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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

Rectal biopsy  

MedlinePLUS

A rectal biopsy is a procedure to remove a small piece of rectal tissue for examination. ... A rectal biopsy is usually part of anoscopy or sigmoidoscopy . A digital rectal exam is done first. Then, a ...

3

Bisacodyl Rectal  

MedlinePLUS

Fleet® Bisacodyl Enema ... Rectal bisacodyl comes as a suppository and enema to use rectally. It is usually used at the time that a bowel movement is desired. The suppositories usually cause a bowel movement ...

4

Rectal Hyposensitivity  

PubMed Central

Impaired or blunted rectal sensation, termed rectal hyposensitivity (RH), which is defined clinically as elevated sensory thresholds to rectal balloon distension, is associated with disorders of hindgut function, characterised primarily by symptoms of constipation and fecal incontinence. However, its role in symptom generation and the pathogenetic mechanisms underlying the sensory dysfunction remain incompletely understood, although there is evidence that RH may be due to 'primary' disruption of the afferent pathway, 'secondary' to abnormal rectal biomechanics, or to both. Nevertheless, correction of RH by various interventions (behavioural, neuromodulation, surgical) is associated with, and may be responsible for, symptomatic improvement. This review provides a contemporary overview of RH, focusing on diagnosis, clinical associations, pathophysiology, and treatment paradigms.

Burgell, Rebecca E

2012-01-01

5

Rectal cancer  

Microsoft Academic Search

PURPOSE: This study was designed to assess the local recurrence rate and prognostic factors for local recurrence in patients undergoing curative anterior or abdominoperineal resections without radiotherapy. METHODS: From January 1980 to December 1996, 514 consecutive patients underwent curative resections for rectal cancer. We excluded those with preoperative radiotherapy (n=23), postoperative radiotherapy (n=27), local resection (n=36), and 11 (2.1 percent)

F. A. Bonadeo; C. A. Vaccaro; M. L. Benati; G. M. Ojea Quintana; X. E. Garione; M. T. Telenta

2001-01-01

6

Digital rectal exam  

MedlinePLUS

A digital rectal exam is an examination of the lower rectum. The doctor uses a gloved, lubricated finger to check for ... signs of prostate cancer . In women, a digital rectal exam may be performed during a routine gynecologic ...

7

Digital Rectal Exam (DRE)  

MedlinePLUS

... and lower belly, including: Prostate cancer in men Rectal cancer or cancer in the lower colon of men and women Uterine or ovarian cancer in women (in association with a vaginal examination) A DRE may be done as ... such as rectal bleeding, a change in bowel habits, urethral discharge ...

8

Rectal culture (image)  

MedlinePLUS

A rectal culture test is performed by inserting a cotton swab in the rectum. The swab is rotated gently, and withdrawn. A smear of the swab is placed in culture media to encourage the growth of microorganisms. The ...

9

Sodium Phosphate Rectal  

MedlinePLUS

Fleet Enema® ... Fleet Enema EXTRA® ... Fleet Pedia-Lax Enema® ... Rectal sodium phosphate comes as an enema to insert in the rectum. It is usually inserted when a bowel movement is desired. The enema usually causes a bowel movement ...

10

Recurrent Rectal Cancer  

Microsoft Academic Search

\\u000a Recurrent rectal cancer poses a significant morbidity and mortality. Survival is ultimately shortened while patients concurrently\\u000a suffer far greater disability with the recurrence. Recurrent pelvic disease often results in a diminished quality of life\\u000a and is often associated with increased pain, incontinence, sexual and urinary dys­function, and possibly colonic obstruction.\\u000a The primary goal of therapy for rectal cancer is preventing

Sowsan Rasheid; Dana R. Sands; Laurence R. Sands

11

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

2001-01-01

12

Ageism in rectal carcinoma?  

Microsoft Academic Search

Background. Rectal cancer adjuvant and neo-adjuvant therapies are associated with improved survival and local control rates. Concerns\\u000a regarding adverse treatment effects tend to reduce administration in the elderly—the very population this disease affects.\\u000a \\u000a \\u000a Purpose. To determine the extent to which age alters rectal cancer treatment and its outcome.\\u000a \\u000a \\u000a \\u000a \\u000a Methods and Materials. Using the population based provincial cancer registry, patients with

Melina W. Dharma-Wardene; Christopher de Gara; Heather-Jane Au; John Hanson; Juanita Hatcher

2002-01-01

13

Rectal bleeding and polyps  

Microsoft Academic Search

Colorectal polyps are an important albeit uncommon cause of rectal bleeding in children. Colonoscopy promotes both rapid and accurate diagnosis and the opportunity for immediate therapeutic polypectomy. A 10 year audit of polyps diagnosed and treated endoscopically has been undertaken in the children's endoscopy unit. Twenty nine polyps were diagnosed from 730 colonoscopies; 24 were juvenile, two inflammatory, two Peutz-Jeghers,

T T Latt; R Nicholl; P Domizio; J A Walker-Smith; C B Williams

1993-01-01

14

Rectal bleeding and polyps.  

PubMed Central

Colorectal polyps are an important albeit uncommon cause of rectal bleeding in children. Colonoscopy promotes both rapid and accurate diagnosis and the opportunity for immediate therapeutic polypectomy. A 10 year audit of polyps diagnosed and treated endoscopically has been undertaken in the children's endoscopy unit. Twenty nine polyps were diagnosed from 730 colonoscopies; 24 were juvenile, two inflammatory, two Peutz-Jeghers, and one an adenomatous polyp. All but one of the juvenile polyps were solitary. All children had bleeding per rectum as one of the major presenting features. About two thirds of the patients were under the age of 5 years; the mean age was 5.6 years. Most of the juvenile polyps were on the left side of the colon; 41% were distal to the sigmoid colon. However polyps were found throughout the colon, indicating that total colonoscopy is wise and rewarding in any child with persistent and intermittent rectal bleeding. Images

Latt, T T; Nicholl, R; Domizio, P; Walker-Smith, J A; Williams, C B

1993-01-01

15

Rectal prolapse and intussusception.  

PubMed

Rectal prolapse continues to be problematic for both patients and surgeons alike, in part because of increased recurrence rates despite several well-described operations. Patients should be aware that although the prolapse will resolve with operative therapy, functional results may continue to be problematic. This article describes the recommended evaluation, role of adjunctive testing, and outcomes associated with both perineal and abdominal approaches. PMID:24280403

Hatch, Quinton; Steele, Scott R

2013-12-01

16

Anorectal conditions: rectal prolapse.  

PubMed

Rectal prolapse, the protrusion of the layers of the rectal wall through the anal canal, may be partial (mucosal) or complete (full thickness). Although prolapse is most common among older women, it affects individuals of all ages, including children. Associated fecal incontinence and constipation are typical. Urinary incontinence and uterovaginal/bladder prolapse also may coexist. Some patients may have rectal ulcers. Diagnosis is predominantly clinical; visualization of the prolapse may require the patient to strain while sitting or squatting. Imaging studies, including fluoroscopic or dynamic magnetic resonance defecography, can confirm the prolapse if the diagnosis is uncertain, and endoscopy can aid in detecting other colonic/extracolonic pathology. Nonsurgical management (eg, increased fiber intake, fiber supplements, biofeedback) often is therapeutic in minor (first- or second-degree) mucosal prolapse and can help alleviate constipation and incontinence before and after surgery for patients with full-thickness prolapse. However, for full-thickness prolapse, transabdominal procedures are the most effective management and are favored for healthy patients, irrespective of age. Perineal procedures (eg, rubber band ligation, mucosal excision) can be used for patients with full-thickness prolapse who are not candidates for transabdominal surgery and for those with second- and third-degree mucosal prolapse. PMID:24742085

Fox, Audralan; Tietze, Pamela H; Ramakrishnan, Kalyanakrishnan

2014-04-01

17

Ventricular fibrillation during rectal examination.  

PubMed

The case of a 74-year-old man who developed ventricular fibrillation during a digital rectal examination is presented. The patient was subsequently resuscitated and developed cardiac enzyme elevation without ECG changes, indicating a nontransmural myocardial infarction. Although controlled studies have not shown any ill effects of rectal examination in patients with acute myocardial infarction, there have been multiple case reports of bradycardia, ectopy, and ventricular arrhythmias resulting from rectal examination. The postulated etiology of the ectopy is twofold; increased vagal tone from rectal parasympathetic innervation or increased sympathetic tone from anxiety-stimulated catecholamine release. Rectal examination is definitely indicated in a subset of patients including those with gastrointestinal or genitourinary complaints, unexplained hypotension or anemia, trauma, and neurological deficits, and those who will receive anticoagulation or thrombolytic therapy. In the remaining patients, the decision must be made on a case-by-case basis. Awareness of and precautions for possible ill effects of the examination are prudent. PMID:2914050

Munter, D W; Stoner, R

1989-01-01

18

Rectal Microbicide Development  

PubMed Central

Purpose of review Individuals practicing unprotected receptive anal intercourse are at particularly high risk of HIV infection. Men who have sex with men (MSM) in the developed and developing world continue to have disproportionate and increasing levels of HIV infection. The last few years have seen important progress in demonstrating the efficacy of oral pre-exposure prophylaxis (PrEP), vaginal microbicides, and treatment as prevention but there has also been significant progress in the development of rectal microbicides (RM). The purpose of this review is to summarize the status of RM research and to identify opportunities, challenges, and future directions in this important field of HIV prevention. Recent findings Recent Phase 1 RM studies have characterized the safety, acceptability, compartmental pharmacokinetics (PK), and pharmacodynamics (PD) of both UC781 and tenofovir gels. The tenofovir gel formulation used in vaginal studies was not well tolerated in the rectum and newer rectal specific formulations have been developed and evaluated in Phase 1 studies. Summary Complex Phase 1 studies have provided important data on candidate RMs. Tenofovir gel is poised to move into Phase 2 evaluation and it is possible that a Phase 2B/3 effectiveness study could be initiated in the next 2–3 years.

McGowan, Ian

2013-01-01

19

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

20

Preoperative radiochemotherapy in rectal cancer  

Microsoft Academic Search

Purpose: To assess toxicity and long-term results of preoperative chemoradiotherapy in rectal cancer.Methods and Materials: Between 1989 and 1997, as a phase II study, 66 patients with T3 M0 rectal cancer received preoperatively a 45 Gy dose pelvic radiotherapy (XRT) combined with two 5-day chemotherapy courses (CT) of 5-Fluorouracil (5-FU) and Leucovorin (LV) delivered the first and fifth week of

Jean-François Bosset; Valérie Magnin; Philippe Maingon; Georges Mantion; Edouard P Pelissier; Mariette Mercier; Gaelle Chaillard; Jean-Claude Horiot

2000-01-01

21

Treatment of early rectal cancer.  

PubMed

The treatment of rectal cancer has undergone a tremendous surgical evolution over the past century. In the past three decades, transanal excision has emerged as a popular treatment option for T1 and selected T2 rectal adenocarcinomas, allowing less morbidity for early cancers. The surgical options offered to the patient are the Parks' per anal excision and the transanal endoscopic microsurgery (TEM). PMID:20811921

Kesisoglou, I; Sapalidis, K

2010-11-01

22

Chemotherapy, Radiation Therapy, and Surgery in Treating Patients With Locally Advanced Rectal Cancer  

ClinicalTrials.gov

Adenocarcinoma of the Rectum; 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

2013-01-09

23

Thermometers and rectal perforations in the neonate  

Microsoft Academic Search

Three neonates with rectal perforations probably caused by the use of the rectal thermometer, are reported. The dangers of this condition and the difficulty of diagnosis even at laporatomy are emphasised. It is suggested that since the axillary temperature in the neonate is an adequate reflection of the core temperature the routine use of the rectal thermometer, except in exceptional

J D Frank; S Brown

1978-01-01

24

Rectal prolapse: Diagnosis and clinical management  

Microsoft Academic Search

The exact cause of rectal prolapse is not well addressed, but it is often associated with long standing constipation, advanced age, chronic obstructive pulmonary disease and some neurological disorders. Rectal prolapse is usu- ally only a symptom, which needs a focus on discovery of the underlying pathology or disorder. Three different clinical presentations are often combined and called rectal prolapse.

Randa Mohamed Mostafa

2010-01-01

25

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

2012-01-01

26

Management of extraperitoneal rectal injuries.  

PubMed Central

Twenty-eight consecutive extraperitoneal rectal injuries for a period of 34 months ending in May 1990 were reviewed retrospectively. All injuries were due to penetrating gunshot wounds. The rectal exam was positive in 75% of patients versus 80.8% with proctosigmoidoscopy. All 28 patients had diversion of the fecal stream. Diverting colostomies were performed in 17 patients, Hartmann's colostomies in 7 patients, and proximal loop colostomies in 4 patients. Presacral drainage was used in 25 patients (89.3%). Distal irrigation was performed in 13 patients (46.4%) and primary repair in 9 patients (32.1%). There was one infectious complication (3.6%) and no deaths (0%). Fecal diversion and presacral drainage are the mainstay of therapy for civilian rectal injuries. The importance of distal irrigation of the rectum has not been established. Primary repair of the rectum has no effect on morbidity and mortality.

Bostick, P. J.; Johnson, D. A.; Heard, J. F.; Islas, J. T.; Sims, E. H.; Fleming, A. W.; Sterling-Scott, R. P.

1993-01-01

27

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

28

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

29

Targeted Therapy in Rectal Cancer  

PubMed Central

Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also “normalize” tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.

WILLETT, CHRISTOPHER G.; DUDA, DAN G.; CZITO, BRIAN G.; BENDELL, JOHANNA C.; CLARK, JEFFREY W.; JAIN, RAKESH K.

2009-01-01

30

Delayed Colon Perforation after Palliative Treatment for Rectal Carcinoma with Bare Rectal Stent: A Case Report  

PubMed Central

In order to relieve mechanical obstruction caused by rectal carcinoma, a bare rectal stent was inserted in the sigmoid colon of a 70-year-old female. The procedure was successful, and for one month the patient made good progress. She then complained of abdominal pain, however, and plain radiographs of the chest and abdomen revealed the presence of free gas in the subdiaphragmatic area. Surgical findings showed that a spur at the proximal end of the bare rectal stent had penetrated the rectal mucosal wall. After placing a bare rectal stent for the palliative treatment of colorectal carcinoma, close follow-up to detect possible perforation of the bowel wall is necessary.

Lee, Jeong-Min; Lee, Tae-Hoon

2000-01-01

31

Conservative Management of Rectal Adenocarcinoma by Radiotherapy  

Microsoft Academic Search

Purpose: The aim of this study was to analyze the experience of Centre GF Leclerc for conservative and curative treatment by radiotherapy of low rectal cancer.Patients and Methods: A total of 151 patients received radiotherapy alone for rectal adenocarcinoma with curative intent. They were clinically staged according to size (T1 3 cm) and depth of infiltration (A = superficial, and

Philippe Maingon; Stéphane Guerif; Ryad Darsouni; Sandrine Salas; Isabelle Barillot; Anne d’Hombres; Marie-Christine Bône-Lepinoy; Jean Fraisse; Jean-Claude Horiot

1998-01-01

32

Sucralfate retention enemas in solitary rectal ulcer  

Microsoft Academic Search

The conservative treatment of solitary rectal ulcer is generally unsatisfactory. Six patients, aged 27–54 years, with recurrent solitary rectal ulcer were treated with topical administration of sucralfate in a daily dose of 2 g twice a day for 6 weeks. Four patients experienced complete relief of symptoms and the remaining two patients had marked improvement. Although macroscopic healing of the

Showkat Ali Zargar; Mohammad Sultan Khuroo; Rakesh Mahajan

1991-01-01

33

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

34

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2010 CFR

... Therapeutic Devices § 876.5450 Rectal dilator. (a) Identification. A rectal dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening may interfere with its function or the passage of an...

2009-04-01

35

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2010 CFR

... Therapeutic Devices § 876.5450 Rectal dilator. (a) Identification. A rectal dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening may interfere with its function or the passage of an...

2010-04-01

36

Solitary rectal ulcer syndrome: A radiologic diagnosis?  

Microsoft Academic Search

The solitary rectal ulcer syndrome (SRUS) is an uncommon condition in which a solitary area of discrete ulceration is typically found on the anterior wall of the rectum. Between 1981 and 1983, we collected 8 pathologically proven cases of SRUS in which barium enema examinations had been performed (7 double-contrast, 1 single-contrast). Seven patients had rectal bleeding. On the original

Marc S. Levine; Marcelle L. Piccolello; Linda C. Sollenberger; Igor Laufer; Scott H. Saul

1986-01-01

37

[Extensive resections in rectal carcinoma. Our experiences].  

PubMed

The authors review their experience in the surgical management of rectal cancer. They analyze rectal malignancies and their recurrences from natural history to surgical strategies and survival rates. In particular, the need to perform extended operations in order to offer patients a better prognosis is discussed. PMID:1292562

Barabino, M; Tommasi, G V; Arcuri, V; Morelli, N; Fontana, I; Casolino, V; Mondello, R; Carisetto, A; Bacigalupo, P; Valente, U

1992-01-01

38

Solitary rectal ulcer syndrome: a case series.  

PubMed

A retrospective analysis of the clinical profile, endoscopic features and management of 22 children (age 18 months-18 years) diagnosed as solitary rectal ulcer syndrome is presented. The majority (81.8%) were ?8 years of age. Rectal bleeding was the presenting feature in all the children. Mucorrhea, constipation, tenesmus and rectal prolapse were observed in 77.3%, 63.6%, 59% and 13.6% children, respectively. Colonoscopy showed classical single rectal ulcer in 68.2% and multiple ulcers in 22.7%. Polypoidal and erosive lesions were documented in 4.5% each. The medical management comprised of bowel training and high fibre diet for all children. The other modalities included oral 5-amino salicylate (59%), sucralfate enema (4.5%) and rectal mesalamine in 9%. 64% children recovered and 13.6% had recurrence of symptoms. PMID:20453265

Suresh, N; Ganesh, R; Sathiyasekaran, Malathi

2010-12-01

39

Rectal duplication cyst in a cat.  

PubMed

Enteric duplication is a rare developmental malformation in people, dogs and cats. The purpose of the present report is to describe the first case of a rectal duplication cyst in a 7-year-old domestic shorthair cat presenting for acute constipation and tenesmus. On rectal palpation a spherical mass compressing the lumen of the rectum could be felt in the dorsal wall of the rectum. A computed tomography (CT) scan confirmed the presence of a well demarcated cystic lesion in the pelvic canal, dorsal to the rectum. The cyst was surgically removed via a perineal approach. No communication with the rectal lumen could be demonstrated. Histopathological examination was consistent with a rectal duplication cyst. Clinical signs resolved completely after excision of this conjoined non-communicating cystic rectal duplicate. PMID:21115381

Kook, Peter H; Hagen, Regine; Willi, Barbara; Ruetten, Maja; Venzin, Claudio

2010-12-01

40

Genetic Mutations in Blood and Tissue Samples in Predicting Response to Treatment in Patients With Locally Advanced Rectal Cancer Undergoing Chemoradiation  

ClinicalTrials.gov

Mucinous Adenocarcinoma of the Rectum; Recurrent Rectal Cancer; 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

2014-05-06

41

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

2014-05-01

42

Mantle Cell Lymphoma Mimicking Rectal Carcinoma  

PubMed Central

Mantle cell lymphoma (MCL) is a mature B-cell non-Hodgkin lymphoma. After the (11;14) translocation was identified as its constant finding in 1992, MCL was recognized as a separate subgroup of non-Hodgkin lymphoma (NHL). In MCL, extranodal involvement may be observed in the bone marrow, the spleen, the liver, and the gastrointestinal system (GIS). Cases of MCL that present with a massive and solitary rectal mass are rare in the literature. In this case report, our aim was to present an MCL patient with a rarely observed solitary rectal involvement mimicking rectal carcinoma and to discuss treatment options for this patient.

Atay, Hilmi; Y?ld?z, Levent; Bektas, Ahmet; Turgut, Mehmet

2014-01-01

43

MRI staging of low rectal cancer.  

PubMed

Low rectal tumours, especially those treated by abdominoperineal excision (APE), have a high rate of margin involvement when compared with tumours elsewhere in the rectum. Correct surgical management to minimise this rate of margin involvement is reliant on highly accurate imaging, which can be used to plan the planes of excision. In this article we describe the techniques for accurate magnetic resonance imaging (MRI) assessment and a novel staging system for low rectal tumours. Using this staging system it is possible for the radiologist to demonstrate accurately tumour-free planes for surgical excision of low rectal tumours. PMID:18810451

Shihab, Oliver C; Moran, Brendan J; Heald, Richard J; Quirke, Philip; Brown, Gina

2009-03-01

44

A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.  

PubMed

Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema. PMID:21644097

Temiz, Abdulkerim; Tander, Burak; Temiz, Muhyittin; Bar??, Sancar; Ar?türk, Ender

2011-03-01

45

[Chronic constipation and rectal functional investigations].  

PubMed

Chronic constipation is caused by disordered colonic motility, impaired rectal evacuation (dyschezia) or a combination of the two. It is important to distinguish the predominant mechanism of constipation in order to choose the optimal therapy (laxatives or prokinetics versus pelvic floor retraining or surgery). The contribution of dyschezia to constipation can usually be identified by a digital rectal examination, but should, in our opinion, be confirmed by anal manometry, transrectal ultrasonography or defecography. These diagnostic methods provide additional information on the severity of the rectal outlet obstruction, the contribution of rectal hyposensitivity and the presence of potentially correctable anomalies such as a rectocele, enterocele or rectoanal intussusception. We conclude that clinical anorectal examination and functional studies are both necessary and complementary to each other in the evaluation and management of patients with chronic constipation who do not respond to standard laxative treatment. PMID:23425719

De Schepper, Heiko U; Bredenoord, Albert J; Smout, André J P M

2013-01-01

46

Low Rectal Cancer Study (MERCURY II)  

ClinicalTrials.gov

Adenocarcinoma; Adenocarcinoma, Mucinous; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Cystic, Mucinous, and Serous; Colorectal Neoplasms; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Diseases; Rectal Diseases

2013-12-04

47

Drugs Approved for Colon and Rectal Cancer  

Cancer.gov

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for use in colon cancer and rectal cancer. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters.

48

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

49

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

50

Silicone rubber band treatment of rectal prolapse.  

PubMed Central

Fifty-two patients with rectal prolapse have been treated by the silicone rubber band perianal suture technique and satisfactory results have been obtained in 46 (89%). Eleven patients required reoperation to achieve this result. The procedure is a minor one, with little morbidity and no mortality. Provided that faecal impaction can be avoided in patients having this operation a successful outcome, can be expected. It is recommended especially for the frail and elderly with rectal prolapse.

Jackaman, F. R.; Francis, J. N.; Hopkinson, B. R.

1980-01-01

51

An unusual endoscopic presentation of solitary rectal ulcer syndrome.  

PubMed

Solitary rectal ulcer syndrome (SRUS) is an uncommon rectal disorder. Massive rectal bleeding is a rare presentation of SRUS, and can pose an endoscopic challenge in differentiating from other causes of massive rectal bleeding. A 22-year-old man presented with massive rectal bleeding which had SRUS with spurting bleeding on lower endoscopic evaluation. He was treated by endoscopic hemostasis using argon plasma coagulation. He had no complaint after a month and follow up lower endoscopy proved complete healing within two months. SRUS should be considered as a potential cause of massive rectal bleeding. PMID:22585569

Yazdanpanah, Kambiz; Shavakhi, Ahmad; Sanei, Mohammad Hossein; Pezeshki, Amir Hossein; Sarrami, Amir Hossein

2013-01-01

52

Intestinal obstruction due to rectal endometriosis: a surgical enigma.  

PubMed

Obstructed rectal endometriosis is an uncommon presentation. The clinical and intraoperative presentation may present as malignant obstruction. The difficulty in making the diagnosis may delay the definitive management of the patient. We report a unique case of rectal endometriosis mimicking malignant rectal mass causing intestinal obstruction and discuss the management of the case. PMID:16877213

Jarmin, Razman; Idris, Mohd Azim; Shaharuddin, Shaharin; Nadeson, Sukumar; Rashid, Lukman Mohd; Mustaffa, Wan Muhaizan Wan

2006-07-01

53

[Rectal prolapse. Abdominal or local approach].  

PubMed

Surgical treatment of rectal prolapse aims to correct morphology and restore function. Many techniques are available, but none can be considered a gold standard. Abdominal approaches differ with regard to abdominal access, extent of rectal mobilisation, technique of rectal pexy, and concomitant sigmoid resection. Local (perineal/transanal) procedures plicate or resect the rectum. The choice of operative approach is based on the patient's condition and expected outcome of the procedure, e.g. recurrence rate, morbidity, and function. Abdominal operations are favored in fit patients, while local procedures are considered for the elderly and frail. This review compares differences in the most common techniques, focussing on recurrence, morbidity, and functional outcome. PMID:18418563

Matzel, K E; Heuer, S; Zhang, W

2008-05-01

54

Novel radiation techniques for rectal cancer  

PubMed Central

The concepts for management of rectal cancer have changed drastically over the past few years. Through national bowel cancer screening programmes in the Western countries and the increasing use of endoscopic procedures as diagnostic tool, there is increase in detection of rectal cancer in early stages. There is increase in ageing population worldwide but more so in Western countries. In addition, there is realisation of harm from extirpative surgical procedures which are directed towards managing advanced rectal cancer in the past. Increase in cost of health care burden has also led the investigators to seek alternative treatment options which are effective, safe and cost effective. There are several modern radiation techniques which fits this bill and we need to be aware of newer novel radiation techniques to fulfil this gap.

2014-01-01

55

Neoadjuvant Treatment in Rectal Cancer: Actual Status  

PubMed Central

Neoadjuvant (preoperative) concomitant chemoradiotherapy (CRT) has become a standard treatment of locally advanced rectal adenocarcinomas. The clinical stages II (cT3-4, N0, M0) and III (cT1-4, N+, M0) according to International Union Against Cancer (IUCC) are concerned. It can reduce tumor volume and subsequently lead to an increase in complete resections (R0 resections), shows less toxicity, and improves local control rate. The aim of this review is to summarize actual approaches, main problems, and discrepancies in the treatment of locally advanced rectal adenocarcinomas.

Garajova, Ingrid; Di Girolamo, Stefania; de Rosa, Francesco; Corbelli, Jody; Agostini, Valentina; Biasco, Guido; Brandi, Giovanni

2011-01-01

56

Microsatellite instability and survival in rectal cancer  

Microsoft Academic Search

Objective  High levels of microsatellite instability (MSI-H) have been associated in many studies with improved prognosis in colon cancer.\\u000a Very few studies have evaluated the effect of MSI-H on rectal cancer survival. We assessed MSI-H and other genetic and epigenetic\\u000a changes on survival of 990 individuals diagnosed with first primary rectal cancer.\\u000a \\u000a \\u000a \\u000a Methods  MSI was assessed primarily by instability in the mononucleotide

Wade S. Samowitz; Karen Curtin; Roger K. Wolff; Sheryl R. Tripp; Bette J. Caan; Martha L. Slattery

2009-01-01

57

Rectal and sigmoid atresia: transanal approach.  

PubMed

We report 2 patients with rectal and low sigmoid atresia operated on, respectively, at 6 and 3 months of age using the transanal approach, similar to the transanal technique for Hirschsprung disease, after exploratory laparotomy with colostomy at birth. There were no intraoperative or postoperative complications after a follow-up time of 2 years. After closure of the colostomy, both patients had no fecal incontinence. The transanal approach is a safe and effective technique in the management of rectal and sigmoid atresia. PMID:22703823

Hamzaoui, M; Ghribi, A; Makni, W; Sghairoun, N; Gasmi, M

2012-06-01

58

Transvaginal low anterior resection for rectal cancer.  

PubMed

Adenocarcinoma of the lower rectum can be resected with a sphincter-sparing procedure but exposure of the lower pelvis may be difficult and sphincter function may be compromised. We have performed a low anterior resection for rectal cancer in a 69-year-old woman with mobilisation of the tumour and anastomosis performed transvaginally without a covering stoma. This way we could get good exposure of the lower rectum and anal sphincters. The patient made an uneventful recovery and was fully continent after surgery. Transvaginal low anterior resection is an alternative route which may be useful in cases of difficult exposure of low rectal cancer. PMID:18512019

Yücesoy, A N; Ercan Bülbül, E; Bahat, R; Cafer Kö?kero?lu, C

2008-03-01

59

Laparoscopic intersphincteric resection for low rectal cancer.  

PubMed

The goal of this review is to outline some of the important surgical issues surrounding the management of patients with low rectal cancer submitted to laparoscopic intersphincteric resection (ISR). Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Nevertheless, all progress in the development of oncologic therapy (i.e., radiation and chemotherapy), radical surgical removal of the tumour is the only chance for permanent cure of rectal cancer. Beside this main objective, the preservation of faecal continence is the second-most important goal to reach an acceptable quality of life with preservation of sphincter function. Information concerning the depth of tumour penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection with ISR allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Data from small, non-randomized studies evaluating laparoscopic ISR suggest that this procedure is feasible by experienced surgeons. A literature search identified five studies [Uchikoshi F, Nishida T, Ueshima S, Nakahara M, Matsuda H. Laparoscope-assisted anal sphincter-preserving operation preceded by transanal procedure. Tech Coloprocto 2006;10:5-9; Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J. Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Disease 2003;5:451-3; Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J. Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. British Journal of Surgery 2003;90:445-51; Watanabe M, Teramoto T, Hasegawa H, Kitajima M. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer. Diseases of the Colon and Rectum 2000;43(Suppl. 10):S94-7; Miyajima N, Yamakawa T. Laparoscopic surgery for early rectal carcinoma. Nippon Geka Gakkai Zasshi 1999;100:801-5]. The aim was to find those studies that documented potential clinical application of laparoscopic ISR. These studies concluded that a laparoscopic approach can be considered in most patients with low rectal cancer in which laparoscopic ISR represents a feasible alternative to conventional open surgery. Hopefully, randomized controlled trials, which utilize these alternative procedures, will in future determine the results of laparoscopic ISR in terms of sphincter function, faecal continence, disease free and overall survival. The reviewed studies concluded that high quality and less invasive surgery could be achieved if ISR and laparoscopic surgery were combined. PMID:18023571

Orsenigo, Elena; Di Palo, Saverio; Vignali, Andrea; Staudacher, Carlo

2007-12-01

60

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

2012-01-01

61

Differences in microbial signatures between rectal mucosal biopsies and rectal swabs  

PubMed Central

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.

Araujo-Perez, Felix; McCoy, Amber N.; Okechukwu, Charles; Carroll, Ian M.; Smith, Kevin M.; Jeremiah, Kim; Sandler, Robert S.; Asher, Gary N.; Keku, Temitope O.

2012-01-01

62

Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis?  

PubMed Central

INTRODUCTION Colorectal cancer is an important cause of death. Most cases of colon and rectal cancer arise from a preexisting adenomatous polyp. However, if colorectal polyps are very large or not accessible for endoscopic ablation, or if they cannot be removed without an increased risk of perforation, surgical procedures are required. PRESENTATION OF CASE The case of a patient with a giant villous adenoma of the rectum is described. The patient had diarrhea for 2 years associated with asthenia. Colonoscopy revealed a sessile lesion in the rectum measuring 14 cm in the largest diameter. Rectal eversion technique was used, resecting the lesion under direct visibility and an external coloanal anastomosis was performed. Surgery was satisfactory and the resection margins were free. DISCUSSION Removal of these polyps should be performed aiming to reduce the incidence of colorectal cancer, as well as to control local and systemic symptoms, such as diarrhea and fluid and electrolyte disorders, mainly in villous adenomas. Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply. The rectal stump eversion technique was described by Maunsell (1892), for rectal cancer. CONCLUSION Eversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas.

Roriz-Silva, Renato; Andrade, Alexei Almeida; Ivankovics, Ivan Gregorio

2013-01-01

63

Locally recurrent rectal cancer: Surgical strategy  

Microsoft Academic Search

Relapses after “curative resection” of rectal cancer may be localized and thus amenable to surgical treatment. The risk of relapse may be higher than previously believed depending on adequacy and length of follow-up, the diagnostic modalities used, and the number of autopsies performed. Technical refinements such as a distal margin >2 cm, radical pelvic lymphadenectomy, and high ligation of the

J. Pedro de Azevedo; Roger R. Dozois; Leonard L. Gunderson

1992-01-01

64

Functional results after postirradiation rectal reconstruction  

Microsoft Academic Search

The functional results obtained in 26 patients operated on for postirradiation rectovaginal fistula, stricture, or combination of fistula and stricture are reported in detail. Emphasis is placed on the degree of continence obtained. The operation consists of use of proximal nonirradiated colon to repair the damaged area without doing a rectal resection. It has been found that nonirradiated colon with

Eugene M. Bricker; William G. Kraybill; Marvin J. Lopez

1986-01-01

65

Traitement chirurgical de l’endométriose rectale  

Microsoft Academic Search

Intestinal endometriosis accounts for 8-12% of all endometriosis and rectal involvement is most often encountered in the context of deep pelvic infiltration. Intestinal symptoms, often nonspecific, are most typically seen as painful defecation or constipation worsening in the premenstrual period associated with pelvic pain, dysmenorrheal, dyspareunia, and infertility.Physical examination should include a pelvic exam under anesthesia. Endorectal ultrasound best evaluates

M. Leconte; C. Chapron; B. Dousset

2007-01-01

66

Surgical treatment of recurrent complete rectal prolapse  

Microsoft Academic Search

PURPOSE: Complete recurrent rectal prolapse (RRP) after initial prolapse surgery is well described. Our aim was to examine the possible causes for RRP, to learn of the operations performed most frequently, and to examine the outcome following recurrence surgery. METHODS: Patients with RRP were reviewed retrospectively from 1963 to 1993. RESULTS: A total of 24 patients (19 females) had RRP.

Graham R. Hool; Tracy L. Hull; Victor W. Fazio

1997-01-01

67

Rectal carcinoids: The most frequent carcinoid tumor  

Microsoft Academic Search

One hundred seventy patients with gastrointestinal carcinoid tumors were treated at Ochsner Clinic from 1958 to 1990. Ninety-four rectal carcinoid tumors were diagnosed and treated during this time. Carcinoid tumors of the rectum represented the most frequent primary site (55 percent), followed by carcinoids of the ileum (12 percent), appendix (12 percent), colon (6 percent), stomach (6 percent), jejunum (2

Allen B. Jetmore; John E. Ray; J. Byron Gathright Jr; Kevin M. McMullen; Terry C. Hicks; Alan E. Timmcke

1992-01-01

68

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

69

Adjuvant therapy of resectable rectal cancer  

Microsoft Academic Search

The two conventional treatments for clinically resectable rectal cancer are surgery followed by postoperative combined modality therapy and preoperative combined modality therapy followed by surgery and postoperative chemotherapy. Preoperative therapy (most commonly combined modality therapy) has gained acceptance as a standard adjuvant therapy. The potential advantages of the preoperative approach include decreased tumor seeding, less acute toxicity, increased radiosensitivity due

Bruce D Minsky

2002-01-01

70

[Rectal cancer and adjuvant chemotherapy: which conclusions?].  

PubMed

Adenocarcinoma of the rectum represents about a third of cases of colorectal cancer, with an annual incidence of 12,000 cases in France. On the contrary of colon cancer, the benefice of adjuvant chemotherapy in rectal cancer has not been definitively proved, more because this question was assessed in few recent studies than because negative results. Preoperative radiochemotherapy is now the reference treatment for mid and lower rectal cancers, and allow to increase the local control without improvement of progression free survival and overall survival. The data of the "historical studies" of adjuvant treatment in rectal cancer published before 1990, of the meta-analysis of adjuvant trials in rectal cancer and of the QUASAR study suggest that adjuvant chemotherapy with fluoropyrimidines (intravenous or oral), in absence of pre-operative treatment, decrease the risk of metastatic relapse after curative surgery for a rectal cancer of stage II or III. This benefice seems similar to the one observed in colon cancer. In the EORTC radiotherapy group trial 22921, an adjuvant chemotherapy with 5-fluorouracil and low dose of leucovorin was not associated with a significantly improvement of overall survival but, despite the fact that only 42.9% of patients received all planed cycles, the progression free survival was increased (not significantly) in groups receiving adjuvant chemotherapy. The French recommendations are to discuss the indication of adjuvant chemotherapy by fluoropyrimidines in cases of stage III rectal cancer on histopathologic reports and no chemotherapy in case of stade II. Despite the fact that none study have assessed a combination of fluoropyrimidines and oxaliplatin in adjuvant setting in rectal cancer, like in colon cancer, the Folfox4, modified Folfox6 or Xelox regimens are valid options in stage III (experts opinion). In cases of pathologic complete remission or in absence of involved nodes, the benefice of adjuvant chemotherapy is not assessed. In all cases, the decision of adjuvant chemotherapy has to be taken during a multidisciplinary meeting. The interest of a combination of fluoropyrimidine and oxaliplatin is assessed in currently adjuvant trials (PETTAC-6 and CAO/ARO/AIO-04), and future trials will assess the interest of neoadjuvant chemotherapy. PMID:19965305

Bachet, J-B; Rougier, P; de Gramont, A; André, T

2010-01-01

71

Failed stapled rectal resection in a constipated patient with rectal aganglionosis  

PubMed Central

A rare case of a severely constipated patient with rectal aganglionosis is herein reported. The patient, who had no megacolon/megarectum, underwent a STARR, i.e., stapled transanal rectal resection, for obstructed defecation, but her symptoms were not relieved. She started suffering from severe chronic proctalgia possibly due to peri-retained staples fibrosis. Intestinal transit times were normal and no megarectum/megacolon was found at barium enema. A diverting sigmoidostomy was then carried out, which was complicated by an early parastomal hernia, which affected stoma emptying. She also had a severe diverting proctitis, causing rectal bleeding, and still complained of both proctalgia and tenesmus. A deep rectal biopsy under anesthesia showed no ganglia in the rectum, whereas ganglia were present and normal in the sigmoid at the stoma site. As she refused a Duhamel procedure, an intersphincteric rectal resection and a refashioning of the stoma was scheduled. This case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure.

Pescatori, Lorenzo C; Villanacci, Vincenzo; Pescatori, Mario

2014-01-01

72

Failed stapled rectal resection in a constipated patient with rectal aganglionosis.  

PubMed

A rare case of a severely constipated patient with rectal aganglionosis is herein reported. The patient, who had no megacolon/megarectum, underwent a STARR, i.e., stapled transanal rectal resection, for obstructed defecation, but her symptoms were not relieved. She started suffering from severe chronic proctalgia possibly due to peri-retained staples fibrosis. Intestinal transit times were normal and no megarectum/megacolon was found at barium enema. A diverting sigmoidostomy was then carried out, which was complicated by an early parastomal hernia, which affected stoma emptying. She also had a severe diverting proctitis, causing rectal bleeding, and still complained of both proctalgia and tenesmus. A deep rectal biopsy under anesthesia showed no ganglia in the rectum, whereas ganglia were present and normal in the sigmoid at the stoma site. As she refused a Duhamel procedure, an intersphincteric rectal resection and a refashioning of the stoma was scheduled. This case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure. PMID:24764689

Pescatori, Lorenzo C; Villanacci, Vincenzo; Pescatori, Mario

2014-04-21

73

How useful is rectal endosonography in the staging of rectal cancer?  

