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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 invaginaçăo 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

EDITAL COMPLETO PARA INGRESSO POR TRANSFERNCIA EXTERNA  

E-print Network

1 EDITAL COMPLETO PARA INGRESSO POR TRANSFER�NCIA EXTERNA (BRASIL) PERÍODO 2014.1 PRAZO PARA deverá entregar a convalidação dos estudos concedida pela Secretaria Estadual de Educação, no Brasil. Se, do qual conste: A forma de ingresso / processo seletivo (vestibular, ENEM, transferência externa

3

Rectal Prolapse  

MedlinePLUS

... Surgery for Colorectal Cancer Genetics and Colorectal Cancer Hemorrhoids Hemorrhoids: Expanded Version Irritable Bowel Syndrome Ostomy Pelvic Floor ... is identified. Is rectal prolapse the same as hemorrhoids? Some of the symptoms may be the same: ...

4

Rectal Glands in Woodlice  

Microsoft Academic Search

THE structure and function of the rectal glands of insects have been investigated by several workers1. Later, Wigglesworth2 studied these glands more thoroughly in a number of species. No report, however, has yet appeared in the literature regarding the presence of rectal glands in woodlice (Crustacea : Isopoda), although Edney3 stated : ``the fćcal pellets are moist, and there appears

Minati Gupta

1961-01-01

5

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 The swab is rotated gently, and withdrawn.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 ...

6

Rectal Microbicide Development  

PubMed Central

The last few years have seen important progress in demonstrating the efficacy of oral pre-exposure prophylaxis, vaginal microbicides, and treatment as prevention as effective strategies for reducing the risk of acquiring or transmitting HIV infection. There has also been significant progress in the development of rectal microbicides. Preclinical non-human primate studies have demonstrated that antiretroviral microbicides can provide significant protection from rectal challenge with SIV or SHIV. Recent Phase 1 rectal microbicide studies have characterized the safety, acceptability, compartmental pharmacokinetics (PK), and pharmaco-dynamics (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. The PK/PD data generated in these Phase 1 studies may reduce the risk of advancing ineffective candidate rectal microbicides into late stage development. Tenofovir gel is currently poised to move into Phase 2 evaluation and it is possible that a Phase 2B/3 effectiveness study with this product could be initiated in the next 2–3 years. PMID:23612991

Dezzutti, Charlene

2014-01-01

7

Presentations of Localized Rectal Cancer  

Cancer.gov

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

8

Chemoradiation of rectal cancer.  

PubMed

The treatment of locally advanced rectal cancer is a challenge. Surgery, chemotherapy and radiotherapy comprise the multimodal therapy that is administered in most cases. Therefore, a multidisciplinary approach is required. Because this cancer has a high rate of local recurrence, efforts have been made to improve clinical outcomes while minimizing toxicity and maintaining quality of life. Thus, total mesorectal excision technique was developed as the standard surgery, and chemotherapy and radiotherapy have been established as neoadjuvant treatment. Both approaches reduce locoregional relapse. Two neoadjuvant treatments have emerged as standards of care: short-course radiotherapy and long-course chemoradiotherapy with fluoropyrimidines; however, long-course chemoradiotherapy might be more appropriate for low-lying neoplasias, bulky tumours or tumours with near-circumferential margins. If neoadjuvant treatment is not administered and locally advanced stage is demonstrated in surgical specimens, adjuvant chemoradiotherapy is recommended. The addition of chemotherapy to the treatment regimen confers a significant benefit. Adjuvant chemotherapy is widely accepted despite scarce evidence of its benefit. The optimal time for surgery after neoadjuvant therapy, the treatment of low-risk T3N0 neoplasms, the convenience of avoiding radiotherapy in some cases and tailoring treatment to pathological response have been recurrent subjects of debate that warrant more extensive research. Adding new drugs, changing the treatment sequence and selecting the treatment based on prognostic or predictive factors other than stage remain experimental. PMID:23584263

Arrazubi, V; Suárez, J; Novas, P; Pérez-Hoyos, M T; Vera, R; Martínez Del Prado, P

2013-02-01

9

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2013 CFR

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

2013-04-01

10

21 CFR 876.5450 - Rectal dilator.  

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

2014-04-01

11

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2010 CFR

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

2010-04-01

12

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2012 CFR

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

2012-04-01

13

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2011 CFR

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

2011-04-01

14

ACR Appropriateness Criteria on Resectable Rectal Cancer  

SciTech Connect

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

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

2008-04-01

15

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

16

Surgical Treatment of Rectal Prolapse  

PubMed Central

Rectal prolapse is defined as a protrusion of the rectum beyond the anus. Although rectal prolapse was recognized as early as 1500 BC, the optimal surgical procedure is still debated. The varied operative procedures available for treating rectal prolapsed can be confusing. The aim of treatment is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. In elderly and high-risk patients, perineal approaches, such as Delorme's operation and Altemeier's operation, have been preferred, although the incidence of recurrence and the rate of persistent incontinence seem to be high when compared with transabdominal procedures. Abdominal operations involve dissection and fixation of the rectum and may include a rectosigmoid resection. From the late twentieth century, the laparoscopic procedure has been applied to the treatment of rectal prolapse. Current laparoscopic surgical techniques include suture rectopexy, stapled rectopexy, posterior mesh rectopexy with artificial material, and resection of the sigmoid colon with colorectal anastomosis with or without rectopexy. The choice of surgery depends on the status of the patient and the surgeon's preference. PMID:21431090

2011-01-01

17

Rectal duplication: a case report.  

PubMed

Gastrointestinal tract duplications are uncommon congenital abnormalities, that may occur anywhere along the alimentary tract. Most frequently they occur at the level of the small bowel tract and are symptomatic before the age of two. In our case we report the history of a 68-years old women with a colon duplication, especially a rectal duplication. This is very exceptional. PMID:24224443

Didden, K; Masereel, B; Geyskens, P

2013-01-01

18

Rectal neutropenic enteropathy of children  

Microsoft Academic Search

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

Assmae Sqalli Houssaini

2009-01-01

19

Robotic rectal surgery: what are the benefits?  

PubMed

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

Kim, C W; Baik, S H

2013-10-01

20

Laparoscopic rectal resection versus open rectal resection with minilaparotomy for invasive rectal cancer  

PubMed Central

Background The minilaparotomy approach is technically feasible for the resection of rectal cancer in selected patients with rapid postoperative recovery and small incision. The study aimed to compare the clinical and oncological outcomes of minilaparotomy and laparoscopic approaches in patients with rectal cancer. Methods The 122 included patients with rectal cancer were assigned to either minilaparotomy group (n=65) or laparoscopic group (n=57) which ran from January 2005 to January 2008. Clinical characteristics, perioperative outcomes, postoperative and long-term complications, pathological results and survival rates were compared between the groups. Results The demographic data of the two groups were similar. The time to normal diet (P=0.024) and the hospital stay (P=0.043) were less in the laparoscopic group than that in the minilaparotomy group. Compared with the minilaparotomy group, the mean operation time was significantly longer [low anterior resection (LAR), P=0.030; abdominoperineal resection (APR), P=0.048] and the direct costs higher for laparoscopic group (P<0.001). The morbidity and mortality were comparable between the two groups. Local recurrence was similar (5.3% laparoscopic, 1.5% minilaparotomy, P=0.520). The 5-year overall and disease-free survival rates were also similar (overall survival is 87.1% in laparoscopic group, and 82.5%in minilaparotomy group, P=0.425; disease-free survival is 74.2% in the laparoscopic group, and 71.4% in mini- laparotomy group, P=0.633). Conclusions The minilaparotomy approach was similarly safe and oncologically equivalent to laparoscopic approach for patients with rectal cancer. At the expense of a longer operative time and higher cost, laparoscopic surgery was associated with faster postoperative recovery. PMID:24490041

Zhou, Tong; Tian, Hongpeng; Liu, Zuoliang; Xia, Shusen

2014-01-01

21

Rectal injuries during radical perineal prostatectomy  

Microsoft Academic Search

Objectives. To review a contemporary series of rectal injuries occurring during radical perineal prostatectomy.Methods. Of 81 patients who underwent radical perineal prostatectomy, 9 (11 %) sustained a full-thickness laceration of the anterior rectal wall. All 9 patients had a preoperative bowel preparation, although only 1 received a complete oral lavage regimen. All received prophylactic perioperative intravenous antibiotics. None had undergone

Patrick M. Lassen; Wilfred S. Kearse

1995-01-01

22

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

ClinicalTrials.gov

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

2014-09-09

23

Müllerian adenosarcoma arising from rectal endometriosis.  

PubMed

A Müllerian adenosarcoma is an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. A Müllerian adenosarcoma occurs mainly in the uterus, but also in extrauterine locations. Extrauterine Müllerian adenosarcomas are thought to arise from endometriotic deposits. A 36-year-old female presented to Daegu Catholic University Medical Center with a symptom of loose stool for several months. The imaging studies revealed a rectal mass, so she underwent a laparoscopic low anterior resection. Although extemporary pathology revealed an inflammatory myofibroblastic tumor, the final histologic diagnosis was a Müllerian adenosarcoma arising from rectal endometriosis. To our knowledge, except a concomitant rectal villotubular adenoma, cases of Müllerian adenosarcomas arising the rectal wall are rare. An adenosarcoma arising from endometriosis should be considered in the differential diagnosis of a pelvic mass, even one appearing in rectal wall, because ectopic endometrial tissue exists everywhere. PMID:25360431

Yang, Chunseok; Oh, Hoon Kyu; Kim, Daedong

2014-10-01

24

Transanal endoscopic surgery in rectal cancer  

PubMed Central

Total mesorectal excision (TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery (TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond (T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentage of infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present. PMID:25206260

Serra-Aracil, Xavier; Mora-Lopez, Laura; Alcantara-Moral, Manel; Caro-Tarrago, Aleidis; Gomez-Diaz, Carlos Javier; Navarro-Soto, Salvador

2014-01-01

25

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

26

Rectal mesh exposure after laparoscopic sacrocolpopexy.  

PubMed

Herein we report the case of a 68-year-old woman who had rectal bleeding 13 days after laparoscopic sacrocolpopexy. Clinical examination and rectoscopy revealed rectal exposure of the posterior polyester mesh placed during the surgery. Endorectal surgery was performed to remove the exposed mesh and repair the rectal erosion. No further complications occurred during follow-up. Although vaginal erosions are a well-known complication of synthetic implants after surgery to repair pelvic organ prolapse, one must keep in mind the possibility of more uncommon types of mesh exposure. PMID:24075836

Ferry, Philippe; Sedille, Lucie; Roncheau, Valérie

2014-01-01

27

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

Microsoft Academic Search

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

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

1999-01-01

28

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

29

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

30

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

31

Wind sock deformity in rectal atresia.  

PubMed

Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age. PMID:19568581

Hosseini, Sayed M V; Ghahramani, Farhad; Shamsaeefar, Alireza; Razmi, Tannaz; Zarenezhad, Mohammad

2009-04-01

32

Wind Sock Deformity in Rectal Atresia  

PubMed Central

Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age. PMID:19568581

Hosseini, Sayed M. V.; Ghahramani, Farhad; Shamsaeefar, Alireza; Razmi, Tannaz; Zarenezhad, Mohammad

2009-01-01

33

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.

34

Variations in treatment of rectal cancer  

Microsoft Academic Search

PURPOSE: Surgical options for the treatment of rectal cancer may involve sphincter-sparing procedures (SSP) or abdominoperineal\\u000a resection (APR). We sought to examine variations in the surgical treatment of rectal cancer for a large, well-defined patient\\u000a population and specifically to determine if differences exist in management and survival based on hospital type and surgical\\u000a caseload. METHODS: The Cancer Surveillance Program database

Anthony J. Simons; Rhonda Ker; Susan Groshen; Conway Gee; Gary J. Anthone; Adrian E. Ortega; Petar Vukasin; Ronald K. Ross; Robert W. Beart

1997-01-01

35

Rectal carcinoma in a renal transplant patient  

Microsoft Academic Search

The occurrence of a rectal adenocarcinoma in a 48-year-old man 11 years after he received a cadaveric renal transplant is\\u000a reported. Since his operation, the patient had been receiving prednisone and azathioprine for immunosuppression. The occurrence\\u000a of rectal carcinoma in this patient at an early age, after a decade of immunosuppression, suggests an association between\\u000a the malignancy and his altered

G. Letsou; G. H. Ballantyne; I. M. Zdon; R. M. Cambria; I. M. Modlin

1986-01-01

36

Regorafenib in Reducing Recurrence in Patients With Non-metastatic Rectal Cancer Who Have Completed Curative-Intent Treatment  

ClinicalTrials.gov

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

2014-11-06

37

Management of rectal foreign bodies  

PubMed Central

Background Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault. Methods Between 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. Results All patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died. Conclusions Foreign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body. PMID:23497492

2013-01-01

38

Rectal cancer treatment: Improving the picture  

PubMed Central

Multidisciplinary approach for rectal cancer treatment is currently well defined. Nevertheless, new and promising advances are enriching the portrait. Since the US NIH Consensus in the early 90’s some new characters have been added. A bird’s-eye view along the last decade shows the main milestones in the development of rectal cancer treatment protocols. New drugs, in combination with radiotherapy are being tested to increase response and tumor control outcomes. However, therapeutic intensity is often associated with toxicity. Thus, innovative strategies are needed to create a better-balanced therapeutic ratio. Molecular targeted therapies and improved technology for delivering radiotherapy respond to the need for accuracy and precision in rectal cancer treatment. PMID:17990346

Diaz-Gonzalez, Juan A; Arbea, Leire; Aristu, Javier

2007-01-01

39

Curative Surgery for Local Pelvic Recurrence of Rectal Cancer  

Microsoft Academic Search

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

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

2003-01-01

40

Traumatic rectal hematoma following anal rape.  

PubMed

We describe the case of a 28-year-old male prisoner with a traumatic rectal hematoma caused by anal rape. Barium enema showed a large rectal mass confirmed to be a hematoma by proctoscopic examination. Surgery was performed due to a falling hemoglobin level, and an 800-mL hematoma was evacuated. The patient became febrile following surgery, and computed tomography revealed a pelvic mass consistent with recurrent hematoma or abscess. Repeat surgery showed recurrent hematoma. The patient recovered uneventfully. PMID:3487997

Chen, Y M; Davis, M; Ott, D J

1986-07-01

41

Massive zosteriform cutaneous metastasis from rectal carcinoma.  

PubMed

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

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

2003-07-01

42

Rectal impaction following enema with concrete mix.  

PubMed

This article describes an unusual rectal foreign body resulting from homosexual anal erotic activities. The patient had used an enema containing a concrete mix which became impacted and required surgical removal. The use, abuse, and complications of enemas are reviewed. PMID:3649167

Stephens, P J; Taff, M L

1987-06-01

43

Rectal ulcers induced by systemic lupus erythematosus.  

PubMed

A 28-year-old woman presented with diarrhoea, haematochezia, tenesmus and rectal pain for 2?months. She was diagnosed with systemic lupus erythematosus (SLE) 8?years ago and remained on prednisone, azathioprine and hydroxychloroquine. Blood work revealed a positive ANA (antinuclear antibody test), anti-dsDNA 749?IU/mL (0-300?IU/mL), C3 0.22?g/L (0.65-1.65?g/L) and C4 0.05?g/L (0.16-0.60?g/L). Stool studies were unremarkable. MRI of the pelvis showed a rectum with eccentric wall thickening. Flexible sigmoidoscopy showed severe proctitis with multiple deep ulcers and diffuse submucosal haemorrhage. Rectal biopsy revealed crypt architectural distortion and reactive fibrosis in the lamina propria. The patient was given mesalamine suppository for 2?weeks with minimal improvement. Repeat flexible sigmoidoscopy showed a coalesced 3×4?cm full-thickness rectal ulcer. Therefore, the patient was given intravenous methylprednisolone for 3?days, followed by intravenous cyclophosphamide for 2?weeks. Her symptoms resolved and repeat flexible sigmoidoscopy showed fibrotic healing of the rectal ulcers. PMID:25150239

Yau, Alan Hoi Lun; Chu, Karen; Yang, Hui Min; Ko, Hin Hin

2014-01-01

44

[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

45

Novel Approach to Rectal Foreign Body Extraction  

PubMed Central

Introduction: The impacted rectal foreign body often poses a management challenge. Ideally, such objects are removed in the emergency department utilizing a combination of local anesthesia, sedation, minimal instrumentation, and manual extraction. In some instances, simple manual extraction is unsuccessful and general anesthesia may be necessary. We describe a novel approach to retrieval and removal of a rectal foreign body utilizing a SILS port. Case Description: A 31-y-old male presented to the emergency department approximately 12 h after transanal insertion of a plastic cigar case. Abdominal examination revealed no evidence of peritonitis. On rectal examination, the tip of the cigar case was palpable. The foreign body, however, was unable to be removed manually in the emergency department. In the operating room, with the patient under general anesthesia, multiple attempts to remove the object were unsuccessful. A SILS port was inserted transanally. The rectum was then insufflated manually by attaching the diaphragm of the rigid sigmoidoscope to the SILS insufflation port. A 5-mm 0-degree laparoscope was placed through the SILS port. An atraumatic laparoscopic grasper was then placed through the port and used to grasp the visible end of the cigar case. The rectal foreign body was removed expeditiously. Direct visualization of the rectum revealed no evidence of mucosal injury. The patient was discharged home shortly after the procedure. Discussion: The SILS port allows minimally invasive extraction of rectal foreign bodies not amenable to simple manual extraction. It provides excellent visualization and eliminates the morbidity inherent in more invasive and traditional methods of retrieval. PMID:23925034

Bak, Yury; Merriam, Margaret; Neff, Marc

2013-01-01

46

Intramedullary Spinal Cord Metastasis From Rectal Cancer  

PubMed Central

Intramedullary spinal cord metastasis (ISCM) is an uncommon condition of the central nervous system (CNS) cause by systemic malignant tumors. Most ISCM cases are known to occur in patients with lung cancer and breast cancer; however, ISCM also very rarely occurs in patients with colorectal cancer. For the first time in Korea, we experienced a case of ISCM arising from rectal cancer, where a 75-year-old man presented with an abruptly-developed left-foot drop and numbness in both legs. The patient had lung metastases from rectal cancer that had been treated with chemotherapy. Magnetic resonance imaging revealed an intramedullary nodular lesion at the T12 level. ISCM was diagnosed and treated with steroids and radiotherapy. The patient's neurological symptoms were relieved for a while after treatment, but his condition deteriorated progressively. He died 4 months after ISCM had been diagnosed. PMID:25360432

Yang, Kyung Ho; Yi, Seong Yoon; Jung, Joo Hyuk; Kang, Seung Hee; Choi, Pyong Hwa

2014-01-01

47

Intramedullary spinal cord metastasis from rectal cancer.  

PubMed

Intramedullary spinal cord metastasis (ISCM) is an uncommon condition of the central nervous system (CNS) cause by systemic malignant tumors. Most ISCM cases are known to occur in patients with lung cancer and breast cancer; however, ISCM also very rarely occurs in patients with colorectal cancer. For the first time in Korea, we experienced a case of ISCM arising from rectal cancer, where a 75-year-old man presented with an abruptly-developed left-foot drop and numbness in both legs. The patient had lung metastases from rectal cancer that had been treated with chemotherapy. Magnetic resonance imaging revealed an intramedullary nodular lesion at the T12 level. ISCM was diagnosed and treated with steroids and radiotherapy. The patient's neurological symptoms were relieved for a while after treatment, but his condition deteriorated progressively. He died 4 months after ISCM had been diagnosed. PMID:25360432

Yang, Kyung Ho; Lee, Hye Ran; Yi, Seong Yoon; Jung, Joo Hyuk; Kang, Seung Hee; Choi, Pyong Hwa

2014-10-01

48

[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

49

Is surgery always necessary in rectal cancer?  

PubMed

Rectal cancer is a major health problem around the world, representing about one-third of the total colorectal cancer cases. Because of its anatomical location, there is a higher risk of local recurrence, and treatment often requires a complex multidisciplinary approach which includes neoadjuvant radiotherapy, chemotherapy, and a radical surgical procedure that commonly leads to a permanent colostomy. The cure rate with this strategy is good, with some patients having no residual disease in the surgical specimen. While the prognosis for those patients is excellent, their quality of life is permanently compromised. In this article, we review risks and benefits of the standard treatment approach and compare standard treatment with alternative methods aimed at rectal preservation. PMID:25144282

Sabbaga, Jorge; Braghiroli, Maria Ignez; Hoff, Paulo M

2014-07-01

50

Rectal expulsion of a hepatic artery catheter.  

