Brady; V. W. Fazio

2003-01-01

100

Preoperative radiotherapy in operable rectal cancer  

Microsoft Academic Search

The effect of preoperative radiotherapy (31.5 Gy in 3.5 weeks) in operable rectal cancer was examined with respect to resectability and prognosis after two surgical procedures, abdominoperineal resection, or low anterior resection. Preoperative radiation did not influence the surgeon's selection of low anterior resection, which was similar (40 percent) in each group. Radiation improved five-year survival probability and decreased the

Arild Horn; Jan F. Halvorsen; Olav Dahl

1990-01-01

101

Prostatic carcinoma: rectal bleeding after radiation therapy  

Microsoft Academic Search

A 64-year-old man had a prostatic nodule on routine physical examination; per-rectal needle biopsies revealed a single focus of well differentiated adenocarcinoma. The patient had no history of urinary obstruction or of bowel difficulties. Accordingly, this was clinical stage II carcinoma of the prostate. The patient chose to receive external radiation therapy and was given small-field rotational treatment to a

A. R. Kagan; R. J. Steckel

1981-01-01

102

Absorption kinetics of rectally and orally administered ibuprofen.  

PubMed

The bioavailability of rectally administered sodium ibuprofen solution and aluminum ibuprofen suspension was determined in eight normal subjects relative to the same treatments administered orally. The results indicate that the suspension was less bioavailable than the solution irrespective of the route of administration. Although not bioequivalent, rectally administered ibuprofen solution compared favourably with orally administered ibuprofen solution. The mean AUC and Cmax from rectal administration were 87 per cent and 62 per cent of the corresponding values achieved after oral administration. Mean residence times and peak times were 1-3 h longer with the rectal solution, indicating a slower rate of absorption. Absorption after rectal administration was zero order in some subjects while absorption after oral administration was first order. This may be due to the large differences in surface area between absorption sites. Since sodium ibuprofen solution is absorbed when given rectally, this route of administration could be used in patients unable to take oral ibuprofen. PMID:2720131

Eller, M G; Wright, C; Della-Coletta, A A

103

The urogenital and rectal pain syndromes.  

PubMed

Pain syndromes of the urogenital and rectal area are well described but poorly understood and underrecognized focal pain syndromes. They include vulvodynia, orchialgia, urethral syndrome, penile pain, prostatodynia, coccygodynia, perineal pain, proctodynia and proctalgia fugax. The etiology of these focal pain syndromes is not known. A specific secondary cause can be identified in a minority of patients, but most often the examination and work-up remain unrevealing. Although these patients are often depressed, rarely are these pain syndromes the only manifestation of a psychiatric disease. This review article presents an overview of the neuroanatomy of the pelvis, which is a prerequisite to trying to understand the chronic pain syndromes in this region. We then discuss the clinical presentation, etiology and differential diagnosis of chronic pain syndromes of the urogenital and rectal area and review treatment options. The current knowledge of the psychological aspects of these pain syndromes is reviewed. Patients presenting with these pain syndromes are best assessed and treated using a multidisciplinary approach. Currently available treatment options are empirical only. Although cures are uncommon, some pain relief can be provided to almost all patients using a multidisciplinary approach including pain medications, local treatment regimens, physical therapy and psychological support, while exercising caution toward invasive and irreversible therapeutic procedures. Better knowledge of the underlying pathophysioloigical mechanisms of the urogenital and rectal pain syndromes is needed to allow investigators to develop treatment strategies, specifically targeted against the pathophysiological mechanism. PMID:9469518

Wesselmann, U; Burnett, A L; Heinberg, L J

1997-12-01

104

Advances in Radiotherapy in Operable Rectal Cancer  

PubMed Central

Aims Radiotherapy (RT) reduces local recurrence in rectal cancer but the optimal treatment schedule is unknown. Relevant questions in designing optimal therapy are set out. This review identifies evidence that influences current practice and shapes future trials in treatment of operable rectal cancer. Methods PubMed and MEDLINE search. Results RT reduces local recurrence and pre-operative treatment is superior to post-operative treatment. Longer interval to surgery and concurrent chemotherapy are associated with greater downstaging, although influence on sphincter preservation and survival is minimal. Short-course RT (SCRT) demonstrates lower recurrence, but with long-term dysfunction and minimal survival benefit. The role of SCRT should be re-evaluated to encompass new criteria/areas. Conclusion SCRT should be used selectively rather than as a blanket treatment policy. SCRT compounds functional morbidity caused by mesorectal excision which may be excessive in some patient groups, especially early-stage rectal cancer or frail elderly patients. RT and local excision may be a feasible surgical alternative in these groups. Alternatively, SCRT and delayed surgery may be a future alternative to current long-course chemoradiotherapy. As survival is only marginally affected despite low local recurrence, future trials should aim to address metastatic disease. End points which incorporate function and quality of life must be used.

Suppiah, Aravind; Hartley, John E.; Monson, John R.T.

2009-01-01

105

Preoperative staging of rectal cancer by intrarectal ultrasound  

Microsoft Academic Search

Digital examination and computed tomography are the current modalities employed to assess the depth of invasion of rectal\\u000a cancer. Each technique has limitations in that high rectal tumors cannot be examined digitally and CT is unable to detect\\u000a small tumors. However, preoperative diagnostic capability can be improved with the use of intrarectal ultrasound. We have\\u000a examined 25 patients with rectal

U. Hildebrandt; G. Feifel

1985-01-01

106

Results of treatment for rectal prolapse and fecal incontinence  

Microsoft Academic Search

Fifty-six patients were treated for rectal prolapse or incontinence. Rectal prolapse was present in 32 patients and was associated\\u000a with fecal incontinence in 24 (75 per cent). Incontinence without prolapse was present in 24 patients, 12 of whom were less\\u000a than 40 years old. Rectopexy was used for treatment of rectal prolapse. Surgical treatment of fecal incontinence was by post-anal

Michael R. B. Keighley; Duncan M. Matheson

1981-01-01

107

Rectal compliance in the assessment of patients with fecal incontinence  

Microsoft Academic Search

Rectal compliance (dV\\/dP) was studied in 31 patients with fecal incontinence, 8 patients with constipation, and 16 control subjects. Patients with fecal incontinence experienced a constant defecation urge at a lower rectal volume and also had a lower maximal tolerable volume and a lower rectal compliance than control subjects (median 126vs.155 ml, 170vs.220 ml, and 9vs.15 ml\\/mm Hg, respectively;tP;P.

Ole Rasmussen; Birgitte Christensen; Michael Sørensen; Tine Tetzschner; John Christiansen

1990-01-01

108

[Standardized treatment of mid-low rectal cancer].  

PubMed

In recent years, the treatment strategy of mid-low rectal cancer has changed from surgical resection alone to multidisciplinary treatment. In order to offer the greatest benefits to the mid-low rectal cancer patients, it is necessary to carry out the preoperative TNM staging for appropriate therapeutic strategies. Total mesorectal excision(TME), preoperative TNM staging and neoadjuvant chemoradiotherapy together may achieve a breakthrough in the therapeutic outcome of mid-low rectal cancer. PMID:23801201

Tao, Kai-Xiong; Shuai, Xiao-Ming

2013-06-01

109

[Rectal cancer in a pregnant woman, a case report].  

PubMed

A case of disseminated rectal cancer in a 32-year-old pregnant woman is described. Pain was her main complaint, but this had been ascribed to haemorrhoids and treated with topical agents. She was diagnosed with rectal cancer late in the third trimester when her midwife referred her for surgical assessment. Following caesarian section, diagnostic workup showed multiple liver metastases. Rectal cancer in pregnancy is rare, while haemorrhoids are common. We recommend keeping the differential diagnoses in mind and performing a digital rectal examination if pregnant women have anal symptoms. PMID:22735121

Højgaard, Helle Manfeld; Rahr, Hans

2012-06-25

110

An evaluation of the role of rectal endosonography in rectal cancer.  

PubMed Central

The applications of rectal endosonography (ES) in the preoperative staging and follow-up of patients with rectal cancer have been investigated. Endosonography is an accurate method of staging local invasion (93%) preoperatively and is superior to digital examination (58%) and computed tomography (CT) (74%). In addition, ES can predict mesorectal lymph node involvement with an accuracy of 83% which compares favourably with CT (57%). Extrarectal, locally recurrent cancer can be detected using ES and established recurrence assessed more objectively. Images fig. 1 fig. 2 fig. 3 fig. 4 fig. 5 fig. 6 fig. 7 fig. 8

Beynon, J.

1989-01-01

111

Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention  

Microsoft Academic Search

AIM: To determine the accuracy of high-resolution magnetic resonance imaging (MRI) using phased- array coil for preoperative assessment of T staging and mesorectal fascia infi ltration in rectal cancer with rectal distention. METHODS: In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging (in-plane resolution, 0.66 × 0.56) with phased-array coil were performed for T-staging

Sheng-Xiang Rao; Meng-Su Zeng; Jian-Ming Xu; Xin-Yu Qin; Cai-Zhong Chen; Ren-Chen Li

112

Total rectal resection, mesorectum excision, and coloendoanal anastomosis: A therapeutic option for the treatment of low rectal cancer  

Microsoft Academic Search

Background: There is recent and sporadic evidence indicating that patients with very low rectal cancer may be treated via a sphincter-saving procedure, obviating the need for abdominoperineal resection and definitive colostomy. This study confirms these findings.\\u000aMethods: From March 1990 to October 1994, 79 patients affected with primary low rectal cancers were submitted for total rectal resection, mesorectum excision, and

Ermanno Leo; Filiberto Belli; Salvatore Andreola; Maria Teresa Baldini; Gian Francesco Gallino; Riccardo Giovanazzi; Luigi Mascheroni; Roberto Patuzzo; Marco Vitellaro; Cinzia Lavarino; Rosaria Bufalino

1996-01-01

113

Operative management of civilian rectal gunshot wounds: simpler is better.  

PubMed

Extraperitoneal rectal gunshot wounds have been managed with a variety of methods from simple diverting colostomy to combinations of rectal repair, proximal diversion, transperitoneal or presacral drainage, and distal bowel irrigation techniques. Treatment methodology is chosen based on anecdotal experience, and there is no clear evidence that any technique is superior to the others. The objective of this study was to compare 3 methods of managing civilian extraperitoneal gunshot wounds. Retrospective analysis of 30 consecutive patients with extraperitoneal rectal gunshot wounds was undertaken. Patients were treated with 1 of these 3 techniques: (1) simple diverting colostomy without rectal repair (group A, 12 patients); (2) diverting colostomy and rectal repair (group B, 12 patients); and (3) diverting colostomy and presacral drainage without repair (group C, 6 patients). Injury, hospital course, and outcome data were compared. The 3 groups were similar in age, injury severity, admission hemodynamics, preoperative and intraoperative time, blood loss, fecal contamination, and associated injuries. The overall incidence of complications was 27% (8/27): 25% (3/12) in group A, 33% (4/12) in group B, and 17% (1/6) in group C (p = NS). Complications directly associated with the rectal injury were found in 2 cases (7%): 1 group A patient developed a vesicorectal fistula and 1 group B patient developed a rectocutaneous fistula. For 10 patients with both rectal and bladder injuries, the complication rates for groups A, B, and C were 50%, 20%, and 0%, respectively (p = NS). No patient died. In conclusion, diverting colostomy without rectal repair or drainage appears to be safe for the management of most civilian retroperitoneal rectal gunshot wounds. Additional surgical maneuvers may be required for combined rectal and urinary trauma or other complex rectal injuries. Sound surgical principles, tailored to the individual case, should overrule any unproven dogmas. PMID:10594214

Velmahos, G C; Gomez, H; Falabella, A; Demetriades, D

2000-01-01

114

[Recent progress in diagnosis and treatment of rectal cancer].  

PubMed

Rectal cancer is an emerging health issue in Korea because its incidence is rapidly increasing with changes in life styles and diets. The optimal treatment of rectal cancer is based on multimodality. Among them, surgical treatment is the corner-stone. In the past, local recurrence rate has been reported as high as 30-40%, but the concept of total mesorectal excision (TME) lowered the rate of local recurrence down to less than 10%. TME focuses on sharp pelvic dissection and complete removal of rectal cancer with surrounding mesorectum inside the rectal proper fascia. TME is now considered as a standard procedure for surgical treatment of mid and low rectal cancer. With the introduction of pelvic magnetic resonance imaging (MRI) for preoperative staging of rectal cancer, risk factors for local recurrence can be predicted before surgery to distinguish patients who are in high risk for recurrence that requires preoperative neoadjuvant chemoradiation therapy. Early rectal cancer was assessed by transrectal ultrasonography (TRUS) and endorectal MRI with coil. Transanal local excision can be applied with anal sphincter preservation safely. Neoadjuvant chemoradiation therapy was performed in patients with locally advanced rectal cancer, and this resulted in tumor size reductions and histopathologic downstaging effect. As far as the quality of life is concerned, sexual and voiding function are much improved by techniques preserving nerve. Many experts have dealt with challenging practical problems of managing rectal cancer from diagnosis to quality of life. This issue contains recent progresses in the diagnosis and treatment of rectal cancer which will serve as a comprehensive reference for those who manage rectal cancer in their medical practice. PMID:16632973

Kim, Nam Kyu

2006-04-01

115

Regional Rectal Perfusion: A New in Vivo Approach to Study Rectal Drug Absorption in Man  

Microsoft Academic Search

Background: In vivo permeability measurements of drugs in the colonic\\/rectal region in humans are difficult. A new instrument for the perfusion of a defined and closed segment in the colon\\/rectum was developed. The objective of this study was to evaluate its use for studying drug absorption mechanisms in the human rectum and to investigate the effect of transmucosal water absorption

Hans Lennernäs; Urban Fagerholm; Yngve. Raab; Bengt Gerdin; Roger Hällgren

1995-01-01

116

Current trends in staging rectal cancer  

PubMed Central

Management of rectal cancer has evolved over the years. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hot spots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. In future, functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy.

Samee, Abdus; Selvasekar, Chelliah Ramachandran

2011-01-01

117

Is rectal MRI beneficial for determining the location of rectal cancer with respect to the peritoneal reflection?  

PubMed Central

Background An objective method for determining the location of the cancer with respect to peritoneal reflection would be helpful to decide the treatment modality for rectal cancer. This study was designed to evaluate the accuracy and usefulness of rectal MRI to determine spatial relations between the peritoneal reflection and rectal cancer and to compare these with operative findings. Patients and methods Patients that underwent a rectal cancer operation after a rectal MRI check between November 2008 and June 2010 were considered for the study. The patients that received preoperative concurrent chemoradiation or trans-anal local excision were excluded. Results Fifty-four patients constituted the study cohort. By comparing surgical and radiologic findings, the accuracy for predicting tumour location in relation to the peritoneal reflection by rectal MRI in all patients was 90.7%. In terms of tumour location in relation to peritoneal reflection, the accuracy of rectal MRI was 93.5% in patients with a tumour located above the peritoneal reflection, 90.0% in patients with a tumour located on the peritoneal reflection, and 84.6% in patients with a tumour located below the peritoneal reflection (p=0.061). When the cohort was subdivided by gender, body mass index (BMI), operative findings, or tumour size, no significant difference was observed among subgroups. Conclusions Rectal MRI could be a useful tool for evaluating the relation between rectal cancer and peritoneal reflection especially when tumour size is less than 8cm. Rectal MRI can provide information regarding the location of rectal cancer in relation to the peritoneal reflection for treatment planning purposes.

Jung, Eun Joo; Ryu, Chun Geun; Kim, Gangmi; Kim, Su Ran; Nam, Sang Eun; Park, Hee Sun; Kim, Young Jun; Hwang, Dae-Yong

2012-01-01

118

Androgen and progesterone receptors in colonic and rectal cancers  

Microsoft Academic Search

Androgen, progesterone and estrogen receptors were analyzed in 12 primary colonic cancers and 16 primary rectal cancers. Androgen\\u000a and progesterone receptors were positive in some colonic cancers and rectal carcinomas; however, none of the specimens analyzed\\u000a showed estradiol receptor.

M. d'Istria; S. Fasano; F. Catuogno; F. Gaeta; L. Bucci; G. Benassai; F. Mazzeo; G. Delrio

1986-01-01

119

Confirming the Chlamydia trachomatis status of referred rectal specimens  

Microsoft Academic Search

Objectives: To assess the reliability of different laboratory methods for the detection of Chlamydia trachomatis in rectal specimensMethods: 1782 rectal specimens confirmed as C trachomatis positive using a standard laboratory method, were forwarded to the Sexually Transmitted Bacteria Reference Laboratory (STBRL). All specimens were retested using a C trachomatis specific independent in-house real time polymerase chain reaction (PCR). If this

Sarah Alexander; Iona Martin; Catherine Ison

2007-01-01

120

Simplified treatment of massive rectal bleeding following prostate needle biopsy.  

PubMed

Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound-guided prostate biopsy, but it usually stops spontaneously. We report a case of life-threatening rectal bleeding following this procedure. Bleeding was controlled using an ordinary condom, which was successfully inflated in the rectum over the bleeding site. PMID:15242373

Gonen, Murat; Resim, Sefa

2004-07-01

121

Progression and tumor heterogeneity analysis in early rectal cancer  

Microsoft Academic Search

Purpose: Adequate preoperative staging of large sessile rectal tumors requires identifying adenomas that already contain an invasive focus, specifically those that are growing in or beyond the submucosa. We systematically compared chromosomal instability patterns in adenoma and carcinoma fractions of the same lesion to assess specific steps in rectal tumor progression. Experimental Design: We analyzed 36 formalin-fixed, paraffin-embedded tumors. Both

Esther H. Lips; Ronald van Eijk; Graaf de E. J. R; Pascal G. Doornebosch; Miranda de N. F. C. C; Jan Oosting; Tom Karsten; Paul H. C. Eilers; Rob A. E. M. Tollenaar; Tom van Wezel; Hans Morreau

2008-01-01

122

Biofeedback Therapy in the Colon and Rectal Practice  

Microsoft Academic Search

In coloproctology, biofeedback has been used for more than 20 years to treat patients with fecal incontinence, constipation, and rectal pain. It can be performed in a number of conditions with minimal risk and discomfort. However, it does require the presence of some degree of sphincter contraction and rectal sensitivity. Biofeedback can be time-consuming and demands motivation. The purpose of

Jose Marcio N. Jorge; Angelita Habr-Gama; Steven D. Wexner

2003-01-01

123

Local Excision of Rectal Cancer: Review of Literature  

Microsoft Academic Search

In selected patients, local excision of rectal cancer may be an alternative to radical surgery such as abdominoperineal excision of the rectum or anterior resection. Local excision carries lower mortality and morbidity, without the functional disturbance or alteration in body image that can be associated with radical surgery. There are several techniques of local therapy for rectal cancer, with most

Piero Nastro; Daniel Beral; John Hartley; John R. T. Monson

2005-01-01

124

[Late results of laparoscopic rectal fixation for its prolapse].  

PubMed

Late functional results of laparoscopic rectal fixation in 14 patients, performed for its total prolapse were estimated. In majority of the patients, suffering concurrent somatic diseases, laparoscopic rectopexy was performed without rectal resection. This method of treatment was suggested as an effective one, permitting to escape recurrence and to improve the quality of life significantly. PMID:18020290

Kucher, M D; Kryvoruk, O M; Dorozhkina, R S

2007-07-01

125

Laparoscopic Total Mesorectal Excision for Rectal Cancer Surgery  

Microsoft Academic Search

The introduction of total mesorectal excision in the early 1980s has improved local control and survival in patients with rectal cancer. Laparoscopic resections for colonic malignancies are gaining acceptance in the light of the recent evidence of oncologic adequacy from randomized clinical trials. Technical difficulties and the difference in the natural history of the disease have excluded rectal cancer from

Jacques Marescaux; Francesco Rubino; Joel Leroy

2005-01-01

126

Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for MSM  

PubMed Central

Rationale To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk. Methods In Stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in Stage 2 to 105 MSM. Results More than half of participants who completed Stage 1 douched during the trial despite having been advised not to do so. Of the 105 HIV uninfected participants in Stage 2, 51% reported using rectal douches in the prior six months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about two hours prior to or one hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent STIs. Conclusion Rectal douching appears to be a popular behavior among men who have RAI. It is necessary to identify harmless douches. If HIV/STI preventive douches can be developed, rectal douching prior to or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of one type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use).

Carballo-Dieguez, Alex; Bauermeister, Jose; Ventuneac, Ana; Dolezal, Curtis; Mayer, Kenneth

2009-01-01

127

[Rectal cancer: which patients benefit from radiotherapy?].  

PubMed

The prognosis of patients with rectal cancer has improved in recent years, particularly as regards the lower probability of local recurrence. These positive results are obtained through correct preoperative staging and an adequate surgical resection of the affected lesion, as well as a multidisciplinary therapeutic approach. Based on the available scientific evidence, our aim is to clarify the framework in which options for the right therapy can be taken, especially in relation to the preoperative staging and its limitations, with regards to radiotherapy and its indications. We also emphasize the need of a tailor-made approach for each case. PMID:20413110

Ais Conde, Guillermo; Fadrique Fernández, Begoña; Vázquez Santos, Pablo; López Pérez, Juan; Picatoste Merino, Miguel; Manzanares Sacristán, Javier

2010-04-21

128

[Local diagnostics for rectal cancer. What is realistic?].  

PubMed

Accurate pretherapeutic staging of rectal cancer is crucial for further therapeutic management and important for prognosis. The most accurate diagnostic tools in the assessment of T and N categories of rectal cancer are endorectal ultrasound (EUS) and magnetic resonance imaging (MRI). Furthermore, MRI can accurately predict the distance of the tumor to the colorectal membrane (CRM) and computed tomography (CT) is more suitable for detecting distant metastases. In the routine care of rectal cancer EUS is the most frequently used diagnostic tool for local staging. The achieved accuracy for determining T category by EUS in routine clinical staging is lower than results reported in the literature. Furthermore, the accuracy of EUS depends on the experience of the examiner. Currently the frequency of using MRI for routine clinical staging of rectal cancer is low and in one out of five cases the local staging of rectal cancer is exclusively carried out by CT. PMID:22573247

Ptok, H; Gastinger, I; Lippert, H

2012-05-01

129

[Preoperative radiotherapy for rectal cancer: Target volumes].  

PubMed

Preoperative radiochemotherapy followed by total mesorectal excision is the standard of care for T3-T4-N0 or TxN1 rectal cancer. Defining target volumes relies on the patterns of nodal and locoregional failures. The lower limit of the clinical target volume depends also on the type of surgery. Conformational radiotherapy with or without intensity-modulated radiotherapy implies an accurate definition of volumes and inherent margins in the context of mobile organs such as the upper rectum. Tumoral staging recently improved with newer imaging techniques such as MRI with or without USPIO and FDG-PET-CT. The role of PET-CT remains unclear despite encouraging results and MRI is a helpful tool for a reliable delineation of the gross tumour volume. Co-registration of such modalities with the planning CT may particularly guide radiation oncologists through the gross tumour volume delineation. Acute digestive toxicity can be reduced with intensity modulation radiation therapy. Different guidelines and CT-based atlas regarding the target volumes in rectal cancer give the radiation oncologist a lot of ground for reproducible contours. PMID:24011671

Huertas, A; Marchal, F; Peiffert, D; Créhange, G

2013-09-05

130

Rectal microbicides: clinically relevant approach to the design of rectal specific placebo formulations  

Microsoft Academic Search

Background  The objective of this study is to identify the critical formulation parameters controlling distribution and function for the\\u000a rectal administration of microbicides in humans. Four placebo formulations were designed with a wide range of hydrophilic\\u000a characteristics (aqueous to lipid) and rheological properties (Newtonian, shear thinning, thermal sensitive and thixotropic).\\u000a Aqueous formulations using typical polymers to control viscosity were iso-osmotic and

Lin Wang; Roger L Schnaare; Charlene Dezzutti; Peter A Anton; Lisa C Rohan

2011-01-01

131

Comparison of rectal volume definition techniques and their influence on rectal toxicity in patients with prostate cancer treated with 3D conformal radiotherapy: a dose-volume analysis  

PubMed Central

Background To evaluate the impact of four different rectum contouring techniques and rectal toxicities in patients with treated with 3D conformal radiotherapy (3DCRT). Methods Clinical and dosimetric data were evaluated for 94 patients who received a total dose 3DCRT of 70 Gy, and rectal doses were compared in four different rectal contouring techniques: the prostate-containing CT sections (method 1); 1 cm above and below the planning target volume (PTV) (method 2); 110 mm starting from the anal verge (method 3); and from the anal verge to the sigmoid flexure (method 4). The percentage of rectal volume receiving RT doses (30–70 Gy) and minimum, mean rectal doses were assessed. Results Median age was 69 years. Percentage of rectal volume receiving high doses (? 70 Gy) were higher with the techniques that contoured smaller rectal volumes. In methods 2 and 3, the percentage of rectal volume receiving ? 70 Gy was significantly higher in patients with than without rectal bleeding (method 2: 30.8% vs. 22.5%, respectively (p = 0.03); method 3: 26.9% vs. 18.1%, respectively (p = 0.006)). Mean rectal dose was significant predictor of rectal bleeding only in method 3 (48.8 Gy in patients with bleeding vs. 44.4 Gy in patients without bleeding; p = 0.02). Conclusion Different techniques of rectal contouring significantly influence the calculation of radiation doses to the rectum and the prediction of rectal toxicity. Rectal volume receiving higher doses (? 70 Gy) and mean rectal doses may significantly predict rectal bleeding for techniques contouring larger rectal volumes, as was in method 3.

Onal, Cem; Topkan, Erkan; Efe, Esma; Yavuz, Melek; Sonmez, Serhat; Yavuz, Aydin

2009-01-01

132

Use of a colonic pouch as a rectal substitute after rectal excision.  

PubMed

Mid or distal rectal resection with straight coloanal anastomosis effectively treats distal rectal cancer and avoids a permanent stoma. However, the straight colonic segment is a poor reservoir for stools, and patients usually experience varying degrees of impaired rectal function after operation, including frequent bowel movements, incontinence, tenesmus, and soiling. In contrast, a J-shaped colonic pouch provides an adequate neorectal reservoir after operation. Patients with a colonic pouch-anal canal anastomosis have fewer bowel movements per day than patients with straight colorectal or coloanal anastomosis. Furthermore, the morbidity of the colonic pouch is not greater than that of the straight coloanal anastomosis. An important technical aspect of the colonic pouch procedure is that the limbs used to form the pouch must be no longer than 5 to 6 cm. Patients with larger pouches experience emptying difficulties. Also, the level of the anastomosis between the pouch and the anal canal must be no more than 4 cm from the anal verge, again to avoid problems with defecation. With these caveats, the operation should be considered in patients who require excision of the mid and distal rectum for cancer. PMID:10511890

Teixeira, F V; Pera, M; Kelly, K A

133

The radiation-induced changes in rectal mucosa: Hyperfractionated vs. hypofractionated preoperative radiation for rectal cancer  

SciTech Connect

Purpose: The purpose of the study was the qualitative and quantitative evaluation of acute radiation-induced rectal changes in patients who underwent preoperative radiotherapy according to two different irradiation protocols. Patients and Methods: Sixty-eight patients with rectal adenocarcinoma underwent preoperative radiotherapy; 44 and 24 patients underwent hyperfractionated and hypofractionated protocol, respectively. Fifteen patients treated with surgery alone served as a control group. Five basic histopathologic features (meganucleosis, inflammatory infiltrations, eosinophils, mucus secretion, and erosions) and two additional features (mitotic figures and architectural glandular abnormalities) of radiation-induced changes were qualified and quantified. Results: Acute radiation-induced reactions were found in 66 patients. The most common were eosinophilic and plasma-cell inflammatory infiltrations (65 patients), erosions, and decreased mucus secretion (54 patients). Meganucleosis and mitotic figures were more common in patients who underwent hyperfractionated radiotherapy. The least common were the glandular architectural distortions, especially in patients treated with hypofractionated radiotherapy. Statistically significant differences in morphologic parameters studied between groups treated with different irradiation protocols were found. Conclusion: The system of assessment is a valuable tool in the evaluation of radiation-induced changes in the rectal mucosa. A greater intensity of regenerative changes was found in patients treated with hyperfractionated radiotherapy.

Starzewski, Jacek J. [Department of General and Colorectal Surgery, Medical University of Silesia, Sosnowiec (Poland); Pajak, Jacek T. [Department of Pathology, Medical University of Silesia, Katowice (Poland); Pawelczyk, Iwona [Department of General and Colorectal Surgery, Medical University of Silesia, Sosnowiec (Poland); Lange, Dariusz [Department of Tumor Pathology, Comprehensive Cancer Center Division, Gliwice (Poland); Golka, Dariusz [Department of Pathology, Medical University of Silesia, Katowice (Poland)]. E-mail: dargolka@wp.pl; Brzeziska, Monika [Department of General and Colorectal Surgery, Medical University of Silesia, Sosnowiec (Poland); Lorenc, Zbigniew [Department of General and Colorectal Surgery, Medical University of Silesia, Sosnowiec (Poland)

2006-03-01

134

Transanal Endoscopic Microsurgery for Rectal Tumors: A Review  

PubMed Central

Since its introduction in 1983, transanal endoscopic microsurgery (TEM) has emerged as a safe and effective method to treat rectal lesions including benign tumors, early rectal cancer, and rectal fistulas and strictures. This minimally invasive technique offers the advantages of superior visualization of the lesion and greater access to proximal lesions with lower margin positivity and specimen fragmentation and lower long-term recurrence rates over traditional transanal excision. In addition, over two decades of scientific data support the use of TEM as a viable alternative to radical excision of the rectum with less morbidity, faster recovery, and greater potential cost savings when performed at specialized centers.

Kunitake, Hiroko; Abbas, Maher A

2012-01-01

135

Viscoelastic properties of the rectal wall in Hirschsprung's disease.  

PubMed Central

Viscoelastic properties of the rectal wall were compared with Hirschsprung's disease. The elasticity of the rectal wall after accomodation to distension was found to be significantly greater (P less than 0.001) in patients, and the time taken by the rectum to accomodate was also found to be longer (P less than 0.001). The increased elasticity correlated well with severity of the illness, but none of the parameters correlated with length of aganglionic segment. Measuring elastic properties of the rectal wall may help to assess the severity of illness in patients with Hirschsprung's disease.

Arhan, P; Devroede, G; Danis, K; Dornic, C; Faverdin, C; Persoz, B; Pellerin, D

1978-01-01

136

Applying for a Fellowship in Colon and Rectal Surgery  

PubMed Central

Colon and Rectal Surgery is a challenging and fulfilling field with interesting and widely variable tasks, making it the preferred career for an increasing number of residents who are in the final path of their general surgery training. Due to the steadily rising interest in the field, it has become increasingly difficult to match into a fellowship in Colon and Rectal Surgery. For those who have decided to pursue a career in Colon and Rectal Surgery, this overview may be of some use during the quite cumbersome and costly process of applying for a fellowship.

Einarsdottir, Hulda

2011-01-01

137

Comparison of digital rectal and microchip transponder thermometry in cats.  

PubMed

This study compares the use of traditional rectal thermometry with an implantable microchip temperature transponder in cats. The microchip transponder was implanted over the shoulder blades and was programmed with cat identification information. Concurrently, the cats were involved in a study in which they were infected experimentally with feline herpesvirus 1; this situation enabled temperature comparisons in both normal and abnormal ranges. Results from the microchip transponder technique were compared with rectal thermometry by using a concordance test of agreement. These data revealed close agreement between rectal and microchip transponder thermometry in the cat at both normal and abnormal temperature ranges. PMID:19653950

Quimby, Jessica M; Olea-Popelka, Francisco; Lappin, Michael R

2009-07-01

138

Comparison of Digital Rectal and Microchip Transponder Thermometry in Cats  

PubMed Central

This study compares the use of traditional rectal thermometry with an implantable microchip temperature transponder in cats. The microchip transponder was implanted over the shoulder blades and was programmed with cat identification information. Concurrently, the cats were involved in a study in which they were infected experimentally with feline herpesvirus 1; this situation enabled temperature comparisons in both normal and abnormal ranges. Results from the microchip transponder technique were compared with rectal thermometry by using a concordance test of agreement. These data revealed close agreement between rectal and microchip transponder thermometry in the cat at both normal and abnormal temperature ranges.

Quimby, Jessica M; Olea-Popelka, Francisco; Lappin, Michael R

2009-01-01

139

Intersphincteric Resection for Low Rectal Cancer: An Overview  

PubMed Central

The treatment of rectal cancer has evolved from being solely a surgical endeavor to a multidisciplinary practice. Despite the improvement in outcomes conferred by the addition of chemoradiation therapy to rectal cancer treatment, advances in surgical technique have significantly increased rates of sphincter preservation and the avoidance of a permanent stoma. In recent years, intersphincteric resection for low rectal cancer has been offered and performed in patients as an alternative to abdominoperineal resection. An overview of this procedure, including indications, oncological and functional results based on current literature, is presented herein.

Spanos, Constantine P.

2012-01-01

140

Approach of trans-rectal NIR optical tomography probing for the imaging of prostate with trans-rectal ultrasound correlation  

NASA Astrophysics Data System (ADS)

The trans-rectal implementation of NIR optical tomography makes it possible to assess functional status like hemoglobin concentration and oxygen saturation in prostate non-invasively. Trans-rectal NIR tomography may provide tissue-specific functional contrast that is potentially valuable for differentiation of cancerous lesions from normal tissues. Such information will help to determine if a prostate biopsy is needed or can be excluded for an otherwise ambiguous lesion. The relatively low spatial resolution due to the diffuse light detection in trans-rectal NIR tomography, however, limits the accuracy of localizing a suspicious tissue volume. Trans-rectal ultrasound (TRUS) is the clinical standard for guiding the positioning of biopsy needle owing to its resolution and convenience; nevertheless, TRUS lacks the pathognomic specificity to guide biopsy to only the suspicious lesions. The combination of trans-rectal NIR tomography with TRUS could potentially give better differentiation of cancerous tissue from normal background and to accurately localize the cancer-suspicious contrast obtained from NIR tomography. This paper will demonstrate the design and initial evaluation of a trans-rectal NIR tomography probe that can conveniently integrate with a commercial TRUS transducer. The transrectal NIR tomography obtained from this probe is concurrent with TRUS at matching sagittal imaging plane. This design provides the flexibility of simple correlation of trans-rectal NIR with TRUS, and using TRUS anatomic information as spatial prior for NIR image reconstruction.

Piao, Daqing; Jiang, Zhen; Xu, Guan; Musgrove, Cameron; Bunting, Charles F.

2008-03-01

141

Absence of effect of nicotine on rectal sensation, rectal compliance, and anal sphincter pressures in healthy subjects.  

PubMed

We examined the effect of nicotine on rectal sensation, rectal compliance, and anorectal sphincter function in healthy volunteers. Eleven healthy (ex-smoker) subjects were randomized in a double-blind, crossover, placebo-controlled study of 12 mg nicotine-containing chewing gum. All treatment periods (nicotine or placebo chewing gum) were preceded by a control period without chewing gum. Crossover study was done after a washout period of more than seven days. The following measurements were made: highest anorectal sphincter tone, highest anorectal sphincter squeeze tone, percentage relaxation of the anorectal sphincter with rectal balloon distension, threshold of rectal sensation, maximal tolerable volume of air inflation of a rectal balloon, and rectal compliance. There was no significant difference in the two control periods. Chewing placebo gum had no significant effect on any of the measurements when compared with control. Compared with placebo, nicotine did not significantly affect on any of the measurements. We conclude that neither nicotine nor the sham-feeding effect of chewing placebo gum appear to have any effect on anorectal sensorimotor function or on rectal compliance in healthy ex-smokers. PMID:7587796

Kavin, H; Shivley, S

1995-10-01

142

Closed rectosacropexy for rectal prolapse in children.  

PubMed

This report describes a simple, effective, and permanent surgical solution for persistent rectal prolapse (RP). The technique simply involves passing multiple U-shaped sutures through the stab incisions made in the skin posterior to the anus, into the sacral fascia, then into the wall of rectum, down to the anal canal, and out through the stab incisions. The strands of the suture are tied subcutaneously through the stab incisions. This operation was successfully performed in 42 children (mean age, 3.5 years) who had suffered from recurrent RP for 3-5 months. None of the children experienced any further recurrence or specific complications during follow-up ranging from 1 to 3 years. Thus, I believe that closed rectosacropexy offers a simple, minimally invasive, and effective method of treating complete RP in children. PMID:12884108

Lasheen, Ahmed E

2003-01-01

143

Persisting anorectal dysfunction after rectal cancer surgery.  

PubMed

AIM: Sphincter saving rectal cancer management affects anorectal function. This study evaluated persisting anorectal dysfunction and its impact on patients' well-being. METHOD: Seventy-nine patients with a follow-up of 12 - 37 (median 22) months and seventy-nine age- and sex-matched control subjects completed questionnaires. RESULTS: The median number of diurnal bowel movements was 3 in patients and 1 in controls (p<.0001). Nocturnal defecation occurred in 53% of patients. The median Vaizey score was 8 in patients and 4 in controls (p<.0001). Urgency without incontinence was reported by 47% of patients and 49% of controls (p=0.873), soiling by 28% of patients and 3% in controls (p<0.0001), incontinence for flatus by 73% of patients and 49% of controls (p=0.0019), incontinence for solid stools by 16% of patients and 4% of controls (p=0.0153). Incontinence of liquid stools occurred in 17 of 20 patients and 1 of 5 controls who had liquid stools (p=0.0123). Incontinence for gas, liquid or solid stool occurred once or more weekly in 47%, 19% and 6% of patients respectively. Evacuation difficulties were reported by 98% of patients, but also by 77% in controls. Neoadjuvant radio(chemo)therapy adversely affected defecation frequency and continence. Incontinence was associated with severe discomfort in 50% of patients, severe anxiety in 40%, and severe embarrassment in 48%. CONCLUSION: Anorectal dysfunction is a frequent problem after management of rectal cancer with an impact on the wellbeing of patients. This article is protected by copyright. All rights reserved. PMID:23692392

Maris, A; Penninckx, F; Devreese, A M; Staes, F; Moons, P; Van Cutsem, E; Haustermans, K; D'Hoore, A

2013-05-21

144

Rectal wall sparing by dosimetric effect of rectal balloon used during intensity-modulated radiation therapy (IMRT) for prostate cancer.  

PubMed

The use of an air-filled rectal balloon has been shown to decrease prostate motion during prostate radiotherapy. However, the perturbation of radiation dose near the air-tissue interfaces has raised clinical concerns of underdosing the prostate gland. The aim of this study was to investigate the dosimetric effects of an air-filled rectal balloon on the rectal wall/mucosa and prostate gland. Clinical rectal toxicity and dose-volume histogram (DVH) were also assessed to evaluate for any correlation. A film phantom was constructed to simulate the 4-cm diameter air cavity created by a rectal balloon. Kodak XV2 films were utilized to measure and compare dose distribution with and without air cavity. To study the effect in a typical clinical situation, the phantom was computed tomography (CT) scanned on a Siemens DR CT scanner for intensity-modulated radiation therapy (IMRT) treatment planning. A target object was drawn on the phantom CT images to simulate the treatment of prostate cancer. Because patients were treated in prone position, the air cavity was situated superiorly to the target. The treatment used a serial tomotherapy technique with the Multivane Intensity Modulating Collimator (MIMiC) in arc treatment mode. Rectal toxicity was assessed in 116 patients treated with IMRT to a mean dose of 76 Gy over 35 fractions (2.17-Gy fraction size). They were treated in the prone position, immobilized using a Vac-Loktrade mark bag and carrier-box system. Rectal balloon inflated with 100 cc of air was used for prostate gland immobilization during daily treatment. Rectal toxicity was assessed using modifications of the Radiation Therapy Oncology Group (RTOG) and late effects Normal Tissue Task Force (LENT) scales systems. DVH of the rectum was also evaluated. From film dosimetry, there was a dose reduction at the distal air-tissue interface as much as 60% compared with the same geometry without the air cavity for 15-MV photon beam and 2x2-cm field size. The dose beyond the interface recovered quickly and the dose reductions due to air cavity were 50%, 28%, 11%, and 1% at 2, 5, 10, and 15 mm, respectively, from the distal air-tissue interface. Evaluating the dose profiles of the more clinically relevant situation revealed the dose at air-tissue interface was approximately 15% lower in comparison to that without an air cavity. The dose built up rapidly so that at 1 and 2 mm, there was only an 8% and 5% differential, respectively. The dosimetric coverage at the depth of the posterior prostate wall was essentially equal with or without the air cavity. The median follow-up was 31.3 months. Rectal toxicity profile was very favorable: 81% (94/116) patients had no rectal complaint while 10.3% (12/116), 6.9% (8/116), and 1.7% (2/116) had grade 1, 2, and 3 toxicity, respectively. There was no grade 4 rectal toxicity. DVH analysis revealed that none of the patients had more than 25% of the rectum receiving 70 Gy or greater. Rectal balloon has rendered anterior rectal wall sparing by its dosimetric effects. In addition, it has reduced rectal volume, especially posterior and lateral rectal wall receiving high-dose radiation by rectal wall distension. Both factors may have contributed to decreased rectal toxicity achieved by IMRT despite dose escalation and higher than conventional fraction size. The findings have clinical significance for future very high-dose escalation trials whereby radiation proctitis is a major limiting factor. PMID:15749008

Teh, Bin S; Dong, Lei; McGary, John E; Mai, Wei-Yuan; Grant, Walter; Butler, E Brian

2005-01-01

145

Rectal wall sparing by dosimetric effect of rectal balloon used during Intensity-Modulated Radiation Therapy (IMRT) for prostate cancer  

SciTech Connect

The use of an air-filled rectal balloon has been shown to decrease prostate motion during prostate radiotherapy. However, the perturbation of radiation dose near the air-tissue interfaces has raised clinical concerns of underdosing the prostate gland. The aim of this study was to investigate the dosimetric effects of an air-filled rectal balloon on the rectal wall/mucosa and prostate gland. Clinical rectal toxicity and dose-volume histogram (DVH) were also assessed to evaluate for any correlation. A film phantom was constructed to simulate the 4-cm diameter air cavity created by a rectal balloon. Kodak XV2 films were utilized to measure and compare dose distribution with and without air cavity. To study the effect in a typical clinical situation, the phantom was computed tomography (CT) scanned on a Siemens DR CT scanner for intensity-modulated radiation therapy (IMRT) treatment planning. A target object was drawn on the phantom CT images to simulate the treatment of prostate cancer. Because patients were treated in prone position, the air cavity was situated superiorly to the target. The treatment used a serial tomotherapy technique with the Multivane Intensity Modulating Collimator (MIMiC) in arc treatment mode. Rectal toxicity was assessed in 116 patients treated with IMRT to a mean dose of 76 Gy over 35 fractions (2.17-Gy fraction size). They were treated in the prone position, immobilized using a Vac-LokTM bag and carrier-box system. Rectal balloon inflated with 100 cc of air was used for prostate gland immobilization during daily treatment. Rectal toxicity was assessed using modifications of the Radiation Therapy Oncology Group (RTOG) and late effects Normal Tissue Task Force (LENT) scales systems. DVH of the rectum was also evaluated. From film dosimetry, there was a dose reduction at the distal air-tissue interface as much as 60% compared with the same geometry without the air cavity for 15-MV photon beam and 2 x 2-cm field size. The dose beyond the interface recovered quickly and the dose reductions due to air cavity were 50%, 28%, 11%, and 1% at 2, 5, 10, and 15 mm, respectively, from the distal air-tissue interface. Evaluating the dose profiles of the more clinically relevant situation revealed the dose at air-tissue interface was approximately 15% lower in comparison to that without an air cavity. The dose built up rapidly so that at 1 and 2 mm, there was only an 8% and 5% differential, respectively. The dosimetric coverage at the depth of the posterior prostate wall was essentially equal with or without the air cavity. The median follow-up was 31.3 months. Rectal toxicity profile was very favorable: 81% (94/116) patients had no rectal complaint while 10.3% (12/116), 6.9% (8/116), and 1.7% (2/116) had grade 1, 2, and 3 toxicity, respectively. There was no grade 4 rectal toxicity. DVH analysis revealed that none of the patients had more than 25% of the rectum receiving 70 Gy or greater. Rectal balloon has rendered anterior rectal wall sparing by its dosimetric effects. In addition, it has reduced rectal volume, especially posterior and lateral rectal wall receiving high-dose radiation by rectal wall distension. Both factors may have contributed to decreased rectal toxicity achieved by IMRT despite dose escalation and higher than conventional fraction size. The findings have clinical significance for future very high-dose escalation trials whereby radiation proctitis is a major limiting factor.