PubMed Central

It is essential in treating rectal cancer to have adequate preoperative imaging, as accurate staging can influence the management strategy, type of resection, and candidacy for neoadjuvant therapy. In the last twenty years, endorectal ultrasound (ERUS) has become the primary method for locoregional staging of rectal cancer. ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers (T stage). Lower accuracy for T2 tumors is commonly reported, which could lead to sonographic overstaging of T3 tumors following preoperative therapy. Unfortunately, ERUS is not as good for predicting nodal metastases as it is for tumor depth, which could be related to the unclear definition of nodal metastases. The use of multiple criteria might improve accuracy. Failure to evaluate nodal status could lead to inadequate surgical resection. ERUS can accurately distinguish early cancers from advanced ones, with a high detection rate of residual carcinoma in the rectal wall. ERUS is also useful for detection of local recurrence at the anastomosis site, which might require fine-needle aspiration of the tissue. Overstaging is more frequent than understaging, mostly due to inflammatory changes. Limitations of ERUS are operator and experience dependency, limited tolerance of patients, and limited range of depth of the transducer. The ERUS technique requires a learning curve for orientation and identification of images and planes. With sufficient time and effort, quality and accuracy of the ERUS procedure could be improved.

Kav, Taylan; Bayraktar, Yusuf

2010-01-01

74

[Rectal cancer--diagnostic and therapeutic difficulties].  

PubMed

This paper aim is to analyze the main diagnostic and therapeutic aspects in rectal cancer; for this purpose we analyzed the Craiova's Surgical II Clinic statistics and we report them to the present literature. There were 179 rectal cancers, diagnosed over 10 years period (between 1995 and 2004); 163 cases were operated on, in 62 cases (38.03%) the surgical intervention aim being curative; global resection of tumor was 84.66%. The operation was preceded by preoperative radiotherapy in 82 cases; all cases diagnosed in the last four years in curative stage of disease were treated by preoperative radiotherapy. The postoperative mortality was 3.68% (6 cases) and the morbidity rate (55 cases - 33.74%) is still important, mainly because of the associated diseases. In conclusion we emphasize the importance of untimely diagnosis and the obligatorily sequential treatment: preoperative radiotherapy curative surgical resection - postoperative adjuvant treatment. PMID:16623373

Vîlcea, I D; Vasile, I; Pa?alega, M; Calot?, F; Mesin?, C; Scurtu, S; Mirea, C

2006-01-01

75

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

76

Adult intussusception presenting as rectal prolapse.  

PubMed

We present a case of an elderly man with what appeared to be an episode of rectal prolapse following straining while defaecating. Laparotomy revealed the prolapse to be an intussusception of large bowel with a villous adenoma as its lead point. Reduction resection was performed with primary anastomosis, and the patient recovered well from the surgery. Rectal prolapse has often been viewed as a benign condition in the elderly, but more thought needs to be put into the diagnosis in patients with risks of malignancy. Prolapse of an intussuscepted bowel segment in adults is an exceedingly rare presentation, often signifying a risk of malignancy. Appropriate investigations and surgical techniques need to be employed in effectively resolving symptoms while minimising the chances of tumour seeding. PMID:24777082

Mahmood, Arshad; Ruan, Qing Zhao; O'Hara, Richard; Canna, Khalid

2014-01-01

77

Transanal evisceration caused by rectal laceration.  

PubMed

Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained. PMID:24639971

Martínez Pérez, Aleix; Torres Sánchez, María Teresa; Richart Aznar, Jose Manuel; Martí Martínez, Eva María; Martínez-Abad, Manuel

2014-02-01

78

Distal intramural spread of rectal carcinomas  

Microsoft Academic Search

Forty-three consecutive specimens of resected rectal carcinomas, 16 abdominoperineal and 27 anterior resections, were examined\\u000a for distal intramural spread. Thirty-four of the resections were considered curative and nine palliative. Eighteen carcinomas\\u000a (42 percent) showed no distal spread, and 14 (33 percent) showed very limited distal spread (0–5 mm). In the remaining cases,\\u000a 11 (25 percent) had distal spread of more

Per M. Madsen; John Christiansen

1986-01-01

79

Rectal dosimetric analysis following prostate brachytherapy  

Microsoft Academic Search

Purpose: To retrospectively assess the rectal tolerance dose in transperineal ultrasound-guided prostate brachytherapy using easily measured point doses.Methods and Materials: Forty-five consecutive patients who underwent prostate seed implantation from January 1996 to October 1996, using either 125I or 103Pd as monotherapy or as a boost following 45 Gy of external beam radiotherapy (XRT), were evaluated. For monotherapy using 125I, the

Gregory S Merrick; Wayne M Butler; Anthony T Dorsey; Jonathan H Lief; Holly L Walbert; Heather J Blatt

1999-01-01

80

Career Options in Colon and Rectal Surgery  

PubMed Central

As Colon and Rectal Surgery has grown and diversified, the practice opportunities available have greatly expanded. The wealth of choices, may be daunting and even paralyzing for the new graduate or practitioner looking for a career change. Prior to making a decision, candidates must first make an honest assessment of their goals, abilities, and priorities. In this article, the authors briefly outline some of these challenges and help lay the groundwork for a successful decision process.

Alavi, Karim; Madoff, Robert D.; Rothenberger, David A.

2011-01-01

81

Reappraisal of Delorme's procedure for rectal prolapse  

Microsoft Academic Search

Eighteen patients with second- and third-degree rectal prolapse were treated by simplified Delorme operation during a nine-year\\u000a period. Operative mortality was nil and significant complications developed in three patients (17 percent). Long-term follow-up\\u000a (average, 42 months) was established for all 18 patients revealing excellent results in 15 (83 percent). There was only one\\u000a recurrent prolapse (6 percent) observed during this

Adolf L. Gundersen; Thomas H. Cogbill; Jeffrey Landercasper

1985-01-01

82

Fine needle aspiration cytology of rectal masses.  

PubMed Central

This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure. Images Figure 1 Figure 2 Figure 3

Kochhar, R; Rajwanshi, A; Wig, J D; Gupta, N M; Kesiezie, V; Bhasin, D K; Malik, A K; Gupta, S K; Mehta, S K

1990-01-01

83

Solitary rectal ulcer syndrome: physiology and treatment options.  

PubMed

Solitary rectal ulcer syndrome (SRUS) is a rare condition that can lead to pain, rectal bleeding and mucus. It is associated with chronic straining and abnormal defaecatory behaviour, including digitating and several unsuccessful visits to the toilet daily. Other symptoms can include tenesmus, altered bowel habit and incontinence. It can also be accompanied with a rectal prolapse, which may involve protrusion of either the rectal mucosa or the entire wall of the rectum. SRUS is known for its chronicity and can be difficult to treat. This article reviews SRUS, discussing possible causes and the various treatments that might be used, including medication, surgery and biofeedback therapy. PMID:20081680

Swatton, Anna

84

The effects of biofeedback on rectal sensation and distal colonic motility in patients with disorders of rectal evacuation  

Microsoft Academic Search

OBJECTIVE:Abnormalities of descending colon motility reported in a subset of patients with rectal evacuation disorders are consistent with a rectocolonic inhibitory reflex. Our aims were to evaluate distal colon motor function and rectal sensation in such patients and assess effects of biofeedback (BF) training on these functions.METHODS:Seven patients (five women, two men; mean age 36 yr) with rectal evacuation disorders

Roland M. H. G. Mollen; Beatrice Salvioli; Michael Camilleri; Duane Burton; Louis J. Kost; Sidney F. Phillips; John H. Pemberton

1999-01-01

85

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

86

Management of rectal stenosis with endoscopic balloon dilatation.  

PubMed

We present a rare case of female newborn that presented with atypical genitalia, vaginal atresia and a short segment rectal stenosis which was successfully managed in a minimally invasive fashion using urological endoscopic and balloon dilatation technology. We believe that this technique is safe and feasible for short rectal stenotic segments and might prevent the need for major reconstruction surgery. PMID:23583158

Hidas, Guy; Gibbs, David; Alireza, Alamsahebpour; Khoury, Antoine E

2013-04-01

87

Recurrence and survival after surgical management of rectal cancer  

Microsoft Academic Search

BACKGROUND: Reported local recurrence rates for rectal cancer are significantly reduced using a combination of superior surgical technique, in the form of total mesorectal excision, and routine radiotherapy. In an attempt to determine the effectiveness of current local management strategies, a review of Vancouver Island Cancer Centre patients with rectal cancer was performed and the overall local recurrence rate was

Alison Ross; Conrad Rusnak; Brian Weinerman; Peter Kuechler; Allan Hayashi; Gordon MacLachlan; Ewan Frew; William Dunlop

1999-01-01

88

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

89

Generic Planning Target Margin for Rectal Cancer Treatment Setup Variation  

Microsoft Academic Search

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.

John M. Robertson; Jonathon P. Campbell; Di Yan

2009-01-01

90

Reassessment of rectal approach to neuropathology in childhood  

Microsoft Academic Search

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

E. M. Brett; B. D. Lake

1975-01-01

91

Risk factors for sexual dysfunction after rectal cancer treatment  

Microsoft Academic Search

This study aimed to identify risk factors for long-term sexual dysfunction (SD) after rectal cancer treatment.Patients with resectable rectal cancer were randomised to total mesorectal excision with or without preoperative radiotherapy (PRT). Preoperatively and at 3, 6, 12, 18 and 24 months postoperatively, SD scores were filled out in questionnaires. Possible risk factors for postoperative deterioration of sexual functioning, including

M. M. Lange; C. A. M. Marijnen; C. P. Maas; H. Putter; H. J. Rutten; A. M. Stiggelbout; E. Meershoek-Klein Kranenbarg

2009-01-01

92

Massive arterial bleeding from a single rectal vessel.  

PubMed Central

We report a case of massive rectal haemorrhage arising from a single ectatic arterial vessel above the haemorrhoidal cushion in normal rectal mucosa. Use of an anal retractor enable identification of the bleeding vessel and avoided a major laparatomy. Images Figure

Harrison, J. D.; Calatayud, A.; Thava, V. R.; Kirby, R. M.

1997-01-01

93

Improvement in irritable bowel syndrome following ano-rectal surgery  

Microsoft Academic Search

Background and aims: To assess the effect on irritable bowel syndrome (IBS) of treating ano-rectal problems by applying multiple Barron's bands to prolapsing mucosa and excising haemorrhoids, with or without a low lateral sphincterotomy. Patients and methods: 144 patients with IBS whose ano-rectal abnormalities were treated by a single consultant surgeon. A prospective 'within person' study of consecutive patients referred

Bernard V. Palmer; John W. Lockley; Robert B. Palmer; Elena Kulinskaya

2002-01-01

94

Is Fecal Diversion Necessary for Nondestructive Penetrating Extraperitoneal Rectal Injuries?  

Microsoft Academic Search

Background: Current management of penetrating extraperitoneal rectal injury in- cludes diversion of the fecal stream. The purpose of this study is to assess whether nondestructive penetrating extraperitoneal rectal injuries can be managed successfully without diversion of the fecal stream. Methods: This study was performed at an urban Level I trauma center during a 28-month period from February 2003 through June

Richard P. Gonzalez; Herbert Phelan; Moustaffa Hassan; C. Neal Ellis; Charles B. Rodning

2006-01-01

95

Abdominoperineal resection and perineal colostomy for low rectal cancer  

Microsoft Academic Search

PURPOSE: We sought to evaluate a new technique for creation of a continent perineal colostomy following abdominoperineal resection (APR) of the rectum for low rectal cancer. METHODS: Nine selected patients with low rectal cancer (two males; median age, 55.6 years; classified as Dukes A, 6 patients and as Dukes B, 3 patients) underwent APR. Following this, the original Lazaro da

Nadko G. Velitchkov; Gueno K. Kirov; Julian E. Losanoff; Kirien T. Kjossev; Georgi I. Grigorov; Miroslav B. Mironov; Ivan S. Klenov

1997-01-01

96

Abdominoperineal resection for locally recurrent rectal cancer.  

PubMed

To evaluate whether surgical resection confers survival advantages in selected patients with resectable locally recurrent rectal cancer, data on 430 patients who underwent R0 resection for primary rectal cancer were prospectively collected over a 14-year period. Resection of recurrent disease was considered R0 when all cancer tissue was resected with microscopically tumor-free surgical margins. Microscopic evidence of disease at resection margins was considered an R1 resection. Recurrent disease was detected in 158 of 430 patients. Local recurrence was found in 91 patients, including (79%) with resection-site relapse only. These patients were considered for surgery unless defined unresectability criteria were met. A total of 35 patients who had abdominoperineal excision following anterior resection were studied retrospectively. Mortality associated with the procedure was 3% and morbidity was 20%. The resection was R0 in 12 patients, while microscopic margins were involved in 23 patients. 10 patients had extended resection of one or several adjacent organs Median operating time and blood loss were 250 min and 500 ml respectively. Median hospital stay was 25 days. 21/23 R1 patients received postoperative radiotherapy. Return to normal activity occurred at 8.2 (SD 4.2) weeks. No patients were lost to follow-up. Overall median survival was 26.4 months; 5-year survival was 25.4%. In spite of several survival predictors at univariate analysis, R0 or R1 resection was the only independent predictor of survival at multivariate analysis (add ratio 112.7, 95% CI 3.6-3500, p=0.007). Median survival rate was not reached at the 146-month follow-up in patients with R0 resection. Median survival rate was 16.6 months in patients with R1 resection. In conclusion, uninvolved microscopic margins produce long-term survivors after surgical resection for locally recurrent rectal cancer. PMID:11862566

Bergamaschi, R; Pessaux, P; Burtin, P; Arnaud, J P

2001-08-01

97

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

98

Rectal Lipoma Associated with Genital Prolapse  

PubMed Central

Lipomas are the tumors of mature lipocytes with its occurrence most often on the torso, neck, upper thighs, upper arms, and armpits, but they can occur almost anywhere in the body. They are the rare tumors of intestine, more frequently located in large intestine compared to small intestine. We present the case of a 58-year-old post-menopausal lady presenting with rectal bleeding and utero-vaginal prolapse. The prolapsing mass was excised, and histopathological examination diagnosed the lesion to be a lipoma.

Krishnan, P; Adlekha, S; Chadha, T; Babu, AK

2013-01-01

99

Comparison of rectal and axillary temperatures in dogs and cats.  

PubMed

Objective-To compare rectal versus axillary temperatures in dogs and cats. Design-Prospective observational study. Animals-94 dogs and 31 cats. Procedures-Paired axillary and rectal temperatures were measured in random order with a standardized method. Animal signalment, initial complaint, blood pressure, blood lactate concentration, and variables associated with vascular perfusion and coat were evaluated for associations with axillary and rectal temperatures. Results-Axillary temperature was positively correlated with rectal temperature (? = 0.75 in both species). Median axillary temperature (38.4°C [101.1°F] in dogs, and 38.4°C [101.2°F] in cats) was significantly different from median rectal temperature in dogs (38.9°C [102.0°F]) but not in cats (38.6°C [101.5°F]). Median rectal-axillary gradient (difference) was 0.4°C (0.7°F; range, -1.3° to 2.3°C [-2.4° to 4.1°F]) in dogs and 0.17°C (0.3°F; range -1.1° to 1.6°C [-1.9° to 3°F]) in cats. Sensitivity and specificity for detection of hyperthermia with axillary temperature were 57% and 100%, respectively, in dogs and 33% and 100%, respectively, in cats; sensitivity and specificity for detection of hypothermia were 86% and 87%, respectively, in dogs and 80% and 96%, respectively, in cats. Body weight (? = 0.514) and body condition score (? = 0.431) were correlated with rectal-axillary gradient in cats. Conclusions and Clinical Relevance-Although axillary and rectal temperatures were correlated in dogs and cats, a large gradient was present between rectal temperature and axillary temperature, suggesting that axillary temperature should not be used as a substitute for rectal temperature. PMID:24786164

Goic, Joana B; Reineke, Erica L; Drobatz, Kenneth J

2014-05-15

100

[Radiochemotherapy plus hyperthermia in rectal carcinoma].  

PubMed

In locally advanced rectal cancer (uT3/uT4) resectability as well as local control is reduced. In the patients combined preoperative radiochemotherapy demonstrated an increase of resectability and a reduction of local recurrence. Radiotherapy was applied in standard blocks, 5 x 1.8 Gy up to 45 Gy. Chemotherapy consisted out of two cycles of 5-Fluorouracil (300-350 mg/m2/d) and Leucovorin (50 mg). Prior to radiotherapy additionally thermotherapy was carried out using the SIGMA 60 applicator BSD 2000 once a week. The hyperthermia method is based on heating up affected tissue compartments to temperature above 42 degrees Celsius without damaging surrounding tissue compartments. In regional hyperthermia tumors in the abdominal region are treated by emitting radio waves into the patient. 4-6 weeks after radiochemotherapy, surgery was performed. The therapeutic toxicity was acceptable and the resectability rate was up to 90%. Response rate to treatment was 60%. Our data with preoperative combined treatment in locally advanced rectal cancer revealed encouraging downstaging, local control, and survival rates. PMID:11320886

Rau, B; Wust, P; Riess, H; Schlag, P M

2001-04-01

101

In vivo real-time rectal wall dosimetry for prostate radiotherapy  

Microsoft Academic Search

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 real-time 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

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

2010-01-01

102

Evaluation and outcome of the delorme procedure in the treatment of rectal outlet obstruction  

Microsoft Academic Search

PURPOSE: This study was designed to assess the results of the Delorme procedure in the treatment of patients with rectal outlet obstruction. METHODS: A descriptive retrospective study from October 1989 to October 1997 was undertaken. Thirty-four patients with an abnormal defecography documenting rectal outlet obstruction caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele were

Harry Liberman; Charles Hughes; Anthony Dippolito

2000-01-01

103

Microscopy detection of rectal gonorrhoea in asymptomatic men.  

PubMed

This audit aimed to determine the usefulness of microscopy to detect presumptive rectal gonorrhoea (GC) infection in asymptomatic men. We retrospectively audited more than 400 male patients attending a London genitourinary medicine clinic from January 2005 to March 2007 who tested rectal culture positive for Neisseria gonorrhoeae and compared this with the microscopy detection rate. In total, 123/423 (29%) of culture positive samples were microscopy positive. Of those that tested microscopy negative (300/423), 64 (21%) were symptomatic and 236 (79%) asymptomatic. In addition, a time and motion study examined 81 rectal slides over a two-week period to identify microscopy reading time required to make a presumptive diagnosis of GC. Three slides were positive, resulting in six hours and 45 minutes to detect one positive sample. Given the low sensitivity for rectal microscopy coupled with the length of time required to obtain a presumptive positive rectal GC result, we believe rectal microscopy is no longer a cost-effective tool screening for asymptomatic men, and this report supports the BASHH guideline that it is not recommended in the management of asymptomatic rectal infection. PMID:19833693

Forni, J; Miles, K; Hamill, M

2009-11-01

104

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

105

Persistent rectal prolapse in children: sclerotherapy and surgical management.  

PubMed

Persistent rectal prolapse is an uncommon but distressing condition in children. Significant controversy exists regarding its surgical management. The aim of this study was to identify a successful management strategy for persistent rectal prolapse in the paediatric population. Records of all children with rectal prolapse treated surgically at Birmingham Children's Hospital between 1995 and 2003 were retrospectively reviewed. Demographic data, clinical presentation, investigations, treatment modality, complications, and outcome were recorded. Inclusion criteria for the study were failure of conservative management leading to operative treatment. An exclusion criterion was cystic fibrosis. A total of 24 patients with persistent rectal prolapse were identified. Two children with cystic fibrosis were excluded from the analysis. Children below the age of 5 years, group I (n=17), were successfully managed by submucous hypertonic saline injections. Eighty-three percent (14/17) were cured by injection sclerotherapy in this group, 12/14 (71%) requiring one injection and 2/14 requiring a second injection. In the three (17.6%) children in group I in whom sclerotherapy failed, cow's milk protein (CMP) allergy was identified as the causative factor. Children older than 5, group II (n=5), either had behavioural problems (n=3) or were autistic (n=2). This group of children with adult-type, full-thickness rectal prolapse were found to be refractory to initial attempts of injection sclerotherapy. All five children were successfully managed with surgical correction. We conclude that rectal submucous hypertonic saline injections are highly effective for managing early-onset idiopathic childhood rectal prolapse. CMP allergy should be considered in young children with recurrent rectal prolapse. We recommend early definitive corrective surgery in older children with persistent rectal prolapse, as they do not respond to conservative measures or injection sclerotherapy. PMID:15761711

Shah, A; Parikh, D; Jawaheer, G; Gornall, P

2005-04-01

106

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

107

Outcome After Curative Resection for Locally Recurrent Rectal Cancer  

Microsoft Academic Search

\\u000a Purpose  Few biologic markers have been studied as prognostic factors in recurrent rectal carcinoma patients. We sought to determine\\u000a the influence of clinical, pathologic, and biologic (p53, bcl-2, and ki-67) variables on survival after curative resection\\u000a of locally recurrent rectal cancer.\\u000a \\u000a \\u000a \\u000a Methods  Retrospective review of patients with locally recurrent rectal cancer who received surgery with curative intent.\\u000a \\u000a \\u000a \\u000a Results  From 1988 to 1998, 134

Isabelle Bedrosian; Geoffrey Giacco; Lee Pederson; Miguel A. Rodriguez-Bigas; Barry Feig; Kelly K. Hunt; Lee Ellis; Steven A. Curley; Jean Nicolas Vauthey; Marc Delclos; Christopher H. Crane; Nora Janjan; John M. Skibber

2006-01-01

108

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

109

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

110

[Radiotherapy in rectal cancer: when, why and how?].  

PubMed

Since several decades, radiotherapy plays a crucial role in the management and local control of the rectal adenocarcinoma. The local recurrences pattern of the rectal tumor has completely changed with the systematic use of the Total Mesorectal Excision surgery (TME). In this context, the rate of radiotherapy needs to be reviewed. In this article we propose an overview of the main studies using radiotherapy in a pre- or post-operative setting in the context ofTME surgery. This will help to better define the indications of radiotherapy in rectal cancer. PMID:24822304

Martinive, P; Vandaele, D; Lennerts, E; Polus, M; Coimbra, C; Kohnen, L; Vanderick, J; Collignon, J; Coucke, P

2014-01-01

111

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

112

An unusual case of mesalazine intoxication: oral and rectal overloading of the rectal suppository form.  

PubMed

Drugs containing 5-acetylsalicylic acid (5-ASA) have been commonly used for inflammatory bowel diseases for more than half a century, but no case about overdose of suppository form of mesalazine which was taken both orally and rectally has been reported in the related literature up to now. In the present case, a 20-year-old male patient who took 14.5 g of mesalazine rectally and orally for suicide purpose is discussed. He was an ulcerative colitis patient and depressed about his illness and routine life traffic. Although it was hard for him to take the suppository form orally because of its bad taste and structure, he took it with the help of water. In the patient's colonoscopy, diffuse hyperemia and edema extending from the anal channel to the proximal rectal mucosa and a 1.5 cm diameter ulcer expanding from anal channel through the rectum were identified. No pathology was found in the upper gastrointestinal endoscopy. Routine laboratory examination was performed and no abnormality was identified in the patient's total blood account, biochemical parameters and full-urine examination. In the control rectoscopy applied to the patient 15 days later, recovery of the ulcer was observed and he was discharged to be followed in the psychiatry clinic. PMID:20670990

Koseoglu, Zikret; Satar, Salim; Kara, Banu; Sebe, Ahmet; Kosenli, Ozgun

2011-07-01

113

Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception  

PubMed Central

AIM: To evaluate the safety and efficacy of stapled transanal rectal resection (STARR), and to analyze the outcome of the patients 12-mo after the operation. METHODS: From May 2007 to October 2008, 50 female patients with rectocele and/or rectal intussusception underwent STARR. The preoperative status, perioperative and postoperative complications at baseline, 3, 6 and 12-mo were assessed. Data were collected prospectively from standardized questionnaires for the assessment of constipation [constipation scoring system, Longo’s obstructed defecation syndrome (ODS) score system, symptom severity score], patient satisfaction (visual analogue scale), and quality of life (Patient Assessment of Constipation-Quality of Life Questionnaire). RESULTS: At a 12-mo follow-up, significant improvement in the constipation scoring system, ODS score system, symptom severity score, visual analog scale and quality of life (P < 0.0001) was observed. The symptoms of constipation improved in 90% of patients at 12 mo after surgery. The self-reported definitive outcome was excellent in 15 (30%) patients, fairly good in 8 (16%), good in 22 (44%), and poor in 5 (10%). CONCLUSION: STARR can be performed safely without major morbidity. Moreover, the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

Zhang, Bin; Ding, Jian-Hua; Yin, Shu-Hui; Zhang, Meng; Zhao, Ke

2010-01-01

114

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

115

How to identify rectal sub-regions likely involved in rectal bleeding in prostate cancer radiotherapy  

NASA Astrophysics Data System (ADS)

Nowadays, the de nition of patient-speci c constraints in prostate cancer radiotherapy planning are solely based on dose-volume histogram (DVH) parameters. Nevertheless those DVH models lack of spatial accuracy since they do not use the complete 3D information of the dose distribution. The goal of the study was to propose an automatic work ow to de ne patient-speci c rectal sub-regions (RSR) involved in rectal bleeding (RB) in case of prostate cancer radiotherapy. A multi-atlas database spanning the large rectal shape variability was built from a population of 116 individuals. Non-rigid registration followed by voxel-wise statistical analysis on those templates allowed nding RSR likely correlated with RB (from a learning cohort of 63 patients). To de ne patient-speci c RSR, weighted atlas-based segmentation with a vote was then applied to 30 test patients. Results show the potentiality of the method to be used for patient-speci c planning of intensity modulated radiotherapy (IMRT).

Dréan, G.; Acosta, O.; Ospina, J. D.; Voisin, C.; Rigaud, B.; Simon, A.; Haigron, P.; de Crevoisier, R.

2013-11-01

116

Local resection of early rectal cancer.  

PubMed

The introduction of the National Danish screening programme for colorectal cancer will result in the detection of more early rectal cancers (ERC), which may be considered for local excision. For the low risk ?T1 cancer, the oncological outcome at local excision in smaller patient series has shown similar results to conventional surgery, but with a significantly lower rate of serious complications, morbidity and mortality. The challenge is correct preoperative staging, and a meticulous systematic histopathological staging of the excised specimen to distinguish the low risk from high-risk cases, where rescue surgery may be considered. The establishment of a regional or national clinical database is necessary to improve the local treatment of ERC. PMID:25046201

Baatrup, Gunnar; Qvist, Niels

2014-08-01

117

[Local therapy principles in rectal carcinoma].  

PubMed

In the therapeutic algorithm for treatment of rectal cancer, primarily in the lower two-thirds of the rectum, local excision currently plays a limited role, but clearly adheres to diagnostic, oncologic, and technical principles. This should be considered particularly against the background that aspects of maintaining function and the associated positive effects on quality of life, based on expanding knowledge of the complications of radical interventions and their ramifications, have gained in importance. The following addresses the oncologic-histologic, clinical-diagnostic, and technical principles of local excision as well as the results for patients treated according to the devised diagnostic/therapeutic algorithm and included in the Erlanger Register of Colorectal Cancer (ERCRC). PMID:14605731

Matzel, K E; Merkel, S; Hohenberger, W

2003-10-01

118

Survival of rectal cancer in yazd, iran.  

PubMed

Background: Colorectal cancer is common in Iran. However our knowledge about survival of rectal cancer in our province is low. The aim of this study is to evaluate this question. Materials and Methods: Patients with documented pathology of adenocarcinoma of the rectum and rectosigmoid junction referred to our center from September 2004 to September 2012 were enrolled in this study. Metastatic and recurrent patients were excluded. A questionnaire including clinicopathologic parameters, quality and sequence of treatment modalities was filled in for each patient. Patients treated with a combination of surgery, chemotherapy and radiation therapy were divided into standard and non -standard treatment groups, according to the sequence of treatment. Results: One hundred and nineteen patients were evaluated. Mean age was 60.8 year. The median overall survival was 62 months and five year survival was 55%. TNM staging system was not possible due to (Nx) in 21 (17.6%) patients. The others were in stage I, 20 patients (16.8%), II, 35 (29%.5) and III, 43(36.1%). According to our definition only 25 patients (21%) had been treated with standard treatment and 79% had not received it. A five year survival in patients with standard treatment was 85% and in the non-standard group it was 52%.Age, sex, stage and grade of tumor did not show any significant relation to survival. Conclusions: Our study showed a five year survival of rectal cancer in our patients was about 10% lower than the rate which is reported for developed countries. Preoperative concurrent chemoradiation significantly improved local control and even overall survival. PMID:24998553

Akhavan, Ali; Binesh, Fariba; Soltani, Amin

2014-01-01

119

USC researchers link genetic marker to rectal cancer treatment:  

Cancer.gov

A team of University of Southern California researchers has identified a genetic marker that may predict which patients with rectal cancer can be cured by certain chemotherapies when combined with surgery.

120

[Skeletal muscle metastasis of rectal carcinoma--a case report].  

PubMed

Skeletal muscle metastasis of carcinoma is comparatively rare. We report a case of metastasis to the quadriceps femoris muscle after the operation for rectal carcinoma. A 70-year-old man underwent rectal amputation in May 2007 due to rectal carcinoma. In May 2008, he noticed a painful tumor in the right femoral region. We obtained the diagnosis of recurrent rectal carcinoma by open biopsy. Simultaneously, lung metastasis was revealed by a close examination. Metastatic tumor resection was performed before chemotherapy, because it was important to preserve his performance status. From June 2008, chemotherapy was started. A year after the second operation, lung metastatic lesions were gradually progressed. At present, new skeletal muscle metastasis is not found. He is receiving chemotherapy in outpatient care. The resection of skeletal muscle metastasis made a contribution to his quality of life. PMID:20037385

Okada, Toshimasa; Nishimura, Taku; Nakamura, Mitsuo; Sakata, Koichiro; Setoguchi, Mihoko; Ihara, Kouichiro

2009-11-01

121

Role of laparoscopy in rectal cancer: A review  

PubMed Central

Despite established evidence on the advantages of laparoscopy in colon cancer resection, the use of laparoscopy for rectal cancer resection is still controversial. The initial concern was mainly regarding the feasibility of laparoscopy to achieve an adequate total mesorectal excision specimen. These concerns have been raised following early studies demonstrating higher rates of circumferential margins positivity following laparoscopic resection, as compared to open surgery. Similar to colon resection, patients undergoing laparoscopic rectal cancer resection are expected to benefit from a shorter length of hospital stay, less analgesic requirements, and a faster recovery of bowel function. In the past decade there have been an increasing number of large scale clinical trials investigating the oncological and perioperative outcomes of laparoscopic rectal cancer resection. In this review we summarize the current literature available on laparoscopic rectal cancer surgery.

Mizrahi, Ido; Mazeh, Haggi

2014-01-01

122

Simultaneous Laparoscopy-Assisted Resection for Rectal and Gastric Cancer  

PubMed Central

Laparoscopy-assisted surgery for either rectal or gastric cancer has been increasingly performed. However, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is rarely reported in the literature. In our study, 3 cases of patients who received simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer were recorded. The results showed that all 3 patients recovered well, with only 253 minutes of mean operation time, 57 mL of intraoperative blood loss, 5 cm of assisted operation incision, 4 days to resume oral intake, 12 days' postoperative hospital stay, and no complication or mortality. No recurrence or metastasis was found within the follow-up period of 22 months. When performed by surgeons with plentiful experience in laparoscopic technology, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is safe and feasible, with the benefits of minimal trauma, fast recovery, and better cosmetic results, compared with open surgery.

Fang, Jiafeng; Chen, Tufeng; Zheng, Zongheng; Wei, Bo; Huang, Yong; Huang, Jianglong; Xu, Haozhong

2014-01-01

123

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

124

Continued progress of preoperative therapy for rectal cancer  

Microsoft Academic Search

The indications for adjuvant therapy for rectal cancer are based on the patterns of failure after surgery. Despite radical surgery, local-regional failure occurs frequently in patients with transmural or node-positive rectal cancers. The incidence of local failure in the pelvis increases from less than 10% in stages T1-2N0M0 to 15% to 30% in stages T3N0M0 and T1-2N1M0, and is as

Laura Cerezo Padellano

2001-01-01

125

Local staging of rectal cancer: the current role of MRI  

Microsoft Academic Search

With the advent of powerful gradient coil systems and high-resolution surface coils, magnetic resonance imaging (MRI) has\\u000a recently extended its role in the staging of rectal cancer. MRI is superior to endorectal ultrasound, the most widely used\\u000a staging modality in patients with rectal tumors, in that it visualizes not only the intestinal wall but also the surrounding\\u000a pelvic anatomy. The

Christian Klessen; Patrik Rogalla; Matthias Taupitz

2007-01-01

126

Complete rectal prolapse in adults: a Tanzanian experience.  

PubMed

This is a retrospective report of nine patients with complete rectal prolapse managed by the authors at the Muhimbili Medical Centre, Dar es Salaam between 1990 and 1993. The average age of patients was 36 years and eight of the patients were males. Six of the patients presented as emergency admissions of whom three had irreducibility and required perineal proctosigmoidectomy. This was the procedure of choice for irreducible complete rectal prolapse. PMID:7882416

Aziz, M R; Mbembati, N A

1994-12-01

127

Bioavailabilities of rectal and oral methadone in healthy subjects  

PubMed Central

Aims Rectal administration of methadone may be an alternative to intravenous and oral dosing in cancer pain, but the bioavailability of the rectal route is not known. The aim of this study was to compare the absolute rectal bioavailability of methadone with its oral bioavailability in healthy humans. Methods Seven healthy subjects (six males, one female, aged 20–39 years) received 10 mg d5-methadone-HCl rectally (5 ml in 20% glycofurol) together with either d0-methadone intravenously (5 mg) or orally (10 mg) on two separate occasions. Blood samples for the LC-MS analyses of methadone and it's metabolite EDDP were drawn for up to 96 h. Noninvasive infrared pupillometry was peformed at the same time as blood sampling. Results The mean absolute rectal bioavalability of methadone was 0.76 (0.7, 0.81), compared to 0.86 (0.75, 0.97) for oral administration (mean (95% CI)). Rectal absorption of methadone was more rapid than after oral dosing with Tmax values of 1.4 (0.9, 1.8) vs. 2.8 (1.6, 4.0) h. The extent of formation of the metabolite EDDP did not differ between routes of administration. Single doses of methadone had a duration of action of at least 10 h and were well tolerated. Conclusions Rectal administration of methadone results in rapid absorption, a high bioavailability and long duration of action. No evidence of presystemic elimination was seen. Rectal methadone has characteristics that make it a potential alternative to intravenous and oral administration, particularly in cancer pain and palliative care.

Dale, Ola; Sheffels, Pamela; Kharasch, Evan D

2004-01-01

128

Laparoscopic rectal cancer surgery: Where do we stand?  

PubMed Central

Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach, whether the same oncologic clearance, specifically an adequate TME can be obtained is of concern. The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes. The data from 8 RCTs, 3 meta-analyses, and 2 Cochrane Database of Systematic Reviews was reviewed. Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss, earlier return of bowel function, and shorter hospital length of stay. Concerns that laparoscopic rectal cancer surgery compromises short-term oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature. Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.

Krane, Mukta K; Fichera, Alessandro

2012-01-01

129

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

130

Rectal suppository: commonsense and mode of insertion.  

PubMed

Rectal suppository is a well-known form of medication and its use is increasing. The commonest shape is one with an apex (pointed end) tapering to a base (blunt end). Because of a general lack of information about mode of insertion, we asked 360 lay subjects (Egyptians and non-Egyptians) and 260 medical personnel (physicians, pharmacists, and nurses) by questionnaire which end they inserted foremost. Apart from 2 individuals, all subjects suggested insertion with the apex foremost. Commonsense was the most frequent basis for this practice (86.9% of lay subjects and 84.6% of medical personnel) followed by information from a relative, a friend, or medical personnel, or from study at medical school. Suppository insertion with the base or apex foremost was compared in 100 subjects (60 adults, 40 infants and children). Retention with the former method was more easily achieved in 98% of the cases, with no need to introduce a finger in the anal canal (1% vs 83%), and lower expulsion rate (0% vs 3%). The designer of the "torpedo-shaped" suppository suggested its insertion with apex foremost. Our data suggest that a suppository is better inserted with the base foremost. Reversed vermicular contractions or pressure gradient of the anal canal might press it inwards. PMID:1681170

Abd-el-Maeboud, K H; el-Naggar, T; el-Hawi, E M; Mahmoud, S A; Abd-el-Hay, S

1991-09-28

131

Chemoembolization Using Irinotecan in Treating Patients With Liver Metastases From Metastatic Colon or Rectal Cancer  

ClinicalTrials.gov

Liver Metastases; 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 IV Colon Cancer; Stage IV Rectal Cancer

2014-05-13

132

Dose–volume response analyses of late rectal bleeding after radiotherapy for prostate cancer  

Microsoft Academic Search

PurposeTo compare the fits of various normal tissue complication probability (NTCP) models to a common set of late rectal toxicity data, with the aim of identifying the best model for predicting late rectal injury after irradiation.

Susan L. Tucker; Rex Cheung; Lei Dong; H. Helen Liu; Howard D. Thames; Eugene H. Huang; Deborah Kuban; Radhe Mohan

2004-01-01

133

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

134

Quantification of Organ Motion During Chemoradiotherapy of Rectal Cancer Using Cone-Beam Computed Tomography  

SciTech Connect

Purpose: There has been no previously published data related to the quantification of rectal motion using cone-beam computed tomography (CBCT) during standard conformal long-course chemoradiotherapy. The purpose of the present study was to quantify the interfractional changes in rectal movement and dimensions and rectal and bladder volume using CBCT and to quantify the bony anatomy displacements to calculate the margins required to account for systematic ({Sigma}) and random ({sigma}) setup errors. Methods and Materials: CBCT images were acquired from 16 patients on the first 3 days of treatment and weekly thereafter. The rectum and bladder were outlined on all CBCT images. The interfraction movement was measured using fixed bony landmarks as references to define the rectal location (upper, mid, and low), The maximal rectal diameter at the three rectal locations was also measured. The bony anatomy displacements were quantified, allowing the calculation of systematic ({Sigma}) and random ({sigma}) setup errors. Results: A total of 123 CBCT data sets were analyzed. Analysis of variance for standard deviation from planning scans showed that rectal anterior and lateral wall movement differed significantly by rectal location. Anterior and lateral rectal wall movements were larger in the mid and upper rectum compared with the low rectum. The posterior rectal wall movement did not change significantly with the rectal location. The rectal diameter changed more in the mid and upper than in the low rectum. No consistent relationship was found between the rectal and bladder volume and time, nor was a significant relationship found between the rectal volume and bladder volume. Conclusions: In the present study, the anterior and lateral rectal movement and rectal diameter were found to change most in the upper rectum, followed by the mid rectum, with the smallest changes seen in the low rectum. Asymmetric margins are warranted to ensure phase 2 coverage.

Chong, Irene; Hawkins, Maria; Hansen, Vibeke; Thomas, Karen; McNair, Helen; O'Neill, Brian; Aitken, Alexandra [Royal Marsden National Health Service Foundation Trust, Sutton, Surrey (United Kingdom); Tait, Diana, E-mail: Diana.Tait@rmh.nhs.uk [Royal Marsden National Health Service Foundation Trust, Sutton, Surrey (United Kingdom)

2011-11-15

135

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

136

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

137

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

138

Pudendal nerve terminal motor latency influences surgical outcome in treatment of rectal prolapse  

Microsoft Academic Search

Purpose: This study was undertaken to document the effect of pudendal nerve function on anal incontinence after repair of rectal prolapse. METHODS: Patients with full rectal prolapse (n=24) were prospectively evaluated by anal manometry and pudendal nerve terminal motor latency (PNTML) before and after surgical correction of rectal prolapse (low anterior resection (LAR; n=13) and retrorectal sacral fixation (RSF; n=11)).