PubMed

The outlook for patients with colorectal liver metastases remains poor, survival in our hospital being only 6 months. The results of conventional treatment are disappointing. With the advent of implantable silicone catheters and small portable pumps, regional chemotherapy is more frequently administered, although complications relating to the catheter do occur. We describe a patient who expelled his hepatic artery catheter rectally, following removal of the catheter port for sepsis. PMID:8772078

Doughty, J C; Gallagher, H; Kane, E; McArdle, C S

1996-08-01

51

Rectal biopsy findings in infantile neuroaxonal dystrophy.  

PubMed

A 21-month-old boy with a family history of parental consanguinity and two siblings having died of a progressive neurological disorder was investigated for a neurometabolic disease because of recent loss of gait and lack of intellectual progress. While a lysosomal disease could not be verified, his clinical findings were compatible with infantile neuroaxonal dystrophy, the diagnosis of which was electron microscopically established by demonstrating typical enlarged axonal terminals in rectal biopsy tissue. PMID:7207709

Goebel, H H; Kohlschütter, A; Schulte, F J

1980-11-01

52

Clinically based management of rectal prolapse  

Microsoft Academic Search

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

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

2003-01-01

53

Rectal Prolapse: A 10-Year Experience  

PubMed Central

Purpose: To compare perineal to abdominal procedures for rectal prolapse over a 10-year period at a single tertiary care institution. Methods: Between May 1, 1995, and January 1, 2005, 75 patients underwent surgical intervention for primary rectal prolapse at a tertiary referral center. Surgical techniques included perineal-based repairs (Altemeier and Delorme procedures) and abdominal procedures (open and laparoscopic resection and/or rectopexy). Medical records were abstracted for data pertaining to patient characteristics, signs and symptoms at presentation, surgical procedure, postoperative length of hospitalization, morbidity and mortality, and recurrence of rectal prolapse. Results: Seventy-five patients underwent surgical intervention for rectal prolapse during the study period. The average patient age was 60.8 years. Sixty-two patients (82.7%) underwent perineal-based repair (Altemeier n = 48, Delorme n = 14); eight patients (10.7%) underwent open abdominal procedures (resection and rectopexy n = 4, rectopexy only n = 4); and five patients (6.7%) underwent laparoscopic repair (laparoscopic LAR n = 3, laparoscopic resection and rectopexy n = 2). Average hospitalization was shorter with perineal procedures (2.6 days) than with abdominal procedures (4.8 days) (p < 0.0031). Postoperative complications were observed in 13.3% of cases. With a median follow-up of 39 months (range 6–123 months), there was no mortality for primary repair, a postoperative morbidity occurred in 13% of patients, and the overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). Conclusion: Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. PMID:21603476

Hammond, Kerry; Beck, David E.; Margolin, David A.; Whitlow, Charles B.; Timmcke, Alan E.; Hicks, Terry C.

2007-01-01

54

Current status of laparoscopy for the treatment of rectal cancer  

PubMed Central

Surgery for rectal cancer in complex and entails many challenges. While the laparoscopic approach in general and specific to colon cancer has been long proven to have short term benefits and to be oncologically safe, it is still a debatable topic for rectal cancer. The attempt to benefit rectal cancer patients with the known advantages of the laparoscopic approach while not compromising their oncologic outcome has led to the conduction of many studies during the past decade. Herein we describe our technique for laparoscopic proctectomy and assess the current literature dealing with short term outcomes, immediate oncologic measures (such as lymph node yield and specimen quality) and long term oncologic outcomes of laparoscopic rectal cancer surgery. We also briefly evaluate the evolving issues of robotic assisted rectal cancer surgery and the current innovations and trends in the minimally invasive approach to rectal cancer surgery. PMID:25386061

Shussman, Noam; Wexner, Steven D

2014-01-01

55

Massive rectal bleeding due to jejunal and colonic tuberculosis.  

PubMed

A case of massive rectal bleeding due to colonic tuberculosis in advanced pregnancy with intrauterine foetal death is reported. Patient was treated with resection of the left colon and left transverse end colostomy with closure of the rectal stump. Hysterotomy for the removal of the dead foetus was performed. The patient improved in health with antitubercular treatment. The colorectal anastomosis was performed after 4 months. Massive rectal bleeding in intestinal tuberculosis, though rare should be kept in mind. PMID:10228447

Joshi, M A; Balsarkar, D; Abhyankar, A; Pereira, D G; Avasare, N; Pradhan, C; Subramanyan, P; Changlani, T T; Deshmukh, H L; Shirahatti, R G; Biswas, B

1998-01-01

56

Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care  

PubMed Central

Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III “pain ladder” drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient’s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 mL every 4.5–11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077–0.154 mg·kg?1) and bupivacaine in enema (1.820 mg·kg?1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng·mL?1 and 235.7 ng·mL?1, respectively. Bupivacaine elimination was slower after rectal than after intrathecal administration (t˝= 5.50 versus 2.02 hours, respectively). Limitations This study reports two cases only, and there could be inter-patient variation. Conclusion Bupivacaine in boluses administered intrathecally (0.25%, 2 mL) provided effective, safe analgesia in advanced cancer patients. Bupivacaine enema (100 mg·100 mL?1) was shown to be a valuable option for control of end-of-life tenesmoid cancer pain. PMID:25336967

Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; Luczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; Glowka, Franciszek

2014-01-01

57

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

58

Urinary and sexual dysfunction after rectal cancer treatment  

Microsoft Academic Search

In light of the improving prognosis for patients with rectal cancer, the quality of functional outcome has become increasingly important. Despite the good functional results achieved by expert surgeons, large multicenter studies show that urogenital dysfunction remains a common problem after rectal cancer treatment. More than half of patients experience a deterioration in sexual function, consisting of ejaculatory problems and

Marilyne M. Lange

2010-01-01

59

Comparison of Laparoscopic and Open Surgery for Total Rectal Prolapse  

Microsoft Academic Search

Purpose. Total rectal prolapse is a devastating disorder causing constipation and anal incontinence. We compared open and laparoscopic surgical approaches in a limited series. Methods. The subjects of this study were 23 patients who underwent laparoscopic procedures (LP group) and 17 patients who underwent open procedures (OP group) for rectal prolapse. We assessed the preoperative colonic transit time, postoperative pain

Sezai Demirbas; M. Levhi Akin; Murat Kalemoglu; Ibrahim Ogün; Tuncay Çelenk

2005-01-01

60

Amígdala rectal o hiperplasia folicular linfoide del recto  

Microsoft Academic Search

The rectal tonsil is a reactive proliferation of lymphoid tissue located in the rectum. The morphology of the lymphoid proliferation of the colon is usually polypoid or, less commonly, nodular. Only in exceptional cases does lymphoid proliferation of the colon present as a mass in the rectum (rectal tonsil), although this is the most common presentation in middle-aged patients. It

L. Trillo Fandińo; M. Arias González; A. Iglesias Castańón; M. P. Fernández Eire

61

Laparoscopic Total Mesorectal Excision for Rectal Cancer Surgery  

Microsoft Academic Search

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

Jacques Marescaux; Francesco Rubino; Joel Leroy

2005-01-01

62

Adjuvant radiotherapy on older and oldest elderly rectal cancer patients  

Microsoft Academic Search

The purpose of this study was to evaluate the impact of radiotherapy in terms of feasibility and activity in the patients aged ?75 with advanced rectal cancer. From January 2002 to December 2006, 41 consecutive patients (27 men and 14 women) aged ?75 received radiotherapy for local advanced rectal cancer, 9 in a pre-operative and 22 in a post-operative setting.

F. Fiorica; F. Cartei; B. Carau; S. Berretta; D. Spartŕ; U. Tirelli; A. Santangelo; D. Maugeri; S. Luca; C. Leotta; R. Sorace; M. Berretta

2009-01-01

63

Colorectal polyps: an important cause of rectal bleeding.  

PubMed Central

Seventy one children with rectal bleeding were examined by total fibreoptic colonoscopy. Large bowel polyps were found in 45; 27 (60%) had solitary rectal polyps. Altogether, 83% of resected polyps were juvenile. No complication of colonoscopic polypectomy occurred. New polyps reoccurred in four (9%) treated children. PMID:3493736

Perisic, V N

1987-01-01

64

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

65

Local Excision of Rectal Cancer: Review of Literature  

Microsoft Academic Search

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

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

2005-01-01

66

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. PMID:24349839

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

2013-01-01

67

Outcomes of rectal cancer with liver oligometastases  

PubMed Central

Purpose In patients with oligometastatic colorectal cancer to the liver, long term survival is possible and a multi-modality treatment approach may be considered. This is a report of a single institution experience of oligometastatic rectal cancer patients after treatment of the primary tumor and pelvic lymph nodes with extended course chemoradiation therapy. Methods Between 2004 and 2013, 26 oligometastatic rectal cancer patients with liver metastases were treated with extended course chemoradiation at our institution followed by total mesorectal excision (TME). Amongst these there were 17 men and 9 women. The mean age at the time of diagnosis was 59.8 years, with a range from 36 to 87 years of age. Eleven patients had metastases in other sites in addition to liver, and one patient in our cohort had lung metastasis with no liver metastasis. Kaplan-Meier method was used to generate overall survival (OS), progression free survival (PFS), distant metastases (DM) and local control (LC). Results OS rates were 95%, and 70% at 12 and 24 months respectively, with a mean survival time of 40.5 months. PFS rates were 91% and 36% at 12 and 24 months respectively, with a mean PFS time of 23.1 months. LC rates were 91% and 66% at 12 and 24 months respectively. DM rates were 0% and 61% at 12 and 24 months respectively. Finally, when censoring deaths, progression of liver metastases and distant progression, Kaplan-Meier analysis demonstrated five events of local failure. Conclusions This series demonstrated an OS of 70% at 24 months, with a mean survival of 40.5 months. Significantly, LC was only 66% despite the use of extended course chemoradiation and TME. This data suggests that many patients with oligometastatic rectal cancer will survive past 2 years, and that a substantial number will fail locally as well as distantly. Therefore, a multimodality approach is reasonable. Recent data suggests that a hypofractionated radiation regiment of 25 Gy in 5 Gy fractions allows an equivalent LC compared to extended course chemoradiation with 50.4 Gy in 1.8 Gy fractions. A short course of radiation may be more consistent with the goals of care of the oligometastatic rectal cancer patient who is at high risk of recurrence.

Hsu, Howard; Du, Kevin

2014-01-01

68

M?llerian Adenosarcoma Arising From Rectal Endometriosis  

PubMed Central

A Müllerian adenosarcoma is an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. A Müllerian adenosarcoma occurs mainly in the uterus, but also in extrauterine locations. Extrauterine Müllerian adenosarcomas are thought to arise from endometriotic deposits. A 36-year-old female presented to Daegu Catholic University Medical Center with a symptom of loose stool for several months. The imaging studies revealed a rectal mass, so she underwent a laparoscopic low anterior resection. Although extemporary pathology revealed an inflammatory myofibroblastic tumor, the final histologic diagnosis was a Müllerian adenosarcoma arising from rectal endometriosis. To our knowledge, except a concomitant rectal villotubular adenoma, cases of Müllerian adenosarcomas arising the rectal wall are rare. An adenosarcoma arising from endometriosis should be considered in the differential diagnosis of a pelvic mass, even one appearing in rectal wall, because ectopic endometrial tissue exists everywhere. PMID:25360431

Yang, Chunseok; Oh, Hoon Kyu

2014-01-01

69

[Preoperative radiotherapy for rectal cancer: target volumes].  

PubMed

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

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

2013-10-01

70

Laparoscopic rectopexy for solitary rectal ulcer syndrome without overt rectal prolapse. A case report and review of the literature.  

PubMed

Solitary rectal ulcer syndrome is a rare clinical entity. Several treatment options has been described. However, there is no consensus yet on treatment algorithm and standard surgical procedure. Rectopexy is one of the surgical options and it is generally performed in patients with solitary rectal ulcer accompanied with overt prolapse. Various outcomes have been reported for rectopexy in the patients with occult prolapse or rectal intussusception. In the literature; outcomes of laparoscopic non-resection rectopexy procedure have been reported in the limited number of case or case series. No study has emphasized the outcomes of laparoscopic non-resection rectopexy procedure in the patients with solitary rectal ulcer without overt prolapse. In this report we aimed to present clinical outcomes of laparoscopic non-resection posterior suture rectopexy procedure in a 21-year-old female patient with solitary rectal ulcer without overt prolapse. PMID:24795925

Menekse, Ebru; Ozdogan, Mehmet; Karateke, Faruk; Ozyazici, Sefa; Demirturk, Pelin; Kuvvetli, Adnan

2014-02-01

71

Laparoscopic rectopexy for solitary rectal ulcer syndrome without overt rectal prolapse: a case report and review of the literature.  

PubMed

Solitary rectal ulcer syndrome is a rare clinical entity. Several treatment options has been described. However, there is no consensus yet on treatment algorithm and standard surgical procedure. Rectopexy is one of the surgical options and it is generally performed in patients with solitary rectal ulcer accompanied with overt prolapse. Various outcomes have been reported for rectopexy in the patients with occult prolapse or rectal intussusception. In the literature; outcomes of laparoscopic non-resection rectopexy procedure have been reported in the limited number of case or case series. No study has emphasized the outcomes of laparoscopic non-resection rectopexy procedure in the patients with solitary rectal ulcer without overt prolapse. In this report we aimed to present clinical outcomes of laparoscopic non-resection posterior suture rectopexy procedure in a 21-year-old female patient with solitary rectal ulcer without overt prolapse. PMID:24785548

Menekse, Ebru; Ozdogan, Mehmet; Karateke, Faruk; Ozyazici, Sefa; Demirturk, Pelin; Kuvvetli, Adnan

2014-01-01

72

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

73

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. PMID:22778935

Spanos, Constantine P.

2012-01-01

74

Transanal Endoscopic Microsurgery for Rectal Tumors: A Review  

PubMed Central

Since its introduction in 1983, transanal endoscopic microsurgery (TEM) has emerged as a safe and effective method to treat rectal lesions including benign tumors, early rectal cancer, and rectal fistulas and strictures. This minimally invasive technique offers the advantages of superior visualization of the lesion and greater access to proximal lesions with lower margin positivity and specimen fragmentation and lower long-term recurrence rates over traditional transanal excision. In addition, over two decades of scientific data support the use of TEM as a viable alternative to radical excision of the rectum with less morbidity, faster recovery, and greater potential cost savings when performed at specialized centers. PMID:22745615

Kunitake, Hiroko; Abbas, Maher A

2012-01-01

75

Laparoscopic resection for rectal cancer: a case-matched study  

Microsoft Academic Search

Introduction  The field of laparoscopic rectal cancer surgery is expanding. We compare short-term and early oncological outcomes after laparoscopic\\u000a versus open resection in carefully matched rectal cancer patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All consecutive patients undergoing elective laparoscopic resection for rectal cancer were reviewed. Laparoscopic resections\\u000a were matched 1:1 to open resections by age, gender, American Society of Anesthesiologists class, body mass index, neoadjuvant\\u000a chemoradiation,

Andre da Luz Moreira; Isabella Mor; Daniel P. Geisler; Feza H. Remzi; Ravi P. Kiran

2011-01-01

76

[Clinical course and treatment of traumatic rectal fistula].  

PubMed

From experience in treatment of 104 patients with rectal fistulas of traumatic origin the authors distinguished the specific features of the clinical manifestations of the disease which must be taken into consideration in choosing the therapeutic tactics. In contrast to the management of common chronic paraproctitis, the treatment of traumatic rectal fistulas differs in principle, particularly when the internal opening of the fistula is in the wall of the rectal ampulla++. The authors determined the indications for various methods of treatment and techniques of operative interventions, including multistage surgical treatment with the creation of temporary colostomy. PMID:2232595

Dul'tsev, Iu V; Lebedev, A V; Poletov, N N

1990-07-01

77

[Rectal tonsil or lymphoid follicular hyperplasia of the rectum].  

PubMed

The rectal tonsil is a reactive proliferation of lymphoid tissue located in the rectum. The morphology of the lymphoid proliferation of the colon is usually polypoid or, less commonly, nodular. Only in exceptional cases does lymphoid proliferation of the colon present as a mass in the rectum (rectal tonsil), although this is the most common presentation in middle-aged patients. It is important to be familiar with the rectal tonsil because in cases of exuberant growth it can be difficult to distinguish it from other types of masses. We present the case of rectal tonsil in a four-year-old girl. We describe the magnetic resonance imaging findings and review the literature. PMID:22112591

Trillo Fandińo, L; Arias González, M; Iglesias Castańón, A; Fernández Eire, M P

2014-01-01

78

High Rate of Sexual Dysfunction Following Surgery for Rectal Cancer  

PubMed Central

Purpose Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncological treatment, research on rectal-cancer survivors' sexual function remains limited. Sexual dysfunction (SD) after rectal cancer treatment was measured, and possible predisposing factors that may have an impact on the development of this disorder were identified. Methods Patients undergoing curative rectal cancer surgery from January 2012 to September 2013 were surveyed using questionnaires. The female sexual function index or the International Index of Erectile Function was recorded. A multiple logistic regression was used to test associations of clinical factors with outcomes. Results Fifty-six men (56%) and 28 women (44%) who completed the questionnaire were included in the study. A total of 76 patients of the 86 patients (90.5%) with the diagnosis of rectal cancer who were included in this study reported different levels of SD after radical surgery. A total of 64 patients (76%) from the whole cohort reported moderate to severe SD after treatment of rectal cancer. Gender (P = 0.011) was independently associated with SD. Female patients reported significantly higher rates of moderate to severe SD than male patients. Patients were rarely treated for dysfunction. Conclusion Sexual problems after surgery for rectal cancer are common, but patients are rarely treated for SD. Female patients reported higher rates of SD than males. These results point out the importance of sexual (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes. PMID:25360427

Ertekin, Caglar; Tinay, Ilker; Yegen, Cumhur

2014-01-01

79

Rectal anatomy following ripstein's operation for prolapse studied by cineradiography  

Microsoft Academic Search

Summary  Eleven patients operated on for rectal prolapse, according to the method described by Ripstein, were examined pre- and postoperatively\\u000a with cineradiography of the rectum. The patients were asked to fill in a questionnaire to evaluate their histories of constipation.\\u000a There is no apparent anatomic explanation for postoperative constipation. One patient had a rectal stricture and another,\\u000a a recurrence in the

Sven Ahlbäck; Bror Brodén; Göran Brodén; Staffan Ewerth; Bo Holmström

1979-01-01

80

Laparoscopic-assisted abdominoperineal proctosigmoidectomy for rectal prolapse  

Microsoft Academic Search

.   The inability to completely mobilize the redundant colon in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness\\u000a rectal prolapse is a main contributor to the recurrence rate associated with the procedure. However, the presence of a redundant\\u000a sigmoid after the Ripstein procedure or other rectal sling operations is the main cause of the high rate of postoperative\\u000a constipation and stool impaction.

M. Allam; G. Piskun; R. Fogler

1997-01-01

81

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

PubMed

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

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

2012-05-01

82

Isolation of Helicobacter spp. from mice with rectal prolapses.  