Teh, Bin S. [Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, Houston, TX (United States)]. E-mail: bteh@bcm.tmc.edu; Dong Lei [Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, Houston, TX (United States); McGary, John E. [Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, Houston, TX (United States); Mai Weiyuan [Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, Houston, TX (United States); Grant, Walter [Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, Houston, TX (United States); Butler, E. Brian [Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, Houston, TX (United States)

2005-03-31

146

Caffeine Attenuates the Afterdrop in Rectal Temperature After Mild Cooling.  

National Technical Information Service (NTIS)

Previous research has shown that subjects who experience immersion hypothermia often show a continued decreased in rectal temperature (afterdrop) during the initial phase of rewarming. Because caffeine, the principal constituent of coffee, influences ther...

J. R. Thomas R. L. Hesslink S. B. Lewis S. T. Ahlers

1990-01-01

147

Pelvic lymphoscintigraphy: contribution to the preoperative staging of rectal cancer.  

National Technical Information Service (NTIS)

Preservation of the lower rectal sphincters has been the main concern of colorectal surgeons in an attempt to avoid colostomy. Various proposed procedures contradict the oncological principles of the operation's radicality, especially pelvic lymphadenecto...

J. H. Silva

1996-01-01

148

Pseudomembranes in rectal prolapse: a report of two cases.  

PubMed

Pseudomembranes in colonic biopsies are normally associated with antibiotic related pseudomembranous colitis. Although pseudomembranes have rarely been reported in other conditions, their presence in rectal prolapse has not been previously reported. PMID:23222810

Coyne, John D

2012-12-05

149

A crunching colon: rectal bezoar caused by pumpkin seed consumption.  

PubMed

Rectal seed bezoars are an uncommon cause of fecal impaction, particularly in the United States. Although the literature has reported several cases of phytobezoars composed of various types of seeds, bezoars formed of pumpkin seeds have rarely been reported. We report a case of a man, aged 62 years, with a rectal bezoar composed of pumpkin seeds with complications necessitating extensive treatment, including manual disimpaction and colonoscopy. PMID:22031478

Manne, Janaki R; Rangu, Venu M; Motapothula, Uma Maheswara R; Hall, Matthew C

2011-10-26

150

A Crunching Colon: Rectal Bezoar Caused by Pumpkin Seed Consumption  

PubMed Central

Rectal seed bezoars are an uncommon cause of fecal impaction, particularly in the United States. Although the literature has reported several cases of phytobezoars composed of various types of seeds, bezoars formed of pumpkin seeds have rarely been reported. We report a case of a man, aged 62 years, with a rectal bezoar composed of pumpkin seeds with complications necessitating extensive treatment, including manual disimpaction and colonoscopy.

Manne, Janaki R.; Rangu, Venu M.; Motapothula, Uma Maheswara R.; Hall, Matthew C.

2012-01-01

151

Endoscopic therapy of a massive rectal bleeding after prostate biopsy  

Microsoft Academic Search

We report on the case of a 65-year-old man with an indication for a transrectal multibiopsy of the prostate based on a PSA\\u000a value of 4.5 ng\\/ml. A massive haemoglobin effective rectal bleeding occurred post-intervention, which due to haemodynamic\\u000a instability required the administration of erythrocyte concentrates. Both manual compression and rectal tamponade failed to\\u000a stop the bleeding, and immediate haemostasis was

Kay-P. Braun; Matthias May; Christian Helke; Bernd Hoschke; Helmut Ernst

2007-01-01

152

On biomarkers and pathways in rectal cancer: What's the target?  

PubMed Central

In spite of tremendous progresses in surgical and chemo-radiotherapeutic regimens, rectal cancer still suffers from high relapse and mortality rates, and metastatic disease is incurable. Here we assess some of the most recent and validated biomarkers and potential targets studied in rectal cancer, and provide comments to a recent monographic topic covering several aspects of colorectal cancer, published in Current Cancer Drug Targets.

Zoppoli, Gabriele; Ferrando, Valter; Scabini, Stefano

2012-01-01

153

Phase II Study of Preoperative Helical Tomotherapy for Rectal Cancer  

Microsoft Academic Search

Purpose: To explore the efficacy and toxicity profile of helical tomotherapy in the preoperative treatment of patients with rectal cancer. Patients and Methods: Twenty-four patients with T3\\/T4 rectal cancer were included in this nonrandomized noncontrolled study. A dose of 46 Gy in daily fractions of 2 Gy was delivered to the presacral space and perineum if an abdominoperineal resection was

Mark De Ridder; Koen M. S. Tournel; Yves Van Nieuwenhove; Benedikt Engels; Anne Hoorens; Hendrik Everaert; Bart Op de Beeck; Vincent Vinh-Hung; Jacques De Grève; Georges Delvaux; Dirk Verellen; Guy A. Storme

2008-01-01

154

Geometric modeling, functional parameter calculation, and visualization of the in-vivo distended rectal wall  

NASA Astrophysics Data System (ADS)

The rectum can distend to accommodate stool, and contracts in response to distention during defecation. Rectal motor dysfunctions are implicated in the pathophysiology of functional defecation disorders and fecal incontinence. These rectal motor functions can be studied by intra-luminal measurements of pressure by manometry, or combined with volume during rectal balloon distention. Pressure-volume (p-v) relationships provide a global index of rectal mechanical properties. However, balloon distention alone does not measure luminal radius or wall thickness, which are necessary to compute wall tension and stress respectively. It has been suggested that the elastic modulus, which is the linear slope of the stress-strain relationship, is a more accurate measure of wall stiffness. Also, measurements of compliance may not reflect differences in rectal diameter between subjects prior to inflation, and imaging is necessary to determine if, as has been suggested, rectal pressure-volume relationships are affected by extra-rectal structures. We have developed a technique to measure rectal stress:strain relationships in humans, by simultaneous magnetic resonance imaging (MRI) during rectal balloon distention. After a conditioning distention, a rectal balloon was distended with water from 0 to 400 ml in 50 ml steps, and imaged at each step with MRI. The fluid filled balloon was segmented from each volume, the phase-ordered binary volumes were transformed into a geometric characterization of the inflated rectal surface. Taken together with measurements of balloon pressure and of rectal wall thickness, this model of the rectal surface was used to calculate regional values of curvature, tension, strain, and stress for the rectum. In summary, this technique has the unique ability to non-invasively measure the rectal stress:strain relationship and also determine if rectal expansion is limited by extra-rectal structures. This functional information allows the direct clinical analysis of rectal motor function and offers the potential for characterizing abnormal mechanical properties of the rectal wall in disease.

Haider, Clifton R.; Manduca, Armando; Camp, Jon J.; Fletcher, Joel G.; Robb, Richard A.; Bharucha, Adil E.

2006-03-01

155

Rectal microbicides: clinically relevant approach to the design of rectal specific placebo formulations  

PubMed Central

Background The objective of this study is to identify the critical formulation parameters controlling distribution and function for the rectal administration of microbicides in humans. Four placebo formulations were designed with a wide range of hydrophilic characteristics (aqueous to lipid) and rheological properties (Newtonian, shear thinning, thermal sensitive and thixotropic). Aqueous formulations using typical polymers to control viscosity were iso-osmotic and buffered to pH 7. Lipid formulations were developed from lipid solvent/lipid gelling agent binary mixtures. Testing included pharmaceutical function and stability as well as in vitro and in vivo toxicity. Results The aqueous fluid placebo, based on poloxamer, was fluid at room temperature, thickened and became shear thinning at 37°C. The aqueous gel placebo used carbopol as the gelling agent, was shear thinning at room temperature and showed a typical decrease in viscosity with an increase in temperature. The lipid fluid placebo, myristyl myristate in isopropyl myristate, was relatively thin and temperature independent. The lipid gel placebo, glyceryl stearate and PEG-75 stearate in caprylic/capric triglycerides, was also shear thinning at both room temperature and 37°C but with significant time dependency or thixotropy. All formulations showed no rectal irritation in rabbits and were non-toxic using an ex vivo rectal explant model. Conclusions Four placebo formulations ranging from fluid to gel in aqueous and lipid formats with a range of rheological properties were developed, tested, scaled-up, manufactured under cGMP conditions and enrolled in a formal stability program. Clinical testing of these formulations as placebos will serve as the basis for further microbicide formulation development with drug-containing products.

2011-01-01

156

Analysis of outcomes of intra-operative rectal washout in patients with rectal cancer during anterior resection.  

PubMed

Local recurrence is a major setback for patients with rectal cancer after surgery. Implantation of exfoliated malignant cells has been considered as a possible mechanism of tumor recurrence. Although still controversial, intra-operative rectal washout has been described as a method to remove exfoliated malignant cells and reduce recurrence rates. The current study was designed to assess the differences in outcomes of patients with or without rectal washout. Data of 144 patients with rectal cancer undergoing anterior resection between 2006 and 2007 were reviewed in our study. 69 patients received rectal washout with approximately 1,500 ml physiological saline before anastomosis, and 75 patients received no-washout. The washout samples were sent for cytological examination. The incidence of recurrence and 5-year disease-free survival rates of the two groups were compared. Three patients had local recurrence in the washout group compared with 5 patients with no-washout during a median follow-up of 48 months (p = 0.721). The 5-year disease-free survival rate was 79.7 and 74.7 % in washout and no-washout groups, respectively (p = 0.553). Our results demonstrated that exfoliated malignant cells were ubiquitous in the rectal lumen during anterior resection. The difference of prognosis was not statistically significant, though trended toward being improved in the washout group. A large-scale research with longer follow-up time is required to draw a significant conclusion. PMID:23288723

Xingmao, Zhang; Jianjun, Bi; Zheng, Wang; Jianwei, Liang; Junjie, Hu; Zhixiang, Zhou

2013-01-04

157

Colectomy with ileorectal anastomosis for familial adenomatous polyposis: the risk of rectal cancer.  

PubMed

One hundred thirty-three patients with familial adenomatous polyposis undergoing colectomy and ileorectal anastomosis have been reviewed for the occurrence of cancer in the rectal stump. Ten patients developed rectal cancer (Actuarial survivorship rate of 88% for those patients free of rectal cancer at 20 years). Potential risk factors for the development of rectal cancer, including age at colectomy, previous colon cancer, number of rectal polyps, and length of the rectal stump, were analyzed and no significant differences were found. A policy of total colectomy with ileorectal anastomosis at 12 to 15 cm with conscientious lifelong follow-up thereafter is advocated for persons affected by familial adenomatous polyposis. PMID:3026060

Sarre, R G; Jagelman, D G; Beck, G J; McGannon, E; Fazio, V W; Weakley, F L; Lavery, I C

1987-01-01

158

Sexual Function in Males After Radiotherapy for Rectal Cancer  

SciTech Connect

Purpose: Knowledge of sexual problems after pre- or postoperative radiotherapy (RT) with 50 Gy for rectal cancer is limited. In this study, we aimed to compare self-rated sexual functioning in irradiated (RT+) and nonirradiated (RT-) male patients at least 2 years after surgery for rectal cancer. Methods and Materials: Patients diagnosed with rectal cancer from 1993 to 2003 were identified from the Norwegian Rectal Cancer Registry. Male patients without recurrence at the time of the study. The International Index of Erectile Function, a self-rated instrument, was used to assess sexual functioning, and serum levels of serum testosterone were measured. Results: Questionnaires were returned from 241 patients a median of 4.5 years after surgery. The median age was 67 years at survey. RT+ patients (n = 108) had significantly poorer scores for erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction with sex life compared with RT- patients (n = 133). In multiple age-adjusted analysis, the odds ratio for moderate-severe erectile dysfunction in RT+ patients was 7.3 compared with RT- patients (p <0.001). Furthermore, erectile dysfunction of this degree was associated with low serum testosterone (p = 0.01). Conclusion: RT for rectal cancer is associated with significant long-term effects on sexual function in males.

Bruheim, Kjersti, E-mail: Kjersti.bruheim@medisin.uio.n [Oslo University Hospital, Ulleval Cancer Centre, Oslo (Norway); Guren, Marianne G. [Oslo University Hospital, Ulleval Cancer Centre, Oslo (Norway); Dahl, Alv A. [Oslo University Hospital, Department of Clinical Cancer Research, the Norwegian Radium Hospital, Oslo (Norway); Faculty of Medicine, University of Oslo, Oslo (Norway); Skovlund, Eva [School of Pharmacy, University of Oslo, Oslo (Norway); Balteskard, Lise [University Hospital of Northern Norway, Tromso (Norway); Carlsen, Erik [Oslo University Hospital, Department of Gastrointestinal Surgery, Ulleval, Oslo (Norway); Fossa, Sophie D. [Oslo University Hospital, Department of Clinical Cancer Research, the Norwegian Radium Hospital, Oslo (Norway); Faculty of Medicine, University of Oslo, Oslo (Norway); Tveit, Kjell Magne [Oslo University Hospital, Ulleval Cancer Centre, Oslo (Norway); Faculty of Medicine, University of Oslo, Oslo (Norway)

2010-03-15

159

Voiding Dysfunction after Total Mesorectal Excision in Rectal Cancer  

PubMed Central

Purpose The aim of this study was to assess the voiding dysfunction after rectal cancer surgery with total mesorectal excision (TME). Methods This was part of a prospective study done in the rectal cancer patients who underwent surgery with TME between November 2006 and June 2008. Consecutive uroflowmetry, post-voided residual volume, and a voiding questionnaire were performed at preoperatively and postoperatively. Results A total of 50 patients were recruited in this study, including 28 male and 22 female. In the comparison of the preoperative data with the postoperative 3-month data, a significant decrease in mean maximal flow rate, voided volume, and post-voided residual volume were found. In the comparison with the postoperative 6-month data, however only the maximal flow rate was decreased with statistical significance (P=0.02). In the comparison between surgical methods, abdominoperineal resection patients showed delayed recovery of maximal flow rate, voided volume, and post-voided residual volume. There was no significant difference in uroflowmetry parameters with advances in rectal cancer stage. Conclusions Voiding dysfunction is common after rectal cancer surgery but can be recovered in 6 months after surgery or earlier. Abdominoperineal resection was shown to be an unfavorable factor for postoperative voiding. Larger prospective study is needed to determine the long-term effect of rectal cancer surgery in relation to male and female baseline voiding condition.

Kim, Jae Heon; Noh, Tae Il; Oh, Mi Mi; Park, Jae Young; Lee, Jeong Gu; Um, Jun Won; Min, Byung Wook

2011-01-01

160

[Transanal endocopic microsurgery (TEM) in advanced rectal cancer disease treatment].  

PubMed

After Heald's revolution in 1982, who introduced the total mesorectal excision, for improve the results in terms of recurrance and survival rate, there is a need to explore new therapeutic options in treatment of sub-peritoneal rectal cancer. In particular, local excision represent more often a valid technique for non advanced rectal cancer treatment in comparison with the more invasive procedure, especially in elderly and/or in poor health patients. The introduction of TEM by Buess (transanal endoscopy microsurgery), has extended the local treatment also to classes of patients who would normally have been candidates for TME. The author gives literature's details and his experience in the use of TEM for early rectal cancer sub-peritoneal. The aim of the study is to analyze short and long term results in terms of local recurrence and survival rate comparing TEM technique with the other transanal surgery in rectal cancer treatment. Preoperative Chemio-Radio therapy and rigorous Imaging Staging are the first steps to planning surgery. It's time, for local rectal cancer, has come to make the devolution a few decades ago has been accomplished in the treatment of breast cancer PMID:21322272

Paci, Marcello; Scoglio, Daniele; Ursi, Pietro; Barchetti, Luciana; Fabiani, Bernardina; Ascoli, Giada; Lezoche, Giovanni

161

Reducing rectal injury during external beam radiotherapy for prostate cancer.  

PubMed

Rectal bleeding and faecal incontinence are serious injuries that men with prostate cancer who receive radiotherapy can experience. Although technical advances--including the use of intensity-modulated radiotherapy coupled with image-guided radiotherapy--have enabled the delivery of dose distributions that conform to the shape of the tumour target with steep dose gradients that reduce the dose given to surrounding tissues, radiotherapy-associated toxicity can not be avoided completely. Many large-scale prospective studies have analysed the correlations of patient-related and treatment-related parameters with acute and late toxicity to optimize patient selection and treatment planning. The careful application of dose-volume constraints and the tuning of these constraints to the individual patient's characteristics are now considered the most effective ways of reducing rectal morbidity. Additionally, the use of endorectal balloons (to reduce the margins between the clinical target volume and planning target volume) and the insertion of tissue spacers into the region between the prostate and anterior rectal wall have been investigated as means to further reduce late rectal injury. Finally, some drugs and other compounds are also being considered to help protect healthy tissue. Overall, a number of approaches exist that must be fully explored in large prospective trials to address the important issue of rectal toxicity in prostate cancer radiotherapy. PMID:23670182

Valdagni, Riccardo; Rancati, Tiziana

2013-05-14

162

ACR Appropriateness Criteria®??Resectable Rectal Cancer  

PubMed Central

The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

2012-01-01

163

[Supplement of CT evaluation on staging of rectal carcinoma].  

PubMed

Preoperative pelvic computed tomographic (CT) images were analyzed in 50 patients with rectal carcinoma to evaluate the depth of mural invasion. Firstly the rectum was inflated with air. Secondly cross-sectional CT images of the rectal carcinoma were taken, in all cases referring to lateral scout view films and barium enema films. The circle rate of the tumor was determined in the cross-sectional image. Perirectal changes on CT were evaluated where there were spiculated and nodular appearances. The circle rate correlated with the extent of mural invasion. In cases within 1/3 circle in the circle rate and without perirectal nodular appearance, more than 90% of the tumors were limited to the muscularis propria of the rectal wall. These findings were very useful for assessing suitable surgical treatment. PMID:1613070

Fukunaga, J

1992-06-01

164

Clinical significance of magnetic resonance imaging findings in rectal cancer  

PubMed Central

Staging of rectal cancer is essential to help guide clinicians to decide upon the correct type of surgery and determine whether or not neoadjuvant therapy is indicated. Magnetic resonance imaging (MRI) is currently one of the most accurate modalities on which to base treatment decisions for patients with rectal cancer. MRI can accurately detect the mesorectal fascia, assess the invasion of the mesorectum or surrounding organs and predict the circumferential resection margin. Although nodal disease remains a difficult radiological diagnosis, new lymphographic agents and diffusion weighted imaging may allow identification of metastatic nodes by criteria other then size. In light of this, we have reviewed the literature on the accuracy of specific MRI findings for staging the local extent of primary rectal cancer. The aim of this review is to establish a correlation between MRI findings, prognosis, and available treatment options.

Bellows, Charles F; Jaffe, Bernard; Bacigalupo, Lorenzo; Pucciarelli, Salvatore; Gagliardi, Guiseppe

2011-01-01

165

Metachronous penile metastasis from rectal cancer after total pelvic exenteration  

PubMed Central

Despite its abundant vascularization and extensive circulatory communication with neighboring organs, metastases to the penis are a rare event. A 57-year-old male, who had undergone total pelvic exenteration for rectal cancer sixteen months earlier, demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography. A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia. No other obvious recurrent site was noted except the penile lesion. Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer. A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor. The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7, which strongly supported a diagnosis of penile metastasis from the rectum. The patient is alive more than two years without any recurrence.

Kimura, Yuta; Shida, Dai; Nasu, Keiichi; Matsunaga, Hiroki; Warabi, Masahiro; Inoue, Satoru

2012-01-01

166

Laparoscopic surgery for rectal cancer: The state of the art  

PubMed Central

At present time, there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions, lower morbidity rate and earlier recovery compared to open surgery. Technical limitations and a steep learning curve have limited the wide application of mini-invasive surgery for rectal cancer. The present article discusses the current status of laparoscopic resection for rectal cancer. A review of the more recent retrospective, prospective and randomized controlled trial (RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed. A particular emphasis was dedicated to mid and low rectal cancers. Few prospective and RCT trials specifically addressing laparoscopic rectal cancer resection are currently available in the literature. Improved short-term outcomes in term of lesser intraoperative blood loss, reduced analgesic requirements and a shorter hospital stay have been demonstrated. Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin. This data however was not confirmed by other prospective comparative studies. Moreover, a similar local recurrence rate has been reported in RCT and comparative series. Similar findings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any definitive conclusions. On the basis of available data in the literature, the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence. With respect to long-term survival, a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.

Staudacher, Carlo; Vignali, Andrea

2010-01-01

167

Daily rhythms of rectal temperature and total locomotor activity in trained and untrained horses  

Microsoft Academic Search

In this study the authors evaluated the influence of physical activity on the daily rhythm of rectal temperature and total locomotor activity in untrained and trained horses. Rectal temperature and locomotor activity of 12 Italian saddle horses, 6 untrained (group A) and 6 trained (group B), was recorded for 48 h. Rectal temperature was recorded every 4 h with a

Giuseppe Piccione; Claudia Giannetto; Simona Marafioti; Stefania Casella; Francesco Fazio; Giovanni Caola

2011-01-01

168

Nitrates in Drinking Water and Risk of Death from Rectal Cancer in Taiwan  

Microsoft Academic Search

The relationship between nitrate levels in drinking water and rectal cancer development has been inconclusive. A matched case-control and nitrate ecology study was used to investigate the association between mortality attributed to rectal cancer and drinking-water nitrate exposure in Taiwan. All deaths due to rectal cancer of Taiwan residents from 1999 through 2003 were obtained from the Bureau of Vital

Hsin-Wei Kuo; Trong-Neng Wu; Chun-Yuh Yang

2007-01-01

169

Environmental factors affect colon carcinoma and rectal carcinoma in men and women differently  

Microsoft Academic Search

Background and aims Colon cancer is thought to be more closely associated with environmental factors than rectal cancer, but evidence is currently insufficient. We examined whether there are differences in the degree of environmental effect on colon cancer and rectal cancer in Japan. Methods We performed a birth cohort analysis for colon and rectal cancers using Japanese vital statistics from

Shigeyuki Nakaji; Takashi Umeda; Tadashi Shimoyama; Kazuo Sugawara; Ken Tamura; Shinsaku Fukuda; Juichi Sakamoto; Stefano Parodi

2003-01-01

170

Osmotically Induced Conductance and Capacitance Changes in in vitro Perfused Rectal Gland Tubules of Squalus acanthias  

Microsoft Academic Search

The rectal gland of Squalus acanthias is critically involved in the homeostasis of NaCl and water metabolism and hence in overall osmoregulation. In the present study, we have examined the acute responses of rectal gland slices and in vitro perfused rectal gland tubule (RGT) cells to the exposure to dilute and hypertonic peritubule solutions. Five series were performed. (i) With

I. Thiele; R. Warth; M. Bleich; S. Waldegger; F. Lang; R. Greger

1998-01-01

171

Prickly pear fruit bezoar presenting as rectal perforation in an elderly patient  

Microsoft Academic Search

Background and aims. Prickly pear fruit rectal seed bezoars are an extremely rare entity. Only nine cases of rectal seed bezoar have been reported, only one of which involved the prickly pear fruit seed. Furthermore, to our knowledge, this is also the first reported case presenting as rectal perforation.Patients and methods. We report a case of prickly pear fruit bezoar

Jordan M. Steinberg; Arieh Eitan

2003-01-01

172

Impact of Increased Body Mass Index on Laparoscopic Surgery for Rectal Cancer  

Microsoft Academic Search

Background: Laparoscopy was initially considered to be a risky procedure for rectal cancer patients, especially patients with an increased body weight. The literature is scarce regarding the effects of obesity on laparoscopic rectal surgery. The aim of the current study was to analyze the effect of an increased body mass index (BMI) on outcome of laparoscopic surgery for rectal cancer.

Tayfun Karahasanoglu; Ismail Hamzaoglu; Bilgi Baca; Erman Aytac; Ebru Kirbiyik

2011-01-01

173

Variability of Marker-Based Rectal Dose Evaluation in HDR Cervical Brachytherapy  

SciTech Connect

In film-based intracavitary brachytherapy for cervical cancer, position of the rectal markers may not accurately represent the anterior rectal wall. This study was aimed at analyzing the variability of rectal dose estimation as a result of interfractional variation of marker placement. A cohort of five patients treated with multiple-fraction tandem and ovoid high-dose-rate (HDR) brachytherapy was studied. The cervical os point and the orientation of the applicators were matched among all fractional plans for each patient. Rectal points obtained from all fractions were then input into each clinical treated plan. New fractional rectal doses were obtained and a new cumulative rectal dose for each patient was calculated. The maximum interfractional variation of distances between rectal dose points and the closest source positions was 1.1 cm. The corresponding maximum variability of fractional rectal dose was 65.5%. The percentage difference in cumulative rectal dose estimation for each patient was 5.4%, 19.6%, 34.6%, 23.4%, and 13.9%, respectively. In conclusion, care should be taken when using rectal markers as reference points for estimating rectal dose in HDR cervical brachytherapy. The best estimate of true rectal dose for each fraction should be determined by the most anterior point among all fractions.

Wang Zhou, E-mail: Zhou.Wang@RoswellPark.or [Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States); Jaggernauth, Wainwright; Malhotra, Harish K.; Podgorsak, Matthew B. [Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States)

2010-01-01

174

A Summary of Preclinical Topical Microbicide Rectal Safety and Efficacy Evaluations in a Pigtailed Macaque Model  

PubMed Central

Background There is widespread recognition of the potential promise of vaginal microbicides as a tool to combat global HIV/AIDS and STI epidemics, and candidate product development has maintained a rapid pace in recent years; however, rectal microbicide development has received less attention. As it is likely that commercial products developed for vaginal use will also be used rectally, there is a clear need to assess the safety and efficacy of candidate microbicide products specifically in the rectal compartment. Methods We have developed a standardized protocol for preclinical rectal safety and (chlamydial) efficacy assessment of topical microbicide candidates in a non-human primate model. We evaluated a total of twelve test compounds for rectal safety (via rectal pH, microflora, and rectal lavage) and one compound for efficacy against rectal chlamydial infection. Results In this paper, we describe our methods in detail and summarize our results, particularly noting the ability of our model to distinguish products with deleterious effects on the rectal environment. We also outline the specific criteria used to recommend products move into preclinical rectal efficacy trials or be recommended for reformulation to the product developer. In sum, we observed significant adverse effects in two products. The single product that underwent efficacy evaluation was not observed to be protective against rectal chlamydial infection. Conclusions A preclinical safety and efficacy model is critical to promoting rectal microbicide development, which will ultimately offer a significant opportunity for intervention in the global HIV/AIDS epidemic.

Patton, Dorothy L.; Sweeney, Yvonne T. Cosgrove; Paul, Kathleen J.

2009-01-01

175

Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions  

Microsoft Academic Search

Rectally administered medications are essential in palliative medicine, particularly in the last days of life. They are underutilized. The pharmacology of rectally administered medications relates not only to the medication but also to the suppository base, additives, drug ionization, pKa, absorptive surface of the rectum, and rectal health. The pharmacokinetics may differ from those of orally administered medications owing to

Mellar P. Davis; Declan Walsh; Susan B. LeGrand; Michael Naughton

2002-01-01

176

Repetitive sigmoid stimulation induces rectal hyperalgesia in patients with irritable bowel syndrome  

Microsoft Academic Search

BACKGROUND & AIMS: Only a fraction of patients with irritable bowel syndrome (IBS) show hypersensitivity to rectal distention. The current study sought to determine if repetitive high-pressure stimulation of sigmoid mechanoreceptors modulates perception of rectal pain and discomfort. METHODS: In 14 patients with IBS and 11 healthy controls, perception thresholds for discomfort and pain during rectal sensory tracking and verbal

J Munakata; B Naliboff; F Harraf; A Kodner; T Lembo; L Chang; DH Silverman; EA Mayer

1997-01-01

177

Rectal fist insertion. An unusual form of sexual behavior.  

PubMed

Rectal fist insertion (fist fucking) is an uncommon and potentially dangerous sexual practice. This is usually a homosexual activity, but can also be a heterosexual or an autoerotic practice. One known death has been reported associated with rectal fist insertion, in which the complications of anal and colonic tears and bleeding had occurred (see Editor's note). The possibility of drug overdose is also probable, as drugs and alcohol are commonly introduced into the rectum to promote sphincter relaxation and to ease the discomfort of anal dilatation. PMID:4072987

Shook, L L; Whittle, R; Rose, E F

1985-12-01

178

Microstructure imaging of human rectal mucosa using multiphoton microscopy  

NASA Astrophysics Data System (ADS)

Multiphoton microscopy (MPM) has high resolution and sensitivity. In this study, MPM was used to image microstructure of human rectal mucosa. The morphology and distribution of the main components in mucosa layer, absorptive cells and goblet cells in the epithelium, abundant intestinal glands in the lamina propria and smooth muscle fibers in the muscularis mucosa were clearly monitored. The variations of these components were tightly relevant to the pathology in gastrointestine system, especially early rectal cancer. The obtained images will be helpful for the diagnosis of early colorectal cancer.

Liu, N. R.; Chen, G.; Chen, J. X.; Yan, J.; Zhuo, S. M.; Zheng, L. Q.; Jiang, X. S.

2011-01-01

179

Management of stage IV rectal cancer: palliative options.  

PubMed

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease. PMID:21412493

Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

2011-02-21

180

Lumbar sympathectomy in the management of rectal tenesmoid pain.  

PubMed Central

Lumbar sympathectomy was performed in twelve patients whose main or sole complaint was rectal tenesmus resulting from pelvic carcinoma, and in whom psychotropic drugs had failed to control their symptom. Following bilateral chemical lumbar sympathectomy, ten patients achieved complete relief and one patient achieved partial relief. No patient achieving relief had recurrence of their tenesmoid pain. Patients were followed up for between three days and seven months. No complications were noted except temporary hypotension in one patient. It is concluded that lumbar sympathectomy is a safe and effective treatment for rectal tenesmus and may be the treatment of choice if pharmacological methods have failed to control this symptom.

Bristow, A.; Foster, J. M.

1988-01-01

181

Fatal cerebral air embolism following endoscopic evaluation of rectal stump.  

PubMed

A 63-year-old man underwent endoscopic evaluation of the rectal stump for rectal bleeding and suffered a massive cerebral air embolism with severe neurological impairment and subsequent death. The patient underwent a Hartmann's procedure 9 month previously for ischaemic bowel and was noted to have portal hypertension at laparotomy. We hypothesise that air entered the venous plexus around rectum and entered the azygos vein via a porto-systemic shunt and travelled retrogradely via the superior vena cava to the venous sinuses of the brain. PMID:23704447

Baban, Chwanrow Karim; Murphy, Michael; Hennessy, Tony; O'Hanlon, Deirdre

2013-05-22

182

Optimal management of small rectal cancers: TAE, TEM, or TME?  

PubMed

Total mesorectal excision (TME) remains the gold standard for rectal cancer because it provides superior oncologic outcomes compared with local excision (LE). LE can be offered as an alternative for carefully selected patients; however, it must be emphasized that even in ideal patients, LE does not achieve equivalent results regarding oncologic outcomes compared with TME. With LE, patients trade a higher cancer cure rate for a lower risk of mortality and lower morbidity. The role of chemoradiation and LE in the treatment of rectal cancer is still under study. PMID:20883951

Garcia-Aguilar, Julio; Holt, Alicia

2010-10-01

183

Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy  

Microsoft Academic Search

The results and complications of perineal rectosigmoidectomy for complete rectal prolapse in 114 patients have been reviewed. Most patients were elderly and high risk by virtue of other concurrent medical conditions. Fourteen patients (12 percent) developed significant postoperative complications. Hospital stay was short (median, four days). Ten patients were lost to follow-up. The remaining 104 patients were followed for 3

J. Graham Williams; David A. Rothenberger; Robert D. Madoff; Stanley M. Goldberg

1992-01-01

184

Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma  

Microsoft Academic Search

Purpose: Treatment results for locally recurrent rectal cancers are poor. This is a result of the fact that surgery is hampered due to the severance of the anatomical planes during the primary procedure and that radiotherapy is limited by normal tissue tolerance, especially after previous irradiation. This paper describes the results of a combined treatment modality in this patient group.Methods

Guido H. H Mannaerts; Hendrik Martijn; Mariad A Crommelin; Guido N. M Stultiëns; Wim Dries; Ocker J Repelaer van Driel; Harm J. T Rutten

1999-01-01

185

Imatinib mesylate neoadjuvant treatment for rectal malignant gastrointestinal stromal tumor  

PubMed Central

Surgical treatments including radical resection and local excision remain the main treatment for primary rectal gastrointestinal stromal tumors (GISTs). However, since patients with high-grade rectal GISTs have a higher risk of tumor recurrence and a shorter life expectancy, neoadjuvant treatment is necessary. In this case report, the efficacy of imatinib mesylate (IM) as a neoadjuvant therapy was assessed in an old man with malignant rectal GIST. The patient received IM preoperative treatment for a short period of one and a half months; at the end of the IM treatment, computed tomography scanning showed a markedly reduced tumor size and cystic changes of the tissue. At that time, a function sphincter-sparing surgery was performed. The histological examination of the resected specimen detected no tumor cells, but residual blood vessels and scattered inflammatory lymphocytes. After surgery, the patient has been followed up without additional IM treatment and remained disease-free for 57 mo. This case indicates that IM neoadjuvant therapy can dramatically improve the prognosis of rectal malignant GIST.

Hou, Ying-Yong; Zhou, Yang; Lu, Shao-Hua; Qi, Wei-Dong; Xu, Cheng; Hou, Jun; Tan, Yun-Shan

2009-01-01

186

Reassessment of rectal approach to neuropathology in childhood  

PubMed Central

A series of 93 rectal biopsies performed for diagnosis of suspected progressive neurometabolic disease between 1967 and 1973 is reviewed, and the results of this and of two previously published series totalling 307 biopsies are analysed. In GM1 and GM2 gangliosidosis, Batten's disease, and certain other neuronal storage diseases rectal biopsy is a reliable diagnostic alternative to brain biopsy. However, the need for biopsy has diminished with improvement in other diagnostic methods, particularly enzyme assay, the availability of which should determine the extent to which biopsy is used. It is suggested that rectal biopsy is necessary in the various forms of Batten's disease and in the neurovisceral storage disease with supranuclear ophthalmoplegia described by Neville et al. (1973). In certain diseases its use is unjustified, either because the result would be negative or because other less traumatic, reliable investigations are available. On rare occasions it is justifiable to use rectal biopsy either as an `excluding investigation' to exclude Batten's disease for certain in a healthy sib of a known case with this disorder or to detect the disease before onset of clinical symptoms. The need for a full thickness biopsy and for a full range of staining methods is emphasized. Without these the investigation cannot be expected to give diagnostic information and may be misleading, giving `false negative' results. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6

Brett, E. M.; Lake, B. D.

1975-01-01

187

Solitary rectal ulcer syndrome in children: A literature review  

PubMed Central

Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less in children. It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding, copious mucus discharge, feeling of incomplete defecation, and rarely rectal prolapse. SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings. The current treatments are suboptimal, and despite correct diagnosis, outcomes can be unsatisfactory. Some treatment protocols for SRUS include conservative management such as family reassurance, regulation of toilet habits, avoidance of straining, encouragement of a high-fiber diet, topical treatments with salicylate, sulfasalazine, steroids and sucralfate, and surgery. In children, SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases, however, it is being reported more than in the past. This condition in children is benign; however, morbidity is an important problem as reflected by persistence of symptoms, especially rectal bleeding. In this review, we discuss current diagnosis and treatment for SRUS.

Dehghani, Seyed Mohsen; Malekpour, Abdorrasoul; Haghighat, Mahmood

2012-01-01

188

Recurrent acute renal failure due to a rectal villous adenoma.  

PubMed Central

A case is reported in which a rectal villous adenoma was complicated by severe fluid and electrolyte depletion producing recurrent renal failure. The pathophysiology of the depletion syndrome and its complications are discussed. Successful management by acute haemodialysis and early surgical resection of the tumour is described.

Williams, B.; Pearson, H. J.; Barrie, W. W.; Walls, J.

1988-01-01

189

Visual diagnosis: Rectal foreign body: A primer for emergency physicians  

PubMed Central

We present a case that is occasionally seen within emergency departments, namely a rectal foreign body. After presentation of the case, a discussion concerning this entity is given, with practical information on necessity of an accurate and thorough history and removal of the object for clinicians.

2011-01-01

190

Response of gastric fundus to rectal distension in healthy persons  

Microsoft Academic Search

We aimed to record fundic motor activity in man using the barostat to ascertain if fundic motility is affected by rectal distension. The distal ends of two barostat tubes were placed in the gastric fundus and rectum in 10 healthy volunteers. The gastric bag was first inflated to a constant pressure level that recorded phasic motor activity as changes in

Jaime Zighelboim; Nicholas J. Talley; Sidney F. Phillips

1994-01-01

191

Central Processing of Rectal Pain: A Functional MR Imaging Study  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Although the central processing of somatic pain has been dealt with in numerous brain imaging studies, the neural correlates of visceral pain have re- ceived much more limited attention. Our goal was to assess the feasibility of detecting brain activation patterns induced by rectal pain by means of functional MR imaging. We hypothe- sized that the cerebral

Monica V. Baciu; Bruno L. Bonaz; Emmanuel Papillon; Richard A. Bost; Jean-Francois Le Bas; Jacques Fournet; Christoph M. Segebarth

192

Response of gastric fundus to rectal distension in healthy persons.  

PubMed

We aimed to record fundic motor activity in man using the barostat to ascertain if fundic motility is affected by rectal distension. The distal ends of two barostat tubes were placed in the gastric fundus and rectum in 10 healthy volunteers. The gastric bag was first inflated to a constant pressure level that recorded phasic motor activity as changes in volume of the air-filled bag. Baseline motor activity was recorded before, during, and after a 15-min period of constant rectal distension that was clearly perceived by all subjects but was not painful. In all subjects, continuous phasic volume changes, reflecting fundic motor activity, were recorded at a rate of 1-3/min. During rectal distension, a consistent change in mean contractile force of these phasic volume events was not detected; a decrease of more than 30% occurred in only three subjects. We conclude that fundic phasic volume changes are recordable by the barostat, but these are not substantially inhibited by rectal distension. PMID:8026254

Zighelboim, J; Talley, N J; Phillips, S F

1994-07-01

193

Rectal sensory perception in females with obstructed defecation  

Microsoft Academic Search

PURPOSE: Parasympathetic afferent nerves are thought to mediate rectal filling sensations. The role of sympathetic afferent nerves in the mediation of these sensations is unclear. Sympathetic nerves have been reported to mediate nonspecific sensations in the pelvis or lower abdomen in patients with blocked parasympathetic afferent supply. It has been reported that the parasympathetic afferent nerves are stimulated by both

M. J. Gosselink; W. R. Schouten

2001-01-01

194

[Rectal cancer--review of methods and treatment results].  

PubMed

Rectal cancer poses a significant worldwide problem. Until the late 19 century surgeons were convinced that surgical attempts of treating rectal cancers were doomed to failure. Currently, surgery is associated with a poor prognosis, a high likelihood of permanent colostomy and a high rate of local recurrence in patients with regional disease. Functional changes such as bladder dysfunction and impotence remain distressingly common consequences of conventional surgery. An important understanding of rectal cancer pathology allied to modern surgical techniques such as intestinal stapling guns has led to an increased number of sphincter saving operations. The technique of sharp dissection along definable planes known as total mesorectal excision (TME) produces the complete resection of an intact package of the rectum and surrounding mesorectum, enveloped within the visceral pelvic fascia with uninvolved circumferential margins. As a result of TME, 5-year survival figures have risen from 45-50% to 78%, local recurrence rates have declined from 30% to 5-8%, sphincter preservation has risen by at least 20%, and the rates of bladder dysfunction and impotence have declined from 50-70% to 15%. In some selected cases transanal techniques with or without radiotherapy have improved the success of local excision. The value of laparoscopic surgery for rectal cancer in terms of cancer outcome can only be assessed by large clinical trials with sufficient follow-up. PMID:15190612

Grotowski, Maciej

2004-03-01

195

Rectal salmon calcitonin for the treatment of postmenopausal osteoporosis  

Microsoft Academic Search

In a 2-year study, we examined bone mass and calcium metabolism in 36 elderly women with moderate osteoporosis. The study period comprised 1 year of observation, during which the women received no treatment affecting calcium metabolism, and 1 year of treatment, during which all participants received daily salmon calcitonin (sCT) 100 IU rectally and calcium 500 mg. During the observational

Kirsten Overgaard; Marc Allan Hansen; Karen-Lisbeth Dirksen; Claus Christiansen

1992-01-01

196

Calcipotriol inhibits rectal epithelial cell proliferation in ulcerative proctocolitis.  