Elisa H. Birnbaum; Linda Stamm; Janice F. Rafferty; Robert D. Fry; Ira J. Kodner; James W. Fleshman

1996-01-01

139

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

140

The effect of rectal examination on serum acid phosphatase levels in benign and malignant prostatic disese  

Microsoft Academic Search

Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who had become refractory

D. N. Osegbe; G. Magoha

1982-01-01

141

[Evaluation of preoperative effect for rectal cancer by transrectal ultrasonography].  

PubMed

The ultrasonographic examination was applied for the purpose of volume estimation of rectal cancer. We have performed 15 cases of echographic volume estimation compared with that of resected specimen (control group) and mean volume estimation error rate was 14.6% between two methods. And we also performed 17 preoperative irradiation cases of rectal cancer. Each tumor volume of pre- and post-irradiation was estimated echogenically and was compared with that of resected specimen. In the case when irradiation effect was remarkable, estimated volume by ultrasonography was much smaller in post-irradiation compared with that of pre-irradiation. Same tendency was also recognized in the study of resected specimen. Histopathological irradiation effect was also highly recognized in the case when echographic diminished rate was prominent. This method will useful for the judgement of preoperative irradiation effect in rectal cancer. PMID:2038288

Taniyama, S

1991-02-01

142

Rectal Chlamydia trachomatis infection in women. Is it overlooked?  

PubMed

Screening for rectal chlamydia was not routinely offered in our department until we had a local outbreak of lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in 2004/2005. We later decided to extend the screening to high-risk women (women who had receptive anal sex, contacts of gonorrhoea, women, with anorectal symptoms, women who had been sexually assaulted). A retrospective study of 152 women from whom 160 rectal chlamydia swabs were taken was carried out. Twenty (12.5%) swabs were positive, 19 of which were also positive at the cervix. All were non-LGV serovars. The groups at greatest risk were high-risk women aged less than 20 years and women with proven gonococcal infection where the prevalence was 22.6% and 30%, respectively. We conclude that rectal chlamydial infection in women may be common and further studies are needed to elucidate its importance. PMID:19917639

Sethupathi, M; Blackwell, A; Davies, H

2010-02-01

143

Local surgical treatment with curative intent in rectal cancer.  

PubMed

The surgical treatment of rectal cancer includes radical resection techniques and local excision procedures. Radical resection techniques are still the golden standard in the management of rectal cancer, but the increased postoperative morbidity and mortality led to the idea that less traumatizing procedures of local excision may have the same oncologic results, in selected cases. Yet, the significantly higher local recurrence rate after local excision in comparison to radical resection has been certified by most studies; that points out the need of clearly defined guidelines for local excision. In the present review the following aspects were taken into consideration, when considering local surgical excision as a radical procedure for rectal cancer: the clinico-pathological features of the tumours, the various types of surgical techniques used in local excision, the need for an adjuvant or neoadjuvant oncological treatment, the variety of results obtained in a large number of studies, making this particular issue a topic that is currently subject to debate. PMID:23464763

Mirea, C S; Vilcea, I D; Vasile, I; Mita, A

2013-01-01

144

Metachronous penile metastasis from rectal cancer after total pelvic exenteration.  

PubMed

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. PMID:23082066

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

2012-10-14

145

Urinary Function following Laparoscopic Lymphadenectomy for Male Rectal Cancer  

PubMed Central

Objectives Urinary function can be protected following open lateral node dissection (LND) with pelvic autonomic nerve preservation (PANP) for advanced rectal cancer. However data regarding urinary function after laparoscopic LND with PANP have not been reported. The goal of this study was to determine the effects of laparoscopic LND with PANP on urinary function in male patients with rectal cancer. Methods Urine flowmetry was performed using an Urodyn flowmeter. Patients were also asked to complete the standardized International Prostate Symptom Score (IPSS) questionnaire before surgery and 6 months after. In total, this study consisted of 60 males with advanced rectal cancer. Results No significant differences were seen in maximal urinary flow rate, voided volume or residual volume before and after surgery. The total IPSS score increased significantly after surgery and at least 41 patients (68.3%) reported there was no change in one of the seven IPSS questions. Conclusions Laparoscopic LND with PANP was relatively safe in preserving urinary function.

Cao, Yong-kuan; Zhang, Lin; Wang, Pei-hong; Tang, Li-jun

2013-01-01

146

Surgery for rectal cancer-what is on the horizon?  

PubMed

The management of rectal cancer has improved considerably in recent decades. Surgery remains the cornerstone of the treatment. However, the role of preoperative imaging has made it possible to optimize the treatment plan in rectal patients. Neoadjuvant treatment may be indicated in efforts to sterilize possible tumor deposits outside the surgical field, or may be used to downsize and downstage the tumor itself. The optimal sequence of treatment modalities can be determined by a multidisciplinary team, who not only use pretreatment imaging, but also review pathologic results after surgery. The pathologist plays a pivotal role in providing feedback about the success of surgery, i.e., the distance between the tumor and the circumferential resection margin, the quality of surgery, and the effect of neoadjuvant treatment. Registry and auditing of all treatment variables can further improve outcomes. In this century, rectal cancer treatment has become a team effort. PMID:24488545

Vermeer, Thomas A; Orsini, Ricardo G; Rutten, Harm J T

2014-03-01

147

Role of MRI for staging of rectal cancer.  

PubMed

Total mesorectal excision has been established as a standard surgical procedure for rectal cancer. MRI is now routinely used for preoperative staging of rectal cancer and provides accurate assessment of the tumor relative to the circumferential margin, that is, the mesorectal fascia. This identifies patients at risk of local recurrence and those likely to benefit from neoadjuvant therapy. Compared with CT and ultrasound, MRI is more reliable for the evaluation of the extent of locoregional disease, planning radiation therapy, assessing postoperative changes and pelvic recurrence. The evaluation of nodal metastases remains a challenge with routine MRI. In this review, we describe the role of MRI in staging rectal cancer as well as highlight some limitations and recent advances to overcome these. PMID:19374600

Jhaveri, Kartik S; Sadaf, Arifa

2009-04-01

148

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

149

Minimally invasive surgery for rectal cancer: Are we there yet?  

PubMed Central

Laparoscopic colon surgery for select cancers is slowly evolving as the standard of care but minimally invasive approaches for rectal cancer have been viewed with significant skepticism. This procedure has been performed by select surgeons at specialized centers and concerns over local recurrence, sexual dysfunction and appropriate training measures have further hindered widespread acceptance. Data for laparoscopic rectal resection now supports its continued implementation and widespread usage by expeienced surgeons for select patients. The current controversies regarding technical approaches have created ambiguity amongst opinion leaders and are also addressed in this review.

Champagne, Bradley J; Makhija, Rohit

2011-01-01

150

Lingual tonsillar metastasis from rectal carcinoma: a rare occurrence.  

PubMed

A 66-year-old man presenting with sacral pain 18 months after radical transabdominal resection of rectal mucinous adenocarcinoma underwent F-FDG PET/CT cancer surveillance. Detection of multiple nodules in lingual tonsil and left neck by imaging initially suggested tonsillar squamous carcinoma (as a second primary) with spread to cervical nodes, given the rarity with which rectal carcinoma metastasizes to the head and neck. Ultimately, the tonsillar neoplasm proved to be adenocarcinoma of colorectal origin based on its shared histologic features and compatible immunostaining profile. PMID:24686212

Su, Minggang; Jiang, Chong; Li, Lin; Li, Fanglan; Tian, Rong

2014-06-01

151

Synchronous rectal adenocarcinoma and bilateral clear cell renal carcinoma.  

PubMed

A 69-year-old man was admitted for resection of rectal adenocarcinoma diagnosed by colonoscopy. Preoperative computed tomography scan and abdominal ultrasonography revealed bilateral renal tumors measuring up to 2 and 2.8 cm in largest diameter, respectively. The patient underwent partial colectomy and bilateral partial nephrectomy. Microscopically, rectal adenocarcinoma penetrated the submucosa, without invasion of the muscularis propria. Both renal tumors were clear cell renal carcinomas of Fuhrmann nuclear grade 2. To our knowledge, this is the first case of synchronous adenocarcinoma of the rectum and bilateral clear cell renal cell carcinoma described in the literature to date. PMID:21086735

Spaji?, Borislav; Grubisi?, Igor; Spaji?, Marija; Marusi?, Zlatko; Demirovi?, Alma; Miji?, August; Kruslin, Bozo; Tomas, Davor

2010-06-01

152

Symposium on rectal cancer: 2. Local recurrence after surgery for rectal cancer  

PubMed Central

Local recurrence is a serious complication in patients with rectal cancer because of the frequency with which it occurs, its impact on quality of life and the fact that treatment is rarely successful. Although local recurrence rates varying from 4% to 51% have been reported, recent series have reported rates of less than 10%. Various factors may affect the rate of local recurrence, including the stage and location of the tumour. Other prognostic factors may be of importance, but it is controversial whether they are independent risk factors. Finally, there is mounting evidence that the local recurrence rate varies with the surgeon. Whether this is due to the surgical technique or surgical expertise is not clear, but randomized controlled trials addressing the issue of extent of resection are indicated in order to optimize surgical results.

McLeod, Robin S.

1997-01-01

153

The Impact of Maximum Rectal Distention and Tandem Angle on Rectal Dose in 3D Planned Gynecologic High-Dose-Rate Brachytherapy for Locally Advanced Cervical Cancer  

PubMed Central

Objective Computed tomography (CT)-based treatment planning for cervical cancer has allowed investigation into the volumetric radiation dose delivered to the rectum. The goal of intracavitary brachytherapy is to maximize the tumor dose while decreasing the dose to normal tissue like the rectum. We investigated the effects of tandem angle and maximum rectal distention on rectal dose delivered in HDR brachytherapy for locally advanced cervical cancer. Methods and Materials Between July 2007 and January 2010, 97 brachytherapy treatment planning CT scans from the first and last implant of 51 patients with locally advanced cervical cancer were reviewed. The rectum was manually contoured from the ischial tuberosity to the bottom of the sacroiliac joint. The maximum rectal distention was determined by measuring the largest anterior-posterior diameter of the rectum superior to the tandem ring and inferior to the end of the applicator. A volumetric measurement of the maximum and mean rectal dose, dose to 2cc (D2cc), dose to 1cc (D1cc) of the rectum was calculated. The tandem angle and the ICRU rectal point were recorded, and a dose volume histogram was referenced. Results The mean maximum rectal distention was 3.01cm. The mean D1cc, D2cc, mean rectal dose, maximum rectal dose, and ICRU rectal dose were 3.03 Gy, 2.78 Gy, 4.19 cGy, 1.40 cGy, and 2.99 Gy per treatment, respectively. In a multivariate analysis controlling for surface area, tandem angle, and body mass index (BMI), there was a significant increase in D2cc with increasing rectal distention (P=.016). There were no significant findings when observing the effects of tandem angle on D2cc. Conclusion Rectal distention significantly impacts D2cc delivered in HDR brachytherapy. In contrast, tandem angle does not. Concerted efforts to decrease rectal distention should be considered during treatment planning and delivery.

Lim, Jihoon; Durbin-Johnson, Blythe; Valicenti, Richard; Mathai, Matthew; Stern, Robin; Mayadev, Jyoti

2013-01-01

154

Rectal Foreign Bodies: What Is the Current Standard?  

PubMed Central

Rectal foreign bodies represent a challenging and unique field of colorectal trauma. The approach includes a careful history and physical examination, a high index of suspicion for any evidence of perforation, a creative approach to nonoperative removal, and appropriate short-term follow-up to detect any delayed perforation.

Cologne, Kyle G.; Ault, Glenn T.

2012-01-01

155

Multiple myeloma presenting as CEA-producing rectal cancer  

PubMed Central

We report the case of a 57-year-old patient with multiple myeloma, characterized by extramedullary involvement of the rectum at presentation. Malignant plasma cells were found to produce carcinoembryonic antigen (CEA), a tumor antigen more commonly associated with rectal adenocarcinomas.

Talamo, Giampaolo; Barochia, Amitkumar; Zangari, Maurizio; Loughran, Thomas P

2010-01-01

156

Studies of lactic dehydrogenase content in rectal mucosal biopsies  

Microsoft Academic Search

The total lactic dehydrogenase (LD) content and LD isoenzyme ratios were studied in homogenized rectal mucosa from 31 patients with established non-specific mucosal ulcerative colitis and from 16 normal subjects. The total LD content was found to be significantly increased in patients with active ulcerative colitis when compared with patients with inactive colitis or with normal subjects. There was a

P. S. Hunt; P. M. Dennis; P. Jablonski; S. K. Khoo; L. McLeod; H. D. P. Thomson; J. Mc K. Watts

1974-01-01

157

Rectal Bleeding in Infancy: Clinical, Allergological, and Microbiological Examination  

Microsoft Academic Search

OBJECTIVE.Rectal bleeding is an alarming symptom and requires additional investi- gation. In infants it has been explained mainly by hypersensitivity. In addition to dietary antigens, intraluminal microbial agents challenge the immature gut mu- cosa. Although controlled in the mature gut, these antigens may induce inflam- mation in the developing gastrointestinal tract. The objectives of this study were to evaluate prospectively

Taina Arvola; Tarja Ruuska; Jaakko Keranen; Heikki Hyoty; Seppo Salminen; Erika Isolauri

158

Solitary rectal ulcer syndrome in children: a literature review.  

PubMed

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. PMID:23236227

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

2012-12-01

159

Treatment of detrusor instability with oxybutynin rectal suppositories  

Microsoft Academic Search

Our aim was to determine whether oxybutynin hydrochloride suppositories can be used as a treatment for detrusor instability in patients who have not been able to tolerate oral pharmacological agents. A retrospective chart review of 25 women diagnosed with detrusor instability and treated with oxybutynin rectal suppositories was conducted. Each suppository contained 5 mg oxybutynin, 15 mg micronized Sila gel,

H. A. Winkler; P. K. Sand

1998-01-01

160

Refining Preoperative Therapy for Locally Advanced Rectal Cancer  

Cancer.gov

In the current clinical trial, dubbed PROSPECT, patients with locally advanced, resectable rectal cancer will be randomly assigned to receive either standard neoadjuvant chemoradiation therapy or neoadjuvant FOLFOX chemotherapy, with chemoradiation reserved for those patients who cannot tolerate or do not respond to FOLFOX chemotherapy.

161

Recurrent acute renal failure due to a rectal villous adenoma  

Microsoft Academic Search

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.

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

1988-01-01

162

Thermally reversible xyloglucan gels as vehicles for rectal drug delivery  

Microsoft Academic Search

The aim of this study was to investigate the potential application of thermoreversible gels formed by a xyloglucan polysaccharide derived from tamarind seed for rectal drug delivery. Xyloglucan that had been partially degraded by ?-galactosidase to eliminate 44% of galactose residues formed gels at concentrations of between 1 to 2% w\\/w at gelation temperatures decreasing over the range 27 to

Shozo Miyazaki; Fumie Suisha; Naoko Kawasaki; Mayumi Shirakawa; Kazuhiko Yamatoya; David Attwood

1998-01-01

163

Rectal angiolipoma: A case report and review of literature  

Microsoft Academic Search

Angiolipoma is a rare vascular variant of the benign lipomatous tumors and is generally seen in subcutaneous tissues. We report a 70-year-old female with abdominal distension not related to rectal small polypoid mass with peduncule described as angiolipoma by histologically, and review the literature.

Sabite Kacar; Sedef Kuran; Tulay Temucin; Bulent Odemis; Nilufer Karadeniz; Nurgul Sasmaz

164

Retrospective review of rectal cancer surgery in northern Alberta  

PubMed Central

Introduction Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same region to determine whether practice patterns have changed and whether outcomes have improved. Methods We reviewed the charts of all patients with rectal adenocarcinoma diagnosed between 1998 and 2003 who had a potentially curative resection. The main outcomes examined were 5-year local recurrence (LR) and disease-specific survival (DSS). Surgeons were classified into 3 groups according to training and volume, and we compared outcome measures among them. We also compared our results to those of the previous study from our region. Results We included 433 cases in the study. Subspecialty-trained colorectal surgeons performed 35% of all surgeries in our study compared to 16% in the previous study. The overall 5-year LR rate and DSS in our study were improved compared to the previous study. On multivariate analysis, the only factor associated with increased 5-year LR was presence of obstruction, and the factors associated with decreased 5-year DSS were high-volume noncolorectal surgeons, presence of obstruction and increased stage. Conclusion Over the past 10 years, the long-term outcomes of treatment for rectal cancer have improved. We found that surgical subspecialization was associated with improved DSS but not LR. Increased surgical volume was not associated with LR or DSS.

Pelletier, Jean-Sebastien; DeGara, Christopher; Porter, Geoff; Ghosh, Sunita; Schiller, Dan

2013-01-01

165

Morbidity and mortality of wide pelvic lymphadenectomy for rectal adenocarcinoma  

Microsoft Academic Search

This retrospective study was aimed at defining the morbidity and mortality of a radical resection for adenocarcinoma of the rectum complemented by a wide pelvic lymphadenectomy. Twenty-seven consecutive patients with rectal carcinoma who underwent a surgical resection with conventional (Group I) or wide (Group II) pelvic lymphadenectomy were analyzed. Group I consisted of 10 patients (three women and seven men;

Fabrizio Michelassi; George E. Block

1992-01-01

166

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

167

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors  

PubMed Central

Background To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors. Methods We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period. Results We included 28 patients in our study. After a median follow-up of 35 months, 53.6% of patients were alive with no evidence of disease. The 3-year actuarial disease-free and overall survival rates were 52.2% and 75.1%, respectively. On univariate analysis, recurrent disease, preoperative body mass index greater than 30 and lymphatic invasion were poor prognostic factors for disease-free survival, and only lymphatic invasion predicted overall survival. Additionally, multivariate analysis identified lymphatic invasion as an independent poor prognostic factor for disease-free survival in this patient population with locally advanced and recurrent rectal carcinoma. Conclusion Despite the significant morbidity, TPE can provide long-term survival in patients with rectal carcinoma. Additionally, lymphatic invasion on final pathology was an independent prognostic factor for disease-free survival.

Domes, Trustin S.; Colquhoun, Patrick H.D.; Taylor, Brian; Izawa, Jonathan I.; House, Andrew A.; Luke, Patrick P.W.

2011-01-01

168

Management of complete response after chemoradiation in rectal cancer.  

PubMed

There are an increasing number of reports on nonoperative management of rectal cancer patients who achieve a dramatic response to neoadjuvant therapy. This review discusses the current literature, and describes treatment strategies for patients who have a complete clinical response on follow-up endoscopy after chemoradiotherapy. PMID:24267169

Weiser, Martin R; Beets-Tan, Regina; Beets, Gerard

2014-01-01

169

Treatment of locally advanced rectal cancer: Controversies and questions  

PubMed Central

Rectal cancers extending through the rectal wall, or involving locoregional lymph nodes (T3/4 or N1/2), have been more difficult to cure. The confines of the bony pelvis and the necessity of preserving the autonomic nerves makes surgical extirpation challenging, which accounts for the high rates of local and distant relapse in this setting. Combined multimodality treatment for rectal cancer stage II and III was recommended from National Institute of Health consensus. Neoadjuvant chemoradiation using fluoropyrimidine-based regimen prior to surgical resection has emerged as the standard of care in the United States. Optimal time of surgery after neoadjuvant treatment remained unclear and prospective randomized controlled trial is ongoing. Traditionally, 6-8 wk waiting period was commonly used. The accuracy of studies attempting to determine tumor complete response remains problematic. Currently, surgery remains the standard of care for rectal cancer patients following neoadjuvant chemoradiation, whereas observational management is still investigational. In this article, we outline trends and controversies associated with optimal pre-treatment staging, neoadjuvant therapies, surgery, and adjuvant therapy.

Trakarnsanga, Atthaphorn; Ithimakin, Suthinee; Weiser, Martin R

2012-01-01

170

Optimal surgical treatment of locally advanced low rectal cancer.  

PubMed

Colorectal adenocarcinoma is the second leading cause of cancer deaths in Western countries. Rectal cancer comprises approximately 25% of the malignancies arising in the large bowel. However, the past two decades have seen many major advances in the diagnosis and treatment of this disease. While surgery is still the cornerstone of curative therapy, a multidisciplinary approach including neoadjuvant chemoradiotherapy has resulted in significantly improved outcomes. Information concerning the T, N, M stage and the exact location of tumor in relation to the anal verge are of crucial importance when planning a curative rectal cancer resection. Preoperative staging, utilizing a combination of diagnostic modalities, must be undertaken to determine whether or not neoadjuvant therapy is indicated. In radical resection of locally advanced low rectal cancer, several unique surgical management issues should be considered: 1) total mesorectal excision (TME); 2) longitudinal and circumferential resection margins; 3) autonomic nerve preservation (ANP); 4) sphincter preservation versus abdominoperineal resection (APR); 5) restoration of bowel continuity; and 6) laparoscopic versus open resection. The surgeon must first strive to achieve an oncologic cure, but whenever possible this should be undertaken with the goal of maintaining the patient's quality of life. The purpose of this review is to outline the critical surgical issues involved in management of locally advanced low rectal cancer. PMID:20548274

Liska, D; Weiser, M R

2010-04-01

171

[Radiotherapy for elderly patient with rectal cancer: which benefit?].  

PubMed

Age acts as a major risk factor of cancer. In the near future, with the aging of the population, we will treat more and more elderly patients with oncologic disease. Unfortunately, these patients are often excluded from randomized trials. How can we, therefore, define guidelines for this particular population of patients? Moreover, older patients often present multiple morbidities synchronously with the oncologic disease. This constellation of diseases makes the therapeutic strategy even more difficult. The highest incidence of rectal cancer is observed at 80 years old or above. This is significantly older than the mean age of the population included in clinical trials. Although, the prognosis of young patients with rectal cancer has improved over the past few decades, this is not the case for patients over 75 years old. A geriatric evaluation, as a part of a multidisciplinary approach, may allow to better select patient able to benefit from a combined treatment. Radiotherapy plays a crucial role in the treatment of rectal cancer. There are no solid data currently available on the real impact of radiotherapy on survival in an elderly population with rectal cancer. Do these patients really benefit from this treatment and what is the impact of radiotherapy on their quality of life? This review will try to give some answers to these important questions. PMID:24822305

Martinive, P; Allepaert, S; Vandaele, D; Polus, M; Coimbra, C; Kohnen, L; Collignon, J; Lennerts, E; Vanderick, J; Coucke, P

2014-01-01

172

Single-access laparoscopic rectal surgery is technically feasible.  

PubMed

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. PMID:23577248

Sirikurnpiboon, Siripong; Jivapaisarnpong, Paiboon

2013-01-01

173

Palliative Resection in the Presence of Advanced Rectal Cancer  

Microsoft Academic Search

Introduction: At some time, every general surgeon will be faced with the task of trying to decide what to do with a patient who presents with rectal cancer and unresectable distant metastases. What advice should be given? Should the primary tumor be resected despite the incurability of the disease? Should only a defunctioning stoma be raised or should the patient

Nasser Al-Sanea; William H. Isbister

2003-01-01

174

Anal versus Rectal Melanoma: Does Site of Origin Predict Outcome?  

PubMed Central

Background Anatomic site is a predictive factor in subtypes of cutaneous and mucosal melanoma. Objective The aim of this study was to examine the clinical relevance of location of origin of anorectal melanoma as a prognostic factor. Design Using a prospectively maintained database, clinical characteristics, management, and outcomes were compared according to site of origin. Settings, Patients, Interventions A retrospective review was conducted of patients diagnosed with anorectal melanoma from 1994–2010. Tumors were defined as anal, anorectal or rectal melanoma according to their anatomic relationship to the dentate line. Main Outcome Measures Clinicopathologic factors were compared by Chi-square test. Time-to-event analysis was performed by Kaplan Meier analysis. Results Of the 96 patients included (41 anal, 32 anorectal, 23 rectal), patients with rectal and anorectal mucosal melanoma had advanced primary tumors (median Breslow thickness 12mm and 8mm respectively, p =0.002), while anal lesions could be found at earlier depths (median thickness 6.5mm). Patients with anal tumors more commonly underwent transanal excision (p <0.02) and sentinel lymph node biopsy (p=0.004) versus anorectal and rectal tumors. Patterns of recurrence were also distinct; nearly two-thirds of anorectal and rectal tumors recurred systemically, while anal melanoma more often recurred within the lymph nodes first (63%; p <0.02). Recurrence occurred in 24 (59%) patients with anal tumors, 23 (72%) anorectal tumors, and 16 (70%) rectal tumors. Median OS was 22 months for anal melanoma, 28 months for anorectal melanoma and 27 months for rectal melanoma. Recurrence and survival were not statistically different between the groups. Limitations This study is limited by small sample size and its retrospective nature. Conclusions This study represents the only series describing the outcomes of anorectal melanoma by anatomic location. Lesions at or proximal to the dentate line present with more advanced disease, possibly related to a delay in diagnosis. Lesions distal to the dentate line more commonly recur within lymph nodes, which may represent differences in nodal drainage. Irrespective of location, long-term prognosis remains poor for all cases of anorectal melanoma.

Bello, Danielle M.; Smyth, Elizabeth; Perez, Daniel; Khan, Shaheer; Temple, Larissa K.; Ariyan, Charlotte E.; Weiser, Martin R.; Carvajal, Richard D.

2012-01-01

175

Three-dimensional endosonography for staging of rectal cancer.  

PubMed Central

OBJECTIVE: This prospective study was conducted to investigate the value of three-dimensional (3D) endosonography for staging of rectal cancer. SUMMARY BACKGROUND DATA: Transrectal ultrasound is the most sensitive technique for peroperative staging and follow-up of rectal cancer. Major limitations of this technique include the complexity of image interpretation and the inability to examine stenotic tumors or to identify recurrent rectal cancer. METHODS: Three-dimensional endosonography was performed in 100 patients with rectal tumors. Transrectal volume scans were obtained using a 3D multiplane transducer (7.5/10.0 MHz). Stenotic tumors were examined with a 3D frontfire transducer (5.0/7.5 MHz). The volume scans were processed and analyzed on a Combison 530 workstation (Kretztechnik, Zipf, Austria). RESULTS: The 3D endosonography and conventional endosonography were performed in 49 patients with nonstenotic rectal cancer. Display of volume data in three perpendicular planes or as 3D view facilitated the interpretation of ultrasound images and enhanced the diagnostic information of the data. The accuracy of 3D endosonography in the assessment of infiltration depth was 88% compared to 82% with the conventional technique. In the determination of lymph node involvement, 3D and two-dimensional endosonography provided accuracy rates of 79% and 74%, respectively. The 3D scanning allowed the visualization of obstructing tumors using reconstructed planes in front of the transducer. Correct assessment of the infiltration depth was possible in 15 of 21 patients with obstructing tumors (accuracy, 76%). Three-dimensional endosonography displayed suspicious pararectal lesions in 30 patients. Transrectal ultrasound-guided biopsy was extremely precise (accuracy, 98%) and showed malignancy in 10 of 30 patients. Histologic analysis changed the endosonographic diagnosis in 8 (27%) of the patients. CONCLUSIONS: The 3D endosonography permits examination of rectal cancer using previously unattainable planes and 3D views. The 3D imaging and ultrasound-guided biopsy seem capable to improve staging of rectal cancer and should be evaluated in further studies. Images Figure 1. Figure 2. Figure 3. Figure 4.

Hunerbein, M; Schlag, P M

1997-01-01

176

Colostomy and drainage for civilian rectal injuries: is that all?  

PubMed Central

One hundred consecutive patients with injuries to the extraperitoneal rectum were treated over a ten-year period at an urban trauma center. The mechanisms of injury included firearms in 82 patients, stab wounds in 3 patients, a variety of other penetrating injuries in 10 patients, and in 5 patients the injuries resulted from blunt trauma. Treatment of the rectal injury was determined by the bias of the operating surgeon, the condition of the patient, and the magnitude of the rectal injury. Proximal loop colostomies were performed in 44 patients, diverting colostomies in 51 patients, Hartmann's procedure in 4 patients, and an abdominoperineal resection in 1 patient. Extraperitoneal rectal perforations were closed in 21 patients and the rectum was irrigated free of feces in 46 patients. Transperineal, presacral drainage was used in 93 patients. Infectious complications potentially related to the management of the rectal wound occurred in 11 patients (11%) and included abdominal or pelvic abscesses (4 patients), wound infections (6 patients), rectocutaneous fistulas (3 patients), and missile tract infections (2 patients). Four patients (4%) died as a result of their injuries. Of the therapeutic options available, statistical analysis revealed that only the failure to drain the presacral space increased the likelihood of infectious complications (p = 0.03); however, as it could not be determined with certainty that the use of, or failure to use, any particular therapeutic option had an effect on the risk of death. It is concluded that colostomy and drainage are the foundations of the successful treatment of civilian injuries to the extraperitoneal rectum. The use of adjuncts such as diverting colostomies, repair of the rectal wound, and irrigation of the rectum has little effect on mortality and morbidity.

Burch, J M; Feliciano, D V; Mattox, K L

1989-01-01

177

Multimodal imaging evaluation in staging of rectal cancer  

PubMed Central

Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to control rectal cancer. Endorectal ultrasonography (EUS) is suitable for assessing the extent of tumor invasion, particularly in early-stage or superficial rectal cancer cases. In advanced cases with distant metastases, computed tomography (CT) is the primary approach used to evaluate the disease. Magnetic resonance imaging (MRI) is often used to assess preoperative staging and the circumferential resection margin involvement, which assists in evaluating a patient’s risk of recurrence and their optimal therapeutic strategy. Positron emission tomography (PET)-CT may be useful in detecting occult synchronous tumors or metastases at the time of initial presentation. Restaging after neoadjuvant chemoradiotherapy (CRT) remains a challenge with all modalities because it is difficult to reliably differentiate between the tumor mass and other radiation-induced changes in the images. EUS does not appear to have a useful role in post-therapeutic response assessments. Although CT is most commonly used to evaluate treatment responses, its utility for identifying and following-up metastatic lesions is limited. Preoperative high-resolution MRI in combination with diffusion-weighted imaging, and/or PET-CT could provide valuable prognostic information for rectal cancer patients with locally advanced disease receiving preoperative CRT. Based on these results, we conclude that a combination of multimodal imaging methods should be used to precisely assess the restaging of rectal cancer following CRT.

Heo, Suk Hee; Kim, Jin Woong; Shin, Sang Soo; Jeong, Yong Yeon; Kang, Heoung-Keun

2014-01-01

178

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

Microsoft Academic Search

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 {+-}

Jinesh N. Shah; Ronald D.. Ennis

2006-01-01

179

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

180

Rectal cancer level significantly affects rates and patterns of distant metastases among rectal cancer patients post curative-intent surgery without neoadjuvant therapy  

PubMed Central

Background Rectal cancer patients have a higher incidence of pulmonary metastases than those with colon cancer. This study aimed to examine the effects of rectal cancer level on recurrence patterns in rectal cancer patients. Methods Patients with T3/T4 rectal cancers who underwent surgery between 2002 and 2006 were recruited in this study. All the patients were followed up on until death. Recurrence patterns and survival rates were calculated in relation to clinical variables. Results There were 884 patients were enrolled in this study. Patients with low-rectal cancer had significantly worse five-year overall survival (OS) and disease-free survival (DFS) rates (47.25% and 44.07%, respectively) than patients with mid-rectal (63.46% and 60.22%, respectively) and upper-rectal cancers (73.91% and 71.87%, respectively). The level of the tumor (P <0.001), nodal status (P <0.001), tumor invasion depth (P <0.001), and tumor differentiation (P?=?0.047, P?=?0.015) significantly affected the surgical outcomes related to OS and DFS in the univariate and multivariate analyses. Furthermore, the level of the rectal cancer was a significant risk factor (hazard ratio 1.114; 95% CI, 1.074 to 1.161; P <0.001) for local recurrence, lung metastases, bone metastases, and systemic lymph node metastases. Significantly higher incidence rates of bone (53.8%) and brain metastases (22.6%) after initial lung metastases rather than initial liver metastases (14.8% and 2.9%, respectively) were also observed. Conclusions For rectal cancer patients who underwent surgical resection, the rectal cancer level significantly affected surgical outcomes including rates and patterns of distant metastases.

2014-01-01

181

Revised Tumor and Node Categorization for Rectal Cancer Based on Surveillance, Epidemiology, and End Results and Rectal Pooled Analysis Outcomes  

PubMed Central

Purpose The sixth edition of the American Joint Committee on Cancer (AJCC) rectal cancer staging subdivided stage II into IIA (T3N0) and IIB (T4N0) and stage III into IIIA (T1-2N1M0), IIIB (T3-4N1M0), and IIIC (anyTN2M0). Subsequent analyses supported revised substaging of stage III as a result of improved survival with T1-2N2 versus T3-4N2 and survival of T4N1 more similar to T3-4N2 than T3N1. The AJCC Hindgut Taskforce sought population-based validation that depth of invasion interacts with nodal status to affect survival. Methods Surveillance, Epidemiology, and End Results (SEER) population-based data from January 1992 to December 2004 for 35,829 patients with rectal cancer were compared with rectal pooled analysis data (3,791 patients). T4N0 cancers were stratified by tumors that perforate visceral peritoneum (T4a) versus tumors that invade or are adherent to adjacent organs or structures (T4b). N1 and N2 were stratified by number of positive nodes as follows: N1a/N1b (one v two to three nodes) and N2a/N2b (four to six v ? seven nodes). Five-year observed and relative survival rates were obtained for each TN category. Results SEER rectal cancer analyses confirm that T1-2N2 cancers have better prognosis than T3-4N2, T4bN1 have similar prognosis to T4N2, T1-2N1 have similar prognosis to T2N0/T3N0, and T1-2N2a have similar prognosis to T2N0/T3N0 (T1N2a) or T4aN0 (T2N2a). Prognosis for T4a lesions is better than T4b by N category. The number of positive nodes affects prognosis. Conclusion This SEER population-based rectal cancer analysis validates the rectal pooled analyses and supports the shift of T1-2N2 lesions from IIIC to IIIA or IIIB and T4bN1 from IIIB to IIIC. SEER outcomes support subdividing T4, N1, and N2 and revised substaging of stages II and III. Survival by TN category suggests a complex biologic interaction between depth of invasion and nodal status.

Gunderson, Leonard L.; Jessup, John Milburn; Sargent, Daniel J.; Greene, Frederick L.; Stewart, Andrew

2010-01-01

182

Atypical Phimosis Secondary to a Preputial Metastasis from Rectal Carcinoma  

PubMed Central

Background Cutaneous metastases from colorectal cancer are uncommon, accounting for 6.5% of all secondary skin lesions. They occur in advanced disease. The most common site is the abdomen. The penis is a rare site. Case Report We report the case of a 79-year-old patient who presented, two years after rectocolectomy for a rectal adenocarcinoma, obstructive renal failure secondary to a presacral recurrence, as well as symptomatic phimosis associated with papulonodules invading the penis, scrotum and pubis. After hemodialysis, percutaneous pyelostomy, and double-J catheter placement, the patient underwent circumcision and a pubic skin biopsy. On histology and immunohistochemistry, a cutaneous metastasis originating from the rectal adenocarcinoma was diagnosed. Conclusions Penile invasion by colorectal cancer revealed by phimosis is a rare occurrence but needs to be recognized and promptly diagnosed by biopsy in order to propose appropriate adjuvant therapy. These rare lesions can occur without any liver or lung involvement.

Goris Gbenou, Maximilien C.; Wahidy, Tawfik; Llinares, Karine; Cracco, Dominique; Perrot, Alain; Riquet, Dominique

2011-01-01

183

Congenital cutis laxa with rectal and uterovaginal prolapse.  

PubMed

A two-month-old female infant born of a consanguineous marriage, presented with loose, wrinkled and inelastic skin over the neck, axillae, trunk, inguinal region and thighs with slow elastic recoil. Patient also had systemic manifestations in the form of bilateral apical lobe consolidation of lung, bilateral inguinal hernia, rectal and uterovaginal prolapse. Histopathological examination of skin biopsy with special stain for elastic tissue revealed absence of dermal elastic tissue. Genital abnormalities in patients with congenital cutis laxa have been reported rarely. But rectal and uterovaginal prolapse have not been reported at an early age of two months. In the absence of mutational screening, with history and clinical findings our case is likely to be Type I autosomal recessive form of congenital cutis laxa. PMID:21508572

Choudhary, Sanjiv V; Bisati, Shazia; Koley, Sankha

2011-01-01

184

Manometric evaluation of rectal prolapse and faecal incontinence.  

PubMed Central

Sixty-three patients with complete rectal prolapse and/or faecal incontinence have undergone anal manometry and the results have been compared with an equal number of age- and sex-matched controls. Maximal basal pressure (MBP) and maximum squeeze pressure (MSP) were measured before and at four months and a year after treatment. The anal pressures of normal subjects are presented. Patients with rectal prolapse alone had normal anal pressures, whereas patients with incontinence with or without prolapse had significantly lower basal and squeeze pressures than controls. Successful surgical treatment of prolapse or incontinence did not produce significant change in anal canal pressures, whereas the combination of pelvic floor exercises and a continence aid was associated with a significant rise in MSP.

Matheson, D M; Keighley, M R

1981-01-01

185

Bioavailability of piroxicam: oral and rectal multiple application in humans.  

PubMed

The aim of the work is to evaluate the bioequivalence of piroxicam administered orally and rectally in 20 mg dose every 24 hours. The corresponding "in vivo" study was undertaken and plasma samples were collected during the ninth dosing interval. HPLC method was used for piroxicam plasma concentrations determination. AUC and C were calculated and the obtained data were statistically analyzed. Analog-hybrid simulation was used to confirm additionally the similarity between the discussed formulations. No significant differences were observed using paired t-test and two-way analysis of variance while the methods of Hauck and Westlake, looking strictly, gave nonbioequivalence. Simulated response of one compartment model is suitable for "in vivo" data in both cases. Measured and simulated average steady state concentrations are equal and in complete accordance with those given in literature. Finally it can be concluded that oral and rectal application are bioequivalent in the sense of expected clinical effects. PMID:3623735

Kozjek, F; Mrhar, A; Kmetec, V; Primozic, S; Karba, R; Janezic, A; Jerman, P

1987-06-01

186

Necrotizing Fasciitis of the Thigh Secondary to Radiation Colitis in a Rectal Cancer Patient  

PubMed Central

Necrotizing fasciitis usually occurs after dermal injury or through hematogenous spread. To date, few cases have been reported as necrotizing fasciitis of the thigh secondary to rectal perforation in rectal cancer patients. A 66-year-old male complained of pelvic and thigh pain and subsequently developed necrotizing fasciitis in his right thigh. Four years earlier, he had undergone a low anterior resection and radiotherapy due to of rectal cancer. An ulcerative lesion had been observed around the anastomosis site during the colonoscopy that had been performed two months earlier. Pelvic computed tomography and sigmoidoscopy showed rectal perforation and presacral abscess extending to buttock and the right posterior thigh fascia. Thus, the necrotizing fasciitis was believed to have occurred because of ulcer perforation, one of the complications of chronic radiation colitis, at the anastomosis site. When a rectal-cancer patient complains of pelvic and thigh pain, the possibility of a rectal perforation should be considered.