PubMed

Enterohepatic Helicobacter species (EHS) often are associated with typhlocolitis and rectal prolapse in mice. We sought to describe rectal prolapses histologically, relate lesions to mouse genotype and EHS infection status, and characterize EHS pathogens on our campus. Our mouse population was housed among 6 facilities on our main campus and a seventh, nearby facility. We investigated cases of rectal prolapse over 1 y and included 76 mice, which were broadly categorized according to genotype. Microscopically, lesions ranged from mild to severe typhlocolitis, often with hyperplastic and dysplastic foci. Neoplastic foci tended to occur at the ileocecal-colic junction. Lesions were most severe in strains that had lower-bowel inflammatory disease, notably IL10, Rag1, and Rag2 knockout strains; prolapses occurred in these strains when housed both in areas with endemic EHS and in our Helicobacter-free barrier facility. Most mice with rectal prolapses were immunocompromised genetically modified mice; however, the most frequently sampled strain, the lamellipodin knockout, was noteworthy for its high incidence of rectal prolapse, localized distal colonic and rectal lesions, and lack of known immunodeficiency. This strain is being explored as a model of rectal carcinoma. Most of the colons examined tested PCR-positive for EHS, often with coinfections. Although H. bilis is prevalent on our campus, we did not find this organism in any mice exhibiting clinical signs of rectal prolapse. Identification of H. apodemus in 22% of cases has fueled increased surveillance on our campus to characterize this organism and differentiate it from the closely related H. rodentium. PMID:24956208

Miller, Cassandra L; Muthupalani, Sureshkumar; Shen, Zeli; Fox, James G

2014-06-01

83

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. PMID:21385339

2011-01-01

84

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

85

Locally aggressive colonic and rectal cancer ,clinical trial  

PubMed Central

This clinical trial studies local invasions from primary colonic and rectal cancers (urinary bladder, abdominal wall, small bowls, uterus, vagina, stomach, bile tract, spleen, duodenum, pancreas, ureters, kidneys), with or without undiscovered metastasis. Primary locally aggressive colonic and rectal cancers include tumors that are staged T4N1–2Mx on diagnosis, and are often associated with a lower prognosis than earlier cancers. [2] Diagnosis is based on thorough clinical evaluation, imagistic support: abdominal XR with contrast (barium enema), colonoscopy, abdominal and pelvic ultrasound exam, endoscopic endolumenal ultrasound exam, abdominal and pelvic CT / IRM with contrast (administrated both orally and intravenously), PET Scan, and intra–operatory confirmation. [3] The primary symptom was pain. Locally aggressive colonic and rectal cancers, primary or secondary, can extend to any visceral or parietal structure. The ability to perform a total resection is based upon anatomical localization and on the fixation of other organs to the lesion. Identifying the anatomical extension provides a better appreciation of the purpose of the tumoral resection. [1] Radical nuanced surgery is the base of treatment of the locally aggressive colon–rectal cancer. The studies have shown that in certain localizations of the colon–rectal cancer, the locally aggressive forms can be better controlled by using multimodal therapy, including radiotherapy, either external or guided intraoperatory radiotherapy and chemotherapy with much better results. [5] PMID:20945823

Ion, D; serban, MB; Ciurea, M

2010-01-01

86

Locally aggressive colonic and rectal cancer--clinical trial.  

PubMed

This clinical trial studies local invasions from primary colonic and rectal cancers (urinary bladder, abdominal wall, small bowls, uterus, vagina, stomach, bile tract, spleen, duodenum, pancreas, ureters, kidneys), with or without undiscovered metastasis. Primary locally aggressive colonic and rectal cancers include tumors that are staged T4N1-2Mx on diagnosis, and are often associated with a lower prognosis than earlier cancers. Diagnosis is based on thorough clinical evaluation, imagistic support: abdominal XR with contrast (barium enema), colonoscopy, abdominal and pelvic ultrasound exam, endoscopic endolumenal ultrasound exam, abdominal and pelvic CT/IRM with contrast (administrated both orally and intravenously), PET Scan, and intra-operatory confirmation. The primary symptom was pain. Locally aggressive colonic and rectal cancers, primary or secondary, can extend to any visceral or parietal structure. The ability to perform a total resection is based upon anatomical localization and on the fixation of other organs to the lesion. Identifying the anatomical extension provides a better appreciation of the purpose of the tumoral resection. Radical nuanced surgery is the base of treatment of the locally aggressive colon-rectal cancer. The studies have shown that in certain localizations of the colon-rectal cancer, the locally aggressive forms can be better controlled by using multimodal therapy, including radiotherapy, either external or guided intraoperatory radiotherapy and chemotherapy with much better results. PMID:20945823

Radu, Victor; Ion, Daniel; Serban, Mihai Bogdan; Ciurea, Mircea

2010-01-01

87

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

88

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

89

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

PubMed Central

AIM: To determine the accuracy of high-resolution magnetic resonance imaging (MRI) using phased-array coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal distention. METHODS: In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging (in-plane resolution, 0.66 × 0.56) with phased-array coil were performed for T-staging and measurement of distance between the tumor and the mesorectal fascia. The assessment of MRI was compared with postoperative histopathologic findings. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were evaluated. RESULTS: The overall magnetic resonance accuracy was 85.1% for T staging and 88% for predicting mesorectal fascia involvement. Magnetic resonance sensitivity, specificity, accuracy, positive predictive value, and negative predictive value was 70%, 97.9%, 89.6%, 93.3% and 88.5% for ? T2 tumors, 90.5%, 76%, 85.1%, 86.4% and 82.6% for T3 tumors, 100%, 95.2%, 95.5%, 62.5% and 100% for T4 tumors, and 80%, 90.4%, 88%, 70.6% and 94% for predicting mesorectal fascia involvement, respectively. CONCLUSION: High-resolution MRI enables accurate preoperative assessment for T staging and mesorectal fascia infiltration in rectal cancer with rectal distention. PMID:17696238

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

2007-01-01

90

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

91

Approach to concomitant rectal and uterine prolapse: case report  

PubMed Central

The classic description of rectal prolapse is a protrusion of the rectum beyond the anus. Peaks of occurrences are noted in the fourth and seventh decades of life, and most patients (80–90%) are women. The condition is often concurrent with pelvic floor descent and prolapse of other pelvic floor organs, such as the uterus or the bladder. In this study, two cases having contraindication to general anesthesia with rectal and uterine prolapse are presented. These cases were operated on under local anesthesia with support of sedation by Leforte and Delorme’s operation at the same time. In conclusion; pelvic floor disorders should be considered as a whole, and surgical correction of rectal prolapse and uterine prolapse may be done at the same time under local anesthesia with the support of sedation. Performance of these operations by experienced and trained pelvic reconstructive surgeons may be advocated. PMID:24627680

Karateke, Ates; Batu, P?nar; Asoglu, Mehmet Resit; Selcuk, Selcuk; Cam, Cetin

2012-01-01

92

Human Collagen Injections to Reduce Rectal Dose During Radiotherapy  

SciTech Connect

Objectives: The continuing search for interventions, which address the incidence and grade of rectal toxicities associated with radiation treatment of prostate cancer, is a major concern. We are reporting an investigational trial using human collagen to increase the distance between the prostate and anterior rectal wall, thereby decreasing the radiation dose to the rectum. Methods: This is a pilot study evaluating the use of human collagen as a displacing agent for the rectal wall injected before starting a course of intensity-modulated radiotherapy (IMRT) for prostate cancer. Using a transperineal approach, 20 mL of human collagen was injected into the perirectal space in an outpatient setting. Computerized IMRT plans were performed pre- and postcollagen injection, and after a patient completed their radiotherapy, to determine radiation dose reduction to the rectum associated with the collagen injection. Computed tomography scans were performed 6 months and 12 months after completing their radiotherapy to evaluate absorption rate of the collagen. All patients were treated with IMRT to a dose of 75.6 Gy to the prostate. Results: Eleven patients were enrolled into the study. The injection of human collagen in the outpatient setting was well tolerated. The mean separation between the prostate and anterior rectum was 12.7 mm. The mean reduction in dose to the anterior rectal wall was 50%. All men denied any rectal symptoms during the study. Conclusions: The transperineal injection of human collagen for the purpose of tissue displacement is well tolerated in the outpatient setting. The increased separation between the prostate and rectum resulted in a significant decrease in radiation dose to the rectum while receiving IMRT and was associated with no rectal toxicities.

Noyes, William R., E-mail: noyes@cancercenternd.com [Department of Radiation Oncology, Cancer Center of North Dakota, Grand Forks, ND (United States); Hosford, Charles C. [Department of Medical Statistics, University of North Dakota School of Medicine, Grand Forks, ND (United States); Schultz, Steven E. [Department of Urology, RiverView Health, Grand Forks, ND (United States)

2012-04-01

93

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

Microsoft Academic Search

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

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

1998-01-01

94

Functional results of operative treatment of rectal prolapse over an 11-year period  

Microsoft Academic Search

PURPOSE: A variety of surgical procedures have been developed to treat rectal prolapse, but there is still no consensus on the operation of choice. The aim of this study was to evaluate the functional results of operative treatment of rectal prolapse during an 11-year period in our department. METHODS: All patients treated for complete rectal prolapse during an 11-year period,

T. Aitola; Kari-Matti Hiltunen; Martti J. Matikainen

1999-01-01

95

Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function  

Microsoft Academic Search

PURPOSE: Colonic and anorectal function are altered after posterior rectopexy. The aim of this randomized, prospective study was to evaluate the effects of rectal mobilization and division of the lateral ligaments on colonic and anorectal function. METHODS: Posterior rectopexy was performed in 18 patients with complete rectal prolapse. Anal manometry and measurement of rectal compliance, total and segmental colonic transit

R. M. H. G. Mollen; J. H. C. Kuijpers; F. van Hoek

2000-01-01

96

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

97

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

98

Management of stage IV rectal cancer: Palliative options  

PubMed Central

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

Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

2011-01-01

99

Concomitant preoperative radiochemotherapy in operable locally advanced rectal cancer  

Microsoft Academic Search

PURPOSE: The aim of this study was to examine the effectiveness of a combination of preoperative radiotherapy and chemotherapy for operable locally advanced rectal cancer (Stages II and III). METHODS: Chemotherapy and radiotherapy are started jointly on day one of the therapy. 5-Fluorouracil is given in a dosage of 1000 mg\\/ m2\\/day as a continuous 24-hour infusion for 4 days.

Aurelio Picciocchi; Claudio Coco; Paolo Magistrelli; Giuliano Roncolini; Gaetano Netri; Claudio Mattana; Numa Cellini; Vincenzo Valentini; Antonio De Franco; Fabio Maria Vecchio; Renato Cavaliere; Maurizio Cosimelli; Fabrizio Ambesi Impiombato

1994-01-01

100

Tumeur stromale rectale: ? propos d'une observation  

PubMed Central

Les tumeurs stromales gastro-intestinales sont des tumeurs mésenchymateuses peu fréquentes. Elles sont localisées préférentiellement eu niveau de l'estomac. La localisation rectale reste rare. A un nouveau cas de tumeur stromale du rectum ainsi qu'une bref revue de la littérature, on se propose d’étudier les particularités cliniques, radiologiques et thérapeutiques de cette entité rare. PMID:25120863

Rejab, Haitham; Kridis, Wala Ben; Ben Ameur, Hazem; Feki, Jihene; Frikha, Mounir; Beyrouti, Mohamed Issam

2014-01-01

101

Overview of Radiation Therapy for Treating Rectal Cancer  

PubMed Central

A major outcome of importance for rectal cancer is local control. Parallel to improvements in surgical technique, adjuvant therapy regimens have been tested in clinical trials in an effort to reduce the local recurrence rate. Nowadays, the local recurrence rate has been reduced because of both good surgical techniques and the addition of radiotherapy. Based on recent reports in the literature, preoperative chemoradiotherapy is now considered the standard of care for patients with stages II and III rectal cancer. Also, short-course radiotherapy appears to provide effective local control and the same overall survival as more long-course chemoradiotherapy schedules and, therefore, may be an appropriate choice in some situations. Capecitabine is an acceptable alternative to infusion fluorouracil in those patients who are able to manage the responsibilities inherent in self-administered, oral chemotherapy. However, concurrent administration of oxaliplatin and radiotherapy is not recommended at this time. Radiation therapy has long been considered an important adjunct in the treatment of rectal cancer. Although no prospective data exist for several issues, we hope that in the near future, patients with rectal cancer can be treated by using the best combination of surgery, radiation therapy, and chemotherapy in near future.

Kye, Bong-Hyeon

2014-01-01

102

Enhancing cosmesis in laparoscopic colon and rectal surgery  

Microsoft Academic Search

PURPOSE: The only unanimously accepted advantage of laparoscopic colon and rectal surgery, at present, is cosmesis. Techniques to enhance cosmesis in laparoscopic surgery are presented. METHOD: Careful and meticulous placement of laparoscopic ports and incisions enhance the cosmetic effect of the procedure. Determination of port sites is aided, in part, by preoperative assessment of natural skin folds and creases by

Tiong-Ann Teoh; Petachia Reissman; Eric G. Weiss; Roberto Verzaro; Steven D. Wexner

1995-01-01

103

Anterior sagittal approach without splitting the rectal wall  

PubMed Central

INTRODUCTION The anterior sagittal transrectal approach (ASTRA) has already become popular to treat lesions in the proximal urethra such as trauma, duplicity and stenosis, prostatic utricle, urethral–vaginal fistulas and urogenital sinus anomalies. It provides much better exposure than the traditional perineal approach. Morbidity caused by this technique could be potentially decreased if the anterior sagittal access were to be made without sectioning the rectum. We report our initial experience using anterior approach without rectal sectioning for the treatment of three different types of pelvic disorders. PRESENTATION OF CASE Anterior sagittal access without sectioning the rectal wall was carried out in three different clinical cases – a vaginoplasty in a female patient with congenital adrenal hyperplasia; to treat paradoxical urinary incontinence in a patient with proximal hypospadias (46XY karyotype) and another one with gonadal dysgenesis (46XO/XY karyotype). DISCUSSION Several surgical techniques have been reported to repair congenital or acquired lesions in the posterior urethra with high morbidity and no guarantees of adequate and safe surgical exposition. ASTRA provides an excellent exposure, splitting only the anterior rectal wall. In this study, the anterior sagittal approach was applied without splitting the rectal wall to repair different posterior urethral anomalies, providing excellent exposure without compromising the fecal continence mechanism. CONCLUSION The anterior sagittal approach without splitting the rectum is a feasible procedure which provides excellent exposure to the posterior urethra in most cases and leads to less morbidity as it avoids the splitting and suturing of the rectum anterior wall. PMID:23811390

Leite, Mila Torii Correa; Fachin, Camila Girardi; de Albuquerque Maranhao, Renato Frota; Shida, Marcia Emilia Francisco; Martins, Jose Luiz

2013-01-01

104

Anatomy of the presacral venous plexus: implications for rectal surgery  

Microsoft Academic Search

The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to

P. Baqué; B. Karimdjee; A. Iannelli; E. Benizri; A. Rahili; D. Benchimol; J.-L. Bernard; E. Sejor; S. Bailleux; F. de Peretti; A. Bourgeon

2004-01-01

105

Cyclin A predicts metastatic potential of rectal neuroendocrine tumors.  

PubMed

Rectal neuroendocrine tumors (NETs) are rare tumors representing 10% to 15% of gastroenteropancreatic NETs. The grade of these tumors, according to the World Health Organization (WHO) 2010 classification and based on Ki-67 index and mitotic count, correlates with their metastatic potential. We studied the expression of a cell cycle regulatory protein, cyclin A, in rectal NETs. Our tumor series of rectal NETs comprised 73 tumors, of which 71 cases were available for immunohistochemistry. We assessed how well expression of cyclin A predicts the occurrence of metastatic lesions. Expression of cyclin A correlated well with metastatic potential because all tumors with high expression (?5%) were metastatic. Cyclin A expression and WHO 2010 grade were independent prognostic factors. Cyclin A failed to recognize 3 metastatic tumors classified as grade 2 tumors. On the other hand, 2 grade 2 tumors with low expression of cyclin A remained local. The WHO 2010 classification showed excellent prognostic accuracy for rectal NETs. Additional reliable prognostic tools would nevertheless be valuable. This study showed cyclin A expression to correlate well with metastatic potential. Both cyclin A and WHO 2010 grade were very specific in identifying patients at risk for metastasis (100% versus 96%). Grade was more sensitive (100% versus 60%). Tumors with strong expression of both cyclin A and Ki-67 were all metastatic, and these patients will require careful monitoring and may benefit from adjuvant therapy. PMID:24824027

Jernman, Juha; Välimäki, Matti J; Hagström, Jaana; Louhimo, Johanna; Haapasalo, Hannu; Arola, Johanna; Haglund, Caj

2014-08-01

106

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.

107

Rectal angiolipoma: A case report and review of literature  

PubMed Central

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. PMID:17457984

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

2007-01-01

108

Screening and Testing to Detect Cancer: Colon and Rectal Cancer  

Cancer.gov

Screening methods to find colon or rectal changes that may lead to cancer include laboratory tests such as fecal occult blood tests (FOBT), and imaging tests such as sigmoidoscopy and colonoscopy. Screening by the latter two tests can find precancerous polyps which can be removed during the test and may find cancer early when it is most treatable.

109

Diffuse excess mucosal collagen in rectal biopsies facilitates differential diagnosis of solitary rectal ulcer syndrome from other inflammatory bowel diseases  

Microsoft Academic Search

Solitary rectal ulcer syndrome (SRUS) is sufficiently uncommon that the clinician or general pathologist may lack familiarity with the disorder and may confuse it with other inflammatory bowel diseases. To evaluate the role of collagen staining in facilitating the differential diagnosis of SRUS, an initial open review was undertaken on 1672 consecutive patients whose 4780 colorectal biopsies were stained with

Douglas S. Levine; Christina M. Surawicz; Terese N. Ajer; Patrick J. Dean; Cyrus E. Rubin

1988-01-01

110

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

SciTech Connect

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

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

2010-07-01

111

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

SciTech Connect

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

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

2006-06-01

112

Dose Constraint for Minimizing Grade 2 Rectal Bleeding Following Brachytherapy Combined With External Beam Radiotherapy for Localized Prostate Cancer: Rectal Dose-Volume Histogram Analysis of 457 Patients  

SciTech Connect

Purpose: To determine the rectal tolerance to Grade 2 rectal bleeding after I-125 seed brachytherapy combined with external beam radiotherapy (EBRT), based on the rectal dose-volume histogram. Methods and Materials: A total of 458 consecutive patients with stages T1 to T3 prostate cancer received combined modality treatment consisting of I-125 seed implantation followed by EBRT to the prostate and seminal vesicles. The prescribed doses of brachytherapy and EBRT were 100 Gy and 45 Gy in 25 fractions, respectively. The rectal dosimetric factors were analyzed for rectal volumes receiving >100 Gy and >150 Gy (R100 and R150) during brachytherapy and for rectal volumes receiving >30 Gy to 40 Gy (V30-V40) during EBRT therapy in 373 patients for whom datasets were available. The patients were followed from 21 to 72 months (median, 45 months) after the I-125 seed implantation. Results: Forty-four patients (9.7%) developed Grade 2 rectal bleeding. On multivariate analysis, age (p = 0.014), R100 (p = 0.002), and V30 (p = 0.001) were identified as risk factors for Grade 2 rectal bleeding. The rectal bleeding rate increased as the R100 increased: 5.0% (2/40 patients) for 0 ml; 7.5% (20/267 patients) for >0 to 0.5 ml; 11.0% (11/100 patients) for >0.5 to 1 ml; 17.9% (5/28 patients) for >1 to 1.5 ml; and 27.3% (6/22 patients) for >1.5 ml (p = 0.014). Grade 2 rectal bleeding developed in 6.4% (12/188) of patients with a V30 {<=}35% and in 14.1% (26/185) of patients with a V30 >35% (p = 0.02). When these dose-volume parameters were considered in combination, the Grade 2 rectal bleeding rate was 4.2% (5/120 patients) for a R100 {<=}0.5 ml and a V30 {<=}35%, whereas it was 22.4% (13/58 patients) for R100 of >0.5 ml and V30 of >35%. Conclusion: The risk of rectal bleeding was found to be significantly volume-dependent in patients with prostate cancer who received combined modality treatment. Rectal dose-volume analysis is a practical method for predicting the risk of development of Grade 2 rectal bleeding.

Shiraishi, Yutaka; Yorozu, Atsunori [Department of Radiology, Tokyo Medical Center, Tokyo (Japan); Ohashi, Toshio, E-mail: ohashi@rad.med.keio.ac.jp [Department of Radiology, Keio University, School of Medicine, Tokyo (Japan); Toya, Kazuhito [Department of Radiology, Tokyo Medical Center, Tokyo (Japan); Seki, Satoshi [Department of Radiology, Keio University, School of Medicine, Tokyo (Japan); Yoshida, Kayo; Kaneda, Tomoya [Department of Radiology, Tokyo Medical Center, Tokyo (Japan); Saito, Shiro; Nishiyama, Toru [Department of Urology, Tokyo Medical Center, Tokyo (Japan); Hanada, Takashi; Shigematsu, Naoyuki [Department of Radiology, Keio University, School of Medicine, Tokyo (Japan)

2011-11-01

113

Postoperative adjuvant irradiation of rectal and rectosigmoid cancer.  