PubMed Central

Vitamin D3 reduces human rectal crypt cell production rate (CCPR) and may thereby protect against colorectal cancer. Cell turnover is increased in ulcerative proctocolitis, which might therefore respond to vitamin D3 metabolites. This study investigated the effect of calcipotriol, a synthetic vitamin D3 analogue that avoids hypercalcaemia, on human rectal CCPR in ulcerative proctocolitis. Paired rectal biopsy specimens from seven patients with severe disease were established in organ culture with or without calcipotriol (1 x 10(-6) M). After 15 hours, vincristine (0.6 microgram/ml) was added to induce metaphase arrest, and CCPR was determined by linear regression analysis of accumulated metaphases. Compared with values in 17 controls with incidental anal conditions, median rectal CCPR was 28% higher in ulcerative proctocolitis: 5.90 (5.00-9.50) v 4.80 (2.85-7.07) cells/crypt/hour (p < 0.01). Calcipotriol reduced CCPR by 62% in patients with ulcerative proctocolitis, from 5.90 (5.00-9.50) to 2.21 (0.81-3.22) cells/crypt/hour (median with range) p < 0.01. Thus calcipotriol can dampen the hyperproliferative state in ulcerative proctocolitis and could have a therapeutic role in the control of this inflammatory condition.

Thomas, M G; Nugent, K P; Forbes, A; Williamson, R C

1994-01-01

197

Single-Access Laparoscopic Rectal Surgery Is Technically Feasible  

PubMed Central

Introduction. Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments. Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications. Settings and Design. Prospective study. Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5?cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules. Statistical Analysis Used. Mean, minimum–maximum. Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.

Sirikurnpiboon, Siripong; Jivapaisarnpong, Paiboon

2013-01-01

198

Rectal hydrocortisone during stress in patients with adrenal insufficiency  

PubMed Central

OBJECTIVE—Patients with glucocorticoid deficiency need lifelong glucocorticoid replacement treatment. During acute stressful events, steroid dosage must be increased several times, which is often problematical in children. This study investigated the reliability of rectal hydrocortisone administration as an alternative to the intramuscular route.?STUDY DESIGN—Serum cortisol was assessed during stress in normal children to determine the concentration that should be achieved after rectal hydrocortisone. Subsequently, serum cortisol concentrations were measured three hours after administering a suppository containing hydrocortisone 100 mg/m2 to 57 patients with adrenocortical insufficiency. In eight patients, the time dependency of the cortisol rise after rectal administration was established.?RESULTS—In 51 previously healthy children admitted to hospital with an acute stressful condition, the mean serum cortisol concentration was 1092 nmol/l. Rectal hydrocortisone in patients with adrenocortical insufficiency resulted in a mean serum cortisol concentration of 1212 nmol/l three hours after insertion of the suppository containing hydrocortisone. In 14 of 57 children, serum cortisol was < 1000 nmol/l and in eight children it was below 600 nmol/l. One hour after administration, the mean cortisol concentration had reached 1000 nmol/l. This was sustained for more than four hours.?CONCLUSION—Rectal hydrocortisone is a safe alternative to parenteral administration in the self management of Addisonian prone conditions. However, because eight of 57 children did not achieve concentrations > 600 nmol/l, its use is recommended only after previously documenting an adequate serum cortisol concentration three hours after receiving a test dose.??

De Vroede, M; Beukering, R; Spit, M; Jansen, M

1998-01-01

199

Rectal Dose and Source Strength of the High-Dose-Rate Iridium-192 Both Affect Late Rectal Bleeding After Intracavitary Radiation Therapy for Uterine Cervical Carcinoma  

SciTech Connect

Purpose: The purpose of this study was to reconfirm our previous findings that the rectal dose and source strength both affect late rectal bleeding after high-dose-rate intracavitary brachytherapy (HDR-ICBT), by using a rectal dose calculated in accordance with the definitions of the International Commission on Radiation Units and Measurements Report 38 (ICRU{sub RP}) or of dose-volume histogram (DVH) parameters by the Groupe Europeen de Curietherapie of the European Society for Therapeutic Radiology and Oncology. Methods and Materials: Sixty-two patients who underwent HDR-ICBT and were followed up for 1 year or more were studied. The rectal dose for ICBT was calculated by using the ICRP{sub RP} based on orthogonal radiographs or the DVH parameters based on computed tomography (CT). The total dose was calculated as the biologically equivalent dose expressed in 2-Gy fractions (EQD{sub 2}). The relationship between averaged source strength or the EQD{sub 2} and late rectal bleeding was then analyzed. Results: When patients were divided into four groups according to rectal EQD{sub 2} ({>=} or =} or <2.4 cGy.m{sup 2}.h{sup -1}), the group with both a high EQD{sub 2} and a high source strength showed a significantly greater probability of rectal bleeding for ICRU{sub RP}, D{sub 2cc}, and D{sub 1cc}. The patients with a median rectal dose above the threshold level did not show a greater frequency of rectal bleeding unless the source strength exceeded 2.4 cGy.m{sup 2}.h{sup -1}. Conclusions: Our results obtained with data based on ICRU{sub RP} and CT-based DVH parameters indicate that rectal dose and source strength both affect rectal bleeding after HDR-ICBT.

Isohashi, Fumiaki, E-mail: isohashi@radonc.med.osaka-u.ac.j [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Yoshioka, Yasuo [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Koizumi, Masahiko [Division of Medical Physics, Oncology Center, Osaka University Hospital, Osaka (Japan)

2010-07-01

200

Rectal bleeding after high-dose-rate brachytherapy combined with hypofractionated external-beam radiotherapy for localized prostate cancer: Impact of rectal dose in high-dose-rate brachytherapy on occurrence of grade 2 or worse rectal bleeding  

SciTech Connect

Purpose: To evaluate the incidence of Grade 2 or worse rectal bleeding after high-dose-rate (HDR) brachytherapy combined with hypofractionated external-beam radiotherapy (EBRT), with special emphasis on the relationship between the incidence of rectal bleeding and the rectal dose from HDR brachytherapy. Methods and Materials: The records of 100 patients who were treated by HDR brachytherapy combined with EBRT for {>=}12 months were analyzed. The fractionation schema for HDR brachytherapy was prospectively changed, and the total radiation dose for EBRT was fixed at 51 Gy. The distribution of the fractionation schema used in the patients was as follows: 5 Gy x 5 in 13 patients; 7 Gy x 3 in 19 patients; and 9 Gy x 2 in 68 patients. Results: Ten patients (10%) developed Grade 2 or worse rectal bleeding. Regarding the correlation with dosimetric factors, no significant differences were found in the average percentage of the entire rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose from EBRT between those with bleeding and those without. The average percentage of the entire rectal volume receiving 10%, 30%, 50%, 80%, and 90% of the prescribed radiation dose from HDR brachytherapy in those who developed rectal bleeding was 77.9%, 28.6%, 9.0%, 1.5%, and 0.3%, respectively, and was 69.2%, 22.2%, 6.6%, 0.9%, and 0.4%, respectively, in those without bleeding. The differences in the percentages of the entire rectal volume receiving 10%, 30%, and 50% between those with and without bleeding were statistically significant. Conclusions: The rectal dose from HDR brachytherapy for patients with prostate cancer may have a significant impact on the incidence of Grade 2 or worse rectal bleeding.

Akimoto, Tetsuo [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan)]. E-mail: takimoto@showa.gunma-u.ac.jp; Katoh, Hiroyuki [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Kitamoto, Yoshizumi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Tamaki, Tomoaki [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Harada, Kosaku [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Shirai, Katsuyuki [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan)

2006-06-01

201

Aneuploidy-Dependent Massive Deregulation of the Cellular Transcriptome and Apparent Divergence of the Wnt\\/B-catenin Signaling Pathway in Human Rectal Carcinomas  

Microsoft Academic Search

To identify genetic alterations underlying rectal carcinogen- esis, we used global gene expression profiling of a series of 17 locally advanced rectal adenocarcinomas and 20 normal rectal mucosa biopsies on oligonucleotide arrays. A total of 351 genes were differentially expressed (P < 1.0e7) between normal rectal mucosa and rectal carcinomas, 77 genes had a >5-fold difference, and 85 genes always

Marian Grade; B. Michael Ghadimi; Sudhir Varma; Richard Simon; Danny Wangsa; Linda Barenboim-Stapleton; Torsten Liersch; Heinz Becker; Thomas Ried; Michael J. Difilippantonio

2006-01-01

202

Rectal toxicity profile after transperineal interstitial permanent prostate brachytherapy: Use of a comprehensive toxicity scoring system and identification of rectal dosimetric toxicity predictors  

SciTech Connect

Purpose: To better understand rectal toxicity after prostate brachytherapy, we employed the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0), a comprehensive system with distinct and separately reported gastrointestinal adverse event items (unlike Radiation Therapy Oncology Group morbidity scoring), to evaluate item-specific postimplant rectal toxicities. Methods and Materials: We analyzed 135 patients treated with brachytherapy {+-} hormonal therapy, using CTCAE v3.0 to score acute/late rectal toxicities (median follow-up, 41 months). Dosimetric parameters were evaluated for ability to predict toxicities. Results: Use of CTCAE yielded a novel rectal toxicity profile consisting of diarrhea, incontinence, urgency, proctitis, pain, spasms, and hemorrhage event rates. No item had a <5% Grade 1-2 acute toxicity rate (except spasms). Rectal dosimetry predicted late toxicities: for diarrhea, 5% Grade 1 toxicity rate for %V{sub 25} (percent of rectal volume receiving 25% of prescribed prostate dose) {<=} 25% vs. 60% for %V{sub 25} > 25% (p < 0.001); for maximum toxicity, 10% Grade 1 toxicity rate for %V{sub 1} {<=} 40% vs. 44% for %V{sub 1} > 40% (p = 0.007). Conclusions: A comprehensive understanding of item-specific postimplant rectal toxicities was obtained using CTCAE. Rectal %V{sub 25} > 25% and %V{sub 1} > 40% predicted worse late diarrhea and maximum toxicity, respectively.

Shah, Jinesh N. [Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, NY (United States); Ennis, Ronald D. [Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, NY (United States)]. E-mail: rennis@chpnet.org

2006-03-01

203

Study of the mechanism of rectal motility: the 'mass squeeze contraction'.  

PubMed

The motor physiology of the rectum has remained largely obscure, especially concerning the mechanism of rectal motility. In the current communication we tested the possibility of characterizing the mechanism of rectal motility during filling and evacuation through the study of the rectal electric activity in 16 healthy volunteers (mean age 43.6 +/- 10.8 years; 11 men). Two monopolar silver-silver chloride electrodes were introduced per annum and fixed to the rectal mucosa by suction. The rectum was distended in 10 ml increments of water by means of a balloon-ended catheter inserted into the rectum. The rectal pressure was measured by one catheter placed above and a second one below the rectal balloon, and the 2 catheters were connected to 2 strain gauge pressure transducers. Regular triphasic slow waves or pacesetter potentials (PPs) were recorded from the 2 electrodes at rest. PPs were superimposed or followed randomly by action potentials (APs). APs but not PPs were coupled with elevated rectal pressure. Rectal distension with 10 ml of water caused no significant changes of the rectal pressure or EMG activity. Distension with a mean volume of 27.3 +/- 4.7 ml effected a significant increase (p < 0.05) of the rectal electromechanical activity proximally to the balloon and a decrease distally (p < 0.05) to it. With progressive increase of the rectal distension, the electromechanical activity continued to increase proximally and to decrease distally to the balloon, until, at a mean distending volume of 76.3 +/- 3.7 ml, the balloon was dispelled to the exterior. In conclusion, the identification of the modality of rectal motility during defecation was feasible by recording the rectal electromechanical activity. The rectal contraction is suggested to occur in a 'mass squeeze manner' which squeezes the rectal contents aborally into the anal canal. The recognition of the rectal motor modality appears to be important for the understanding of rectal motility disorders. However, further studies are required to confirm these findings. PMID:11935382

Shafik, A; El-Sibai, O; Mostafa, R M; Shafik, I

2001-12-01

204

[Anal squamous cell carcinoma synchronous with rectal adenocarcinoma].  

PubMed

Most often colorectal carcinoma occurs single; synchronous multiple carcinomas usually develop at widely disparate sites. We report the case of a 75-year-old male, accusing rectal bleeding, disturbances in bowel transit and weight loss. The rectoscopy examination revealed a fungating, bleeding tumor located 5 cm from anal verge. Pathological diagnostic of the endo-biopsy was ulcerated moderate differentiated adenocarcinoma. Patient underwent surgical amputation of the rectum with lymphadenectomy. Microscopical examination of the surgical specimens confirmed the presence of the adenocarcinoma adjacent to a squamous cell carcinoma, moderate differentiated, with reduced keratinization, infiltrative. Also, 2 from the 7 lymph nodes presented squamous cell carcinoma metastases. The most important differential diagnostic is a rectal adenosquamous carcinoma. Prognostic depends on stage of the disease, generally being worse than of the corresponding adenocarcinoma, and can be improved by radio- and chemotherapy. PMID:16004220

Danciu, M; Ferariu, D; Teleman, S; Mihailovici, Maria-Sultana

205

The Role of EUS in Rectal Cancer and Fecal Incontinence  

Microsoft Academic Search

\\u000a Endoscopic ultrasound (EUS) has emerged as an important imaging tool used in the locoregional staging of rectal cancer and\\u000a assists in selecting patients with advanced disease that may benefit from neoadjuvant therapy. Studies have shown EUS to have\\u000a a T staging accuracy of 80–95% and an N staging accuracy of 70–80%. EUS with fine needle aspiration (EUS-FNA) may improve\\u000a accuracy

Uzma D. Siddiqui; Harry R. Aslanian

206

Emergency department management of retained rectal foreign bodies.  

PubMed

A plastic toothbrush case was removed from the rectum of a prison inmate in the emergency department using a rigid sigmoidoscope and a fogarty catheter. The patient was subsequently discharged from the emergency department. Previous literature regarding rectal foreign bodies has emphasized inpatient treatment and tended to ignore the potential value of the emergency service. Guidelines for selecting appropriate patients for emergency department management are presented and basic principles for safe outpatient removal are reviewed. PMID:3291887

Wigle, R L

1988-07-01

207

Clinical Course of Rectal Bleeding Following I-125 Prostate Brachytherapy  

Microsoft Academic Search

Purpose: Despite the occurrence of some rectal complications in most large series of patients treated with radiation, there is surprisingly little information regarding their management. We report here the clinical course of such patients after I-125 brachytherapy, in an effort to help delineate a rational management policy.Methods and Materials: 109 patients with stage T1 to T2 prostatic carcinoma and Gleason

Kenneth Hu; Kent Wallner

1998-01-01

208

Ulcerative colitis: Rectal dilations in a patient with refractory diarrhea  

Microsoft Academic Search

A 45-year-old man with an eight-year history of ulcerative colitis was evaluated for severe, nonbloody diarrhea. Symptoms, which began two years earlier, were characterized by 15 bowel movements per day, accompanied by urgency and incontinence. A reduced rectal compliance was measured at manometry. All conventional treatments were not able to modify the symptoms despite improvement of inflammatory colonic lesions. PURPOSE:

G. Frieri; E. Ligas; B. Perugini; L. Onori; A. Marcheggiano; R. Caprilli

1995-01-01

209

Sphincter Preservation for Distal Rectal Cancer: Paradise Lost?  

Microsoft Academic Search

In this issue of the Annals of Surgical Oncology , Dr. Steele and colleagues report the long awaited results of the only multi-institutional prospective controlled trial of sphincter-sparing treatment for distal rectal carcinoma in the literature. The objectives of the study were clearly delineated and included: (1) determination of whether survival of patients with T1 and T2 adenocarcinomas who are

Nicholas J. Petrelli; Thomas K. Weber

1999-01-01

210

Rapid Dissemination of SIV Follows Multisite Entry after Rectal Inoculation  

PubMed Central

Receptive ano-rectal intercourse is a major cause of HIV infection in men having sex with men and in heterosexuals. Current knowledge of the mechanisms of entry and dissemination during HIV rectal transmission is scarce and does not allow the development of preventive strategies. We investigated the early steps of rectal infection in rhesus macaques inoculated with the pathogenic isolate SIVmac251 and necropsied four hours to nine days later. All macaques were positive for SIV. Control macaques inoculated with heat-inactivated virus were consistently negative for SIV. SIV DNA was detected in the rectum as early as four hours post infection by nested PCR for gag in many laser-microdissected samples of lymphoid aggregates and lamina propria but never in follicle-associated epithelium. Scarce SIV antigen positive cells were observed by immunohistofluorescence in the rectum, among intraepithelial and lamina propria cells as well as in clusters in lymphoid aggregates, four hours post infection and onwards. These cells were T cells and non-T cells that were not epithelial cells, CD68+ macrophages, DC-SIGN+ cells or fascin+ dendritic cells. DC-SIGN+ cells carried infectious virus. Detection of Env singly spliced mRNA in the mucosa by nested RT-PCR indicated ongoing viral replication. Strikingly, four hours post infection colic lymph nodes were also infected in all macaques as either SIV DNA or infectious virus was recovered. Rapid SIV entry and dissemination is consistent with trans-epithelial transport. Virions appear to cross the follicle-associated epithelium, and also the digestive epithelium. Viral replication could however be more efficient in lymphoid aggregates. The initial sequence of events differs from both vaginal and oral infections, which implies that prevention strategies for rectal transmission will have to be specific. Microbicides will need to protect both digestive and follicle-associated epithelia. Vaccines will need to induce immunity in lymph nodes as well as in the rectum.

Pretet, Jean-Luc; Michel-Salzat, Alice; Messent, Valerie; Bogdanova, Anna; Couedel-Courteille, Anne; Souil, Evelyne; Cheynier, Remi; Butor, Cecile

2011-01-01

211

Update on neoadjuvant strategies for rectal cancer patients  

Microsoft Academic Search

Neoadjuvant treatment is becoming the standard for T3-4 (distal T2) rectal adenocarcinoma. Phase III ongoing clinical trials\\u000a will yield the definition of optimal concurrent chemoradiotherapy protocol. Phase II trials will test new medical treatments\\u000a (targeted biotherapy) and innovative radiation technique (contact radiotherapy). Most importantly, phase II and III trials\\u000a will address the question of new strategies using neoadjuvant approach to

Jean-Pierre Gérard; Eric François

2007-01-01

212

Three-Year Experience With Rectal Prolapse Patients  

PubMed Central

Background Rectal prolapse (RP) is a rare condition characterized by rectums protrusion through the anus with all of its layers. RP is a condition deteriorating the quality of life. Although more than 100 surgical procedures were described so far for the treatment of RP, the ideal treatment method still remains unclear. In this study, demographical data and clinical results of 13 patients who were treated at our clinic for RP for a period of 3 years were retrospectively studied, with the aim of comparing with the results of other repair methods mentioned in the literature. Methods Total of 13 patients admitted to the general surgery unit and the emergency units between January 2008 and December 2010 were included in the study. All of the cases were treated by modified Notoras technique using various synthetic materials. Results Of the patients, 8 were male, and 5 were female. Average age was 45.6 years (range: 23 - 79 years), and the average hospitalization time was 11.3 days (range: 3 - 19 days), with the symptom time being an average of 12 years (range: 1 - 30 years). All patients having complaints described mass prolapsing from the anal canal during defecation, rectal pain, and constipation. Six of our patients also had complaints of rectal bleeding. Average follow-up time was 24 months. No recurrence and mortality were monitored in patients who were followed. Conclusions The main purposes in the surgical treatment of RP were to control the prolapse, and to achieve continence and remedy constipation. We believe that the modified Notoras technique made using synthetic materials the most suitable one compared to other rectopexy methods in the treatment of RP because it is safe and easily applicable. Keywords Rectal prolapse; Rectopexy; Modified Notoras technique

Ozgonul, Abdullah; Uzunkoy, Ali; Sogut, Ozgur; Yalcin, Metin

2010-01-01

213

Necrotizing soft-tissue infection from rectal abscess  

Microsoft Academic Search

Rectal abscess may result in necrotizing soft-tissue infection including fasciitis, myositis, and extraperitoneal dissection\\u000a of pus without muscle necrosis. The presentation and therapy of ten patients treated over the past six years are reviewed.\\u000a \\u000a Early recognition of rapidly spreading infection was imperative. The mortality rate of 40 per cent correlated with the degree\\u000a of sepsis present at admission. The high

Philip Huber; Alfred S. Kissack; C. Thomas Simonton

1983-01-01

214

Factors influencing sexual function in patients with rectal cancer  

Microsoft Academic Search

Only few studies have investigated the impact of surgery for rectal cancer on sexual function. Little of that research included quality of life (QoL) aspects and hardly any study analyzed the impact of age, gender and type of surgery on sexual function. The aim of the presented study was to address these issues. Over a 5 y period, EORTC-QLQ-C-30 and

C E Schmidt; B Bestmann; T Küchler; B Kremer

2005-01-01

215

New prospects in the conservative treatment of rectal cancer  

Microsoft Academic Search

Conservative treatment of rectal cancer is applicable only to limited tumors that are assumed to have no lymphatic spread;\\u000a these are well or moderately well differentiated adenocarcinomas confined to the bowel wall, without palpable pararectal metastatic\\u000a lymph nodes. The experience of intracavitary irradiation (contact x-ray therapy often combined with iridium 192 implant),\\u000a based on 245 patients followed for more than

Jean Papillon

1984-01-01

216

Frequency of HER-2 positivity in rectal cancer and prognosis.  

PubMed

In patients with advanced rectal cancer (cUICC II and III) multimodality therapy resulted in better long-term local tumor control. Ongoing clinical trials are focusing on therapy intensification to improve disease-free (DFS) and cancer-specific survival (CSS), the integration of biomarkers for prediction of individual recurrence risk, and the identification of new targets. In this context, we investigated HER-2, a member of the epidermal growth factor receptor family, whose expression pattern and role was unclear in rectal cancer. A total of 264 patients (192 male, 72 female; median age 64 y) received standardized multidisciplinary treatment according to protocols of phase II/III trials of the German Rectal Cancer Study Group. HER-2 status was determined in pretherapeutic biopsies and resection specimens using immunohistochemistry scoring and detection of silver in situ hybridization amplification. Tumors with an immunohistochemistry score of 3 or silver in situ hybridization ratios of ?2.0 were classified HER-2 positive; these results were correlated with clinicopathologic parameters [eg, resection (R) status, nodal status ((y)pN)], DFS, and CSS. Positive HER-2 status was found in 12.4% of biopsies and in 26.7% of resected specimens. With a median follow-up of 46.5 months, patients with HER-2 positivity showed in trend a better DFS (P=0.1) and a benefit in CSS (P=0.03). The 5-year survival rate was 96.0% (HER-2 positive) versus 80.0% (HER-2 negative). In univariate and multivariate analyses, HER-2 was an independent predictor for CSS (0.02) along with the (y)pN status (P<0.00001) and R status (P=0.011). HER-2 amplification is detectable in a relevant proportion (26.7%) of rectal cancer patients. For the development of innovative new therapies, HER-2 may represent a promising target and should be further assessed within prospective clinical trials. PMID:23282976

Conradi, Lena-Christin; Styczen, Hanna; Sprenger, Thilo; Wolff, Hendrik A; Rödel, Claus; Nietert, Manuel; Homayounfar, Kia; Gaedcke, Jochen; Kitz, Julia; Talaulicar, Recca; Becker, Heinz; Ghadimi, Michael; Middel, Peter; Beissbarth, Tim; Rüschoff, Josef; Liersch, Torsten

2013-04-01

217

Complications of Loop Ileostomy Closure in Patients with Rectal Tumor  

Microsoft Academic Search

Background  Loop ileostomy is customary after very low rectal anastomosis to reduce the rate of pelvic sepsis that can result from anastomotic\\u000a leakage. To evaluate complications of stoma closure is important to maximize the benefit of making the defunctioning stoma.\\u000a The aim of this study was to examine possible risk factors associated with complications, especially wound infections, after\\u000a loop ileostomy closure

Takashi Akiyoshi; Yoshiya Fujimoto; Tsuyoshi Konishi; Hiroya Kuroyanagi; Masashi Ueno; Masatoshi Oya; Toshiharu Yamaguchi

2010-01-01

218

A comparison of N-butylscopolammonium and lidocaine for control of rectal pressure in horses.  

PubMed

In its FDA approved formulation, N-butylscopolammonium bromide (Buscopan Injectable Solution, Boehringer Ingelheim Vetmedica) is an anticholinergic spasmolytic agent indicated for management of abdominal pain associated with spasmodic colic, flatulent colic, and simple impactions in horses. Use of this drug ablates gastrointestinal peristalsis and rectal pressure. It ahs been suggested that N-butylscopolammonium bromide could be used to facilitate rectal examinations in horses. This study compared the effects of N-butylscopolammonium bromide versus lidocaine and a saline control on rectal pressure and the number of rectal strains during rectal examination. The results of this study indicate that this drug increases the quality and, presumably, the safety of rectal examinations in horses. PMID:17039447

Luo, Tong; Bertone, Joseph J; Greene, Holly M; Wickler, Steven J

2006-01-01

219

[Primitive ano-rectal neuralgia. Atypical cases (author's transl)].  

PubMed

In a new statistic concerning 245 cases of primary ano-rectal neuralgia, it can be seen that the schematic classical classification derived from Thaysen, Theile, and Bensaude must be maintained (proctalgia fugax: 45 cases; coccygodynia: 44 cases; ano-rectal neuralgia: 95 cases), partially integrating unusual cases of pruritus ani. Among the 4 principle etiologies, while not underestimating the neuropsychical and intestinal factors (constipation, laxatives), the importance of two other factors must be underlined (the urogenital factor, and particularly, the role of menopause, and important pelvic operations (33 cases) often overestimated; rachidian factors: tendomyositis (Garrigues), pseudoradicular factor. The interest of this study is to show that besides these typical cases (81,7%), a number of atypical cases exist, which have often been under-estimated. These cases can be classified in intermediary (4%), associated (10%), alternating (3,3%) cases, in the course of which the different syndromes replace each other or seem superposed. It must be underlined that the notion of these primitive ano-rectal neuralgias must be inserted in the much larger class of perineal urinary, gynecological or bone and ligament neuralgias. The classification remains opened. An etiopathogenical treatment must be installed, that rejects all regional or surgical aggressive acts when not absolutely necessary, and underlines the importance of massage, internal (levator ani), or external (Maigne's technique, attentive and repeated sessions of rachidian massage).U PMID:6280309

Duhamel, J; Garrigues, J M; Romand-Heuyer, Y; Robert, R; Longgreen, C

1982-02-18

220

Rectal strictures: treatment with fluoroscopically guided balloon dilation.  

PubMed

The authors performed 25 fluoroscopically guided balloon dilation procedures in nine patients with rectal strictures. In all cases, the stricture developed after rectal surgery. Four patients underwent ileoanal anastomosis after total colectomy for various conditions; five patients underwent rectosigmoid end-to-end anastomosis after resection of a tumor or as treatment for diverticulitis. Maximal stricture dilatation was attained in 20 instances with a single 15-30-mm balloon. In five procedures, two balloons (20 or 15 mm) were inflated simultaneously ("kissing balloons" technique) to dilate the strictures. In five patients, only one dilation procedure was required for effective treatment of the strictures, with no clinical evidence of strictures after follow-up of 1.5-56 months (mean, 29.5 months). In the other four patients, multiple procedures were performed: nine in one patient, five in one patient, and three in two patients. In these patients, no recurrent symptoms developed during follow-up of 1.25-18 months (mean, 8.1 months) after the last dilation. Complicating leaks, infection, or hemorrhage did not occur after any of the procedures. Fluoroscopically guided balloon dilation is a safe and effective procedure for the treatment of rectal strictures. PMID:1987611

de Lange, E E; Shaffer, H A

1991-02-01

221

Prediction of rectal temperature from ear canal temperature.  

PubMed

Personal heat strain monitoring provides the best means for maximizing worker safety and productivity in hot jobs. The present study compared methods for reducing the environmental effect on aural canal temperature in an attempt to reduce the predictive error of a personal heat stress monitor (QST) and a simple ear thermistor (EAR). Subjects underwent three exposures in impermeable protective clothing (PC) in an environment of 30.1 degrees C wet bulb globe temperature (WBGT) wearing either ear plugs (PLG), ear moulds (MLD) or ear moulds and earmuffs (MFS). Mean work time across all trials was 63.1 +/- 7.9 min, with a mean rectal temperature at 60 min of 38.5 +/- 0.1 degrees C and a sweat production rate of 29.7 +/- 8.6 g/min. Rectal temperature was used as the criterion measure of core temperature. Although group mean predictions were satisfactory, large SD of mean differences (+/- 0.36) meant that predictive ability of QST for individuals was greatly impaired. A simple well-insulated ear thermistor showed slightly better accuracy (+/- 0.28) as a predictor of rectal temperature across time, particularly at peak temperatures. Incorporating the predictive error of aural temperature still extended the duration of safe work times relative to ACGIH guidelines. Further investigation is still necessary to ensure that predictions based on aural temperature are accurate and safe for the worker population across varying conditions. PMID:11693247

Muir, I H; Bishop, P A; Lomax, R G; Green, J M

2001-09-15

222

Local staging of rectal cancer: the current role of MRI  

PubMed Central

With the advent of powerful gradient coil systems and high-resolution surface coils, magnetic resonance imaging (MRI) has recently extended its role in the staging of rectal cancer. MRI is superior to endorectal ultrasound, the most widely used staging modality in patients with rectal tumors, in that it visualizes not only the intestinal wall but also the surrounding pelvic anatomy. The crucial advantage of MRI is not that it enables exact T-staging but precise evaluation of the topographic relationship of a tumor to the mesorectal fascia. This fascia is the most important anatomic landmark for the feasibility of total mesorectal excision, which has evolved into the standard operative procedure for the resection of cancer located in the middle or lower third of the rectum. MRI is currently the only imaging modality that is highly accurate in predicting whether or not it is likely that a tumor-free margin can be achieved and thus provides important information for planning of an effective therapeutic strategy, especially in patients with advanced rectal cancer.

Rogalla, Patrik; Taupitz, Matthias

2006-01-01

223

Superiority of laparoscopic rectal surgery: Towards a new era  

PubMed Central

While laparoscopic colon surgery has been established to some degree over this decade, laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field, the lack of precise anatomy of the pelvis, immature procedures of rectal transaction and so on. On the other hand, maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness. However, some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes. This review article discusses how to keep a clear operative field, removing normally existing abdominal structures, and how to transact the rectum and restore the discontinuity based on anatomical investigations. According to this review, laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far, actually entering a new era.

Fukunaga, Yosuke

2011-01-01

224

A New Technique for Laparoscopic Anterior Resection for Rectal Endometriosis  

PubMed Central

Background: Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endometriosis. We describe a completely laparoscopic approach as a new way of excising rectal endometriosis that can be used without opening any part of the rectum. This avoids opening the abdomen or any risk of fecal spillage. Methods: The patient received preoperative oral bowel preparation. Ureteric stents (6 F) were inserted cystoscopically. The peritoneum in the ovarian fossae was opened lateral to any disease and the rectum reflected off the back of the cervix, leaving any endometriosis on the front of the rectum. The pelvic peritoneum was reflected medially, below the level of the ureters. The mesorectum was then dissected off a 6-cm length of rectum by using a Harmonic scalpel. A circular end-to-end anastomosis instrument was passed anally until the outline of the anvil was visible, inside the colon, above the diseased rectum. The anvil was detached and held by a soft grasper before the rectum was then divided above and below the disease using a laparoscopic stapling device. The tip of the anvil was pushed through the proximal end of the colon allowing reanastomosis of the rectal stump. Conclusion: The patient was discharged after 5 days without complications.

English, James; Miles, W. F. Anthony; Giannopoulos, Theo

2005-01-01

225

Putting rectal 5-aminosalicylic acid in its place: the role in distal ulcerative colitis  

Microsoft Academic Search

Oral aminosalicylates such as sulfasalazine and mesalamine are widely prescribed for the treatment of mild or moderately active distal ulcerative colitis. However, a critical review of the literature demonstrates that rectal 5-aminosalicylic acid (5-ASA) is the optimal therapy for this disease. Meta-analyses of published trials show that rectally delivered 5-ASA is superior to placebo and to conventional rectal corticosteroids in

John K. Marshall; E. Jan Irvine

2000-01-01

226

Geometric modeling, functional parameter calculation, and visualization of the in-vivo distended rectal wall  

Microsoft Academic Search

The rectum can distend to accommodate stool, and contracts in response to distention during defecation. Rectal motor dysfunctions are implicated in the pathophysiology of functional defecation disorders and fecal incontinence. These rectal motor functions can be studied by intra-luminal measurements of pressure by manometry, or combined with volume during rectal balloon distention. Pressure-volume (p-v) relationships provide a global index of

Clifton R. Haider; Armando Manduca; Jon J. Camp; Joel G. Fletcher; Richard A. Robb; Adil E. Bharucha

2006-01-01

227

Successful treatment of endoscopically unmanageable rectal varices by balloon-occluded antegrade transvenous sclerotherapy followed by microcoil embolization.  

PubMed

The present report describes two cases of endoscopically unmanageable rectal varices that were treated by balloon-occluded antegrade transvenous sclerotherapy (BATS) followed by microcoil embolization. Follow-up endoscopy confirmed eradication of the rectal varices. Balloon-occluded rectal venography showed stasis of contrast material and sclerosing agent for 30 minutes in both cases of rectal varices, which indicated that the inflow vessel was a single dilated superior rectal vein without other minor inflow vessels. BATS appears to be a feasible therapeutic option for the treatment of rectal varices of this hemodynamic type. PMID:23973026

Minamiguchi, Hiroki; Kawai, Nobuyuki; Sato, Morio; Ikoma, Akira; Sanda, Hiroki; Nakata, Kouhei; Tanaka, Takami; Nakai, Motoki; Sonomura, Tetsuo

2013-09-01

228

Fermentation of mucin by bifidobacteria from rectal samples of humans and rectal and intestinal samples of animals  

Microsoft Academic Search

Bifidobacteria (246 strains in total) were isolated from rectal samples of infants and adult humans and animals, and from\\u000a intestinal samples of calves. Twenty-five strains grew well on mucin: 20 from infants, two from adults, and three from goatlings.\\u000a Poor or no growth on mucin was observed in 156 bifidobacterial strains of animal origin. The difference between human and\\u000a animal

J. Killer; M. Marounek

2011-01-01

229

Retained rectal foreign body with rectal perforation; a complication of the traditional management of haemorrhoids: a case report.  

PubMed

Retained rectal foreign bodies are most commonly seen in homosexuals and after assault. A few have been reported after self-treatment of anorectal conditions and prostatic massage. Harmful traditional medical practices have been reported in many communities in Africa but therapeutic anal insertion of foreign bodies for the management of haemorrhoids is rare. We present a patient with features of peritonitis following insertion of a wine bottle into his rectum in an attempt to manage his prolapsed haemorrhoids. PMID:24065516

Olaoye, Iyiade Olatunde; Adensina, Micheal Dapo

2013-09-24

230

Which endoscopic treatment is the best for small rectal carcinoid tumors?  

PubMed Central

The incidence of rectal carcinoids is rising because of the widespread use of screening colonoscopy. Rectal carcinoids detected incidentally are usually in earlier stages at diagnosis. Rectal carcinoids estimated endoscopically as < 10 mm in diameter without atypical features and confined to the submucosal layer can be removed endoscopically. Here, we review the efficacy and safety of various endoscopic treatments for small rectal carcinoid tumors, including conventional polypectomy, endoscopic mucosal resection (EMR), cap-assisted EMR (or aspiration lumpectomy), endoscopic submucosal resection with ligating device, endoscopic submucosal dissection, and transanal endoscopic microsurgery. It is necessary to carefully choose an effective and safe primary resection method for complete histological resection.

Choi, Hyun Ho; Kim, Jin Su; Cheung, Dae Young; Cho, Young-Seok

2013-01-01

231

Akt Inhibitor MK2206 in Treating Patients With Previously Treated Colon or Rectal Cancer That is Metastatic or Cannot Removed by Surgery  

ClinicalTrials.gov

Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Recurrent Colon Cancer; Recurrent Rectal Cancer; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Stage IIIA Colon Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

2013-08-19

232

In vivo real-time rectal wall dosimetry for prostate radiotherapy.  

PubMed

Rectal balloons are used in external beam prostate radiotherapy to provide reproducible anatomy and rectal dose reductions. This is an investigation into the combination of a MOSFET radiation detector with a rectal balloon for realtime in vivo rectal wall dosimetry. The MOSFET used in the study is a radiation detector that provides a water equivalent depth of measurement of 70 microm. Two MOSFETs were combined in a face-to-face orientation. The reproducibility, sensitivity and angular dependence were measured for the dual MOSFET in a 6 MV photon beam. The dual MOSFET was combined with a rectal balloon and irradiated with hypothetical prostate treatments in a phantom. The anterior rectal wall dose was measured in real time and compared with the planning system calculated dose. The dual MOSFET showed angular dependence within +/-2.5% in the azimuth and +2.5%/-4% in the polar axes. When compared with an ion chamber measurement in a phantom, the dual MOSFET agreed within 2.5% for a range of radiation path lengths and incident angles. The dual MOSFET had reproducible sensitivity for fraction sizes of 2-10 Gy. For the hypothetical prostate treatments the measured anterior rectal wall dose was 2.6 and 3.2% lower than the calculated dose for 3DCRT and IMRT plans. This was expected due to limitations of the dose calculation method used at the balloon cavity interface. A dual MOSFET combined with a commercial rectal balloon was shown to provide reproducible measurements of the anterior rectal wall dose in real time. The measured anterior rectal wall dose agreed with the expected dose from the treatment plan for 3DCRT and IMRT plans. The dual MOSFET could be read out in real time during the irradiation, providing the capability for real-time dose monitoring of the rectal wall dose during treatment. PMID:20571209

Hardcastle, Nicholas; Cutajar, Dean L; Metcalfe, Peter E; Lerch, Michael L F; Perevertaylo, Vladimir L; Tomé, Wolfgang A; Rosenfeld, Anatoly B

2010-07-01

233

Anterior Resection for Rectal Cancer With Mesorectal Excision  

PubMed Central

Objective: This study aims to review the operative results and oncological outcomes of anterior resection for rectal and rectosigmoid cancer. Comparison was made between patients with total mesorectal excision (TME) for mid and distal cancer and partial mesorectal excision (PME) for proximal cancer, when a 4- to 5-cm mesorectal margin could be achieved. Risk factors for local recurrence and survival were also analyzed. Summary Background Data: Anterior resection has become the preferred treatment option rectal cancer. TME with sharp dissection has been shown to be associated with a low local recurrence rate. Controversies still exist as to the need for TME in more proximal tumor. Methods: Resection of primary rectal and rectosigmoid cancer was performed in 786 patients from August 1993 to July 2002. Of these, 622 patients (395 men and 227 women; median age, 67 years) underwent anterior resection. The technique of perimesorectal dissection was used. Patients with mid and distal rectal cancer were treated with TME while PME was performed for those with more proximal tumors. Prospective data on the postoperative results and oncological outcomes were reviewed. Risk factors for anastomotic leakage, local recurrence, and survival of the patients were analyzed with univariate and multivariate analysis. Results: The median level of the tumor was 8 cm from the anal verge (range, 2.5–20 cm) and curative resection was performed in 563 patients (90.5%). TME was performed in 396 patients (63.7%). Significantly longer median operating time, more blood loss, and a longer hospital stay were found in patients with TME. The overall operative mortality and morbidity rates were 1.8% and 32.6%, respectively, and there were no significant differences between those of TME and PME. Anastomotic leak occurred in 8.1% and 1.3% of patients with TME and PME, respectively (P < 0.001). Independent factors for a higher anastomotic leakage rate were TME, the male gender, the absence of stoma, and the increased blood loss. The 5-year actuarial local recurrence rate was 9.7%. The advanced stage of the disease and the performance of coloanal anastomosis were independent factors for increased local recurrence. The 5-year cancer-specific survival was 74.5%. The independent factors for poor survival were the advanced stage of the disease and the presence of lymphovascular and perineural invasion. Conclusions: Anterior resection with mesorectal excision is a safe option and can be performed in the majority of patients with rectal cancer. The local recurrence rate was 9.7% and the cancer-specific survival was 74.5%. When the tumor requires a TME, this procedure is more complex and has a higher leakage rate than in those higher tumors where PME provides adequate mesorectal clearance. By performing TME in patients with mid and distal rectal cancer, the local control and survival of these patients are similar to those of patients with proximal cancers where adequate clearance can be achieved by PME.

Law, Wai Lun; Chu, Kin Wah

2004-01-01

234

Preoperative radiotherapy for rectal adenocarcinoma: Which are strong prognostic factors?  