Park, So Hyun; Choi, Jung Ran; Song, Ji Young; Kang, Kyu Keun; Yoo, Woong Sun; Han, Sung Wan

2012-01-01

187

Clinical application of multimodality imaging in radiotherapy treatment planning for rectal cancer  

PubMed Central

Abstract Radiotherapy plays an important role in the treatment of rectal cancer. Three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are mainstay techniques of radiotherapy for rectal cancer. However, the success of these techniques is heavily reliant on accurate target delineation and treatment planning. Computed tomography simulation is a cornerstone of rectal cancer radiotherapy, but there are limitations, such as poor soft-tissue contrast between pelvic structures and partial volume effects. Magnetic resonance imaging and positron emission tomography (PET) can overcome these limitations and provide additional information for rectal cancer treatment planning. PET can also reduce the interobserver variation in the definition of rectal tumor volume. However, there is a long way to go before these image modalities are routinely used in the clinical setting. This review summarizes the most promising studies on clinical applications of multimodality imaging in target delineation and treatment planning for rectal cancer radiotherapy.

Zhe, Hong

2013-01-01

188

Colon and Rectal Surgery Without Mechanical Bowel Preparation  

PubMed Central

Objective To assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. Summary Background Data Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. However, in cases of penetrating colon trauma, primary colonic anastomosis has proven to be safe even though the bowel is not prepared. 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 Three hundred eighty patients were included in the study, 187 in group A and 193 in group B. Demographic characteristics, indications for surgery, and type of surgical procedure did not significantly differ between the two groups. Colo-colonic or colorectal anastomosis was performed in 63% of the patients in group A and 66% in group B. There was no difference in the rate of surgical infectious complications between the two groups. The overall infectious complications rate was 10.2% in group A and 8.8% in group B. Wound infection, anastomotic leak, and intra-abdominal abscess occurred in 6.4%, 3.7%, and 1.1% versus 5.7%, 2.1%, and 1%, respectively. Conclusions These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.

Zmora, Oded; Mahajna, Ahmad; Bar-Zakai, Barak; Rosin, Danny; Hershko, Dan; Shabtai, Moshe; Krausz, Michael M.; Ayalon, Amram

2003-01-01

189

Novel chronotherapeutic rectal aminophylline delivery system for therapy of asthma.  

PubMed

The aim of this study was to develop a new chronotherapeutic pharmaceutical preparation as a sustained-release suppository for prevention and therapeutic use against bronchial asthma in the early morning. Sustained-release hollow-type (SR-HT) suppositories using sodium alginate (Alg-Na), sodium polyacrylate (PANa) or polyacrylate-PANa co-polymer (PA-PANa) as gelling polymers (gel agent) were prepared and pharmaceutical characteristics of these suppositories were investigated. Type A SR-HT suppositories comprised a suppository shell prepared with oleaginous base and containing aminophylline only or aminophylline with Alg-Na or PANa in the cavity (hollow space). Type B SR-HT suppositories comprised a suppository shell prepared with oleaginous base and gel agent (30%), with aminophylline in the hollow space. In drug-release studies, the acrylate polymer-containing suppositories showed linearity of delayed release rate, providing significantly decreased the highest concentration of theophylline in plasma (C(max)) and delayed the time required to reach C(max) (t(max)) and the mean residence time (MRT) after rectal administrated in rabbits. In particular, suppositories containing PA-PANa maintained significantly higher theophylline concentrations than control suppositories at 12h after rectal administration. Furthermore, histopathological examination indicated that these suppositories using acrylate polymers did not result in rectal lesions. The SR-HT suppository, particularly using PA-PANa as a gel agent, may thus be useful against nocturnal symptoms of asthma. In this study, we confirmed new formulation of sustained-release suppository for chronotherapy of theophylline using oily base material in combination with polymer such as PA-PANa. The hollow-type suppository containing oleaginous base and hydrophilic polymer in the shell could be useful device for rectal administration of various drugs with prolongation of plasma concentration. PMID:19555748

Shiohira, Hideo; Fujii, Makiko; Koizumi, Naoya; Kondoh, Masuo; Watanabe, Yoshiteru

2009-09-01

190

Current Options for the Management of Rectal Cancer  

Microsoft Academic Search

Opinion statement  Patients diagnosed with rectal cancer should undergo locoregional staging with transrectal endoscopic ultrasound (EUS) or\\u000a surface coil array MRI of the pelvis if that technique is available. Patients thought to have more than very early stage (T1\\u000a or T2) disease should undergo abdominal imaging as well by CT or MRI, and chest imaging with either CXR or preferably CT.

Bert H. O’Neil; Joel E. Tepper

2007-01-01

191

Rectal Cancer and Importance of Chemoradiation in the Treatment  

Microsoft Academic Search

\\u000a \\u000a Neoadjuvant chemoradiation is used as a preoperative standard treatment for the majority of patients with Stage II\\/III rectal\\u000a cancers and, in attempt to facilitate surgical intervention, reduce the rate of local recurrence and improve overall outcomes\\u000a in patients suffering from this malignancy. However, this modality results in a wide range of clinical responses. In many\\u000a cases, a pathological complete response

Sergio Huerta

192

Rectal cancer in anorectal malformation with rectovestibular fistula  

Microsoft Academic Search

PURPOSE: The aim of this study was to describe and discuss the anosphincter-restoring procedure adopted in an adult patient with rectal cancer, affected by anorectal atresia and rectovestibular fistula not previously treated. METHODS: After anterior resection and transverse dissection of the rectovaginal septum, a straight double-staple low colorectal anastomosis was performed. A subcutaneous tunnel was extended from the inter-rectovaginal space,

Vincenzo Violi; Adamo S. Boselli; Leopoldo Sarli; Renato Costi; Luigi Roncoroni

2001-01-01

193

Transanal endoscopic microsurgical excision of rectal tumors: Indications and results  

Microsoft Academic Search

Transanal endoscopic microsurgery (TEM) allows local excision of rectal tumors located 4 to 18 cm above the anal verge. The\\u000a technique is not yet generally established because of the necessary special instrumentation and tools, the unusual technical\\u000a aspects of the approach, and the stringent patient selection criteria. The aim of this prospective, descriptive study was\\u000a to analyze the currently accepted

Nicolas Demartines; Marcus O. von Flüe; Felix H. Harder

2001-01-01

194

Total mesorectal excision for rectal cancer: The truth lies underneath  

Microsoft Academic Search

The surgical technique itself has emerged as a crucial factor for local recurrence since the popularization of total mesorectal\\u000a excision for the treatment of rectal cancer. This procedure is associated with lower local recurrence rates after “curative”\\u000a surgery compared to traditional dissection of the rectum. The aim is to remove an intact mesorectal envelope from the promontorium\\u000a down to the

Jesús A. Fernández-Represa; Julio M. Mayol; Julio Garcia-Aguilar

2004-01-01

195

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

196

Asymptomatic isolated coccygeal metastasis in low rectal carcinoma.  

PubMed

As well as being relatively rare, osseous metastases from colorectal cancer are frequently asymptomatic and represent a late manifestation of disease. We report a case of an unidentified, asymptomatic coccygeal metastasis discovered on histological processing of the resection specimen from a patient with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by radical abdomino-perineal resection with coccygectomy. The anatomical explanation for this finding may involve passage of tumour cells via the vertebral venous plexus. PMID:19609484

Stewart, Duncan; Kitsanta, P; Hampton, J; Shorthouse, A

2011-09-01

197

Retroperitoneal, mediastinal, and subcutaneous emphysema, complicating colonoscopy and rectal polypectomy.  

PubMed

Complications of flexible endoscopy-though still rare-are increasing in frequency lately as more invasive procedures are routinely performed. Perforation, hemorrhage, coagulation disorders, thrombophlebitis, and splenic rupture have all been reported to complicate colonoscopy and colorectal polypectomies. In this paper, we report on a case of retroperitoneal, mediastinal, and neck surgical emphysema, complicating colonoscopy and rectal polypectomy, presented initially as a change in the voice and facial swelling. PMID:18803515

Ballas, Konstantinos D; Rafailidis, Savas F; Triantaphyllou, Apostolos; Symeonidis, Nikolaos; Pavlidis, Theodoros E; Psarras, Kyriakos; Marakis, Georges N; Sakadamis, Athanasios K

2008-10-01

198

Hyperthermia in the multimodal therapy of advanced rectal carcinomas.  

PubMed

The synergistic effects of hyperthermia (raising temperatures to 40 degrees C and above) when combined with radiotherapy and cytotoxic drugs and a modulation of immunological phenomena have been demonstrated in the laboratory. Pre-clinical data relating to hyperthermia are summed up, along with their implications for clinical application. Controlled studies of local and regional hyperthermia have been performed during recent years, and these show us that the adjunction of hyperthermia provides at least an improvement of local control compared with radiotherapy alone. Current clinical results are summarized. Therapy systems based on radiowave irradiation have been commercially available for regional hyperthermia of the pelvis since the mid 1980s. This technology allows us to perform sufficiently tolerable and effective regional hyperthermia on rectal carcinomas. Used as part of curative preoperative and postoperative multimodal therapeutic strategies, hyperthermia can lead to improvement in local control (resectability, down-staging, progression-free time, recurrence rate), at least for certain risk groups. The preoperative radio-chemo-thermotherapy of advanced primary and recurring rectal carcinoma, uT3/4, was tested in a phase-I/II study of 20 patients. Therapy procedure, acute toxicity, thermal parameters, and response are described and discussed for this patient group. The regimen proved to be sufficiently tolerable, and complications did not occur. Tumor resection was performed on 14 of the 20 patients; 13 of the procedures were R0-resections and one was an R2 resection. In 64% of the resected rectal carcinomas, histopathological down-staging of the pretherapeutic endosonographical stadium was achieved; in three of the patients, despite continued non-resectability, local control has now been maintained for more than 12 months. In two patients with nonresectable rectal carcinomas, local progress was seen during the neoadjuvant combination therapy. PMID:8893348

Wust, P; Gellermann, J; Rau, B; Löffel, J; Speidel, A; Stahl, H; Riess, H; Vogl, T J; Felix, R; Schlag, P M

1996-01-01

199

Efficacy of rectal ibuprofen in controlling postoperative pain in children  

Microsoft Academic Search

The efficacy of ibuprofen with scheduled administration, starting preoperatively, for postoperative pain was studied in 128\\u000a boys and girls, 4 to 12 yr old, having elective surgery. In a double blind placebo-controlled study, rectal ibuprofen (40\\u000a mg · kg?1. day?1 in divided doses) or placebo was given for up to three days. For two hours after surgery heart rate, blood

Eeva-Liisa Maunuksela; Pauli Ryhänen; Leena Janhunen

1992-01-01

200

Intensified neoadjuvant radiochemotherapy for rectal cancer enhances surgical complications  

PubMed Central

Background Neoadjuvant radiochemotherapy has proven superior to adjuvant treatment in reducing the rate of local recurrence without impairing cancer related survival or the incidence of distant metastases. The present study aimed at addressing the effects of an intensified protocol of neoadjuvant treatment on the development of postoperative complications. Methods A total of 387 patients underwent oncological resection for rectal cancer in our institution between January 2000 and December 2009. 106 patients received an intensified radiochemotherapy. Perioperative morbidity and mortality were analyzed retrospectively with special attention on complication rates after intensified radio-chemotherapy. Therefore, for each patient subjected to neoadjuvant treatment a patient without neoadjuvant treatment was matched in the following order for tumor height, discontinuous resection/exstirpation, T-category of the TNM-system, dividing stoma and UICC stage. Results Of all patients operated for rectal cancer, 27.4% received an intensified neoadjuvant treatment. Tumor location in the matched patients were in the lower third (55.2%), middle third (41.0%) and upper third (3.8%) of the rectum. Postoperatively, surgical morbidity was higher after intensified neoadjuvant treatment. In the subgroup with low anterior resection (LAR) the anastomosis leakage rate was higher (26.6% vs. 9.7%) and in the subgroup of patients with rectal exstirpations the perineal wound infection rate was increased (42.2% vs. 18.8%) after intensified radiochemotherapy. Conclusions In rectal cancer the decision for an intensified neoadjuvant treatment comes along with an increase of anastomotic leakage and perineal wound infection. Quality of life is often reduced considerably and has to be balanced against the potential benefit of intensifying neoadjuvant radiochemotherapy.

2013-01-01

201

Thymidylate synthase germline polymorphisms in rectal cancer patients treated with neoadjuvant chemoradiotherapy based on 5-fluorouracil  

Microsoft Academic Search

Purpose  Chemoradiotherapy using 5-fluorouracil has shown to be effective treatment for rectal cancer. Thymidylate synthase (TS) is\\u000a an important target enzyme for the fluoropyrimidines. However, the predictive role of TS levels in early stage rectal cancer\\u000a is not yet well understood. We analyzed the value of TS gene polymorphisms as a predictive marker in patients with stage II\\u000a and III rectal

David PaezLaia Pare; Laia Paré; Albert Altés; Francesc Josep Sancho-Poch; Lourdes Petriz; Jordi Garriga; Josep Maria Monill; Juliana Salazar; Elisabeth del Rio; Agustí Barnadas; Eugenio Marcuello; Montserrat Baiget

2010-01-01

202

Plasma concentrations after high-dose (45 mg · kg ?1 ) rectal acetaminophen in children  

Microsoft Academic Search

Although the recommended dose of rectal acetaminophen (25–30 mg · kg?1) is twice that for oral administration (10–15 mg · kg?1), the literature justifies the use of a higher dose when acetaminophen is administered via the rectal route. We measured’\\u000a venous plasma acetaminophen concentrations resulting from 45 mg · kg?1 of rectal acetaminophen in ten ASA 1, 15 kg paediatric

Carolyne J. Montgomery; James P. McCormack; Clayton C. Reichert; Colin P. Marsland

1995-01-01

203

Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer  

Microsoft Academic Search

Objectives. Anterior rectal resection with partial removal of the internal sphincter is an option for low rectal cancer. The objective of this study was to evaluate the functional outcome after this intersphincteric rectal resection.Methods. Anal continence was evaluated by anorectal manometry and a standardized questionnaire (Wexner Score) in 33 patients 28±15 weeks and 100±45 weeks, respectively, after intersphincteric resection. Nineteen

B. Bittorf; U. Stadelmaier; J. Göhl; W. Hohenberger; K. E. Matzel

2004-01-01

204

Embolization of Rectal Arteries: An Alternative Treatment for Hemorrhagic Shock Induced by Traumatic Intrarectal Hemorrhage  

SciTech Connect

Rectal injuries caused by foreign bodies or iatrogenic insertions may lead to severe complications whose therapeutic management remains controversial. At times, both the rapid identification and treatment of subsequent active rectal bleeding may be challenging, especially when endoscopy fails to locate and control the arterial hemorrhage. We present the first two successful cases of middle rectal artery embolization in patients presenting with sustained bleeding and hemorrhagic shock.

Pichon, Nicolas, E-mail: nicolas.pichon@unilim.fr, E-mail: nicolas.pichon@chu-limoges.fr; Francois, Bruno [Dupuytren University Hospital, Intensive Care Unit (France); Pichon-Lefievre, Florence [Dupuytren University Hospital, Department of Radiology (France); Mathonnet, Murielle [Dupuytren University Hospital, Department of Surgery (France); Maubon, Antoine [Dupuytren University Hospital, Department of Radiology (France); Vignon, Philippe [Dupuytren University Hospital, Intensive Care Unit (France)

2005-05-15

205

Enteral, oral, and rectal absorption of ceftriaxone using glyceride enhancers.  

PubMed

In vivo models in rodents and primates were used to investigate ways of overcoming the poor oral and rectal absorption of ceftriaxone. The sodium salt of ceftriaxone at 20 mg/kg was formulated in C8-C10 chain length, mono- and diglyceride extracts of coconut oil (Capmul) and administered intraduodenally to adult rats. Peak plasma levels of 17-52 micrograms/ml and bioavailability averaging 38% were attained. Significant plasma levels (42-45 micrograms/ml) were also demonstrated in squirrel monkeys with doses of 20 mg/kg ceftriaxone formulated in Capmul and given by the enteral route. Enteric-coated capsules containing this formulation were also orally administered to squirrel monkeys and gave high plasma levels (10-31 micrograms/ml) between 1 and 6 h following dosing. In rectal absorption studies, ceftriaxone formulated in Capmul as a suspension gave peak blood levels of 62-84 micrograms/ml (average bioavailability 42%) in the rabbit. In the baboon, rectal administration of ceftriaxone formulated with Capmul in a Witepsol H15 suppository gave Cmax levels ranging from 9 to 48 micrograms/ml, depending on the dose of the antibiotic and the drug/enhancer ratio. PMID:3391054

Beskid, G; Unowsky, J; Behl, C R; Siebelist, J; Tossounian, J L; McGarry, C M; Shah, N H; Cleeland, R

1988-01-01

206

Rectal Swabs for Analysis of the Intestinal Microbiota  

PubMed Central

The composition of the gut microbiota is associated with various disease states, most notably inflammatory bowel disease, obesity and malnutrition. This underlines that analysis of intestinal microbiota is potentially an interesting target for clinical diagnostics. Currently, the most commonly used sample types are feces and mucosal biopsy specimens. Because sampling method, storage and processing of samples impact microbiota analysis, each sample type has its own limitations. An ideal sample type for use in routine diagnostics should be easy to obtain in a standardized fashion without perturbation of the microbiota. Rectal swabs may satisfy these criteria, but little is known about microbiota analysis on these sample types. In this study we investigated the characteristics and applicability of rectal swabs for gut microbiota profiling in a clinical routine setting in patients presenting with various gastro-intestinal disorders. We found that rectal swabs appeared to be a convenient means of sampling the human gut microbiota. Swabs can be performed on demand, whenever a patient presents; swab-derived microbiota profiles are reproducible, whether they are gathered at home by patients or by medical professionals in an outpatient setting and may be ideally suited for clinical diagnostics and large-scale studies.

Budding, Andries E.; Grasman, Matthijs E.; Eck, Anat; Bogaards, Johannes A.; Vandenbroucke-Grauls, Christina M. J. E.; van Bodegraven, Adriaan A.; Savelkoul, Paul H. M.

2014-01-01

207

Risk factors for adverse outcome in low rectal cancer  

PubMed Central

AIM: To demonstrate the oncologic outcomes of low rectal cancer and to clarify the risk factors for survival, focusing particularly on the type of surgery performed. METHODS: Data from patients with low rectal carcinomas who underwent surgery, either sphincter-preserving surgery (SPS) or abdominoperineal resection (APR), at The First Affiliated Hospital of Sun Yat-sen University in China from August 1994 to December 2005 were retrospectively analyzed. RESULTS: Of 331 patients with low rectal cancer, 159 (48.0%) were treated with SPS. A higher incidence of positive resection margins and a higher 5-year cumulative local recurrence rate (14.7% vs 6.8%, P = 0.041) were observed in patients after APR compared to SPS. The five-year overall survival (OS) was 54.6% after APR and 66.8% after SPS (P = 0.018), and the 5-year disease-free survival (DFS) was 52.9% after APR and 65.5% after SPS (P = 0.013). In multivariate analysis, poor OS and DFS were significantly related to positive resection margins, pT3-4, and pTNM III-IV but not to the type of surgery. CONCLUSION: Despite a higher rate of positive resection margins after APR, the type of surgery was not identified as an independent risk factor for survival.

Chen, Zhi-Hui; Song, Xin-Ming; Chen, Shi-Cai; Li, Ming-Zhe; Li, Xin-Xin; Zhan, Wen-Hua; He, Yu-Long

2012-01-01

208

Ostomies in rectal cancer patients: what is their psychosocial impact?  

PubMed

The resection of a low-lying rectal cancer can lead to the creation of an ostomy to discharge fecal material. In view of this reconfiguration of anatomy and life-changing modification of daily bodily functions, it is not surprising that a rapidly growing literature has examined ostomy patients' psychosocial challenges. The current study was designed (1) to systematically review the published literature on these psychosocial challenges and (2) to explore, in a single-institution setting, whether medical oncologists appear to acknowledge the existence of an ostomy during their post-operative evaluations of rectal cancer patients. This systematic review identified that social isolation, sleep deprivation; financial concerns; sexual inhibition; and other such issues are common among patients. Surprisingly, however, in our review of 66 consecutive rectal cancer patients, in 17%, the ostomy was not mentioned at all in the medical record during the first medical oncology visit; and, in one patient, it was never mentioned at all during months of adjuvant chemotherapy. Even in the setting of ostomy complications, the ostomy was not always mentioned. This study underscores the major psychosocial issues cancer patients confront after an ostomy and suggests that healthcare providers of all disciplines should work to remain sensitive to such issues. PMID:24118361

Kenderian, S; Stephens, E K; Jatoi, A

2014-05-01

209

Laparoscopic Resection for Rectal Cancer: What Is the Evidence?  

PubMed Central

Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients' quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short- and long-term outcomes and evidence for laparoscopic resection for rectal cancer.

Chan, Dedrick Kok-Hong; Chong, Choon-Seng; Lieske, Bettina; Tan, Ker-Kan

2014-01-01

210

Does calretinin immunohistochemistry reduce inconclusive diagnosis in rectal biopsies for Hirschsprung disease?  

PubMed

Many difficulties occur during the evaluation of rectal biopsies for the diagnosis of Hirschsprung disease. We investigated whether the introduction of calretinin (CR) immunohistochemistry in a diagnostic panel could decrease the rate of inconclusive results. Data from 82 patients undergoing rectal biopsies before and after CR introduction were analyzed. Inconclusive results were obtained in 17 of 45 rectal biopsies (37.8%) in the series of cases before CR introduction and in 5 of 42 rectal biopsies (11.9%) in the series of cases after CR (P < 0.006). The inclusion of CR in the histopathologic panel may improve the diagnostic accuracy of Hirschsprung disease. PMID:24345837

de Arruda Lourenção, Pedro L T; Takegawa, Bonifácio K; Ortolan, Erika V P; Terra, Simone A; Rodrigues, Maria A M

2014-05-01

211

A Case of Solitary Rectal Diverticulum Presenting with a Retrorectal Mass  

PubMed Central

Colonic diverticula are common whereas but rectal diverticula are very rare, with only sporadic reports in the literature since 1911. Most patients with rectal diverticula are diagnosed incidentally, inflammatory processes may have developed at the time of the diagnosis. We report the case of a 42-year-old woman presenting with a retrorectal mass that was detected incidentally. She was suspected of having a rectal diverticulum by transrectal ultrasonography and magnetic resonance imaging. However, the colonoscopic findings were unremarkable. A rectal diverticulum was confirmed intraoperatively, and a transanal diverticulectomy was performed.

Jung, Sang Hun

2010-01-01

212

A novel technique for the treatment of post operative retro-rectal haematoma: two case reports  

PubMed Central

Rectal bleeding following any form of rectal surgery is a well recognised complication 1, 2, 3 & 4. However retro-rectal bleeding and tracking which then presents as rectal bleeding has not been reported in the literature. We describe a novel way of dealing with this technically difficult post-operative complication. We present two cases of significant rectal bleeding (one following STARR procedure and other after Delormes procedure). Both patients had to be taken back to theatre due to continuing, significant bleeding. Examination under anaesthesia on both occasions revealed a posterior boggy swelling, with an opening which admitted a finger. In both cases clots were evacuated and a corrugated drain was inserted in to the retro rectal space. The authors believe that following any form of rectal surgery, retro-rectal bleeding with tracking can present as rectal bleeding. Treatment in the form of EUA and insertion of corrugated helped to resolve the problem. We present both cases and literature review of the complications of stapled haemorrhoidopexy.

2010-01-01

213

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

214

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

2014-05-30

215

Stapled Transanal Rectal Resection for the Surgical Treatment of Obstructed Defecation Syndrome Associated with Rectocele and Rectal Intussusception  

PubMed Central

Obstructed defecation syndrome (ODS) is one of the most widespread clinical problems which frequently affects middle-aged females. There is a new surgical technique called stapled transanal rectal resection (STARR) that makes it possible to remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler. This surgical technique developed by Antonio Longo was proposed as an effective alternative for the treatment of ODS. In this study we present our preliminary results with the STARR operation for the treatment of ODS. For this purpose, 40 consecutive female patients with ODS due to rectal intussusception (RI) and/or rectocele (RE) were recruited in this prospective clinical study, from May 2008 to October 2010. No major operative or postoperative complications were recorded, and after 12-month follow-up, significant improvement in the ODS score system was observed, and the symptoms of constipation improved in 90% of patients; 20% of patients judged their final clinical outcome as excellent, 55% as good, and 15% as moderate, with only 10% having poor results. After analyzing our results we can conclude that STARR is an effective and safe procedure for the treatment of obstructed defecation syndrome due to rectal intussusception and/or rectocele and can be performed safely without major morbidity.

Hasan, Hesham M.; Hasan, Hani M.

2012-01-01

216

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

217

In vivo real-time rectal wall dosimetry for prostate radiotherapy  

NASA Astrophysics Data System (ADS)

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 real-time 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 µm. 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.

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

2010-07-01

218

In vivo real-time rectal wall dosimetry for prostate radiotherapy  

PubMed Central

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 real time 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?m. Two MOSFETs were combined in a face-to-face orientation. The reproducibility, sensitivity and angular dependence were measured for the dual MOSFET in a 6MV 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 2-10Gy. 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 capability for real time dose monitoring of the rectal wall dose during treatment.

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

2010-01-01

219

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies  

PubMed Central

Background and aims: Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated. Methods: Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n?=?27) and those with normal rectal sensation (n?=?25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed. Results: External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity. Conclusions: We have identified a subset of patients with urge faecal incontinence—namely, those with rectal hypersensitivity—who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensive assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.

Chan, C L H; Lunniss, P J; Wang, D; Williams, N S; Scott, S M

2005-01-01

220

Endoscopic and imaging appearance after injection of an ano-rectal bulking agent.  

PubMed

The use of hyaluronic acid and dextranomer (Solesta, Salix) injection in the anal canal is an emerging modality in the treatment of fecal incontinence. However, little is known regarding the endoscopic and radiological appearance following injection of this ano-rectal bulking agent. We report computed tomography and endoscopic findings after hyaluronic acid/dextranomer injection in the ano-rectal area. PMID:25031792

Papafragkakis, Haris; Changela, Kinesh; Bhatia, Taruna; Ona, Mel A; Malieckal, Anju; Paleti, Vani; Fuksbrumer, Moshe S; Anand, Sury

2014-07-16

221

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

222

Depletion of neuroendocrine cells in rectal biopsy specimens from HIV positive patients  

Microsoft Academic Search

AIMS: To compare the density of neuroendocrine cells in rectal biopsy specimens from human immunodeficiency virus (HIV) infected individuals with that of a control group. METHODS: Neuroendocrine cells in rectal biopsies were identified using an immunohistochemical stain for chromogranin and subsequently quantified using a method of linear intercept. RESULTS: Neuroendocrine cells were found to be significantly decreased in the HIV

J B McCullough; P A Batman; A R Miller; P M Sedgwick; G E Griffin

1992-01-01

223

Endoscopic and imaging appearance after injection of an ano-rectal bulking agent  

PubMed Central

The use of hyaluronic acid and dextranomer (Solesta, Salix) injection in the anal canal is an emerging modality in the treatment of fecal incontinence. However, little is known regarding the endoscopic and radiological appearance following injection of this ano-rectal bulking agent. We report computed tomography and endoscopic findings after hyaluronic acid/dextranomer injection in the ano-rectal area.

Papafragkakis, Haris; Changela, Kinesh; Bhatia, Taruna; Ona, Mel A; Malieckal, Anju; Paleti, Vani; Fuksbrumer, Moshe S; Anand, Sury

2014-01-01

224

PHASE I-II TRIAL OF CETUXIMAB, CAPECITABINE, OXALIPLATIN, AND RADIOTHERAPYAS PREOPERATIVE TREATMENT IN RECTAL CANCER  

Microsoft Academic Search

Purpose: To evaluate the safety and activity of preoperative radiotherapy (RT) with concurrent cetuximab, cape- citabine, and oxaliplatin in rectal cancer patients. Patients and Methods: A total of 60 patients with rectal cancer (T3-T4 or N+, M1 allowed) entered the trial at five investigator sites; the data from 58 patients were assessable. Cetuximab was given as an initial dose of

CLAUS RODEL; DIRK ARNOLD; MATTHIAS HIPP; TORSTEN LIERSCH; KATHRIN DELLAS; IGORS IESALNIEKS; ROBERT MICHAEL HERMANN; FLORIAN LORDICK; AXEL HINKE; ROLF SAUER

225

Effect of prebiotic or probiotic supplementation and ileo rectal anastomosis on intestinal morphology of weaned piglets  

Microsoft Academic Search

Forty eight 21 days old piglets were used to compare the effect of prebiotic or probiotic supplementation and ileo rectal anastomosis on the morphology of the small intestine. Half of the piglets were maintained intact and the other half was subjected to an ileo rectal anastomosis (IRA). Each group of piglets received one of the following diets: 1) basal diet (C),

M. C. Marinho; M. A. Pinho; R. D. Mascarenhas; F. C. Silva; M. M. Lordelo; L. F. Cunha; J. P. B. Freire

2007-01-01

226

Altered rectal perception is a biological marker of patients with irritable bowel syndrome  

Microsoft Academic Search

Background & Aims: Lowered visceral perception thresholds have been suggested as a biological marker of irritable bowel syndrome (IBS). The current study sought to determine the prevalence of altered rectal visceral perception in patients with IBS and the correlation of altered perception thresholds with subjective symptoms. Methods: Anorectal manometry and rectal perception thresholds to balloon distention were determined in 100

Howard Mertz; Bruce Naliboff; Julie Munakata; Negar Niazi; Emeran A. Mayer

1995-01-01

227

Sentinel Surveillance of Rectal Chlamydia and Gonorrhea Among Males—San Francisco, 2005–2008  

Microsoft Academic Search

Objectives: Estimates of STD burden that are based on case reports can be biased by changes in testing. To assess trends in rectal chla- mydia and gonorrhea among males in San Francisco, we examined test frequency and positivity at sentinel sites across a 4-year period. Methods: The San Francisco Department of Public Health provides rectal chlamydia and gonorrhea testing and

Julia L. Marcus; Kyle T. Bernstein; Sally C. Stephens; Ameera Snell; Robert P. Kohn; Sally Liska; Jeffrey D. Klausner

2010-01-01

228

Rectal epithelial cell proliferation patterns as predictors of adenomatous colorectal polyp recurrence  

Microsoft Academic Search

To determine whether proliferative patterns in flat rectal mucosal samples can predict the recurrence of adenomatous colorectal polyps, after polypectomy, biopsy specimens from normal looking rectal mucosa were obtained at endoscopy from 55 patients diagnosed for the first time as having adenomatous colorectal polyps. Epithelial cell proliferation was assessed in biopsy specimens through 3H-thymidine autoradiography. After polypectomy, patients were followed

M Anti; G Marra; F Armelao; A Percesepe; R Ficarelli; G M Ricciuto; A Valenti; G L Rapaccini; I De Vitis; G DAgostino

1993-01-01

229

Epithelial cell proliferation in the rectal stump of patients with ileorectal anastomosis for ulcerative colitis  

Microsoft Academic Search

Epithelial cell proliferation in the rectal stump after ileorectal anastomosis for ulcerative colitis was studied in 19 patients. This was achieved through in vitro incorporation of tritiated thymidine in mucosal biopsies and radioautographic analysis of the number and position of labelled nuclei in the crypts. Rectal biopsies from nine unoperated patients with ulcerative colitis and from 10 controls, were processed

T Lehy; M Mignon; J L Abitbol

1983-01-01

230

BIOCHEMICAL SIGNS OF IMPAIRED COBALAMIN STATUS DURING AND AFTER RADIOTHERAPY FOR RECTAL CANCER  

Microsoft Academic Search

Purpose: The aim of the study was to investigate whether pelvic radiotherapy for rectal cancer had a negative impact on cobalamin status. Methods and Materials: Consecutive patients receiving pelvic radiotherapy (50 Gy) for rectal cancer were evaluated prospectively (n 54). Serum cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine (tHcy) were measured at start and end of radiotherapy, at

MARIANNE GRØNLIE GUREN; JØRN SCHNEEDE; KJELL MAGNE TVEIT; PER MAGNE UELAND; EBBA NEXØ; SVEIN DUELAND

2004-01-01

231

The Postoperative Adjuvant Radiation Therapy and Radiochemotherapy for UICC Stage II and III Rectal Cancer  

Microsoft Academic Search

Aim: This analysis was undertaken to review the outcome and toxicity of postoperative adjuvant therapy for Stage II and III rectal cancer. Patients and Methods: We reviewed 112 patients treated with radiotherapy (44 patients) and radiochemotherapy (68 patients) after potentially curative (R0) surgery for rectal cancer (UICC Stages II and III), between 1983 and 1994 at the University Clinic of

Athanasios Bagatzounis; Jochen Willner; Ulrich Oppitz; Michael Flentje

2000-01-01

232

Selection criteria for internal rectal prolapse repair by delorme's transrectal excision  

Microsoft Academic Search

PURPOSE: The aim of this study was to review our results of Delorme's transrectal excision for internal rectal prolapse, with a view to determining preoperative selection criteria associated with a satisfactory outcome. METHODS: Between 1992 and 1998, 20 patients with internal rectal prolapse underwent Delorme's transrectal excision. The last patient was excluded from the study because of a follow-up period

Igor Sielezneff; Andrew Malouf; Jacques Cesari; Christian Brunet; Jean-Claude Sarles; Bernard Sastre

1999-01-01

233

Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas  

Microsoft Academic Search

Background and study aims: Large (>2 cm) rectal adenomas are currently treated by either transanal endoscopic microsurgery (TEM) or piecemeal endoscopic mucosal resection (EMR). The potential lower morbidity of EMR may become irrelevant if EMR is less effective. The aim of this study was to compare the safety and effectiveness of EMR and TEM for large rectal adenomas. Patients and

R. M. Barendse; Broek van den F. J. C; E. Dekker; W. A. Bemelman; Graaf de E. J. R; P. Fockens; J. B. Reitsma

2011-01-01

234

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

235

Rectal misoprostol in the prevention of postpartum hemorrhage: A placebo-controlled trial  

Microsoft Academic Search

Objective: This study investigated the effectiveness of rectal misoprostol in preventing postpartum hemorrhage. Study Design: In a randomized, placebo-controlled study, 550 women were randomly allocated to rectally receive 400 ?g misoprostol or nonidentical placebo after normal vaginal delivery. Any excessive bleeding was actively managed with conventional oxytocic agents. Blood loss was measured directly. Results: The baseline variables were similar. Blood

Anthony A. Bamigboye; G. Justus Hofmeyr; Derek A. Merrell

1998-01-01

236

Successful treatment of rectal cancer with perineal invasion: Three case reports  

PubMed Central

Rectal cancer occasionally invades adjacent organs. However, rectal cancer with perineal invasion is uncommon and difficult to treat. Locally advanced colorectal cancer may be clinically treated with neoadjuvant therapy, followed by en bloc resection. Skin invasion may lead to tumor dissemination via cutaneous blood flow and lymphatic routes. There is currently no firm evidence regarding the treatment of these significantly advanced rectal cancers. In this study, we report 3 cases of rectal cancer with perineal invasion, successfully managed by multimodality treatment. Case 1 is a 52-year-old man with rectal cancer that had invaded the perineum; case 2 is a 38-year-old man with rectal cancer infiltrating the perineal skin and liver metastasis; and case 3 is a 50-year-old woman with rectal cancer and perineal invasion. All the cases were treated with radical excision. No severe complications were observed in the perioperative period. Case 2, in particular, was confirmed to remain alive 5 years after the surgery. Our experience suggests that multimodality treatment, including extended radical surgery, may be a feasible approach to the treatment of rectal cancer with perineal skin invasion.

KITAHARA, TOMOHIRO; UEMURA, MAMORU; HARAGUCHI, NAOTSUGU; NISHIMURA, JUNICHI; SHINGAI, TATSUSHI; HATA, TAISHI; TAKEMASA, ICHIRO; MIZUSHIMA, TSUNEKAZU; DOKI, YUICHIRO; MORI, MASAKI; YAMAMOTO, HIROFUMI

2014-01-01

237

New barium paste mixture for helical (slip-ring) CT evaluation of rectal carcinoma.  

PubMed

We describe a new method for complete opacification of the rectum using helical CT and a newly developed anal contrast agent. Rectal cancers were easily identified in all of the 21 patients examined, and diagnostic accuracy in detecting local invasion was 94%. Our method of rectal CT is easy to perform and well tolerated. PMID:9135647

Ogawa, Y; Noda, Y; Nishioka, A; Inomata, T; Yoshida, S; Toki, T; Ogoshi, S; Ma, J

1997-01-01

238

Irinotecan-Eluting Beads in Treating Patients With Refractory Metastatic Colon or Rectal Cancer That Has Spread to the Liver  

ClinicalTrials.gov

Liver Metastases; 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 IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

2014-04-09

239

Prophylactic use of cefotaxime in colonic and rectal surgery.  

PubMed

Two hundred and seventeen patients, undergoing abdominal colonic and rectal surgery, received after randomization, the following regimen: group A (74 patients): cefotaxime 1 g intravenous at the induction of anaesthesia, the beginning of the resection, 4 and 8 h later; group B (72 patients): cefotaxime in the same regimen associated with ornidazole or metronidazole 0.5 g intravenous at the induction of anaesthesia and 0.5 g intravenous with the last injection of cefotaxime; group C (71 patients):cefotaxime following the same regimen as groups A and B and metronidazole orally 0.5 tds 3 days before surgery. All wounds were assessed daily, until discharge from hospital. Severe sepsis included: septicaemia, peritonitis, intra-abdominal abscess and extra-abdominal infections with death. Non-severe sepsis included all others. All the patients having a history of allergy to beta-lactam antibiotics and those with pre-operative infection were excluded. Mean age of the population was: 64.5 years. Seventy-seven patients had rectal cancer and 82 patients cancer of the colon; Twenty-five patients had inflammatory bowel disease, and in 33 others disease such as polyposis was present. Risk factors of post-operative infection were present in 115 cases (A, 36 patients; B, 37 patients; C, 42 patients). All three groups were very well matched for age, sex, type of intervention and diagnosis. Non-infectious complications appeared in 56 patients. Sepsis developed in 76 patients (A, 27 patients; B, 27 patients; C, 22 patients, no significant difference). Severe sepsis occurred in 14 patients (A, 6 patients; B, 4 patients; C, 4 patients, no significant difference) and in 62 patients non severe sepsis (A, 21 patients; B, 23 patients; C, 18 patients, no significant difference). Post-operative peritonitis was not seen. This study suggests that cefotaxime alone 4 g peri-operatively is useful in prophylaxis during rectal and colonic surgery.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6094448

Favre, J P; Bouchet, Y; Clotteau, J E; Hypousteguy, L; Marchal, G; Mercier, R; Michotey, G; Saubier, E C

1984-09-01

240

Preoperative infusional chemoradiation therapy for stage T3 rectal cancer  

SciTech Connect

To evaluate preoperative infusional chemoradiation for patients with operable rectal cancer. Preoperative chemoradiation therapy using infusional 5-fluorouracil (5-FU), (300 mg/m{sup 2}/day) together with daily irradiation (45 Gy/25 fractions/5 weeks) was administered to 77 patients with clinically Stage T3 rectal cancer. Endoscopic ultrasound confirmed the digital rectal exam in 63 patients. Surgery was performed approximately 6 weeks after the completion of chemoradiation therapy and included 25 abdominoperineal resections and 52 anal-sphincter-preserving procedures. Posttreatment tumor stages were T1-2, N0 in 35%, T3, N0 in 25%, and T1-3, N1 in 11%; 29% had no evidence of tumor. Local tumor control after chemoradiation was seen in 96% (74 out of 77); 2 patients had recurrent disease at the anastomosis site and were treated successfully with abdominoperineal resection. Overall, pelvic control was obtained in 99% (76 out of 77). The survival after chemoradiation was higher in patients without node involvement than in those having node involvement (p = n.s.). More patients with pathologic complete responses or only microscopic foci survived than did patients who had gross residual tumor (p = 0.07). The actuarial survival rate was 83% at 3 years; the median follow-up was 27 months, with a range of 3 to 68 months. Acute, perioperative, and late complications were not more numerous or more severe with chemoradiation therapy than with traditional radiation therapy (XRT) alone. Excellent treatment response allowed two-thirds of the patients to have an anal-sphincter-sparing procedure. Gross residual disease in the resected specimen indicates a poor prognosis, and therapies specifically targeting these patients may improve survival further. 22 refs., 2 figs., 3 tabs.