PubMed

Local recurrence is a major problem for approximately 40% of stage B and C rectal cancer patients following successful complete resection by either anterior (AR) or abdominoperineal resection (APR). We retrospectively analyzed the sites of local recurrence in 138 patients following curative surgery, and evaluated the effect of 5,000 rad adjuvant postoperative pelvic EXRT in reducing the incidence of local recurrence in 40 patients. PMID:3150586

Kumar, P P; Good, R R; Conlan, M G; Edney, J A; Hodgson, P E; McCaul, G F

1988-01-01

114

Local recurrence after rectal cancer treatment in Manitoba  

PubMed Central

Background By optimizing surgical and/or radiotherapy treatment, local recurrence rates of resectable rectal cancers have been reported to be less than 10% in both clinical trials and in some population-based studies. We examined patterns of care and local recurrence rates for rectal cancers in the province of Manitoba. Methods We used the provincial cancer registry to identify all rectal cancers diagnosed from 1994 to 1997. These dates allowed for a minimum of 5 years of follow-up. We obtained information on cancer staging through a retrospective chart review and information on surgical procedures from the cancer registry. We included in our study only those patients with stages I, II and III disease who had an anterior resection, Hartmann procedure or abdominal perineal resection with clear margins. We determined local recurrences by chart review and we reported the crude rate. Results We identified 333 patients among whom there was a relatively even distribution of stage I, II and III cancers. Fifty-three percent of patients received a stoma. Adjuvant radiotherapy was administered in 6%, 45% and 80% of patients with stage I, II and III cancers, respectively. Radiotherapy was only given preoperatively to 3 patients. We identified local recurrences in 13%, 16% and 24% of patients with stage I, II and III disease, respectively, with an overall rate of 17.4%. Recurrence rates by hospital ranged from 12% to 43%. Actual rates may be a few percentage points higher because 13% of patients had incomplete follow-up information and were assumed to have no recurrence. Conclusion Between 1994 and 1997, the management of resectable rectal cancer in Manitoba did not meet benchmarks for the period in terms of documentation, treatment and, most importantly, the outcome of local recurrence. Initiatives should be taken to ensure that current performance and outcomes have improved. PMID:19234651

Latosinsky, Steven; Turner, Donna

2009-01-01

115

Efficacy of Rectal Misoprostol for Prevention of Postpartum Hemorrhage  

PubMed Central

Postpartum hemorrhage is an important cause of maternal morbidity and mortality after delivery. Active management of postpartum hemorrhage by an uterotonic drug decreases the rate of postpartum hemorrhage. The aim of this study is to evaluate the efficacy of rectal misoprostol for prevention of postpartum hemorrhage. This double blind randomized clinical trial was performed on full term pregnant women candidate for vaginal delivery, referred to Zahedan Imam Ali Hospital during 2008-2009. They were randomly divided into two groups of rectal misoprostol and oxytocin. The women in misoprostol group received 400 ?g rectal misoprostol after delivery and the women in oxytocin group received 3 IU oxytocin in 1 L ringer serum, intravenously. Rate of bleeding, need to any surgery interventions, rate of transfusion and changes in hemoglobin and hematocrite were compared between two groups. A total of 400 patients (200 cases in misoprostol group and 200 in oxytocin group) entered to the study. Rate of bleeding > 500 cc was significantly higher in oxytocin group than misoprostol group (33% vs. 19%) (p = 0.005). Also, need to excessive oxytocin for management of postpartum hemorrhage was significantly lower in misoprostol group than oxytocin group (18% vs. 30%) (p = 0.003). Decrease in hematocrite was significantly more observed in oxytocin group than misoprostol group (mean decrease of hematocrite was 1.3 ± 1.6 in misoprostol group and 1.6 ± 2.2 in oxytocin group). Two groups were similar in terms of side-effects. Rectal misoprostol as an uterotonic drug can decrease postpartum hemorrhage and also can prevent from decrease of hemoglobin as compared to oxytocin. PMID:24250623

Mirteimouri, Masoumeh; Tara, Fatemeh; Teimouri, Batool; Sakhavar, Nahid; Vaezi, Afsaneh

2013-01-01

116

Correction of rectal procidentia by use of polypropylene mesh (Marlex)  

Microsoft Academic Search

Summary and Conclusions  A simple rapid method for the correction of rectal procidentia by the use of polypropylene mesh (Marlex) is described. The\\u000a excellent results of this procedure make it preferable to any other. The material used gives the impression that an external\\u000a sphincter is present immediately postoperatively. It is hoped that this technic will permit treatment of the elderly patient

Max I. Lomas; Howard Cooperman

1972-01-01

117

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

118

Angiodysplasia of the colon: A cause of rectal bleeding  

Microsoft Academic Search

Colonic angiodysplasia is a vascular lesion of the colon that may become the source of low grade chronic or intermittently\\u000a massive rectal bleeding.\\u000a \\u000a It is a lesion of the elderly, almost always found in the cecum and the ascending colon. Etiology and pathogenesis are unknown.\\u000a The diagnosis can be made with angiography based on the demonstration of a vascular tuft

C. A. Athanasoulis; J. J. Galdabini; A. C. Waltman; R. A. Novelline; A. J. Greenfield; M. L. Ezpeleta

1978-01-01

119

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. PMID:24334539

Zhe, Hong

2013-01-01

120

Alcohol consumption and rectal tumor mutations and epigenetic changes  

PubMed Central

Purpose An association between alcohol and rectal cancer has been reported in the epidemiological literature. In this study we further explore the association by examining specific tumor markers with alcohol consumption as well as types of alcoholic beverages consumed. Methods We assessed alcohol consumption with CpG Island Methylator Phenotype, TP53 and KRAS2 mutations in incident rectal cancer cases and compared them to population-based controls. We evaluated type, long-term, and recent alcohol consumption. Results We observed a trend toward increasing risk of CpG Island Methylator Phenotype positive tumors and long-term alcohol consumption. In contrast, after adjusting for recent total alcohol intake, recent high beer consumption significantly increased the odds of having a TP53 mutation compared to those who did not drink beer (Odds Ratios 2.19 95% Confidence Interval 1.34, 3.57). We observed a non-statistically significant reduced risk of a TP53 mutation among those who drank wine (particularly red wine) versus non-consumers of wine. The association between TP53 mutations and recent beer consumption was strongest for transversion mutations. Conclusions These data suggest that both alcohol and specific constituents of alcoholic beverages contribute to rectal cancer risk among unique disease pathways. PMID:20628283

Slattery, Martha L.; Wolff, Roger K.; Herrick, Jennifer S; Curtin, Karen; Caan, Bette J.; Samowitz, Wade

2010-01-01

121

The emerging role of neoadjuvant chemotherapy for rectal cancer  

PubMed Central

Locally advanced rectal cancer remains a substantial public health problem. Historically, the disease has been plagued by high rates of both distant and local recurrences. The standardization of pre-operative chemoradiation and transmesorectal excision (TME) have greatly lowered the rates of local recurrence. Efforts to improve treatment through use of more effective radiosensitizing therapies have proven unsuccessful in rectal cancer. Presently, due to improved local therapies, distal recurrences represent the dominant problem in this disease. Adjuvant chemotherapy is currently of established benefit in colorectal cancer. As such, adjuvant chemotherapy, consisting of fluoropyrimidine and oxaliplatin, represent the standard of care for many patients. However, after pre-operative chemoradiotherapy and rectal surgery, the administration of highly effective chemotherapy regimens has proven difficult. For this reason, novel neoadjuvant approaches represent appealing avenues for investigation. Strategies of neoadjuvant chemotherapy alone, neoadjuvant chemotherapy followed by chemoradiation and neoadjuvant chemoradiation followed by chemotherapy are under investigation. Initial encouraging results have been noted, though definitive phase III data is lacking.

Fakih, Marwan

2014-01-01

122

Extended resection and pelvic exenteration in distal third rectal cancer.  

PubMed

Approximately 10% of all low rectal cancer needs surgical resection extended to other pelvic structures. Indication for extended resection should be given according to a precise systemic and local preoperative staging. Magnetic Resonance Imaging is the most important instrument utilized by the Multidisciplinary Team to decide therapeutic strategy according to the surgical risk. The status of the pathological circumferential resection margin is the most important prognostic factor determining local recurrence risk and oncological outcome and for this reason it should be considered pivotal in the decision of the strategy of treatment. When extended resection is performed, the presence of an expert colorectal surgeon is mandatory, often coordinating a group of specialists including urologist, plastic surgeon, vascular surgeon and orthopaedist when sacrectomy is necessary. The most frequent extended resection in women with low rectal cancer is the partial resection of vagina. In men, the infiltration of the prostate could be treated with partial prostatectomy, total prostatectomy with bladder preservation or pelvic exenteration, total or posterior, when the bladder is infiltrated. Rectal cancer infiltration of the pelvic sidewalls or of the sacrum is less frequent and obliges to perform a total pelvic exenteration including sometimes the hypogastric vessel or extended to the sacrum. PMID:24842690

García-Granero, Eduardo; Frasson, Matteo; Trallero, Marta

2014-03-01

123

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

PubMed

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

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

1982-02-18

124

Fatal Clostridium sordellii ischio-rectal abscess with septicaemia complicating ultrasound-guided transrectal prostate biopsy  

Microsoft Academic Search

Clostridium sordellii is a Gram-positive spore-forming anaerobic bacillus rarely encountered in human infection. A case of C. sordellii ischio-rectal abscess with rapidly fatal septicaemia is described which complicated ultrasound-guided transrectal biopsy of the prostate, despite ciprofloxacin prophylaxis. Neither C. sordellii ischio-rectal abscess nor ischio-rectal abscess complicating transrectal biopsy have been reported previously. Judging from our experience and the reviewed literature,

A. Borer; J. Gilad; E. Sikuler; K. Riesenberg; F. Schlaeffer; D. Buskila

1999-01-01

125

Laparoscopic mesh rectopexy for complete rectal prolapse in children: a new simplified technique  

Microsoft Academic Search

Purpose  Rectal prolapse in children without underlying conditions is usually a self-limiting problem and requires no surgical treatment.\\u000a For children with persistent rectal prolapse, a variety of surgical procedures have been described with success. Recently,\\u000a there are many reports addressing the successful use of different laparoscopic approaches for complete rectal prolapse. We\\u000a present a novel simplified laparoscopic technique for management of

Rafik Shalaby; Maged Ismail; Mohamad Abdelaziz; Refaat Ibrahem; Khaled Hefny; Abdelaziz Yehya; Abdelghany Essa

2010-01-01

126

Surgical management of a retro-rectal cystic hamartoma (tailgut cyst) using a trans-rectal approach: a case report and review of the literature  

PubMed Central

Introduction Retro-rectal cystic hamartoma (tailgut cyst) is a rare congenital developmental lesion arising from post-natal primitive gut remnants in the retro-rectal space. The rarity of the lesion and its anatomical position usually leads to difficulty in diagnosis and surgical management. Complete surgical resection remains the cornerstone of treatment. A dozen or so surgical approaches have been described in the literature to date to make the operation as simple as possible, but the trans-rectal access route is extremely rarely reported and not well described. Here, we present a case that demonstrates the trans-rectal approach to a retro-rectal tumor is a feasible option in terms of surgical radicality, minimal invasiveness and safety for carefully selected patients with this rare type of retro-rectal cystic lesion. Case presentation A 29-year-old Caucasian woman was referred to our institution due to perineal pain extending to the right inguinal region. Her symptoms had been present for the last two months. She was first examined at her regional hospital for a suspected ruptured ovarian cyst; however, after consultation with a gynecologist and a computed tomography scan of her pelvis, a tumor in the retro-rectal space was discovered. Our patient was admitted to our hospital and when a pelvic magnetic resonance imaging study confirmed the diagnosis of the retro-rectal cystic formation, a complete extirpation of retro-rectal tumor fixed to the coccyx using trans-rectal approach was performed. The final pathological diagnosis was retro-rectal cystic hamartoma (tailgut cyst) with no evidence of malignancy. Her post-operative course was uneventful, and at four months after surgery our patient is symptom free with no evidence of recurrent or residual disease. Conclusions Trans-rectal excision is feasible in terms of surgical radicality and is a simple to perform, minimally invasive and safe option, providing complete recovery for carefully selected patients with retro-rectal cystic hamartoma treated operatively. PMID:24393234

2014-01-01

127

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

PubMed

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

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

2013-09-01

128

Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis: 10 years’ experience from a tertiary referral unit  

PubMed Central

Background. The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection (LSARR) depending upon the extent and severity of the disease. Objective. To report the efficacy of LSARR in terms of pain, quality of life and short- and long-term complications—in particular, those pertaining to bowel function. Methods. The case notes of all patients undergoing LSARR were reviewed. The analysed variables included surgical complications, overall symptomatic improvement rate, dysmenorrhoea, dyspareunia, and dyschezia. Chronic pain was measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre (MSKCC) questionnaire. Results. Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study. Sixty-nine (93.2%) women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem. Approximately 42% of women who wished to conceive had at least one baby. The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score. Post-operative complications were recorded in 14.9% of cases. Conclusions. LSARR for rectal endometriosis is associated with a high degree of symptomatic relief. Pain relief achieved following LSARR does not appear to degrade with time. As anticipated, some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction. PMID:25146341

English, James; Sajid, Muhammad S.; Lo, Jenney; Hudelist, Guy; Baig, Mirza K.; Miles, William A.

2014-01-01

129

Correlation of Chromosomal Instability, Telomere Length and Telomere Maintenance in Microsatellite Stable Rectal Cancer: A Molecular Subclass of Rectal Cancer  

PubMed Central

Introduction Colorectal cancer (CRC) tumor DNA is characterized by chromosomal damage termed chromosomal instability (CIN) and excessively shortened telomeres. Up to 80% of CRC is microsatellite stable (MSS) and is historically considered to be chromosomally unstable (CIN+). However, tumor phenotyping depicts some MSS CRC with little or no genetic changes, thus being chromosomally stable (CIN-). MSS CIN- tumors have not been assessed for telomere attrition. Experimental Design MSS rectal cancers from patients ?50 years old with Stage II (B2 or higher) or Stage III disease were assessed for CIN, telomere length and telomere maintenance mechanism (telomerase activation [TA]; alternative lengthening of telomeres [ALT]). Relative telomere length was measured by qPCR in somatic epithelial and cancer DNA. TA was measured with the TRAPeze assay, and tumors were evaluated for the presence of C-circles indicative of ALT. p53 mutation status was assessed in all available samples. DNA copy number changes were evaluated with Spectral Genomics aCGH. Results Tumors were classified as chromosomally stable (CIN-) and chromosomally instable (CIN+) by degree of DNA copy number changes. CIN- tumors (35%; n=6) had fewer copy number changes (<17% of their clones with DNA copy number changes) than CIN+ tumors (65%; n=13) which had high levels of copy number changes in 20% to 49% of clones. Telomere lengths were longer in CIN- compared to CIN+ tumors (p=0.0066) and in those in which telomerase was not activated (p=0.004). Tumors exhibiting activation of telomerase had shorter tumor telomeres (p=0.0040); and tended to be CIN+ (p=0.0949). Conclusions MSS rectal cancer appears to represent a heterogeneous group of tumors that may be categorized both on the basis of CIN status and telomere maintenance mechanism. MSS CIN- rectal cancers appear to have longer telomeres than those of MSS CIN+ rectal cancers and to utilize ALT rather than activation of telomerase. PMID:24278232

Boardman, Lisa A.; Johnson, Ruth A.; Viker, Kimberly B.; Hafner, Kari A.; Jenkins, Robert B.; Riegert-Johnson, Douglas L.; Smyrk, Thomas C.; Litzelman, Kristin; Seo, Songwon; Gangnon, Ronald E.; Engelman, Corinne D.; Rider, David N.; Vanderboom, Russell J.; Thibodeau, Stephen N.; Petersen, Gloria M.; Skinner, Halcyon G.

2013-01-01

130

Comparision between transrectal ultrasonography and computed tomography with rectal inflation of gas in preoperative staging of lower rectal cancer  

Microsoft Academic Search

.   Computed tomography with rectal air insufflation was compared with transrectal ultrasonography (TRUS) in 63 patients. The\\u000a CT protocol involved pre- and postcontrast scans with 5 mm slice thickness following air insufflation in IV antiperistaltic\\u000a agent. Of the patients, 79 % were scanned in the prone position. Results of the preoperative examinations were compared with\\u000a the histological findings. The CT

M. F. Osti; F. Scattoni Padovan; C. Pirolli; S. Sbarbati; V. Tombolini; C. Meli; R. Maurizi Enrici

1997-01-01

131

Rectal corticosteroids versus alternative treatments in ulcerative colitis: a meta-analysis.  

PubMed Central

BACKGROUND: Clear strategies to optimise the use of corticosteroids in ulcerative colitis are lacking. AIM: A meta-analysis was undertaken to examine critically the role of rectal corticosteroids in the management of active distal ulcerative colitis. METHODS: All reported randomised controlled trials were retrieved by searching the Medline and EMBASE databases and the bibliographies of relevant studies. Trials which met inclusion criteria were assessed for scientific rigour. Data were extracted by two independent observers according to predetermined criteria. RESULTS: Of 83 trials retrieved, 33 met inclusion criteria. Pooled odds ratios (POR) showed conventional rectal corticosteroids and rectal budesonide to be clearly superior to placebo. In seven trials, rectal 5-aminosalicylic acid (5-ASA) was significantly better than conventional rectal corticosteroids for inducing remission of symptoms, endoscopy, and histology with POR of 2.42 (95% confidence interval (CI) 1.72-3.41), 1.89 (95% CI 1.29-2.76), and 2.03 (95% CI 1.28-3.20), respectively. Rectal budesonide was of comparable efficacy to conventional corticosteroids but produced less endogenous cortisol suppression. Side effects, although inconsistently reported, were generally minor. A cost comparison of rectal preparations showed 5-ASA to be less expensive than corticosteroids. CONCLUSIONS: Rectal 5-ASA is superior to rectal corticosteroids in the management of distal ulcerative colitis. PMID:9245932

Marshall, J K; Irvine, E J

1997-01-01

132

Clinical and therapeutic considerations of rectal lymphoma: A case report and literature review  

PubMed Central

Primary rectal lymphoma is a rare presentation of gastrointestinal lymphomas. Its clinical presentation is indistinguishable from that of rectal carcinoma. Although surgical resection is often technically feasible, optimal therapy for colorectal lymphoma has not yet been identified. We report a case of primary rectal lymphoma (non-Hodgkin’s large cell lymphoma of type B) with high-grade features that disappeared completely after chemo-radiotherapy. This case underlines that primary treatment with systemic chemotherapy and involved-field radiotherapy can be successful for rectal lymphoma, with surgery reserved for complications and chemotherapy failures. PMID:15637770

Bilsel, Yilmaz; Balik, Emre; Yamaner, Sumer; Bugra, Dursun

2005-01-01

133

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. PMID:22577584

Hasan, Hesham M.; Hasan, Hani M.