SciTech Connect

Purpose: This retrospective 12-year study evaluated the prognostic value of initial and postoperative staging of rectal tumors. Methods and Materials: Between 1985 and 1996, 297 patients were treated with preoperative radiotherapy (39 Gy in 13 fractions) and surgery for Stage T2-T4N0-N1M0 rectal adenocarcinoma. Pretreatment staging included a clinical examination and endorectal ultrasonography (EUS) since 1988. Clinical staging was performed by digital rectal examination and rigid proctoscopy. EUS was performed in 236 patients. Postoperative staging was performed by examination of the pathologic specimen. Results: The median follow-up was 49 months. The overall 5-year survival rate was 67%, with a local failure rate of 9%. The rate of sphincter preservation was 65%. The clinical examination findings were strong prognostic factor for both cT stage (p < 0.001) and cN stage (p < 0.006) but had poor specificity for cN stage (only 25 lymph nodes detected). In both univariate and multivariate analyses, EUS had a statistically significant prognostic value for uT (p < 0.014) but not for uN (p < 0.47) stage. In contrast, pT and pN stages were strong prognostic factors (p < 0.001 and p < 0.001, respectively). Conclusion: Pretreatment staging, including clinical examination and EUS, seemed accurate enough to present a high prognostic value for the T stage. EUS was insufficient to stage lymph node involvement. Owing to its lack of specificity, uN stage was not a reliable prognostic factor. An improvement in N staging is necessary and essential. Despite downstaging, postoperative staging remained a very strong prognostic factor for both T and N stages.

Chapet, Olivier [Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite (France)]. E-mail: ochapet@med.umich.edu; Romestaing, Pascale [Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite (France); Mornex, Francoise [Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite (France); Souquet, Jean-Christophe [Department of Gastroenterology, Croix Rousse Hospital, Lyon (France); Favrel, Veronique [Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite (France); Ardiet, Jean-Michel [Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite (France); D'Hombres, Anne [Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite (France); Gerard, Jean-Pierre [Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite (France)

2005-04-01

235

Generic Planning Target Margin for Rectal Cancer Treatment Setup Variation  

SciTech Connect

Purpose: To calculate the generic planning target margin (GPTM) for patients receiving radiation therapy (RT) for rectal cancer placed in a prone position with a customized cradle for small-bowel exclusion. Methods and Materials: A total of 25 consecutive rectal cancer patients were treated for 25 or 28 fractions in a prone position using a cradle to maximize small bowel exclusion. Treatment planning computed tomography (CT) scans were used to create orthogonally digitally reconstructed radiographs (DRRs) for portal image registration, which were compared with daily portal images from an electronic portal-imaging device (EPID). Translation values needed to align the DRRs and EPIDs were recorded for the superior to inferior (SI), right to left (RL), and anterior to posterior (AP) directions, and used to calculate the GPTM using the four-parameter model. Age, weight, and body mass index were tested compared with the setup variation using a Pearson correlation and a t test for significance. Gender versus setup variation was compared with a t test. Results: A total of 1,723 EPID images were reviewed. The GPTM was 10 mm superior, 8 mm inferior, 7 mm RL and 10 mm AP. Age and gender were unrelated to setup variation. Weight was significantly associated with systematic AP variation (p < 0.05). BMI was significantly associated with systematic SI (p < 0.05) and AP (p < 0.01) variation and random RL variation (p < 0.05). Conclusions: The GPTM for rectal cancer is asymmetric with a maximum of 10 mm in the superior, anterior and posterior dimensions. Body mass index may effect setup variation. Research using advanced treatment planning should include these margins in the planning target volume definition.

Robertson, John M. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)], E-mail: jrobertson@beaumont.edu; Campbell, Jonathon P.; Yan Di [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

2009-08-01

236

Metformin use and improved response to therapy in rectal cancer  

PubMed Central

Locally advanced rectal cancer is commonly treated with chemoradiation prior to total mesorectal excision (TME). Studies suggest that metformin may be an effective chemopreventive agent in this disease as well as a possible adjunct to current therapy. In this study, we examined the effect of metformin use on pathologic complete response (pCR) rates and outcomes in rectal cancer. The charts of 482 patients with locally advanced rectal adenocarcinoma treated from 1996 to 2009 with chemoradiation and TME were reviewed. Median radiation dose was 50.4 Gy (range 19.8–63). Nearly, all patients were treated with concurrent 5-fluorouracil-based chemotherapy (98%) followed by adjuvant chemotherapy (81.3%). Patients were categorized as nondiabetic (422), diabetic not taking metformin (40), or diabetic taking metformin (20). No significant differences between groups were found in clinical tumor classification, nodal classification, tumor distance from the anal verge or circumferential extent, pretreatment carcinoembryonic antigen level, or pathologic differentiation. pCR rates were 16.6% for nondiabetics, 7.5% for diabetics not using metformin, and 35% for diabetics taking metformin, with metformin users having significantly higher pCR rates than either nondiabetics (P = 0.03) or diabetics not using metformin (P = 0.007). Metformin use was significantly associated with pCR rate on univariate (P = 0.05) and multivariate (P = 0.01) analyses. Furthermore, patients taking metformin had significantly increased disease-free (P = 0.013) and overall survival (P = 0.008) compared with other diabetic patients. Metformin use is associated with significantly higher pCR rates as well as improved survival. These promising data warrant further prospective study.

Skinner, Heath D.; Crane, Christopher H.; Garrett, Christopher R.; Eng, Cathy; Chang, George J.; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Kelly, Patrick; Sandulache, Vlad C.; Delclos, Marc E.; Krishnan, Sunil; Das, Prajnan

2013-01-01

237

Luminal and humoral influences on human rectal epithelial cytokinetics.  

PubMed Central

Multiple genetic and environmental steps may underpin the development of human colorectal neoplasia, and experimental evidence suggests that promoters of colorectal cancer also induce colorectal epithelial cell hyperplasia. In vitro crypt cell production rate (CCPR) was measured to determine the effect of calcium, epidermal growth factor (EGF), vitamin D3 metabolites and synthetic analogues on human rectal epithelial cell proliferation. In a double-blind trial of oral calcium supplementation, CCPR was reduced by 49% in patients with familial adenomatous polyposis (FAP), but there was no effect on established neoplasia. In control tissue, the active form of vitamin D3 (1,25(OH)2D3) reduced rectal CCPR by 57% at 1 microM, 55% at 10 nM and 45% at 100 pM. Likewise, in tissue taken from patients with FAP, 1,25(OH)2D3 reduced CCPR by 52%. Vitamin D3 has profound effects on calcium metabolism, but synthetic analogues can avoid these. The effects of a synthetic analogue (MC-903) on human rectal CCPR were therefore studied. MC-903 (10(-7) M) reduced CCPR in control tissue by 51%, and in FAP tissue by 52% at 10(-6) M and 51% at 10(-7) M. In addition, MC-903 and a related analogue, EB 1089, produced a clear-cut dose-dependent inhibition of both HT-29 and Caco2 colorectal cancer cells maintained in culture. Hence, vitamin D3 and its analogues can reduce the rate of cell proliferation in normal, premalignant and malignant colorectal epithelial cells and might therefore have future therapeutic uses as chemoprotective or chemotherapeutic agents. Lastly, EGF increases CCPR by 102% in FAP tissue that expresses the EGF receptor.(ABSTRACT TRUNCATED AT 250 WORDS)

Thomas, M. G.

1995-01-01

238

Transanal Excision with Radiation Therapy for Rectal Adenocarcinoma  

PubMed Central

Objective To evaluate the efficacy of transanal excision (TAE) combined with radiotherapy for rectal adenocarcinoma, assess the ability of pretreatment endoscopic ultrasound (EUS) to predict failures, and determine the prognostic value of downstaging and complete pathological response. Design Retrospective outcomes study. Setting Radiation oncology clinic. Participants Thirty-eight patients with rectal adenocarcinoma. Methods The medical records of patients treated with radiotherapy from 1998 to 2008 and followed for a median of 5.9 years were reviewed. Results Kaplan-Meier estimates of freedom from selected endpoints at 5 years after treatment were: overall survival, 79%; cause-specific survival, 91%; local control, 90%; and freedom from distant metastasis, 76%. Seven patients (21%) had eventual abdominoperineal resection or lower anterior resection, four patients had local recurrence, and three patients had incomplete treatment or poor margins. T3 lesions clinically staged by EUS were a predictor of local failure (P=0.0110), but not distant metastasis (P=0.35). Patients with either a pathological or clinical T3 lesion did not have a significantly greater rate of metastasis (P=0.096). Patients who were downstaged did not have a significantly different rate of local recurrence or metastasis. Patients who experienced a complete pathological response did not have a significantly different rate of local control or distant metastasis. Conclusion Patients with early-stage rectal lesions who undergo preoperative or postoperative radiation and TAE have similar outcomes to those who undergo abdominoperineal resection; local recurrence was higher for patients with T3 lesions when both were compared. Abdominal surgery should be considered for these patients. TAE is reasonable when patients are unwilling or unable to tolerate the morbidity of traditional transabdominal surgery.

Tennyson, Nathan; Mendenhall, William M.; Morris, Christopher G.; Huang, Emina H.; Zlotecki, Robert A.

2012-01-01

239

Phase II Study of Preoperative Helical Tomotherapy for Rectal Cancer  

SciTech Connect

Purpose: To explore the efficacy and toxicity profile of helical tomotherapy in the preoperative treatment of patients with rectal cancer. Patients and Methods: Twenty-four patients with T3/T4 rectal cancer were included in this nonrandomized noncontrolled study. A dose of 46 Gy in daily fractions of 2 Gy was delivered to the presacral space and perineum if an abdominoperineal resection was deemed necessary. This dose was increased by a simultaneous integrated boost to 55.2 Gy when the circumferential resection margin was less than 2 mm on magnetic resonance imaging. Acute toxicity was evaluated weekly. Metabolic response was determined in the fifth week after the end of radiotherapy by means of fluorodeoxyglucose-positron emission tomography scan. A metabolic response was defined as a decrease in maximal standardized uptake value of more than 36%. Results: The mean volume of small bowel receiving more than 15 Gy and mean bladder dose were 227 ml and 20.8 Gy in the no-boost group and 141 ml and 21.5 Gy in the boost group. Only 1 patient developed Grade 3 enteritis. No other Grade 3 or 4 toxicities were observed. Two patients developed an anastomotic leak within 30 days after surgery. The metabolic response rate was 45% in the no-boost group compared with 77% in the boost group. All except 1 patient underwent an R0 resection. Conclusions: Helical tomotherapy may decrease gastrointestinal toxicity in the preoperative radiotherapy of patients with rectal cancer. A simultaneous integrated radiation boost seems to result in a high metabolic response rate without excessive toxicity.

Ridder, Mark de [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium)], E-mail: mark.deridder@uzbrussel.be; Tournel, Koen M.S. [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Nieuwenhove, Yves van [Department of Surgery, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Engels, Benedikt [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Hoorens, Anne [Department of Pathology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Everaert, Hendrik [Department of Nuclear Medicine, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Beeck, Bart op de [Department of Radiology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Vinh-Hung, Vincent [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); De Greve, Jacques [Department of Medical Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Delvaux, Georges [Department of Surgery, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Verellen, Dirk; Storme, Guy A. [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium)

2008-03-01

240

The rectal trumpet: Use of a nasopharyngeal airway to contain fecal incontinence in critically ill patients  

Microsoft Academic Search

Objective: Our objective was to determine if a nasopharyngeal airway (rectal trumpet) could be used as a fecal containment device with less trauma than traditional devices, such as a fecal incontinence pouch or balloon rectal catheter. Design: A single-subject clinical series was used. Setting and Subjects: A nonrandom sample of critically ill adult and geriatric patients (n = 22) with

Tracy A. Grogan; David J. Kramer

2002-01-01

241

SwiftLase: a new technology for char-free ablation in rectal surgery  

NASA Astrophysics Data System (ADS)

We describe layer-by-layer char-free ablation of hemorrhoids and other rectal lesions at very low CO2 laser power levels with a miniature `SwiftLaser' optomechanical flashscanner. Increased speed with excellent control, very shallow thermal damage, and less postoperative pain are the main advantages of the flashscan technology in rectal surgery.

Arnold, David A.

1995-05-01

242

Local and Systemic Immune Responses to Rectal Administration of Recombinant Cholera Toxin B Subunit in Humans  

PubMed Central

The induction of immune responses to rectally administered recombinant cholera toxin B subunit (CTB) in humans was studied. Three immunizations induced high levels of CTB-specific antibody-secreting cells, particular of the immunoglobulin A isotype, in both rectum and peripheral blood. Antitoxin antibody responses in rectal secretions and serum were also found.

Jertborn, Marianne; Nordstrom, Inger; Kilander, Anders; Czerkinsky, Cecil; Holmgren, Jan

2001-01-01

243

Improved survival of patients with rectal cancer since 1980: a population-based study  

Microsoft Academic Search

The treatment of rectal cancer has changed over the last two decades as far as surgical techniques and radiotherapy are concerned. We studied the changes in patterns of care for patients with rectal cancer and the effect on prognosis. All patients with cancer of the rectum or rectosigmoid in South-east Netherlands, diagnosed in the period of 1980–2000, were included in

H. Martijn; A. C. Voogd; L. V. van de Poll-Franse; O. J. Repelaer van Driel; H. J. T. Rutten; J. W. W. Coebergh

2003-01-01

244

A Case of a Mucinous Adenocarcinoma Arising from a Rectal Diverticulum  

PubMed Central

The occurrence of an adenocarcinoma arising from a rectal diverticulum that causes mechanical ileus is very rare. Recently, we diagnosed a case of a mucinous adenocarcinoma in a rectal diverticulum after an emergent abdominal perineal resection and permanent colostomy by laparotomy. Here, we present a case report and a review of the literature.

Kwon, Jang Hoon; Chang, Woo-Sung; Nam, Ki-Ho; Han, Myoung Sik; Ahn, Jae Hong; Han, Sang Hak; Cheon, Gab Jin

2012-01-01

245

High intensity focused ultrasound (HIFU) for the treatment of rectal tumors: a feasibility study  

Microsoft Academic Search

A rigid ultrasound probe is under development for combined imaging and ablation of rectal tumors with high intensity focused ultrasound (HIFU). To test the device and to assess safety and efficacy of this technology, a canine model was developed by inducing rectal pseudotumors. These animals were imaged by ultrasound and treated with HIFU. The gross pathology and microscopic histology examinations

N. T. Sanghvi; R. Hawes; K. Kopecky; F. Gress; S. Ikenberry; O. Cummings; S. Zaidi; C. Hennige

1994-01-01

246

Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer  

Microsoft Academic Search

AIM: To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US). METHODS: Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from

Bao-Jun Zhou; Wei-Qing Song; Qing-Hui Yan; Jian-Hui Cai; Feng-An Wang; Jin Liu; Guo-Jian Zhang; Guo-Qiang Duan; Zhan-Xue Zhang; Zhou BJ; Wang FA; Liu J; Duan GQ

2008-01-01

247

Aggressive surgical management of recurrent rectal cancer—Is it worthwhile?  

Microsoft Academic Search

OBJECTIVE: The purpose of this study was to determine whether radical surgery in appropriately selected patients who have recurrent rectal cancer can produce significant disease-free survival. PATIENTS AND METHODS: This is a retrospective review of the management of all patients presenting with recurrent local and metastatic rectal cancer at a single institution during an 11-year period. RESULTS: Of 489 patients

Olagunju A. Ogunbiyi; Kevin McKenna; Elisa H. Birnbaum; James W. Fleshman; Ira J. Kodner

1997-01-01

248

A simple device for prostate and rectal localization in radiation therapy  

Microsoft Academic Search

A simple device for prostate and rectum localization in radiation therapy may be constructed as follows: first, dental wax is used to make up a shape of the rectal probe. Second, dental stone is used to make a two-piece mold by molding the dental wax probe. Third, using the mold, the rectal probe is made from a mixture of silicone

Stephen Kishel; Anthony K. Ho; Claudio H. Sibata; Richard Russo; Kyu H. Shin

1995-01-01

249

Rectal wall contractility in response to an evoked urge to defecate in patients with obstructed defecation  

Microsoft Academic Search

PURPOSE: The aim of this study was to examine rectal sensory perception and rectal wall contractility in response to an evoked urge to defecate and to identify differences between control subjects and patients with obstructed defecation. METHODS: Twenty control patients (10 men; median age, 47 (range, 17–78) years) and 29 female patients with disabling obstructed defecation (median age, 48 (range,

William R. Schouten; Manon J. Gosselink; Michiel O. Boerma; Abida Z. Ginai

1998-01-01

250

Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence  

Microsoft Academic Search

The relation between sensory perception of rapid balloon distension of the rectum and the motor responses of the rectum and external and internal anal sphincters in 27 normal subjects and 16 patients with faecal incontinence who had impaired rectal sensation but normal sphincter pressures was studied. In both patients and normal subjects, the onset and duration of rectal sensation correlated

W M Sun; N W Read; P B Miner

1990-01-01

251

Combined preoperative radiation and mitomycin\\/5-fluorouracil treatment for locally advanced rectal adenocarcinoma  

Microsoft Academic Search

Background: In the treatment of locally advanced rectal carcinoma, radiation therapy before surgery has been shown to decrease local recurrence rates, but has minimal effect on survival. Recently, chemotherapy in combination with preoperative radiation therapy has been shown to be effective for certain malignancies. We postulated that such combination therapy might improve the resectability of advanced rectal cancer.Study Design: During

Stephen J Burke; Bernard A Percarpio; David C Knight; Edward M Kwasnik

1998-01-01

252

Laparoscopic suture rectopexy without resection is effective treatment for full-thickness rectal prolapse  

Microsoft Academic Search

PURPOSE: The study was undertaken to evaluate the role of laparoscopic suture rectopexy without resection as a safe and effective treatment for full-thickness rectal prolapse. METHOD: Data were prospectively collected and analyzed on 25 patients who underwent laparoscopic rectopexy without resection for full-thickness rectal prolapse between October 1994 and July 1998. Four patients had conversions from laparoscopic to open surgery.

S. M. Heah; J. E. Hartley; J. Hurley; G. S. Duthie; J. R. T. Monson

2000-01-01

253

Prospective Study of Factors Affecting Postoperative Pain and Symptom Persistence After Stapled Rectal Mucosectomy for Hemorrhoids  

Microsoft Academic Search

PURPOSE: The purpose of the study was to determine the variables associated with postoperative pain and the clinical response of patients with uncomplicated hemorrhoidal disease treated with stapled rectal mucosectomy in the medium term. METHODS: Patients with Grade II to IV, uncomplicated hemorrhoidal disease who underwent stapled rectal mucosectomy were prospectively included. The basal characteristics of the population were evaluated

José M. Correa-Rovelo; Oscar Tellez; Leoncio Obregón; Ximena Duque-López; Adriana Miranda-Gómez; Raúl Pichardo-Bahena; Manuel Mendez; Segundo Moran

2003-01-01

254

Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention  

Microsoft Academic Search

PurposeAfter total mesorectal excision (TME) for rectal cancer, pathology is standardized with margin status as a predictor for recurrence. This has yet to be implemented after transanal endoscopic microsurgery (TEM) and was investigated prospectively for T1 rectal adenocarcinomas.

E. J. R. De Graaf; P. G. Doornebosch; R. A. E. M. Tollenaar; E. Meershoek-Klein Kranenbarg; A. C. de Boer; F. C. Bekkering

2009-01-01

255

Single nucleotide polymorphism array analysis of chromosomal instability patterns discriminates rectal adenomas from carcinomas  

Microsoft Academic Search

Total mesorectal excision (TME) is the standard treatment for rectal cancer, while transanal endoscopic microsurgery (TEM) is a recently introduced surgical approach for the treatment of rectal adenomas. Incorrect preoperative staging before TEM is a problem. To identify genetic changes that might correlate with tumour stage and could lead to optimized treatment selection we performed a genome-wide chromosomal instability search

EH Lips; EJ de Graaf; RAEM Tollenaar; R van Eijk; J Oosting; K Szuhai; T Karsten; Y Nanya; S Ogawa; CJ van de Velde; PHC Eilers; Tom van Wezel; H Morreau

2007-01-01

256

Laparoscopy-Assisted Low Anterior Resection with a Prolapsing Technique for Low Rectal Cancer  

Microsoft Academic Search

Laparoscopy-assisted low anterior resection (LAR) for low rectal cancer is a difficult procedure, presenting problems with rectal washout, selecting the appropriate distal transection line, and achieving safe anastomosis. To resolve these problems, we used a prolapsing technique to perform laparoscopy-assisted LAR. Total mesorectal excision (TME) is performed laparoscopically. The proximal colon is transected laparoscopically with the aid of an endoscopic

Masaki Fukunaga; Akio Kidokoro; Toshiaki Iba; Kazuyoshi Sugiyama; Tetu Fukunaga; Kunihiko Nagakari; Masaru Suda; Seiichiro Yoshikawa

2005-01-01

257

Ultrastructural organization of the rectal pads in adult Stenophylax permistus McL. (Trichoptera)  

Microsoft Academic Search

The epithelium of the rectal sac in S. permistus is organized to form numerous circular pads. Each pad consists of about ten large cells covered by a cuticle and surrounded by sheath cells that form a barrier isolating the rectal pad. The largest cells (cortical cells), with long microvilli in the apical region and numerous structural complexes formed by the

Fernanda Cianficconi; Carla Corallini Sorcetti; Giampaolo Moretti; Romano Dallai

1985-01-01

258

Lymph Node Metastases of Prostatic Adenocarcinoma in the Mesorectum in Patients with Rectal Cancer  

PubMed Central

Lymph node involvement is the most important prognostic factor of rectal cancer. Cancer originating from sites other than the rectum rarely metastasizes to the mesorectal lymph node. We report a rectal cancer patient with a synchronous metastatic prostatic carcinoma to the mesorectal lymph node.

Park, In Ja; Kim, Hee Cheol; Yu, Chang Sik; Kim, Choung Soo; Kim, Jung Sun

2005-01-01

259

The Effective and Efficient Management of Patients with Rectal Bleeding to Identify the Few with Cancer  

Microsoft Academic Search

There are currently insufficient resources to fully investigate all patients with rectal bleeding to exclude the small possibility of cancer, and this is the dominant factor in developing strategies for the management of rectal bleeding. However, even if there were unlimited resources it may not be desirable to investigate all patients because the small risks associated with the investigative procedure

Michael R. Thompson; Edwin T. Swarbrick; Brian G. Ellis; Iona C. Heath; L. Faulds Wood; Wendy S. Atkin

260

Study on the Relationship between Lymphatic Vessel Density and Distal Intramural Spread of Rectal Cancer  

Microsoft Academic Search

Background: The smallest safe margin of distal clearance for lower rectal cancer is very important for the operation. In a previous study, a few factors were found to play a role in distal intramural spread (DIS), but there are few data regarding the influence of lymphangiogenesis. We studied the relationship between lymphatic vessel density (LVD) and DIS of rectal cancer,

W. Chen; W. Shen; M. Chen; G. Cai; X. Liu

2007-01-01

261

Prioritisation of patients with rectal bleeding for urgent outpatient colonoscopy—a pilot study  

Microsoft Academic Search

Aim Rectal bleeding is a common symptom in general practice and may be associated with colorectal neoplasia. Waiting-lists for outpatient colonoscopies and first specialist appointments are long. The aim of our study was to determine the value of presenting signs and symptoms in prioritising patients with rectal bleeding for urgent colonoscopy. Method Patients were asked to fill out a 'Bowel

Akanksha Bhargava; Ali Aldameh; Joanna Stewart; Andrew G Hill

262

Rectal cancer in Luxembourg : a national population-based data report, 1988–1998  

Microsoft Academic Search

BACKGROUND: Morphologic criteria which might help to support the need for a preventive strategy for early detection of rectal cancer were analysed. Population-based data on rectal adenomas with high-grade dysplastic changes (n = 199) and invasive adenocarcinomas (n = 912) registered by the national Morphologic Tumour Registry (MTR) and diagnosed in a central department of pathology in Luxembourg between 1988

René Scheiden; Julien Sand; Joseph Weber; Philippe Turk; Yolande Wagener; Catherine Capesius

2003-01-01

263

Rectal administration of diazepam in solution in the acute treatment of convulsions in infants and children  

Microsoft Academic Search

In a prospective study 44 children, aged 6 months to 5 years, admitted to hospital with febrile convulsions or epilepsy, were treated with diazepam in solution administered rectally during 59 generalised attacks. Rectal administration of diazepam was effective in the acute treatment of convulsions in 80% of cases. In 10% the treatment failed, whereas diazepam administered intravenously had prompt effect;

F U Knudsen

1979-01-01

264

Results of ileal J-pouch-anal anastomosis in familial adenomatous polyposis complicated by rectal carcinoma  

Microsoft Academic Search

PURPOSE: Rectal cancer frequently occurs in patients with familial adenomatous polyposis (FAP) and, in some cases, proctocolectomy and ileal pouch-anal anastomosis (IPAA) can be proposed as an alternative to end ileostomy. This study aimed to assess the results of IPAA for familial adenomatous polyposis complicated by rectal carcinoma. PATIENTS AND METHODS: Postoperative morbidity and bowel function following IPAA were assessed

Christophe Penna; Emmanuel Tiret; Frederic Daude; Rolland Parc

1994-01-01

265

Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children  

Microsoft Academic Search

Parasitic infestations, mainly enterobiasis and amoebiasis, and poor toilet training practices are commonly associated with rectal prolapse in developing countries. Injection sclerotherapy is one of the commonly used modalities for treating partial rectal prolapse in children. Various materials are available for such injection, but each has its advantages and complications. Comparing different materials used in the treatment of such pathology

M. A. Baky Fahmy; Sahar Ezzelarab

2004-01-01

266

Artemisinin kinetics and dynamics during oral and rectal treatment of uncomplicated malaria  

Microsoft Academic Search

Objective: To compare parasite clearance times after oral and rectal administration of artemisinin in adults with uncomplicated malaria and to relate pharmacodynamics with artemisinin kinetics and to disclose any pharmacokinetic changes during treatment.Methods: Thirty male Vietnamese patients with falciparum malaria were randomized to treatment with 500 mg artemisinin daily by either the oral or rectal route of administration. Parasite densities

Michael Ashton; Nguyen Duy Sy; Nguyen Van Huong; Toufigh Gordi; Trinh Ngoc Hai; Dinh Xuan Huong; Nguyen Thi Niêu; Le Dinh Công

1998-01-01

267

Cellular and molecular biology of chloride secretion in the shark rectal gland: Regulation by adenosine receptors  

Microsoft Academic Search

Cellular and molecular biology of chloride secretion in the shark rectal gland: Regulation by adenosine receptors. The rectal gland of the dogfish shark (Squalus acanthias) is a sodium chloride secreting epithelial organ whose function was discovered in 1959 by Wendell Burger. The gland, composed of homogenous tubules of a single cell type, is an important model for secondary active chloride

John N Forrest

1996-01-01

268

[Rectal prolapse. Abdominal or perineal approach? Current situation].  

PubMed

Rectal prolapse is a major challenge for the surgeon who has to resolve the anatomical problem and the functional disturbances in the same procedure. Abdominal procedures are the most appropriate in young patients, and the most common technique is rectopexia with or without resection. The use of mesh or sutures provides the same results and the choice depends on the surgeon's preference. Laparoscopic surgery has been demonstrated to have similar efficacy to conventional surgery and may become the option of the future. The perineal approach is the best option in elderly patients and in those with associated morbidity; the Delorme technique is simple to carry out, but rectosigmoidectomy provides better results. PMID:16478616

Muñoz, Fernando; del Valle, Emilio; Rodríguez, Marcos; Zorrilla, Jaime

2005-12-01

269

Endorectal ultrasonography in rectal cancer: a preliminary Barbadian experience.  

PubMed

Preoperative staging of rectal cancer assists in surgical decision making regarding the suitability of curative local excision as well as in the selective use of preoperative adjuvant radiation and chemoradiation, both of which have been shown to reduce the incidence of loco-regional cancer recurrence substantially. Most colorectal units employ endorectal ultrasound (ERUS) in the assessment to define tumour depth (T) and nodal (N) status. The preliminary Barbadian experience of 40 such cases showing an accuracy for T stage of 85% and for N stage of 50% in keeping with international reports is presented The interpretation and limitations of this technology are presented PMID:17373297

Zbar, A P

2006-10-01

270

Identification and genotyping of bacteria from paired vaginal and rectal samples from pregnant women indicates similarity between vaginal and rectal microflora  

PubMed Central

Background The vaginal microflora is important for maintaining vaginal health and preventing infections of the reproductive tract. The rectum has been suggested as the major source for the colonisation of the vaginal econiche. Methods To establish whether the rectum can serve as a possible bacterial reservoir for colonisation of the vaginal econiche, we cultured vaginal and rectal specimens from pregnant women at 35-37 weeks of gestation, identified the isolates to the species level with tRNA intergenic length polymorphism analysis (tDNA-PCR) and genotyped the isolates for those subjects from which the same species was isolated simultaneously vaginally and rectally, by RAPD-analysis. One vaginal and one rectal swab were collected from a total of each of 132 pregnant women at 35-37 weeks of gestation. Swabs were cultured on Columbia CNA agar and MRS agar. For each subject 4 colonies were selected for each of both sites, i.e. 8 colonies in total. Results Among the 844 isolates that could be identified by tDNA-PCR, a total of 63 bacterial species were present, 9 (14%) only vaginally, 26 (41%) only rectally, and 28 (44%) in both vagina and rectum. A total of 121 (91.6%) of 132 vaginal samples and 51 (38.6%) of 132 rectal samples were positive for lactobacilli. L. crispatus was the most frequently isolated Lactobacillus species from the vagina (40% of the subjects were positive), followed by L. jensenii (32%), L. gasseri (30%) and L. iners (11%). L. gasseri was the most frequently isolated Lactobacillus species from the rectum (15%), followed by L. jensenii (12%), L. crispatus (11%) and L. iners (2%). A total of 47 pregnant women carried the same species vaginally and rectally. This resulted in 50 vaginal/rectal pairs of the same species, for a total of eight different species. For 34 of the 50 species pairs (68%), isolates with the same genotype were present vaginally and rectally and a high level of genotypic diversity within species per subject was also established. Conclusion It can be concluded that there is a certain degree of correspondence between the vaginal and rectal microflora, not only with regard to species composition but also with regard to strain identity between vaginal and rectal isolates. These results support the hypothesis that the rectal microflora serves as a reservoir for colonisation of the vaginal econiche.

2009-01-01

271

Fitting late rectal bleeding data using different NTCP models: results from an Italian multi-centric study (AIROPROS0101)  

Microsoft Academic Search

Background and purposeRecent investigations demonstrated a significant correlation between rectal dose-volume patterns and late rectal toxicity. The reduction of the DVH to a value expressing the probability of complication would be suitable. To fit different normal tissue complication probability (NTCP) models to clinical outcome on late rectal bleeding after external beam radiotherapy (RT) for prostate cancer.

T. Rancati; C. Fiorino; G. Gagliardi; G. M. Cattaneo; G. Sanguineti; V. Casanova Borca; C. Cozzarini; G. Fellin; F. Foppiano; G. Girelli; L. Menegotti; A. Piazzolla; V. Vavassori; R. Valdagni

2004-01-01

272

Study on reconstruction of rectal sensation based on wavelet packet analysis and SVM strategy.  

PubMed

To control anal incontinence, we have developed an artificial anal sphincter system with sensor feedback. The artificial anal sphincter system is a novel hydraulic-electric muscle which mainly comprises an artificial anal sphincter, a wireless power supply subsystem, and a rectal sensation reconstruction subsystem. To investigate the features of the patients' rectal sensation, we have developed an in vitro experimental platform of artificial anal sphincter. In vitro experiments have been performed, and demonstrate that the traditional threshold method is not suitable for predicting the time for defecation. The traditional threshold method only uses single-dimensional pressure time series which may contain a few interdependent components simultaneously. A wavelet packet analysis algorithm is employed to extract the feature vector of the rectal pressure signal, then the rectal sensation prediction model is constructed based on a support vector machine for defecation pattern recognition. The results show that the proposed method is an effective approach for the reconstruction of patients' rectal sensation. PMID:22455610

Zan, P; Ren, P; Shao, Y; Jiang, E; Zhu, X

2012-03-29

273

Sigmoidoscopic and microscopic appearance of the rectal mucosa in homosexual men.  

PubMed Central

The aims of the study were to determine what microscopic changes occur in the rectal mucosa of men who have had anal intercourse and to correlate the sigmoidoscopic and microscopic appearances. Histological abnormalities were found in 29 of 100 men who attended consecutively a sexually-transmitted diseases clinic. The histopathology of rectal gonorrhoea, as observed in 18 patients, is described as are the microscopic findings in the rectal mucosa of 10 patients with early syphilis. Of 70 men without any detectable rectal infection, biopsies from 15 (21.4%) were abnormal. Intestinal spirochaetosis was observed in biopsies from 36 of these 100 men. With the use of strict criteria to describe the macroscopic appearance of the rectal mucosa, the sigmoidoscopic findings correlated well with the histology. Images Fig. 1 Fig. 2 Fig. 3

McMillan, A; Lee, F D

1981-01-01

274

[Impact of endoscopy and endosonography on local staging of rectal carcinoma].  

PubMed

For rectal carcinoma the decision between primary resection, neoadjuvant therapy and local excision depends on an accurate local staging. Local staging includes digital examination, rigid rectoscopy and endorectal ultrasound (EUS). The rectal digitation allows clinical staging according to the mobility of the tumor in relation to the rectal mucosa or the rectal wall. The rigid rectoscopy determines the aboral distance of the tumor from the dentate line or the anal verge. The endorectal ultrasound determines the pre-therapeutic UICC stage on the basis of evaluating the pretherapeutic T and N categories. Results of EUS should be discussed on the background of neoadjuvant therapy including response evaluation and in comparison with the results of magnetic resonance imaging. In addition, there is only little information available concerning evaluation of the circumferential resection margin by EUS. Technical improvements, such as the 3D-EUS, might be appropriate in the future to provide enhancement of EUS staging of rectal tumors. PMID:22573246

Isbert, C; Germer, C-T

2012-05-01

275

Role of the enteric nervous plexus in rectal motile activity: an experimental study.  

PubMed

The gut innervation is formed by an intrinsic and an extrinsic component. The former is responsible for the intestinal contractions that occur in the total absence of extrinsic innervation. We hypothesize that the intrinsic plexuses do not produce local contraction, but mediate reflex actions of the gut musculature. This hypothesis was investigated in the rectum of the experimental animal. In 16 anesthetized mongrel dogs, the rectum was exposed, and 3 monopolar silver-silver chloride electrodes were sutured serially to the rectal wall and connected to a rectilinear pen recorder. The rectal electric activity was recorded at rest and on rectal inflation while the anal pressure was synchronously registered. The tests were repeated after separate drug administration using phentolamine, propranolol (adrenoceptor blocking agents), atropine (cholinergic blocking agent), drotaverine (direct smooth muscle relaxant), and nitroglycerine. (NO donor, inhibitory noncholinergic, nonadrenergic mediator). Slow waves or pacesetter potentials (PPs) and action potentials (APs) were recorded from the three electrodes. Rectal balloon distension caused an increase of frequency, amplitude, and conduction velocity of these waves, as well as a decrease of anal pressure. Repetition of the test after administration of phentolamine, propranotol, and atropine effected no change in rectal electromyelographic (EMG) activity or anal pressure, while drotaverine and nitroglycerine administration aborted both the electric activity and the anal pressure response. We conclude that the rectal electric activity, presumably responsible for rectal motility, was not aborted by enteric nervous plexus block but by direct muscle relaxant. This suggests that the enteric plexus has no direct action on the rectal motile activity but mediates the rectal reflex actions. This concept might explain some of the hitherto unknown mechanisms of rectal dyssynergia syndromes. PMID:11700921

Shafik, A; El-Sibai, O

276

Massive rectal bleeding distant from a blunt car trauma.  

PubMed

Mesenteric trauma is one of the possible injuries caused by the use of seat belts in case of motor vehicle crash. We report here a rare case of rectal bleeding by rupture of a mesosigmoid haematoma. An emergent laparotomy revealed a mesosigmoid haematoma with a centimetric rectal perforation. The wearing of safety belts added some specific blunt abdominal trauma, which directly depends on lap-and-sash belts. Mesenteric injuries are found out up to 5% of blunt abdominal traumas. "Seat belt mark" leads the surgical team to strongly suspect an intra-abdominal trauma. When "seat belt mark" sign is found, in patients with mild to severe blunt car injuries, CT-scan has to be realised to eliminate intra-abdominal complications, including mesenteric and mesosigmoid ones. In case of proved mesenteric haematoma associated to intestinal bleeding, a surgical treatment must be considered as first choice. Conservative approach remains possible in stable patients but surgical exploration remains necessary in unstable patients with active bleeding. PMID:20638207

Gruden, E; Ragot, E; Arienzo, R; Revaux, A; Magri, M; Grossin, M; Leroy, C; Msika, S; Kianmanesh, R

2010-07-16

277

Argon plasma coagulation of hemorrhagic solitary rectal ulcer syndrome.  

PubMed

Solitary ulcer syndrome (SUS) is a rare disorder that may provoke hematochezia. Argon plasma coagulation (APC) is used in a wide range of gastrointestinal bleeding. We experienced APC in a patient with a bleeding gigantic SUS: a 64-year-old woman who developed a SUS at 60. After 3 years, recurrent hematochezia, secondary anemia, and rectal pain occurred. Endoscopy revealed a large rectal bleeding ulcer. Moreover, the pain led the patient to assume analgesics. These conditions stimulated us to treat this ulcer with APC within 4 sessions; each session spaced out at 30-day intervals. The patient experienced and maintained the following benefits: (1) resolution of bleeding and secondary anemia after the first session, (2) reduction of ulcer depth, disappearance of pain and analgesic withdrawal at the end of the cycle, (3) almost complete endoscopic healing of the ulcer after 9 months of follow-up. This experience suggests that APC may represent a therapeutic approach for bleeding SUS even if controlled studies are necessary before recommending it as acceptable treatment. PMID:14564186

Stoppino, Vincenzo; Cuomo, Rosario; Tonti, Paolo; Gentile, Marco; De Francesco, Vincenzo; Muscatiello, Nicola; Panella, Carmine; Ierardi, Enzo

278

Pilot Study of a Clinical Pathway Implementation in Rectal Cancer  

PubMed Central

Background: Rectal cancer is a highly prevalent disease which needs a multidisciplinary approach to be treated. The absence of specific protocols implies a significant and unjustifiable variability among the different professionals involved in this disease. The purpose is to develop a clinical pathway based on the analysis process and aims to reduce this variability and to reduce unnecessary costs. Methods: We created a multidisciplinary team with contributors from every clinical area involved in the diagnosis and treatment in this disease. We held periodic meetings to agree on a protocol based on the best available clinical practice guidelines. Once we had agreed on the protocol, we implemented its use as a standard in our institution. Every patient older than 18 years who was diagnosed with rectal cancer was considered a candidate to be treated via the pathway. Results: We evaluated 48 patients during the course of this study. Every parameter measured was improved after the implementation of the pathway, except the proportion of patients with 12 nodes or more analysed. The perception that our patients had about this project was very good. Conclusions: Clinical pathways are needed to improve the quality of health care. This kind of project helps reduce hospital costs and optimizes the use of limited resources. On the other hand, unexplained variability is also reduced, with consequent benefits for the patients.

Una, Esther; Lopez-Lara, Francisco

2010-01-01

279

Lymph node harvest in colon and rectal cancer: Current considerations  

PubMed Central

The prognostic significance of identifying lymph node (LN) metastases following surgical resection for colon and rectal cancer is well recognized and is reflected in accurate staging of the disease. An established body of evidence exists, demonstrating an association between a higher total LN count and improved survival, particularly for node negative colon cancer. In node positive disease, however, the lymph node ratios may represent a better prognostic indicator, although the impact of this on clinical treatment has yet to be universally established. By extension, strategies to increase surgical node harvest and/or laboratory methods to increase LN yield seem logical and might improve cancer staging. However, debate prevails as to whether or not these extrapolations are clinically relevant, particularly when very high LN counts are sought. Current guidelines recommend a minimum of 12 nodes harvested as the standard of care, yet the evidence for such is questionable as it is unclear whether an increasing the LN count results in improved survival. Findings from modern treatments, including down-staging in rectal cancer using pre-operative chemoradiotherapy, paradoxically suggest that lower LN count, or indeed complete absence of LNs, are associated with improved survival; implying that using a specific number of LNs harvested as a measure of surgical quality is not always appropriate. The pursuit of a sufficient LN harvest represents good clinical practice; however, recent evidence shows that the exhaustive searching for very high LN yields may be unnecessary and has little influence on modern approaches to treatment.

McDonald, James R; Renehan, Andrew G; O'Dwyer, Sarah T; Haboubi, Najib Y

2012-01-01

280

The Implementation of a Standardized Approach to Laparoscopic Rectal Surgery  

PubMed Central

Background and Objectives: The purpose of this study was to audit our results after implementation of a standardized operative approach to laparoscopic surgery for rectal cancer within a fast-track recovery program. Methods: From January 2009 to February 2011, 100 consecutive patients underwent laparoscopic surgery on an intention-to-treat basis for rectal cancer. The results were retrospectively reviewed from a prospectively collected database. Operative steps and instrumentation for the procedure were standardized. A standard perioperative care plan was used. Results: The following procedures were performed: low anterior resection (n=26), low anterior resection with loop-ileostomy (n=39), Hartmann's operation (n=14), and abdominoperineal resection (n=21). The median length of hospital stay was 7 days; 9 patients were readmitted. There were 9 cases of conversion to open surgery. The overall complication rate was 35%, including 6 cases (9%) of anastomotic leakages requiring reoperation. The 30-day mortality was 5%. The median number of harvested lymph nodes was 15 (range, 2 to 48). There were 6 cases of positive circumferential resection margins. The median follow-up was 9 (range, 1 to 27) months. One patient with disseminated cancer developed port-site metastasis. Conclusions: The results confirm the safety of a standardized approach, and the oncological outcomes are comparable to those of similar studies.

Aslak, Katrine Kanstrup

2012-01-01

281

Prediction of Lymphovascular Invasion in Rectal Cancer by Preoperative CT.  