Rich, T.A.; Skibber, J.M.; Ajani, J.A. [Univ. of Texas M. D. Anderson Cancer Center, Houston, TX (United States)] [and others] [Univ. of Texas M. D. Anderson Cancer Center, Houston, TX (United States); and others

1995-07-15

241

Laparoscopic resection for middle and low rectal cancer  

PubMed Central

AIMS: The purpose of this study was to evaluate the technical feasibility, safety and oncological outcomes of laparoscopic resection for middle and low rectal cancers. MATERIALS AND METHODS: From January 2004 to December 2011, review of prospectively collected database revealed a series of 97 laparoscopic resections for middle and low rectal cancer within 10 cm from the anal verge. Five patients with multiple primary cancers were excluded. Operation time, intra-operative blood loss, surgical complications, duration of hospital stay, retrieved lymph nodes, tumour, node, metastasis (TNM) stage and recurrence were retrospectively analysed. RESULTS: Tumours were located within 5 cm of the anal verge in 28 patients (30.4%) and from 5 cm to 10 cm in 64 patients (69.6%). Abdominoperineal resection was performed in 12 patients (13%), and conversion to open surgery was necessary in four patients (4.3%). The mean operation time was 199.7 min (range 105-450 min) and the mean intra-operative blood loss was 169.9 mL (range 20-800 mL). The mean hospital stay was 11.8 days (range 5-45 days) and a mean of 12.2 lymph nodes were retrieved. The incidence of surgical complications was 11.9%, including anastomosis site leakage in five patients (5.4%). There were no mortalities resulting from laparoscopic surgery. The median follow-up period was 28.4 months (range 7-85 months). Recurrence occurred in eight patients (8.7%). CONCLUSIONS: Laparoscopic resection can be applied for middle and low rectal cancers with acceptable surgical and oncological outcomes.

Park, Kwang-Kuk; Lee, Seung-Hyun; Baek, Sung-Uhn; Ahn, Byung-Kwon

2014-01-01

242

Palliative Treatment of Rectal Carcinoma Recurrence Using Radiofrequency Ablation  

SciTech Connect

Purpose: To evaluate the safety and efficacy of CT-guided radiofrequency (RF) ablation for the palliative treatment of recurrent unresectable rectal tumors. Materials and Methods: Twenty-seven patients with locally recurrent rectal cancer were treated with computed tomography (CT)-guided RF ablation. Therapy was performed with the patient under conscious sedation with a seven- or a nine-array expandable RF electrode for 8-10 min at 80-110 Degree-Sign C and a power of 90-110 W. All patients went home under instructions the next day of the procedure. Brief Pain Inventory score was calculated before and after (1 day, 1 week, 1 month, 3 months, and 6 months) treatment. Results: Complete tumor necrosis rate was 77.8% (21 of a total 27 procedures) despite lesion location. BPI score was dramatically decreased after the procedure. The mean preprocedure BPI score was 6.59, which decreased to 3.15, 1.15, and 0.11 at postprocedure day 1, week 1, and month 1, respectively, after the procedure. This decrease was significant (p < 0.01 for the first day and p < 0.001 for the rest of the follow-up intervals (paired Student t test; n - 1 = 26) for all periods during follow-up. Six patients had partial tumor necrosis, and we were attempted to them with a second procedure. Although the necrosis area showed a radiographic increase, no complete necrosis was achieved (secondary success rate 65.6%). No immediate or delayed complications were observed. Conclusion: CT-guided RF ablation is a minimally invasive, safe, and highly effective technique for treatment of malignant rectal recurrence. The method is well tolerated by patients, and pain relief is quickly achieved.

Mylona, Sophia, E-mail: mylonasophia@yahoo.com; Karagiannis, Georgios, E-mail: gekaragiannis@yahoo.gr; Patsoura, Sofia, E-mail: sofia.patsoura@yahoo.gr [Hellenic Red Cross Hospital 'Korgialenio-Benakio' (Greece); Galani, Panagiota, E-mail: gioulagalani@yahoo.com [Amalia Fleming Hospital (Greece); Pomoni, Maria, E-mail: marypomoni@gmail.com [Evgenidion Hospital (Greece); Thanos, Loukas, E-mail: loutharad@yahoo.com [Sotiria Hospital (Greece)

2012-08-15

243

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

244

Clinical impact of HLA class I expression in rectal cancer  

Microsoft Academic Search

Purpose  To determine the clinical impact of human leukocyte antigen (HLA) class I expression in irradiated and non-irradiated rectal\\u000a carcinomas.\\u000a \\u000a \\u000a \\u000a Experimental design  Tumor samples in tissue micro array format were collected from 1,135 patients. HLA class I expression was assessed after immunohistochemical\\u000a staining with two antibodies (HCA2 and HC10).\\u000a \\u000a \\u000a \\u000a Results  Tumors were split into two groups: (1) tumors with >50% of tumor cells

Frank M. Speetjens; Elza C. de Bruin; Hans Morreau; Eliane C. M. Zeestraten; Hein Putter; Maaike M. van Buren; Monique van Velzen; N. Geeske Dekker-Ensink; Peter J. K. Kuppen

2008-01-01

245

A metastatic colon cancer model using nonoperative transanal rectal injection  

Microsoft Academic Search

Background  This study aimed to develop a noninvasive orthotopic model for metastasis of colon and rectal cancer using a transanal approach.\\u000a Currently, the most accurate orthotopic representation of metastatic human colon cancer is via a cecal injection. The transanal\\u000a model allows for further examination of systemic immune responses, tumor take, and onset of metastasis without prior surgical\\u000a intervention.\\u000a \\u000a \\u000a \\u000a Methods  For this study,

Melissa Donigan; Bryan D. Loh; Laurie S. Norcross; Shuan Li; Paul R. Williamson; Samuel DeJesus; Andrea Ferrara; Joseph T. Gallagher; Cheryl H. Baker

2010-01-01

246

Testing for and the role of anal and rectal sensation.  

PubMed

The rectum is insensitive to stimuli capable of causing pain and other sensations when applied to a somatic cutaneous surface. It is, however, sensitive to distension by an experimental balloon introduced through the anus, though it is not known whether it is the stretching or reflex contraction of the gut wall, or the distortion of the mesentery and adjacent structures which induces the sensation. No specific sensory receptors are seen on careful histological examination of the rectum in humans. However, myelinated and non-myelinated nerve fibres are seen adjacent to the rectal mucosa, but no intraepithelial fibres arise from these. The sensation of rectal distension travels with the parasympathetic system to S2, S3 and S4. The two main methods for quantifying rectal sensation are rectal balloon distension and mucosal electrosensitivity. The balloon is progressively distended until particular sensations are perceived by the patient. The volumes at which these sensations are perceived are recorded. Three sensory thresholds are usually defined: constant sensation of fullness, urge to defecate, and maximum tolerated volume. The modalities of anal sensation can be precisely defined. Touch, pain and temperature sensation exist in normal subjects. There is profuse innervation of the anal canal with a variety of specialized sensory nerve endings: Meissner's corpuscles which record touch sensation, Krause end-bulbs which respond to thermal stimuli, Golgi-Mazzoni bodies and pacinian corpuscles which respond to changes in tension and pressure, and genital corpuscles which respond to friction. In addition, there are large diameter free nerve endings within the epithelium. The nerve pathway for anal canal sensation is via the inferior haemorrhoidal branches of the pudendal nerve to the sacral roots of S2, S3 and S4. Anal sensation may be quantitatively measured in response to electrical stimulation. The technique involves the use of a specialized constant current generator and bipolar electrode probe inserted in the anal canal. The equipment is generally available and the technique has been shown to be an accurate and repeatable quantitative test of anal sensation. PMID:1586768

Rogers, J

1992-03-01

247

Molecular targeted treatment and radiation therapy for rectal cancer  

Microsoft Academic Search

\\u000a \\u000a Background:\\u000a   EGFR (epidermal growth factor receptor) and VEGF (vascular endothelial growth factor) inhibitors confer clinical benefit in\\u000a metastatic colorectal cancer when combined with chemotherapy. An emerging strategy to improve outcomes in rectal cancer is\\u000a to integrate biologically active, targeted agents as triple therapy into chemoradiation protocols.\\u000a \\u000a \\u000a \\u000a \\u000a Material and Methods:\\u000a   Cetuximab and bevacizumab have now been incorporated into phase I–II studies

Friederike Marquardt; Franz Rödel; Gianni Capalbo; Christian Weiss; Claus Rödel

2009-01-01

248

Controversial aspects of rectal cancer surgery following preoperative chemoradiation.  

PubMed

The role of surgery in the loco-regional control of adenocarcinoma of the rectum is being increasingly challenged by the good response rates of neoadjuvant oncological treatment. This review represents an opinion paper outlining well-established choices and new trends in surgical intervention, unresolved difficulties of local and regional staging of rectal malignancy and accurate assessment of tumour response to preoperative downstaging chemoradiation. The influence of preoperative chemoradiation on subsequent surgical strategy is discussed highlighting several controversial aspects of surgical management both when the tumour fails to respond and appears to be irresectable and when complete clinical response is observed. PMID:20618364

Artioukh, D Y

2010-08-01

249

Iatrogenic Rectal Perforation During Operative Colonoscopy: Closure With Endoluminal Clips  

PubMed Central

The risk of perforation during diagnostic or operative colonoscopy can be as high as 2%. Despite conservative treatment being acceptable, the closure of the perforation is usually mandatory, and surgery (either open or laparoscopic) is commonly advocated as rescue therapy. Currently, with the availability of the Endoclip, endoscopists are able to manage iatrogenic perforations avoiding surgery. Clip placement, if necessary, will not delay surgery and might help the surgeon find the site of perforation. However, data in the literature are scant, especially for the closure of large colonic defects. Endoscopic repair using Endoclip devices for a large high rectal perforation following polypectomy is described herein.

Vecchio Blanco, Giovanna Del; Benavoli, Domenico; Gaspari, Achille L.

2009-01-01

250

Primary rectal squamous cell carcinoma treated with surgery and radiotherapy.  

PubMed

Primary squamous cell carcinoma of the rectum is a rare malignancy, and the discrete dual lesions of rectum are even rarer. There is currently no effective and satisfactory treatment for this disease. Here we report a case of an elderly female with bi-primary squamous cell carcinoma of the rectum treated with radical resection and radiotherapy. The patient is still alive 43 mo after the initial curative resection of the tumor. We suggest that surgery as the primary treatment followed by concomitant radiotherapy may be an effective protocol for elderly patients with rectal squamous cell carcinoma. PMID:24744603

Wang, Jun-Feng; Wang, Zhen-Xing; Xu, Xiao-Xiao; Wang, Cui; Liu, Jian-Zhong

2014-04-14

251

Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases  

PubMed Central

Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS.

Urganc?, Nafiye; Eken, Kamile Gulcin

2013-01-01

252

Visual diagnosis: 12-year-old girl with constipation and rectal bleeding.  

PubMed

Rectal duplication cysts are rare, thought to be due to defects in embryologic development, and often associated with other structural abnormalities. Clues to the existence of a rectal cyst are mainly due to bowel compression and presence of ectopic gastric mucosa within the cyst, leading to rectal bleeding. The diagnosis of a rectal duplication cyst requires a high index of suspicion. Confirming the diagnosis can be difficult based on the location of the cyst. Efforts to confirm the diagnosis include digital rectal examination, computed tomography, magnetic resonance imaging, ultrasonography, and Meckel scan. Surgical resection is the treatment of choice, especially because of the cyst’s potential for malignant transformation. Because of the cyst’s proximal location to the nerves innervating the anal canal and sphincters, surgical resection can lead to fecal incontinence. PMID:24488834

Srinath, Arvind; Wendel, Danielle; Bond, Geoffrey; Lowe, Mark

2014-02-01

253

Rectal arteriovenous fistula resected laparoscopically after laparoscopic sigmoidectomy: a case report.  

PubMed

We report a very rare case of rectal arteriovenous fistula following sigmoidectomy and discuss this case in the context of the existing literature. In April 2011, the patient, a man in his 60s, underwent laparoscopic sigmoidectomy with lymph node dissection for sigmoid colon cancer. Beginning in February 2012, he experienced frequent diarrhea. Abdominal contrast-enhanced CT revealed local thickening of the rectal wall and rectal arteriovenous fistula near the anastomosis site. Rectitis from the rectal arteriovenous fistula was diagnosed. No improvement was seen with conservative treatment. Therefore, surgical resection was performed laparoscopically and the site of the lesion was confirmed by intraoperative angiography. The arteriovenous fistula was identified and resected. Postoperatively, diarrhea symptoms resolved, and improvement in rectal wall thickening was seen on abdominal CT. No recurrence has been seen as of 1 year postoperatively. PMID:24450345

Ushigome, Hajime; Hayakawa, Tetsushi; Morimoto, Mamoru; Kitagami, Hidehiko; Tanaka, Moritsugu

2014-01-01

254

Solitary rectal ulcer syndrome in children: a report of six cases.  

PubMed

Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS. PMID:24312719

Urganc?, Nafiye; Kalyoncu, Derya; Eken, Kamile Gulcin

2013-11-01

255

Indwelling bowel management system as a cause of life-threatening rectal bleeding.  

PubMed

A 79-year-old male was transferred to the intensive care unit for postoperative respiratory support. An indwelling bowel management system was inserted for containment of noninfective diarrhoea. Following only 11 days of continual use the patient developed life-threatening rectal bleeding. Preoperative normal rectal mucosa and anatomy were documented. There was no evidence of postoperative coagulopathy. Mesenteric angiography identified bleeding from a branch of the superior rectal artery. Rectal mucosa pressure necrosis secondary to the indwelling Flexi-Seal® Fecal Management System was diagnosed. The patient required an 11-unit transfusion of packed red cells. Following intraarterial coil embolization of the superior rectal artery the bleeding abated. Indwelling bowel management systems are commonly used in immobile and critically ill patients with diarrhoea or faecal incontinence. This is the first report of this important complication in the literature. PMID:21490868

Bright, Elizabeth; Fishwick, Guy; Berry, David; Thomas, Michael

2008-01-01

256

Indwelling Bowel Management System as a Cause of Life-Threatening Rectal Bleeding  

PubMed Central

A 79-year-old male was transferred to the intensive care unit for postoperative respiratory support. An indwelling bowel management system was inserted for containment of noninfective diarrhoea. Following only 11 days of continual use the patient developed life-threatening rectal bleeding. Preoperative normal rectal mucosa and anatomy were documented. There was no evidence of postoperative coagulopathy. Mesenteric angiography identified bleeding from a branch of the superior rectal artery. Rectal mucosa pressure necrosis secondary to the indwelling Flexi-Seal® Fecal Management System was diagnosed. The patient required an 11-unit transfusion of packed red cells. Following intraarterial coil embolization of the superior rectal artery the bleeding abated. Indwelling bowel management systems are commonly used in immobile and critically ill patients with diarrhoea or faecal incontinence. This is the first report of this important complication in the literature.

Bright, Elizabeth; Fishwick, Guy; Berry, David; Thomas, Michael

2008-01-01

257

Umbilical metastasis derived from early stage rectal cancer: a case report  

PubMed Central

Background Umbilical metastasis, also called Sister Mary Joseph’s nodule (SMJN), is defined as the umbilical nodule associated with advanced metastatic intra-abdominal and pelvic malignancies. A patient with umbilical metastasis has been deemed to have a poor prognosis. Rectal cancer presenting with a SMJN is a rare phenomenon, especially in the early stage and in middle-low rectal cancer. Case presentation We report a case of a 70-year-old male presenting with umbilical metastasis derived from rectal cancer (10 cm from the anal verge, T2N0). Discussion and conclusion For rectal cancer with umbilical metastasis, the exact metastatic routes as well as the criterion of diagnosis and treatments are not very clear. Here we review the literature on rectal cancer and SMJN to deepen the understanding of this disease.

2014-01-01

258

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

2012-05-01

259

A Comparative Proteomic Analysis of the Soluble Immune Factor Environment of Rectal and Oral Mucosa  

PubMed Central

Objective Sexual transmission of HIV occurs across a mucosal surface, which contains many soluble immune factors important for HIV immunity. Although the composition of mucosal fluids in the vaginal and oral compartments has been studied extensively, the knowledge of the expression of these factors in the rectal mucosa has been understudied and is very limited. This has particular relevance given that the highest rates of HIV acquisition occur via the rectal tract. To further our understanding of rectal mucosa, this study uses a proteomics approach to characterize immune factor components of rectal fluid, using saliva as a comparison, and evaluates its antiviral activity against HIV. Methods Paired salivary fluid (n?=?10) and rectal lavage fluid (n?=?10) samples were collected from healthy, HIV seronegative individuals. Samples were analyzed by label-free tandem mass spectrometry to comprehensively identify and quantify mucosal immune protein abundance differences between saliva and rectal fluids. The HIV inhibitory capacity of these fluids was further assessed using a TZM-bl reporter cell line. Results Of the 315 proteins identified in rectal lavage fluid, 72 had known immune functions, many of which have described anti-HIV activity, including cathelicidin, serpins, cystatins and antileukoproteinase. The majority of immune factors were similarly expressed between fluids, with only 21 differentially abundant (p<0.05, multiple comparison corrected). Notably, rectal mucosa had a high abundance of mucosal immunoglobulins and antiproteases relative to saliva, Rectal lavage limited HIV infection by 40–50% in vitro (p<0.05), which is lower than the potent anti-HIV effect of oral mucosal fluid (70–80% inhibition, p<0.005). Conclusions This study reveals that rectal mucosa contains many innate immune factors important for host immunity to HIV and can limit viral replication in vitro. This indicates an important role for this fluid as the first line of defense against HIV.

Romas, Laura M.; Hasselrot, Klara; Aboud, Lindsay G.; Birse, Kenzie D.; Ball, T. Blake; Broliden, Kristina; Burgener, Adam D.

2014-01-01

260

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

2003-01-01

261

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

262

Differences in telomerase activity between colon and rectal cancer  

PubMed Central

Background Colorectal cancer is one of the most common cancers and the third leading cause of cancer death in both sexes. The disease progresses as a multistep process and is associated with genetic alterations. One of the characteristic features of cancer is telomerase activation. We sought to evaluate the differences in telomerase activity between colon cancer and adjacent normal tissue and to correlate the differences in telomerase activity between different locations with clinicopathological factors and survival. Methods Matched colon tumour samples and adjacent normal mucosa samples 10 cm away from the tumour were collected during colectomy. We assessed telomerase activity using real time polymerase chain reaction. Several pathological characteristics of tumours, including p53, Ki-67, p21, bcl2 and MLH1 expression were also studied. Results We collected samples from 49 patients. There was a significantly higher telomerase activity in colon cancer tissue than normal tissue. Adenocarcinomas of the right colon express significantly higher telomerase than left-side cancers. Colon cancers and their adjacent normal tissue had significantly more telomerase and were more positive to MLH1 than rectal cancers. The expression of p53 negatively correlated to telomerase activity and was linked to better patient survival. Conclusion Colon and rectal cancers seem to have different telomerase and MLH1 profiles, and this could be another factor for their different biologic and clinical behaviour and progression. These results support the idea that the large bowel cannot be considered a uniform organ, at least in the biology of cancer.

Ayiomamitis, Georgios D.; Notas, George; Zaravinos, Apostolos; Zizi-Sermpetzoglou, Adamantia; Georgiadou, Maria; Sfakianaki, Ourania; Kouroumallis, Elias

2014-01-01

263

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

264

An Update on Preoperative Radiotherapy for Locally Advanced Rectal Cancer  

PubMed Central

Even in patients undergoing an optimal surgical technique (e.g., total mesorectal excision), radiotherapy provides a significant benefit in the local control of rectal cancer. Compared with postoperative treatment, chemoradiotherapy given preoperatively has been shown to decrease local recurrence rates and toxicity. Additionally, preoperative chemoradiotherapy permits the early identification of tumor responses to this cytotoxic treatment by surgical pathology. Pathological parameters reflecting the tumor response to chemoradiotherapy have been shown to be surrogate markers for long-term clinical outcomes. Post-chemoradiotherapy downstaging from cStage II-III to ypStage 0-I indicates a favorable prognosis, with no difference between ypStage 0 and ypStage I. Research is ongoing to develop useful tools (clinical, molecular, and radiological) for clinical determination of the pathologic chemoradiotherapeutic response before surgery, and possibly even before preoperative treatment. In the future, risk-adapted strategies, including intensification of preoperative therapy, conservative surgery, or the selective administration of postoperative chemotherapy, will be realized for locally-advanced rectal cancer patients based on their response to preoperative chemoradiotherapy.

Yeo, Seung-Gu

2012-01-01

265

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

266

[Thermography in the diagnosis of recurrences of rectal cancer].  

PubMed

Thermography results of 126 patients were analysed for the diagnosis of recurrences of rectal cancer. Sixteen patients were examined after radical operations for rectal cancer without signs of recurrence to study the features of a thermal regimen in this area. The examination included thermoscopy, thermography and distant thermometry. The presence of the zone of hyperthermia in the perineum with the involvement of the sacral region and the coccygeal bone after extirpation of the rectum was shown to indicate cancer recurrence. The coincidence of thermography findings with those of computerized and ultrasound tomography was observed in 81.7% of the cases. As a result of a perineal fistula, chronic prostatitis, etc., false positive results of thermography were marked in 17 (18.3%) patients. False negative results were not observed. A rise of local temperature from +0.5 to 1 degrees C was considered suspicious of cancer recurrence. These patients were actively followed up and it allowed one to confirm cancer recurrence in them after 3-6 mos. The use of thermography as a screening test made it possible to detect cancer recurrence and to define a high risk group in need of an active follow up and more thorough clinical examination. PMID:4068939

Lenskaia, O P; Ozhiganov, E L; Bogdasarov, Iu B

1985-11-01

267

Formulation and Evaluation of Irinotecan Suppository for Rectal Administration  

PubMed Central

Irinotecan suppository was prepared using the moulding method with a homogeneous blend. A sensitive and specific fluorescence method was developed and validated for the determination of irinotecan in plasma using HPLC. The pharmacokinetics of intravenous administered and rectal administered in rabbits was investigated. Following a single intravenous dose of irinotecan (50 mg/kg), the plasma irinotecan concentration demonstrated a bi-exponential decay, with a rapid decline over 15 min. Cmax, t1/2, AUC0–30h and AUC0-? were 16.1 ± 2.7 g/ml, 7.6 ± 1.2 h, 71.3 ± 8.8 ?g·h/ml and 82.3 ± 9.5 ?g·h/ml, respectively. Following rectal administration of 100 mg/kg irinotecan, the plasma irinotecan concentration reached a peak of 5.3 ± 2.5 ?g/ml at 4 h. The AUC0–30h and AUC0-? were 32.2 ± 6.2 ?g·h/ml and 41.6 ± 7.2 ?g·h/ml, respectively. It representing ?50.6% of the absolute bioavailability.

Feng, Haiyang; Zhu, Yuping; Li, Dechuan

2014-01-01

268

Rectal suction biopsy for the diagnosis of Hirschsprung's disease.  

PubMed Central

The diagnosis of Hirschsprung's disease is at times difficult, particularly in the young patient. Since 1972 we have used rectal suction biopsy as a screening technique in neonates and infants with failure to pass meconium or evidence of obstruction. In addition, it is used to confirm the diagnosis of Hirschsprung's disease when suspected by barium enema study. This technique has been used in 444 patients, 302 of whom were less than one year of age. No anesthesia is necessary, and there have been no associated complications. Only one patient early in the study had an initial misdiagnosis. There have been no false-positive or false-negative specimens since this initial problem, and no patients have undergone inappropriate pull-through procedures for suspected Hirschsprung's disease. It is recommended that all neonates who do not pass meconium in the first 48 hours of life undergo rectal suction biopsy to establish the diagnosis of congenital megacolon. Images Fig. 1a. Fig. 1b. Fig. 2. Fig. 3.

Andrassy, R J; Isaacs, H; Weitzman, J J

1981-01-01

269

Longitudinal plication - a surgical strategy for complete rectal prolapse management  

PubMed Central

Background Rectal prolapse is a known problem since antiquity and the cause is not fully understood. Despite the presence of more than 100 lines of treatment, none of them is ideal. Methods Between the years of (2005–2011), thirty patients with full-thickness rectal prolapse were operated upon. Age ranged between (2–65 years) with a mean of 21.5 year. Male to female ratio was (2:1). Each prolapsed rectum was repaired with longitudinal plication (LP) at two or three points accordingly using braded polyglycolic acid – absorbable 1.0 suture material. Plications started by inserting a stitch at the most proximal part of the prolapse, followed by successive similar transverse stiches continuing in a spiral fashion till the mucocutaneous junction. We used three LP in adults and two in children. All of the patients where operated upon as a day-case procedure and discharged 6 hours after the operation. Results In this series of patients, twenty-nine of them had complete recovery from the prolapse. Only one patient had recurrence 2 years after the operation, and the same procedure was applied successfully with uneventful post-operative period. Although twenty-three patients had fecal Incontinence, twenty-one of them regained continence after operation. Conclusions This method is an easy perineal procedure, with fewer complications. It can be performed for all age groups, in an ordinary surgical unit, by an expert anorectal surgeon. We found that our procedure is simple, safe and less invasive.

2014-01-01

270

A Simple and Safe Procedure to Repair Rectal Prolapse Perineally Using Stapling Devices  

PubMed Central

Rectal prolapses are not life-threatening, however the bleeding and fecal incontinence associated with them significantly erode quality of life and can cause concern among patients’ caregivers in nursing homes. Many procedures have been reported that repair rectal prolapses, and the procedure used depends on the severity of the prolapse; however, the treatments are yet to be established. Here we report a simple and safe procedure to repair rectal prolapse perineally using stapling devices. We performed this procedure on 5 patients within a short time. All patients were followed up for over 24 months and none had any recurrences of their rectal prolapses. No complications occurred during the operations and postoperative periods. Most patients who have prolapses are elderly and fragile, so the treatment must be easy, safe, and rapid. While rectal prolapse is not life-threatening, the goal of treatment is to alleviate its symptoms. The procedure we describe is consistent with this concept. We suggest that this procedure, which uses surgical stapling devices, might be a better option for the treatment of complete rectal prolapse. We will continue to surgically correct complete rectal prolapses and investigate the long-term outcomes of the procedure.

Hata, Fumitake; Nishimori, Hidefumi; Ikeda, Shinichiro; Yajima, Tomomi; Nishio, Akihiko; Ishiyama, Yuji

2014-01-01

271

Penetrating bladder trauma: a high risk factor for associated rectal injury.  

PubMed

Demographics and mechanisms were analyzed in prospectively maintained level one trauma center database 1990-2012. Among 2,693 trauma laparotomies, 113 (4.1%) presented bladder lesions; 51.3% with penetrating injuries (n = 58); 41.3% (n = 24) with rectal injuries, males corresponding to 95.8%, mean age 29.8 years; 79.1% with gunshot wounds and 20.9% with impalement; 91.6% arriving the emergence room awake (Glasgow 14-15), hemodynamically stable (average systolic blood pressure 119.5?mmHg); 95.8% with macroscopic hematuria; and 100% with penetrating stigmata. Physical exam was not sensitive for rectal injuries, showing only 25% positivity in patients. While 60% of intraperitoneal bladder injuries were surgically repaired, extraperitoneal ones were mainly repaired using Foley catheter alone (87.6%). Rectal injuries, intraperitoneal in 66.6% of the cases and AAST-OIS grade II in 45.8%, were treated with primary suture plus protective colostomy; 8.3% were sigmoid injuries, and 70.8% of all injuries had a minimum stool spillage. Mean injury severity score was 19; mean length of stay 10 days; 20% of complications with no death. Concomitant rectal injuries were not a determinant prognosis factor. Penetrating bladder injuries are highly associated with rectal injuries (41.3%). Heme-negative rectal examination should not preclude proctoscopy and eventually rectal surgical exploration (only 25% sensitivity). PMID:24527030

Pereira, B M; Reis, L O; Calderan, T R; de Campos, C C; Fraga, G P

2014-01-01

272

Rectal and vaginal immunization of mice with human papillomavirus L1 virus-like particles.  

PubMed

Human papillomavirus (HPV) vaccines based on L1 virus-like particle (VLP) can prevent genital HPV infection and associated lesions after three intramuscular injections. Needle-free administration might facilitate vaccine implementation, especially in developing countries. Here we have investigated rectal and vaginal administration of HPV16 L1 VLPs in mice and their ability to induce anti-VLP and HPV16-neutralizing antibodies in serum and in genital, rectal and oral secretions. Rectal and vaginal immunizations were not effective in the absence of adjuvant. Cholera toxin was able to enhance systemic and mucosal anti-VLPs responses after rectal immunization, but not after vaginal immunization. Rectal immunization with Resiquimod and to a lesser extent Imiquimod, but not monophosphoryl lipid A, induced anti-HPV16 VLP antibodies in serum and secretions. Vaginal immunization was immunogenic only if administered in mice treated with nonoxynol-9, a disrupter of the cervico-vaginal epithelium. Our findings show that rectal and vaginal administration of VLPs can induce significant HPV16-neutralizing antibody levels in secretions, despite the fact that low titers are induced in serum. Imidazoquinolines, largely used to treat genital and anal warts, and nonoxonol-9, used as genital microbicide/spermicide were identified as adjuvants that could be safely used by the rectal or vaginal route, respectively. PMID:19428847

Fraillery, Dominique; Zosso, Nathalie; Nardelli-Haefliger, Denise

2009-04-14

273

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

274

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

275

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

276

Volume-outcome relationship in rectal cancer surgery: A new perspective  

Microsoft Academic Search

Purpose  Numerous studies on the volume-outcome relationships in rectal cancer surgery have assessed surgical mortality. However, little\\u000a is known about the association between hospital\\/surgeon volumes and postoperative complications, including anastomotic leakage\\u000a and infection, following rectal cancer surgery.\\u000a \\u000a \\u000a \\u000a Methods  Using a web-based patient registration system, data were collected on inpatients who underwent rectal cancer surgery between\\u000a November 1, 2006 and February 28, 2007

Hideo Yasunaga; Yutaka Matsuyama; Kazuhiko Ohe

2009-01-01

277

Treatment of locally recurrent rectal cancer with special focus on regional pelvic hyperthermia.  

PubMed

Progress in surgery and adjuvant therapy has markedly improved local control and survival rates in patients with primary, non-metastatic rectal cancer. However, the prognosis of patients with locally recurrent disease is still poor, and a realistic chance for repeated treatment with curative intent is still restricted to the minority of cases. Therefore, effective palliation of symptoms and preservation of a good quality of life are the major goals of therapy for most patients with local recurrence of rectal cancer. Here we give a short overview on the options available for the treatment of pelvic recurrence of rectal cancer, with special focus on adjunctive regional pelvic radiofrequency hyperthermia. PMID:15585984

Hildebrandt, B; Wust, P; Gellermann, J; Nicolaou, A; Trappe, R-U; Felix, R; Riess, H; Rau, B

2004-10-01

278

Prevalence and types of rectal douches used for anal intercourse: results from an international survey  

PubMed Central

Background Rectal products used with anal intercourse (AI) may facilitate transmission of STIs/HIV. However, there is limited data on rectal douching behavior in populations practicing AI. We examined the content, types of products, rectal douching practices and risk behaviors among those reporting AI. Methods From August 2011 to May 2012, 1,725 women and men reporting receptive AI in the past 3 months completed an internet-based survey on rectal douching practices. The survey was available in English, French, German, Mandarin, Portuguese, Russian, Spanish, and Thai and included questions on sexual behaviors associated with AI including rectal douching. Differences by rectal douching practices were evaluated using chi-square methods and associations between reported douching practices and other factors including age and reported STI history were evaluated using logistic regression analysis. Results Respondents represented 112 countries, were mostly male (88%), and from North America (55%) or Europe (22%). Among the 1,339 respondents (66%) who reported rectal douching, most (83%) reported always/almost always douching before receptive AI. The majority of rectal douchers reported using non-commercial/homemade products (93%), with water being the most commonly used product (82%). Commercial products were used by 31%, with the most common product being saline-based (56%). Rectal douching varied by demographic and risk behaviors. The prevalence of rectal douching was higher among men (70% vs. 32%; p-value?rectal douching before receptive AI is common and because rectal douching was associated with other sexual risk behaviors the contribution of this practice to the transmission and acquisition of STIs including HIV may be important.

2014-01-01

279

The Use of Rectal Douches among HIV-uninfected and Infected Men who Have Unprotected Receptive Anal Intercourse: Implications for Rectal Microbicides  

PubMed Central

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). 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.

Carballo-Dieguez, Alex; Bauermeister, Jose A.; Ventuneac, Ana; Dolezal, Curtis; Balan, Ivan; Remien, Robert H.

2010-01-01

280

Rectal impalement injury through the pelvis, abdomen and thorax  

PubMed Central

Impalement rectal injuries with intraperitoneal organ injuries are rare. It is even rarer for such injuries to result in pelvic, abdominal and thoracic internal injuries. We present the case of a 39-year-old man who was admitted after an assault where a broken broomstick was inserted forcibly into his rectum. Surgery revealed penetration through the rectum, dome of the bladder, mesentery, liver and right lung. The patient survived following management by a multispecialty surgical team. Our literature review identified four similar cases with one fatality only. Prognosis seems to be good in these types of injuries provided there is an early presentation, the penetrating object is left in situ before the operation and, most importantly, an organised team approach to deal with the various injuries.

Ho, LC; El Shafei, H; Barr, J; Al Kari, B

2012-01-01

281

Rectal impalement injury through the pelvis, abdomen and thorax.  

PubMed

Impalement rectal injuries with intraperitoneal organ injuries are rare. It is even rarer for such injuries to result in pelvic, abdominal and thoracic internal injuries. We present the case of a 39-year-old man who was admitted after an assault where a broken broomstick was inserted forcibly into his rectum. Surgery revealed penetration through the rectum, dome of the bladder, mesentery, liver and right lung. The patient survived following management by a multispecialty surgical team. Our literature review identified four similar cases with one fatality only. Prognosis seems to be good in these types of injuries provided there is an early presentation, the penetrating object is left in situ before the operation and, most importantly, there is an organised team approach to deal with the various injuries. PMID:22943322

Ho, L C; El Shafei, H; Barr, J; Al Kari, B; Aly, E H

2012-09-01

282

Rectal duplications accompanying rectovestibular fistula: report of two cases.  

PubMed

Rectal duplication (RD) cysts are rare congenital anomalies that can be diagnosed with the presence of another opening in the perineum. They seldom accompany anorectal malformations (ARM). Two cases of RD accompanying ARM at opposite ends of the phenotypic spectrum, are described. A 3-month-old baby and a 2-year-old girl with ARM were scheduled for posterior sagittal anorectoplasty. The infant had an orifice at the anal dimple and the other had an orifice at the vestibulum posterior to the rectovestibular fistula. The infant presented with no other anomalies whereas the older one presented with an unusual coexistence of caudal duplication and caudal regression syndromes. Perioperatively both orifices were found to be related to retrorectal cysts, and were excised. Clinicians should always be alert when dealing with complex malformations. Because these malformations have variable anatomical and clinical presentations, they can represent a diagnostic and therapeutic challenge. PMID:23910814

Pampal, Arzu; Ozbayoglu, Asli; Kaya, Cem; Pehlivan, Yildiz; Poyraz, Aylar; Ozen, I Onur; Percin, Ferda E; Demirogullari, Billur

2013-08-01

283

Use of robotics in colon and rectal surgery.  

PubMed

The pace of innovation in the field of surgery continues to accelerate. As new technologies are developed in combination with industry and clinicians, specialized patient care improves. In the field of colon and rectal surgery, robotic systems offer clinicians many alternative ways to care for patients. From having the ability to round remotely to improved visualization and dissection in the operating room, robotic assistance can greatly benefit clinical outcomes. Although the field of robotics in surgery is still in its infancy, many groups are actively investigating technologies that will assist clinicians in caring for their patients. As these technologies evolve, surgeons will continue to find new and innovative ways to utilize the systems for improved patient care and comfort. PMID:24436647

Pucci, Michael J; Beekley, Alec C

2013-03-01

284

Use of Robotics in Colon and Rectal Surgery  

PubMed Central

The pace of innovation in the field of surgery continues to accelerate. As new technologies are developed in combination with industry and clinicians, specialized patient care improves. In the field of colon and rectal surgery, robotic systems offer clinicians many alternative ways to care for patients. From having the ability to round remotely to improved visualization and dissection in the operating room, robotic assistance can greatly benefit clinical outcomes. Although the field of robotics in surgery is still in its infancy, many groups are actively investigating technologies that will assist clinicians in caring for their patients. As these technologies evolve, surgeons will continue to find new and innovative ways to utilize the systems for improved patient care and comfort.

Pucci, Michael J.; Beekley, Alec C.

2013-01-01

285

[Ultrasound diagnostics and preoperative staging of rectal cancer].  

PubMed

Ultrasound (transrectal and transabdominal) examination was performed in 1991 patients. Rectal tumors were revealed in 117 (5,9%) patients, liver metastases were diagnosed in 31 (26,5%) patients. Transrectal ultrasound allowed to diagnose tumor in all examined 50 patients. Stage uT2 was diagnosed in 20 (40%) and uT3 stage of rectum cancer in 30 (60%) of patients. 10 (20%) patients revealed a pararectal lymph nodes tumor invasion. All patients were operated on. The sensitivity of the method for rectum cancer staging was 95,6%, specificity--40%, accuracy 85,7%. Sensitivity of ultrasound in pararectal lymph nodes invasion detection was 95,2%, specificity--95,0% and accuracy--92,3%. PMID:18833188

Sazhin, V P; Zhabolenko, V P; Gostin, P A; Siatkin, D A

2008-01-01

286

IL6 genotypes and colon and rectal cancer  

PubMed Central

Inflammation appears to play a key role in the development of colorectal cancer (CRC). In this study we examine factors involved in the regulation of inflammation and risk of CRC. Data from a multi-center case–control study of colon (N = 1579 cases and N = 1977 controls) and rectal (N = 794 cases and N = 1005 controls) cancer were used to evaluate the association between the rs1800795 and rs1800796 IL6 polymorphisms and CRC. We evaluated the joint effects of IL6 single nucleotide polymorphisms and regular use of aspirin/NSAIDs and vitamin D receptor (VDR) genotype. Having a C allele of the rs1800796 IL6 polymorphisms and the GG genotype of the rs1800795 IL6 polymorphisms was associated with a statistically significantly reduced the risk of colon (OR 0.76 95% CI 0.57, 1.00), but not rectal (OR 1.49 95% CI 1.02,2.16) cancer. Both IL6 polymorphisms were associated with significant interaction with current use of aspirin/NSAIDs to alter risk of colon cancer: individuals with a C allele in either polymorphism who were current users of aspirin/NSAIDs had the lowest colon cancer risk. CRC risk also was associated with an interaction between VDR and IL6 genotypes that was modified by current use of aspirin/NSAIDs. This study provides further support for inflammation-related factors in the etiology of CRC. Other studies are needed to explore other genes in this and other inflammation-related pathways.