2012-01-01

134

?H NMR-based metabolic profiling of human rectal cancer tissue  

PubMed Central

Background Rectal cancer is one of the most prevalent tumor types. Understanding the metabolic profile of rectal cancer is important for developing therapeutic approaches and molecular diagnosis. Methods Here, we report a metabonomics profiling of tissue samples on a large cohort of human rectal cancer subjects (n?=?127) and normal controls (n?=?43) using 1H nuclear magnetic resonance (1H NMR) based metabonomics assay, which is a highly sensitive and non-destructive method for the biomarker identification in biological systems. Principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and orthogonal projection to latent structure with discriminant analysis (OPLS-DA) were applied to analyze the 1H-NMR profiling data to identify the distinguishing metabolites of rectal cancer. Results Excellent separation was obtained and distinguishing metabolites were observed among the different stages of rectal cancer tissues (stage I?=?35; stage II?=?37; stage III?=?37 and stage IV?=?18) and normal controls. A total of 38 differential metabolites were identified, 16 of which were closely correlated with the stage of rectal cancer. The up-regulation of 10 metabolites, including lactate, threonine, acetate, glutathione, uracil, succinate, serine, formate, lysine and tyrosine, were detected in the cancer tissues. On the other hand, 6 metabolites, including myo-inositol, taurine, phosphocreatine, creatine, betaine and dimethylglycine were decreased in cancer tissues. These modified metabolites revealed disturbance of energy, amino acids, ketone body and choline metabolism, which may be correlated with the progression of human rectal cancer. Conclusion Our findings firstly identify the distinguishing metabolites in different stages of rectal cancer tissues, indicating possibility of the attribution of metabolites disturbance to the progression of rectal cancer. The altered metabolites may be as potential biomarkers, which would provide a promising molecular diagnostic approach for clinical diagnosis of human rectal cancer. The role and underlying mechanism of metabolites in rectal cancer progression are worth being further investigated. PMID:24138801

2013-01-01

135

Patient Delay in Colorectal Cancer Patients: Associations with Rectal Bleeding and Thoughts about Cancer  

PubMed Central

Rectal bleeding is considered to be an alarm symptom of colorectal cancer. However, the symptom is seldom reported to the general practitioner and it is often assumed that patients assign the rectal bleeding to benign conditions. The aims of this questionnaire study were to examine whether rectal bleeding was associated with longer patient delays in colorectal cancer patients and whether rectal bleeding was associated with cancer worries. All incident colorectal cancer patients during a 1-year period in the County of Aarhus, Denmark, received a questionnaire. 136 colorectal cancer patients returned the questionnaire (response rate: 42%). Patient delay was assessed as the interval from first symptom to help-seeking and was reported by the patient. Patients with rectal bleeding (N?=?81) reported longer patient intervals than patients without rectal bleeding when adjusting for confounders including other symptoms such as pain and changes in bowel habits (HR?=?0.43; p?=?0.004). Thoughts about cancer were not associated with the patient interval (HR?=?1.05; p?=?0.887), but more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding (chi2?=?15.29; p<0.001). Conclusively, rectal bleeding was associated with long patient delays in colorectal cancer patients although more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding. This suggests that assignment of symptoms to benign conditions is not the only explanation of long patient delays in this patient group and that barriers for timely help-seeking should be examined. PMID:23894527

Pedersen, Anette F.; Hansen, Rikke P.; Vedsted, Peter

2013-01-01

136

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

137

Metformin use and improved response to therapy in rectal cancer  

PubMed Central

Locally advanced rectal cancer is commonly treated with chemoradiation prior to total mesorectal excision (TME). Studies suggest that metformin may be an effective chemopreventive agent in this disease as well as a possible adjunct to current therapy. In this study, we examined the effect of metformin use on pathologic complete response (pCR) rates and outcomes in rectal cancer. The charts of 482 patients with locally advanced rectal adenocarcinoma treated from 1996 to 2009 with chemoradiation and TME were reviewed. Median radiation dose was 50.4 Gy (range 19.8–63). Nearly, all patients were treated with concurrent 5-fluorouracil-based chemotherapy (98%) followed by adjuvant chemotherapy (81.3%). Patients were categorized as nondiabetic (422), diabetic not taking metformin (40), or diabetic taking metformin (20). No significant differences between groups were found in clinical tumor classification, nodal classification, tumor distance from the anal verge or circumferential extent, pretreatment carcinoembryonic antigen level, or pathologic differentiation. pCR rates were 16.6% for nondiabetics, 7.5% for diabetics not using metformin, and 35% for diabetics taking metformin, with metformin users having significantly higher pCR rates than either nondiabetics (P = 0.03) or diabetics not using metformin (P = 0.007). Metformin use was significantly associated with pCR rate on univariate (P = 0.05) and multivariate (P = 0.01) analyses. Furthermore, patients taking metformin had significantly increased disease-free (P = 0.013) and overall survival (P = 0.008) compared with other diabetic patients. Metformin use is associated with significantly higher pCR rates as well as improved survival. These promising data warrant further prospective study. PMID:24133632

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

2013-01-01

138

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

139

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

140

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

NASA Astrophysics Data System (ADS)

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

Arnold, David A.

1995-05-01

141

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

Microsoft Academic Search

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

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

2003-01-01

142

Photodynamic Therapy with Motexafin Lutetium for Rectal Cancer: A Preclinical Model in the Dog  

E-print Network

Photodynamic Therapy with Motexafin Lutetium for Rectal Cancer: A Preclinical Model in the Dog H despite multi-modality therapy. Photodynamic Therapy (PDT) is a cancer treatment which generates tumor of rectal resection after motexafin lutetium-mediated photodynamic therapy. Methods. Ten mixed breed dogs

Yodh, Arjun G.

143

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

144

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. PMID:25031792

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

2014-01-01

145

Rectal Cancer Mortality and Total Hardness Levels in Taiwan's Drinking Water  

Microsoft Academic Search

The possible association between the risk of rectal cancer and hardness levels in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. All eligible rectal cancer deaths (986 cases) of Taiwan residents from 1990 through 1994 were compared with deaths from other causes (986 controls), and the hardness levels of the drinking water used by

Chun-Yuh Yang; Shang-Shyue Tsai; Tai-Cheng Lai; Chung-Feng Hung; Hui-Fen Chiu

1999-01-01

146

Is Local Excision of T2\\/T3 Rectal Cancers Adequate?  

Microsoft Academic Search

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

D. L. Beral; J. Monson

147

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

Microsoft Academic Search

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

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

2007-01-01

148

Quality assurance in colon and rectal cancer surgery.  

PubMed

Surgery remains the cornerstone in the multidisciplinary treatment of colon and rectal cancer. Many diagnostic, technical, and adjuvant therapies are known to impact the immediate and long-term oncologic results. Guidelines for appropriate cancer-specific management of colorectal cancer should be adhered to so as to optimize the oncologic outcomes. Similarly, patient-specific surgical outcomes are also linked to many systems-based factors, such as appropriate use of perioperative antibiotics, venous thromboembolism prophylaxis, and avoidance of surgical complications. PMID:24267162

Mathis, Kellie L; Cima, Robert R

2014-01-01

149

Primary rectal squamous cell carcinoma treated with surgery and radiotherapy  

PubMed Central

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

2014-01-01

150

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

PubMed Central

Background The vaginal microflora is important for maintaining vaginal health and preventing infections of the reproductive tract. The rectum has been suggested as the major source for the colonisation of the vaginal econiche. Methods To establish whether the rectum can serve as a possible bacterial reservoir for colonisation of the vaginal econiche, we cultured vaginal and rectal specimens from pregnant women at 35-37 weeks of gestation, identified the isolates to the species level with tRNA intergenic length polymorphism analysis (tDNA-PCR) and genotyped the isolates for those subjects from which the same species was isolated simultaneously vaginally and rectally, by RAPD-analysis. One vaginal and one rectal swab were collected from a total of each of 132 pregnant women at 35-37 weeks of gestation. Swabs were cultured on Columbia CNA agar and MRS agar. For each subject 4 colonies were selected for each of both sites, i.e. 8 colonies in total. Results Among the 844 isolates that could be identified by tDNA-PCR, a total of 63 bacterial species were present, 9 (14%) only vaginally, 26 (41%) only rectally, and 28 (44%) in both vagina and rectum. A total of 121 (91.6%) of 132 vaginal samples and 51 (38.6%) of 132 rectal samples were positive for lactobacilli. L. crispatus was the most frequently isolated Lactobacillus species from the vagina (40% of the subjects were positive), followed by L. jensenii (32%), L. gasseri (30%) and L. iners (11%). L. gasseri was the most frequently isolated Lactobacillus species from the rectum (15%), followed by L. jensenii (12%), L. crispatus (11%) and L. iners (2%). A total of 47 pregnant women carried the same species vaginally and rectally. This resulted in 50 vaginal/rectal pairs of the same species, for a total of eight different species. For 34 of the 50 species pairs (68%), isolates with the same genotype were present vaginally and rectally and a high level of genotypic diversity within species per subject was also established. Conclusion It can be concluded that there is a certain degree of correspondence between the vaginal and rectal microflora, not only with regard to species composition but also with regard to strain identity between vaginal and rectal isolates. These results support the hypothesis that the rectal microflora serves as a reservoir for colonisation of the vaginal econiche. PMID:19828036

2009-01-01

151

Pharmacokinetics of rectal drug administration, Part I. General considerations and clinical applications of centrally acting drugs.  

PubMed

Generally, oral administration is the route of choice in the daily practice of pharmacotherapy. However, in some circumstances this is impractical or even impossible (during nausea and vomiting or convulsions, in uncooperative patients and before surgery). In these cases, the rectal route may represent a practical alternative and rectal administration is now well accepted for delivering, for example, anticonvulsants, non-narcotic and narcotic analgesics, theophylline, antiemetics and antibacterial agents, and for inducing anaesthesia in children. It may also represent an interesting alternative to intravenous or other injection routes of drug administration. The rate and extent of rectal drug absorption are often lower than with oral absorption, possibly an inherent factor owing to the relatively small surface area available for drug uptake. In addition, the composition of the rectal formulation (solid vs liquid, nature of the suppository base) appears to be an important factor in the absorption process by determining the pattern of drug release. This relation between formulation and drug uptake has been clearly demonstrated for drugs like diazepam, paracetamol (acetaminophen), indomethacin, methadone and diflunisal. Coadministration of absorption-promoting agents (surfactants, sodium salicylate, enamines) represents another approach towards manipulating rectal drug absorption, although this concept requires further research concerning both efficacy and safety. For a number of drugs the extent of rectal absorption has been reported to exceed oral values, which may reflect partial avoidance of hepatic first-pass metabolism after rectal delivery. This phenomenon has been reported for morphine, metoclopramide, ergotamine, lidocaine (lignocaine) and propranolol. Rectal drug delivery in a site- and rate-controlled manner using osmotic pumps or hydrogel formulations may provide opportunities for manipulating systemic drug concentrations and drug effects. The extent of first-pass metabolism may be influenced (lidocaine), depending on the site of drug administration in the rectum. The rate of delivery may determine systemic drug action and side effects (nifedipine), and it may affect the local action of concurrently administered absorption promoters on drug uptake (cefoxitin). Local irritation is increasingly being acknowledged as a possible complication of rectal drug therapy. Long term medication with rectal ergotamine and acetylsalicylic acid, for example, may result in rectal ulceration, and irritation after a single administration of several drugs and formulations has been described. The assessment of tolerability and safety is imperative in the design of rectal formulations. Recent studies corroborate the clinical relevance of rectal drug therapy, and the value of the rectal route as an alternative to parenteral administration has been assessed for several drugs, e.g. diazepam, midazolam, morphine and diclofenac.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1717195

van Hoogdalem, E; de Boer, A G; Breimer, D D

1991-07-01

152

The functional results after colectomy and ileorectal anastomosis for severe constipation (Arbuthnot Lane's disease) as related to rectal sensory function  

Microsoft Academic Search

Rectoanal manovolumetry during graded isobaric rectal distension was carried out in 12 women with severe constipation classified as slow transit constipation (Arbuthnot Lane's disease). The resting anal sphincter pressure, the rectoanal inhibitory reflex and the rectal capacity were all normal. While thedistension volumes required to elicit sensation of rectal filling and an urge to defaecate were within normal limits in

S. Ĺkervall; S. Fasth; S. Nordgren; T. Öresland; L. Hultén

1988-01-01

153

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

154

[A method of surgical treatment of acute ischio-rectal and pelvio-rectal paraproctitis with a transsphincter and extrasphincter position of the primary pus meatus].  

PubMed

A one-moment radical method of surgical treatment was used in treatment of 36 patients with ischio-rectal and pelvio-rectal forms of acute paraproctitis. The method of surgical treatment of acute paraproctitis considerably shortened the period of hospital treatment, promoted the formation of a soft scar, excluded the development of the anal sphincter incompetence, and reduced the percentage of recurrent diseases. PMID:18522195

Lavreshin, N M; Gobedzhishvili, V K; Aliev, M M; Khutov, A B; Lavreshin, M P

2008-01-01

155

Topical application of WR-2721 achieves high concentrations in the rectal wall.  

PubMed

Rectal wall injury is an important treatment-related morbidity in patients treated with radiation for prostate cancer. We have undertaken this study to investigate the merits of topical intrarectal application of the radioprotective compound WR-2721. Male Copenhagen rats were injected intrarectally with 2% WR-2721 gel. At 10, 20, 30 and 40 min after application, a laparotomy was performed, and the rectum and prostate were removed. Concentrations of total WR-1065 (the active metabolite of WR-2721) were determined in these samples by an HPLC assay. While the concentration in the rectal wall tended to increase with time, it did not change substantially in the prostate. The concentration in the rectal wall was found to be significantly higher at all times. We conclude that preferential accumulation of WR-2721 in the rectal wall can be achieved by topical application. This is a promising approach to modifying rectal wall tolerance that deserves more study. PMID:7597137

Ben-Josef, E; Mesina, J; Shaw, L M; Bonner, H S; Shamsa, F; Porter, A T

1995-07-01

156

Primary hepatic non-Hodgkin’s lymphoma with rectal cancer: A case report  

PubMed Central

Primary hepatic non-Hodgkin’s lymphoma (NHL) is an extremely rare disease that is commonly neglected as a possible diagnosis. The present study reports the case of a middle-aged male with chronic hepatitis B in which primary hepatic NHL and rectal cancer occurred simultaneously. A large solitary tumor in the left lobe of the liver was incidentally detected on routine examination prior to the laparoscopic resection of the rectal cancer. Laparoscopic resection of the rectal cancer and a liver biopsy were performed simultaneously. The pathology revealed that the hepatic tumor was NHL and that the rectal cancer was adenocarcinoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, therefore, primary hepatic lymphoma (PHL) was diagnosed. PHL associated with rectal adenocarcinoma is extremely rare and to the best of our knowledge, has never been reported. At present, the cause and most effective therapy for the condition remain unclear.

WU, GUO-BIN; HUANG, CHAO-YUAN; HUANG, SHAN; RU, HAI-MING; XIANG, BANG-DE; YUAN, WEI-PING; WU, FEI-XIANG; LIU, JIAN-YONG; ZHANG, ZHI-MING; MA, LIANG; CHEN, ZU-SHUN; ZHAO, YIN-NONG; LI, LE-QUN

2015-01-01

157

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

PubMed Central

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 to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even if such determination was preceded by rectal examination. There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination. PMID:6189110

Osegbe, D. N.; Magoha, G.

1982-01-01

158

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. PMID:24978053

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

2014-01-01

159

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. PMID:24869613

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

2014-01-01

160

Current treatment of rectal cancer adapted to the individual patient  

PubMed Central

Preoperative radiochemotherapy and total mesorectal excision surgery is a recommended standard therapy for patients with locally advanced rectal cancer. However, some subgroups of patients benefit more than others from this approach. In order to avoid long-term complications of radiation and chemotherapy, efforts are being made to subdivide T3N0 stage using advanced imaging techniques, and to analyze prognostic factors that help to define subgroup risk patients. Long-course radiochemotherapy has the potential of downsizing the tumor before surgery and may increase the chance of sphincter preservation in some patients. Short-course radiotherapy (SCRT), on the other hand, is a practical schedule that better suits patients with intermediated risk tumors, located far from the anal margin. SCRT is also increasingly being used among patients with disseminated disease, before resection of the rectal tumor. Improvements in radiation technique, such as keeping the irradiation target below S2/S3 junction, and the use of IMRT, can reduce the toxicity associated with radiation, specially long-term small bowel toxicity. PMID:24416579

Cerezo, Laura; Ciria, Juan Pablo; Arbea, Leire; Linan, Olga; Cafiero, Sergio; Valentini, Vincenzo; Cellini, Francesco

2013-01-01

161

The Current State of Targeted Agents in Rectal Cancer  

PubMed Central

Targeted biologic agents have an established role in treating metastatic colorectal cancer (CRC), and the integration of targeted therapies into the treatment of CRC has resulted in significant improvements in outcomes. Rapidly growing insight into the molecular biology of CRC, as well as recent developments in gene sequencing and molecular diagnostics, has led to high expectations for the identification of molecular markers to be used in personalized treatment regimens. The mechanisms of action and toxicities of targeted therapies differ from those of traditional cytotoxic chemotherapy. Targeted therapy has raised new insight about the possibility of tailoring treatment to an individual's disease, the assessment of drug effectiveness and toxicity, and the economics of cancer care. This paper covers the last decade of clinical trials that have explored the toxicity and efficacy of targeted agents in locally advanced and metastatic CRC and how their role may benefit patients with rectal cancer. Future efforts should include prospective studies of these agents in biomarker-defined subpopulations, as well as studies of novel agents that target angiogenesis, tumor-stromal interaction, and the cell signaling pathways implicated in rectal cancer. PMID:22675625

Kim, Dae Dong; Eng, Cathy

2012-01-01

162

Practice parameters for the management of rectal cancer (revised).  

PubMed

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient. PMID:15875292

Tjandra, Joe J; Kilkenny, John W; Buie, W Donald; Hyman, Neil; Simmang, Clifford; Anthony, Thomas; Orsay, Charles; Church, James; Otchy, Daniel; Cohen, Jeffrey; Place, Ronald; Denstman, Frederick; Rakinic, Jan; Moore, Richard; Whiteford, Mark

2005-03-01

163

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. PMID:24655367

2014-01-01

164

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. PMID:24596626

Feng, Haiyang; Zhu, Yuping; Li, Dechuan

2014-01-01

165

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

PubMed

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

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

2007-07-01

166

Penetrating Bladder Trauma: A High Risk Factor for Associated Rectal Injury  

PubMed Central

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

167

Predictive Factors and Management of Rectal Bleeding Side Effects Following Prostate Cancer Brachytherapy  

SciTech Connect

Purpose: To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ?grade 2 proctitis. Methods and Materials: A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Results: Actuarial risk of ?grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ?2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Conclusions: Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following BT.

Price, Jeremy G. [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stone, Nelson N. [Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stock, Richard G., E-mail: Richard.Stock@mountsinai.org [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States)

2013-08-01

168

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. PMID:24555695

2014-01-01

169

Multimodal treatment strategies for locally advanced rectal cancer.  

PubMed

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

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

2012-04-01

170

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. PMID:24436647

Pucci, Michael J.; Beekley, Alec C.

2013-01-01

171

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

172

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.?? PMID:10325815

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

1999-01-01

173

Position Verification for the Prostate: Effect on Rectal Wall Dose  

SciTech Connect

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

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

2011-06-01

174

Adjuvant radiotherapy on older and oldest elderly rectal cancer patients.  

PubMed

The purpose of this study was to evaluate the impact of radiotherapy in terms of feasibility and activity in the patients aged > or = 75 with advanced rectal cancer. From January 2002 to December 2006, 41 consecutive patients (27 men and 14 women) aged > or = 75 received radiotherapy for local advanced rectal cancer, 9 in a pre-operative and 22 in a post-operative setting. Sixteen patients received concomitant chemotherapy. Variables considered were age, co-morbidities, evaluated according to the adult co-morbidity evaluation index (ACE-27), surgery versus no surgery, and timing of radiotherapy. The median age was 80.5 years (range 75-90). A total of 19.5% of the patients had no co-morbidity, 48.8% mild, 17.1% moderate, and 14.6% had severe co-morbidities. Thirty-nine subjects (95.1%) were submitted to surgery. All patients but one completed the planned radiation schedule. At a median follow-up of 23.1 months, the 2- and 4-year overall survival rates were 71.8% and 61.6%, respectively. There was a better survival for patients with no or mild co-morbidities (p=0.002) and a good performance status (p=0.003). The cancer-free survival at 2 and 4 years was 78.9% and 26.4%, respectively. No difference in acute and late toxicity rates was found between patients with different ACE-27 indexes. We conclude that compliance with radiotherapy is good and rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have a significantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirm these results. PMID:18573548

Fiorica, F; Cartei, F; Carau, B; Berretta, S; Spartŕ, D; Tirelli, U; Santangelo, A; Maugeri, D; Luca, S; Leotta, C; Sorace, R; Berretta, M

2009-01-01

175

75 FR 51080 - Determination That DIASTAT (Diazepam Rectal Gel), 5 Milligrams/Milliliter, 10 Milligrams/2...  

Federal Register 2010, 2011, 2012, 2013

...diazepam rectal gel) is an anticonvulsant agent indicated for use in the management of selected, refractory patients with epilepsy, on stable regimens of antiepileptic drugs, who require intermittent use of diazepam to control bouts of increased...