PubMed

OBJECTIVE. The purpose of this study was to investigate whether the diameter of superior hemorrhoidal vein on preoperative CT can predict the presence of lymphovascular invasion (LVI). SUBJECTS AND METHODS. This study recruited 102 patients with treatment-naive rectal cancers. The diameters of superior hemorrhoidal vein and inferior mesenteric vein (IMV) on pretreatment CT and postoperative pathologic reports were reviewed. Univariate analysis and receiver operating characteristic curve analysis were applied to determine the correlation between clinical factors and pathologic features and the diameters of superior hemorrhoidal vein and IMV. RESULTS. The diameter of superior hemorrhoidal vein was significantly higher in patients with LVI than in those without (mean diameter, 44 vs 30 mm, respectively; p < 0.001) and was significantly higher in patients with distant metastases than in those without (p = 0.044). There was no significant difference between IMV diameter in LVI and that in distant metastasis (p = 0.521). CONCLUSION. Patients having rectal cancers with LVI showed a significantly increased mean superior hemorrhoidal vein diameter at presentation, which could be identified with pretreatment CT and help to direct the application of neoadjuvant treatment strategies. PMID:24147468

Wu, Chih-Chun; Lee, Rheun-Chuan; Chang, Cheng-Yen

2013-11-01

282

Effect of Biofeedback Therapy in Constipation According to Rectal Sensation  

PubMed Central

Background/Aims The pathophysiologic mechanism of rectal hyposensitivity (RH) is not well documented, and the significance of RH in biofeedback therapy (BFT) has not been evaluated. Thus, we aimed to assess the effect of BFT in constipated patients according to the presence of RH. Methods Five hundred and ninety constipated patients (238 males and 352 females) underwent anorectal physiologic assessments. Of these, anorectal manometry was performed before and after BFT in 244 patients (63 RH and 181 non-RH patients). Results The success rate of BFT was 56% in the RH and 61% in the non-RH group (p=0.604). The measurements of resting pressure, squeezing pressure, desire to defecate volume, urge to defecate volume, and maximum volume were decreased after BFT in the RH group (p<0.05), whereas only resting and squeezing pressures were decreased in the non-RH group (p<0.05). Among the RH group, individuals who responded to BFT showed decreased resting pressure, squeezing pressure, desire to defecate, urge to defecate, and maximum volume and increased balloon expulsion rate; among those who did not respond to BFT, only desire to defecate volume was improved. Conclusions In constipated patients with RH, changes of anorectal manometric findings differed in comparison to patients without RH. The responses to BFT showed both anorectal muscle relaxation and restoration of rectal sensation.

Ahn, Ji Yong; Jung, Kee Wook; Yang, Dong-Hoon; Koo, Hyun Sook; Seo, So Young; Yoon, In Ja; Kim, Kyung Jo; Ye, Byong Duk; Byeon, Jeong-Sik; Jung, Hwoon-Yong; Yang, Suk-Kyun; Kim, Jin-Ho

2013-01-01

283

The Current State of Targeted Agents in Rectal Cancer  

PubMed Central

Targeted biologic agents have an established role in treating metastatic colorectal cancer (CRC), and the integration of targeted therapies into the treatment of CRC has resulted in significant improvements in outcomes. Rapidly growing insight into the molecular biology of CRC, as well as recent developments in gene sequencing and molecular diagnostics, has led to high expectations for the identification of molecular markers to be used in personalized treatment regimens. The mechanisms of action and toxicities of targeted therapies differ from those of traditional cytotoxic chemotherapy. Targeted therapy has raised new insight about the possibility of tailoring treatment to an individual's disease, the assessment of drug effectiveness and toxicity, and the economics of cancer care. This paper covers the last decade of clinical trials that have explored the toxicity and efficacy of targeted agents in locally advanced and metastatic CRC and how their role may benefit patients with rectal cancer. Future efforts should include prospective studies of these agents in biomarker-defined subpopulations, as well as studies of novel agents that target angiogenesis, tumor-stromal interaction, and the cell signaling pathways implicated in rectal cancer.

Kim, Dae Dong; Eng, Cathy

2012-01-01

284

Safety and Efficacy of Low Anterior Resection for Rectal Cancer  

PubMed Central

Objective To determine perioperative morbidity, survival, and local failure rates in a large group of consecutive patients with rectal cancer undergoing low anterior resection by multiple surgeons on a specialty service. The primary objective was to assess the surgical complications associated with preoperative radiation sequencing. Summary Background Data The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, sexual, and bladder function. Surgical resection using sharp perimesorectal dissection is important for achieving these goals. The complications and mortality rate of this surgical strategy, particularly in the setting of preoperative chemoradiation, have not been well defined. Methods There were 1233 patients with primary rectal cancer treated at the authors’ cancer center from 1987 to 1995. Of these, 681 underwent low anterior resection and/or coloanal anastomosis for primary rectal cancer. The surgical technique used the principles of sharp perimesorectal excision. Morbidity and mortality rates were compared between patients receiving preoperative chemoradiation (Preop RT, n = 150) and those not receiving preoperative chemoradiation (No Preop RT, n = 531). Recurrence and survival data were determined in patients undergoing curative resection (n = 583, 86%) among three groups of patients: those receiving Preop RT (n = 131), those receiving postoperative chemoradiation (Postop RT, n = 110), and those receiving no radiation therapy (No RT, n = 342). Results The perioperative mortality rate was 0.6% (4/681). Postoperative complications occurred in 22% (153/681). The operative time, estimated blood loss, and rate of pelvic abscess formation without associated leak were higher in the Preop RT group than the No Preop RT group. However, the overall complication rate, rate of wound infection, anastomotic leak, and length of hospital stay were no different between Preop RT and No Preop RT patients. With a median follow-up of 45.6 months, the overall actuarial 5-year recurrence rate for patients undergoing curative resection (n = 583) was 19%, with 4% having local recurrence only, 12% having distant recurrence, and 3% having both local and distant recurrence, for an overall local recurrence rate of 7%. The actuarial 5-year overall survival rate was 81%; the disease-free survival rate was 75% and the local recurrence rate was 10%. The overall survival rate was similar between Preop RT (85%), Postop RT (72%), and No RT (83%) patients (p = 0.10), whereas the disease-free survival rate was significantly worse for Postop RT (65%) patients compared with Preop RT (79%) and No RT (77%) patients (p = 0.04). Conclusion The use of preoperative chemoradiation results in increased operative time, blood loss, and pelvic abscess formation but does not increase the rate of anastomotic leaks or the length of hospital stay after low anterior resection for rectal cancer. The 5-year actuarial overall survival rate for patients undergoing curative resection exceeded 80%, with a local recurrence rate of 10%.

Enker, Warren E.; Merchant, Nipun; Cohen, Alfred M.; Lanouette, Nicole M.; Swallow, Carol; Guillem, Jose; Paty, Philip; Minsky, Bruce; Weyrauch, Katherine; Quan, Stuart H. Q.

1999-01-01

285

Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate  

SciTech Connect

In a prospective study, 37 consecutive patients with radiation-induced proctosigmoiditis were randomized to receive a four-week course of either 3.0 g oral sulfasalazine plus 20 mg twice daily rectal prednisolone enemas (group I, N = 18) or 2.0 g twice daily rectal sucralfate enemas plus oral placebo (group II, N = 19). The two groups were comparable with respect to demographic features, duration of symptoms, and clinical and endoscopic staging of the disease. Fifteen patients in group I and 17 in group II completed the trial. At four weeks, both groups showed significant clinical improvement (P less than 0.01 for group I and P less than 0.001 for group II) and endoscopic healing (P less than 0.01 for group I and P less than 0.001 for group II). When the two groups were compared, sucralfate enemas showed a significantly better response as assessed clinically (P less than 0.05), although endoscopically the response was not statistically different (P greater than 0.05). We conclude that both treatment regimens are effective in the management of radiation proctitis. Sucralfate enemas give a better clinical response, are tolerated better, and because of the lower cost should be the preferred mode of short-term treatment.

Kochhar, R.; Patel, F.; Dhar, A.; Sharma, S.C.; Ayyagari, S.; Aggarwal, R.; Goenka, M.K.; Gupta, B.D.; Mehta, S.K. (Postgraduate Institute of Medical Education and Research, Chandigarh (India))

1991-01-01

286

Gasterophilosis: a major cause of rectal prolapse in working donkeys in Ethiopia.  

PubMed

A retrospective study was conducted to investigate the cause of rectal prolapse in working donkeys in Ethiopia. Analysis of data on rectal prolapse cases obtained from the Donkey Health and Welfare Project clinic at the School of Veterinary Medicine, Addis Ababa University, from 1995 to 2004 revealed that 83.6% (n = 177) of the cases were associated with Gasterophilus nasalis. The rest 10.7% and 5.7% were associated with work-related (overloading) cause and diarrhoea, respectively. The mean and median numbers of G. nasalis recovered from the rectum of infected donkeys were 66 and 64, respectively, with a range of 2-195. Over 100 G. nasalis larvae were recovered from the rectum of 22% of the donkeys. Circular demarcated ulcer-like and deep circumferential pits or ring-like mucosal lesions were found at the larval attachment sites. G. nasalis infection and the associated rectal prolapse were observed year round. However, the intensity of rectal larval infection and incidence of rectal prolapse were significantly higher during the rainy season (P < 0.01). Age and sex of the donkeys had no significant effect on the intensity of rectal larval infection and incidence of rectal prolapse (P > 0.05). PMID:21870062

Getachew, Adako Mulugeta; Innocent, Giles; Trawford, Andrew Francis; Reid, Stuart William James; Love, Sandy

2011-08-27

287

PrPCWD in rectal lymphoid tissue of deer (Odocoileus spp.).  

PubMed

The utility of rectal lymphoid tissue sampling for the diagnosis of chronic wasting disease (CWD) infections in mule deer (Odocoileus hemionus) and white-tailed deer (Odocoileus virginianus) was evaluated. CWD-associated prion protein (PrP(CWD)) deposits were observed in the rectal mucosa from 19 orally inoculated mule deer by 381 days post-inoculation (p.i.); similarly, 45 out of 50 naturally infected mule deer had PrP(CWD) in their rectal mucosa. In orally inoculated white-tailed deer, the presence of glycine (G) or serine (S) at codon 96 of the native PrP (denoted 96GG, 96GS or 96SS) appeared to influence the temporal patterns of PrP(CWD) deposition: nine out of 11 infected 96GG individuals had PrP(CWD) in their rectal mucosa by 342 days p.i., whereas only three out of seven infected 96GS individuals had PrP(CWD) in their rectal mucosa by 381 days p.i. and none of three 96SS individuals had PrP(CWD) in their rectal mucosa by 751 days p.i. These findings support further evaluation of rectal mucosa sampling in CWD surveillance. PMID:17554043

Wolfe, Lisa L; Spraker, Terry R; González, Lorenzo; Dagleish, Mark P; Sirochman, Tracey M; Brown, Jeremy C; Jeffrey, Martin; Miller, Michael W

2007-07-01

288

Modeling the potential impact of rectal microbicides to reduce hiv transmission in bathhouses.  

PubMed

We evaluate the potential impact of rectal microbicides for reducing HIV transmission in bathhouses. A new mathematical model describing HIV transmission dynamics among men who have sex with men (MSM) in bathhouses is constructed and analyzed. The model incorporates key features affecting transmission, including sexual role behavior (insertive and receptive anal intercourse acts), biological transmissibility of HIV, frequency and efficacy of condom usage, and, most pertinently, frequency and efficacy of rectal microbicide usage. To evaluate the potential impact of rectal microbicide usage, we quantify the effect of rectal microbicides (ranging in efficacy from 10% to 90%) on reducing the number of HIV infections in the bathhouse. We conduct uncertainty analyses to assess the effect of variability in both biological and behavioral parameters. We find that even moderately effective rectal microbicides (if used in 10% to 50% of the sex acts) would substantially reduce transmission in bathhouses. For example, a 50% effective rectal microbicide (used in 50% of sex acts) would reduce the number of secondary infections by almost 13% at disease invasion. Our modeling analyses show that even moderately effective rectal microbicides could be very effective prevention tools for reducing transmission in bathhouses and also potentially limit the spread of HIV in the community. PMID:20210374

Breban, Romulus; McGowan, Ian; Topaz, Chad; Schwartz, Elissa J; Anton, Peter; Blower, Sally

2006-07-01

289

Prostatic irradiation is not associated with any measurable increase in the risk of subsequent rectal cancer  

SciTech Connect

Purpose: To investigate a putative increased risk of rectal cancer subsequent to prostatic radiotherapy. Methods and Materials: In an analysis of the Surveillance, Epidemiology, and End Results registry, we compared men who had radiotherapy for prostatic carcinoma with those treated surgically and those treated with neither modality. Kaplan-Meier analyses for the time to failure from rectal cancer were performed between age-matched subgroups of the three cohorts. Cox proportional hazards analyses were performed to ascertain what influences might affect the incidence of subsequent rectal cancer. Results: In all, 33,831 men were irradiated, 167,607 were treated surgically, and 36,335 received neither modality. Rectal cancers developed in 243 (0.7%) of those irradiated (mean age, 70.7 years), 578 (0.3%) of those treated surgically (68.7 years), and 227 (0.8%) of those treated with neither modality (74.2 years). When age effects and the differences between the surgical and untreated cohorts were controlled for, we were unable to demonstrate any significant increased incidence of rectal cancer in men irradiated for prostatic cancer. Conclusions: An increased frequency of rectal cancer after prostatic irradiation, apparent on crude analysis, could be attributed to age confounding and other unmeasured confounders associated with prostate cancer treatment and rectal cancer risk.

Kendal, Wayne S. [Division of Radiation Oncology, Ottawa Hospital Regional Cancer Center, Ottawa, Ontario (Canada) and Ottawa Health Research Institute, Ottawa, Ontario (Canada)]. E-mail: wkendal@ottawahospital.on.ca; Eapen, Libni [Division of Radiation Oncology, Ottawa Hospital Regional Cancer Center, Ottawa, Ontario (Canada); Ottawa Health Research Institute, Ottawa, Ontario (Canada); MacRae, Robert [Division of Radiation Oncology, Ottawa Hospital Regional Cancer Center, Ottawa, Ontario (Canada); Ottawa Health Research Institute, Ottawa, Ontario (Canada); Malone, Shawn [Division of Radiation Oncology, Ottawa Hospital Regional Cancer Center, Ottawa, Ontario (Canada); Ottawa Health Research Institute, Ottawa, Ontario (Canada); Nicholas, Garth [Division of Medical Oncology, Ottawa Hospital Regional Cancer Center, Ottawa, Ontario (Canada); Ottawa Health Research Institute, Ottawa, Ontario (Canada)

2006-07-01

290

Minute liver metastases from a rectal carcinoid: A case report and review  

PubMed Central

We here report a 43-year-old male patient with minute liver metastases from a rectal carcinoid. Hepatic nodules were diagnosed during surgery, although they were not diagnosed by preoperative computed tomography or ultrasound examination. The rectal carcinoid was resected together with liver metastases and the patient has had no disease recurrence for 5 years following postoperative treatment of hepatic arterial infusion chemotherapy (HAIC) using 5-fluorouracil (5-FU) and oral administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU). In 2003, a health check examination indicated presence of occult blood in his stool. Barium enema study revealed a rectal tumor in the lower rectum and colonoscopy showed a yellowish lesion with a size of 30 mm in diameter. Pathological examination of the biopsy specimen indicated that the rectal tumor was carcinoid. Although preoperative imaging examinations failed to detect liver metastases, 2 min nodules were found on the surface of liver during surgery. A rapid pathological examination revealed that they were metastatic tumors from the rectal carcinoid. Low anterior resection was performed for the rectal tumor and the pathological report indicated that there were 4 metastatic lymph nodes in the rectal mesentery. The patient received treatment by HAIC using 5-FU plus oral administration of HCFU and survived for 5 years. We also review world-wide current treatments and their efficacy for hepatic metastases of carcinoid tumors.

Yamamoto, Hirofumi; Hemmi, Hideyuki; Gu, Jin-Yu; Sekimoto, Mitsugu; Doki, Yuichiro; Mori, Masaki

2010-01-01

291

Rectal-wall dose dependence on postplan timing after permanent-seed prostate brachytherapy  

SciTech Connect

Purpose: Dose to rectal wall after permanent-seed prostate brachytherapy is dependent on distance between posterior prostatic seeds and anterior rectal wall and is influenced by postimplant periprostatic edema. We analyzed the effect of postplan timing on anterior rectal-wall dose. Methods and Materials: Twenty patients received permanent seed {sup 125}I brachytherapy as monotherapy (145 Gy). Implants were preplanned by use of transrectal ultrasound (TRUS) and carried out by use of preloaded needles. Postimplant dosimetry was calculated by use of magnetic resonance imaging-computed tomography fusion on Days 1, 8, and 30. The anterior rectal-wall dose is reported as the isodose enclosing 1.0 or 2.0 cc of rectal wall and as the RV100 in cc. Results: The dose to rectal wall increased progressively over time. The median increase in dose to 1.0 cc of rectal wall (RD [1 cc]) from Day 1 to 30 was 39.2 Gy (p < 0.001). RV100 increased from a median of 0.07 cc on Day 1 to 0.67 cc on Day 30. The most significant predictor of rectal-wall dose (RD [1 cc], RD [2 cc], or RV100) was the time of evaluation (p < 0.001). Conclusion: Although periprostatic edema cannot be quantified by postimplant imaging, the dose to the anterior rectal wall increases significantly over time as prostatic and periprostatic edema resolve. Critical-organ dose reporting and guidelines for minimizing toxicity must take into account the time of the assessment.

Taussky, Daniel [Department of Radiation Oncology, Princess Margaret Hospital, Toronto (Canada); Yeung, Ivan [Department of Radiation Physics, Princess Margaret Hospital, Toronto (Canada); Williams, Theresa [Department of Radiation Medicine, Princess Margaret Hospital, Toronto (Canada); Pearson, Shannon [Department of Radiation Medicine, Princess Margaret Hospital, Toronto (Canada); McLean, Michael [Department of Radiation Oncology, Princess Margaret Hospital, Toronto (Canada); Pond, Gregory [Department of Biostatistics, Princess Margaret Hospital, Toronto (Canada); Crook, Juanita [Department of Radiation Oncology, Princess Margaret Hospital, Toronto (Canada)]. E-mail: Juanita.crook@rmp.uhn.on.ca

2006-06-01

292

Surgical Correction Is Ineffective for Improvement of Dyssynergic Defecation in Patients With Rectal Prolapse  

PubMed Central

Background/Aims The patients with rectal prolapse suffer from not only a prolapse rectum but also associated dysfunction. However, most surgical techniques are successful regarding the prolapse, but either do not solve or even worsen defecation dysfunction. The purpose of this study was to investigate the functional and physiological results after surgical correction in patients with rectal prolapse. Methods This study is a retrospective review of a single-institution experience. Patients with rectal prolapse who underwent anorectal manometry before and after Delorme's procedure were included. The primary outcomes measured were improvement of clinical symptoms and physiologic study. Results Consecutive 19 patients with rectal prolapse (17 females, mean age of 68.1 ± 10.8 years) underwent anorectal manometry before and after Delorme's procedure. The two most prevalent symptoms before operation were rectal tenesmus (15/19, 78.9%) and excessive straining (13/19, 68.4%). The two most prevalent symptoms after operation were rectal tenesmus (14/19, 73.6%) and excessive straining (13/19, 68.4%). No significant differences in resting anal pressure, squeezing anal pressure, defecation index, and rectal sense were found postoperatively. However, vector asymmetry index before surgery was higher than that after surgery (35.0 vs. 32.0, P = 0.018). Ten patients (52.5%) had type I dyssynergic defecation before surgery. No improvement of dyssynergic pattern occurred after surgery. Conclusions In conclusion, dyssynergic defecation was not improved after reduction of rectal prolapse in patients with rectal prolapse. Further study about combination treatment with biofeedback therapy in these subgroups may be necessary.

Park, Seon-Young; Cho, Sung-Bum; Park, Chang-Hwan; Joo, Jae-Kyun; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu

2013-01-01

293

Update and Debate Issues in Surgical Treatment of Middle and Low Rectal Cancer  

PubMed Central

Based on a review of the literature, this paper provides an update on surgical treatment of middle and low rectal cancer and discusses issues of debate surrounding that treatment. The main goal of the surgical treatment of rectal cancer is radical resection of the tumor and surrounding lymphatic tissue. Local excision of early rectal cancer can be another treatment option, in which the patient can avoid possible complications related to radical surgery. Neoadjuvant chemoradiation therapy (CRT) has been recommended for patients with cT3-4N0 or any T N+ rectal cancer because CRT shows better local control and less toxicity than adjuvant CRT. However, recent clinical trials showed promising results for local excision after neoadjuvant CRT in selected patients with low rectal cancer. In addition, the "wait and see" concept is another modality that has been reported for the management of tumors that show complete clinical remission after neoadjuvant CRT. Although radical surgery for middle and low rectal cancer is the cornerstone therapy, an ultralow anterior resection with or without intersphincteric resection (ISR) has become an alternative standard surgical method for selected patients. Many studies have reported on the oncological safety of the ISR, but few of them have addressed the issue the functional outcome. Furthermore, an abdominoperineal resection (APR) has problems with high rates of tumor perforations and positive circumferential resection margins, and those factors have contributed to its having a high rate of local recurrence and a poor survival rate for rectal cancer compared with sphincter-saving procedures. Recently, great efforts have been made to reduce these problems, and the total levator excision or the extended APR concept has emerged. Surgical management for low rectal cancer should aim to radically excise the tumor and to preserve as much of the sphincter function as possible by using multidisciplinary approaches. However, further prospective clinical trials are needed for tailored treatment of rectal cancer patients.

Kim, Min Sung; AL-Asari, Sami F.

2012-01-01

294

Multidisciplinary Discussion and Management of Rectal Cancer: A Population-based Study  

Microsoft Academic Search

Background  The purpose of the present study was to evaluate the value of discussing rectal cancer patients in a multidisciplinary team\\u000a (MDT).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All treated rectal cancer patients (>T1M0) diagnosed in 2006–2008 were included. According to the national guidelines, neoadjuvant\\u000a (chemo)radiotherapy should be given to all rectal cancer patients. Patients were scored as “discussed” (MDT+) only if documented\\u000a proof was available. The

H. A. M. Swellengrebel; E. G. Peters; A. Cats; O. Visser; H. G. T. Blaauwgeers; V. J. Verwaal; M. L. van Velthuysen; H. A. Cense; S. C. Bruin; C. A. M. Marijnen

295

C-reactive protein as early predictor for infectious postoperative complications in rectal surgery  

Microsoft Academic Search

Background  This study evaluated the role of the acute phase C-reactive protein (CRP) in the postoperative course of a large series of\\u000a rectal resections on the basis of a prospective database. Main focus of this study was the early identification of complications.\\u000a \\u000a \\u000a \\u000a Materials and methods  Three hundred eighty-three rectal resections with primary anastomosis for rectal cancer were screened for infectious postoperative\\u000a complications.

T. Welsch; S. A. Müller; A. Ulrich; A. Kischlat; U. Hinz; P. Kienle; M. W. Büchler; J. Schmidt; B. M. Schmied

2007-01-01

296

Reduction of a large incarcerated rectal prolapse by use of an elastic compression wrap.  

PubMed

Reduction of a large rectal prolapse may be difficult because of significant edema that collects in the rectal tissues. If reduction is unsuccessful, an emergent laparotomy and internal reduction is required. A wide elastic wrap applied around the prolapsed rectum provides progressive compression, which reduces the amount of edema, allowing subsequent manual reduction. This novel technique is simple, safe, inexpensive, and can easily be performed in the emergency department setting. Manual reduction, by this or other described methods, should be attempted before emergent laparotomy for incarcerated rectal prolapse is performed. PMID:15789124

Sarpel, Umut; Jacob, Brian P; Steinhagen, Randolph M

2005-06-01

297

Aluminum Potassium Sulfate and Tannic Acid Injection in the Treatment of Total Rectal Prolapse: Early Outcomes  

Microsoft Academic Search

Purpose  No surgical method for repair of total rectal prolapse has been established as optimal. We describe a new technique that uses\\u000a ALTA (aluminum potassium sulfate and tannic acid) injection as a simple perianal procedure for total rectal prolapse.\\u000a \\u000a \\u000a \\u000a Methods  Fourteen patients with total rectal prolapse were treated with sclerosing therapy by using ALTA injection. Via a perianal\\u000a approach, 0.5 to 1 ml

Yoshikazu Hachiro; Masao Kunimoto; Tatsuya Abe; Masahiro Kitada; Yoshiaki Ebisawa

2007-01-01

298

Digital assessment of lower rectum fixity in rectal prolapse (DALR): a simple clinical anatomical test to determine the most suitable approach (abdominal versus perineal) for repair  

Microsoft Academic Search

Selection of an appropriate approach to treat full thickness rectal prolapse remains problematic and controversial. We propose\\u000a that rectal prolapse may be classified as ‘low type‘ (true rectal prolapse) or ‘high type’ (intussusception of the sigmoid\\u000a with a fixed lower rectum). This assessment can be made via a simple clinical test of digital rectal assessment of lower rectal\\u000a fixity (‘the

Deya Marzouk; Michael J Ramdass; Amyn Haji; Mansoor Akhtar

2005-01-01

299

Rectal bleeding in a 4-month-old boy  

SciTech Connect

A case of bleeding Meckel's diverticulum is described in an infant. A 4-month-old boy was seen initially with a 24-hour history of painless hematochezia. His parents had noted two episodes of maroon-colored stool that did not appear to be associated with any abdominal distress. His medical history was unremarkable, with normal growth and development. Physical examination revealed a well-nourished, well-hydrated infant in no apparent distress. Vital signs were normal. Rectal examination revealed no masses, but bright-red blood was noted on the examining finger. Findings from the remainder of the examination were normal. An upright roentgenogram of the abdomen was obtained and demonstrated no abnormalities. The abdominal technetium scan was abnormal. An exploratory laparotomy was performed later on the day of admission.

Dutro, J.A.; Santanello, S.A.; Unger, F.; Goodwin, C.D.

1986-10-24

300

Multimodal treatment strategies for locally advanced rectal cancer.  

PubMed

This review outlines the important multimodal treatment issues associated with locally advanced rectal cancer. Changes to chemotherapy and radiation schema, as well as modern surgical approaches, have led to a revolution in the management of this disease but the morbidity and mortality remains high. Adequate treatment is dependent on precise preoperative staging modalities. Advances in staging via endorectal ultrasound, computed tomography, MRI and PET have improved pretreatment triage and management. Important prognostic factors and their impact for this disease are under investigation. Here we discuss the different treatment options including modern tumor-related surgical approaches, neoadjuvant as well as adjuvant therapies. Further clinical progress will largely depend on the broader implementation of multidisciplinary treatment strategies following the principles of evidence-based medicine. PMID:22500685

Weber, Georg F; Rosenberg, Robert; Murphy, Janet E; Meyer zum Büschenfelde, Christian; Friess, Helmut

2012-04-01

301

[Death in the bathtub--rectal drug administration].  

PubMed

A young nurse was found dead in a bathtub. An autopsy revealed the following results: pulmonary emphysema, severe edema of both lungs, transudation in both pleural cavities. Conspicuous were skin sticks of a white wax material. In chemical-toxicological analysis diazepam, tetrazepam and phenobarbital were detected in this material. After anal-rectal and additionally oral ingestion the following blood concentrations were determined: BAC 0.03/1000; diazepam 500 ng/ml; nordiazepam 65 ng/ml; tetrazepam 180 ng/ml; phenobarbital 9.4 mg/l. In connection with this drug effects an acute, multifocal, suppurating bronchopneumonia in both lungs was revealed as the cause of death. PMID:9582974

Musshoff, F; Dettmeyer, R; Madea, B

302

Left hemicolectomy with rectal excision for severe idiopathic constipation.  

PubMed

The standard surgical therapy for severe idiopathic constipation is total colectomy with ileorectal anastomosis, but this results in intractable diarrhoea in a third of the patients and recurrent constipation in another 10%. Studies which employ either radio-isotopes or radio-opaque markers permit the delineation of regional delay in colonic transit. Based on these studies, and evidence that the rectum is also abnormal in these patients, we have performed a left hemicolectomy with rectal excision in 2 patients with proven left colonic delay. After 2 and 3 years of follow-up, both patients have normal frequency, transit studies and anorectal physiology studies. Segmental resection based on physiological studies may offer better relief of symptoms with a lower chance of side effects in selected patients. PMID:2033355

Kamm, M A; van der Sijp, J R; Hawley, P R; Phillips, R K; Lennard-Jones, J E

1991-02-01

303

[Combination therapy of rectal cancer using 198Au].  

PubMed

The authors analyzed the results of therapy of 2 groups of patients with stage I-III rectal cancer. Combined therapy of 92 patients included preoperative large fractional radiotherapy at a total focal dose of 20-25 Gy, radical operation and i.v. injection of 1.48-1.85 GBq of 198Au shortly after the operation. The control group of 131 patients underwent surgery only. The groups did not differ significantly in the main prognostic characteristics. The combined therapeutic method was shown to be more effective than surgery alone, and the 5-year survival rates were 70.6 +/- 5.2 and 55.4 +/- 4.91% respectively (P X2 less than 0.05). The frequency of postoperative complications and lethality were not increased. Leukopenia was of temporary nature and disappeared either by itself or as a result of leukostimulating and substitution therapy. PMID:2824962

Knysh, V I; Barsukov, Iu A; Kokhniuk, V T

1987-11-01

304

Position Verification for the Prostate: Effect on Rectal Wall Dose  

SciTech Connect

Purpose: To evaluate the effect of gold marker (GM)-based position correction on the cumulative dose in the anorectal wall compared with traditional bony anatomy (BA)-based correction, taking into account changes in anorectal shape and position. Methods and Materials: A total of 20 consecutive prostate cancer patients, treated with curative external beam radiotherapy, were included. Four fiducial GMs were implanted in the prostate. Positioning was verified according to the shift in BA and GMs on daily electronic portal images. Position corrections were determined using on- and off-line position verification protocols according to the position of the GMs (GM-on and GM-off) and BA (BA-off). For all patients, intensity-modulated radiotherapy plans were made for the GM (8-mm planning target volume margin) and BA (10-mm planning target volume margin) protocols. The dose distribution was recomputed on 11 repeat computed tomography scans to estimate the accumulated dose to the prostate and anorectal wall while considering internal organ motion. Results: The dose that is at least received by 99% of the prostate was, on average, acceptable for all protocols. The individual patient data showed the best coverage for both GM protocols, with >95% of the prescribed dose for all patients. The anorectal wall dose was significantly lower for the GM protocols. The dose that is at least received by 30% of the rectal wall was, on average, 54.6 Gy for GM-on, 54.1 Gy for GM-off, and 58.9 Gy for BA-off (p <.001). Conclusion: Position verification with GM and reduced planning target volume margins yielded adequate treatment of the prostate and a lower rectal wall dose, even when accounting for independent movement of the prostate and anorectal wall.

Haverkort, Marie A.D., E-mail: m.a.haverkort@amc.uva.n [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Kamer, Jeroen B. van de; Pieters, Bradley R.; Tienhoven, Geertjan van; Assendelft, Esther; Lensing, Andrea L. [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Herk, Marcel van [Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Reijke, Theo M. de [Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Stoker, Jaap [Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Koning, Caro C.E. [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

2011-06-01

305

Rectal temperature as an indicator for heat tolerance in chickens.  

PubMed

High environmental temperature is perhaps the most important inhibiting factor to poultry production in hot regions. The objective of this study was to test adaptive responses of chickens to high ambient temperatures and identify suitable indicators for selection of heat-tolerant individuals. Full-sib or half-sib Anak-40 pullets (n?=?55) with similar body weights were raised in a room with a temperature ranging from 24°C to 28°C, and relative humidity of 50% from 61 to 65 days of age. On day 66, the ambient temperature was increased within 60?min to 35?±?1°C which was defined as the initial of heat stress (0?h). Rectal temperature (RT) was measured on each pullet at 0, 6, 18, 30, 42, 54 and 66?h. After 66?h the ambient temperature was increased within 30?min to 41?±?1°C and survival time (HSST) as well as lethal rectal temperatures (LRT) were recorded for each individual. The gap between the RT and initial RT was calculated as ?Tn (?T6, ?T18, ?T30, ?T42, ?T54 and ?T66), and the interval between LRT and initial RT as ?TT, respectively. A negative correlation was found between HSST and ?Tn as well as ?TT (r? T 18 ?=?-0.28 and r? TT ?=?-0.31, respectively, P?

Chen, Xing Y; Wei, Pei P; Xu, Shen Y; Geng, Zhao Y; Jiang, Run S

2013-05-01

306

The use of rectal douches among HIV-uninfected and infected men who have unprotected receptive anal intercourse: implications for rectal microbicides.  

PubMed

Although some rectal douches result in surface epithelium loss and potential increase of HIV transmission, men who have sex with men (MSM) continue to use them. We describe the prevalence of this practice among MSM engaging in unprotected receptive anal intercourse (URAI) in risky circumstances. A multiethnic sample with overrepresentation of HIV-negative MSM who had URAI in the previous year was recruited exclusively through the Internet. Participants were 105 MSM (78 HIV-negative, 27 HIV-positive). A total of 53% of HIV-negative and 96% of HIV-positive men douched in preparation for sex, most of them frequently or always, mainly for hygienic purposes. 27% of HIV-negative and 44% of HIV-positive douched after sex, partly believing douching protected from infections. Douching practices started around age 25. Regression analyses found the association between HIV status and douching occasions persisted after controlling for demographic characteristics and number of URAI occasions. Rectal douching in preparation for sex is common among men who practice URAI. This population could benefit from alternatives to condoms, such as rectal microbicides. Given the popularity of pre-coital douching and its frequency, a harmless rectal douche that could deliver a rectal microbicide could have great acceptability. PMID:17705033

Carballo-Diéguez, Alex; Bauermeister, José A; Ventuneac, Ana; Dolezal, Curtis; Balan, Ivan; Remien, Robert H

2007-08-18

307

Cluster model analysis of late rectal bleeding after IMRT of prostate cancer: A case-control study  

SciTech Connect

Purpose: Cluster models are newly developed normal-tissue complication probability models in which the spatial aspects of radiation-induced injury are taken into account by considering the size of spatially contiguous aggregates of damaged tissue units. The purpose of this study was to test the validity of a two-dimensional cluster model of late rectal toxicity based on maximum cluster size of damage to rectal surface. Methods and Materials: A paired case-control study was performed in which each of 9 patients experiencing Grade 2 or higher late rectal toxicity after intensity-modulated radiation therapy of localized prostate cancer was paired with a patient having a similar rectal dose-surface histogram but free of rectal toxicity. Numeric simulations were performed to determine the distribution of maximum cluster size on each rectal surface for each of many different choices of possible model parameters. Results: Model parameters were found for which patients with rectal toxicity were consistently more likely to have a significantly larger mean maximum cluster size than their matched controls. These parameter values correspond to a 50% probability of tissue-unit damage at doses near 30 Gy. Conclusions: This study suggests that a cluster model based on maximum cluster size of damage to rectal surface successfully incorporates spatial information beyond that contained in the rectal dose-surface histogram and may therefore provide a useful new tool for predicting rectal normal-tissue complication probability after radiotherapy.

Tucker, Susan L. [Department of Biostatistics and Applied Mathematics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: sltucker@mdanderson.org; Zhang Ming [Department of Biostatistics and Applied Mathematics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Dong Lei [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Mohan, Radhe [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Kuban, Deborah [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Thames, Howard D. [Department of Biostatistics and Applied Mathematics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2006-03-15

308

The role of the robotic technique in minimally invasive surgery in rectal cancer  

PubMed Central

Laparoscopic rectal surgery is feasible, oncologically safe, and offers better short-term outcomes than traditional open procedures in terms of pain control, recovery of bowel function, length of hospital stay, and time until return to working activity. Nevertheless, laparoscopic techniques are not widely used in rectal surgery, mainly because they require a prolonged and demanding learning curve that is available only in high-volume and rectal cancer surgery centres experienced in minimally invasive surgery. Robotic surgery is a new technology that enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, promising to overcome some of the technical difficulties associated with standard laparoscopy. The aim of this review is to summarise the current data on clinical and oncological outcomes of minimally invasive surgery in rectal cancer, focusing on robotic surgery, and providing original data from the authors’ centre.

Bianchi, Paolo Pietro; Luca, Fabrizio; Petz, Wanda; Valvo, Manuela; Cenciarelli, Sabine; Zuccaro, Massimiliano; Biffi, Roberto

2013-01-01

309

Core Temperature Measurement During Submaximal Exercise: Esophageal, Rectal, and Intestinal Temperatures.  

National Technical Information Service (NTIS)

The purpose of this study was to determine if intestinal temperature (Tin) might be in acceptable alternative to esophageal (Tes) and rectal temperature (Trec) to assess thermoregulation during supine exercise. We hypothesized that Tin would have values s...

S. M. Schneider S. M. C. Lee W. J. Williams

2000-01-01

310

Women's anal sex practices: implications for formulation and promotion of a rectal microbicide.  

PubMed

To gain insight into practices that may inform formulation and use of rectal microbicides, in-depth interviews were conducted with an ethnically diverse sample of 28 women who engage in anal intercourse. Microbicides are compounds under development to decrease sexually transmitted infections. Most women practiced anal sex in conjunction with vaginal intercourse. Anal sex typically was not preplanned, and few women reported preparation. Condom use was rare. Most women relied on saliva, vaginal fluids, prelubricated condoms, or used no lubrication at last intercourse. Women were uncertain about the amount of lubricant used during sex, with typical estimates of 1 to 2 teaspoons. This may prove challenging to the formulation and promotion of rectal microbicides, as substantially higher amounts may be required. Additional challenges include infrequent use of packaged lubricants, and typical male lubricant application, which may make women's control of rectal microbicides more difficult. Women overwhelmingly expressed interest in rectal microbicides. PMID:18433320

Exner, T M; Correale, J; Carballo-Diéguez, A; Salomon, L; Morrow, K M; Dolezal, C; Mayer, K

2008-04-01

311

[Omphalourachitis with abscess of the urachus and rectal prolapse in a llama cria (Lama glama)].  

PubMed

This case report describes the diagnosis and therapy of an omphalo-urachitis in a llama cria. Additionally, the cria developed a rectal prolapse, which was successfully treated with a temporary pararectal tobacco pouch suture following umbilical surgery. PMID:23608893

Schwantag, S; Zanolari, P

2013-01-01

312

Treatment of rectal prolapse in children with cow milk injection sclerotherapy: 30-year experience  

PubMed Central

AIM: To evaluate the role and our experience of injection sclerotherapy with cow milk in the treatment of rectal prolapse in children. METHODS: In the last 30 years (1976-2006) we made 100 injections of sclerotherapy with cow milk in 86 children. In this study we included children who failed to respond to conservative treatment and we perform operative treatment. RESULTS: In our study we included 86 children and in all of the patients we perform cow milk injection sclerotherapy. In 95.3% (82 children) of patients sclerotherapy was successful. In 4 (4.7%) patients we had recurrent rectal prolapse where we performed operative treatment. Below 4 years we had 62 children (72%) and 24 older children (28%). In children who needed operative treatment we performed Thiersch operation and without any complications. CONCLUSION: Injection sclerotherapy with cow milk for treatment rectal prolapse in children is a simple and effective treatment for rectal prolapse with minimal complications.

Zganjer, Mirko; Cizmic, Ante; Cigit, Irenej; Zupancic, Bozidar; Bumci, Igor; Popovic, Ljiljana; Kljenak, Antun

2008-01-01

313

Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation.  

PubMed

Rectal cancer management benefits from a multidisciplinary approach involving medical and radiation oncology as well as surgery. Presented are the current dominant issues in rectal cancer management with an emphasis on our treatment algorithm at the Lankenau Medical Center. By basing surgical decisions on the downstaged rectal cancer we explore how sphincter preservation can be extended even for cancers of the distal 3 cm of the rectum. TATA and TEM techniques can be used to effectively treat cancer from an oncologic standpoint while maintaining a high quality of life through sphincter preservation and avoidance of a permanent colostomy. We review the results of our efforts, including the use of advanced laparoscopy in the surgical management of low rectal cancers. PMID:21640918

Marks, John H; Frenkel, Joseph L; D'Andrea, Anthony P; Greenleaf, Chistopher E

2011-07-01

314

Effect of preoperative rectal indomethacin on postoperative pain reduction after open cholecystectomy.  

PubMed

The preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to have a positive impact on postoperative pain, but there is little research regarding the use of rectal NSAIDs given before surgery. The purpose of this study was to evaluate the effects of rectally administered indomethacin on postoperative pain in patients undergoing open cholecystectomy. A randomized controlled design was used to compare rectally administered indomethacin with placebo. Pain intensity, total opioid dose, and postoperative time to first request for analgesic were evaluated. The indomethacin group experienced significantly less postoperative pain and required less total opioid dose compared with the placebo group. Preoperative rectal administration of indomethacin reduces postoperative pain in open cholecystectomy when compared with placebo. PMID:20159529

Bahar, Mostafa Mehrabi; Jangjoo, Ali; Soltani, Ehsan; Armand, Masoomeh; Mozaffari, Samira

2010-02-01

315

Genomic profiling of rectal adenoma and carcinoma by array-based comparative genomic hybridization  

PubMed Central

Background Rectal cancer is one of the most common cancers in the world. Early detection and early therapy are important for the control of death caused by rectal cancer. The present study aims to investigate the genomic alterations in rectal adenoma and carcinoma. Methods We detected the genomic changes of 8 rectal adenomas and 8 carcinomas using array CGH. Then 14 genes were selected for analyzing the expression between rectal tumor and paracancerous normal tissues as well as from adenoma to carcinoma by real-time PCR. The expression of GPNMB and DIS3 were further investigated in rectal adenoma and carcinoma tissues by immunohistochemistry. Results We indentified ten gains and 22 losses in rectal adenoma, and found 25 gains and 14 losses in carcinoma. Gains of 7p21.3-p15.3, 7q22.3-q32.1, 13q13.1-q14.11, 13q21.1-q32.1, 13q32.2-q34, 20p11.21 and 20q11.23-q12 and losses of 17p13.1-p11.2, 18p11.32-p11.21 and 18q11.1-q11.2 were shared by both rectal adenoma and carcinoma. Gains of 1q, 6p21.33-p21.31 and losses of 10p14-p11.21, 14q12-q21.1, 14q22.1-q24.3, 14q31.3-q32.1, 14q32.2-q32.32, 15q15.1-q21.1, 15q22.31 and 15q25.1-q25.2 were only detected in carcinoma but not in adenoma. Copy number and mRNA expression of EFNA1 increased from rectal adenoma to carcinoma. C13orf27 and PMEPA1 with increased copy number in both adenoma and carcinoma were over expressed in rectal cancer tissues. Protein and mRNA expression of GPNMB was significantly higher in cancer tissues than rectal adenoma tissues. Conclusion Our data may help to identify the driving genes involved in the adenoma-carcinoma progression.