Wolff, Roger K.; Herrick, Jennifer S.; Caan, Bette J.; Potter, John D.

2008-01-01

287

Molecular prognostic factors in rectal cancer treated by preoperative chemoradiotherapy  

PubMed Central

The present study evaluated the expression of p53, pRb, hMLH1 and MDM2 prior to preoperative chemoradiotherapy (CRT) in patients with rectal cancer, and attempted to determine any correlation with treatment outcome. Forty-five patients with available pretreatment biopsy tissues and who received preoperative CRT were enrolled in this study. Preoperative CRT consisted of a median 50.4 Gy and 2 cycles of concurrent administration of 5-fluorouracil + leucovorin. Surgery was performed approximately seven weeks after CRT. Protein expression in formalin-fixed paraffin-embedded biopsy specimens was assessed by immunohistochemistry. A positive expression of p53, pRb, hMLH1 and MDM2 was found in 40, 46.7, 40 and 66.7% of the tissue specimens, respectively. The 5-year overall (OS), disease-free (DFS) and locoregional recurrence-free survival (LRFS) rates for patients included in the study were 71.3, 66.1 and 60.9%, respectively. p53 expression presented a significantly different OS (positive vs. negative, 45.8 vs. 86.2%; p=0.02). However, the expression of pRb, hMLH1 and MDM2 was not significant for OS. The expression of p53 was a borderline significant prognostic factor for DFS and for LRFS. Age, p53 and MDM2 expression were significant factors in the multivariate analysis performed for OS with 12 covariates, including 8 clinicopathological parameters and 4 proteins. No significant factor affected DFS or LRFS in the multivariate analysis. We suggest that the expression of p53 is a potential marker of survival. Determinations of this protein expression may be useful for selecting candidates from rectal cancer patients for more tailored treatment.

NAM, TAEK-KEUN; LEE, JI-SHIN; KIM, HYEONG-ROK; AHN, SUNG-JA; SONG, JU-YOUNG; YOON, MEE SUN

2010-01-01

288

Pharmacokinetics and metabolism of rectally administered paracetamol in preterm neonates  

PubMed Central

AIM—To investigate the pharmacokinetics, metabolism, and dose-response relation of a single rectal dose of paracetamol in preterm infants in two different age groups. ?METHODS—Preterm infants stratified by gestational age groups 28-32 weeks (group 1) and 32-36 weeks (group 2) undergoing painful procedures were included in this study. Pain was assessed using a modified facies pain score. ?RESULTS—Twenty one infants in group 1 and seven in group 2 were given a single rectal dose of 20 mg/kg body weight. Therapeutic concentrations were reached in 16/21 and 1/7 infants in groups 1 and 2, respectively. Peak serum concentrations were significantly higher in group 1.Median time to reach peak concentrations was similar in the two groups. As serum concentration was still in the therapeutic range for some infants in group 1, elimination half life (T1/2) could not be determined in all infants: T1/2 was 11.0 ± 5.7in 11 infants in group 1 and 4.8 ± 1.2 hours in group 2. Urinary excretion was mainly as paracetamol sulphate. The glucuronide:sulphate ratio was 0.12 ± 0.09 (group 1) and 0.28 ± 0.35 (group 2). The pain score did not correlate with therapeutic concentrations.?CONCLUSIONS—A 20 mg/kg single dose of paracetamol can be safely given to preterm infants in whom sulphation is the major pathway of excretion. Multiple doses in 28-32 week old neonates would require an interval of more than 8 hours to prevent progressively increasing serum concentrations.??

van Lingen, R A; Deinum, J; Quak, J; Kuizenga, A; van Dam, J G; Anand, K; Tibboel, D; Okken, A

1999-01-01

289

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

2013-11-01

290

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

291

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

292

Rectal adenocarcinoma resection specimen with an incidental carcinoid in the resection margin  

PubMed Central

Three cases of incidental carcinoid tumors have been identified in the surgical margin of rectal adenocarcinoma resection specimens. In all cases the rectal carcinoids exhibited low-risk features, such as a tumor size <10 mm, no muscularis propria invasion and no lymph node involvement. No further excision was conducted and the three cases were followed up for 38, 26 and 14 months, respectively. No regional or distant rectal carcinoid recurrence was identified. Occasionally this is inevitable in order to achieve a positive resection margin for the microcarcinoid during the surgical treatment of another malignancy. However, such carcinoids are usually low-risk and behave less aggressively than same-site adenocarcinomas. Thus, it appears reasonable to avoid further excision in patients who are undergoing a rectal adenocarcinoma resection that exhibits a positive margin for low-risk carcinoid tumor.

ZHOU, JIE; TENG, XIAODONG

2014-01-01

293

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

294

McKittrick-Wheelock syndrome presenting with dermatomyositis and rectal prolapsed  

PubMed Central

McKittrick–Wheelock syndrome is a rare disease characterized by a large hypersecretory rectosigmoid villous adenoma resulting in persistent large volume diarrhea, electrolyte abnormalities, and renal dysfunction. We report an unusual presentation of this syndrome in a patient who developed persistent diarrhea along with dermatomyositis and rectal prolapse and was later discovered to have a large rectal villous adenoma along with a smaller sigmoid tubulovillous adenoma. In our literature review, we were able to find one case report of a dermatomyositis occurring in conjunction with a tubulovillous adenoma and few case reports of rectal prolapse in the setting of a secretory villous adenoma. However, there were no reports on both occurring in association with McKittrick–Wheelock syndrome. This report highlights the variable manifestations of colorectal adenomas and the importance of searching for an underlying neoplastic entity in patients with new onset dermatomyositis or rectal prolapse or both.

Khalife, Mohamad; Eloubeidi, Mohamad A; Hosn, Maen Aboul

2013-01-01

295

McKittrick-Wheelock syndrome presenting with dermatomyositis and rectal prolapsed.  

PubMed

McKittrick-Wheelock syndrome is a rare disease characterized by a large hypersecretory rectosigmoid villous adenoma resulting in persistent large volume diarrhea, electrolyte abnormalities, and renal dysfunction. We report an unusual presentation of this syndrome in a patient who developed persistent diarrhea along with dermatomyositis and rectal prolapse and was later discovered to have a large rectal villous adenoma along with a smaller sigmoid tubulovillous adenoma. In our literature review, we were able to find one case report of a dermatomyositis occurring in conjunction with a tubulovillous adenoma and few case reports of rectal prolapse in the setting of a secretory villous adenoma. However, there were no reports on both occurring in association with McKittrick-Wheelock syndrome. This report highlights the variable manifestations of colorectal adenomas and the importance of searching for an underlying neoplastic entity in patients with new onset dermatomyositis or rectal prolapse or both. PMID:23825927

Khalife, Mohamad; Eloubeidi, Mohamad A; Hosn, Maen Aboul

2013-01-01

296

Can mesorectal lymph node excision be avoided in rectal cancer surgery?  

PubMed

Rectal excision is the standard in rectal cancer treatment. The morbidity of rectal excision, together with the low rate of positive lymph nodes in patients with a good response after radiochemotherapy, raises the challenging concept of organ preservation. Patients with a complete response can benefit from a nonoperative strategy based on a strict follow up. Those with a complete or subcomplete response can be treated by local excision. Limitations in accurately assessing a complete response by conventional and modern imaging modalities suggest that local excision is more appropriate for the majority of patients when organ preservation is being considered. The encouraging results of retrospective series of local excision in downstaged clinical T2/T3 low rectal cancer after radiochemotherapy, however, need to be confirmed by the ongoing multicentre phase II United States and phase III French trials before routinely proposing organ preservation in patients with a good response. PMID:22098516

Rullier, E; Vendrely, V

2011-11-01

297

Rectal Colonization by Group B Streptococcus as a Predictor of Vaginal Colonization  

PubMed Central

Objective To describe rectal colonization by Group B Streptococcus (GBS) and its role in predicting vaginal colonization. Study Design In this prospective cohort of 1248 nonpregnant women, vaginal and rectal swabs for GBS culture were obtained at enrollment and three 4-month intervals. Generalized estimating equations were used to identify factors associated with colonization. Results Eight hundred fourteen (65%) women were colonized by GBS sometime during the observation period. Rectal GBS colonization was the strongest predictor of vaginal colonization (adjusted odds ratio = 14.3; 95% confidence interval: 11.9 to 17.1). Recent sexual intercourse, vaginal colonization with yeast, and a vaginal Nugent score ? 4 were also independent determinants of vaginal GBS colonization. Antimicrobial use decreased vaginal GBS colonization only among women lacking rectal colonization. Conclusions GBS in the gastrointestinal tract is a risk factor for vaginal GBS. Sexual activity and abnormal vaginal microflora are independent determinants of vaginal GBS colonization.

MEYN, Leslie A.; KROHN, Marijane A.; HILLIER, Sharon L.

2009-01-01

298

Case report: locoregional (perineum and inguinal) recurrence after treatment of rectal cancer by low anterior resection  

PubMed Central

This report presents a case of perineal and inguinal recurrence and metastasis after treatment of rectal cancer by low anterior resection. A 57-year-old Chinese woman was diagnosed with rectal cancer in September 2008. The tumor and metastasis were recurrent many times in the perineum and inguinal regions from first diagnosis to October 2011. Twelve surgeries were performed and several nodules were removed. Adjuvant radiation therapy and chemotherapy were also carried out. Pathological analysis indicated that most nodules were adenocarcinoma. The interesting finding was that this case did not seem to belong to any traditional rectal cancer metastasis pathway. This case is representative and worthy of further study to explore whether there is another rectal cancer metastasis pathway.

2013-01-01

299

Single-layer continuous colon and rectal anastomosis using monofilament absorbable suture (Maxon®)  

Microsoft Academic Search

PURPOSE: The study purpose was to evaluate the results of continuous, single-layer colon and rectal anastomoses using a monofilament absorbable suture material (Maxon®). METHODS: Four hundred ninety-two consecutive patients undergoing five hundred colon and rectal anastomoses with the above technique were evaluated for outcome, including anastomotic leakage, stricture, and other complications, by means of chart review. RESULTS: Three patients (0.6

W. L. Law; H. Randolph Bailey; Ernest Max; Donald R. Butts; Kenneth W. Smith; David A. Thompson; Gary B. Skakun; Ernie Graves

1999-01-01

300

Lack of Prophylactic Efficacy of Oral Maraviroc in Macaques despite High Drug Concentrations in Rectal Tissues  

PubMed Central

Maraviroc (MVC) is a potent CCR5 coreceptor antagonist that is in clinical testing for daily oral pre-exposure prophylaxis (PrEP) for HIV prevention. We used a macaque model consisting of weekly SHIV162p3 exposures to evaluate the efficacy of oral MVC in preventing rectal SHIV transmission. MVC dosing was informed by the pharmacokinetic profile seen in blood and rectal tissues and consisted of a human-equivalent dose given 24 h before virus exposure, followed by a booster postexposure dose. In rectal secretions, MVC peaked at 24 h (10,242 ng/ml) with concentrations at 48 h that were about 40 times those required to block SHIV infection of peripheral blood mononuclear cells (PBMCs) in vitro. Median MVC concentrations in rectal tissues at 24 h (1,404 ng/g) were 30 and 10 times those achieved in vaginal or lymphoid tissues, respectively. MVC significantly reduced macrophage inflammatory protein 1?-induced CCR5 internalization in rectal mononuclear cells, an indication of efficient binding to CCR5 in rectal lymphocytes. The half-life of CCR5-bound MVC in PBMCs was 2.6 days. Despite this favorable profile, 5/6 treated macaques were infected during five rectal SHIV exposures as were 3/4 controls. MVC treatment was associated with a significant increase in the percentage of CD3+/CCR5+ cells in blood. We show that high and durable MVC concentrations in rectal tissues are not sufficient to prevent SHIV infection in macaques. The increases in CD3+/CCR5+ cells seen during MVC treatment point to unique immunological effects of CCR5 inhibition by MVC. The implications of these immunological effects on PrEP with MVC require further evaluation.

Massud, Ivana; Aung, Wutyi; Martin, Amy; Bachman, Shanon; Mitchell, James; Aubert, Rachael; Solomon Tsegaye, Theodros; Kersh, Ellen; Pau, Chou-Pong; Heneine, Walid

2013-01-01

301

Differences in Survival between Colon and Rectal Cancer from SEER Data  

PubMed Central

Background Little is known about colorectal cancer or colon and rectal cancer. Are they the same disease or different diseases? Objectives The aim of this epidemiology study was to compare the features of colon and rectal cancer by using recent national cancer surveillance data. Design and setting Data included colorectal cancer (1995–2008) from the Surveillance, Epidemiology, and End Results Program (SEER) database. Only adenocarcinoma was included for analysis. Patients A total of 372,130 patients with a median follow-up of 32 months were analyzed. Main outcome measures Mean survival of patients with the same stage of colon and rectal cancer was evaluated. Results Around 35% of patients had stage information. Among them, colon cancer patients had better survival than those with rectal cancer, by a margin of 4 months in stage IIB. In stage IIIC and stage IV, rectal cancer patients had better survival than colon cancer patients, by about 3 months. Stage IIB colorectal cancer patients had a poorer prognosis than those with stage IIIA and IIIB colorectal cancer. After adjustment of age, sex and race, colon cancer patients had better survival than rectal cancer of stage IIB, but in stage IIIC and IV, rectal cancer patients had better survival than colon cancer. Limitations The study is limited by its retrospective nature. Conclusion This was a population-based study. The prognosis of rectal cancer was not worse than that of colon cancer. Local advanced colorectal cancer had a poorer prognosis than local regional lymph node metastasis. Stage IIB might require more aggressive chemotherapy, and no less than that for stage III.

Lee, Yen-Chien; Lee, Yen-Lin; Chuang, Jen-Pin; Lee, Jenq-Chang

2013-01-01

302

Limited segmental anterior rectal resection for the treatment of rectovaginal endometriosis: pain and complications  

Microsoft Academic Search

The aim of this cohort study was to assess the long-term response, complications and quality of life in patients undergoing\\u000a segmental anterior rectal resection for endometriosis. The subjects consisted of patients who have undergone a segmental anterior\\u000a rectal resection for endometriosis in the setting of a tertiary referral unit for the management of severe endometriosis.\\u000a The data were obtained by

J. English; N. Kenney; S. Edmonds; M. K. Baig; A. Miles

2007-01-01

303

Ten-Year Historic Cohort of Quality of Life and Sexuality in Patients With Rectal Cancer  

Microsoft Academic Search

PURPOSE  In various studies, type of surgery, age, and gender had different impact on sexuality and quality of life in patients with rectal cancer. This study was designed to investigate how sexuality and quality of life are affected by age, gender, and type of surgery.METHODS  A total of 516 patients who had undergone surgery for rectal cancer in our department from 1992

Christian E. Schmidt; Beate Bestmann; Thomas Küchler; Walter E. Longo; Bernd Kremer

2005-01-01

304

Evaluation of echographic diagnosis of rectal cancer using intrarectal ultrasonic examination  

Microsoft Academic Search

Ultrasonic examinations conducted in order to diagnose the depth of invasion and local lymph node metastases of rectal cancer.\\u000a The intrarectal approach was performed preoperatively in 99 patients with rectal cancer, using either an Olympus-Aloka ultrasonic\\u000a endoscopeTM (7.5 MHz) or other probes (Aloka, 7.5 MHz, 5 MHz). Through this method, intrapelvic organs were detected clearly, and hypoechoic\\u000a findings due to

Norio Saitoh; Katsuji Okui; Hiromi Sarashina; Masaru Suzuki; Tatsuo Arai; Masao Nunomura

1986-01-01

305

Cure de rectocèle par prothèse type Transvaginal Mesh et compression rectale: à propos de trois cas  

Microsoft Academic Search

Résumé  L’utilisation des prothèses synthétiques dans la chirurgie de la statique pelvienne est en plein essor. Pour les chirurgiens,\\u000a l’inquiétude majeure concerne les complications secondaires à l’utilisation de ces matériaux. La compression rectale, encore\\u000a jamais décrite dans la littérature, en fait partie. Nous rapportons trois cas de compressions rectales après mise en place\\u000a d’une prothèse prérectale par voie vaginale. Des symptômes

V. Emmanuelli; C. Rubod; E. Poncelet; J.-P. Lucot; J.-F. Quinton; M. Cosson

2010-01-01

306

Lack of prophylactic efficacy of oral maraviroc in macaques despite high drug concentrations in rectal tissues.  

PubMed

Maraviroc (MVC) is a potent CCR5 coreceptor antagonist that is in clinical testing for daily oral pre-exposure prophylaxis (PrEP) for HIV prevention. We used a macaque model consisting of weekly SHIV162p3 exposures to evaluate the efficacy of oral MVC in preventing rectal SHIV transmission. MVC dosing was informed by the pharmacokinetic profile seen in blood and rectal tissues and consisted of a human-equivalent dose given 24 h before virus exposure, followed by a booster postexposure dose. In rectal secretions, MVC peaked at 24 h (10,242 ng/ml) with concentrations at 48 h that were about 40 times those required to block SHIV infection of peripheral blood mononuclear cells (PBMCs) in vitro. Median MVC concentrations in rectal tissues at 24 h (1,404 ng/g) were 30 and 10 times those achieved in vaginal or lymphoid tissues, respectively. MVC significantly reduced macrophage inflammatory protein 1?-induced CCR5 internalization in rectal mononuclear cells, an indication of efficient binding to CCR5 in rectal lymphocytes. The half-life of CCR5-bound MVC in PBMCs was 2.6 days. Despite this favorable profile, 5/6 treated macaques were infected during five rectal SHIV exposures as were 3/4 controls. MVC treatment was associated with a significant increase in the percentage of CD3(+)/CCR5(+) cells in blood. We show that high and durable MVC concentrations in rectal tissues are not sufficient to prevent SHIV infection in macaques. The increases in CD3(+)/CCR5(+) cells seen during MVC treatment point to unique immunological effects of CCR5 inhibition by MVC. The implications of these immunological effects on PrEP with MVC require further evaluation. PMID:23740994

Massud, Ivana; Aung, Wutyi; Martin, Amy; Bachman, Shanon; Mitchell, James; Aubert, Rachael; Solomon Tsegaye, Theodros; Kersh, Ellen; Pau, Chou-Pong; Heneine, Walid; García-Lerma, J Gerardo

2013-08-01

307

Metachronous Bilateral Isolated Adrenal Metastasis from Rectal Adenocarcinoma: A Case Report  

PubMed Central

We report a case of adrenal metastasis from colorectal cancer in a 54-year-old woman. Nine months after resection for advanced rectal carcinoma, a computed tomography scan revealed bilateral adrenal metastasis. The level of serum carcinoembryonic antigen was normal. A bilateral adrenalectomy was performed after chemotherapy. Histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. Adrenal metastasis should be considered in the patients' follow-up for colorectal cancer.

Jabir, H.; Tawfiq, N.; Moukhlissi, M.; Akssim, M.; Guensi, A.; Kadiri, B.; Bouchbika, Z.; Taleb, A.; Benchekroun, N.; Jouhadi, H.; Sahraoui, S.; Zamiati, S.; Benider, A.

2014-01-01

308

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

309

Temporal stability of acetylcholinesterase staining in colonic and rectal neural tissue  

Microsoft Academic Search

Confirmation of the clinical diagnosis of Hirschsprung's disease on standard rectal suction biopsy requires demonstration\\u000a of aganglionosis in 60 adequate serial sections of submucosa. Positive staining for acetylcholinesterase (AChE), demonstrating\\u000a an increase in nerve fibres within the lamina propria, muscularis mucosae, and subjacent submucosa, is a useful adjunctive\\u000a test. In this study, sections of distal colonic muscularis propria and rectal

R. W. Byard; M. Carli

1997-01-01

310

Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma  

Microsoft Academic Search

Preoperative chemoradiation therapy (CRT) in patients with locally advanced rectal cancer allows for radical surgery with\\u000a sphincter preservation in many patients. To determine whether patients downsized with preoperative CRT may be potential candidates\\u000a for local excision, we investigated residual disease patterns after neoadjuvant treatment. A retrospective analysis was carried\\u000a out of patients with T3 or T4 rectal adenocarcinoma who were

Isabelle Bedrosian; Miguel A. Rodriguez-Bigas; Barry Feig; Kelly K. Hunt; Lee Ellis; Steven A. Curley; Jean Nicolas Vauthey; Marc Delclos; Christopher Crane; Nora Janjan; John M. Skibber

2004-01-01

311

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

312

Cross-Linked Hyaluronan Gel Reduces the Acute Rectal Toxicity of Radiotherapy for Prostate Cancer  

Microsoft Academic Search

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

Richard B. Wilder; Greg A. Barme; Ronald F. Gilbert; Richard E. Holevas; Luis I. Kobashi; Richard R. Reed; Ronald S. Solomon; Nancy L. Walter; Lucy Chittenden; Albert V. Mesa; Jeffrey Agustin; Jessica Lizarde; Jorge Macedo; John Ravera; Kenneth M. Tokita

2010-01-01

313

Relationship Between Surgeon Caseload and Sphincter Preservation in Patients With Rectal Cancer  

Microsoft Academic Search

PURPOSE  The aim of this study was to determine by means of a national database whether higher surgeon caseload correlates with greater utilization of sphincter-sparing procedures than of abdominoperineal resections in treatment of patients with rectal cancer.METHODS  Patients with a primary International Classification of Diseases-9 diagnosis code of rectal cancer who underwent a sphincter-sparing procedure or abdominoperineal resection were selected from the

Harriett Purves; Ricardo Pietrobon; Sheleika Hervey; Ulrich Guller; William Miller; Kirk Ludwig

2005-01-01

314

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

315

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

316

Identification of the differential expressive tumor associated genes in rectal cancers by cDNA microarray  

PubMed Central

AIM: To identify tumor associated genes of rectal cancer and to probe the application possibility of gene expression profiles for the classification of tumors. METHODS: Rectal cancer tissues and their paired normal mucosa were obtained from patients undergoing surgical resection of rectal cancer. Total RNA was extracted using Trizol reagents. First strand cDNA synthesis was indirectly labeled with aminoallyl-dUTP and coupled with Cy3 or Cy5 dye NHS mono-functional ester. After normalization to total spots, the genes which background subtracted intensity did not exceed 2 SD above the mean blank were excluded. The data were then sorted to obtain genes differentially expressed by ? 2 fold up or down in at least 5 of the 21 patients. RESULTS: In the 21 rectal cancer patients, 23 genes were up-regulated in at least 5 samples and 15 genes were down-regulated in at least 5 patients. Hierachical cluster analysis classified the patients into two groups according to the clinicopathological stage, with one group being all above stage II and one group all below stage II. CONCLUSION: The up-regulated genes and down-regulated genes may be molecular markers of rectal cancer. The expression profiles can be used for classification of rectal cancer.

Gao, Xue-Qin; Han, Jin-Xiang; Xu, Zhong-Fa; Zhang, Wei-Dong; Zhang, Hua-Ning; Huang, Hai-Yan

2007-01-01

317

Development of a Clinically-Precise Mouse Model of Rectal Cancer  

PubMed Central

Currently-used rodent tumor models, including transgenic tumor models, or subcutaneously growing tumors in mice, do not sufficiently represent clinical cancer. We report here development of methods to obtain a highly clinically-accurate rectal cancer model. This model was established by intrarectal transplantation of mouse rectal cancer cells, stably expressing green fluorescent protein (GFP), followed by disrupting the epithelial cell layer of the rectal mucosa by instilling an acetic acid solution. Early-stage tumor was detected in the rectal mucosa by 6 days after transplantation. The tumor then became invasive into the submucosal tissue. The tumor incidence was 100% and mean volume (±SD) was 1232.4 ± 994.7 mm3 at 4 weeks after transplantation detected by fluorescence imaging. Spontaneous lymph node metastasis and lung metastasis were also found approximately 4 weeks after transplantation in over 90% of mice. This rectal tumor model precisely mimics the natural history of rectal cancer and can be used to study early tumor development, metastasis, and discovery and evaluation of novel therapeutics for this treatment-resistant disease.

Kishimoto, Hiroyuki; Momiyama, Masashi; Aki, Ryoichi; Kimura, Hiroaki; Suetsugu, Atsushi; Bouvet, Michael; Fujiwara, Toshiyoshi; Hoffman, Robert M.

2013-01-01

318

Mycobacterium bovis BCG Induces Similar Immune Responses and Protection by Rectal and Parenteral Immunization Routes  

PubMed Central

We compared cellular immune responses to rectal, subcutaneous, and intradermal administration of Mycobacterium bovis BCG for 5 to 20 weeks in mice, guinea pigs, and macaques. Strong lymphoproliferative responses were induced in spleen cells after in vitro stimulation with purified protein derivative in guinea pigs and macaques, whatever the route of immunization. Comparable high numbers of gamma interferon- and tumor necrosis factor alpha-producing cells were found in the spleen after rectal, subcutaneous, and intradermal immunization of mice and macaques. Similar levels of precursors of cytotoxic T lymphocytes specific for mycobacterial antigens were observed in mice for all immunization routes. In macaques, cytotoxic activity, determined only at the end of the experiment (20 weeks), was similar after rectal and intradermal immunization. Six months after immunization, rectal and subcutaneous routes induced in mice similar levels of protective immunity against challenge with a virulent Mycobacterium tuberculosis strain (H37Rv). Rectal immunization gave immune responses and protective capacity similar to those for parenteral immunization and seemed to be a promising new route of vaccination against tuberculosis; in our study, immunization via the rectal route never induced side effects associated with parenteral routes (axillary adenitis) and could also effectively reduce the risks of viral transmission associated with unsafe injections in the developing world.

M, Abolhassani; Lagranderie, M.; Chavarot, P.; Balazuc, A.-M.; Marchal, G.

2000-01-01

319

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

320

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

321

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

322

Survival after rectal cancer: differences between hospital catchment areas. A nationwide study in Sweden  

PubMed Central

BACKGROUND—The quality of rectal cancer surgery at small units has been debated. No national studies of this issue have been undertaken and most studies have been based on insufficient data to clarify the controversy. It has been claimed that observed differences in outcomes between specialised centres and smaller hospitals are confounded by differences in stage/severity.?AIM—To compare survival after rectal cancer between hospital catchment areas.?PATIENTS—All patients with rectal cancer notified to the Swedish Cancer Register in 1973-1992 (n = 30 811) were followed up by record linkage to the nationwide Death Register.?METHODS—Relative survival—that is, ratio of observed to expected survival—was computed as a measure of excess mortality attributable to rectal cancer. Multivariate analysis was then performed to estimate the independent effects of hospital catchment area categories and age, year of diagnosis, and duration of follow up.?RESULTS—One year relative survival among rectal cancer patients residing in catchment areas of large regional hospitals was 76%, compared with 72% for small local hospitals (p<0.001). A difference was already noted after 30 days and remained five years after diagnosis. Relative survival improved considerably overall, but the differences between catchment area categories persisted. These were not reduced by adjustment for age, time after diagnosis, or time period in multivariate models.?CONCLUSION—The differences in outcome between catchment area categories could not be explained by differences in age, time period, or duration of follow up after diagnosis. They are unlikely to be explained by differences between catchment area populations with regard to the average stage of the disease at which symptoms lead to diagnosis. The differences may therefore be attributable to different strategies for diagnosing and managing patients with rectal cancer.???Keywords: rectal neoplasms; cancer; survival; Sweden

Blomqvist, P; Ekbom, A; Nyren, O; Krusemo, U; Bergstrom, R; Adami, H

1999-01-01

323

Impact on rectal dose from the use of a prostate immobilization and rectal localization device for patients receiving dose escalated 3D conformal radiation therapy  

Microsoft Academic Search

Purpose: When >25% of the rectum is irradiated to ?70 Gy, the risk of developing Grade 2 or higher rectal complications is significantly increased. This study evaluates the impact on dose to the rectum from the use of an intrarectal (IR) balloon device, previously shown to immobilize the prostate gland and localize the rectum, in patients receiving dose escalated 3-dimentional

Mona V Sanghani; Jane Ching; Delray Schultz; Robert Cormack; Marian Loffredo; Elizabeth McMahon; Clair Beard; Anthony V D’Amico

2004-01-01

324

Combined modality therapy of resectable rectal cancer: current approaches.  

PubMed

There are two conventional treatments for clinically resectable rectal cancer. First is surgery and, if the tumor is in stage T3 or N1-2, this is followed by postoperative combined modality therapy. The second is preoperative combined modality therapy followed by surgery and postoperative combined modality therapy if the tumor is classified at ultrasound as uT3-4 or N+. A number of new chemotherapeutic agents have been developed for the treatment of patients with colorectal cancer. Ongoing phase I and II trials are examining the use of these new chemotherapeutic agents in combination with pelvic radiation therapy, most commonly in the preoperative setting; early results suggest that the complete response rates are higher. Based on results from phase I and II trials, the standard regimen for patients who receive combined modality therapy is continuous infusion 5-fluorouracil (5-FU) and pelvic radiation. Regimens using CPT-11 or oxaliplatin-based combined modality therapy plus either continuous infusion 5-FU or capecitibine are under active development. PMID:15309641

Minsky, B D

2004-08-01

325

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

326

TEM in the treatment of recurrent rectal cancer in elderly  

PubMed Central

Introduction Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. Patients and Methods During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months. Results The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies. Discussion The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy. Conclusion In selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results.

2013-01-01

327

Endoscopic findings of rectal mucosal damage after pelvic radiotherapy for cervical carcinoma: correlation of rectal mucosal damage with radiation dose and clinical symptoms  

PubMed Central

Purpose To describe chronic rectal mucosal damage after pelvic radiotherapy (RT) for cervical cancer and correlate these findings with clinical symptoms and radiation dose. Materials and Methods Thirty-two patients who underwent pelvic RT were diagnosed with radiation-induced proctitis based on endoscopy findings. The median follow-up period was 35 months after external beam radiotherapy (EBRT) and intracavitary radiotherapy (ICR). The Vienna Rectoscopy Score (VRS) was used to describe the endoscopic findings and compared to the European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) morbidity score and the dosimetric parameters of RT (the ratio of rectal dose calculated at the rectal point [RP] to the prescribed dose, biologically effective dose [BED] at the RP in the ICR and EBRT plans, ?/? = 3). Results Rectal symptoms were noted in 28 patients (rectal bleeding in 21 patients, bowel habit changes in 6, mucosal stools in 1), and 4 patients had no symptoms. Endoscopic findings included telangiectasia in 18 patients, congested mucosa in 20, ulceration in 5, and stricture in 1. The RP ratio, BEDICR, BEDICR+EBRT was significantly associated with the VRS (RP ratio, median 76.5%; BEDICR, median 37.1 Gy3; BEDICR+EBRT, median 102.5 Gy3; p < 0.001). The VRS was significantly associated with the EORTC/RTOG score (p = 0.038). Conclusion The most prevalent endoscopic findings of RT-induced proctitis were telangiectasia and congested mucosa. The VRS was significantly associated with the EORTC/RTOG score and RP radiation dose.

Kim, Tae Gyu; Park, Won

2013-01-01

328

Precipitous intussusception with anal protrusion and complete overt rectal prolapse presenting with intestinal obstruction and an associated rectal adenoma in a young man: a case report  

PubMed Central

Background Intestinal obstruction secondary to intussusception, occurring simultaneously with complete rectal prolapse, is an unusual entity among young adults. When it occurs the intussusceptum may protrude per anus. Few cases are cited in literature; each with a unique clinical presentation. There is apparently no uniform trend in its clinical and pathological picture. Case presentation A 38-year-old, African-Ugandan man presented with sudden occurrence of rectal prolapse for one day. He had otherwise been in good health. Symptoms were precipitous. A clinical diagnosis of intussusception of the lower gut with rectal prolapse, and intestinal obstruction, was made. The intussusception was found to have a polyp as the ‘lead point’. He was treated by manual reduction of the intussusception and the prolapse under general anesthesia. Histopathologic examination of the polyp showed it to be an adenoma. Definitive surgical treatment of the patient was not completed due to socioeconomic challenges. Conclusions Rectal prolapse and intussusception are commonly childhood conditions. Rectal prolapse alone is commoner in the middle-aged and elderly; females in particular. The finding of this combined clinical entity in a young, adult male is therefore a unique condition with an unusual presentation. It is the first case of its kind reported in East Africa. It is also an example of an adenoma constituting a ‘lead point’ for an intussusception at the gastrointestinal tract’s terminus. Even in the presence of a pre-existing adenoma, a relatively common lesion, other differential diagnoses acting as ‘lead points’ ought to be considered in perspective. This characteristic, along with other features described in this case, is useful knowledge for colorectal surgeons, general surgeons, gastrointestinal pathologists, and gastroenterologists given their involvement in the diagnosis and management of anorectal disease of peculiar presentation.

2013-01-01

329

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

330

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

331

Association of MUC6-minisatellite variants with susceptibility to rectal carcinoma.  

PubMed

A secreted MUC6 mucin is reported to be expressed highly in the stomach and gall bladder. In previous our study, the five minisatellites were identified and a significant association between MUC6-MS5 alleles and gastric cancer was reported. Because of aberrant MUC6 expression is often found in gastrointestinal diseases, we evaluated a relationship between MUC6-MS5 and susceptibility to colorectal cancers. Case-control study was performed with 1,103 cancer-free controls and 414 rectal cancer cases. A significant association (OR = 2.70) between short rare MUC6-MS5 alleles (7, 9 repeats) and the occurrence of cancer was observed in rectal cancer [95 % confidence interval (CI), 1.12-6.54; p = 0.022]. Furthermore, a comparison by gender showed the differences in the association ratios between rectal cancer and short rare MUC6-MS5 alleles: male, 3.97 (CI: 1.36-11.5; p = 0.006) versus female 0.91 (CI: 0.18-4.75; p = 0.913). We also examined the association according to lymphovascular invasion (LVI). The frequency of LVI positive rectal cancer was increased in short rare allele cases than in the total rectal cases: 16.2 % versus 42.9 %. Therefore, we suggest that the short rare MUC6-MS5 alleles may be related to cancer development in male and these cancer cases may be related the bad prognosis. PMID:23054008

Ahn, Myoung-Hyun; Bae, Ki Beom; Kwon, Jeong-Ah; Choi, Hong-Jo; Lee, Se-Ra; Kim, Si-Hoon; Jung, Tae Doo; Kim, Sun Hee; An, Min Sung; Hong, Kwan Hee; Heo, Jeonghoon; Kang, Tae-Hong; Chung, Jin Woong; Leem, Sun-Hee

2013-01-01

332

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

333

The effect of preceding biopsy on complete endoscopic resection in rectal carcinoid tumor.  

PubMed

Biopsy of rectal carcinoid tumor is commonly taken before endoscopic resection. However the preceding biopsy can inhibit complete resection by causing blurred tumor border and fibrosis of the tissue. The objective of the study was to investigate the effect of preceding biopsy on complete endoscopic resection in rectal carcinoid tumor. It was also determined if rectal carcinoid tumors can be macroscopically distinguished by endoscopy. We reviewed retrospectively the records of patients with rectal carcinoid tumor who had undergone an endoscopic treatment at our hospital, during a 7-yr period. The resection margin was clear in 57 of 98 cases. The preceding biopsy was taken in 57 cases and the biopsy was significantly associated with the risk of incomplete tumor resection (OR, 3.696; 95% CI, 1.528-8.938, P = 0.004). In 95.9% of the cases, it was possible to suspect a carcinoid tumor by macroscopic appearance during initial endoscopy. The preceding biopsy may disturb complete resection of rectal carcinoid tumor. In most cases, the carcinoid tumor could be suspected by macroscopic appearance. Therefore the preceding biopsy is not essential, and it may be avoided for the complete resection. PMID:24753698

Lee, Sang Pyo; Sung, In-Kyung; Kim, Jeong Hwan; Lee, Sun-Young; Park, Hyung Seok; Shim, Chan Sup

2014-04-01

334

Ovarian cycle approach by rectal temperature and fecal progesterone in a female killer whale, Orcinus orca.  

PubMed

This study aimed to validate the measurements of body temperature and fecal progesterone concentrations as minimally invasive techniques for assessing ovarian cycle in a single sexually mature female killer whale. Rectal temperature data, fecal and blood samples were collected in the dorsal position using routine husbandry training on a voluntary basis. The correlations between rectal temperature and plasma progesterone concentration and between fecal and plasma progesterone concentrations were investigated. Fecal progesterone metabolites were identified by a combination of high-performance liquid chromatography and enzyme immunoassay. Plasma progesterone concentrations (range: 0.2-18.6 ng/ml) and rectal temperature (range: 35.3-35.9°C) changed cyclically, and cycle lengths were an average (±SD) of 44.9±4.0 days (nine cycles) and 44.6±5.9 days (nine cycles), respectively. Rectal temperature positively correlated with the plasma progesterone concentrations (r=0.641, P<0.01). There was a visual trend for fecal progesterone profiles to be similar to circulating plasma progesterone profiles. Fecal immunoreactive progestagen analysis resulted in a marked immunoreactive peak of progesterone. The data from the single killer whale indicate that the measurement of rectal temperature is suitable for minimally invasive assessment of the estrous cycle and monitoring the fecal progesterone concentration is useful to assess ovarian luteal activity. PMID:20648568

Kusuda, Satoshi; Kakizoe, Yuka; Kanda, Koji; Sengoku, Tomoko; Fukumoto, Yohei; Adachi, Itsuki; Watanabe, Yoko; Doi, Osamu

2011-01-01

335

Rectal cancer: future directions and priorities for treatment, research and policy in New Zealand.  

PubMed

New Zealand has one of the highest incidences of rectal cancer in the world, and its optimal management requires a multidisciplinary approach. A National Rectal Cancer Summit was convened in August 2013 to discuss management of rectal cancer in the New Zealand context, to highlight controversies and discuss domestic priorities for the future. This paper summarises the priorities for treatment, research and policy for rectal cancer services in New Zealand identified as part of the Summit in August. The following priorities were identified: - Access to high-quality information for service planning, review of outcomes, identification of inequities and gaps in provision, and quality improvement; - Engagement with the entire sector, including private providers; - Focus on equity; - Emerging technologies; - Harmonisation of best practice; - Importance of multidisciplinary team meetings. In conclusion, improvements in outcomes for patients with rectal cancer in New Zealand will require significant engagement between policy makers, providers, researchers, and patients in order to ensure equitable access to high quality treatment, and strategic incorporation of emerging technologies into clinical practice. A robust clinical information framework is required in order to facilitate monitoring of quality improvements and to ensure that equitable care is delivered. PMID:24929694

Jackson, Christopher; Ehrenberg, Nieves; Frizelle, Frank; Sarfati, Diana; Balasingam, Adrian; Pearse, Maria; Parry, Susan; Print, Cristin; Findlay, Michael; Bissett, Ian

2014-01-01

336

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

337

Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies.  

PubMed

Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangulation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to understand each patient's symptoms, bowel habits, anatomy, and pre-operative expectations. Preoperative workup includes physical exam, colonoscopy, anoscopy, and, in some patients, anal manometry and defecography. With this information, a tailored surgical approach (abdominal versus perineal, minimally invasive versus open) and technique (posterior versus ventral rectopexy +/- sigmoidectomy, for example) can then be chosen. We propose an algorithm based on available outcomes data in the literature, an understanding of anorectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients. PMID:24352613

Bordeianou, Liliana; Hicks, Caitlin W; Kaiser, Andreas M; Alavi, Karim; Sudan, Ranjan; Wise, Paul E

2014-05-01

338

Laparoscopic lower anterior rectal resection using a curved stapler: original technique and preliminary experience.  