2010-08-18

176

Endoscopic Management of Rectal Dieulafoy's Lesion: A Case Series and Optimal Treatment  

PubMed Central

Rectal Dieulafoy's lesion (DL) is rare cause of lower gastrointestinal bleeding. Because of its rarity, there is no consensus on the optimal endoscopic hemostasis technique for rectal DL. We analyzed six patients who underwent endoscopic management for rectal DL after presenting with hematochezia at a single institute over 10 years. Of the six patients, three underwent endoscopic band ligation (EBL) and three underwent endoscopic hemoclip placement (EHP). Only one patient was treated with thermocoagulation. There were no immediate complications in any of the patients. None of the patients required a procedure or surgery for the treatment of rebleeding. Mean procedure times of EBL and EHP were 5.25 minutes and 7 minutes, respectively. Both EHP and EBL are shown to be effective in the treatment of bleeding rectal DL. We suggest that EBL may have potential as the preferred therapy owing to its superiority in technical and economic aspects, especially in elderly and high-risk patients. PMID:25133127

Park, Jung Gil; Park, Jung Chul; Kwon, Yong Hwan; Ahn, Sun Young

2014-01-01

177

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. PMID:23938088

2013-01-01

178

A multidisciplinary clinical treatment of locally advanced rectal cancer complicated with rectovesical fistula: a case report  

PubMed Central

Introduction Rectal cancer with rectovesical fistula is a rare and difficult to treat entity. Here, we describe a case of rectal cancer with rectovesical fistula successfully managed by multimodality treatment. To the best of our knowledge, this is the first such case report in the literature. Case presentation A 51-year-old Chinese man was diagnosed as having rectal cancer accompanied by rectovesical fistula. He underwent treatment with neoadjuvant radiochemotherapy combined with total pelvic excision and adjuvant chemotherapy, as recommended by a multimodality treatment team. Post-operative pathology confirmed the achievement of pathological complete response. Conclusions This case suggests that a proactive multidisciplinary treatment is needed to achieve complete cure of locally advanced rectal cancer even in the presence of rectovesical fistula. PMID:23107561

2012-01-01

179

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

180

Diets, polymorphisms of methylenetetrahydrofolate reductase, and the susceptibility of colon cancer and rectal cancer  

Microsoft Academic Search

The aim of this study was to investigate the association of environmental factors (dietary folate, methionine and drinking status) and polymorphisms in the methylenetetrahydrofolate reductase (MTHFR C677T and A1298C) gene, as well as the combination of these factors, with the risk of colon cancer and rectal cancer. A case-control study of 53 colon cancer patients, 73 rectal cancer patients and

Qinting Jiang; Kun Chen; Xinyuan Ma; Qilong Li; Weiping Yu; Guotong Shu; Kaiyan Yao

2005-01-01

181

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

Microsoft Academic Search

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

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

1983-01-01

182

Emergency department rectal temperatures in over 10 years: A retrospective observational study  

PubMed Central

BACKGROUND: Fever in patients can provide an important clue to the etiology of a patient's symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature. METHODS: A retrospective chart review was made of 27 130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature. RESULTS: The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ?2 °F, and 5.0% having higher rectal temperatures ?4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%, P<0.005), and were more likely to be admitted to the hospital for a higher level of care, such as an intensive care unit, when compared with the full cohort (12.5% vs. 5.8%, P<0.005). CONCLUSIONS: There are significant differences between rectal temperatures and non-invasive triage temperatures in this emergency department cohort. In almost one in five patients, fever was missed by triage temperature.

Walker, Graham A.; Runde, Daniel; Rolston, Daniel M.; Wiener, Dan; Lee, Jarone

2013-01-01

183

Female-specific rectal carcinogenesis in cyclin D1b transgenic mice.  

PubMed

Human cyclin D1 generates two major isoforms via alternative splicing: cyclin D1a and cyclin D1b. Cyclin D1b is hardly expressed in normal tissues but is frequently expressed in certain types of cancer tissues. To clarify the oncogenic potential of cyclin D1b variant, we developed cyclin D1b transgenic (Tg) mice and analyzed their phenotypes. We detected rectal tumors in 63% (15/24) of the female Tg mice. All rectal tumors had the histological characteristics similar to human sessile serrated adenoma/polyps (SSA/Ps). Adenocarcinomas were also found in 53% (8/15) of the rectal tumors, suggesting that these adenocarcinomas originated from the SSA/P-like lesions. No rectal tumors were found in the ovariectomized female cyclin D1b Tg mice (0/10), indicating that ovarian hormones played a critical role in rectal carcinogenesis in these Tg mice. Both phosphorylation of Erk, without activating MEK, and expression of estrogen receptor ? were elevated in the rectal tumors of female cyclin D1b Tg mice compared with normal rectums of female wild-type mice. In addition, we established a cell line, D1bTgRT, derived from a rectal cancer of female Tg mouse. Small interfering RNA-induced cyclin D1b knockdown in this cell line suppressed Erk phosphorylation, anchorage-independent growth, cell invasiveness and tumorigenicity in nude mice. In humans, expression of cyclin D1b messenger RNA was detected in 17% (1/6) of colorectal cancer cell lines and 9.7% (3/31) of colorectal cancer tissues. Taken together, these results indicate that cyclin D1b expression contributes to the female- specific rectal carcinogenesis in mouse model. PMID:23975835

Kim, Chul Jang; Tambe, Yukihiro; Mukaisho, Ken-Ichi; Sugihara, Hiroyuki; Isono, Takahiro; Sonoda, Hiromichi; Shimizu, Tomoharu; Kondoh, Gen; Inoue, Hirokazu

2014-01-01

184

Patterns of lymph node metastasis are different in colon and rectal carcinomas  

PubMed Central

AIM: To describe patterns of lymph node metastasis in invasive colon and rectal carcinomas. METHODS: Clinical data of 2340 patients with colorectal carcinoma (stage I to III) who received radical resection, was retrospectively reviewed. Of the 2340 patients, 1314 patients suffered from rectal carcinoma and 1026 from colon carcinoma. Patients with rectal cancer who received neoadjuvant chemoradiation therapy were excluded. Statistical analysis was performed using Mann-Whitney, ?2 and Cochran’s and Mantel-Haenszel tests (SPSS 15.0). A two-tailed P < 0.05 was considered statistically significant. RESULTS: Lymph node retrieval in the rectal carcinoma group was significantly lower than that in the colon carcinoma group (P < 0.001), while positive lymph node retrieval in the rectal carcinoma group was significantly higher than that in the colon carcinoma group (P < 0.001). The proportion of lymph node positive (N+) cases was higher (patients with one or more positive lymph nodes) in the rectal carcinoma group (P = 0.004). The number of N+ cases was compared at different T stages (T1-T4) to eliminate background bias and the results were confirmed (P < 0.001). In addition, the lymph node ratio (the ratio of number of positive lymph nodes over the number of lymph nodes examined) of stage III cases in the rectal carcinoma group was significantly higher than that in the colon carcinoma group (P < 0.001). CONCLUSION: Rectal carcinomas seem more prone to metastasize to the lymph nodes than colon carcinomas, which may be of potential clinical significance. PMID:21072903

Wang, Hao; Wei, Xian-Zhao; Fu, Chuan-Gang; Zhao, Rong-Hua; Cao, Fu-Ao

2010-01-01

185

Practice patterns in rectal cancer patient follow-up are unaffected by surgeon age  

Microsoft Academic Search

Background. Surveillance strategies for of rectal cancer patients after potentially curative treatment vary significantly. We investigated\\u000a whether the age of the surgeon affects choice of surveillance strategy. Methods. We developed vignetres depicting 4 generally healthy patients with rectal cancer of various stages who received various\\u000a treatments. A questionnaire based on these vignettes was sent to the 1795 members of the

Uday Patel; Kenichi Ode; Riccardo A. Audisio; Katherine S. Virgo; Frank E. Johnson

2008-01-01

186

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

187

Pre-referral rectal artesunate in severe malaria: flawed trial  

PubMed Central

Background Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, have led the WHO to endorse rectal artesunate as a pre-referral treatment for severe malaria. In the light of its public health importance and because its scientific quality has not been assessed for a systematic review, our paper provides a detailed evaluation of the design, conduct, analysis, reporting, and practical features of this trial. Results We performed a checklist-based and an in-depth evaluation of the trial. The evaluation criteria were based on the CONSORT statement for reporting clinical trials, the clinical trial methodology literature, and practice in malaria research. Our main findings are: The inclusion and exclusion criteria and the sample size justification are not stated. Many clearly ineligible subjects were enrolled. The training of the recruiters does not appear to have been satisfactory. There was excessive between center heterogeneity in design and conduct. Outcome evaluation schedule was not defined, and in practice, became too wide. Large gaps in the collection of key data were evident. Primary endpoints were inconsistently utilized and reported; an overall analysis of the outcomes was not done; analyses of time to event data had major flaws; the stated intent-to-treat analysis excluded a third of the randomized subjects; the design-indicated stratified or multi-variate analysis was not done; many improper subgroups were analyzed in a post-hoc fashion; the analysis and reporting metric was deficient. There are concerns relating to patient welfare at some centers. Exclusion of many cases from data analysis compromised external validity. A bias-controlled reanalysis of available data does not lend support to the conclusions drawn by the authors. Conclusions This trial has numerous serious deficiencies in design, implementation, and methods of data analysis. Interpretation and manner of reporting are wanting, and the applicability of the findings is unclear. The trial conduct could have been improved to better protect patient welfare. The totality of these problems make it a flawed study whose conclusions remain subject to appreciable doubt. PMID:21824389

2011-01-01

188

Factors associated with the survival of prostate cancer patients with rectal involvement  

PubMed Central

Background Prostate cancer patients with rectal involvement are rare, and the factors associated with the survival of these patients are yet to be elucidated. Patients and methods We collected data on patients who were admitted to our hospital for prostate cancer in the last thirteen years and of those in studies in the literature. The associations of clinical characteristics with survival were evaluated using Cox regression models. Results This study included 94 patients (5 admitted to our hospital and 89 from studies in the literature) of prostate cancer with rectal involvement. 11 patients in the group of synchronous rectal involvement at first cancer diagnosis (n = 58) and 23 patients in the group of metachronous diagnosis of rectal involvement (n = 29) died at the latest follow up. The estimated overall survival rate (% ± SE) at 1, 3, and 5 years were 68.3 ± 5.3%, 54.4 ± 7.2%, and 38.1 ± 11.1%, respectively. In the Cox univariate analysis, Asian prostate cancer (p = 0.001) was associated with better survival, while rectal bleeding (p = 0.043), metachronous presentation of development of rectal involvement (p = 0.000), prior hormonal therapy (p = 0.000) and extrarectal metastases (p = 0.054) were associated with poor survival. In multivariate analysis, prior hormone therapy (HR = 14.540, p = 0.000) and rectal bleeding (HR = 2.195, p = 0.041) retained independent poor prognostic values. There were 13 patients survived for more than 3 years, the longest survival time was 96 months. Total pelvic extenteration (TPE) combined with hormonal therapy in 12 hormone-untreated prostate cancer give us six of thirteen long-term survivors for more than 3 years in this series. Conclusions Our findings suggest that rectal involvement does not necessarily predict a worse outcome when presenting as a previously hormone-untreated disease and that the prognosis was worse when presenting as a hormone relapsed disease. Prior hormone therapy and rectal bleeding were associated independently with a significantly poor overall survival in prostate cancer patients with rectal involvement. TPE combined with hormonal therapy appears to confer better overall survival in hormonally untreated patients. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1604504118106105. PMID:24555830

2014-01-01

189

Correlation of CD133, OCT4, and SOX2 in Rectal Cancer and Their Association with Distant Recurrence After Chemoradiotherapy  

Microsoft Academic Search

Background  Cancer stem cells are associated with metastatic potential, treatment resistance, and poor patient prognosis. Distant recurrence\\u000a remains the major cause of mortality in rectal cancer patients with preoperative chemoradiotherapy (CRT). We investigated\\u000a the role of three stem cell markers (CD133, OCT4, and SOX2) in rectal cancer and evaluated the association between these gene levels and clinical outcome in rectal cancer

Susumu Saigusa; Koji Tanaka; Yuji Toiyama; Takeshi Yokoe; Yoshinaga Okugawa; Yasuhiro Ioue; Chikao Miki; Masato Kusunoki

2009-01-01

190

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

191

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

PubMed Central

Rectal sexually transmitted infections (STI) are a common health concern for men who have sex with men (MSM) but little is known about these infections among men who had sex with both men and women (MSMW). Self-obtained rectal specimens were collected from a diverse sample of behaviorally bisexual men. From a total sample of 75 bisexual men, 58 collected specimens. A relatively high prevalence of rectal C. trachomatis infection was found. Participants who collected specimens reported overall acceptability and comfort with self-sampling. Future efforts are needed focusing on increasing awareness of and options for rectal STI testing among bisexual men. PMID:22498165

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

2012-01-01

192

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

PubMed

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

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

2013-01-01

193

Sacrococcygeal chordoma presenting as a retro rectal tumour  

PubMed Central

INTRODUCTION Chordomas are rare, slow growing, locally destructive bone tumours arising from the notochord. PRESENTATION OF CASE Presenting a case of a 65 year old man, who presented with complaints of swelling on the right lower back for 1 year associated with pain. On, physical examination, a swelling measuring 5 cm × 4 cm was noted in the lower back with posterior wall indentation on per rectal examination. MRI revealed a mass lesion involving the sacrum (s3–s4) and coccyx. FNAC showed features of a chroma. At surgery, we excised a mass from the retrorectal space and biopsy proved it to be a chondroid chordoma, a variant of chordoma. DISCUSSION Chordomas are solid malignant tumours that arise from vestiges of the foetal notochord. Common locations are the clivus and the sacrococcygeus region. Annual incidence of these tumours is 1 in one million. MRI is the imaging modality of choice. Prognosis improves based on the age, resected margins and postoperative treatment. CONCLUSION Here, we shall discuss the literature, variants, treatment and prognosis of this rare tumour. PMID:25201478

Chigurupati, Pragnya; Venkatesan, Vishnukumar; Thiyagarajan, Manuneethimaran; Vikram, A.; Kiran, Kaundinya

2014-01-01

194

Proteogenomic characterization of human colon and rectal cancer.  

PubMed

Extensive genomic characterization of human cancers presents the problem of inference from genomic abnormalities to cancer phenotypes. To address this problem, we analysed proteomes of colon and rectal tumours characterized previously by The Cancer Genome Atlas (TCGA) and perform integrated proteogenomic analyses. Somatic variants displayed reduced protein abundance compared to germline variants. Messenger RNA transcript abundance did not reliably predict protein abundance differences between tumours. Proteomics identified five proteomic subtypes in the TCGA cohort, two of which overlapped with the TCGA 'microsatellite instability/CpG island methylation phenotype' transcriptomic subtype, but had distinct mutation, methylation and protein expression patterns associated with different clinical outcomes. Although copy number alterations showed strong cis- and trans-effects on mRNA abundance, relatively few of these extend to the protein level. Thus, proteomics data enabled prioritization of candidate driver genes. The chromosome 20q amplicon was associated with the largest global changes at both mRNA and protein levels; proteomics data highlighted potential 20q candidates, including HNF4A (hepatocyte nuclear factor 4, alpha), TOMM34 (translocase of outer mitochondrial membrane 34) and SRC (SRC proto-oncogene, non-receptor tyrosine kinase). Integrated proteogenomic analysis provides functional context to interpret genomic abnormalities and affords a new paradigm for understanding cancer biology. PMID:25043054

Zhang, Bing; Wang, Jing; Wang, Xiaojing; Zhu, Jing; Liu, Qi; Shi, Zhiao; Chambers, Matthew C; Zimmerman, Lisa J; Shaddox, Kent F; Kim, Sangtae; Davies, Sherri R; Wang, Sean; Wang, Pei; Kinsinger, Christopher R; Rivers, Robert C; Rodriguez, Henry; Townsend, R Reid; Ellis, Matthew J C; Carr, Steven A; Tabb, David L; Coffey, Robert J; Slebos, Robbert J C; Liebler, Daniel C

2014-09-18

195

Formulation and Evaluation of Tramadol hydrochloride Rectal Suppositories  

PubMed Central

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

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

2008-01-01

196

Pelvic MRI for guiding treatment decisions in rectal cancer.  

PubMed

Fluoropyrimidine-based chemoradiation (CRT) is used routinely for locally advanced rectal cancer to shrink the tumor preoperatively, improve lateral surgical clearance at total mesorectal excision, prevent local recurrence, and preserve organ function. In Northern Europe, short-course preoperative radiotherapy (SCPRT) is preferred to achieve locoregional control. However, with recent improvements in the quality of surgery, in magnetic resonance imaging (MRI), and in pathologic reporting, we question whether "routine" CRT or SCPRT should be offered indiscriminately for all patients.MRI is considered the optimal modality for locoregional staging and evaluation of the potential for an involved circumferential resection margin. MRI also provides detailed anatomic information for surgical planning, and may identify poor prognostic features, which influence the way in which the pathologist processes specimens. MRI can predict the likelihood of good/poor tumor response to neoadjuvant CRT and can categorize responders/nonresponders following treatment.Using MRI to define the risk of both local recurrence and metastatic spread allows clinicians to determine which patients might benefit from or safely avoid neoadjuvant treatment. We have arrived at these views after comparing data from published observational studies, results from randomized trials, and outcome analyses of the Norwegian National Cancer Registry. PMID:25140623

Glynne-Jones, Robert; Tan, David; Goh, Vicky

2014-08-01

197

Adjuvant androgen deprivation impacts late rectal toxicity after conformal radiotherapy of prostate carcinoma  

PubMed Central

To evaluate whether androgen deprivation impacts late rectal toxicity in patients with localised prostate carcinoma treated with three-dimensional conformal radiotherapy. One hundred and eighty-two consecutive patients treated with 3DCRT between 1995 and 1999 at our Institution and with at least 12 months follow-up were analysed. three-dimensional conformal radiotherapy consisted in 70–76?Gy delivered with a conformal 3-field arrangement to the prostate±seminal vesicles. As part of treatment, 117 patients (64%) received neo-adjuvant and concomitant androgen deprivation while 88 (48.4%) patients were continued on androgen deprivation at the end of three-dimensional conformal radiotherapy as well. Late rectal toxicity was graded according to the RTOG morbidity scoring scale. Median follow up is 25.8 (range: 12–70.2 months). The 2-year actuarial likelihood of grade 2–4 rectal toxicity was 21.8±3.2%. A multivariate analysis identified the use of adjuvant androgen deprivation (P=0.0196) along with the dose to the posterior wall of the rectum on the central axis (P=0.0055) and the grade of acute rectal toxicity (P=0.0172) as independent predictors of grade 2–4 late rectal toxicity. The 2-year estimates of grade 2–4 late rectal toxicity for patients receiving or not adjuvant hormonal treatment were 30.3±5.2% and 14.1±3.8%, respectively. Rectal tolerance is reduced in presence of adjuvant androgen deprivation. British Journal of Cancer (2002) 86, 1843–1847. doi:10.1038/sj.bjc.6600266 www.bjcancer.com © 2002 Cancer Research UK PMID:12085173

Sanguineti, G; Agostinelli, S; Foppiano, F; Franzone, P; Garelli, S; Marcenaro, M; Orsatti, M; Vitale, V

2002-01-01

198

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

SciTech Connect

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

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

2007-11-15

199

Livin expression is an independent factor in rectal cancer patients with or without preoperative radiotherapy  

PubMed Central

Background This study was aimed to investigate the expression significance of Livin in relation to radiotherapy (RT), clinicopathological and biological factors of rectal cancer patients. Methods This study included 144 primary rectal cancer patients who participated in a Swedish clinical trial of preoperative radiotherapy. Tissue microarray samples from the excised primary rectal cancers, normal mucosa and lymph node metastases were immunostained with Livin antibody. The proliferation of colon cancer cell lines SW620 and RKO was assayed after Livin knock-down. Results The expression of Livin was significantly increased from adjacent (P?=?0.051) or distant (P?=?0.028) normal mucosa to primary tumors. 15.4% (2/13) and 39.7% (52/131) patients with Livin-negative and positive tumors died at 180 months after surgery, and the difference tended to be statistically significant (P?=?0.091). In multivariate analyses, the difference achieved statistical significance, independent of TNM stage, local and distant recurrence, grade of differentiation, gender, and age (odds ratio?=?5.09, 95% CI: 1.01-25.64, P?=?0.048). The in vitro study indicated colon cancer cells with Livin knock-down exhibited decreased proliferation compared with controls after RT. Conclusions The expression of Livin was was independently related to survival in rectal cancer patients, suggesting Livin as a useful prognostic factor for rectal cancer patients. PMID:24295240

2013-01-01

200

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

201

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

202

Anterior-only Partial Sacrectomy for en bloc Resection of Locally Advanced Rectal Cancer.  