2012-01-01

316

Clinical Outcome of Laparoscopic Intersphincteric Resection Combined with Transanal Rectal Dissection for T3 Low Rectal Cancer in Patients with a Narrow Pelvis  

PubMed Central

Purpose. The purpose of this study was to analyze the safety and feasibility of laparoscopic intersphincteric resection (ISR) combined with transanal rectal dissection (TARD) for T3 low rectal cancer in a narrow pelvis. Methods. We studied 20 patients with a narrow pelvis of median body mass index 25.3 (16.9–31.2). Median observation period was 23.6 months (range 12.2–56.7). Results. Partial, subtotal, and total ISR was performed in 15, 1, and 4 patients, respectively. Median duration of TARD was 83?min (range 43–135). There were no major complications perioperatively or postoperatively. Surgical margins were histologically free of tumor cells in all patients, and there was no local recurrence. Excluding urgency, frequency of bowel movements, and incontinence status improved gradually after stoma closure. Conclusion. Laparoscopic ISR combined with TARD is technically feasible for selective T3 low rectal cancer in patients with a narrow pelvis.

Funahashi, Kimihiko; Shiokawa, Hiroyuki; Teramoto, Tatsuo; Koike, Junichi; Kaneko, Hironori

2011-01-01

317

Clinical outcome of laparoscopic intersphincteric resection combined with transanal rectal dissection for t3 low rectal cancer in patients with a narrow pelvis.  

PubMed

Purpose. The purpose of this study was to analyze the safety and feasibility of laparoscopic intersphincteric resection (ISR) combined with transanal rectal dissection (TARD) for T3 low rectal cancer in a narrow pelvis. Methods. We studied 20 patients with a narrow pelvis of median body mass index 25.3 (16.9-31.2). Median observation period was 23.6 months (range 12.2-56.7). Results. Partial, subtotal, and total ISR was performed in 15, 1, and 4 patients, respectively. Median duration of TARD was 83?min (range 43-135). There were no major complications perioperatively or postoperatively. Surgical margins were histologically free of tumor cells in all patients, and there was no local recurrence. Excluding urgency, frequency of bowel movements, and incontinence status improved gradually after stoma closure. Conclusion. Laparoscopic ISR combined with TARD is technically feasible for selective T3 low rectal cancer in patients with a narrow pelvis. PMID:22312529

Funahashi, Kimihiko; Shiokawa, Hiroyuki; Teramoto, Tatsuo; Koike, Junichi; Kaneko, Hironori

2011-12-29

318

Management of primary rectal cancer by surgeons in Atlantic Canada: results of a regional survey  

PubMed Central

Background We sought to determine the current practice patterns of general surgeons in Atlantic Canada in the management of primary rectal cancer in relation to surgeon-specific variables. Methods We sent mail-out surveys to all practising general surgeons (n =183) in Atlantic Canada to determine screening preferences, preoperative assessment, the use of neoadjuvant and adjuvant therapy, surgical therapy for rectal cancer and surgeon demographics. We analyzed the responses using ?2 tests. Results The response rate was 98 (54%) after 2 mail-outs; there were 82 (49%) eligible responses. Surgeons in practice for 21 years or more were more likely than those with fewer than 21 years of practice to order preoperative ultrasonography of the liver and were less likely to order preoperative computed tomography. Endorectal ultrasonography was ordered routinely by 23% of surgeons, whereas 71% of surgeons would order it if time and resources were available. Surgeons who were not certified by the Royal College of Physicians and Surgeons of Canada were significantly more likely than those who were certified to use neoadjuvant therapy in all patients with rectal cancer (43% v. 12%; p = 0.031). Surgeons who performed more than 10 rectal cancer surgeries per year were significantly more likely than those who performed 10 or fewer surgeries per year to use neoadjuvant treatment for T3 tumours (94% v. 61%; p = 0.007). Surgeons with medical or radiation oncology services in their communities were significantly more likely than those without such services to recommend neoadjuvant treatment in T3 rectal tumours and rectal tumours with pathologic lymph nodes. Conclusion We found significant variation in the management of rectal cancer depending on surgeon-specific variables. The implications of these differences on the outcomes of patients with rectal cancer are unknown.

Chuah, Teong Kuan; Lee, Tracy; Wirtzfeld, Debrah; Pollett, William

2010-01-01

319

Late rectal toxicity after conformal radiotherapy of prostate cancer (I): multivariate analysis and dose–response  

Microsoft Academic Search

Purpose: The purpose of this paper is to use the outcome of a dose escalation protocol for three-dimensional conformal radiation therapy (3D-CRT) of prostate cancer to study the dose–response for late rectal toxicity and to identify anatomic, dosimetric, and clinical factors that correlate with late rectal bleeding in multivariate analysis.Methods and Materials: Seven hundred forty-three patients with T1c–T3 prostate cancer

Mark W Skwarchuk; Andrew Jackson; Michael J Zelefsky; Ennapadam S Venkatraman; Didier M Cowen; Sabine Levegrün; Chandra M Burman; Zvi Fuks; Steven A Leibel; C. Clifton Ling

2000-01-01

320

Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer  

Microsoft Academic Search

Endorectal ultrasonography (ERUS) with a flexible-type radial scanner (Aloka Co. Ltd., Tokyo, Japan; 7.5 MHz) was applied to 120 patients with rectal cancer for the assessment of wall invasion and pararectal lymph node metastasis. Normal rectal wall was described as a five- or seven-layer structure excluding the lowest part within 3 cm from the anal verge. Loss of normal layers

Yoshinori Katsura; Kazutaka Yamada; Takashi Ishizawa; Heiji Yoshinaka; Hisaaki Shimazu

1992-01-01

321

Can 5-aminosalicylic acid suppository decrease the pain after rectal band ligation?  

PubMed Central

AIM: To investigate the effect of 5-aminosalicylic acid (5-ASA) suppositories on rectal band ligation-induced pain. METHODS: Sixty patients were randomized into two treatment groups. RESULTS: Our results showed that there was no difference between 5-ASA suppository group and the control group for pain control. CONCLUSION: 5-ASA may be an alternative treatment for hemorrhoids; however, it does not affect the rectal band ligation-induced pain.

Kayhan, Burcak; Ozer, Digdem; Akdogan, Meral; Ozaslan, Ersan; Yuksel, Osman

2008-01-01

322

Survival of patients with colon and rectal cancer in central and northern Denmark, 1998-2009  

PubMed Central

Objective The prognosis for colon and rectal cancer has improved in Denmark over the past decades but is still poor compared with that in our neighboring countries. We conducted this population-based study to monitor recent trends in colon and rectal cancer survival in the central and northern regions of Denmark. Material and methods Using the Danish National Registry of Patients, we identified 9412 patients with an incident diagnosis of colon cancer and 5685 patients diagnosed with rectal cancer between 1998 and 2009. We determined survival, and used Cox proportional hazard regression analysis to compare mortality over time, adjusting for age and gender. Among surgically treated patients, we computed 30-day mortality and corresponding mortality rate ratios (MRRs). Results The annual numbers of colon and rectal cancer increased from 1998 through 2009. For colon cancer, 1-year survival improved from 65% to 70%, and 5-year survival improved from 37% to 43%. For rectal cancer, 1-year survival improved from 73% to 78%, and 5-year survival improved from 39% to 47%. Men aged 80+ showed most pronounced improvements. The 1- and 5-year adjusted MRRs decreased: for colon cancer 0.83 (95% confidence interval CI: 0.76–0.92) and 0.84 (95% CI: 0.78–0.90) respectively; for rectal cancer 0.79 (95% CI: 0.68–0.91) and 0.81 (95% CI: 0.73–0.89) respectively. The 30-day postoperative mortality after resection also declined over the study period. Compared with 1998–2000 the 30-day MRRs in 2007–2009 were 0.68 (95% CI: 0.53–0.87) for colon cancer and 0.59 (95% CI: 0.37–0.96) for rectal cancer. Conclusion The survival after colon and rectal cancer has improved in central and northern Denmark during the 1998–2009 period, as well as the 30-day postoperative mortality.

Ostenfeld, Eva B; Erichsen, Rune; Iversen, Lene H; Gandrup, Per; N?rgaard, Mette; Jacobsen, Jacob

2011-01-01

323

Population Pharmacokinetics of Artesunate and Dihydroartemisinin following IntraRectal Dosing of Artesunate in Malaria Patients  

Microsoft Academic Search

BackgroundIntra-rectal artesunate has been developed as a potentially life-saving treatment of severe malaria in rural village settings where administration of parenteral antimalarial drugs is not possible. We studied the population pharmacokinetics of intra-rectal artesunate and the relationship with parasitological responses in patients with moderately severe falciparum malaria.Methods and FindingsAdults and children in Africa and Southeast Asia with moderately severe malaria

Julie A Simpson; Tsiri Agbenyega; Karen I Barnes; Gianni Di Perri; Peter Folb; Melba Gomes; Sanjeev Krishna; Srivicha Krudsood; Sornchai Looareesuwan; Sharif Mansor; Helen McIlleron; Raymond Miller; Malcolm Molyneux; James Mwenechanya; Visweswaran Navaratnam; Francois Nosten; Piero Olliaro; Lorrin Pang; Isabela Ribeiro; Madalitso Tembo; Michele van Vugt; Steve Ward; Kris Weerasuriya; Kyaw Win; Nicholas J White

2006-01-01

324

Population pharmacokinetics of artesunate and dihydroartemisinin following intra-rectal dosing of artesunate in malaria patients  

Microsoft Academic Search

Background Intra-rectal artesunate has been developed as a potentially life-saving treatment of severe malaria in rural village settings where administration of parenteral antimalarial drugs is not possible. We studied the population pharmacokinetics of intra-rectal artesunate and the relationship with parasitological responses in patients with moderately severe falciparum malaria. Methods and Findings Adults and children in Africa and Southeast Asia with

Julie A. Simpson; Tsiri Agbenyega; Karen I. Barnes; Gianni Di Perri; Peter Folb; Melba Gomes; Sanjeev Krishna; Srivicha Krudsood; Vugt van M; Sharif Mansor; Helen McIlleron; Raymond Miller; Malcolm Molyneux; James Mwenechanya; Visweswaran Navaratnam; Francois Nosten; Piero Olliaro; Lorrin Pang; Isabela Ribeiro; Madalitso Tembo; Michele van Vugt; Steve Ward; Kris Weerasuriya; Kyaw Win; Nicholas J. White

2006-01-01

325

Rectal Cancer Surgery in a District General Hospital: Controlled Follow-up Study  

Microsoft Academic Search

.   Local recurrence after curative surgery of rectal cancer indicates failure of the initial treatment. In recent years reported\\u000a local recurrence rates have steadily decreased. In this study 364 patients treated for rectal cancer were analyzed retrospectively\\u000a to determine if it is still justified to treat this disease in small nonspecialized hospitals. An overall local recurrence\\u000a rate of 9.7% was

Gaston Schütz; Marko Aleksic; Bernward Ulrich

1999-01-01

326

Late Rectal Toxicity on RTOG 94-06: Analysis Using a Mixture Lyman Model  

SciTech Connect

Purpose: To estimate the parameters of the Lyman normal-tissue complication probability model using censored time-to-event data for Grade {>=}2 late rectal toxicity among patients treated on Radiation Therapy Oncology Group 94-06, a dose-escalation trial designed to determine the maximum tolerated dose for three-dimensional conformal radiotherapy of prostate cancer. Methods and Materials: The Lyman normal-tissue complication probability model was fitted to data from 1,010 of the 1,084 patients accrued on Radiation Therapy Oncology Group 94-06 using an approach that accounts for censored observations. Separate fits were obtained using dose-volume histograms for whole rectum and dose-wall histograms for rectal wall. Results: With a median follow-up of 7.2 years, the crude incidence of Grade {>=}2 late rectal toxicity was 15% (n = 148). The parameters of the Lyman model fitted to dose-volume histograms data, with 95% profile-likelihood confidence intervals, were TD{sub 50} = 79.1 Gy (75.3 Gy, 84.3 Gy), m = 0.146 (0.107, 0.225), and n = 0.077 (0.041, 0.156). The fit based on dose-wall histogram data was not significantly different. Patients with cardiovascular disease had a significantly higher incidence of late rectal toxicity (p = 0.015), corresponding to a dose-modifying factor of 5.3%. No significant association with late rectal toxicity was found for diabetes, hypertension, rectal volume, rectal length, neoadjuvant hormone therapy, or prescribed dose per fraction (1.8 Gy vs. 2 Gy). Conclusions: These results, based on a large cohort of patients from a multi-institutional trial, are expected to be widely representative of the ability of the Lyman model to describe the long-term risk of Grade {>=}2 late rectal toxicity after three-dimensional conformal radiotherapy of prostate cancer.

Tucker, Susan L., E-mail: sltucker@mdanderson.or [Department of Bioinformatics and Computational Biology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Dong Lei [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Bosch, Walter R. [Image-Guided Therapy QA Center, Washington University, St. Louis, MO (United States); Department of Radiation Oncology, Washington University, St. Louis, MO (United States); Michalski, Jeff [Department of Radiation Oncology, Washington University, St. Louis, MO (United States); Winter, Kathryn [American College of Radiology, Philadelphia, PA (United States); Mohan, Radhe [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Purdy, James A. [Department of Radiation Oncology, University of California Davis Cancer Center, Sacramento, CA (United States); Kuban, Deborah; Lee, Andrew K.; Cheung, M. Rex [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Thames, Howard D. [Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Cox, James D. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2010-11-15

327

Acquired rectal fistula in human immunodeficiency virus-positive children: a causal or casual relationship?  

Microsoft Academic Search

Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks–11 months (median 5 months) with acquired RF were managed

A. F. Uba; L. B. Chirdan; W. Ardill; V. M. Ramyil; A. T. Kidmas

2004-01-01

328

Rectal stricture associated with the long-term use of ibuprofen suppositories  

Microsoft Academic Search

Summary   Here, we report the case of a 64-year-old woman who suffered from chronic lower backache for which she received ibuprofen\\u000a suppositories. The patient was admitted to the hospital with a suspected rectal tumor. Clinical examination did not reveal\\u000a any abnormal finding apart from a mild, bilateral peritibial edema. On rectal examination, an area of stenosis was detected\\u000a approximately 7

S. Alsalameh; R. Al-Ward; P. Berg; T. Aigner; C. Ell

2000-01-01

329

Rectal complications after modern radiation for prostate cancer: A colorectal surgical challenge  

Microsoft Academic Search

The operative management of rectal complications after radiation for prostate cancer has been incompletely studied. Our aim\\u000a was to determine a logical surgical approach to these severe rectal complications. From an institutional database, we identified\\u000a 5719 patients who were evaluated between 1990 and 2003 with a history of prostate cancer that was treated with radiation.\\u000a Fourteen patients were identified from

David W. Larson; Kristin Chrouser; Tonia Young-Fadok; Heidi Nelson

2005-01-01

330

Effects of Prostate-Rectum Separation on Rectal Dose From External Beam Radiotherapy  

SciTech Connect

Purpose: In radiotherapy for prostate cancer, the rectum is the major dose-limiting structure. Physically separating the rectum from the prostate (e.g., by injecting a spacer) can reduce the rectal radiation dose. Despite pilot clinical studies, no careful analysis has been done of the risks, benefits, and dosimetric effects of this practice. Methods and Materials: Using cadaveric specimens, 20 mL of a hydrogel was injected between the prostate and rectum using a transperineal approach. Imaging was performed before and after spacer placement, and the cadavers were subsequently dissected. Ten intensity-modulated radiotherapy plans were generated (five before and five after separation), allowing for characterization of the rectal dose reduction. To quantify the amount of prostate-rectum separation needed for effective rectal dose reduction, simulations were performed using nine clinically generated intensity-modulated radiotherapy plans. Results: In the cadaveric studies, an average of 12.5 mm of prostate-rectum separation was generated with the 20-mL hydrogel injections (the seminal vesicles were also separated from the rectum). The average rectal volume receiving 70 Gy decreased from 19.9% to 4.5% (p < .05). In the simulation studies, a prostate-rectum separation of 10 mm was sufficient to reduce the mean rectal volume receiving 70 Gy by 83.1% (p <.05). No additional reduction in the average rectal volume receiving 70 Gy was noted after 15 mm of separation. In addition, spacer placement allowed for increased planning target volume margins without exceeding the rectal dose tolerance. Conclusion: Prostate-rectum spacers can allow for reduced rectal toxicity rates, treatment intensification, and/or reduced dependence on complex planning and treatment delivery techniques.

Susil, Robert C.; McNutt, Todd R. [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD (United States); DeWeese, Theodore L., E-mail: deweete@jhmi.ed [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD (United States); Song, Danny [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD (United States)

2010-03-15

331

Proposed Rectal Dose Constraints for Patients Undergoing Definitive Whole Pelvic Radiotherapy for Clinically Localized Prostate Cancer  

SciTech Connect

Purpose: Although several institutions have reported rectal dose constraints according to threshold toxicity, the plethora of trials has resulted in multiple, confusing dose-volume histogram recommendations. A set of standardized, literature-based constraints for patients undergoing whole pelvic radiotherapy (RT) for prostate cancer would help guide the practice of prostate RT. The purpose of this study was to develop these constraints, demonstrate that they are achievable, and assess the corresponding rectal toxicity. Methods and Materials: An extensive literature search identified eight key studies relating dose-volume histogram data to rectal toxicity. A correction factor was developed to address differences in the anatomic definition of the rectum across studies. The dose-volume histogram constraints recommended by each study were combined to generate the constraints. The data from all patients treated with definitive intensity-modulated RT were then compared against these constraints. Acute rectal toxicity was assessed. Results: A continuous, proposed rectal dose-constraint curve was generated. Intensity-modulated RT not only met this constraint curve, but also was able to achieve at least 30-40% lower dose to the rectum. The preliminary clinical results were also positive: 50% of patients reported no acute bowel toxicity, 33% reported Grade 1 toxicity, and 17% reported Grade 2 toxicity. No patients reported Grade 3-4 acute rectal toxicity. Conclusions: In this study, we developed a set of proposed rectal dose constraints. This allowed for volumetric assessment of the dose-volume relationship compared with single dose-volume histogram points. Additional research will be performed to validate this threshold as a class solution for rectal dose constraints.

Chan, Linda W. [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA (United States)], E-mail: lindachan@radonc.ucsf.edu; Xia Ping; Gottschalk, Alexander R.; Akazawa, Michelle [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA (United States); Scala, Matthew [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Pickett, Barby M.S.; Hsu, I-C.; Speight, Joycelyn; Roach, Mack [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA (United States)

2008-09-01

332

Sphincter saving rectum resection is the standard procedure for low rectal cancer  

Microsoft Academic Search

Aim To determine the procedure of choice for rectal cancer, particularly low rectal cancer. Methods Complete search, according to evidence-based methods, of comparative studies and national surveys published in English since 1990. Selection criteria: comparative studies between abdominoperineal excision (APER) and sphincter-saving operations (SSO) with a minimum of 50 patients presenting cancer in the lower one-third of the rectum, perfect

E. Di Betta; A. D'Hoore; L. Filez; F. Penninckx

2003-01-01

333

Gasterophilosis: a major cause of rectal prolapse in working donkeys in Ethiopia  

Microsoft Academic Search

A retrospective study was conducted to investigate the cause of rectal prolapse in working donkeys in Ethiopia. Analysis of\\u000a data on rectal prolapse cases obtained from the Donkey Health and Welfare Project clinic at the School of Veterinary Medicine,\\u000a Addis Ababa University, from 1995 to 2004 revealed that 83.6% (n?=?177) of the cases were associated with Gasterophilus nasalis. The rest

Adako Mulugeta Getachew; Giles Innocent; Andrew Francis Trawford; Stuart William James Reid; Sandy Love

334

A modified thiersch operation for complete rectal prolapse using a teflon prosthesis  

Microsoft Academic Search

Summary  Insertion of a crimped Teflon arterial graft around the rectal outlet is described as a modified Thiersch operation for relief\\u000a of complete rectal prolapse. The procedure is not formidable and is of particular value in elderly poor-risk patients or in\\u000a certain patients with a badly damaged and totally incompetent anal sphincter. The advantages of the Teflon tube are discussed.

Benjamin Haskell; Harold Rovner

1963-01-01

335

Management of late complications of Teflon ® sling repair for rectal prolapse  

Microsoft Academic Search

Summary  Recurrent rectal prolapse or postoperative rectal stricture occurred in four of 88 patients (4.5 per cent) who underwent Teflon\\u000a sling repair at the Lahey Clinic during the past 15 years. Management of these and six other similar patients referred for\\u000a treatment suggests that young men appear to be at a higher risk for recurrence. Strictures may be more likely to

Thomas J. Lescher; Marvin L. Corman; John A. Coller; Malcolm C. Veidenheimer

1979-01-01

336

Presence of a sodium-potassium chloride cotransport system in the rectal gland of Squalus acanthias  

Microsoft Academic Search

Summary In order to investigate whether the loop diuretic sensitive, sodium-chloride cotransport system described previously in shark rectal gland is in fact a sodium-potassium chloride cotransport system, plasma membrane vesicles were isolated from rectal glands ofSqualus acanthias and sodium and rubidium uptake were measured by a rapid filtration technique. In addition, the binding of N-methylfurosemide to the membranes was investigated.

J. Hannafin; E. Kinne-Saffran; D. Friedman; R. Kinne

1983-01-01

337

Binding and Transfer of Human Immunodeficiency Virus by DC-SIGN+ Cells in Human Rectal Mucosa  

Microsoft Academic Search

The role of DC-SIGN on human rectal mucosal dendritic cells is unknown. Using highly purified human rectal mucosal DC-SIGN cells and an ultrasensitive real-time reverse transcription-PCR assay to quantify virus binding, we found that HLA-DR\\/DC-SIGN cells can bind and transfer more virus than the HLA- DR\\/DC-SIGN cells. Greater than 90% of the virus bound to total mucosal mononuclear cells (MMCs)

Kevin B. Gurney; Julie Elliott; Hoorig Nassanian; Carol Song; Elizabeth Soilleux; Ian McGowan; Peter A. Anton; Benhur Lee

2005-01-01

338

LUGAR - MELHOR TRABALHO COMPLETO NA CATEGORIA: PREVENÇÃO  

Microsoft Academic Search

Introduction: nursing is recognized as a stressful profession due to physical and mental overload, work load and the need to live with ill persons. These facts become even worse in care for HIV\\/AIDS patients due to the high complexity of care, creating an intensive work environment as a result of the gra- vity of these patients' condition. Objective: the aims

Janice DL Miquelim; Cleide BO Carvalho; Elucir Gir; Nilza TR Pelá

339

Metabolomic Characterization of Human Rectal Adenocarcinoma With Intact Tissue Magnetic Resonance Spectroscopy  

PubMed Central

Purpose This study was designed to test whether metabolic characterization of intact, unaltered human rectal adenocarcinoma specimens is possible using the high-resolution magic angle spinning proton (1H) magnetic resonance spectroscopy technique. Methods The study included 23 specimens from five patients referred for ultrasonographic staging of suspected rectal cancer. Multiple biopsies of macroscopically malignant rectal tumors and benign rectal mucosa were obtained from each patient for a total of 14 malignant and 9 benign samples. Unaltered tissue samples were spectroscopically analyzed. Metabolic profiles were established from the spectroscopy data and correlated with histopathologic findings. Results Metabolomic profiles represented by principle components of metabolites measured from spectra differentiated between malignant and benign samples and correlated with the volume percent of cancer (P=0.0065 and P=0.02, respectively) and benign epithelium (P=0.0051 and P=0.0255, respectively), and with volume percent of stroma, and inflammation. Conclusions Magnetic resonance spectroscopy of rectal biopsies has the ability to metabolically characterize samples and differentiate between pathological features of interest. Future studies should determine its utility in in vivo applications for non-invasive pathologic evaluations of suspicious rectal lesions.

Jordan, Kate W.; Nordenstam, Johan; Lauwers, Gregory Y.; Rothenberger, David A.; Alavi, Karim; Garwood, Michael; Cheng, Leo L.

2009-01-01

340

The impact of multidisciplinary therapy in node-positive rectal cancer.  

PubMed

Multidisciplinary therapy (MDT) of node-positive rectal cancer is considered optimal. We performed a retrospective cohort study of node positive rectal cancer patients diagnosed between January 1, 1994 and December 31, 2003 in Region 5 of the California Cancer Registry to determine the impact of MDT on disease specific survival (DSS). During the study period, 398 patients with stage III rectal cancer were identified. Only 251 patients (63.1%) received radiation (XRT). Patients receiving XRT had significantly improved survival when compared with those who did not (5 year DSS 55% with XRT vs. 36% without XRT, median follow-up 43 months, P < 0.001). There was no statistically significant difference in Tstage (P = 0.41), the number of N1 patients (P = 0.45), or the number of positive nodes harvested (mean 11.5 w/o XRT vs. 12.8 w/XRT, P = 0.37) between patients receiving XRT and those who did not. Patients receiving XRT were far more likely to receive systemic chemotherapy (83% vs. 27%, P < 0.0001). Multidisciplinary therapy of node-positive rectal cancer is associated with improved DSS. However, substantial numbers of node positive rectal cancer patients are not receiving MDT. Greater efforts are needed to implement consistent multidisciplinary algorithms into rectal cancer management. PMID:21105635

Roos, Matthew; Wong, Jan H; Roy-Chowdhury, Sharmila; Lum, Sharon S; Morgan, John W; Kazanjian, A Kevork

2010-10-01

341

Short- and Medium-Term Outcome of Robot-Assisted and Traditional Laparoscopic Rectal Resection  

PubMed Central

Background: Traditional laparoscopic anterior rectal resection (TLAR) has recently been used for rectal cancer, offering good functional results compared with open anterior resection and resulting in a better postoperative early outcome. However, laparoscopic rectal resection can be technically demanding, especially when a total mesorectal excision is required. The aim of this study was to verify whether robot-assisted anterior rectal resection (RLAR) could overcome limitations of the laparoscopic approach. Methods: Sixty-six patients with rectal cancer were enrolled in the study. Twenty-nine patients underwent RLAR and 37 TLAR. Groups were matched for age, BMI, sex ratio, ASA status, and TNM stage, and were followed up for a mean time of 12 months. Results: Robot-assisted laparoscopic rectal resection results in shorter operative time when a total mesorectal excision is performed (165.9±10 vs 210±37 minutes; P<0.05). The conversion rate is significantly lower for RLAR (P<0.05). Postoperative morbidity was comparable between groups. Overall survival and disease-free survival were comparable between groups, even though a trend towards better disease-free survival in the RLAR group was observed. Conclusion: RLAR is a safe and feasible procedure that facilitates laparoscopic total mesorectal excision. Randomized clinical trials and longer follow-ups are needed to evaluate a possible influence of RLAR on patient survival.

Ceccarelli, Graziano; Bartoli, Alberto; Spaziani, Alessandro; Biancafarina, Alessia; Casciola, Luciano

2009-01-01

342

Semi-automatic staging system for rectal cancer using spatially oriented unwrapped endorectal ultrasound  

NASA Astrophysics Data System (ADS)

Endorectal ultrasound is currently the gold standard for the staging of rectal cancer; however, the accurate staging of the disease requires extensive training and is difficult, especially for those clinicians who do not see a large number of patients per year. Therefore, there is a need for a semi-automatic staging system to assist the clinicians in the accurate staging of rectal cancer. We believe that the unwrapping of the circular ERUS images captured by a spatially tracked ERUS system is a step in this direction. The steps by which a 2D image can be unwrapped are described thereby allowing the circular layers of the rectal wall to be displayed as flat layers stacked on top of each other. We test the unwrapping process using images from a cylindrical rectal phantom and a human rectum. The process of unwrapping endorectal ultrasound images qualitatively provides good visualization of the layers of the rectal wall and rectal tumors and supports the continual study of this novel staging system.

Warmath, John R.; Cao, Zhujiang; Bao, Philip; Herline, Alan J.; Galloway, Robert L., Jr.

2005-04-01

343

Laparoscopic ovarian transposition before pelvic radiation in rectal cancer patient: safety and feasibility  

PubMed Central

Background Infertility due to pelvic radiation for advanced rectal cancer treatment is a major concern particularly in young patients. Pre-radiation laparoscopic ovarian transposition may offer preservation of ovarian function during the treatment however its use is limited. Aim The study investigates the safety, feasibility and effectiveness of pre-radiation laparoscopic ovarian transposition and its effect on ovarian function in the treatment o locally advanced rectal cancer. Methods Charts review of all young female patients diagnosed with locally advanced rectal cancer, underwent laparoscopic ovarian transposition, then received preoperative radiotherapy at king Faisal Specialist Hospital and Research Centre between 2003–2007. Results During the period studied three single patients age between 21–27?years underwent pre-radiation laparoscopic ovarian transposition for advanced rectal cancer. All required pretreatment laparoscopic diversion stoma due to rectal stricture secondary to tumor that was performed at the same time. One patient died of metastatic disease during treatment. The ovarian hormonal levels (FSH and LH) were normal in two patients. One has had normal menstrual period and other had amenorrhoea after 4?months follow-up however her ovarian hormonal level were within normal limits. Conclusions Laparoscopic ovarian transposition before pelvic radiation in advanced rectal cancer treatment is an effective and feasible way of preservation of ovarian function in young patients at risk of radiotherapy induced ovarian failure. However, this procedure is still under used and it is advisable to discuss and propose it to suitable patients.

2012-01-01

344

Rectal cancer risk in patients treated for familial adenomatous polyposis. The Leeds Castle Polyposis Group.  

PubMed

Total colectomy with ileorectal anastomosis (IRA) in familial adenomatous polyposis (FAP) leaves patients at risk for rectal cancer. To assess this risk, the rectal cancer incidence in 297 patients with FAP undergoing IRA since 1951 was determined in the population-based registers of Denmark, Finland and Sweden. At the same time, detailed data on 50 patients with FAP and invasive rectal cancer were obtained from 11 international polyposis registries. The cumulative incidence of rectal cancer was 13.1 per cent at 25 years. The 5-year survival rate of patients with FAP developing rectal cancer was 71 per cent. Combining both studies, the risk of dying from rectal cancer after IRA was 2.0 per cent at 15 years of follow-up. These results justify IRA as primary treatment for most patients; restorative proctocolectomy is preferred for some subgroups. The high all-cause mortality rate observed in this relatively young population necessitates lifelong surveillance of patients with FAP. PMID:1336702

De Cosse, J J; Bülow, S; Neale, K; Järvinen, H; Alm, T; Hultcrantz, R; Moesgaard, F; Costello, C

1992-12-01

345

Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer  

PubMed Central

Purpose Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer. Methods A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. Results According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ? 0.15 (P = 0.02). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was independently associated with worse DFS. Conclusion This study showed the prognostic significance of ratio-based staging for rectal cancer and may help in developing better staging systems. LNR 0.15 (15%) was shown to be a cutoff point for determining survival and prognosis in rectal cancer cases.

Gunal, Omer; Manukyan, Manuk; Ozden, Gulden; Yegen, Cumhur

2013-01-01

346

Abdominal Sacral Resection of Locally Recurrent Rectal Cancer  

PubMed Central

Local recurrence of rectal cancer develops in the posterior bony pelvis as an isolated event in about half of the patients with recurrence. Although radiation can palliate sacral root pain, the disease is usually progressive and is rarely amenable to conventional resection. We have adapted a surgical technique usually used for primary sacral tumors, which permits a complete en bloc excision of recurrent rectal cancer in most instances. This approach consists of a laparotomy with pelvic dissection and mobilization of structures to be resected. The patient is repositioned prone and the posterior pelvis (sacrum and side walls) is then resected with preservation of appropriate nerve roots of the posterior pelvis and the sciatic nerve. Reconstruction is done with muscle and skin flaps. We have done 21 such procedures, of which, 11 were for pelvic recurrence of rectal adenocarcinoma. Seven patients had resections for cure and four had palliative resections of fungating or infected tumors. All but one patient was postabdominal perineal resection and nine patients had been irradiated (3000-9000 rads). Two patients had received up to 9000 rads in separate courses (external beam in one and interstitial radiation in the other). The posterior extent of resection was S1-2 to 5 in six patients; S3 to 5 in three patients, and S4-5 in two patients. Anterior exenteration was performed in three patients and three patients had additional resection of other organs. In the curative resection group, three patients are living free of disease at six, ten, and 52 months, and one patient was NED at 60 months, but has again had tumor recurrance and is living with disease at 65 months. One patient died of disease at 13 months and one patient died of a pulmonary embolus following resection for ureteral obstruction at five months. One postoperative death occurred from a cerebrovascular accident at 52 days. In the palliative resection group, three patients survived with relief of local tumor symptoms four, eight, and 12 months. One patient who had received a total of 9000 rads developed flap necrosis, small bowel fistula and died 60 days after resection. Although this is a small series, it suggests that abdominal sacral resection of locally advanced pelvic cancer is feasible and may provide good palliation in most and possible cure in some patients who develop recurrence after primary resection of adenocarcinoma of the rectum. ImagesFig. 1.Fig. 2.Fig. 3a.Fig. 3b.Fig. 4.Fig. 5.Fig. 7a.Fig. 7b.Fig. 7c.Fig. 7d.Fig. 8a.Fig. 8b.Fig. 8c.Fig. 9a.Fig. 9b.Fig. 9c.Fig. 9d.Fig. 10a.Fig. 10b.Fig. 10c.

Wanebo, Harold J.; Marcove, Ralph C.

1981-01-01

347

Late rectal bleeding after conformal radiotherapy of prostate cancer (II): volume effects and dose–volume histograms  

Microsoft Academic Search

Purpose and Objective: Late rectal bleeding is a potentially dose limiting complication of three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. The frequency of late rectal bleeding has been shown to increase as the prescription dose rises above 70 Gy. The purpose of this study is to identify features of the cumulative dose–volume histogram (DVH) for the rectal wall that correlate

Andrew Jackson; Mark W Skwarchuk; Michael J Zelefsky; Didier M Cowen; Ennapadam S Venkatraman; Sabine Levegrun; Chandra M Burman; Gerald J Kutcher; Zvi Fuks; Steven A Liebel; C. Clifton Ling

2001-01-01

348

HIV Incidence Among Men With and Those Without Sexually Transmitted Rectal Infections: Estimates From Matching Against an HIV Case Registry.  

PubMed

Background.?Sexually transmitted bacterial rectal infections are objective markers of HIV risk behavior. Quantifying HIV risk among men who have sex with men (MSM) who have had these infections can inform prevention efforts. We measured HIV risk among MSM who have and those who have not been diagnosed with rectal Chlamydia trachomatis (CT) and/or rectal Neisseria gonorrhoeae (GC). Methods.?HIV incidence among a cohort of 276 HIV-negative MSM diagnosed with rectal CT and/or GC in New York City sexually transmitted disease (STD) clinics was compared to HIV incidence among HIV-negative MSM without these infections. Matches against the citywide HIV/AIDS registry identified HIV diagnoses from STD clinics, and by other providers. Cox proportional hazards models were used to explore factors associated with HIV acquisition among MSM with rectal infections. Results.?HIV-negative MSM with rectal infections (>70% of which were asymptomatic) contributed 464.7 person-years of follow-up. Among them, 31 (11.2%) were diagnosed with HIV, of whom 14 (45%) were diagnosed by non-STD clinic providers. The annual HIV incidence was significantly higher among MSM with rectal infections (6.67%; 95% confidence interval [CI], 4.61%-9.35%) than among MSM without rectal infections (2.53%; 95% CI, 1.31%-4.42%). Black race (hazard ratio, 4.98; 95% CI, 1.75-14.17) was associated with incident HIV among MSM with rectal CT/GC. Conclusions.?One in 15 MSM with rectal infections was diagnosed with HIV within a year, a higher risk than for MSM without rectal infections. Such data have implications for screening for rectal STD, and may be useful for targeting populations for risk-reduction counseling and other HIV prevention strategies, such as preexposure prophylaxis. PMID:23800942

Pathela, Preeti; Braunstein, Sarah L; Blank, Susan; Schillinger, Julia A

2013-06-25

349

Endoscopic posterior mesorectal resection as an option to combine local treatment of early stage rectal cancer with partial mesorectal lymphadenectomy  

Microsoft Academic Search

Background and aims  Low anterior resection and abdominoperineal resection with total mesorectal excision are the standard treatment in patients\\u000a with low rectal cancer. Rectal resection remains a surgical intervention with considerable morbidity and long-term impairment\\u000a of quality of life. Local excision of low rectal cancer is regarded as an alternative to radical surgery; however, occurrence\\u000a of lymph node metastasis even in

Jörg Köninger; Beat P. Müller-Stich; Frank Autschbach; Peter Kienle; Jürgen Weitz; Markus W. Büchler; Carsten N. Gutt

2007-01-01

350

LATE RECTAL BLEEDING AFTER CONFORMAL RADIOTHERAPY OF PROSTATE CANCER (II): VOLUME EFFECTS AND DOSE-VOLUME HISTOGRAMS  

Microsoft Academic Search

Purpose and Objective: Late rectal bleeding is a potentially dose limiting complication of three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. The frequency of late rectal bleeding has been shown to increase as the prescription dose rises above 70 Gy. The purpose of this study is to identify features of the cumulative dose-volume histogram (DVH) for the rectal wall that correlate

ANDREW JACKSON; MARK W. SKWARCHUK; MICHAEL J. ZELEFSKY; DIDIER M. COWEN; ENNAPADAM S. VENKATRAMAN; SABINE LEVEGRUN; CHANDRA M. BURMAN; GERALD J. KUTCHER; ZVI FUKS; STEVEN A. LIEBEL; C. CLIFTON LING

351

Control of rectal gland secretion by blood acid–base status in the intact dogfish shark ( Squalus acanthias)  

Microsoft Academic Search

In order to address the possible role of blood acid–base status in controlling the rectal gland, dogfish were fitted with indwelling arterial catheters for blood sampling and rectal gland catheters for secretion collection. In intact, unanaesthetized animals, isosmotic volume loading with 500mmolL?1 NaCl at a rate of 15mLkg?1h?1 produced a brisk, stable rectal gland secretion flow of about 4mLkg?1h?1. Secretion

Chris M. Wood; R. Stephen Munger; Jill Thompson; Trevor J. Shuttleworth

2007-01-01

352

Rectal Self-Sampling in Non-Clinical Venues for Detection of Sexually Transmitted Infections (STI) among Behaviorally Bisexual Men  

PubMed Central

Rectal sexually transmitted infections (STI) are a common health concern for men who have sex with men (MSM) but little is known about these infections among men who had sex with both men and women (MSMW). Self-obtained rectal specimens were collected from a diverse sample of behaviorally bisexual men. From a total sample of 75 bisexual men, 58 collected specimens. A relatively high prevalence of rectal C. trachomatis infection was found. Participants who collected specimens reported overall acceptability and comfort with self-sampling. Future efforts are needed focusing on increasing awareness of and options for rectal STI testing among bisexual men.

Dodge, Brian; Van Der Pol, Barbara; Reece, Michael; Malebranche, David; Martinez, Omar; Goncalves, Gabriel; Schnarrs, Phillip; Nix, Ryan; Fortenberry, J. Dennis

2012-01-01

353

Impact of rectal balloon-filling materials on the dosimetry of prostate and organs at risk in photon beam therapy.  

PubMed

The use of rectal balloon in radiotherapy of prostate cancer is shown to be effective in reducing prostate motion and minimizing rectal volume, thus reducing rectal toxicity. Air-filled rectal balloon has been used most commonly, but creates dose perturbation at the air-tissue interface. In this study, we evaluate the effects of rectal balloon-filling materials on the dose distribution to the target and organs at risk. The dosimetric impact of rectal balloon filling was studied in detail for a typical prostate patient, and the general effect of the balloon filling was investigated from a study of ten prostate patients covering a wide range of anterior-posterior and left-right separations, as well as rectal and bladder volumes. Hounsfield units (HU) of the rectal balloon filling was changed from -1000 HU to 1000 HU at an interval of 250 HU, and the corresponding changes in the relative electron density (RED) was calculated. For each of the HU of the rectal balloon filling, a seven-field IMRT plan was generated with 6 MV and 15 MV photon beams, respectively. Dosimetric evaluation was performed with the AAA algorithm for inhomogeneity corrections. A detailed study of the rectal balloon filling shows that the GTV, PTV, rectal, and bladder mean dose decreased with increasing values of RED in the rectal balloon. There is significant underdosage in the target volume at the rectum-prostate interface with an air-filled balloon as compared to that with a water-filled balloon for both 6 MV and 15 MV beams. While the dosimetric effect of the rectal balloon filling is reduced when averaged over ten patients, generally an air-filled balloon results in lower minimum dose and lower mean dose in the overlap region (and possibly the PTV) compared to those produced by water-filled or contrast-filled balloons. Dose inhomogeneity in the target volume is increased with an air-filled rectal balloon. Thus a water-filled or contrast-filled rectal balloon is preferred to an air-filled rectal balloon in EBRT of prostate treatment. PMID:23318385

Srivastava, Shiv P; Das, Indra J; Kumar, Arvind; Johnstone, Peter A S; Cheng, Chee-Wai

2013-01-07

354

Controversies in the surgical management of rectal cancer.  

PubMed

At the present time, standard therapy for potentially curable rectal cancer consists of transabdominal surgical resection and adjuvant chemoradiation for American Joint Committee on Cancer stage II/III disease. Controversial issues include the use of local excision as opposed to formal resection and total mesorectal excision (TME) alone without adjuvant therapy. Although early stage tumors are the ideal potential candidates for local excision, clinical staging with endoscopic ultrasound is extremely variable in accurately predicting T and N stage. In addition, even low-grade or T1 tumors are associated with a 7% to 14% chance of nodal metastatic disease. Overall, the risk for local recurrence is higher after local excision but may be reduced by adjuvant therapy. Salvage rates for recurrent disease range from 21% to 91%. In regard to TME, local recurrence rates are an impressive 0% to 12% without adjuvant radiation. However, the addition of radiation therapy may further reduce these already low rates, especially in higher-risk groups. The results of 2 large European studies show acceptable complication rates and the applicability of this technique to a diverse patient population. PMID:14586830

Kane, John M; Petrelli, Nicholas J

2003-10-01

355

Rectal cancer staging: is there an optimal method?  