PubMed

Laparoscopic low anterior rectal resection (LLAR), allowing better visualization and rectal mobilization, can reduce postoperative pain and recovery. A contour curved stapler (CCS) is a very helpful device because of its curved profile that consents better access into the pelvic cavity and allows to perform rectal closure and section in one shot, especially in the presence of a narrow pelvis, complex anatomy, or large tumors. We developed an original technique of laparoscopic rectal resection using CCS. Between 2005 and 2009, in 36 cases, we performed LLAR with a three-trocar technique, starting with mobilization of left colonic flexure followed by the section of inferior mesenteric vessels. The rectum was prepared up to the levator ani with total mesorectal excision. The Lapdisc was inserted trough a suprapubic midline incision, allowing the CCS stapler placement into the pelvic cavity. After the rectal section, the anastomosis was then performed with a circular stapler. Ileostomy was performed if neoadjuvant radiotherapy and chemotherapy have been carried out or if the anastomosis was below 4 cm from the anal verge. Mean operative time was 135 minutes and no intra- or postoperative bleeding occurred. In 27 patients we performed temporary ileostomy. In two cases we observed anastomotic leakage; one of these patients already had ileostomy. No anastomotic stenosis occurred after one-year follow-up. This procedure simplifies the section of the lower rectum, reduces leaking rate resulting from technical difficulties, and does not nullify the benefits of laparoscopy. PMID:23461949

Brescia, Antonio; Mari, Francesco Saverio; Favi, Francesco; Milillo, Andrea; Nigri, Giuseppe; Dall'oglio, Anna; Pancaldi, Alessandra; Masoni, Luigi

2013-03-01

339

HIF-1? Expression Correlates with Cellular Apoptosis, Angiogenesis and Clinical Prognosis in Rectal Carcinoma.  

PubMed

Regional hypoxia caused by accelerated cell proliferation and overgrowth is an important characteristic of neoplasm. Hypoxia can cause a series of changes in gene transcription and protein expression, thereby not only inducing tumor cell resistance to radiotherapy and chemotherapy but also promoting tumor invasion and metastasis. This study aimed to investigate the relationship between HIF-1? expression and cellular apoptosis, angiogenesis and clinical prognosis in rectal carcinoma. In 113 rectal carcinoma cases, cellular apoptosis was analyzed by the in situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay, whereas the levels of HIF-1? expression, VEGF expression, microvessel density (MVD) and lymphatic vessel density(LVD) were examined by immunohistochemical staining. HIF-1 expression was detected in 67 of 113 rectal carcinoma cases (59.3 %). A positive correlation was found among HIF-1? expression, cellular apoptosis and angiogenesis. The 5-year survival rate in the HIF-1?-negative group was significantly higher than that in the HIF-1?-positive group (81.34 % versus 50 %, P?rectal carcinoma. Aberrant HIF-1? expression correlates with apoptosis inhibition, angiogenesis and poor prognosis in rectal carcinoma. PMID:24374863

Feng, Liu; Tao, Lin; Dawei, He; Xuliang, Li; Xiaodong, Luo

2014-07-01

340

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

341

Delayed endoluminal vacuum therapy for rectal anastomotic leaks after rectal resection in a swine model: a new treatment option.  

PubMed

Anastomotic leaks are a dreaded surgical complication following colorectal operations. Creation of a temporary proximal diverting ileostomy is used in high-risk anastomoses, however, additional surgical risk is accumulated with its creation and reversal. Endoluminal vacuum therapy has been shown to seal anastomotic defects in the prophylactic setting in a pig model and we hypothesized it could be utilized in a delayed fashion to rescue subjects with an active anastomotic leak. Yorkshire pigs underwent rectal resection, intentional leak confirmed by fluoroscopy, and endoluminal vacuum therapy device placement to low continuous suction. Following treatment, a contrast enema and necropsy was performed for gross and histopathology. Pigs underwent 2 (or 5) days of free intraperitoneal leak prior to device placement and 5 (or 7) subsequent days of endoluminal vacuum therapy. Six of seven early-treated pigs sealed their anastomotic defect, while two of the four treated pigs in this extended group sealed the defect. Endoluminal vacuum therapy is feasible and well tolerated in a pig model, and it has been shown to seal a significant number of freely leaking anastomoses in the early period (86%). This technology warrants further study as it may provide a noninvasive means to treatment of anastomotic leaks. PMID:24456480

Rosenberger, Laura H; Shada, Amber; Ritter, Lane A; Mauro, David M; Mentrikoski, Mark J; Feldman, Sanford H; Kleiner, Daniel E

2014-04-01

342

Study shows colon and rectal tumors constitute a single type of cancer; The Cancer Genome Atlas generates genomic data for colon and rectal cancers that point to potential targets for treatment  

Cancer.gov

The pattern of genomic alterations in colon and rectal tissues is the same regardless of anatomic location or origin within the colon or the rectum, leading researchers to conclude that these two cancer types can be grouped as one, according to The Cancer Genome Atlas (TCGA) project's large-scale study of colon and rectal cancer tissue specimens.

343

The association of rectal equivalent dose in 2 Gy fractions (EQD2) to late rectal toxicity in locally advanced cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University  

PubMed Central

Purpose To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Materials and Methods Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities. Results Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale ? grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269-22.244). Conclusion The cumulative rectal dose in EQD2 >65 Gy have association with ? grade 2 LENT-SOMA scale.

Meungwong, Pooriwat; Chitapanarux, Taned; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Wanwilairat, Somsak; Traisathit, Patrinee; Galalae, Razvan; Chitapanarux, Imjai

2014-01-01

344

Knowledge and acceptability of the rectal treatment route in Laos and its application for pre-referral emergency malaria treatment  

Microsoft Academic Search

BACKGROUND: Rectal artesunate has been shown to reduce death and disability from severe malaria caused by delays in reaching facilities capable of providing appropriate treatment. Acceptability of this mode of drug delivery in Laos is not known. In 2009 the acceptability of rectal treatments was evaluated among the general Lao population and Lao doctors in a national survey. METHODS: A

Southisouk Inthavilay; Thierry Franchard; Yang Meimei; Elizabeth A Ashley; Hubert Barennes

2010-01-01

345

Modification of antimicrobial prophylaxis based on rectal culture results to prevent fluoroquinolone-resistant Escherichia coli infections after prostate biopsy.  

PubMed

For patients undergoing transrectal ultrasound-guided biopsy of the prostate (TRUBP), use of rectal screening culture results to guide antimicrobial prophylaxis was effective for prevention of fluoroquinolone-resistant Escherichia coli infections. In practice, elimination of infections after TRUBP required the rectal screening protocol and addition of gentamicin for patients missing prior screening. PMID:23917913

Suwantarat, Nuntra; Dumford, Donald M; Ponce-Terashima, Rafael; Kundrapu, Sirisha; Zabarsky, Trina F; Zhu, Hui; Donskey, Curtis J

2013-09-01

346

The surgical anatomy of the rectum — a review with particular relevance to the hazards of rectal mobilisation  

Microsoft Academic Search

Summary The major complications of rectal surgery that are wholly or partially avoidable by the use of an anatomically based dissection are haemorrhage from presacral veins, perforation of the rectum, damage to pelvic autonomic nerves and inadequate clearance of a rectal cancer. Important technical points in minimising the incidence of these complications are: (1) posterior dissection in the presacral space;

J. M. Church; P. J. Raudkivi; G. L. Hill

1987-01-01

347

Outcome of Laparoscopic Rectopexy for Complete Rectal Prolapse in Patients Older than 70 Years Versus Younger Patients  

Microsoft Academic Search

Purpose To evaluate the outcome of laparoscopic rectopexy for complete rectal prolapse in patients above 70 years of age, compared with that in younger patients. Methods Between October 1997 and September 2001, 14 consecutive patients with complete rectal prolapse underwent laparoscopic rectopexy. Nine patients were aged 70 years or older, and five were aged under 70 years. All of the

Yoshihiro Kaiwa; Yoshimochi Kurokawa; Kenji Namiki; Takahito Myojin; Makoto Ansai; Susumu Satomi

2004-01-01

348

Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study  

Microsoft Academic Search

Objective: To investigate whether rectally administered misoprostol is an effective treatment for postpartum hemorrhage unresponsive to conventional first-line management.Methods: We studied 14 women with postpartum hemorrhage unresponsive to oxytocin and ergometrine (n = 10) or, when ergometrine was contraindicated, oxytocin alone (n = 4). While awaiting carboprost, misoprostol 1000 ?g (five tablets) was administered rectally.Results: In all 14 women, the

Patrick O’Brien; Hazem El-Refaey; Alasdair Gordon; Michael Geary; Charles H. Rodeck

1998-01-01

349

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

350

Rectal Transmission of Transmitted/Founder HIV-1 Is Efficiently Prevented by Topical 1% Tenofovir in BLT Humanized Mice  

PubMed Central

Rectal microbicides are being developed to prevent new HIV infections in both men and women. We focused our in vivo preclinical efficacy study on rectally-applied tenofovir. BLT humanized mice (n?=?43) were rectally inoculated with either the primary isolate HIV-1JRCSF or the MSM-derived transmitted/founder (T/F) virus HIV-1THRO within 30 minutes following treatment with topical 1% tenofovir or vehicle. Under our experimental conditions, in the absence of drug treatment we observed 50% and 60% rectal transmission by HIV-1JRCSF and HIV-1THRO, respectively. Topical tenofovir reduced rectal transmission to 8% (1/12; log rank p?=?0.03) for HIV-1JRCSF and 0% (0/6; log rank p?=?0.02) for HIV-1THRO. This is the first demonstration that any human T/F HIV-1 rectally infects humanized mice and that transmission of the T/F virus can be efficiently blocked by rectally applied 1% tenofovir. These results obtained in BLT mice, along with recent ex vivo, Phase 1 trial and non-human primate reports, provide a critically important step forward in the development of tenofovir-based rectal microbicides.

Chateau, Morgan L.; Denton, Paul W.; Swanson, Michael D.; McGowan, Ian; Garcia, J. Victor

2013-01-01

351

Rectal transmission of transmitted/founder HIV-1 is efficiently prevented by topical 1% tenofovir in BLT humanized mice.  

PubMed

Rectal microbicides are being developed to prevent new HIV infections in both men and women. We focused our in vivo preclinical efficacy study on rectally-applied tenofovir. BLT humanized mice (n = 43) were rectally inoculated with either the primary isolate HIV-1JRCSF or the MSM-derived transmitted/founder (T/F) virus HIV-1THRO within 30 minutes following treatment with topical 1% tenofovir or vehicle. Under our experimental conditions, in the absence of drug treatment we observed 50% and 60% rectal transmission by HIV-1JRCSF and HIV-1THRO, respectively. Topical tenofovir reduced rectal transmission to 8% (1/12; log rank p = 0.03) for HIV-1JRCSF and 0% (0/6; log rank p = 0.02) for HIV-1THRO. This is the first demonstration that any human T/F HIV-1 rectally infects humanized mice and that transmission of the T/F virus can be efficiently blocked by rectally applied 1% tenofovir. These results obtained in BLT mice, along with recent ex vivo, Phase 1 trial and non-human primate reports, provide a critically important step forward in the development of tenofovir-based rectal microbicides. PMID:23527295

Chateau, Morgan L; Denton, Paul W; Swanson, Michael D; McGowan, Ian; Garcia, J Victor

2013-01-01

352

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

353

Differences in carcinoembryonic antigen levels between colon and rectal cancer  

PubMed Central

The aim of the present study was to investigate the levels of the serum tumor biomarker carcinoembryonic antigen (CEA) in patients with carcinoma of the colon and rectum in different clinical stages. Colorectal cancer (CRC) is one of the most commonly diagnosed types of cancer worldwide and previous studies have reported rapidly updated therapeutic regimes. While the majority of studies focus on CRC as a single entity, certain studies distinguish colon cancer (CC) from rectal cancer (RC), as there is a hypothesis stating that CC and RC are two naturally different entities. CEA is reported to be an important tumor-associated antigen overexpressed in CRC, which is routinely detected as a significant indicator of CRC. Our study aimed to identify potential differences in the expression of CEA between CC and RC, which may, to some degree, reflect the natural differences between the two. We investigated 240 CRC cases between July, 2010 and December, 2012 from The First and Second Affiliated Hospitals of Dalian Medical University, including 117 CC and 123 RC patients with tumors classified by Duke’s staging as A-D. The serum CEA level was measured preoperatively by radioimmunoassays as a routinely used auxiliary indicator. The expression of CEA differed between CC and RC, with the former exhibiting variation among the four stages, whereas no variation was observed in RC. In addition, there were differences between CC and RC regarding the CEA level in stage C and D. Furthermore, the CEA level in stage C of CC was significantly lower compared to that in any other stage. In conclusion, the intrinsic distribution of the CEA level between CC and RC suggests that CC and RC may be two naturally different entities; the significantly low CEA level in stage C of CC indicates that stage C may be crucial in the evolution of CC.

DING, YUNLONG; XUAN, WEIBO; CHEN, CHUNLIN; CHEN, ZHE; YANG, ZIYI; ZUO, YUNFEI; REN, SHUANGYI

2014-01-01

354

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

355

Cap polyposis: A rare cause of rectal bleeding in children  

PubMed Central

AIM: To evaluate the clinicopathological features and treatment outcomes of cap polyposis in the pediatric population. METHODS: All pediatric patients with histologically proven diagnosis of cap polyposis were identified from our endoscopy and histology database over a 12 year period from 2000-2012 at our tertiary pediatric center, KK Women’s and Children’s Hospital in Singapore. The case records of these patients were retrospectively reviewed. The demographics, clinical course, laboratory results, endoscopic and histopathological features, treatments, and outcomes were analyzed. The study protocol was approved by the hospital institutional review board. The histological slides were reviewed by a pediatric histopathologist to confirm the diagnosis of cap polyposis. RESULTS: Eleven patients were diagnosed with cap polyposis. The median patient age was 13 years (range 5-17 years); the sample included 7 males and 4 females. All of the patients presented with bloody stools. Seven patients (63%) had constipation, while 4 patients (36%) had diarrhea. All of the patients underwent colonoscopy and polypectomies (excluding 1 patient who refused polypectomy). The macroscopic findings were of polypoid lesions covered by fibrinopurulent exudates with normal intervening mucosa. The rectum was the most common involvement site (n = 9, 82%), followed by the rectosigmoid colon (n = 3, 18%). Five (45%) patients had fewer than 5 polyps, and 6 patients (65%) had multiple polyps. Histological examination of these polyps showed surface ulcerations with a cap of fibrin inflammatory exudate. Four (80%) patients with fewer than 5 polyps had complete resolution of symptoms following the polypectomy. One patient who did not consent to the polypectomy had resolution of symptoms after being treated with sulphasalazine. All 6 patients with multiple polyps experienced recurrence of bloody stools on follow-up (mean = 28 mo). CONCLUSION: Cap polyposis is a rare and under-recognised cause of rectal bleeding in children. Our study has characterized the disease phenotype and treatment outcomes in a pediatric cohort.

Li, Jia Hui; Leong, May Ying; Phua, Kong Boo; Low, Yee; Kader, Ajmal; Logarajah, Veena; Ong, Lin Yin; Chua, Joyce HY; Ong, Christina

2013-01-01

356

Acute symptoms, not rectally administered sucralfate, predict for late radiation proctitis: longer term follow-up of a phase III trial—Trans-Tasman Radiation Oncology Group  

Microsoft Academic Search

Purpose: To assess the potential for sucralfate administered rectally to reduce the risk of late rectal morbidity in patients undergoing nonconformal radiotherapy (RT) for carcinoma of the prostate and to study the variables potentially contributing to late rectal morbidity and particularly to explore the relationship between acute and late toxicity.Methods and Materials: Eighty-six patients with localized prostate carcinoma were randomized

Peter C O’Brien; C. Ian Franklin; Michael G Poulsen; David J Joseph; Nigel S Spry; James W Denham

2002-01-01

357

Results of treatment of distal rectal carcinoma since the introduction of total mesorectal excision: a single unit experience, 1994–2003  

Microsoft Academic Search

Background and aims: This study reviewed the results of surgery for distal rectal cancer (where the tumour was within 6 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution. Patients and methods: One hundred and fifty- three patients who had undergone elective curative surgical resection of rectal cancer within 6 cm

Antonio Chiappa; Roberto Biffi; Andrew P. Zbar; Fabrizio Luca; Cristiano Crotti; Emilio Bertani; Francesca Biella; Giulia Zampino; Roberto Orecchia; Nicola Fazio; Marco Venturino; Cristiano Crosta; Gian Carlo Pruneri; Carmine Grassi; Bruno Andreoni

2005-01-01

358

Screening paediatric rectal forms of azithromycin as an alternative to oral or injectable treatment.  

PubMed

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. PMID:22868232

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

2012-10-15

359

Tuberculosis of rectum simulating malignancy and presenting as rectal prolapse - a case report and review.  

PubMed

Tuberculosis of the gastrointestinal tract (GIT) occurs as a primary lesion or secondary to a focus of tuberculosis elsewhere in the body, most commonly in the lungs. Tuberculosis can affect any part of the GIT from the oesophagus to the anal canal. Two main types are - the tuberculous ulcer and the rarer hypertrophic type which is generally found at the ileocecal junction, less commonly in the colon or rectum. Tuberculosis of bowel distal to ileocecal junction is rare and is seldom considered as a differential diagnosis of rectal stricture (2%). We report a case of rectal tuberculosis presenting with rectal prolapse and masquerading as malignancy, clinically, radiologically as well as on colonoscopy. The diagnosis was confirmed by repeated histopathological examination. The patient underwent definitive surgery along with anti-tuberculous therapy. PMID:24000498

Patil, Salil; Shah, A G; Bhatt, Hardik; Nalawade, Nikhil; Mangal, Akshaykumar

2013-07-01

360

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

361

Treatment of rectal cancer by transanal endoscopic microsurgery: review of the literature.  

PubMed

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that was introduced by Buess in the early 1980s. The TEM procedure employs a dedicated rectoscope with a 3D binocular optic and a set of endoscopic surgical instruments. Since the beginning its advantages have been evident: magnification of the operative field, better access to proximal lesions with lower margin positivity and fragmentation over traditional transanal excision techniques. A non-systematic literature search was performed in the PubMed database to identify all original articles on rectal cancer treated by TEM. Only series including at least ten cases of adenocarcinoma with two years' mean minimum follow-up and published in English were selected. Nowadays more than two decades of scientific data support the use of TEM in the treatment of selected patients with non-advanced rectal cancer. This paper describes the indications and the surgical technique of TEM in the treatment of rectal cancer. PMID:23584262

Lezoche, G; Paganini, A M; Campagnacci, R; Ghiselli, R; Pelloni, M; Rombini, A; Guerrieri, M

2013-02-01

362

The role of endoscopic ultrasound in the evaluation of rectal cancer  

PubMed Central

Accurate staging of rectal cancer is essential for selecting patients who can undergo sphincter-preserving surgery. It may also identify patients who could benefit from neoadjuvant therapy. Clinical staging is usually accomplished using a combination of physical examination, CT scanning, MRI and endoscopic ultrasound (EUS). Transrectal EUS is increasingly being used for locoregional staging of rectal cancer. The accuracy of EUS for the T staging of rectal carcinoma ranges from 80-95% compared with CT (65-75%) and MR imaging (75-85%). In comparison to CT, EUS can potentially upstage patients, making them eligible for neoadjuvant treatment. The accuracy to determine metastatic nodal involvement by EUS is approximately 70-75% compared with CT (55-65%) and MR imaging (60-70%). EUS guided FNA may be beneficial in patients who appear to have early T stage disease and suspicious peri-iliac lymphadenopathy to exclude metastatic disease.

Siddiqui, Ali A; Fayiga, Yomi; Huerta, Sergio

2006-01-01

363

Multidisciplinary Approach to Synchronous Prostate and Rectal Cancer: Current Experience and Future Challenges  

PubMed Central

The management of synchronous prostate and rectal cancer is a challeging task for the general surgeons and urologists, due to the complex anatomy of the pelvis and the sequential significant effects on the patient’s functional independency and quality of life. As both rectal and prostate cancers still remain leading causes of death in the male population, along with the increase of the average life expectancy, it is certain that synchronous prostate and rectal cancer will be a clinical scenario that the clinicians of the future will encounter more frequently. Our aim is to perform a comprehensive review on the management of this oncological entity, focusing on the significance of multidisciplinary approach which will enable the formation of an accurate strategy plan, having at all times the patient in the center of desicion-making.

Seretis, Charalampos; Seretis, Fotios; Liakos, Nikolaos

2014-01-01

364

Effect of medium chain glycerides on enteral and rectal absorption of beta-lactam and aminoglycoside antibiotics.  

PubMed

The rat enteral and rabbit rectal models were utilized to study the effect of Capmul (medium chain glycerides) on the absorption of a selection of beta-lactam and aminoglycoside antibiotics. All tested non-orally available beta-lactam antibiotics (cefamandole, cefotaxime, moxalactam, cefoxitin, mezlocillin, carumonam, penicillin G and amdinocillin) showed increased absorption enterally in rats and rectally in rabbits when formulated with Capmul. The orally available beta-lactam antibiotics, cephalexin and cephradine, were not enhanced in their enteral or rectal absorption by Capmul in the two model systems. Ampicillin absorption was enhanced rectally and enterally by Capmul. Rectal absorption of the aminoglycoside antibiotics, tobramycin and gentamycin, was enhanced by Capmul while enteral absorption was not. PMID:3208545

Unowsky, J; Behl, C R; Beskid, G; Sattler, J; Halpern, J; Cleeland, R

1988-01-01

365

ESTIMATION OF ?/? FOR LATE RECTAL TOXICITY BASED ON RTOG 94-06  

PubMed Central

Purpose To estimate ?/?, the parameter ratio from the linear-quadratic (LQ) model, for grade ?2 late rectal toxicity among patients treated on Radiation Therapy Oncology Group (RTOG) protocol 94-06, and to determine whether correcting the rectal dose-volume histogram (DVH) for differences in dose per fraction, based on the LQ model, significantly improves the fit to these data of the Lyman-Kutcher-Burman (LKB) normal-tissue complication probability (NTCP) model. Methods and Materials The generalized LKB model was fitted to the grade ?2 late rectal toxicity data in two ways: 1) using DVHs representing physical dose to rectum, and 2) using a modified approach in which dose bins in the rectal DVH were corrected for differences in dose per fraction using the LQ model, with ?/? estimated as an additional unknown parameter. The analysis included only patients treated with the same treatment plan throughout radiotherapy, so that the dose per fraction to each voxel of rectum could be determined from the DVH. The likelihood ratio test was used to assess whether the fit of the LQ-corrected model was significantly better than the fit of the LKB model based on physical doses to rectum. Results The analysis included 509 of the 1084 patients enrolled on RTOG 94-06. The estimate of ?/? from the LQ-corrected LKB model was 4.8 Gy, with 68% confidence interval 0.6 Gy to 46 Gy. The fit was not significantly different from the fit of the LKB model based on physical dose to rectum (P = 0.236). Conclusions The estimated fractionation sensitivity for grade ?2 late rectal toxicity is consistent with values of ?/? for rectum found previously in humans and rodents. However, the confidence interval is large, and there is no evidence that LQ-correction of the rectal DVH significantly changes the fit or predictions of the LKB model for this endpoint.

Tucker, Susan L.; Thames, Howard D.; Michalski, Jeff M.; Bosch, Walter R.; Mohan, Radhe; Winter, Kathryn; Cox, James D.; Purdy, James A.; Dong, Lei

2011-01-01

366

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

367

Reduction of prostate intrafraction motion using gas-release rectal balloons  

SciTech Connect

Purpose: To analyze prostate intrafraction motion using both non-gas-release (NGR) and gas-release (GR) rectal balloons and to evaluate the ability of GR rectal balloons to reduce prostate intrafraction motion. Methods: Twenty-nine patients with NGR rectal balloons and 29 patients with GR balloons were randomly selected from prostate patients treated with proton therapy at University of Florida Proton Therapy Institute (Jacksonville, FL). Their pretreatment and post-treatment orthogonal radiographs were analyzed, and both pretreatment setup residual error and intrafraction-motion data were obtained. Population histograms of intrafraction motion were plotted for both types of balloons. Population planning target-volume (PTV) margins were calculated with the van Herk formula of 2.5{Sigma}+ 0.7{sigma} to account for setup residual errors and intrafraction motion errors. Results: Pretreatment and post-treatment radiographs indicated that the use of gas-release rectal balloons reduced prostate intrafraction motion along superior-inferior (SI) and anterior-posterior (AP) directions. Similar patient setup residual errors were exhibited for both types of balloons. Gas-release rectal balloons resulted in PTV margin reductions from 3.9 to 2.8 mm in the SI direction, 3.1 to 1.8 mm in the AP direction, and an increase from 1.9 to 2.1 mm in the left-right direction. Conclusions: Prostate intrafraction motion is an important uncertainty source in radiotherapy after image-guided patient setup with online corrections. Compared to non-gas-release rectal balloons, gas-release balloons can reduce prostate intrafraction motion in the SI and AP directions caused by gas buildup.

Su Zhong; Zhao Tianyu; Li Zuofeng; Hoppe, Brad; Henderson, Randy; Mendenhall, William; Nichols, R. Charles; Marcus, Robert; Mendenhall, Nancy [Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida 32206 (United States)

2012-10-15

368

Completeness of colon and rectal cancer staging in the Danish Cancer Registry, 2004-2009  

PubMed Central

Objective To explore the completeness of tumor, node, metastasis (TNM) staging for colon and rectal cancer in the Danish Cancer Registry. Material and methods From the Danish Cancer Registry, we retrieved data on TNM stage, year of diagnosis, sex, and age for 15,976 and 8292 patients, respectively, with first diagnoses of colon or rectal cancer during the 2004–2009 period. From the Danish National Patient Register, we retrieved data on comorbidity (computed as Charlson Comorbidity Index scores). We calculated the completeness of TNM staging overall, by each stage component, and according to a stage algorithm allowing some missing stage components. Analyses were stratified by sex, age, year of diagnosis, and Charlson Comorbidity Index score. Results For colon and rectal cancer, overall TNM completeness was 67.8% (95% confidence interval [CI]: 67.0%–68.5%) and 68.1% (95% CI: 67.0%–69.1%), respectively. For both cancers, completeness decreased with increasing age and level of comorbidity, whereas differences between the sexes were minor. Over the study period, TNM completeness for colon cancer decreased from 71.3% (95% CI: 69.5%–73.0%) to 64.8% (95% CI: 63.0%–66.6%), whereas the completeness for rectal cancer remained stable over time. When using the stage algorithm, the completeness rose markedly, to 81.1% for colon cancer and 79.0% for rectal cancer. Conclusion One-third of colon and rectal cancer cases in the Danish Cancer Registry had missing TNM stage information, which varied with age and level of comorbidity. Cancer cases with unknown staging warrant serious consideration of the methodological implications in future epidemiological studies monitoring cancer incidence and outcomes.

Ostenfeld, Eva Bjerre; Fr?slev, Trine; Friis, S?ren; Gandrup, Per; Madsen, Mogens R?rbaek; S?gaard, Mette

2012-01-01

369

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

370

International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams  

PubMed Central

Background Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. Methods One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. Results One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years’ experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). Conclusions There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.

Augestad, Knut M.; Lindsetmo, Rolv-Ole; Stulberg, Jonah; Reynolds, Harry; Senagore, Anthony; Champagne, Brad; Heriot, Alexander G.; Leblanc, Fabien

2010-01-01

371

Laparoscopic Pelvic Autonomic Nerve-Preserving Surgery for Patients with Lower Rectal Cancer after Chemoradiation Therapy  

Microsoft Academic Search

Objective  This is a phase II study, the aim of which is to determine if a laparoscopic approach can be used in pelvic autonomic nerve-preserving\\u000a surgery for patients with lower rectal cancer following chemoradiation therapy.\\u000a \\u000a \\u000a \\u000a Methods  Patients with T3 lower rectal cancer treated by preoperative chemoradiation were recruited and subjected to laparoscopic pelvic\\u000a autonomic nerve-preserving surgery with total mesorectal excision and a

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

2007-01-01

372

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

373

Molecular and clinico-pathological markers in rectal cancer: a tissue micro-array study  

Microsoft Academic Search

Aims  The aims of the study were to study the effect of pre-operative treatment on the expression of tumour-related proteins and\\u000a to correlate the expression of these proteins with response and survival of patients with advanced rectal cancer.\\u000a \\u000a \\u000a \\u000a Materials and methods  Tissue micro-arrays from pre- and post-treatment biopsies of 99 patients with rectal cancer treated with pre-operative (chemo)radiotherapy\\u000a were stained for epidermal

Annelies Debucquoy; Laurence Goethals; Louis Libbrecht; Christiaan Perneel; Karel Geboes; Nadine Ectors; William H. McBride; Karin Haustermans

2009-01-01

374

The Baseline Ratio of Neutrophils to Lymphocytes is Associated with Patient Prognosis in Rectal Carcinoma  

Microsoft Academic Search

Objective  In cancer patients, the balance between neutrophil (N) and lymphocyte (L) cell counts fluctuates with advancing disease. The\\u000a objective of our study was to determine the prognostic implications of the N\\/L ratio in the peripheral blood of rectal cancer\\u000a patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Study participants were identified from a prospective cohort of patients with rectal cancer in Dalian of China (n?=?123).\\u000a \\u000a \\u000a \\u000a \\u000a Results  The median

Huanran Liu; Ge Liu; Quan Bao; Wei Sun; Haidong Bao; Liang Bi; Wei Wen; Yanfeng Liu; Zhenglin Wang; Xunguo Yin; Yunqing Bai; Xiang Hu

2010-01-01

375

Chronic myelogenous leukemia after postoperative adjuvant S-1 therapy for rectal cancer: a case report  

PubMed Central

We report a case in which chronic myelogenous leukemia (CML) developed after postoperative adjuvant S-1 therapy for rectal cancer. A 56-year-old man was diagnosed with rectal adenocarcinoma, which was treated with abdominoperineal resection followed by a year of adjuvant S-1 therapy. At 39 postoperative months, he was diagnosed with CML. Although it remains unclear that CML that develops after treatment involving cytotoxic agents is treatment-related, clinicians should be aware of the possibility of CML developing after S-1 therapy.

Manabe, Masahiro; Nishii, Takafumi; Okita, Junya; Nagasaki, Johji; Harada, Naonori; Aoyama, Yasutaka; Kumura, Takeo; Ohta, Tadanobu; Furukawa, Yoshio; Takeuchi, Kazuhiro; Mugitani, Atsuko

2013-01-01

376

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

377

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

378

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

379

Significant rectal bleeding as a complication of a fecal collecting device: report of a case.  

PubMed

We report the case of 65-year-old man who developed massive rectal bleeding associated with the use of a fecal collecting device: the Flexi-Seal Fecal Management System. A colonoscopy showed an acute laceration of the anterior rectal wall mucosa, 6 cm from the anal verge, with active bleeding. The tear was most likely the result of an acute event, such as sudden movement of the device within the rectum or trauma sustained during insertion. Massive transfusion was required, and surgical endoscopic treatment was necessary to ensure hemostasis. This is, to our knowledge, the first such case to be reported. PMID:18461400

Page, Blaithin P; Boyce, Stephen A; Deans, Christopher; Camilleri-Brennan, John

2008-09-01

380

Influence of image slice thickness on rectal dose-response relationships following radiotherapy of prostate cancer.  

PubMed

When pooling retrospective data from different cohorts, slice thicknesses of acquired computed tomography (CT) images used for treatment planning may vary between cohorts. It is, however, not known if varying slice thickness influences derived dose-response relationships. We investigated this for rectal bleeding using dose-volume histograms (DVHs) of the rectum and rectal wall for dose distributions superimposed on images with varying CT slice thicknesses. We used dose and endpoint data from two prostate cancer cohorts treated with three-dimensional conformal radiotherapy to either 74 Gy (N = 159) or 78 Gy (N = 159) at 2 Gy per fraction. The rectum was defined as the whole organ with content, and the morbidity cut-off was Grade ?2 late rectal bleeding. Rectal walls were defined as 3 mm inner margins added to the rectum. DVHs for simulated slice thicknesses from 3 to 13 mm were compared to DVHs for the originally acquired slice thicknesses at 3 and 5 mm. Volumes, mean, and maximum doses were assessed from the DVHs, and generalized equivalent uniform dose (gEUD) values were calculated. For each organ and each of the simulated slice thicknesses, we performed predictive modeling of late rectal bleeding using the Lyman-Kutcher-Burman (LKB) model. For the most coarse slice thickness, rectal volumes increased (?18%), whereas maximum and mean doses decreased (?0.8 and ?4.2 Gy, respectively). For all a values, the gEUD for the simulated DVHs were ?1.9 Gy different than the gEUD for the original DVHs. The best-fitting LKB model parameter values with 95% CIs were consistent between all DVHs. In conclusion, we found that the investigated slice thickness variations had minimal impact on rectal dose-response estimations. From the perspective of predictive modeling, our results suggest that variations within 10 mm in slice thickness between cohorts are unlikely to be a limiting factor when pooling multi-institutional rectal dose data that include slice thickness variations within this range. PMID:24936956

Olsson, C; Thor, M; Liu, M; Moissenko, V; Petersen, S E; Høyer, M; Apte, A; Deasy, J O

2014-07-21

381

Quantitative Assessment of Altered Rectal Mucosal Permeability Due to Rectally Applied Nonoxynol-9, Biopsy, and Simulated Intercourse  

PubMed Central

Background.?Microbicide toxicity may reduce the efficacy of topical preexposure prophylaxis for human immunodeficiency virus (HIV) transmission. Noninvasive quantitative measures of microbicide toxicity would usefully inform microbicide development. Methods.?Ten subjects received 3 one-time interventions: 5 mL of Normosol-R fluid alone (negative control), 5 mL of 2% nonoxynol-9 (N-9) gel, and 5 mL of Normosol-R with coital simulation and sigmoidoscopic biopsy (CS + BX). Each dose of N-9 and Normosol-R contained 500 µCi of 99mtechnetium–diethylene triamine pentaacetic acid. Plasma and urine radioactivity was assessed over 24 hours. Results.?The plasma radioisotope concentration peaked 1 hour after N-9 dosing. The mean maximum radioisotope concentration after N-9 receipt was 12.0 times (95% confidence interval [CI], 6.8–21.0) and 8.4 times (95% CI, 5.2–13.5) the mean concentration after Normosol-R control receipt and CS + BX receipt, respectively; paired differences persisted for 24 hours. After N-9 dosing, the urine isotope level was 3.6 times (95% CI, 1.1–11.4) the level observed 8 hours after Normosol-R control receipt and 4.0 times (95% CI, 1.4–11.4) the level observed 4 hours after CS + BX receipt. Permeability after CS + BX receipt was greater than that after Normosol-R control receipt in 0–2-hour urine specimens only (mean permeability, 2.4; 95% CI, 1.0–5.8) but was not greater in blood. Conclusions.?Plasma sampling after rectal radioisotope administration provided quantitative estimates of altered mucosal permeability after chemical and mechanical stresses. Permeability testing may provide a useful noninvasive adjunct to assess the mucosal effects of candidate microbicides. Clinical Trials Registration.?NCT00389311.

Fuchs, Edward J.; Grohskopf, Lisa A.; Lee, Linda A.; Bakshi, Rahul P.; Hendrix, Craig W.

2013-01-01

382

Effect of submucosal alcohol injection on prolonged rectal prolapse in infants and children  

PubMed Central

Aim: Our aim in this study is to evaluate the effect of ethanol as a sclerosing agent on subset of pediatric patients with prolonged rectal prolapse. Materials and Methods: From 1997 to 2003, 165 cases of primary rectal prolapse were treated by submucosal injection of ethyl alcohol (96%) after 8 weeks of conservative therapy. Around 1.5-2 ml of alcohol was linearly injected in three sites (two laterals and one posterior). Results: Twelve of the 165 cases lost the follow-up and 153 cases were followed from 9 months to 6 years. One hundred and six patients (69.3%) had a duration of prolapse for 3-7 months. Forty patients (26.1%) had prolapse for more than 7 months and seven patients had prolapse for more than 1 year. One hundred and forty-seven out of 153 (96%) patients responded to single injection. Three of the children required a second injection. Three patients with age of more than 13 did not respond to the treatment. Twenty five cases had fecal soilage for few days. No infectious complication and no recurrence were observed. Conclusion: We concluded that 4-6 ml of ethyl alcohol (96%) is effective for the treatment of rectal prolapse. The duration of rectal prolapse had no deleterious effect on treatment; however, patients with age more than 13 years did not respond to sclerosing agent, probably due to different etiology.

Bahador, Abi; Foroutan, Hamid Reza; Hosseini, Seyed Mohammad Vahid; Davani, Sam Zeraatian Nejad

2008-01-01

383

Atrial natriuretic peptide stimulates salt secretion by shark rectal gland by releasing VIP  

SciTech Connect

Salt secretion by the isolated perfused rectal gland of the spiny dogfish shark, Squalus acanthias, is stimulated by synthetic rat atrial natriuretic peptide (ANP II) as well as extracts of shark heart, but not by 8-bromo-cyclic guanosine 5'-monophosphate. Cardiac peptides have no effect on isolated rectal gland cells or perfused tubules, suggesting that stimulation requires an intact gland. The stimulation of secretion by ANP II is eliminated by maneuvers that block neurotransmitter release. Cardiac peptides stimulate the release of vasoactive intestinal peptide (VIP), known to be present in rectal glands nerves, into the venous effluent of perfused glands in parallel with their stimulation of salt secretion, but the release of VIP induced by ANP II is prevented by perfusion with procaine. VIP was measured by radioimmunoassay. Cardiac peptides thus appear to regulate rectal gland secretion by releasing VIP from neural stores within the gland. It is possible that other physiological effects of these hormones might be explained by an action to enhanced local release of neurotransmitters.

Silva, P.; Stoff, J.S.; Solomon, R.J.; Lear, S.; Kniaz, D.; Greger, R.; Epstein, F.H.

1987-01-01

384

Sphincter-saving surgeries for rectal cancer: A single center study from Kashmir  

PubMed Central

Summary and Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, bladder and sexual function. Surgical resection using sharp mesorectal dissection is important for achieving these goals. Objectives: The current treatment of choice for carcinoma rectum is sphincter saving procedures, which have practically replaced the previously done abdominoperineal resection. We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer. Materials and Methods: This prospectivestudy included 117 patients, treated for primary rectal cancer by low anterior resection (LAR) from May 2007 to December 2010. All patients underwent standard total mesorectal excision (TME) followed by restoration of continuity. Results: The peri-operative mortality rate was 2.5% (3/117). Post-operative complications occurred in 32% of the patients. After a median follow up of 42 months, local recurrences developed in 6 (5%) patients and distant metastasis in 5 (4.2%). The survival rate was 93%. Conclusion: The concept of total mesorectal excision (TME), advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients. Rectal cancer needs to be managed especially in a specialized unit for better results.