PubMed

Study Design?Case report. Objective?The usual procedure for partial sacrectomies in locally advanced rectal cancer combines a transabdominal and a posterior sacral route. The posterior approach is flawed with a high rate of complications, especially infections and wound-healing problems. Anterior-only approaches have indirectly been mentioned within long series of rectal cancer surgery. We describe a case of partial sacrectomy for en bloc resection of a locally advanced rectal cancer with invasion of the low sacrum through a combined transabdominal and perineal approach without any posterior incision. Methods?Through a midline laparotomy, the tumor was dissected and the sacral osteotomy was performed. Once the sacrum was mobile, the muscular attachments to its posterior wall were cut through the perineal approach. This latter route was also used to remove the whole specimen. Results?The postoperative period was uneventful in terms of infection and wound healing, but the patient developed right foot dorsiflexion paresis that completely disappeared in 1 month. Resection margins were negative. After a follow-up of 18 months, the patient has no local recurrence but presented lung and liver metastases. Conclusion?In cases of rectal cancer involving the low sacrum, the combination of a transabdominal and a perineal route to carry out the partial sacrectomy is a feasible approach that avoids changes of surgical positioning and the morbidity related to posterior incisions. This strategy should be considered when deciding on undertaking partial sacrectomy in locally advanced rectal cancer. PMID:25396109

Roldan, Hector; Perez-Orribo, Luis F; Plata-Bello, Julio M; Martin-Malagon, Antonio I; Garcia-Marin, Victor M

2014-12-01

203

Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer  

PubMed Central

INTRODUCTION An infiltration of urological organs is found in 5–10% of patients with colorectal carcinoma. Total pelvic exenteration is the standard procedure for locally advanced rectal cancer. In selected patients with rectal cancer involving the prostate or seminal vesicles, the bladder can be preserved and en bloc radical prostatectomy with abdominoperineal rectal resection can be performed. We report two patients who treated with this combined approach. PRESENTATION OF CASE Two patients with symptoms of rectal bleeding and pelvic pain were investigated. Colonoscopy demonstrated a tumor in the lower rectum. Biopsies revealed adenocarcinoma. Both pelvic MRI and endorectal ultrasound showed tumors that invaded the prostate and the seminal vesicles directly but without invasion of the bladder. After neoadjuvant chemoradiation, combined radical prostatectomy and abdominoperineal amputation was performed. None has developed local recurrence, but one of them was operated on for a single lung metastasis. After a follow-up of 28 and 20 months, respectively, the patients are alive without evidence of local recurrence or distant disease. DISCUSSION This procedure obviates the need for urinary diversion without compromising the local tumor control. Intraoperative and postoperative diagnostic difficulties, and clinical aspects in relation to postoperative anastomotic leak and survival of patients are discussed. CONCLUSION En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient's quality of life in comparison to total pelvic exenteration. PMID:25105771

Fernandez-Martinez, Daniel; Rodriguez-Infante, Antonio; Castelo-Alvarez, Elsa; Fernandez-Vega, Ivan; Suarez-Hevia, Miguel; Truan-Alonso, Nuria; Baldonedo-Cernuda, Ricardo F.; Alvarez-Perez, Jose A.; Sanchez-Farpon, Herminio

2014-01-01

204

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. PMID:24940506

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

2014-01-01

205

Trans-rectal interventional MRI: initial prostate biopsy experience  

NASA Astrophysics Data System (ADS)

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate gland when evaluated along with T2-weighted images, diffusion-weighted images (DWI) and their corresponding apparent diffusion coefficient (ADC) maps can yield valuable information in patients with rising or elevated serum prostate-specific antigen (PSA) levels1. In some cases, patients present with multiple negative trans-rectal ultrasound (TRUS) biopsies, often placing the patient into a cycle of active surveillance. Recently, more patients are undergoing TRIM for targeted biopsy of suspicious findings with a cancer yield of ~59% compared to 15% for second TRUS biopsy2 to solve this diagnostic dilemma and plan treatment. Patients were imaged in two separate sessions on a 1.5T magnet using a cardiac phased array parallel imaging coil. Automated CAD software was used to identify areas of wash-out. If a suspicious finding was identified on all sequences it was followed by a second imaging session. Under MRI-guidance, cores were acquired from each target region3. In one case the microscopic diagnosis was prostatic intraepithelial neoplasia (PIN), in the other it was invasive adenocarcinoma. Patient 1 had two negative TRUS biopsies and a PSA level of 9ng/mL. Patient 2 had a PSA of 7.2ng/mL. He underwent TRUS biopsy which was negative for malignancy. He was able to go on to treatment for his prostate carcinoma (PCa)4. MRI may have an important role in a subset of patients with multiple negative TRUS biopsies and elevated or rising PSA.

Greenwood, Bernadette M.; Behluli, Meliha R.; Feller, John F.; May, Stuart T.; Princenthal, Robert; Winkel, Alex; Kaminsky, David B.

2010-02-01

206

The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids  

Microsoft Academic Search

BackgroundThe hemorrhoidal artery ligation has been used for submucosal ligation of hemorrhoidal arteries by means of an ultrasonographic transducer since 1995. The success of this technique depends on the submucosal course of these arteries. Our investigation deals with branches of the superior rectal artery which pierce the rectal wall where they cannot be reached by this method.

Felix Aigner; Gerd Bodner; Friedrich Conrad; Godwin Mbaka; Alfons Kreczy; Helga Fritsch

2004-01-01

207

The elasmobranch rectal gland secretes a plasma-hypertonic solution that is generally considered to play a major role in  

E-print Network

The elasmobranch rectal gland secretes a plasma-hypertonic solution that is generally considered- concentration totals nearly 1000mmoll-1, approximately double that in the plasma (Burger and Hess, 1960; Burger-B type (Gunning et al., 1993), and the shark homologue has been cloned from the rectal gland (Aller et al

Evans, David H.

208

Nitrates in Drinking Water and the Risk of Death from Rectal Cancer: Does Hardness in Drinking Water Matter?  

Microsoft Academic Search

The objectives of this study were to (1) examine the relationship between nitrate levels in public water supplies and increased risk of death from rectal cancer and (2) determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of nitrate on development of rectal cancer. A matched case-control study was used to investigate the relationship

Chih-Ching Chang; Chih-Cheng Chen; Deng-Chuang Wu; Chun-Yuh Yang

2010-01-01

209

Trihalomethanes in Drinking Water and the Risk of Death From Rectal Cancer: Does Hardness in Drinking Water Matter?  

Microsoft Academic Search

The objectives of this study were (1) to examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of rectal cancer development and (2) to determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of TTHM on risk of developing rectal cancer. A matched cancer case-control study was used to

Hsin-Wei Kuo; Pei-Shih Chen; Shu-Chen Ho; Li-Yu Wang; Chun-Yuh Yang

2010-01-01

210

Rectal cancer with disseminated carcinomatosis of the bone marrow: report of a case.  

PubMed

Abstract We report a rare case of disseminated carcinomatosis of the bone marrow from rectal cancer with disseminated intravascular coagulation (DIC). A 65-year-old man was admitted with melena and low back pain at rest. X-ray examination showed rectal cancer with multiple bone metastases. Laboratory examination showed severe anemia and DIC. Histologic examination showed disseminated carcinomatosis of the bone marrow. The DIC was considered to be caused by disseminated carcinomatosis of the bone marrow from rectal cancer, and we immediately started treatment with anti-DIC therapy and anticancer chemotherapy with the modified FOLFOX6 regimen (mFOLFOX6). After some response to therapy, the patient's general condition deteriorated, and he died 128 days after admission. This is the first English report showing disseminated carcinomatosis of the bone marrow from colorectal cancer treated with mFOLFOX6. PMID:25216414

Nakashima, Yuichiro; Takeishi, Kazuki; Guntani, Atsushi; Tsujita, Eiji; Yoshinaga, Keiji; Matsuyama, Ayumi; Hamatake, Motoharu; Maeda, Takashi; Tsutsui, Shinichi; Matsuda, Hiroyuki; Fujihara, Megumu; Ishida, Teruyoshi

2014-01-01

211

[Induction chemotherapy with S-1/oxaliplatin prevented colostomy in a patient with advanced rectal cancer].  

PubMed

A 72-year-old woman was admitted to our hospital with bloody stools and constipation. She was diagnosed with advanced lower rectal cancer with multiple liver and pulmonary metastases. Because the rectal cancer was located 2 cm from the anal verge, we suggested she undergo an abdominoperineal resection(Miles operation), but she refused to undergo a colostomy. Then, 6 courses of chemotherapy with S-1/oxaliplatin(SOX)were administered, and the local tumor, liver metastases, and pulmonary metastases were all significantly decreased in size(reduction rate 60%). After chemotherapy, she chose to undergo low anterior resection(LAR), D2. Postoperative recovery was uneventful, and she currently has stable disease with adjuvant SOX chemotherapy. Induction SOX chemotherapy was considered to be useful for maintaining the quality of life(QOL) in a patient with advanced rectal cancer. PMID:24743292

Shimao, Kazuya; Yano, Masao; Sasaki, Kenji; Goto, Tetsuhiro

2014-03-01

212

New technique of transanal proctectomy with completely robotic total mesorrectal excision for rectal cancer.  

PubMed

Anterior resection with total mesorectal excision is the standard method of rectal cancer resection. However, this procedure remains technically difficult in mid and low rectal cancer. A robotic transanal proctectomy with total mesorectal excision and laparoscopic assistance is reported in a 57 year old male with BMI 32 kg/m2 and rectal adenocarcinoma T2N1M0 at 5 cm from the dentate line. Operating time was 420 min. Postoperative hospital stay was 6 days and no complications were observed. Pathological report showed a 33 cm specimen with ypT2N0 adenocarcinoma at 2 cm from the distal margin, complete TME and non affected circumferential resection margin. Robotic technology might reduce some technical difficulties associated with TEM/TEO or SILS platforms in transanal total mesorectal excision. Further clinical trials will be necessary to assess this technique. PMID:24589418

Gómez Ruiz, Marcos; Palazuelos, Carlos Manuel; Martín Parra, José Ignacio; Alonso Martín, Joaquín; Cagigas Fernández, Carmen; del Castillo Diego, Julio; Gómez Fleitas, Manuel

2014-05-01

213

Multidisciplinary approach to synchronous prostate and rectal cancer: current experience and future challenges.  

PubMed

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. PMID:24734141

Seretis, Charalampos; Seretis, Fotios; Liakos, Nikolaos

2014-06-01

214

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. PMID:24734141

Seretis, Charalampos; Seretis, Fotios; Liakos, Nikolaos

2014-01-01

215

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. PMID:20703471

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

2010-01-01

216

Challenge or opportunity: outcomes of laparoscopic resection for rectal cancer in patients with high operative risk.  

PubMed

Abstract This study investigated the impact of laparoscopic rectal cancer resection for patients with high operative risk, which was defined as American Society of Anesthesiology (ASA) grades III and IV. This study was conducted at a single center on patients undergoing rectal resection from 2006 to 2010. After screening by ASA grade III or IV, 248 patients who met the inclusion criteria were identified, involving 104 open and 144 laparoscopic rectal resections. The distribution of the Charlson Comorbidity Index was similar between the two groups. Compared with open rectal resection, laparoscopic resection had a significantly lower total complication rate (P<.0001), lower pain rate (P=.0002), and lower blood loss (P<.0001). It is notable that the two groups of patients had no significant difference in cardiac and pulmonary complication rates. Thus, these data showed that the laparoscopic group for rectal cancer could provide short-term outcomes similar to those of their open resection counterparts with high operative risk. The 5-year actuarial survival rates were 0.8361 and 0.8119 in the laparoscopic and open groups for stage I/II (difference not significant), as was the 5-year overall survival rate in stage III/IV (P=.0548). In patients with preoperative cardiovascular or pulmonary disease, the 5-year survival curves were significantly different (P=.0165 and P=.0210), respectively. The cost per patient did not differ between the two procedures. The results of this analysis demonstrate the potential advantages of laparoscopic rectal cancer resection for high-risk patients, although a randomized controlled trial should be conducted to confirm the findings of the present study. PMID:25376002

Lu, Ai-Guo; Zhao, Xue-Wei; Mao, Zhi-Hai; Han, Ding-Pei; Zhao, Jing-Kun; Wang, Puxiongzhi; Zhang, Zhuo; Zong, Ya-Ping; Thasler, Wolfgang; Feng, Hao

2014-11-01

217

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

218

Slug expression enhances tumor formation in a non-invasive rectal cancer model  

PubMed Central

Background Epithelial-to-mesenchymal transition (EMT) is a series of molecular changes allowing epithelial cancer cells to acquire properties of mesenchymal cells: increased motility and invasion and protection from apoptosis. Transcriptional regulators such as Slug mediate EMT, working in part to repress E-cadherin transcription. We report a novel, non-invasive in vivo rectal cancer model to explore the role of Slug in colorectal cancer (CRC) tumor development. Methods For the generation of DLD-1 cells overexpressing Slug (Slug DLD-1), a Slug or empty (Empty DLD-1) pCMV-3Tag-1 (kanamycin resistant) vector was used for transfection. Cells were evaluated for Slug and E-cadherin expression, and cell migration and invasion. For the in vivo study, colon cancer cells (parental DLD-1, Slug DLD-1, empty DLD-1, and HCT-116) were submucosally injected into the posterior rectum of nude mice using endoscopic guidance. After 28 days, tumors were harvested and tissue was analyzed. Results Slug expression in our panel of colon cancer cell lines was inversely correlated with E-cadherin expression and enhanced migration/invasion. Slug DLD-1 cells demonstrated a 21-fold increased Slug and 19-fold decreased E-cadherin expression compared with empty DLD-1. Similarly, the Slug DLD-1 cells had significantly enhanced cellular migration and invasion. In the orthotopic rectal cancer model, Slug DLD-1 cells formed rectal tumors in 9/10 (90%) of the mice (mean volume = 458 mm3) compared with only 1/10 (10%) with empty DLD-1 cells. Conclusion Slug mediates EMT with enhanced in vivo rectal tumor formation. Our non-invasive in vivo model enables researchers to explore the molecular consequences of altered genes in a clinically relevant rectal cancer in an effort to develop novel therapeutic approaches for patients with rectal cancer. PMID:21470622

Camp, E. Ramsay; Findlay, Victoria J.; Vaena, Silvia G.; Walsh, Jarret; Lewin, David N.; Turner, David P.; Watson, Dennis K

2011-01-01

219

DNA methylation of apoptosis genes in rectal cancer predicts patient survival and tumor recurrence.  

PubMed

Deregulation of the apoptotic pathway, one of the hallmarks of tumor growth and -progression, has been shown to have prognostic value for tumor recurrence in rectal cancer. In order to develop clinically relevant biomarkers, we studied the methylation status of promoter regions of key apoptosis genes in rectal cancer patients, using methylation-sensitive restriction enzymes. DNA was extracted from fresh-frozen tumor tissues of 49 stage I-III rectal cancer patients and 10 normal rectal tissues. The results of this pilot study were validated in 88 stage III tumor tissues and 18 normal rectal tissues. We found that methylation of the intrinsic apoptotic pathway genes Apaf1, Bcl2 and p53 correlated with the apoptotic status (M30) of the tumor. Combined survival analyses of these three genes, based on the number of genes showing high methylation (all low, 1 high, 2 high or all high), showed shorter patient survival and recurrence-free periods with an increasing number of methylated markers. Multivariate analyses showed significant differences for overall survival (p = 0.01; HR = 0.28 (0.09-0.83)), cancer-specific survival (p = 0.004; HR = 0.13 (0.03-0.67)) and distant recurrence-free survival (p = 0.001; HR = 0.22(0.05-0.94)). The shortest survival was observed for patients showing low methylation of all markers, which-as was expected-correlated with high apoptosis (M30), but also with high proliferation (Ki-67). The study of epigenetic regulation of apoptosis genes provides more insight in the tumorigenic process in rectal cancer and might be helpful in further refining treatment regimens for individual patients. PMID:25064172

Benard, Anne; Zeestraten, Eliane C M; Goossens-Beumer, Inčs J; Putter, Hein; van de Velde, Cornelis J H; Hoon, Dave S B; Kuppen, Peter J K

2014-11-01

220

Intersphincteric Resection and Coloanal Anastomosis in Treatment of Distal Rectal Cancer  

PubMed Central

In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection. PMID:22690335

Cipe, Gokhan; Muslumanoglu, Mahmut; Yardimci, Erkan; Memmi, Naim; Aysan, Erhan

2012-01-01

221

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

NASA Astrophysics Data System (ADS)

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. Presented in part at the European Society for Therapeutic Radiotherapy and Oncology Annual Meeting, April 5-8, 2014, Vienna, Austria.

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

2014-07-01

222

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

223

Acute diarrhea and metabolic acidosis caused by tuberculous vesico-rectal fistula.  

PubMed

Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors, surgical injury, inflammatory disorders such as tuberculosis infection, radiotherapy and less commonly diverticulum of the urinary tract. The fistula is often identified by urinary tract abnormalities such as dysuria, recurrent urinary tract infection, pneumaturia, and fecaluria. Here, we report an unusual case of a patient with a vesico-rectal fistula of tuberculous origin, presenting with severe acute diarrhea, metabolic acidosis, hyperchloremia and hypokalemia while with only mild urinary tract symptoms. The patient was cured by tuberculostatic therapy. PMID:25386096

Wei, Xiu-Qing; Zou, Yan; Wu, Zhi-E; Abassa, Kodjo-Kunale; Mao, Wei; Tao, Jin; Kang, Zhuang; Wen, Zhuo-Fu; Wu, Bin

2014-11-01

224

Acute diarrhea and metabolic acidosis caused by tuberculous vesico-rectal fistula  

PubMed Central

Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors, surgical injury, inflammatory disorders such as tuberculosis infection, radiotherapy and less commonly diverticulum of the urinary tract. The fistula is often identified by urinary tract abnormalities such as dysuria, recurrent urinary tract infection, pneumaturia, and fecaluria. Here, we report an unusual case of a patient with a vesico-rectal fistula of tuberculous origin, presenting with severe acute diarrhea, metabolic acidosis, hyperchloremia and hypokalemia while with only mild urinary tract symptoms. The patient was cured by tuberculostatic therapy. PMID:25386096

Wei, Xiu-Qing; Zou, Yan; Wu, Zhi-E; Abassa, Kodjo-Kunale; Mao, Wei; Tao, Jin; Kang, Zhuang; Wen, Zhuo-Fu; Wu, Bin

2014-01-01

225

Laparoscopic nonresectional suture rectopexy in the management of full-thickness rectal prolapse: substantive retrospective series  

Microsoft Academic Search

Background  Numerous surgical options exist for the correction of rectal prolapse, with the optimal choice remaining controversial. The\\u000a laparoscopic approach has proved to be popular and effective. Concern exists about nonresectional rectopexy in the form of\\u000a intractable postoperative constipation. The authors present their experience with nonresectional laparoscopic suture rectopexy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All patients presenting with a full-thickness rectal prolapse between August 1994 and

Jonathan Wilson; Alec Engledow; James Crosbie; Tan Arulampalam; Roger Motson

2011-01-01

226

Laparoscopic Total Mesorectal Excision in a Rectal Cancer Patient with Situs Inversus Totalis  

PubMed Central

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe. PMID:20436720

Huh, Jung Wook; Cho, Sang Hyuk; Kim, Choong Young; Kim, Hoon Jin; Joo, Jae Kyoon; Kim, Young Jin

2010-01-01

227

Robotic surgery for rectal cancer: Current immediate clinical and oncological outcomes  

PubMed Central

Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and stable view, articulated instruments, and reduction of physiologic tremors leading to superior dexterity and ergonomics. Therefore, robotic platforms could potentially address limitations of laparoscopic rectal surgery. It was aimed at reviewing current literature on short-term clinical and oncological (pathological) outcomes after robotic rectal cancer surgery in comparison with laparoscopic surgery. A systematic review was performed for the period 2002 to 2014. A total of 1776 patients with rectal cancer underwent minimally invasive robotic treatment in 32 studies. After robotic and laparoscopic approach to oncologic rectal surgery, respectively, mean operating time varied from 192-385 min, and from 158-297 min; mean estimated blood loss was between 33 and 283 mL, and between 127 and 300 mL; mean length of stay varied from 4-10 d; and from 6-15 d. Conversion after robotic rectal surgery varied from 0% to 9.4%, and from 0 to 22% after laparoscopy. There was no difference between robotic (0%-41.3%) and laparoscopic (5.5%-29.3%) surgery regarding morbidity and anastomotic complications (respectively, 0%-13.5%, and 0%-11.1%). Regarding immediate oncologic outcomes, respectively among robotic and laparoscopic cases, positive circumferential margins varied from 0% to 7.5%, and from 0% to 8.8%; the mean number of retrieved lymph nodes was between 10 and 20, and between 11 and 21; and the mean distal resection margin was from 0.8 to 4.7 cm, and from 1.9 to 4.5 cm. Robotic rectal cancer surgery is being undertaken by experienced surgeons. However, the quality of the assembled evidence does not support definite conclusions about most studies variables. Robotic rectal cancer surgery is associated to increased costs and operating time. It also seems to be associated to reduced conversion rates. Other short-term outcomes are comparable to conventional laparoscopy techniques, if not better. Ultimately, pathological data evaluation suggests that oncologic safety may be preserved after robotic total mesorectal excision. However, further studies are required to evaluate oncologic safety and functional results. PMID:25339823

Araujo, Sergio Eduardo Alonso; Seid, Victor Edmond; Klajner, Sidney

2014-01-01

228

Estimation of Rectal Dose Using Daily Megavoltage Cone-Beam Computed Tomography and Deformable Image Registration  

SciTech Connect

Purpose: The actual dose delivered to critical organs will differ from the simulated dose because of interfractional organ motion and deformation. Here, we developed a method to estimate the rectal dose in prostate intensity modulated radiation therapy with consideration to interfractional organ motion using daily megavoltage cone-beam computed tomography (MVCBCT). Methods and Materials: Under exemption status from our institutional review board, we retrospectively reviewed 231 series of MVCBCT of 8 patients with prostate cancer. On both planning CT (pCT) and MVCBCT images, the rectal contours were delineated and the CT value within the contours was replaced by the mean CT value within the pelvis, with the addition of 100 Hounsfield units. MVCBCT images were rigidly registered to pCT and then nonrigidly registered using B-Spline deformable image registration (DIR) with Velocity AI software. The concordance between the rectal contours on MVCBCT and pCT was evaluated using the Dice similarity coefficient (DSC). The dose distributions normalized for 1 fraction were also deformed and summed to estimate the actual total dose. Results: The DSC of all treatment fractions of 8 patients was improved from 0.75±0.04 (mean ±SD) to 0.90 ±0.02 by DIR. Six patients showed a decrease of the generalized equivalent uniform dose (gEUD) from total dose compared with treatment plans. Although the rectal volume of each treatment fraction did not show any correlation with the change in gEUD (R{sup 2}=0.18±0.13), the displacement of the center of gravity of rectal contours in the anterior-posterior (AP) direction showed an intermediate relationship (R{sup 2}=0.61±0.16). Conclusion: We developed a method for evaluation of rectal dose using DIR and MVCBCT images and showed the necessity of DIR for the evaluation of total dose. Displacement of the rectum in the AP direction showed a greater effect on the change in rectal dose compared with the rectal volume.