PubMed

The staging process in a newly diagnosed rectal cancer is divided into three parts. One essential part is the local staging, in which both endorectal ultrasound and MRI are used to disclose the size of the tumor and its correlation to the perirectal fascia, and to identify lymph node deposits and vascular invasion. This local staging process will guide clinicians to decide upon not only the type of surgery (local excision or radical surgery) but also whether or not some type of neoadjuvant treatment, such as radiotherapy and/or chemotherapy, is indicated. The second part is to evaluate whether or not the tumor has already metastasized at diagnosis. The most important organs to evaluate are the liver and lungs, and imaging techniques such as ultrasound, CT-scan, or sometimes PET-CT, and MRI can be used. The third important part is to investigate the rest of the large bowel for synchronous adenomas or cancers. This will preferably be done with colonoscopy or CT-colonography and sometimes barium enema. This article discusses the imaging techniques used for local staging and distant metastases. PMID:21174540

Påhlman, Lars; Torkzad, Michael R

2011-01-01

356

Formulation and Evaluation of Tramadol hydrochloride Rectal Suppositories.  

PubMed

Rectal suppositories of tramadol hydrochloride were prepared using different bases and polymers like PEG, cocoa butter, agar and the effect of different additives on in vitro release of tramadol hydrochloride was studied. The agar-based suppositories were non-disintegrating/non-dissolving, whereas PEGs were disintegrating/dissolving and cocoa butter were melting suppositories. All the prepared suppositories were evaluated for various physical parameters like weight variation, drug content and hardness. The PEG and cocoa butter suppositories were evaluated for macromelting range, disintegration and liquefaction time. In vitro release study was performed by USP type I apparatus. The prepared suppositories were within the permissible range of all physical parameters. In vitro drug release was in the order of PEG>Agar>cocoa butter. Addition of PVP, HPMC in agar suppositories retards the release. The mechanism of drug release was diffusion controlled and follows first order kinetics. The results suggested that blends of PEG of low molecular weight (1000) with high molecular weight (4000 and 6000) in different percentage and agar in 10% w/w as base used to formulate rapid release suppositories. The sustained release suppositories can be prepared by addition of PVP, HPMC in agar-based suppositories and by use of cocoa butter as base. PMID:21394263

Saleem, M A; Taher, M; Sanaullah, S; Najmuddin, M; Ali, Javed; Humaira, S; Roshan, S

2008-09-01

357

Digital Rectal Examination Standardization for Inexperienced Hands: Teaching Medical Students  

PubMed Central

Objectives. To standardize digital rectal examination (DRE) and set how it correlates with the comprehensive evaluation of lower urinary tract symptoms (LUTS). Methods. After scaled standardization of DRE based on fingertips graphical schema: 10 cubic centimeters—cc for each fingertip prostate surface area on DRE, four randomly selected senior medical students examined 48 male patients presenting with LUTS in an outpatient clinical setting, totaling 12 DRE each. Standardized DRE, international prostate symptom score (IPSS), serum PSA, transabdominal ultrasound (US), urodynamic evaluation, and postvoid residue were compared. Results. The mean and median PVs were US—45 and 34.7?cc (5.5 to 155) and DRE—39 and 37.5?cc (15 to 80). Comparing DRE and US by simple linear regression: US PV = 11.93 + 0.85 × (DRE PV); P = 0.0009. Among patients classified as nonobstructed, inconclusive, and obstructed, the US PVs were 29.8, 43.2, and 53.6?cc (P = 0.033), and DRE PVs were 20, 35, and 60?cc (P = 0.026), respectively. Conclusion. This is the first attempt to DRE standardization focusing on teaching-learning process, establishing a linear correlation of DRE and US PVs with only 12 examinations by inexperienced hands, satisfactorily validated in an outpatient clinical setting.

Reis, Leonardo Oliveira; Simao, Antonio Felipe Leite; Baracat, Jamal; Denardi, Fernandes; Gugliotta, Antonio

2013-01-01

358

Genetic variation in the TGF-?-signaling pathway and colon and rectal cancer risk  

PubMed Central

Background The TGF-?-signaling pathway is an essential regulator of many cellular process involved in carcinogenesis. Smad proteins are central to the function of TGF-?-signaling. In this study we evaluate genetic variation in TGF?1, TGF?R1, Smad1, Smad2, Smad3, and Smad4 and risk of colon and rectal cancer. Methods Data are from a large case-control study of colon (n=1444 cases, 1841 controls) and rectal (n=754 cases, 856 controls) cancer participants with DNA. Results Both TGF?1 rs1800469 and rs4803455 were associated with colon cancer (OR 0.65 and 1.43, 95% CI 0.51,0.84 and 1.18,1.73 respectively) but not rectal cancer. Likewise, 1 of 3 tagSNPs for TGF?R1, 2 of the 4 tagSNPs for Smad2, and 4 of 37 Smad3 tagSNPs were associated with colon cancer. Fewer significant associations were observed for rectal cancer, with only 1 tagSNP in Smad2 and 3 tagSNP in Smad3 having 95% confidence intervals excluding 1.0. Several Smad3 tagSNPs were only associated with CpG island methylator phenotype (CIMP). We observed several statistically significant interactions between genetic variation in the TGF-?-signaling pathway and NF?B1, further illustrating its involvement in proposed mechanisms. Additionally we observed statistically significant interaction between TGF?1, TGF?R1, Smad3 and cigarette smoking, aspirin use, and estrogen status for both colon and rectal cancer. Variation in TGF?1, TGF?R1, and Smad3 appeared to influence survival after diagnosis of colon and rectal cancer. Conclusions These findings provide further support for genetic variation in the TGF-?-signaling pathway and risk of developing both colon and rectal cancer. Impact Insight into biological pathways is provided.

Slattery, Martha L.; Herrick, Jennifer S.; Lundgreen, Abbie; Wolff, Roger K.

2010-01-01

359

Preliminary analysis of risk factors for late rectal toxicity after helical tomotherapy for prostate cancer  

PubMed Central

The purpose of this study is to examine risk factors for late rectal toxicity for localized prostate cancer patients treated with helical tomotherapy (HT). The patient cohort of this retrospective study was composed of 241 patients treated with HT and followed up regularly. Toxicity levels were scored according to the Radiation Therapy Oncology Group grading scale. The clinical and dosimetric potential factors increasing the risk of late rectal toxicity, such as age, diabetes, anticoagulants, prior abdominal surgery, prescribed dose, maximum dose of the rectum, and the percentage of the rectum covered by 70 Gy (V70), 60 Gy (V60), 40 Gy (V40) and 20 Gy (V20) were compared between ? Grade 1 and ? Grade 2 toxicity groups using the Student's t-test. Multivariable logistic regression analysis of the factors that appeared to be associated with the risk of late rectal toxicity (as determined by the Student's t-test) was performed. The median follow-up time was 35 months. Late Grade 2–3 rectal toxicity was observed in 18 patients (7.4%). Age, the maximum dose of the rectum, V70 and V60 of the ? Grade 2 toxicity group were significantly higher than in those of the ? Grade 1 toxicity group (P = 0.00093, 0.048, 0.0030 and 0.0021, respectively). No factor was significant in the multivariable analysis. The result of this study indicates that the risk of late rectal toxicity correlates with the rectal volume exposed to high doses of HT for localized prostate cancer. Further follow-up and data accumulation may establish dose–volume modeling to predict rectal complications after HT.

Tomita, Natsuo; Soga, Norihito; Ogura, Yuji; Hayashi, Norio; Shimizu, Hidetoshi; Kubota, Takashi; Ito, Junji; Hirata, Kimiko; Ohshima, Yukihiko; Tachibana, Hiroyuki; Kodaira, Takeshi

2013-01-01

360

Interleukin genes and associations with colon and rectal cancer risk and overall survival.  

PubMed

Interleukins are a group of cytokines that contribute to growth and differentiation, cell migration, and inflammatory and anti-inflammatory responses by the immune system. In our study, we examined genetic variation in genes from various anti-inflammatory and proinflammatory interleukins to determine association with colon and rectal cancer risk and overall survival. Data from two population-based incident studies of colon cancer (1,555 cases and 1,956 controls) and rectal cancer (754 cases and 954 controls) were used. After controlling for multiple comparisons, single nucleotide polymorphisms (SNPs) from four genes, IL3, IL6R, IL8, IL15, were associated with increased colon cancer risk, and CXCR1 and CXCR2 were significantly associated with increased rectal cancer risk. Only SNPs from genes within the IL-8 pathway (IL8, CXCR1 and CXCR2) showed a significant association with both colon and rectal cancer risk. Several SNPs interacted significantly with IL8 and IFNG SNPs and with aspirin/non-steroidal anti-inflammatory drug (NSAID), cigarette smoking, estrogen use and BMI. For both colon and rectal cancer, increasing numbers of risk alleles were associated with increased hazard of death from cancer; the estimated hazard of death for colon cancer for the highest category of risk alleles was 1.74 (95% confidence interval [CI] 1.18-2.56) and 1.96 (95% CI 1.28-2.99) for rectal cancer. These data suggest that interleukin genes play a role in risk and overall survival for colon and rectal cancer. PMID:22674296

Bondurant, Kristina L; Lundgreen, Abbie; Herrick, Jennifer S; Kadlubar, Susan; Wolff, Roger K; Slattery, Martha L

2012-06-26

361

Preliminary analysis of risk factors for late rectal toxicity after helical tomotherapy for prostate cancer.  

PubMed

The purpose of this study is to examine risk factors for late rectal toxicity for localized prostate cancer patients treated with helical tomotherapy (HT). The patient cohort of this retrospective study was composed of 241 patients treated with HT and followed up regularly. Toxicity levels were scored according to the Radiation Therapy Oncology Group grading scale. The clinical and dosimetric potential factors increasing the risk of late rectal toxicity, such as age, diabetes, anticoagulants, prior abdominal surgery, prescribed dose, maximum dose of the rectum, and the percentage of the rectum covered by 70 Gy (V70), 60 Gy (V60), 40 Gy (V40) and 20 Gy (V20) were compared between ? Grade 1 and ? Grade 2 toxicity groups using the Student's t-test. Multivariable logistic regression analysis of the factors that appeared to be associated with the risk of late rectal toxicity (as determined by the Student's t-test) was performed. The median follow-up time was 35 months. Late Grade 2-3 rectal toxicity was observed in 18 patients (7.4%). Age, the maximum dose of the rectum, V70 and V60 of the ? Grade 2 toxicity group were significantly higher than in those of the ? Grade 1 toxicity group (P = 0.00093, 0.048, 0.0030 and 0.0021, respectively). No factor was significant in the multivariable analysis. The result of this study indicates that the risk of late rectal toxicity correlates with the rectal volume exposed to high doses of HT for localized prostate cancer. Further follow-up and data accumulation may establish dose-volume modeling to predict rectal complications after HT. PMID:23525159

Tomita, Natsuo; Soga, Norihito; Ogura, Yuji; Hayashi, Norio; Shimizu, Hidetoshi; Kubota, Takashi; Ito, Junji; Hirata, Kimiko; Ohshima, Yukihiko; Tachibana, Hiroyuki; Kodaira, Takeshi

2013-03-22

362

Rectal Dose-Volume Differences Using Proton Radiotherapy and a Rectal Balloon or Water Alone for the Treatment of Prostate Cancer  

SciTech Connect

Purpose: To describe dose-volume values with the use of water alone vs. a rectal balloon (RB) for the treatment of prostate cancer with proton therapy. Materials and Methods: We analyzed 30 proton plans for 15 patients who underwent CT and MRI scans with an RB or water alone. Simulation was performed with a modified MRI endorectal coil and an RB with 100 mL of water or water alone. Doses of 78-82 gray equivalents were prescribed to the planning target volume. The two groups were compared for three structures: rectum, rectal wall (RW), and rectal wall 7 cm (RW7) at the level of the planning target volume. Results: Rectum and RW volumes radiated to low, intermediate, and high doses were small: rectum V10, 33.7%; V50, 17.3%; and V70, 10.2%; RW V10, 32.4%; V50, 20.4%; and V70, 14.6%. The RB effectively increased the rectal volume for all cases (139.8 {+-} 44.9 mL vs. 217.7 {+-} 32.2 mL (p < 0.001). The RB also decreased the volume of the rectum radiated to doses V10-V65 (p {<=} 0.05); RW for V10-V50; and RW7 for V10-V35. An absolute rectum V50 improvement >5% was seen for the RB in 5 of 15 cases, for a benefit of 9.2% {+-} 2.3% compared with 2.4% {+-} 1.3% for the remaining 10 cases (p < 0.001). Similar benefit was seen for the rectal wall. No benefit was seen for doses {>=}70 gray equivalents for the rectum, RW, or RW7. No benefit of {<=}1% was seen with an RB in 46% for the rectum V70 and in 40% for the rectal wall V70. Conclusions: Rectum and rectal wall doses with proton radiation were low whether using water or an RB. Selected patients will have a small but significant advantage with an RB; however, water alone was well tolerated and will be an alternative for most patients.

Vargas, Carlos [University of Florida Proton Therapy Institute, Jacksonville, FL (United States)], E-mail: c2002@ufl.edu; Mahajan, Chaitali; Fryer, Amber; Indelicato, Daniel; Henderson, Randal H.; McKenzie, Craig C.; Horne, David C.; Chellini, Angela; Lawlor, Paula C.; Li Zuofeng [University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Oliver, Kenneth [Department of Radiation Oncology, University of Florida, Gainesville, FL (United States); Keole, Sameer [University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

2007-11-15

363

[Interpretations of practice parameters for the management of rectal cancer(2013 released by American Society of Colon and Rectal Surgeons)].  

PubMed

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. It was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. We should also realize that this Guidelines based mostly on the best available evidence, furthermore, most evidence originated from local area. These guidelines are inclusive, and not prescriptive.These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines are not inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. PMID:23980035

Zhan, Tian-Cheng; Li, Ming; Gu, Jin

2013-08-01

364

A comparison of tympanic and rectal temperatures in term NIGERIAN neonates  

PubMed Central

Background Tympanic thermometry has come as a suitable alternative to traditional thermometry because of its safety and ease of use. However, it is still yet to gain wide acceptance in African settings due to conflicting results on its accuracy, thus rectal thermometry remains the gold standard in the newborn. The aim of this study was to compare tympanic and rectal temperatures in term Nigerian neonates. Methods Rectal and tympanic temperatures were measured simultaneously in 300 consecutive term neonates between the ages of 37 and 42?weeks gestation using mercury-in-glass and the Infrared tympanic thermometers respectively. Paired t test, Pearson correlation coefficient and the Bland-Altman plot were used to compute data. Using rectal thermometry as gold standard, the sensitivity, specificity and predictive values of tympanic thermometry at various rectal temperature cut-offs were determined. Receiver Operating Curves (ROC) were constructed and the Areas Under the Curves (AUC) were compared. Results The mean rectal temperature (37.34?±?0.55°C) was significantly higher than the mean tympanic temperature (37.25?±?0.56°C) (p?rectal temperature cut-offs of 37.5°C to 38°C. The positive and negative predictive values of the tympanic temperatures at the various temperature cut-offs ranged from 82% to 93% and 80% to 98% respectively. Accuracy was noted to increase with higher temperatures as shown by the Receiver Operating Curves with the highest accuracy at the temperature cut-off of 38°C and AUC of 0.91. Conclusions The sensitivity of tympanic thermometry was relatively low in detecting rectal temperatures despite the good correlation and agreement between them. The specificities and predictive values of tympanic temperatures in detecting rectal temperatures were high and accuracy increased with higher temperatures. Though using the tympanic route for measuring temperature in the newborn is relatively safe and non-invasive, its low sensitivity limits its use. Further studies would be required to further assess the accuracy of tympanic temperature measurements in the newborn.

2012-01-01

365

The use of pelvic radiation in stage II rectal cancer: a population-based analysis.  

PubMed

National Institutes of Health (NIH) guidelines recommend the use of pelvic radiation in T3N0 rectal cancer. We sought to determine the rate of compliance with NIH radiation guidelines for patients with T3N0 rectal cancer. We performed a retrospective cohort study of T3NO rectal cancer diagnosed between January 1, 1994, and December 31, 2003, in Region 5 of the California Cancer Registry (R5 CCR). Three hundred twenty-nine patients with T3N0 rectal cancer were identified. The mean age of the study population was 68 years (range, 28 to 93 years). Only 54.1 per cent of patients with T3N0 cancer received pelvic radiation. There was no difference in gender (P = 0.13) or the number of nodes examined (P = 0.19) between patients who had treatment with pelvic radiation and those who did not. However, patients receiving radiation were significantly younger (mean 64 years with radiation therapy [XRT] vs. 72 years without XRT, P < 0.001) and significantly more likely to be treated with systemic chemotherapy (75% with XRT vs. 8.6% without XRT, P < 0.001). Significant numbers of patients with T3N0 rectal cancer are not receiving pelvic radiation in R5 CRR. NIH guidelines are not being translated into clinical practice. The reasons for this warrant continued investigation. PMID:21105617

Kuo, Isabella; Wong, Jan H; Roy-Chowdhury, Sharmila; Lum, Sharon S; Morgan, John W; Kazanjian, Kevork

2010-10-01

366

Anatomic Basis of Sharp Pelvic Dissection for Curative Resection of Rectal Cancer  

PubMed Central

The optimal goals in the surgical treatment of rectal cancer are curative resection, anal sphincter preservation, and preservation of sexual and voiding functions. The quality of complete resection of rectal cancer and the surrounding mesorectum can determine the prognosis of patients and their quality of life. With the emergence of total mesorectal excision in the field of rectal cancer surgery, anatomical sharp pelvic dissection has been emphasized to achieve these therapeutic goals. In the past, the rates of local recurrence and sexual/voiding dysfunction have been high. However, with sharp pelvic dissection based on the pelvic anatomy, local recurrence has decreased to less than 10%, and the preservation rate of sexual and voiding function is high. Improved surgical techniques have created much interest in the surgical anatomy related to curative rectal cancer surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of dissection. A complete understanding of rectum anatomy and the adjacent pelvic organs are essential for colorectal surgeons who want optimal oncologic outcomes and safety in the surgical treatment of rectal cancer.

Kim, Nam Kyu

2005-01-01

367

The importance of rectal cancer MRI protocols on iInterpretation accuracy  

PubMed Central

Background Magnetic resonance imaging (MRI) is used for preoperative local staging in patients with rectal cancer. Our aim was to retrospectively study the effects of the imaging protocol on the staging accuracy. Patients and methods MR-examinations of 37 patients with locally advanced disease were divided into two groups; compliant and noncompliant, based on the imaging protocol, without knowledge of the histopathological results. A compliant rectal cancer imaging protocol was defined as including T2-weighted imaging in the sagittal and axial planes with supplementary coronal in low rectal tumors, alongside a high-resolution plane perpendicular to the rectum at the level of the primary tumor. Protocols not complying with these criteria were defined as noncompliant. Histopathological results were used as gold standard. Results Compliant rectal imaging protocols showed significantly better correlation with histopathological results regarding assessment of anterior organ involvement (sensitivity and specificity rates in compliant group were 86% and 94%, respectively vs. 50% and 33% in the noncompliant group). Compliant imaging protocols also used statistically significantly smaller voxel sizes and fewer number of MR sequences than the noncompliant protocols Conclusion Appropriate MR imaging protocols enable more accurate local staging of locally advanced rectal tumors with less number of sequences and without intravenous gadolinium contrast agents.

Suzuki, Chikako; Torkzad, Michael R; Tanaka, Soichi; Palmer, Gabriella; Lindholm, Johan; Holm, Torbjorn; Blomqvist, Lennart

2008-01-01

368

Management of Rectal Cancer and Liver Metastatic Disease: Which Comes First?  

PubMed Central

In the last few decades there have been significant changes in the approach to rectal cancer management. A multimodality approach and advanced surgical techniques have led to an expansion of the treatment of metastatic disease, with improved survival. Hepatic metastases are present at one point or another in about 50% of patients with colorectal cancer, with surgical resection being the only chance for cure. As the use of multimodality treatment has allowed the tackling of more complicated cases, one of the main questions that remain unanswered is the management of patients with synchronous rectal cancer and hepatic metastatic lesions. The question is one of priority, with all possible options being explored. Specifically, these include the simultaneous rectal cancer and hepatic metastases resection, the rectal cancer followed by chemotherapy and then by the liver resection, and finally the “liver-first” option. This paper will review the three treatment options and attempt to dissect the indications for each. In addition, the role of laparoscopy in the synchronous resection of rectal cancer and hepatic metastases will be reviewed in order to identify future trends.

Tsoulfas, Georgios; Pramateftakis, Manousos-Georgios

2012-01-01

369

Radiation-induced rectal cancer originating from a rectocutaneous fistula: report of a case.  

PubMed

This report describes a patient with radiation-induced rectal cancer with an unusual history. A 51-year-old man was admitted in 2000 because of ichorrhea of the skin on the left loin. The patient had received irradiation for a suspicious diagnosis of a malignant tumor in the pelvic cavity in 1975. A subcutaneous abscess in the right loin appeared in 1989, and rectocutaneous fistula was noted in 1992. Moreover, radiation-induced rectal cancer developed in 2000. Plain computed tomography and magnetic resonance imaging of the pelvis demonstrated a presacral mass and tumor in the rectum. Finally, we diagnosed the presacral mass to be an abscess attached to the center of the rectal cancer. The rectum was resected by Miles' operation and a colostomy of the sigmoid colon was also performed. Many cases of radiation-induced rectal cancer have been reported. However, this is a rare case of radiation-induced rectal cancer originating from a presacral abscess and rectocutaneous fistula. PMID:15290404

Yokoyama, Shozo; Takifuji, Katsunari; Arii, Kazuo; Tanaka, Hajime; Matsuda, Kenji; Higashiguchi, Takashi; Yamaue, Hiroki

2004-01-01

370

Endoscopic mucosal resection for rectal carcinoids under micro-probe ultrasound guidance  

PubMed Central

AIM: To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter. METHODS: Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound. RESULTS: All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported. CONCLUSION: EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.

Zhou, Fu-Run; Huang, Liu-Ye; Wu, Cheng-Rong

2013-01-01

371

Oncologic outcomes of primary and post-irradiated early stage rectal cancer: A retrospective cohort study  

PubMed Central

AIM: To evaluate the oncologic outcomes of primary and post-irradiated early stage rectal cancer and the effectiveness of adjuvant chemotherapy for rectal cancer patients. METHODS: Eighty-four patients with stage?I?rectal cancer after radical surgery were studied retrospectively and divided into ypstage?I?group (n = 45) and pstage?I?group (n = 39), according to their preoperative radiation, and compared by univariate and multivariate analysis. RESULTS: The median follow-up time of patients was 70 mo. No significant difference was observed in disease progression between the two groups. The 5-year disease-free survival rate was 84.4% and 92.3%, respectively (P = 0.327) and the 5-year overall survival rate was 88.9% and 92.3%, respectively, for the two groups (P = 0.692). The disease progression was not significantly associated with the pretreatment clinical stage in ypstage?I?group. The 5-year disease progression rate was 10.5% and 19.2%, respectively, for the patients who received adjuvant chemotherapy and for those who rejected chemotherapy in the ypstage?I?group (P = 0.681). CONCLUSION: The oncologic outcomes of primary and post-irradiated early stage rectal cancer are similar. Patients with ypstage?I?rectal cancer may slightly benefit from adjuvant chemotherapy.

Du, Chang-Zheng; Chen, Yong-Chun; Cai, Yong; Xue, Wei-Cheng; Gu, Jin

2011-01-01

372

Oncological outcomes of transanal local excision for high risk T1 rectal cancers  

PubMed Central

AIM: To evaluate the oncological outcomes of transanal local excision and the need for immediate conventional reoperation in the treatment of patients with high risk T1 rectal cancers. METHODS: Twenty five high risk T1 rectal cancers treated by transanal local excision at the Guangdong General Hospital were analyzed retrospectively. Twelve patients received transanal local excision and 13 patients underwent subsequent immediate surgical rescue after transanal local excision within 4 wk. Differences in the local recurrence rates and 5-year overall survival rates between the two groups were analyzed. The prognostic value of immediate conventional reoperation for high risk T1 rectal cancers was also evaluated. RESULTS: The median follow-up period was 62 mo. The local recurrence rates after transanal local excision for high risk T1 rectal cancer were 50%. By immediate conventional reoperation, the local recurrence rates were significantly reduced to 7.7%. The difference between these two groups was statistically significant (P = 0.030). Kaplan-Meier survival analysis showed a trend for decreased 5-year overall survival rates for patients treated by transanal local excision compared with immediate conventional reoperation (63% vs 89%). CONCLUSION: Transanal local excision cannot be considered sufficient treatment for patients with high risk T1 rectal cancers. Immediate conventional reoperation should be performed if the pathology of the local excision is high risk.

Wu, Ze-Yu; Zhao, Gang; Chen, Zhe; Du, Jia-Lin; Wan, Jin; Lin, Feng; Peng, Lin

2012-01-01

373

Colon and rectal surgery for cancer without mechanical bowel preparation: One-center randomized prospective trial  

PubMed Central

Background Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. Methods Patients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications. Results Two hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery. Conclusions These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.

2010-01-01

374

Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report  

PubMed Central

Introduction Fournier gangrene is a rare necrotising fascitis of the perineum and genitals caused by a mixture of aerobic and anaerobic microorganisms. The first case was described by Baurienne in 1764 but the condition was named by Fournier in 1883 who reported the cases of five men with the condition with no apparent etiology. Infection most commonly arises from the skin, urethra, or rectal regions. Despite appropriate therapy, mortality in this disease is still high. We report a case of a low rectal malignancy presenting as Fournier gangrene. This case report serves to highlight an extremely unusual presentation of rectal cancer, a common surgical pathology. Case presentation The patient is a 48 years old Afghanian male that admitted with Fournier gangrene. In the course of medical and surgical treatment the presence of extensive rectal adenocarcinoma was discovered. After partial recovery, standard loop colostomy was inserted. Skin grafting of necrotic areas was performed and systemic rectal cancer chemotherapy initiated after full stabilization. Conclusion Fournier gangrene is an uncommon but life threatening condition with high associated mortality and morbidity. Usually there is an underlying cause for the development of Fournier gangrene, that if addressed correctly, can lead to a good outcome. Early diagnosis and treatment decrease the morbidity and mortality of this life threatening condition. Good management is based on aggressive debridement, broad spectrum antibiotics and intensive supportive care.

2009-01-01

375

How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy?  

PubMed Central

In patients with advanced rectal cancer, neoadjuvant chemo radiotherapy provides tumor downstaging and downsizing and complete pathological response in up to 30% of cases. After proctectomy complete pathological response is associated with low rates of local recurrence and excellent long term survival. Several authors claim a less invasive surgery or a non operative policy in patients with partial or clinical complete response respectively, however to identify patients with true complete pathological response before surgical resection remains a challenge. Current imaging techniques have been reported to be highly accurate in the primary staging of rectal cancer, however neoadjuvant therapy course produces deep modifications on cancer tissue and on surrounding structures such as overgrowth fibrosis, deep stroma alteration, wall thickness, muscle disarrangement, tumor necrosis, calcification, and inflammatory infiltration. As a result, the same imaging techniques, when used for restaging, are far less accurate. Local tumor extent may be overestimated or underestimated. The diagnostic accuracy of clinical examination, rectal ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography using 18F-fluoro-2’-deoxy-D-glucose ranges between 25% and 75% being less than 60% in most studies, both for rectal wall invasion and for lymph nodes involvement. In particular the ability to predict complete pathological response, in order to tailor the surgical approach, remains low. Due to the radio-induced tissue modifications, combined with imaging technical aspects, low rate accuracy is achieved, making modern imaging techniques still unreliable in restaging rectal cancer after chemo-radiotherapy.

De Nardi, Paola; Carvello, Michele

2013-01-01

376

Evaluation of Mucoadhesive Hydrogels Loaded with Diclofenac Sodium-Chitosan Microspheres for Rectal Administration  

PubMed Central

Considering the advantageous for the rectal administration of non-steroidal anti-inflammatory drugs, the objective of this study was to formulate and evaluate rectal mucoadhesive hydrogels loaded with diclofenac-sodium chitosan (DFS-CS) microspheres. Hydroxypropyl methylcellulose (HPMC; 5%, 6%, and 7% w/w) and Carbopol 934 (1% w/w) hydrogels containing DFS-CS microspheres equivalent to 1% w/w active drug were prepared. The physicochemical characterization revealed that all hydrogels had a suitable pH for rectal application (6.5–7.4). The consistency of HPMC hydrogels showed direct proportionality to the concentration of the gelling agent, while carbopol 934 gel showed its difficulty for rectal administration. Farrow’s constant for all hydrogels were greater than one indicating pseudoplastic flow. In vitro drug release from the mucoadhesive hydrogel formulations showed a controlled drug release pattern, reaching 34.6–39.7% after 6 h. The kinetic analysis of the release data revealed that zero-order was the prominent release mechanism. The mucoadhesion time of 7% w/w HPMC hydrogel was 330 min, allowing the loaded microspheres to be attached to the surface of rectal mucosa. Histopathological examination demonstrated the lowest irritant response to the hydrogel loaded with DFS-CS microspheres in response to other forms of the drug.

El-Leithy, Eman S.; Ghorab, Mohamed K.; Abdel-Rashid, Rania S.

2010-01-01

377

Quantitative analysis of rectal cancer by spectral domain optical coherence tomography  

NASA Astrophysics Data System (ADS)

To quantify OCT images of rectal tissue for clinic diagnosis, the scattering coefficient of the tissue is extracted by curve fitting the OCT signals to a confocal single model. A total of 1000 measurements (half and half of normal and malignant tissues) were obtained from 16 recta. The normal rectal tissue has a larger scattering coefficient ranging from 1.09 to 5.41 mm-1 with a mean value of 2.29 mm-1 (std:±0.32), while the malignant group shows lower scattering property and the values ranging from 0.25 to 2.69 mm-1 with a mean value of 1.41 mm-1 (std:±0.18). The peri-cancer of recta has also been investigated to distinguish the difference between normal and malignant rectal tissue. The results demonstrate that the quantitative analysis of the rectal tissue can be used as a promising diagnostic criterion of early rectal cancer, which has great value for clinical medical applications.

Zhang, Q. Q.; Wu, X. J.; Tang, T.; Zhu, S. W.; Yao, Q.; Gao, Bruce Z.; Yuan, X. C.

2012-08-01

378

Reporting Late Rectal Toxicity in Prostate Cancer Patients Treated With Curative Radiation Treatment  

SciTech Connect

Purpose: Long-term rectal toxicity is a concern for patients with prostate cancer treated with curative radiation. However, comparing results of late toxicity may not be straightforward. This article reviews the complexity of reporting long-term side effects by using data for patients treated in our institution with hypofractionated irradiation. Methods and Materials: Seventy-two patients with localized prostate cancer treated with hypofractionated radiotherapy alone to a dose of 66 Gy in 22 fractions were prospectively assessed for late rectal toxicity according to the Common Toxicity Criteria, Version 3, scoring system. Ninety percent of patients had more than 24 months of follow-up. Results are compared with data published in the literature. Results: We found an actuarial incidence of Grade 2 or higher late rectal toxicity of 27% at 30 months and a crude incidence of Grade 2 or higher late rectal toxicity of 18%. This was mostly severe toxicity documented during follow-up. The incidence of Grade 3 rectal toxicity at the last visit was 3% compared with 13% documented at any time during follow-up. Conclusion: Comparison of late toxicity after radiotherapy in patients with prostate cancer must be undertaken with caution because many factors need to be taken into consideration. Because accurate assessment of late toxicity in the evaluation of long-term outcome after radiotherapy in patients with localized prostate cancer is essential, there is a need to develop by consensus guidelines for assessing and reporting late toxicity in this group of patients.

Faria, Sergio L. [Department of Radiation Oncology, McGill University Health Centre, Montreal (Canada)], E-mail: sergio.faria@muhc.mcgill.ca; Souhami, Luis; Joshua, Bosede; Vuong, Te; Freeman, Carolyn R. [Department of Radiation Oncology, McGill University Health Centre, Montreal (Canada)

2008-11-01

379

Chloride secretagogues stimulate inositol phosphate formation in shark rectal gland tubules cultured in suspension  

SciTech Connect

Neuroendocrine activation of transepithelial chloride secretion by shark rectal gland cells is associated with increases in cellular cAMP, cGMP, and free calcium concentrations. We report here on the effects of several chloride secretagogues on inositol phosphate formation in cultured rectal gland tubules. Vasoactive intestinal peptide (VIP), atriopeptin (AP), and ionomycin increase the total inositol phosphate levels of cultured tubules, as measured by ion exchange chromatography. Forskolin, a potent chloride secretagogue, has no effect on inositol phosphate formation. The uptake of {sup 3}H-myo-inositol into phospholipids is very slow, preventing the detection of increased levels of inositol trisphosphate. However, significant increases in inositol monophosphate (IP1) and inositol biphosphate (IP2) were measured. The time course of VIP- and AP-stimulated IP1 and IP2 formation is similar to the effects of these agents on the short-circuit current responses of rectal gland monolayer cultures. In addition, aluminum fluoride, an artificial activator of guanine nucleotide-binding proteins, stimulates IP1 and IP2 formation. We conclude that rectal gland cells contain VIP and AP receptors coupled to the activation of phospholipase C. Coupling may be mediated by G-proteins. Receptor-stimulated increases in inositol phospholipid metabolism is one mechanism leading to increased intracellular free calcium concentrations, an important regulatory event in the activation of transepithelial chloride secretion by shark rectal gland epithelial cells.

Ecay, T.W.; Valentich, J.D. (Univ. of Texas Medical School, Houston (USA))

1991-03-01

380

Impact of Diabetes on Oncologic Outcome of Colorectal Cancer Patients: Colon vs. Rectal Cancer  

PubMed Central

Background To evaluate the impact of diabetes on outcomes in colorectal cancer patients and to examine whether this association varies by the location of tumor (colon vs. rectum). Patients and methods This study includes 4,131 stage I-III colorectal cancer patients, treated between 1995 and 2007 (12.5% diabetic, 53% colon, 47% rectal) in South Korea. Cox proportional hazards modeling was used to determine the prognostic influence of DM on survival endpoints. Results Colorectal cancer patients with DM had significantly worse disease-free survival (DFS) [hazard ratio (HR) 1.17, 95% confidence interval (CI): 1.00–1.37] compared with patients without DM. When considering colon and rectal cancer independently, DM was significantly associated with worse overall survival (OS) (HR: 1.46, 95% CI: 1.11–1.92), DFS (HR: 1.45, 95% CI: 1.15–1.84) and recurrence-free survival (RFS) (HR: 1.32, 95% CI: 0.98–1.76) in colon cancer patients. No association for OS, DFS or RFS was observed in rectal cancer patients. There was significant interaction of location of tumor (colon vs. rectal cancer) with DM on OS (P?=?0.009) and DFS (P?=?0.007). Conclusions This study suggests that DM negatively impacts survival outcomes of patients with colon cancer but not rectal cancer.

Park, Min Geun; Lee, Ji-Won; Chu, Sang Hui; Park, Ji-Hye; Lee, Mi Kyung; Sato, Kaori; Ligibel, Jennifer A.; Meyerhardt, Jeffrey A.; Kim, Nam Kyu

2013-01-01

381

Quantitative analysis of rectal cancer by spectral domain optical coherence tomography  

PubMed Central

To quantify OCT images of rectal tissue for clinic diagnosis, the scattering coefficient of the tissue is extracted by curve fitting the OCT signals to a confocal single model. A total of 1000 measurements (half and half of normal and malignant tissues) were obtained from 16 recta. The normal rectal tissue has a larger scattering coefficient ranging from 1.09 to 5.41 mm–1 with a mean value of 2.29 mm–1 (std: ± 0.32), while the malignant group shows lower scattering property and the values ranging from 0.25 to 2.69 mm–1 with a mean value of 1.41 mm–1 (std: ± 0.18). The peri-cancer of recta has also been investigated to distinguish the difference between normal and malignant rectal tissue. The results demonstrate that the quantitative analysis of the rectal tissue can be used as a promising diagnostic criterion of early rectal cancer, which has great value for clinical medical applications.

Zhang, Q Q; Wu, X J; Tang, T; Zhu, S W; Yao, Q; Gao, Bruce Z; Yuan, X C

2013-01-01

382

Trans-rectal interventional MRI: initial prostate biopsy experience  

NASA Astrophysics Data System (ADS)

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate gland when evaluated along with T2-weighted images, diffusion-weighted images (DWI) and their corresponding apparent diffusion coefficient (ADC) maps can yield valuable information in patients with rising or elevated serum prostate-specific antigen (PSA) levels1. In some cases, patients present with multiple negative trans-rectal ultrasound (TRUS) biopsies, often placing the patient into a cycle of active surveillance. Recently, more patients are undergoing TRIM for targeted biopsy of suspicious findings with a cancer yield of ~59% compared to 15% for second TRUS biopsy2 to solve this diagnostic dilemma and plan treatment. Patients were imaged in two separate sessions on a 1.5T magnet using a cardiac phased array parallel imaging coil. Automated CAD software was used to identify areas of wash-out. If a suspicious finding was identified on all sequences it was followed by a second imaging session. Under MRI-guidance, cores were acquired from each target region3. In one case the microscopic diagnosis was prostatic intraepithelial neoplasia (PIN), in the other it was invasive adenocarcinoma. Patient 1 had two negative TRUS biopsies and a PSA level of 9ng/mL. Patient 2 had a PSA of 7.2ng/mL. He underwent TRUS biopsy which was negative for malignancy. He was able to go on to treatment for his prostate carcinoma (PCa)4. MRI may have an important role in a subset of patients with multiple negative TRUS biopsies and elevated or rising PSA.

Greenwood, Bernadette M.; Behluli, Meliha R.; Feller, John F.; May, Stuart T.; Princenthal, Robert; Winkel, Alex; Kaminsky, David B.

2010-03-01

383

Neoadjuvant Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Radiation for Rectal Cancer  

SciTech Connect

Purpose: To evaluate the feasibility and pathologic complete response rate of induction bevacizumab + modified infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX) 6 regimen followed by concurrent bevacizumab, oxaliplatin, continuous infusion 5-fluorouracil (5-FU), and radiation for patients with rectal cancer. Methods and Materials: Eligible patients received 1 month of induction bevacizumab and mFOLFOX6. Patients then received 50.4 Gy of radiation and concurrent bevacizumab (5 mg/kg on Days 1, 15, and 29), oxaliplatin (50 mg/m{sup 2}/week for 6 weeks), and continuous infusion 5-FU (200 mg/m{sup 2}/day). Because of gastrointestinal toxicity, the oxaliplatin dose was reduced to 40 mg/m{sup 2}/week. Resection was performed 4-8 weeks after the completion of chemoradiation. Results: The trial was terminated early because of toxicity after 26 eligible patients were treated. Only 1 patient had significant toxicity (arrhythmia) during induction treatment and was removed from the study. During chemoradiation, Grade 3/4 toxicity was experienced by 19 of 25 patients (76%). The most common Grade 3/4 toxicities were diarrhea, neutropenia, and pain. Five of 25 patients (20%) had a complete pathologic response. Nine of 25 patients (36%) developed postoperative complications including infection (n = 4), delayed healing (n = 3), leak/abscess (n = 2), sterile fluid collection (n = 2), ischemic colonic reservoir (n = 1), and fistula (n = 1). Conclusions: Concurrent oxaliplatin, bevacizumab, continuous infusion 5-FU, and radiation causes significant gastrointestinal toxicity. The pathologic complete response rate of this regimen was similar to other fluorouracil chemoradiation regimens. The high incidence of postoperative wound complications is concerning and consistent with other reports utilizing bevacizumab with chemoradiation before major surgical resections.

Dipetrillo, Tom; Pricolo, Victor; Lagares-Garcia, Jorge; Vrees, Matt; Klipfel, Adam; Cataldo, Tom; Sikov, William; McNulty, Brendan; Shipley, Joshua; Anderson, Elliot; Khurshid, Humera; Oconnor, Brigid; Oldenburg, Nicklas B.E.; Radie-Keane, Kathy; Husain, Syed [Brown University Oncology Group, Providence, RI (United States); Safran, Howard, E-mail: hsafran@lifespan.org [Brown University Oncology Group, Providence, RI (United States)

2012-01-01

384

Robotic Hybrid Technique in Rectal Surgery for Deep Pelvic Endometriosis.  

PubMed

Background. Deep pelvic endometriosis is a complex disorder that affects 6% to 12% of all women in childbearing age. The incidence of bowel endometriosis ranges between 5.3% and 12%, with rectum and sigma being the most frequently involved tracts, accounting for about 80% of cases. It has been reported that segmental colorectal resection is the best surgical option in terms of recurrence rate and improvement of symptoms. The aim of this study is to analyze indications, feasibility, limits, and short-term results of robotic (Da Vinci Surgical System)-assisted laparoscopic rectal sigmoidectomy for the treatment of deep pelvic endometriosis. Patients and Methods. Between January 2006 and December 2010, 19 women with bowel endometriosis underwent colorectal resection through the robotic-assisted laparoscopic approach. Intraoperative and postoperative data were collected. All procedures were performed in a single center and short-term complications were evaluated. Results. Nineteen robotic-assisted laparoscopic colorectal resections for infiltrating endometriosis were achieved. Additional procedures were performed in 7 patients (37%). No laparotomic conversion was performed. No intraoperative complications were observed. The mean operative time was 370 minutes (range = 250-720 minutes), and the estimated blood loss was 250 mL (range = 50-350 mL). The overall complication rate was 10% (2 rectovaginal fistulae). Conclusions. Deep pelvic endometriosis is a benign condition but may have substantial impact on quality of life due to severe pelvic symptoms. We believe that robotic-assisted laparoscopic colorectal resection is a feasible and relatively safe procedure in the context of close collaboration between gynecologists and surgeons for treatment of deep pelvic endometriosis with intestinal involvement, with low rates of complications and significant improvement of intestinal symptoms. PMID:23657477

Cassini, Diletta; Cerullo, Guido; Miccini, Michelangelo; Manoochehri, Farshad; Ercoli, Alfredo; Baldazzi, Gianandrea

2013-05-01

385

ACR Appropriateness Criteria(R)--Recurrent Rectal Cancer  

PubMed Central

ABSTRACT The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions. These Criteria are reviewed every 2 years by a multidisciplinary expert panel. The development and review of these guidelines includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Local recurrence of rectal cancer can result in devastating symptoms for patients, including intractable pain and discharge. Prior treatment can limit subsequent treatment options. Preoperative 5-FU based chemoradiotherapy is the treatment of choice for patients with a local recurrence who did not receive adjuvant therapy after initial resection or who might have received chemotherapy alone. Chemoradiotherapy followed by evaluation for surgery is the preferred treatment for patients who have undergone previous radiotherapy after surgery. The inclusion of surgery has resulted in the best outcomes in a majority of studies. Palliative chemoradiotherapy is appropriate for patients who have received previous radiotherapy whose recurrent disease is considered inoperable. Radiotherapy can be delivered on a standard or hyperfractionated treatment schedule. Newer systemic treatments have improved response rates and given physicians more options for treating patients in this difficult situation. The use of induction chemotherapy prior to radiotherapy is an evolving treatment option. Specialized treatment modalities should be used at institutions with experience in these techniques and preferably in patients enrolled in clinical trials.