Mir, Shabeer Ahmed; Chowdri, Nisar A.; Parray, Fazl Q.; Mir, Parvez Ahmed; Bashir, Yasir; Nafae, Muntakhab

2013-01-01

385

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study)  

Microsoft Academic Search

BACKGROUND: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does not require expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications. The aim of this

Frank JC van den Broek; Eelco JR de Graaf; Marcel GW Dijkgraaf; Johannes B Reitsma; Jelle Haringsma; Robin Timmer; Bas LAM Weusten; Michael F Gerhards; Esther CJ Consten; Matthijs P Schwartz; Maarten J Boom; Erik J Derksen; A Bart Bijnen; Paul HP Davids; Christiaan Hoff; Hendrik M van Dullemen; G Dimitri N Heine; Klaas van der Linde; Jeroen M Jansen; Rosalie CH Mallant-Hent; Ronald Breumelhof; Han Geldof; James CH Hardwick; Pascal G Doornebosch; Annekatrien CTM Depla; Miranda F Ernst; Ivo P van Munster; Ignace HJT de Hingh; Erik J Schoon; Willem A Bemelman; Paul Fockens; Evelien Dekker

2009-01-01

386

Heritability of rectal temperature and genetic correlations with production and reproduction traits in dairy cattle.  

PubMed

Genetic selection for body temperature during heat stress might be a useful approach to reduce the magnitude of heat stress effects on production and reproduction. Objectives of the study were to estimate the genetic parameters of rectal temperature (RT) in dairy cows in freestall barns under heat stress conditions and to determine the genetic and phenotypic correlations of rectal temperature with other traits. Afternoon RT were measured in a total of 1,695 lactating Holstein cows sired by 509 bulls during the summer in North Florida. Genetic parameters were estimated with Gibbs sampling, and best linear unbiased predictions of breeding values were predicted using an animal model. The heritability of RT was estimated to be 0.17 ± 0.13. Predicted transmitting abilities for rectal temperature changed 0.0068 ± 0.0020°C/yr from (birth year) 2002 to 2008. Approximate genetic correlations between RT and 305-d milk, fat, and protein yields, productive life, and net merit were significant and positive, whereas approximate genetic correlations between RT and somatic cell count score and daughter pregnancy rate were significant and negative. Rectal temperature during heat stress has moderate heritability, but genetic correlations with economically important traits mean that selection for RT could lead to lower productivity unless methods are used to identify genes affecting RT that do not adversely affect other traits of economic importance. PMID:22612974

Dikmen, S; Cole, J B; Null, D J; Hansen, P J

2012-06-01

387

Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer  

PubMed Central

Purpose The safety and the feasibility of performing laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy (CRT) have not yet been established. Thus, the aim of this study was to evaluate the efficacy and the safety of laparoscopic rectal cancer surgery performed after preoperative CRT. Methods We enrolled 124 consecutive patients who underwent laparoscopic surgery for rectal cancer. Of these patients, 56 received preoperative CRT (CRT group), whereas 68 did not (non-CRT group). The patients who were found to have distant metastasis and open conversion during surgery were excluded. The clinicopathologic parameters were evaluated and the short-term outcomes were compared between the CRT and non-CRT groups. Results The mean operation time was longer in the CRT group (294 minutes; range, 140 to 485 minutes; P = 0.004). In the non-CRT group, the tumor sizes were larger (mean, 4.0 cm; range, 1.2 to 8.0 cm; P < 0.001) and more lymph nodes were harvested (mean, 12.9; range, 0 to 35; P < 0.001). However, there was no significant difference between the two groups in time to first bowel movement, tolerance of a soft diet, length of hospital stay, and postoperative complication rate. Conclusion Performing laparoscopic surgery for rectal cancer after preoperative CRT may be safe and feasible if performed by a highly skilled laparoscopic surgeon. Randomized controlled trials and long-term follow-up studies are necessary to support our results.

Ahn, Byong Hyon; Lee, Kyung Ha; Park, Jun Beom; Song, Min Sang; Kim, Ji Yeon

2012-01-01

388

Optimal Total Mesorectal Excision for Rectal Cancer: the Role of Robotic Surgery from an Expert's View  

PubMed Central

Total mesorectal excision (TME) has gained worldwide acceptance as a standard surgical technique in the treatment of rectal cancer. Ever since laparoscopic surgery was first applied to TME for rectal cancer, with increasing penetration rates, especially in Asia, an unstable camera platform, the limited mobility of straight laparoscopic instruments, the two-dimensional imaging, and a poor ergonomic position for surgeons have been regarded as limitations. Robotic technology was developed in an attempt to reduce the limitations of laparoscopic surgery. The robotic system has many advantages, including a more ergonomic position, stable camera platform and stereoscopic view, as well as elimination of tremor and subsequent improved dexterity. Current comparison data between robotic and laparoscopic rectal cancer surgery show similar intraoperative results and morbidity, postoperative recovery, and short-term oncologic outcomes. Potential benefits of a robotic system include reduction of surgeon's fatigue during surgery, improved performance and safety for intracorporeal suture, reduction of postoperative complications, sharper and more meticulous dissection, and completion of autonomic nerve preservation techniques. However, the higher cost for a robotic system still remains an obstacle to wide application, and many socioeconomic issues remain to be solved in the future. In addition, we need more concrete evidence regarding the merits for both patients and surgeons, as well as the merits compared to conventional laparoscopic techniques. Therefore, we need large-scale prospective randomized clinical trials to prove the potential benefits of robot TME for the treatment of rectal cancer.

Kang, Jeonghyun

2010-01-01

389

Patterns and signal intensity characteristics of pelvic recurrence of rectal cancer at MR imaging.  

PubMed

Magnetic resonance (MR) imaging is becoming the cross-sectional imaging modality of choice for follow-up of patients with previous rectal cancer to diagnose pelvic recurrence and plan for surgery. The authors conducted a retrospective review of MR imaging examinations performed at their institution for evaluation of local recurrence of rectal cancer in 42 patients. Twenty-six patients had undergone rectal anastomosis and 16 had undergone abdominoperineal resection. The mean interval between initial surgery and recurrence was 2.5 years. Recurrence sites were axial (involving the anastomosis) (n = 19); lateral (sidewall) (n = 6); anterior (prostate or seminal vesicle [n = 2], bladder [n = 4], ureter [n = 3], vagina or uterus [n = 5]); or posterior (presacral fascia [n = 11], sacrum [n = 2]). Other recurrence sites included the pelvic floor (n = 7), sciatic nerve (n = 2), obturator nerve (n = 1), perineum (n = 1), abdominal wall (n = 1), or adnexa (n = 1). Recurrence was confirmed at surgery or by evidence of tumor growth at follow-up imaging. Recurrence patterns, signal intensity characteristics, findings of unresectability, potential MR imaging pitfalls, and the role of MR imaging versus other modalities in evaluating recurrent rectal carcinoma are discussed. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg335115170/-/DC1. PMID:24025941

Sinaei, Mehrdad; Swallow, Carol; Milot, Laurent; Moghaddam, Parnian Ahmadi; Smith, Andrew; Atri, Mostafa

2013-01-01

390

Is rectal pain sensitivity a biological marker for irritable bowel syndrome: Psychological influences on pain perception  

Microsoft Academic Search

Background & Aims: Rectal pain sensitivity has been called a biological marker for irritable bowel syndrome, but this conclusion may be premature. This article is a critical review of the evidence for psychological influences on perception. Methods: The world literature accessible through Index Medicus from 1973 to 1997 was systematically reviewed. Results: Evidence favoring a biological basis for pain sensitivity

William E. Whitehead; Olafur S. Palsson

1998-01-01

391

Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome  

Microsoft Academic Search

Fifteen patients with the irritable bowel syndrome were studied to assess the effect of hypnotherapy on anorectal physiology. In comparison with a control group of 15 patients who received no hypnotherapy significant changes in rectal sensitivity were found in patients with diarrhoea-predominant irritable bowel syndrome both after a course of hypnotherapy and during a session of hypnosis (p less than

A Prior; S M Colgan; P J Whorwell

1990-01-01

392

Rectal biopsy in patients presenting to an infectious disease unit with diarrhoeal disease  

Microsoft Academic Search

The role of sigmoidoscopy and rectal biopsy was investigated in patients referred to an infectious diseases unit with diarrhoea. Seventy-four patients were studied. Nine patients (12%) had inflammatory bowel disease, either ulcerative colitis or Crohn's disease. Thirty-six patients (48%) had infective diarrhoea. A wide variety of conditions accounted for the diarrhoea in the remaining patients. Sigmoidoscopy was abnormal in 25

R J Dickinson; H M Gilmour; D B McClelland

1979-01-01

393

Circulating lymphocyte is an important determinant of the effectiveness of preoperative radiotherapy in advanced rectal cancer  

Microsoft Academic Search

BACKGROUND: Although preoperative radiotherapy (RT) is widely used as the initial treatment for locally advanced rectal cancer (RC) in the neoadjuvant setting, factors determining clinical response have not been adequately defined. In order to find other factors possibly related with radiosensitivity, we evaluated the relationships between circulating blood cell counts and RT effects. METHODS: In 179 cases with advanced RC,

Joji Kitayama; Koji Yasuda; Kazushige Kawai; Eiji Sunami; Hirokazu Nagawa

2011-01-01

394

Renaissance of contact x-ray therapy for treating rectal cancer.  

PubMed

Contact x-ray therapy (CXRT) with 50 kV has proven to be an efficient radiation therapy technique to achieve local control and rectal preservation for early rectal adenocarcinoma. Despite these results, CXRT has not been used due to the shortage of the no longer manufactured Philips RT 50™ unit. Recently, a new CXRT machine (Papillon 50™) became available on the market. This machine delivers a beam of 50 kV with a dose rate close to 15 Gy/min and has a percentage depth dose of 50% at 6-7 mm. The applicator size varies from 2-3 cm in diameter. Due to the original design of the main tube, treatment delivery is quick and more comfortable for the patients. An online viewing system incorporated in the tube allows a good visualization of the tumor with improved accuracy of radiation delivery. An international collaborative trial (Contact Endoscopic Microsurgery [CONTEM]) was set up to accrue approximately 300 cases of rectal adenocarcinoma staged T1, T2 or early T3 tumors in the UK, France, Denmark and Sweden. This trial should confirm the role of CXRT in curative treatment with organ preservation for early rectal cancers. PMID:21728733

Gérard, Jean-Pierre; Myint, Arthur Sun; Croce, Olivier; Lindegaard, Jacob; Jensen, Anie; Myerson, Robert; Hannoun-Lévi, Jean-Michel; Marcie, Serge

2011-07-01

395

School Nurses' Experience with Administration of Rectal Diazepam Gel for Seizures  

ERIC Educational Resources Information Center

The purpose of this study was to determine school nurses' knowledge of state and school district policies, their experience regarding the administration of rectal diazepam gel in the school, and the perceived benefits and barriers of providing this treatment. Four hundred nineteen nurses responded to a survey conducted during the National…

O'Dell, Christine; O'Hara, Kathryn

2007-01-01

396

Which Patients Benefit from Preoperative Chemoradiotherapy for Intermediate Staged Rectal Cancer?  

Microsoft Academic Search

SummaryBackground: The aim of this study was to identify subgroups that benefit from preoperative or postoperative chemoradiotherapy (CRT) for rectal cancer of intermediate stage. Patients and Methods: Between 1999 and 2004, 118 and 177 patients matched with respect to clinical T stage, circumferential tumor extent (= 60% \\/ > 60%), lymph node metastasis, and lymph node size (< 1 cm

Won Sup Yoon; Won Park; Doo Ho Choi; Yong Chan Ahn; Ho Kyung Chun; Woo Yong Lee; Seong Hyeon Yun; Hee Cheol Kim; Yong Beom Cho; Won Ki Kang; Young Suk Park; Joon Oh Park; Ho-Yeong Lim; Se Hoon Park; Jeeyun Lee

2011-01-01

397

Negative impact of pretreatment anemia on local control after neoadjuvant chemoradiotherapy and surgery for rectal cancer  

PubMed Central

Purpose Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. Materials and Methods We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. Results The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Conclusion Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.

Lee, Hyebin; Park, Won; Choi, Doo Ho; Kim, Young-Il; Park, Young Suk; Park, Joon Oh; Chun, Ho-Kyung; Lee, Woo-Yong; Kim, Hee Cheol; Yun, Seong Hyeon; Cho, Yong Beom; Park, Yoon Ah

2012-01-01

398

Effectiveness of endoluminal sonography in the identification of occult local rectal cancer recurrences  

Microsoft Academic Search

PURPOSE: Local recurrence of rectal cancer after curative surgery appears in 5 to 30 percent of all cases. It is necessary to detect local recurrence in a resectable stage to have an opportunity for currative reintervention or palliative prevention of those symptoms. Because most local recurrences occur extraluminally, conventional follow-up fails to detect them at an early stage. Therefore, a

Mathias Stefan Silvester Löhnert; Julius Marek Doniec; Doris Henne-Bruns

2000-01-01

399

A Model for Teaching Sophomore Medical Students the Essentials of the Male Genital-Rectal Examination.  

ERIC Educational Resources Information Center

Trained nonphysician teaching-associates teach the essentials of the male genital-rectal examination to medical students in a model program developed at the University of Iowa. The teaching associates teach in pairs; one serves as the simulated patient and the other as the examiner. Training of the teaching associates is discussed. (JMD)

Behrens, Anne; And Others

1979-01-01

400

[Rectal tenesmus due to tumor invasion into the pelvic cavity responding favorably to antiarrhythmic drug therapy].  

PubMed

We experienced 3 patients(Cases 1, 3, and 4)with pelvic tumor-related rectal tenesmus showing favorable responses to antiarrhythmic drugs. Based on this experience, we administered antiarrhythmic drugs preferentially to 2 others with tumor derived rectal tenesmus(Cases 2 and 5), and again obtained favorable responses. These 5 patients(1 man, 4 women)were 28-89(mean 58)years of age. The primary lesion was cervical cancer in 3 patients, ovarian cancer in 1, and bladder cancer in 1. In the 3 with cervical cancer, the tumor had directly infiltrated the rectum and vulva. The patient with ovarian cancer had a residual tumor in the Douglas pouch postoperatively. The patient with bladder cancer had undergone total cystectomy and urinary diversion using an ileal conduit at another institution. All 5 patients complained of a frequent desire to defecate without feces(rectal tenesmus). Their rectal tenesmus was attributed to pelvic neurological dysfunction around the rectum. Drug therapy was initiated with oral mexiletine hydrochloride(Mexitil)150 mg in 3 divided doses in 4 patients and with continuous infusion of intravenous lidocaine 2%(Xylocaine)500mg/day in the other(Case 2). None had adverse reactions; all 5 experienced palliation of symptoms and improved quality of life. PMID:23235181

Yoshino, Kazuho; Koizumi, Takahisa; Nakazato, Kenei; Nakagawa, Tomoki; Masuda, Ryota; Mikami, Mikio; Tokuda, Yutaka; Iwasaki, Masayuki

2012-12-01

401

Cloacogenic polyps in an adolescent: a rare cause of rectal bleeding.  

PubMed

Cloacogenic polyps are rare inflammatory lesions occurring around the anal transitional zone and in the lower rectum which can mimic neoplasia. They should be given diagnostic consideration in patients presenting with symptoms of rectal bleeding, tenesmus, and altered bowel habits. PMID:23932634

Zaman, Shafquat; Mistry, Pritesh; Hendrickse, Charles; Bowley, Douglas M

2013-08-01

402

Influence of rectal prolapse on the asymmetry of the anal sphincter in patients with anal incontinence  

Microsoft Academic Search

BACKGROUND: Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence. METHODS: 44 patients, (42

Henri Damon; Luc Henry; Sabine Roman; Xavier Barth; François Mion

2003-01-01

403

Subtotal colectomy by rectal pull-through for treatment of idiopathic megacolon in 2 cats  

PubMed Central

Surgical management of idiopathic megacolon is described in 2 cats by a rectal pull-through with subtotal colectomy performed outside of the abdomen. This newly described technique facilitates access to the rectum for suturing an anastamosis without the need for pubic osteotomy and with minimal risk of abdominal contamination.

Barnes, Darren C.

2012-01-01

404

Fox Chase study finds age tied to spread of rectal cancer to lymph nodes  

Cancer.gov

Rectal cancer is more likely to spread to the lymph nodes in younger patients, according to new findings that Fox Chase Cancer Center researchers presented on October 29 at the American Society for Radiation Oncology’s 54th Annual Meeting. The results—which are the first of their kind—suggest that doctors should search for spreading more aggressively in these patients.

405

Prostate Hypofractionated Radiation Therapy: Injection of Hyaluronic Acid to Better Preserve The Rectal Wall  

SciTech Connect

Purpose: The aim of this study was to evaluate the contribution of an injection of hyaluronic acid (HA) between the rectum and the prostate for reducing the dose to the rectal wall in a hypofractionated irradiation for prostate cancer. Methods and Materials: In a phase 2 study, 10 cc of HA was injected between the rectum and prostate. For 16 patients, the same intensity modulated radiation therapy plan (62 Gy in 20 fractions) was optimized on 2 computed tomography scans: CT1 (before injection) and CT2 (after injection). Rectal parameters were compared: dose to 2.5 cc (D2.5), 5 cc (D5), 10 cc (D10), 15 cc (D15), and 20 cc (D20) of rectal wall and volume of rectum covered by the 90% isodose line (V90), 80% (V80), 70% (V70), 60% (V60), and 50% (V50). Results: The mean V90, V80, V70, V60, and V50 values were reduced by 73.8% (P<.0001), 55.7% (P=.0003), 43.0% (P=.007), 34% (P=.002), and 25% (P=.036), respectively. The average values of D2.5, D5, D10, D15, and D20 were reduced by 8.5 Gy (P<.0001), 12.3 Gy (P<.0001), 8.4 Gy (P=.005), 3.7 Gy (P=.026), and 1.2 Gy (P=.25), respectively. Conclusions: The injection of HA significantly limited radiation doses to the rectal wall.

Chapet, Olivier, E-mail: olivier.chapet@chu-lyon.fr [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France)] [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Udrescu, Corina [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France) [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France); Devonec, Marian [Department of Urology, Centre Hospitalier Lyon Sud, Pierre Benite (France)] [Department of Urology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Tanguy, Ronan [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France)] [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Sotton, Marie-Pierre [Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France)] [Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France); Enachescu, Ciprian [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France)] [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Colombel, Marc [Department of Urology, Hopital Edouard Herriot, Lyon (France)] [Department of Urology, Hopital Edouard Herriot, Lyon (France); Azria, David [Department of Radiation Oncology, Centre Val d'Aurelle, Montpellier (France)] [Department of Radiation Oncology, Centre Val d'Aurelle, Montpellier (France); Jalade, Patrice [Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France)] [Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France); Ruffion, Alain [Department of Urology, Centre Hospitalier Lyon Sud, Pierre Benite (France)] [Department of Urology, Centre Hospitalier Lyon Sud, Pierre Benite (France)

2013-05-01

406

Comparative Analysis of Radiosensitizers for K-RAS Mutant Rectal Cancers  

PubMed Central

Approximately 40% of rectal cancers harbor activating K-RAS mutations, and these mutations are associated with poor clinical response to chemoradiotherapy. We aimed to identify small molecule inhibitors (SMIs) that synergize with ionizing radiation (IR) (“radiosensitizers”) that could be incorporated into current treatment strategies for locally advanced rectal cancers (LARCs) expressing mutant K-RAS. We first optimized a high-throughput assay for measuring individual and combined effects of SMIs and IR that produces similar results to the gold standard colony formation assay. Using this screening platform and K-RAS mutant rectal cancer cell lines, we tested SMIs targeting diverse signaling pathways for radiosensitizing activity and then evaluated our top hits in follow-up experiments. The two most potent radiosensitizers were the Chk1/2 inhibitor AZD7762 and the PI3K/mTOR inhibitor BEZ235. The chemotherapeutic agent 5-fluorouracil (5-FU), which is used to treat LARC, synergized with AZD7762 and enhanced radiosensitization by AZD7762. This study is the first to compare different SMIs in combination with IR for the treatment of K-RAS mutant rectal cancer, and our findings suggest that Chk1/2 inhibitors should be evaluated in new clinical trials for LARC.

Kim, Stephen Y.; Hong, Theodore S.; Haigis, Kevin M.

2013-01-01

407

Glucose Infusion into Exercising Dogs after Confinement: Rectal and Active Muscle Temperatures  

NASA Technical Reports Server (NTRS)

Intravenous glucose infusion into ambulatory dogs results in attenuation of exercise-induced increase of both rectal and thigh muscle temperatures. That glucose (Glu) infusion attenuates excessive increase in body temperature from restricted activity during confinement deconditioning. Intravenous glucose infusion attenuates the rise in exercise core temperature in deconditioned dogs by a yet undefined mechanism.

Greenleaf, J. E.; Kruk, B.; Nazar, K.; Falecka-Wieczorek, I.; Kaciuba-Uscilko, H.

1995-01-01

408

Reversal of visceral and cutaneous hyperalgesia by local rectal anesthesia in irritable bowel syndrome (IBS) patients.  

PubMed

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal illnesses and is characterized by altered visceral perception. The aim of the study was to determine if local anesthetic blockade of peripheral visceral nociceptive input reduces both visceral and cutaneous secondary hyperalgesia in IBS patients. Ten women with IBS (mean age 30+/-10 years) and ten control subjects (all women) (mean age 29+/-7 years) rated pain intensity and unpleasantness to distension of the rectum (35 mmHg) and thermal stimulation (47 degrees C) of the foot before and after rectal administration of either lidocaine jelly or saline jelly in a double blind crossover design. Intrarectal lidocaine (300 mg) reduced reported rectal and cutaneous pain in all of the IBS patients. The effects were statistically much greater than those of placebo and most of the effects were present within 5-15 min after the onset of the treatment. In the control subjects, rectal lidocaine did not decrease pain report from visceral and cutaneous stimuli. The results of this study support the hypothesis that local anesthetic blockade of peripheral impulse input from the rectum/colon reduces both visceral and cutaneous secondary hyperalgesia in IBS patients. The results provide further evidence that visceral hyperalgesia and secondary cutaneous hyperalgesia in IBS reflects central sensitization mechanisms that are dynamically maintained by tonic impulse input from the rectum/colon. Rectal administration of lidocaine jelly may also be a safe and effective means of reducing pain symptoms in IBS patients. PMID:14499439

Verne, G Nicholas; Robinson, Michael E; Vase, Lene; Price, Donald D

2003-09-01

409

Significance of Cox-2 expression in rectal cancers with or without preoperative radiotherapy  

SciTech Connect

Purpose: Radiotherapy has reduced local recurrence of rectal cancers, but the result is not satisfactory. Further biologic factors are needed to identify patients for more effective radiotherapy. Our aims were to investigate the relationship of cyclooxygenase-2 (Cox-2) expression to radiotherapy, and clinicopathologic/biologic variables in rectal cancers with or without radiotherapy. Methods and Materials: Cox-2 expression was immunohistochemically examined in distal normal mucosa (n = 28), in adjacent normal mucosa (n = 107), in primary cancer (n = 138), lymph node metastasis (n = 30), and biopsy (n = 85). The patients participated in a rectal cancer trial of preoperative radiotherapy. Results: Cox-2 expression was increased in primary tumor compared with normal mucosa (p < 0.0001), but there was no significant change between primary tumor and metastasis. Cox-2 positivity was or tended to be related to more p53 and Ki-67 expression, and less apoptosis (p {<=} 0.05). In Cox-2-negative cases of either biopsy (p = 0.01) or surgical samples (p = 0.02), radiotherapy was related to less frequency of local recurrence, but this was not the case in Cox-2-positive cases. Conclusion: Cox-2 expression seemed to be an early event involved in rectal cancer development. Radiotherapy might reduce a rate of local recurrence in the patients with Cox-2 weakly stained tumors, but not in those with Cox-2 strongly stained tumors.

Pachkoria, Ketevan [Department of Oncology, Institute of Biomedicine and Surgery, University of Linkoeping, Linkoeping (Sweden); Zhang Hong [Department of Dermatology, Institute of Biomedicine and Surgery, University of Linkoeping, Linkoeping (Sweden); Adell, Gunnar [Department of Oncology, Institute of Biomedicine and Surgery, University of Linkoeping, Linkoeping (Sweden); Jarlsfelt, Ingvar [Department of Pathology and Cytology, Joenkoeping Hospital, Joenkoeping (Sweden); Sun Xiaofeng [Department of Oncology, Institute of Biomedicine and Surgery, University of Linkoeping, Linkoeping (Sweden)]. E-mail: xiao-feng.sun@ibk.liu.se

2005-11-01

410

P27 does not predict histopathological response to radiochemotherapy in rectal cancer  

Microsoft Academic Search

BackgroundTumor response to radiochemotherapy (RCT) varies considerably, even among patients treated in accordance with the same protocol. The aim of the present study was to test the predictive value of the cell-cycle inhibitor p27kip1 with regard to neoadjuvant RCT response in rectal cancer.

Klaus Günther; Arno Dimmler; Franz Rödel; Udo Reulbach; Susanne Merkel; Birgit R Bittorf; Klaus E Matzel; Thomas Papadopoulos; Werner Hohenberger; Rolf Sauer; Claus Rödel

2003-01-01

411

Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer  

Microsoft Academic Search

PURPOSE: This was a pilot study of high-dose preoperative concurrent radiation and chemotherapy before extensive surgery in patients with locally advanced recurrent rectal cancer. Here we report on curative resectability, acute toxicities during chemoradiotherapy, surgical complications, local control, and three-year survival rates achieved with this aggressive multimodal regimen. METHODS: Between 1994 and 1997, 35 previously nonirradiated patients with pelvic recurrence

Claus Rödel; Gerhard G. Grabenbauer; Klaus E. Matzel; Christoph Schick; Rainer Fietkau; Thomas Papadopoulos; Peter Martus; Werner Hohenberger; Rolf Sauer

2000-01-01

412

Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective?  

PubMed

Rectal infection with Chlamydia trachomatis affects approximately 7% of men having sex with men (MSM), attending departments of Genito-Urinary (GU) Medicine [Manavi et al. Int J STD AIDS 2004;15:162-4], and the British Association for Sexual Health and HIV (BASHH) guidelines for the treatment of uncomplicated genital C. trachomatis infection include 1 g of single-dose oral azithromycin as a recommended regimen [BASHH 2006]. A retrospective analysis was performed on case-notes from all patients diagnosed with rectal C. trachomatis infection in the department of GU Medicine, Edinburgh for the one-year period from 1 June 2005. Of 101 new episodes of rectal chlamydial infection, only 9% were associated with anorectal symptoms. Excluding these, 85% of asymptomatic patients were treated with a single dose of azithromycin 1 g orally, with a calculated treatment failure rate of 13% (nine of 68). This suggests that single-dose azithromycin may be a less than effective treatment in asymptomatic rectal C. trachomatis infection. The potential treatment failure rate with this regimen emphasizes the need for a test of cure at the appropriate interval following treatment to ensure clearance of infection. PMID:19103887

Steedman, N M; McMillan, A

2009-01-01

413

Associations between BMI, energy intake, energy expenditure, VDR genotype and colon and rectal cancers (United States)  

Microsoft Academic Search

Components of energy balance are important elements associated with colorectal cancer risk. In this study we examine the association between VDR genotypes, BMI, physical activity, and energy intake and risk of colorectal cancer. Data from a population-based case–control study of colon (1174 cases and 1174 controls) and rectal (785 cases and 1000 controls) cancer was used to evaluate the associations.

Martha L. Slattery; Maureen Murtaugh; Bette Caan; Khe Ni Ma; Roger Wolff; Wade Samowitz

2004-01-01

414

Robotic surgery for rectal cancer: A systematic review of current practice  

PubMed Central

AIM: To give a comprehensive review of current literature on robotic rectal cancer surgery. METHODS: A systematic review of current literature via PubMed and Embase search engines was performed to identify relevant articles from january 2007 to november 2013. The keywords used were: “robotic surgery”, “surgical robotics”, “laparoscopic computer-assisted surgery”, “colectomy” and “rectal resection”. RESULTS: After the initial screen of 380 articles, 20 papers were selected for review. A total of 1062 patients (male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review. Out of 1062 robotic-assisted operations, 831 (78.2%) anterior and low anterior resections, 132 (12.4%) intersphincteric resection with coloanal anastomosis, 98 (9.3%) abdominoperineal resections and 1 (0.1%) Hartmann’s operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has continued to evolve to its current state with promising results; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.

Mak, Tony Wing Chung; Lee, Janet Fung Yee; Futaba, Kaori; Hon, Sophie Sok Fei; Ngo, Dennis Kwok Yu; Ng, Simon Siu Man

2014-01-01

415

Effect of Sphincter-Sacrificing Surgery for Rectal Carcinoma on Quality of Life in Muslim Patients  

Microsoft Academic Search

PURPOSE: Living with a permanent colostomy significantly diminishes a patient’s quality of life. However, little is known about its influence on worship patterns in Muslims. Therefore, the aim of this study was to assess the quality of life in Muslim patients after surgery for rectal carcinoma, especially with respect to religious worship. METHODS: We studied 178 patients who had undergone

Mehmet Ayhan Kuzu; Ömer Topçu; Keriman Uçar; Suat Ulukent; Ekrem Ünal; Nezih Erverdi; Atilla Elhan; Salim Demirci

2002-01-01

416

Chromosomal copy number changes of locally advanced rectal cancers treated with preoperative chemoradiotherapy  

PubMed Central

Introduction Standard treatment of rectal cancer patients comprises preoperative chemoradiotherapy followed by radical surgery. However, clinicians are faced with the problem that response rates vary from one individual to another. Predictive biomarkers would therefore be helpful. Materials and Methods In order to identify genomic imbalances that might assist in stratifying tumors into responsive or non-responsive, we used metaphase comparative genomic hybridization to prospectively analyze pre-therapeutic biopsies from 42 patients with locally advanced rectal cancers. These patients were subsequently treated with 5-FU based preoperative chemoradiotherapy. Results Based on downsizing of the T-category, 21 rectal cancers were later classified as responsive, while 21 were non-responsive. Comparing these two groups, we could show that gains of chromosomal regions 7q32-q36 and 7q11-q31, and amplifications of 20q11-q13 were significantly associated with responsiveness to preoperative chemoradiotherapy (P<0.05). However, the probability to detect these copy number changes by chance is high (P=0.21). Conclusion Our primary results suggest that pre-therapeutic evaluation of chromosomal copy number changes may be of value for response prediction of rectal cancers to preoperative chemoradiotherapy. This will require validation in a larger cohort of patients.

Grade, Marian; Gaedcke, Jochen; Wangsa, Danny; Varma, Sudhir; Beckmann, Jaje; Liersch, Torsten; Hess, Clemens; Becker, Heinz; Difilippantonio, Michael J.; Ried, Thomas; Ghadimi, B. Michael

2009-01-01

417

Impact of colloid response on survival after preoperative radiotherapy in locally advanced rectal carcinoma.  

PubMed

Neoadjuvant therapy for rectal carcinoma modifies morphology and natural history of the tumor. Colloid response defined by predominant colloid changes with or without residual tumor cells is a form of tumor response whose impact on survival is unknown. This study evaluated influence of tumor histologic response, especially of colloid response, on survival in patients treated by long-course preoperative radiotherapy for rectal cancer. In 200 patients with uT3-T4 or N1 rectal carcinomas, influence of type of surgery, dose of radiotherapy, residual tumor size, surface tumor aspect, tumor response (downstaging vs. colloid or no response), tumor grade, vascular and neural invasion, circumferential margin, and postoperative chemotherapy on 5-year overall and disease-free survival were studied by univariate and multivariate analyses. A colloid response was observed in 20% of the cases. Tumor response, circumferential margin, and vascular invasion were independently associated with the disease-free survival. Patients with downstaging had a better disease-free survival than patients without response (80% vs. 54%), whereas those with colloid response had an intermediate survival (64%). After colloid response, the rate of recurrence was similar to patients with downstaging for local recurrence (0%-3%) and to those with no response for distant recurrence (28%). After preoperative radiotherapy for rectal cancer, survival and type of recurrence are influenced by the tumor response. The intermediate natural history of patients with colloid response suggests taking colloid response into account in postoperative tumor staging to optimize adjuvant therapy. PMID:15832083

Rullier, Anne; Laurent, Christophe; Vendrely, Veronique; Le Bail, Brigitte; Bioulac-Sage, Paulette; Rullier, Eric

2005-05-01

418

Bioresorbable Hyaluronate-Carboxymethylcellulose Membrane (Seprafilm) in Surgery for Rectal Carcinoma: A Prospective Randomized Clinical Trial  

Microsoft Academic Search

Purpose. To evaluate the effectiveness of Seprafilm in preventing abdominal adhesions after radical resection of rectal carcinoma, and to observe whether Seprafilm had any adverse effects in patients treated with radiotherapy and chemotherapy. Methods. A total of 62 patients participated in this prospective randomized clinical study, which was conducted to compare the outcomes of patients operated on with Seprafilm (SEPRA+)

Masato Kusunoki; Hiroki Ikeuchi; Hidenori Yanagi; Masafumi Noda; Hitoshi Tonouchi; Yasuhiko Mohri; Keiichi Uchida; Yasuhiro Inoue; Minako Kobayashi; Chikao Miki; Takehira Yamamura

2005-01-01

419

Comparative clinical pharmacokinetics of single doses of sumatriptan following subcutaneous, oral, rectal and intranasal administration  

Microsoft Academic Search

Sumatriptan, a 5-HT1 receptor agonist active for the acute treatment of migraine, is currently available as subcutaneous injection and oral tablets. Rectal or intranasal formulations may offer advantages over those marketed. This study compared the pharmacokinetics of sumatriptan via all four routes. Usual absorption parameters were described and the rate of absorption was assessed using deconvolution technics. There were no

C Duquesnoy; J. P Mamet; D Sumner; E Fuseau

1998-01-01

420

Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome  

Microsoft Academic Search

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

Tsukasa Nozu; Miwako Kudaira

2009-01-01

421

Ligation of the Inferior Mesenteric Artery in the Surgery of Rectal Cancer: Anatomical Considerations  

Microsoft Academic Search

Background: No agreement has been found in the literature concerning the safest point of ligation of the inferior mesenteric artery (ima) in order to avoid nerve damage during the surgery of rectal cancer. Study Design: The distance between the origin of the ima and the left paraortic trunk was measured, as was the distance between the left paraortic trunk and

Mario Nano; Herbert Dal Corso; Marco Ferronato; Mario Solej; Jean Pierre Hornung; Marcello Dei Poli

2004-01-01

422

The absorption of (99m)Tc-alendronate given by rectal route in rabbits.  

PubMed

Alendronate sodium (ALD) is a bisphosphonate medication used in the treatment and prevention of osteoporosis. Absorption of ALD as oral formulation is very poor (0.5%-1%). Its bioavailability can decrease with food effect. It has some gastrointestinal adverse effects such as gastritis, gastric ulcer, and esophagitis. The aim of this study was to develop a rectal formulation of ALD as an alternative to oral route and to investigate the absorption of it by using gamma scintigraphy. For this reason, ALD was labeled with Technetium-99m ((99m)Tc) by direct method. The radiochemical characterization of the (99m)Tc-ALD was carried out by paper chromatography, thin layer chromatography, and electrophoresis methods. The labeling efficiency of (99m)Tc-ALD was found 99% without significant changes until 6 h postlabeling at room temperature. The rectal suppositories containing (99m)Tc-ALD were prepared by fusion method using polyethylene glycol (PEG) 1500. The (99m)Tc-labeled ALD suppositories were administrated to rabbits by rectal route. Serial scintigrams over all bodies of the rabbits were obtained at different time intervals using a gamma camera. We found that the rectal absorption of (99m)Tc-ALD from suppository formulation was possible. According to our results, this formulation of ALD can be suggested for the therapy of osteoporosis as an alternative route. PMID:18484490

Asiko?lu, Makbule; Ozguney, Isik; Ozcan, Ipek; Orumlu, Oya; Guneri, Tamer; Koseo?lu, Kamil; Ozkilic, Hayal

2008-01-01

423

Clinical Parameters Predicting Pathologic Tumor Response After Preoperative Chemoradiotherapy for Rectal Cancer  

Microsoft Academic Search

Purpose: To identify pretreatment clinical parameters that could predict pathologic tumor response to preoperative chemoradiotherapy (CRT) for rectal cancer. Methods and Materials: The study involved 351 patients who underwent preoperative CRT followed by surgery between October 2001 and July 2006. Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and tumor regression. Statistical analyses were performed to

Sang Min Yoon; Dae Yong Kim; Tae Hyun Kim; Kyung Hae Jung; Hee Jin Chang; Woong Sub Koom; Seok-Byung Lim; Hyo Seong Choi; Seung-Yong Jeong; Jae-Gahb Park

2007-01-01

424

Rectal perforations and fistulae secondary to a glycerin enema: Closure by over-the-scope-clip  

PubMed Central

Rectal perforations due to glycerin enemas (GE) typically occur when the patient is in a seated or lordotic standing position. Once the perforation occurs and peritonitis results, death is usually inevitable. We describe two cases of rectal perforation and fistula caused by a GE. An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE. Her case was further complicated by an abscess in the right rectal wall. The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE. In both cases, we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip (OTSC) procedure. These procedures resulted in dramatic improvement in both patients. Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure, respectively, in elderly patients who are in poor general condition. Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.

Mori, Hirohito; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Kobayashi, Mitsuyoshi; Masaki, Tsutomu; Izuishi, Kunihiko; Suzuki, Yasuyuki

2012-01-01

425

Rectal ulcers and massive bleeding after hemorrhoidal band ligation while on aspirin.  

PubMed

Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids (grade 1 to 3). It is a safe and effective technique with a high success rate. Complications with this procedure are uncommon. Although rectal ulceration due to band ligation is a rare complication, it can cause life-threatening hemorrhage especially when patients are on medications which impair hemostasis like aspirin or non steroidal anti-inflammatory drugs. We present 2 cases of massive lower gastro-intestinal bleeding in patients who had a band ligation procedure performed 2 wk prior to the presentation and were on aspirin at home. Both the patients were hemodynamically unstable requiring resuscitation. They required platelet and blood transfusions and were found to have rectal ulcers on colonoscopy done subsequently. The rectal ulcers corresponded to the site of band ligation. The use of aspirin by these patients would have caused defects in the hemostasis and may have predisposed them to massive bleeding in the presence of rectal ulcers occurring after the band ligation procedure. Managing aspirin before and after the ligation may be difficult especially since adequate guidelines are unavailable. Stopping aspirin in all the cases might not be safe and the decision should be individualized. PMID:24749117

Patel, Shruti; Shahzad, Ghulamullah; Rizvon, Kaleem; Subramani, Krishnaiyer; Viswanathan, Prakash; Mustacchia, Paul

2014-04-16

426

A complete response to mFOLFOX6 and panitumumab chemotherapy in advanced stage rectal adenocarcinoma: a case report  

PubMed Central

Background Pathological complete remission of advanced stage rectal adenocarcinoma by chemotherapy alone is rare. A case of advanced stage, low-lying rectal adenocarcinoma in which a complete response to treatment was obtained with mFOLFOX6 and panitumumab (Pmab) is reported. Case presentation A 53-year-old man was referred to Shiga University of Medical Science hospital Shiga, Japan, complaining of bloody stool. Gastrointestinal endoscopy was performed, and advanced stage rectal adenocarcinoma was diagnosed. Computed tomography (CT) revealed regional lymph node metastases in the mesorectum. Neoadjuvant chemotherapy (NAC) with mFOLFOX6 and Pmab was planned. Endoscopy following four courses of chemotherapy revealed that the rectal cancer had been markedly reduced, and the results of biopsies of the rectal tumor were negative for cancer. On CT, the mesorectal lymph node metastases had disappeared. Total intersphincteric resection (ISR) with a handsewn coloanal anastomosis was performed. Histological examination showed a complete response to mFOLFOX6 and Pmab in advanced stage rectal cancer. Conclusion The result seen in this case suggests that short-term NAC with mFOLFOX6 and Pmab was effective for low-lying rectal adenocarcinoma.