Suh, W. Warren; Herman, Joseph M.; Blackstock, A. William; Hong, Theodore S.; Poggi, Matthew M.; Rodriguez-Bigas, Miguel; Small, William; Thomas, Charles R.; Zook, Jennifer

2012-01-01

386

Late radiation damage in prostate cancer patients treated by high dose external radiotherapy in relation to rectal dose  

Microsoft Academic Search

A retrospective analysis of the incidence of radiation proctitis was performed in 154 patients with carcinoma of the prostate treated with external radiotherapy assisted by CT-scan planning from 1983 to 1985. An attempt was made to assess a dose-response relationship for proctitis. Multivariate Cox regression analysis showed that previous bowel disease or surgery, anterior rectal dose, and average rectal dose

W. G. J. M. Smit; P. A. Helle; W. L. J. Van Putten; A. J. Wijnmaalen; J. J. Seldenrath; B. H. P. Van Der Werf-Messing

1990-01-01

387

Preoperative radiochemotherapy is successful also in patients with locally advanced rectal cancer who have intrinsically high apoptotic tumours  

Microsoft Academic Search

BACKGROUND: Not all patients with locally advanced rectal cancer (LARC) respond equally to neo-adjuvant radiochemotherapy (RCT). Patients with highly apoptotic less advanced rectal cancers do not benefit from short-term radiotherapy. This study investigates whether this is also the case in the setting of RCT for LARC. PATIENTS AND METHODS: Tissue microarrays were constructed of biopsy and resection specimens of 201

M. J. E. M. Gosens; R. C. Dresen; H. J. T. Rutten; G. A. P. Nieuwenhuijzen; J. A. W. M. van der Laak; H. Martijn; I. Tan-Go; I. D. Nagtegaal

2008-01-01

388

Effects on functional outcome after IORT-containing multimodality treatment for locally advanced primary and locally recurrent rectal cancer  

Microsoft Academic Search

Purpose: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer, much attention is focused on the oncologic outcome. Little is known about the functional outcome. In this study, the functional outcome after a multimodality treatment for locally advanced primary and locally recurrent rectal cancer is analyzed.Methods and Materials: Between 1994 and 1999, 55 patients with

Guido H. H Mannaerts; Harm J. T Rutten; Hendrik Martijn; Patrick E. J Hanssens; Theo Wiggers

2002-01-01

389

Prognostic impact of epidermal growth factor receptor (EGFR) expression on loco-regional recurrence after preoperative radiotherapy in rectal cancer  

Microsoft Academic Search

BACKGROUND: Epidermal growth factor receptor (EGFR) represents a major target for current radiosensitizing strategies. We wished to ascertain whether a correlation exists between the expression of EGFR and treatment outcome in a group of patients with rectal adenocarcinoma who had undergone preoperative radiotherapy (RT). METHODS: Within a six-year period, 138 patients underwent preoperative radiotherapy and curative surgery for rectal cancer

David Azria; Frederic Bibeau; Nicolas Barbier; Abderrahim Zouhair; Claire Lemanski; Philippe Rouanet; Marc Ychou; Pierre Senesse; Mahmut Ozsahin; André Pèlegrin; Jean-Bernard Dubois; Simon Thèzenas

2005-01-01

390

Rectal Distention Inhibits the Spinal Micturition Reflex via Glycinergic or GABAergic Mechanisms in Rats with Spinal Cord Injury  

Microsoft Academic Search

Background: We examined the influence of rectal distention on the spinal micturition reflex and the mechanism underlying its inhibition of bladder contraction. Methods: Fourteen conscious female Sprague-Dawley rats were used in this study after transection of the lower thoracic cord. Isovolumetric cystometry was performed before and after distention of the rectum by inflation of a rectal balloon, followed by intrathecal

Minoru Miyazato; Kimio Sugaya; Saori Nishijima; Makoto Morozumi; Choko Ohyama; Yoshihide Ogawa

2005-01-01

391

Colorectal Cancer Association of Canada consensus meeting: raising the standards of care for early-stage rectal cancer  

PubMed Central

The purpose of the meeting reported here was to develop a set of national evidence-based standards for assessing and managing patients with potentially resectable rectal cancer. This report represents the consensus of the multidisciplinary group of Canadian rectal cancer experts attending that meeting.

2009-01-01

392

In-One-Continuity Rectal Excision and Anal Mucosectomy of a Giant Villous Adenoma: An Alternative Surgical Approach  

Microsoft Academic Search

Background: The authors present a woman suffering from McKittrick-Wheelock syndrome (MKWS) with a giant rectal villous adenoma. MKWS is a rare disorder caused by fluid and electrolyte hypersecretion from a rectal tumor. The most frequently reported tumors are villous adenomas. Symptoms of dehydration with severe hyponatremia, hypokalemia, metabolic acidosis and acute renal failure are typical in MKWS. Several options for

G. G. Koning; P. L. Rensma; A. W. M. van Milligen de Wit

2008-01-01

393

Case control study of the geographic variability of exposure to disinfectant byproducts and risk for rectal cancer  

Microsoft Academic Search

BACKGROUND: Levels of byproducts that result from the disinfection of drinking water vary within a water distribution system. This prompted us to question whether the risk for rectal cancer also varies, depending upon one's long term geographic location within the system. Such a geographic distribution in rectal cancer risk would follow naturally from an association between level of byproduct and

Gerald E Bove Jr; Peter A Rogerson; John E Vena

2007-01-01

394

Effect on mice of microwaves in the non-thermal intensity region. Respiration, rectal temperature, and mental reaction  

Microsoft Academic Search

The effect of microwaves (2450 MHz) on respiration, rectal temperature and mental reaction to sound was studied using an intensity of 10 mW\\/sq cm for 30 minutes. The result shows that both respiration and reaction to sound deteriorated during exposure, while the rectal temperature was unaffected. Previous investigations carried out in the same way but at an intensity of 100

Criborn

1978-01-01

395

Nyfoedda Grisars Rektaltemperatu Under Olika Miljoefoerhallanden (Rectal Temperature of the Newborn Pig Measured under Different Environmental Conditions).  

National Technical Information Service (NTIS)

The purpose of this investigation was to study the rectal temperature of normal, newborn pigs during the period of time immediately after birth; to compare the rectal temperature of normal pigs over this time period with that of different groups of weak b...

K. Ahlmann J. Svensen A. C. Bengtsson

1983-01-01

396

Comparison of Functional Results and Quality of Life Between Intersphincteric Resection and Conventional Coloanal Anastomosis for Low Rectal Cancer  

Microsoft Academic Search

PURPOSE: The technique of intersphincteric resection permits sphincter preservation with good oncologic results in very low rectal cancer. This study aimed to investigate functional results and quality of life after intersphincteric resection compared with conventional coloanal anastomoses. METHODS: From 1990 to 2000, 170 patients underwent total mesorectal excision with coloanal anastomosis for low rectal tumors. Questionnaires were obtained from 77

Frédéric Bretagnol; Eric Rullier; Christophe Laurent; Frank Zerbib; Renaud Gontier; Jean Saric

2004-01-01

397

The measurement of rectal and testis temperature in conscious mice, with observations on the effect of direct heating  

Microsoft Academic Search

The application of Newton's law of cooling to freshly killed mice was found not to measure accurately their rectal or testis temperature. Improvements in the fitting process gave satisfactory results for rectal temperature only. A diffusion model was applied to testis cooling but was of no avail. Finally a satisfactory correction factor was determined empirically. This method was applied to

A B Cairnie; L F Prudhomme-Lalonde; R K Harding; M Zuker

1980-01-01

398

Nitrates in Drinking Water and the Risk of Death from Rectal Cancer: Does Hardness in Drinking Water Matter?  

Microsoft Academic Search

The objectives of this study were to (1) examine the relationship between nitrate levels in public water supplies and increased risk of death from rectal cancer and (2) determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of nitrate on development of rectal cancer. A matched case-control study was used to investigate the relationship

Chih-Ching Chang; Chih-Cheng Chen; Deng-Chuang Wu; Chun-Yuh Yang

2010-01-01

399

Trihalomethanes in Drinking Water and the Risk of Death From Rectal Cancer: Does Hardness in Drinking Water Matter?  

Microsoft Academic Search

The objectives of this study were (1) to examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of rectal cancer development and (2) to determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of TTHM on risk of developing rectal cancer. A matched cancer case-control study was used to

Hsin-Wei Kuo; Pei-Shih Chen; Shu-Chen Ho; Li-Yu Wang; Chun-Yuh Yang

2010-01-01

400

A comparison of the use of tympanic, axillary, and rectal thermometers in infants.  

PubMed

This study examined the relationship between three instruments used in measuring tympanic, axillary, and rectal temperatures in infants less than 1 year of age. Temperatures were measured by Oto-temp Pedi Q tympanic thermometers, Becton Dickinson axillary thermometer, and rectal thermometers. A convenience sample of 5 infants less than 90 day and 54 greater than 90 days with fever, as well as 34 infants less than 90 days and 27 infants greater than 90 days without fever were studied. Correlations of infants less than 90 days and greater 90 days of age, as well as differences between infant temperature with and without fevers as variables, were examined. Results indicated a strong statistical relationship between Oto-Temp Pedi Q, Becton Dickinson axillary temperatures, and rectal temperatures, but not strong enough to base critical clinical decisions. Age and presence or absence of fever significantly affected the relationships between thermometers. PMID:10337119

Wilshaw, R; Beckstrand, R; Waid, D; Schaalje, G B

1999-04-01

401

Rectal perforation, rectocutaneous fistula formation, and enterocutaneous fistula formation after pelvic trauma in a dog.  

PubMed

This report describes the management of rectal perforation, incision infection, implant failure, sepsis, osteonecrosis, and enterocutaneous fistula formation in a 3-year-old Yorkshire Terrier that was hit by a car. Rectal perforation from displaced pelvic fractures was suspected because of drainage from the incision, and clinical signs, and blood test results indicative of sepsis. Ilial and acetabular osteonecrosis from wound infection were treated with hemipelvectomy without pelvic limb amputation, and full limb function was regained. Primary repair of the rectal perforation and use of a muscle flap were unsuccessful, and a rectocutaneous fistula developed, but the rectum healed after colostomy for fecal diversion. An enterocutaneous fistula subsequently developed at the rectocutaneous fistula site, resulting in weight loss and continued drainage from the incision. Primary closure of the jejunal stoma, appropriate wound management, and nutritional support by enteral feeding resulted in eventual second-intention healing of the fistula and incision. PMID:7698940

Tobias, K M

1994-11-01

402

Update on Transanal NOTES for Rectal Cancer: Transitioning to Human Trials  

PubMed Central

The feasibility of natural orifice translumenal endoscopic surgery (NOTES) resection for rectal cancer has been demonstrated in both survival swine and fresh human cadaveric models. In preparation for transitioning to human application, our group has performed transanal NOTES rectal resection in a large series of human cadavers. This experience both solidified the feasibility of resection and allowed optimization of technique prior to clinical application. Improvement in specimen length and operative time was demonstrated with increased experience and newer platforms. This extensive laboratory experience has paved the way for successful clinical translation resulting in an ongoing clinical trial. To date, based on published reports, 4 human subjects have undergone successful hybrid transanal NOTES resection of rectal cancer. While promising, instrument limitations continue to hinder a pure transanal approach. Careful patient selection and continued development of new endoscopic and flexible-tip instruments are imperative prior to pure NOTES clinical application.

Telem, Dana A.; Berger, David L.; Bordeianou, Liliana G.; Rattner, David W.; Sylla, Patricia

2012-01-01

403

Solitary rectal cap polyp: Case report and review of the literature  

PubMed Central

Rectal bleeding combined with the presence of a rectal mass has been traditionally associated with the presence of malignant disease. Cap polyposis is a relatively young and still undefined rare entity which mainly involves the rectosigmoid. It is characterized by the presence of inflammatory polyps. In this case report, we present a patient who was diagnosed with a solitary cap polyp of the rectum during the investigation of a bleeding rectal mass. The patient’s age and the absence of family history were not in favor of malignancy, despite the strong initial clinical impression. After confirmation of the diagnosis, the patient underwent a snare excision and remains asymptomatic. Cap polyposis, although rare, should be suspected and, when diagnosed, should be treated according to location, number of polyps and severity of symptoms.

Papaconstantinou, Ioannis; Karakatsanis, Andreas; Benia, Xanthi; Polymeneas, George; Kostopoulou, Evanthia

2012-01-01

404

Preoperative staging of rectal cancer: role of 3D endorectal ultrasonography.  

PubMed

Endorectal ultrasonography has become important part of preoperative staging of rectal cancer, providing adequate information for clinical decision-making in many cases. However, with the currently available ultrasonographic equipment and techniques, a good deal of relevant information may remain hidden. The advent of high-resolution three-dimensional endoluminal ultrasound, constructed from a synthesis of standard two-dimensional cross-sectional images, and of "Volume Render Mode," a technique to analyze information inside a three-dimensional volume, promises to improve the accuracy of rectal cancer staging. The anatomic structures in the pelvis, the axial and longitudinal extension of the tumor, the presence of slight or massive submucosal invasion in early rectal cancer may be imaged in greater detail. This additional information will bring an improvement for both planning and conduct of surgical procedures. PMID:23373359

Santoro, Giulio A

2012-01-01

405

Screening paediatric rectal forms of azithromycin as an alternative to oral or injectable treatment  

PubMed Central

The aim of this study was to identify a candidate formulation for further development of a home or near-home administrable paediatric rectal form of a broad-spectrum antibiotic – specially intended for (emergency) use in tropical rural settings, in particular for children who cannot take medications orally and far from health facilities where injectable treatments can be given. Azithromycin, a broad-spectrum macrolide used orally or intravenously for the treatment of respiratory tract, skin and soft tissue infections, was selected because of its pharmacokinetic and therapeutic properties. Azithromycin in vitro solubility and stability in physiologically relevant conditions were studied. Various pharmaceutical forms, i.e. rectal suspension, two different rectal gels, polyethylene glycol (PEG) suppository and hard gelatin capsule (HGC) were assessed for in vitro dissolution and in vivo bioavailability in the rabbit. Azithromycin PEG suppository appears to be a promising candidate.

Kauss, Tina; Gaudin, Karen; Gaubert, Alexandra; Ba, Boubakar; Tagliaferri, Serena; Fawaz, Fawaz; Fabre, Jean-Louis; Boiron, Jean-Michel; Lafarge, Xavier; White, Nicholas J.; Olliaro, Piero L.; Millet, Pascal

2012-01-01

406

Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility  

PubMed Central

Background Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. Methods We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Results Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r?=??0.438 and ?0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Conclusions Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials.

2013-01-01

407

Neighborhood socioeconomic status and behavioral pathways to risks of colon and rectal cancer in women  

PubMed Central

Background Neighborhood amenities and resources plausibly determine individual modifiable risk factors for colon and rectal cancer. Evidence on the associations between neighborhood socioeconomic status (SES) and incident colon and rectal cancer is limited. Methods We analyzed a prospective cohort of 111,129 women in the Nurses' Health Study with no history of cancer in 1986 followed to 2006. Neighborhood SES was based on Census-derived characteristics of block groups of residence. Cox models were used to estimate the multivariable-adjusted associations between neighborhood SES and incident colon and rectal cancer, and to examine for effect modification. For significant associations, path models were estimated with behavioral risk factors included as potential mediators. Results Neighborhood SES was unassociated with colon cancer among all women. However, among women with college or greater education, higher neighborhood SES was inversely related to colon cancer (p for trend = 0.01; p for interaction between neighborhood SES and education = 0.03). Path analysis suggested mediation by red meat intakes and body mass index (BMI). Higher neighborhood SES was inversely related to rectal cancer among all women (RR in highest quintile = 0.64; 95% CI = 0.44–0.93; p for trend = 0.08). Path analysis was consistent with mediation by multivitamin use and BMI. Conclusion These findings suggest that living in a higher-SES neighborhood may protect against rectal cancer in women and colon cancer in higher-educated women, mediated by selected behavioral risk factors. Risk factor differences between colon and rectal cancer may account for discrepancies in estimated neighborhood effects by cancer site.

Kim, Daniel; Masyn, Katherine E.; Kawachi, Ichiro; Laden, Francine; Colditz, Graham A.

2010-01-01

408

Quality of life estimate in stomach, colon, and rectal cancer patients in a hospital in China.  

PubMed

The objective of this study was to investigate the outcome and coping patterns of patients with stomach, colon, and rectal cancer in a hospital in China. Health-related quality of life was assessed in 118 stomach, colon, and rectal cancer patients in Chinese People's Liberation Army General Hospital, Beijing, China, using the generic version of the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Questionnaire Core 30 Items, Self-rated Anxiety Scores (SAS), Self-rated Depression Scores (SDS), Medical Coping Modes of Questionnaire (MCMQ), and Social Support Requirement Scale (SSRS) questionnaires. The overall QOL was 50.7?±?6.5, 48.1?±?7.7, and 47.6?±?6.4, respectively, for stomach, colon, and rectal cancer groups. Correlations between QOL and SAS and SDS in stomach cancer patients were significantly higher than observed in the cohort of colon or rectal cancer patients (Spearman coefficient of 0.366 and 0.129, respectively). Cluster analysis of MCMQ data revealed four identifiable patterns (resign, confront, avoid-confront, and avoid-resign) of coping in the study group. Subjective support was significantly higher than objective support (p?rectal cancer patients had anxiety and depression stemming from their cancer diagnosis and postdiagnosis treatment, and sex dependency was prevalent in SSRS response. Coping patterns were reliable indicators of psychosocial side effects in patients with stomach, colon, and rectal cancers. PMID:23681801

Deng, Muhong; Lan, Yanhong; Luo, Shali

2013-05-17

409

Slug expression enhances tumor formation in a non-invasive rectal cancer model  

PubMed Central

Background Epithelial-to-mesenchymal transition (EMT) is a series of molecular changes allowing epithelial cancer cells to acquire properties of mesenchymal cells: increased motility and invasion and protection from apoptosis. Transcriptional regulators such as Slug mediate EMT, working in part to repress E-cadherin transcription. We report a novel, non-invasive in vivo rectal cancer model to explore the role of Slug in colorectal cancer (CRC) tumor development. Methods For the generation of DLD-1 cells overexpressing Slug (Slug DLD-1), a Slug or empty (Empty DLD-1) pCMV-3Tag-1 (kanamycin resistant) vector was used for transfection. Cells were evaluated for Slug and E-cadherin expression, and cell migration and invasion. For the in vivo study, colon cancer cells (parental DLD-1, Slug DLD-1, empty DLD-1, and HCT-116) were submucosally injected into the posterior rectum of nude mice using endoscopic guidance. After 28 days, tumors were harvested and tissue was analyzed. Results Slug expression in our panel of colon cancer cell lines was inversely correlated with E-cadherin expression and enhanced migration/invasion. Slug DLD-1 cells demonstrated a 21-fold increased Slug and 19-fold decreased E-cadherin expression compared with empty DLD-1. Similarly, the Slug DLD-1 cells had significantly enhanced cellular migration and invasion. In the orthotopic rectal cancer model, Slug DLD-1 cells formed rectal tumors in 9/10 (90%) of the mice (mean volume = 458 mm3) compared with only 1/10 (10%) with empty DLD-1 cells. Conclusion Slug mediates EMT with enhanced in vivo rectal tumor formation. Our non-invasive in vivo model enables researchers to explore the molecular consequences of altered genes in a clinically relevant rectal cancer in an effort to develop novel therapeutic approaches for patients with rectal cancer.

Camp, E. Ramsay; Findlay, Victoria J.; Vaena, Silvia G.; Walsh, Jarret; Lewin, David N.; Turner, David P.; Watson, Dennis K

2011-01-01

410

Definition and delineation of the clinical target volume for rectal cancer  

SciTech Connect

Purpose: Optimization of radiation techniques to maximize local tumor control and to minimize small bowel toxicity in locally advanced rectal cancer requires proper definition and delineation guidelines for the clinical target volume (CTV). The purpose of this investigation was to analyze reported data on the predominant locations and frequency of local recurrences and lymph node involvement in rectal cancer, to propose a definition of the CTV for rectal cancer and guidelines for its delineation. Methods and Materials: Seven reports were analyzed to assess the incidence and predominant location of local recurrences in rectal cancer. The distribution of lymphatic spread was analyzed in another 10 reports to record the relative frequency and location of metastatic lymph nodes in rectal cancer, according to the stage and level of the primary tumor. Results: The mesorectal, posterior, and inferior pelvic subsites are most at risk for local recurrences, whereas lymphatic tumor spread occurs mainly in three directions: upward into the inferior mesenteric nodes; lateral into the internal iliac lymph nodes; and, in a few cases, downward into the external iliac and inguinal lymph nodes. The risk for recurrence or lymph node involvement is related to the stage and the level of the primary lesion. Conclusion: Based on a review of articles reporting on the incidence and predominant location of local recurrences and the distribution of lymphatic spread in rectal cancer, we defined guidelines for CTV delineation including the pelvic subsites and lymph node groups at risk for microscopic involvement. We propose to include the primary tumor, the mesorectal subsite, and the posterior pelvic subsite in the CTV in all patients. Moreover, the lateral lymph nodes are at high risk for microscopic involvement and should also be added in the CTV.

Roels, Sarah [Department of Radiotherapy, University Hospital Gasthuisberg, Leuven (Belgium); Duthoy, Wim [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Haustermans, Karin [Department of Radiotherapy, University Hospital Gasthuisberg, Leuven (Belgium)]. E-mail: Karin.Haustermans@uzleuven.be; Penninckx, Freddy [Department of Surgery, University Hospital Gasthuisberg, Leuven (Belgium); Vandecaveye, Vincent [Department of Radiology, University Hospital Gasthuisberg, Leuven (Belgium); Boterberg, Tom [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Neve, Wilfried de [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium)

2006-07-15

411

Cross-Linked Hyaluronan Gel Reduces the Acute Rectal Toxicity of Radiotherapy for Prostate Cancer  

SciTech Connect

Purpose: To prospectively analyze whether cross-linked hyaluronan gel reduces the mean rectal dose and acute rectal toxicity of radiotherapy for prostate cancer. Methods and Materials: Between September 2008 and March 2009, we transperitoneally injected 9mL of cross-linked hyaluronan gel (Hylaform; Genzyme Corporation, Cambridge, MA) into the anterior perirectal fat of 10 early-stage prostate cancer patients to increase the separation between the prostate and rectum by 8 to 18mm at the start of radiotherapy. Patients then underwent high-dose rate brachytherapy to 2,200cGy followed by intensity-modulated radiation therapy to 5,040cGy. We assessed acute rectal toxicity using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 grading scheme. Results: Median follow-up was 3 months. The anteroposterior dimensions of Hylaform at the start and end of radiotherapy were 13 {+-} 3mm (mean {+-} SD) and 10 {+-} 4mm, respectively. At the start of intensity-modulated radiation therapy, daily mean rectal doses were 73 {+-} 13cGy with Hylaform vs. 106 {+-} 20cGy without Hylaform (p = 0.005). There was a 0% incidence of National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 Grade 1, 2, or 3 acute diarrhea in 10 patients who received Hylaform vs. a 29.7% incidence (n = 71) in 239 historical controls who did not receive Hylaform (p = 0.04). Conclusions: By increasing the separation between the prostate and rectum, Hylaform decreased the mean rectal dose. This led to a significant reduction in the acute rectal toxicity of radiotherapy for prostate cancer.

Wilder, Richard B., E-mail: richardbwilder@yahoo.co [Cancer Center of Irvine, Irvine, CA (United States); Barme, Greg A.; Gilbert, Ronald F.; Holevas, Richard E.; Kobashi, Luis I.; Reed, Richard R.; Solomon, Ronald S.; Walter, Nancy L.; Chittenden, Lucy; Mesa, Albert V.; Agustin, Jeffrey; Lizarde, Jessica; Macedo, Jorge; Ravera, John; Tokita, Kenneth M. [Cancer Center of Irvine, Irvine, CA (United States)

2010-07-01

412

Associations among milk production and rectal temperature on pregnancy maintenance in lactating recipient dairy cows.  

PubMed

The objective of this study was to evaluate the associations among milk production, rectal temperature, and pregnancy maintenance in lactating recipient dairy cows. Data were collected during an 11-mo period from 463 Holstein cows (203 primiparous and 260 multiparous) assigned to a fixed-time embryo transfer (ET) protocol. Only cows detected with a visible corpus luteum immediately prior to ET were used. Rectal temperatures were collected from all cows on the same day of ET. Milk production at ET was calculated by averaging individual daily milk production during the 7d preceding ET. Pregnancy diagnosis was performed by transrectal ultrasonography 21d after ET. Cows were ranked and assigned to groups according to median milk production (median=35kg/d; HPROD=above median; LPROD=below median) and rectal temperature (?39.0°C=LTEMP; >39.0°C=HTEMP). A milk production×temperature group interaction was detected (P=0.04) for pregnancy analysis because HTEMP cows ranked as LPROD were 3.1 time more likely to maintain pregnancy compared with HTEMP cows ranked as HPROD (P=0.03). Milk production did not affect (P=0.55) odds of pregnancy maintenance within LTEMP cows, however, and no differences in odds of pregnancy maintenance were detected between HTEMP and LTEMP within milk production groups (P>0.11). Within HTEMP cows, increased milk production decreased the probability of pregnancy maintenance linearly, whereas within LTEMP cows, increased milk production increased the probability of pregnancy maintenance linearly. Within HPROD, increased rectal temperature decreased the probability of pregnancy maintenance linearly, whereas within LPROD cows, no associations between rectal temperatures and probability of cows to maintain pregnancy were detected. In summary, high-producing dairy cows with rectal temperatures below 39.0°C did not experience reduced pregnancy maintenance to ET compared to cohorts with reduced milk production. PMID:21899963

Vasconcelos, J L M; Cooke, R F; Jardina, D T G; Aragon, F L; Veras, M B; Soriano, S; Sobreira, N; Scarpa, A B

2011-07-30

413

Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome  

PubMed Central

Background Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed to test the hypothesis that FAPS would show altered visceral sensation compared to healthy controls or IBS. The present study determined the rectal perceptual threshold, intensity of sensation using visual analogue scale (VAS), and rectal compliance in response to rectal balloon distention by a barostat in FAPS, IBS, and healthy controls. Methods First, the ramp distention of 40 ml/min was induced and the thresholds of discomfort, pain, and maximum tolerance (mmHg) were measured. Next, three phasic distentions (60-sec duration separated by 30-sec intervals) of 10, 15 and 20 mmHg were randomly loaded. The subjects were asked to mark the VAS in reference to subjective intensity of sensation immediately after each distention. A pressure-volume relationship was determined by plotting corresponding pressures and volumes during ramp distention, and the compliance was calculated over the linear part of the curve by calculating from the slope of the curve using simple regression. Results Rectal thresholds were significantly reduced in IBS but not in FAPS. The VAS ratings of intensity induced by phasic distention (around the discomfort threshold of the controls) were increased in IBS but significantly decreased in FAPS. Rectal compliance was reduced in IBS but not in FAPS. Conclusion An inconsistency of visceral sensitivity between lower and higher pressure distention might be a key feature for understanding the pathogenesis of FAPS.

2009-01-01

414

Prevalence of Rectal, Urethral, and Pharyngeal Chlamydia and Gonorrhea Detected in 2 Clinical Settings among Men Who Have Sex with Men: San Francisco, California, 2003  

Microsoft Academic Search

Background. The Centers for Disease Control and Prevention developed screening and diagnostic testing guidelines for chlamydia and gonorrhea at urethral, rectal, and pharyngeal sites for men who have sex with men (MSM). However, in most clinical settings, rectal chlamydial testing is not performed for MSM, and primarily sexually transmitted disease (STD) clinics alone perform routine rectal and pharyngeal gonorrhea screening

Charlotte K. Kent; Janice K. Chaw; William Wong; Sally Liska; Steven Gibson; Gregory Hubbard; Jeffrey D. Klausner

2005-01-01

415

Molecular discrimination of sessile rectal adenomas from carcinomas for a better treatment choice: integration of chromosomal instability patterns and expression array analysis  

Microsoft Academic Search

Total mesorectal excision (TME) is the standard treatment for rectal cancer, while transanal endoscopic microsurgery (TEM) is a recently introduced surgical approach for the treatment of rectal adenomas. Incorrect preoperative staging before TEM is a problem. Therefore the aim of this thesis was to identify molecular differences between rectal tumors of different stages, using gene expression profiling and genomic analysis.

Esther Hélène Lips

2008-01-01

416

Determinants of Fecal Continence in Healthy, Continent Subjects: A Comprehensive Analysis by Anal Manometry, Rectal Barostat and a Stool Substitute Retention Test  

Microsoft Academic Search

Background\\/Aims: This study aimed to identify anal sphincter and rectal factors that determine anorectal filling sensations and continence during rectal filling in health. Methods: Measurements of anorectal physiology were collected from 42 continent healthy subjects participating in a prospective trial. Rectal function and capacity were assessed by barostat. Anal sphincter functions were assessed by manometry. A validated stool substitute retention

Mark Fox; Miriam Thumshirn; Heiko Frühauf; Michael Fried; Werner Schwizer

2011-01-01

417

The fate of the rectal stump after subtotal colectomy for ulcerative colitis  

Microsoft Academic Search

Objective  To review the outcome of patients who had undergone subtotal colectomy for ulcerative colitis with formation of a rectal stump.\\u000a To specifically look at the fate of the rectal stump, whether patients underwent emergency colectomy as opposed to urgent\\u000a or elective resection.\\u000a \\u000a \\u000a \\u000a Patients and methods  Between January 1990 and August 2000, a total of 31 patients underwent subtotal colectomy for ulcerative

G. Böhm; S. T. O’Dwyer

2007-01-01

418

Multimodal preoperative evaluation system in surgical decision making for rectal cancer: a randomized controlled trial  

Microsoft Academic Search

Purpose  Multimodal preoperative evaluation (MPE) is a novel strategy for surgical decision making, incorporating the transrectal ultrasound\\u000a (TRUS), 64 multi-slice spiral computer tomography (MSCT), and serum amyloid A protein (SAA) for rectal cancer. This trial\\u000a aims to determine the accuracy of MPE in preoperative staging and its role in surgical decision making for rectal cancer.\\u000a \\u000a \\u000a \\u000a Methods  Two hundred twenty-five participants with histologically

Xiaodong Wang; Donghao Lv; Huan Song; Lei Deng; Qiang Gao; Junhua Wu; Yingyu Shi; Li Li

2010-01-01

419

Laparoscopic Total Mesorectal Excision in a Rectal Cancer Patient with Situs Inversus Totalis  

PubMed Central

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.

Huh, Jung Wook; Cho, Sang Hyuk; Kim, Choong Young; Kim, Hoon Jin; Joo, Jae Kyoon; Kim, Young Jin

2010-01-01

420

Major rectal complications following interstitial implantation of SVI for carcinoma of the prostate  

SciTech Connect

From April 1975 through April 1983, 152 patients were treated for localized adenocarcinoma of the prostate with interstitial implantation of SVI seeds. In each case bilateral pelvic lymph node dissection was performed at implantation. Five rectal complications developed: 2 rectal ulcers and 3 prostatic urethrorectal fistulas. Our method to treat these problems is presented together with our technique of reconstruction in patients with persistent fistulas despite fecal diversion. While urethrorectal fistulas represent potentially devastating complications of the SVI implantation procedure, reconstructive techniques can minimize and have reduced their long-term effects.

Jordan, G.H.; Lynch, D.F.; Warden, S.S.; McCraw, J.D.; Hoffman, G.C.; Schellhammer, P.F.

1985-12-01

421

Laparoscopic Versus Open Surgery for Rectal Cancer: A Meta-Analysis  

Microsoft Academic Search

Background  Laparoscopic rectal cancer surgery aims to provide patients with curative resection while minimizing postoperative morbidity\\u000a and mortality. This study used meta-analytical techniques to compare laparoscopic and open surgery as the primary treatment\\u000a for patients with rectal cancer with regard to short-term and long-term outcomes.\\u000a \\u000a \\u000a \\u000a Methods  A literature search was performed on all studies between 1993 and 2004 comparing laparoscopic and open

Omer Aziz; Vasilis Constantinides; Thanos Athanasiou; Sanjay Purkayastha; Paraskevas Paraskeva; Ara W. Darzi; Alexander G. Heriot

2006-01-01

422

Depth of Tumor Invasion Independently Predicts Lymph Node Metastasis in T2 Rectal Cancer  

Microsoft Academic Search

Objective  The aim of this study was to identify risk factors of lymph node metastasis (LNM) for T2 rectal cancer.\\u000a \\u000a \\u000a \\u000a Methods  From a prospectively maintained single-institution database, we identified 346 consecutive pT2 rectal cancers treated with\\u000a total mesorectal excision from 1998 to 2009. Univariate and multivariate analyses were performed to identify risk factors\\u000a associated with overall and intermediate\\/apical LNM. The incidence of

Pei-Rong Ding; Xin An; Yun Cao; Xiao-Jun Wu; Li-Ren Li; Gong Chen; Zhen-Hai Lu; Yu-Jing Fang; De-Sen Wan; Zhi-Zhong Pan

2011-01-01

423

Intersphincteric Resection and Coloanal Anastomosis in Treatment of Distal Rectal Cancer  

PubMed Central

In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection.

Cipe, Gokhan; Muslumanoglu, Mahmut; Yardimci, Erkan; Memmi, Naim; Aysan, Erhan

2012-01-01

424

MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor  

Microsoft Academic Search

Objective  To evaluate the accuracy of MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor.\\u000a \\u000a \\u000a \\u000a Materials and methods  Thirty-seven patients with rectal tumor underwent preoperative MDCT. Two radiologists evaluated the depth of tumor invasion\\u000a (T staging), regional lymph node involvement (N staging) and mesorectal fascia involvement on axial, sagittal, and coronal\\u000a multiplanar reconstruction images in consensus. MDCT findings were

Ali Ahmeto?lu; Ay?egül Cansu; Duygu Baki; Sibel Kul; Ümit Çobano?lu; Etem Alhan; Feyyaz Özdemir

2011-01-01

425

What Is the Place of Intersphincteric Resection When Operating on Low Rectal Cancer?  

PubMed Central

Operating on low rectal cancer by performing an intersphincteric resection (ISR) with coloanal anastomosis has been adopted as an alternative to abdominoperineal excision (APE) following Schiessel et al. report in 1994, as it preserves the sphincter and avoids the need for a permanent stoma. We undertook a review of the recent literature specifically focusing on long-term oncologic and functional outcomes of ISR to evaluate whether this operation is a valid alternative to an APE. In conclusion, younger patients with T1 or T2 rectal cancers who require no preoperative therapy are ideal candidates for ISR, given that preoperative chemoradiotherapy may cause long-term severe anal dysfunction after ISR.

Nagayama, Satoshi; Al-Kubati, Waheeb; Sakai, Yoshiharu

2012-01-01

426

Endo-rectal balloon cavity dosimetry in a phantom: Performance under IMRT and helical tomotherapy beams  

PubMed Central

Background and Purpose The use of endo-rectal balloons as immobilisation devices in external beam radiotherapy for prostate cancer has lead to improved target position reproducibility and a decrease in rectal toxicity. The air cavity created by an endo-rectal balloon in photon radiotherapy perturbs the dose distribution. In this study, the effect of the balloon cavity on the dose distribution and the accuracy to which two treatment planning systems calculate the dose distribution was investigated. Materials and Methods Single beams as well as 3D conformal, conventional IMRT and helical tomotherapy treatment plans were investigated using a specifically constructed phantom. Radiochromic film was used to measure the cavity wall doses and cavity wall DVHs. Results For a 70Gy prescription dose both the Pinnacle and TomoTherapy TPSs over-predicted the anterior cavity wall dose by 1.43Gy, 3.92Gy and 2.67Gy for 3D conformal, conventional IMRT and helical tomotherapy respectively. The posterior cavity wall dose was under-predicted by 2.62Gy, 2.01Gy and 4.79Gy for 3D conformal, conventional IMRT and helical tomotherapy respectively. An over-prediction by the Pinnacle RTPS of the V50, V60, V65 and V70 values for the cavity wall DVH was measured for the 3D conformal and conventional IMRT cases. These reductions may lead to a less than expected rectal toxicity. The TomoTherapy RTPS under-predicted the V50, V60, V65 and V70 values which may lead to higher rectal toxicity than predicted. Conclusion Calculation of dose around an air cavity created by an endo-rectal balloon provides a challenge for radiotherapy planning systems. Various electronic disequilibrium situations exist due to the cavity, which can lead to a lower anterior rectal wall and higher posterior rectal wall dose than calculated by planning systems. This has consequences for comparisons of dose volume constraints between different modalities.

Hardcastle, Nicholas; Metcalfe, Peter E.; Rosenfeld, Anatoly B.; Tome, Wolfgang A.

2009-01-01

427

Clinical Characteristics and Outcomes in Patients with Advanced Rectal Cancer: A National Prospective Cohort Study  

Microsoft Academic Search

\\u000a Purpose  At the time of diagnosis, approximately one third of patients with rectal cancer present with advanced disease. In this study\\u000a we focus on a group of patients with primary advanced rectal cancer considered as not operable. We address various clinical\\u000a aspects relevant for decision-making in a group of patients in need of palliative care.\\u000a \\u000a \\u000a \\u000a Methods  Between January 1997 and December 2001,

Helgi Kjartan Sigurdsson; Hartwig Körner; Olav Dahl; Arne Skarstein; Jon Arne Søreide

2007-01-01

428

Evaluation of Mucoadhesive Hydrogels Loaded with Diclofenac Sodium–Chitosan Microspheres for Rectal Administration  

Microsoft Academic Search

Considering the advantageous for the rectal administration of non-steroidal anti-inflammatory drugs, the objective of this\\u000a study was to formulate and evaluate rectal mucoadhesive hydrogels loaded with diclofenac-sodium chitosan (DFS-CS) microspheres.\\u000a Hydroxypropyl methylcellulose (HPMC; 5%, 6%, and 7% w\\/w) and Carbopol 934 (1% w\\/w) hydrogels containing DFS-CS microspheres equivalent to 1% w\\/w active drug were prepared. The physicochemical characterization revealed that

Eman S. El-Leithy; Dalia S. Shaker; Mohamed K. Ghorab; Rania S. Abdel-Rashid

2010-01-01

429

Should 'doughnut' histology be routinely performed following anterior resection for rectal cancer?  

PubMed

Stapled low anterior resection is widely employed in the treatment of rectal adenocarcinoma. The technique yields two tissue 'doughnuts' which are often submitted for histological examination. This process is labour intensive and not part of the minimum data set for colorectal cancer histopathology reports. A consecutive series of anterior resection doughnuts from 125 patients was reviewed retrospectively to assess the impact of doughnut pathology on the management of patients. Four doughnuts had a histological abnormality reported but none of these altered treatment. Routine histological examination of 'doughnuts' is not beneficial to the management of patients undergoing surgery for rectal adenocarcinoma. PMID:12585627

Speake, W J; Abercrombie, J F

2003-01-01

430

Surgical issues in locally advanced rectal cancer treated by preoperative chemoradiotherapy  

PubMed Central

The standard treatment for patients with locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision. This approach is supported by randomized trials, but there are still many unanswered questions about the multimodal management of rectal cancer. In surgical terms, these include the optimal time interval between completion of chemoradiotherapy and surgery; adequate distal resection margin and circumferential radial margin; sphincter preservation; laparoscopic surgery; and conservative management, including a 'wait and see' policy and local excision. This review considers these controversial issues in preoperative chemoradiotherapy.

Lim, Seok-Byung

2013-01-01

431

[The ethiology, pathogenesis, diagnostics and clinical features of the complicated posttraumatic rectal fistulae].  

PubMed

The ethiology, pathogenesis, diagnostics, clinical features and the capabilities of modern instrumental methods in the diagnosis of 134 patients with posttraumatic rectal fistulaes. The main causes of the rectal fistulae formation was the mechanism of the forecoming trauma, late hospital admission and postoperative complications. The use of modern diagnostic facilities allows to know the anatomic features of the fistulae, the presence of the septic cavities of the pararectal tissue, the involvement of sphincter muscles to the inflammatory process and their functional state. All the listed above facilitate the efficacy of the surgical treatment. PMID:22951612

Mamedov, N I

2012-01-01

432

Urinary and Sexual Disorders After Laparoscopic TME for Rectal Cancer in Males  

Microsoft Academic Search

Background  Urinary and sexual dysfunctions are frequent after surgery for rectal cancer. Total mesorectal excision (TME) improves local\\u000a recurrence and survival rates, and does not hamper recognition and sparing of hypogastric and pelvic splanchnic nerves. It\\u000a is not known how laparoscopic rectal resection could change functional complication rates.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  From a global series of 1,216 laparoscopic interventions for colorectal diseases,

Carlo Augusto Sartori; Alberto Sartori; Silvia Vigna; Rosario Occhipinti; Gian Luca Baiocchi