Akino, Yuichi, E-mail: akino@radonc.med.osaka-u.ac.jp [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka (Japan); Department of Radiology, Osaka University Hospital, Suita, Osaka (Japan); Yoshioka, Yasuo [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka (Japan); Fukuda, Shoichi [Department of Radiation Oncology, Osaka General Medical Center, Osaka (Japan); Maruoka, Shintaroh [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka (Japan); Takahashi, Yutaka [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka (Japan); Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota (United States); Yagi, Masashi [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka (Japan); Mizuno, Hirokazu [Department of Radiology, Osaka University Hospital, Suita, Osaka (Japan); Isohashi, Fumiaki [Oncology Center, Osaka University Hospital, Suita, Osaka (Japan); Ogawa, Kazuhiko [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka (Japan)

2013-11-01

229

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

Microsoft Academic Search

Although some rectal douches result in surface epithelium loss and potential increase of HIV transmission, men who have sex\\u000a with men (MSM) continue to use them. We describe the prevalence of this practice among MSM engaging in unprotected receptive\\u000a anal intercourse (URAI) in risky circumstances. A multiethnic sample with overrepresentation of HIV-negative MSM who had URAI\\u000a in the previous year

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

2008-01-01

230

Postoperative bladder and sexual function in patients undergoing surgery for rectal cancer: a systematic review and meta-analysis of laparoscopic versus open resection of rectal cancer.  

PubMed

There have been conflicting opinions regarding the superiority of open and laparoscopic surgery in preserving bladder and sexual function after rectal cancer surgery. This systematic review and meta-analysis aims to pool the available data comparing the impact of surgical approaches on postoperative sexual and urinary function. A search of Pubmed, Medline, Cochrane and Embase was undertaken and studies from January 2000 to February 2013 were identified. We included, in our meta-analysis, both prospective and retrospective studies that compared laparoscopic surgery and open surgery for rectal cancer. A total of 876 patients undergoing rectal cancer surgery (lap n = 468, open n = 408) were examined. In men, postoperative ejaculatory function and erectile dysfunction evaluated from two studies comprising of 74 patients showed no difference between groups. The rate of overall sexual dysfunction evaluated from five studies comprising of 289 patients revealed a rate of 34 % in both the open and lap groups. Postoperative urinary function evaluated from five studies comprising of 312 patients showed no difference between groups. In women, postoperative sexual and urinary function were evaluated from five studies comprising of 321 patients. Three studies (n = 219) reported no difference in sexual function between groups. Postoperative urinary function evaluated from four studies comprising of 212 patients was found to be comparable. The available data are limited, but suggest that neither form of surgical approach be it laparoscopy or open surgery demonstrate superiority in preservation of sexual and bladder function. Further research into the technical aspects of surgery and evaluating newer minimally invasive technologies such as the robot may prove to be useful in improving functional outcomes of rectal cancer patients. PMID:25056719

Lim, R S; Yang, T X; Chua, T C

2014-11-01

231

Sphincter preservation for distal rectal cancer - a goal worth achieving at all costs?  

PubMed Central

To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual. PMID:21412495

Mulsow, Jurgen; Winter, Des C

2011-01-01

232

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

233

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

234

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. PMID:24349411

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

2013-01-01

235

Validation of a Bovine Rectal Palpation Simulator for Training Veterinary Students  

E-print Network

issues currently restrict the amount of training available to students in this procedure. Here we present if simulators are to become widely adopted in medical and veterinary training. Without it, the benefitsValidation of a Bovine Rectal Palpation Simulator for Training Veterinary Students Sarah BAILLIE 1

Williamson, John

236

Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients  

Microsoft Academic Search

Background: The applicability of laparoscopic surgery in the treatment of colorectal diseases is still controversial. Early reports on laparoscopic-assisted colectomy in patients with colon cancer suggested that it minimizes surgical trauma, decreases perioperative complications, and leads to a more rapid recovery. To our knowledge, no previous studies have compared the laparoscopic vs the open approach in rectal cancer. The aim

S. Delgado; D. Momblán; L. Salvador; R. Bravo; A. Castells; A. Ibarzabal; J. M. Piqué; A. M. Lacy

2004-01-01

237

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

238

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

239

Rectal bioavailability of lidocaine in the dog: evaluation of first-pass elimination.  

PubMed

The disposition of lidocaine was studied in beagle dogs after I.V., P.O. and rectal administration. Lidocaine HCl solution was used for the I.V. and P.O. studies. For rectal administration 3 gels were prepared: 1) lidocaine base in a hydrophilic vehicle, 2) lidocaine HCl in a hydrophilic vehicle, and 3) lidocaine base in a lipophilic vehicle. The gels were administered 3 cm deep in the rectum. Additionally, the gel of lidocaine HCl in a hydrophilic vehicle was also administered 10 cm deep in the rectum. No significant differences between I.V. and all extravascular administrations were observed for terminal half-life, total clearance and apparent volume of distribution. The systemic bioavailability after P.O. was 31%, and between 32% and 53% for the rectal dosage forms. The lidocaine base in lipophilic vehicle had the lowest systemic availability, the lowest peak concentration and the longest time to peak, whereas the lidocaine HCl in a hydrophilic vehicle, inserted 10 cm deep into the rectum, had the highest systemic bioavailability, highest peak concentration and shortest time to peak. The dog seems to be an excellent model for evaluation of peroral and rectal first-pass elimination. PMID:3695734

Ritschel, W A; Grummich, K W; Hussain, A S; Denson, D D; Ritschel, B E

1987-08-01

240

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

PubMed Central

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

2014-01-01

241

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

242

Comparison of perirectal versus rectal swabs for detection of asymptomatic carriers of toxigenic Clostridium difficile.  

PubMed

For long-term care and spinal cord injury patients, the sensitivity, specificity, and positive and negative predictive values of perirectal versus rectal cultures for detection of asymptomatic carriers of Clostridium difficile were 95%, 100%, 100%, and 97%, respectively. Perirectal cultures provide an accurate method to detect asymptomatic carriers of C. difficile. PMID:23926162

Rogers, David S; Kundrapu, Sirisha; Sunkesula, Venkata C K; Donskey, Curtis J

2013-10-01

243

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

244

Abdominal rectopexy with sigmoidectomy vs. rectopexy alone for rectal prolapse: A prospective, randomized study  

Microsoft Academic Search

A prospective, randomized study comparing abdominal rectopexy and sigmoid resection (Group I; n=15) with polyglycolic acid mesh rectopexy without sigmoidectomy (Group II; n=15) for complete rectal prolapse was carried out. One patient in Group I died of myocardial infarction, one patient in Group II had a small bowel obstruction and two patients in Group I an asymptomatic stricture of the

P. Luukkonen; U. Mikkonen; H. Jiirvinen

1992-01-01

245

Prosthetic rectopexy to the pelvic floor and sigmoidectomy for rectal prolapse  

Microsoft Academic Search

Background: Full thickness rectal prolapse in young adults with normal pelvic floor is a disease in which the rectum is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, which is expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy

Jean Pierre Lechaux; Patrick Atienza; N Goasguen; David Lechaux; Ingrid Bars

2001-01-01

246

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

247

The medical management of eight horses with grade 3 rectal tears.  

PubMed

Eight horses with Grade 3b rectal tears of the peritoneal part of the rectum or small colon were treated by a combination of medical therapy and dietary manipulation. All of the horses developed septic peritonitis during the course of treatment. Medical therapy consisted of a combination of penicillin, gentamicin and flunixin meglumine administered parenterally, metronidazole administered orally and liquid paraffin administered by nasogastric tube. Some horses also received fluid and electrolyte therapy i.v., plasma and heparin i.v. All horses were maintained on a laxative diet. Six of the 8 horses recovered. Duration of therapy in the horses that survived was between 2 and 7 weeks. Three of the 6 horses that recovered developed a rectal diverticulum, which did not appear to cause any subsequent medical problems. In the 2 horses that died, the Grade 3 rectal tear progressed to a Grade 4 tear with subsequent faecal contamination of the abdomen. Manual evacuation of the cavity of the rectal tears during treatment and size of the tears were identified as possible causes for the progression of the disease in these 2 horses. PMID:11202374

Mair, T S

2000-06-01

248

EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: the radiology experts review.  

PubMed

Some interesting shifts have taken place in the diagnostic approach for detection of colorectal lesions over the past decade. This article accompanies the recent EURECCA consensus group reccomendations for optimal management of colon and rectal cancers. In summary, imaging has a crucial role to play in the diagnosis, staging assessment and follow up of patients with colon and rectal cancer. Recent advances include the use of CT colonography instead of Barium Enema in the diagnosis of colonoic cancer and as an alternative to colonoscopy. Modern mutlidetector CT scanning techniques have also shown improvements in prognostic stratification of patients with colonic cancer and clinical trials are underway testing the selective use of neoadjuvant therapy for imaging identified high risk colon cancers. In rectal cancer, high resolution MRI with a voxel size less or equal to 3 × 1 × 1 mm3 on T2-weighted images has a proven ability to accurately stage patients with rectal cancer. Moreover, preoperative identification of prognostic features allows stratification of patients into different prognostic groups based on assessment of depth of extramural spread, relationship of the tumour edge to the mesorectal fascia (MRF) and extramural venous invasion (EMVI). These poor prognostic features predict an increased risk of local recurrence and/or metastatic disease and should form the basis for preoperative local staging and multidisciplinary preoperative discussion of patient treatment options. PMID:24439446

Tudyka, V; Blomqvist, L; Beets-Tan, R G H; Boelens, P G; Valentini, V; van de Velde, C J; Dieguez, A; Brown, G

2014-04-01

249

Which operative repair is associated with a higher likelihood of reoperation after rectal prolapse repair?  

PubMed

The rate of reoperation after transabdominal as compared with transperineal repair for rectal prolapse is unknown. We evaluated all patients who underwent surgical treatment for rectal prolapse performed through transabdominal or transperineal repair from the trackable California Inpatient data files and Revisit Analyses during the time period of January 1, 2005, through December 31, 2007. We specifically evaluated rates of reoperation and stoma formation during the 36-month study period. A total of 3400 patient discharges with rectal prolapse from California during the 36-month study period was identified. Of this cohort, 1772 patients had one or more prolapse repairs. Procedures were more likely to be performed through a transabdominal (1035 [58%]) as compared with a transperineal approach (737 [42%]). There was no difference in reoperation for transabdominal (11%) as compared with transperineal procedures (11%; P = 0.9). However, a significantly larger proportion of patients underwent stoma formation after transabdominal (8%) as compared with transperineal repair (5%; P < 0.02). Time to reoperation was not significantly different for patients treated with transabdominal (295 ± 254 days) as compared with transperineal repair (271 ± 246 days; P = 0.6). In conclusion, the risk of reoperation is substantial for both transabdominal and transperineal procedures for rectal prolapse. PMID:25347504

Ricciardi, Rocco; Roberts, Patricia L; Read, Thomas E; Hall, Jason F; Marcello, Peter W; Schoetz, David J

2014-11-01

250

The dependence of onset and duration of sleep on the circadian rhythm of rectal temperature  

Microsoft Academic Search

The sleep-wake cycle and the circadian rhythm of rectal temperature were recorded in subjects who lived singly in an isolation unit. In 10 subjects, the freerunning rhythms remained internally synchronized, 10 other subjects showed internal desynchronization. Times of onset and end of bedrest (“sleep”) were determined in each cycle and referred to the phase of the temperature rhythm. In the

Jtirgen Zulley; Riitger Wever; Jiirgen Aschoff

1981-01-01

251

A case of primary rectal angioleiomyoma: review of radiologic finding with histopathologic correlation  

PubMed Central

Angioleiomyomas are benign smooth muscle tumors that originate from the tunica media of veins and arteries. They can occur anywhere in the body, but the preferential location of these tumors is the lower extremities. We describe a rare case of rectal angioleiomyoma and present our findings obtained by using computed tomography, magnetic resonance imaging, and histopathological analysis. PMID:25298874

You, Woo Young; Hwang, Dae Hyun; Kang, Ik Won; Chang, Suk Ki; Choi, Jae Jeong; Choi, Young Hee

2014-01-01

252

Intermittent Use of Amifostine during Postoperative Radiochemotherapy and Acute Toxicity in Rectal Cancer Patients  

Microsoft Academic Search

Purpose: Amifostine has been shown to be able to reduce acute radiation toxicity of administered daily prior to radiation during a course of a conventionally fractionated radiotherapy. A disadvantage is the necessity of daily intravenous injection. We have used amifostin in patients undergoing adjuvant radiochemotherapy for rectal cancer. Amifostine was administered only in the first and fifth week of radiotherapy

Jürgen Dunst; Susanne Semlin; Steffi Pigorsch; Arndt-Christian Müller; Thomas Reese

2000-01-01

253

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

254

Long-term rectal administration of high-dose sustained-release morphine tablets  

Microsoft Academic Search

Two proprietary sustained-release morphine tablets for oral administration are available in the USA, and the authors have found that rectal administration of these provide excellent analgesia although their use by this route is not approved by the United States Food and Drug Administration. An illustrative case in a 72-year-old patient with prostate cancer is reported.

Declan Walsh; Pamela S. Tropiano

2002-01-01

255

Preliminary Development and Evaluation of a Bovine Rectal Palpation Simulator for Training Veterinary Students  

Microsoft Academic Search

A computer based teaching tool has been developed using haptic technology to train veterinary students to examine the bovine reproductive tract, simulating rectal palpation. The teacher can visualise the student's actions on a screen and therefore give guidance. The properties of the virtual scene were assessed by veterinary surgeons. Evaluation of the teaching tool was con- ducted with a group

Sarah Baillie; Andrew Crossan; Stephen Brewster; Stuart Reid

256

A watch-and-wait approach to the management of rectal cancer.  

PubMed

There has been increasing interest in whether a watch-and-wait strategy can be pursued instead of routine surgery in selected rectal cancer patients who have a clinical complete response (cCR) after chemoradiation. The watch-and-wait approach could potentially reduce treatment-related toxicity in selected rectal cancer patients. A large study from Brazil and a prospective trial from the Netherlands appear to support this approach, although multiple other studies have raised concerns about the high rate of local recurrence with this strategy. This article reviews current evidence in support of a watch-and-wait approach to rectal cancer management, and discusses the challenges and limitations of this approach. Among these are the facts that current methods of assessing tumor response have limited accuracy, and that a cCR does not necessarily imply pathologic complete response. Careful patient selection and systematic methods of response assessment and follow-up will be critical to the success of nonoperative approaches. Based on the available evidence, ideally a watch-and-wait approach for patients with rectal cancer should be pursued within the context of a prospective clinical trial. PMID:24367851

Das, Prajnan; Minsky, Bruce D

2013-10-01

257

Use of Malone Antegrade Continence Enema in Patients With Perineal Colostomy After Rectal Resection  

Microsoft Academic Search

PURPOSE  Abdominoperineal resection, with iliac colostomy, remains the gold standard treatment for very low-lying rectal cancer, but it alters patients quality of life. Alternatives to iliac colostomy need to be experimented. Antegrade enemas via a cecal access (Malone operation) obtains a colonic emptying and improves continence for incontinent patients. Continence and quality of life after abdominoperineal resection and perineal colostomy associated

Guillaume Portier; Nicolas Bonhomme; Ivan Platonoff; Frank Lazorthes

2005-01-01

258

Laparoscopic low anterior resection for hematogenous rectal metastasis from gastric adenocarcinoma: A Case Report  

PubMed Central

Background Gastric cancer is one of the most common malignancies in the world and is the second most common cause of cancer-related death in Korea. Colorectal metastases from gastric adenocarcinoma are known to be very rare. We report an unusual case of rectal metastasis of gastric adenocarcinoma. Case presentation We report a case of a 43-year-old female patient with gastric cancer who first presented with epigastric pain. The endoscopic and radiologic findings were suggestive of Borrmann type III advanced gastric cancer with linitis plastica. Radical total gastrectomy with D2 lymph node dissection was performed. The pathology report was AJCC TNM Stage II gastric adenocarcinoma (T3N0M0). On follow up at 34 months after surgery, the patient complained of difficulty in defecation. On colonoscopy, a hard, indurated extraluminal mass was detected 7 cm proximal to the anal verge. The biopsy demonstrated chronic nonspecific colitis. Abdominal CT, rectal MRI and PET-CT revealed rectal metastasis from gastric cancer. Laparoscopic ultralow anterior resection with diverting ileostomy was performed. The pathology report was metastatic adenocarcinoma, and this diagnosis was identical to the gastric pathology reported in the previous pathology report. The patient was discharged after the 11th postoperative day with no adverse events. Conclusion Rectal metastasis from gastric cancer is known to be very rare. However, metastatic gastric adenocarcinoma should be considered as a differential diagnosis for patients presenting with a colorectal mass and a past history of gastric cancer. PMID:22074191

2011-01-01

259

Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study  

PubMed Central

INTRODUCTION—To reduce pouch related complications after restorative proctocolectomy, an alternative procedure was developed, the ileo neo-rectal anastomosis (INRA). This technique consists of rectal mucosa replacement by ileal mucosa and straight ileorectal anastomosis. Our study provides a detailed description of the functional results after INRA.?PATIENTS AND METHODS—Eleven patients underwent an INRA procedure with a temporary ileostomy. Anorectal function tests were performed two months prior to and six and 12 months after closure of the ileostomy and comprised: anal manometry, ultrasound examination, rectal balloon distension, and transmucosal electrical nerve stimulation (TENS). Function was subsequently related to the histopathology of rectal biopsy samples.?RESULTS—Median stool frequency decreased from 15/24 hours (10-25) to 6/24 hours (4-11) at one year. All patients reported full continence. Anal sensibility, and resting and squeeze pressures did not change after INRA. Rectal compliance decreased (2.1 (0.7-2.8) v 1.5 (0.4-2.2) and 1.4 (0.8-3.7) ml/mm Hg (p=0.03)) but the maximum tolerated volume increased (70 (50-118) v 96 (39-176) (NS) and 122 (56-185) ml (p=0.03)). Decreasing rectal sensitivity was found: the maximum tolerated pressure increased (14 (8-24) v 22 (8-34) (NS) and 26 (14-40) (p=0.02)) and the rectal threshold for TENS displayed a similar tendency. All patients displayed a low grade chronic inflammatory infiltrate in neorectal biopsy samples before closure of the ileostomy, with no change during follow up.?CONCLUSIONS—The technique of INRA provides a safe alternative for restorative surgery. Stool frequency after INRA improves with time and seems to be related to decreasing sensitivity and not to histopathological changes in the neorectum. Furthermore, after the INRA procedure, all patients reported full continence.???Keywords: restorative proctocolectomy; anorectal physiology; surgery; neorectum; intestinal mucosa transposition; recto-anal inhibition reflex PMID:11302969

Andriesse, G; Gooszen, H; Schipper, M; Akkermans, L; van Vroonhoven, T J M V; van Laarhoven, C J H M

2001-01-01

260

Rectal pouch index: a prognostic indicator for constipation after surgery for high and intermediate anorectal malformations.  

PubMed

Background and Introduction?Constipation following posterior sagittal anorectoplasty (PSARP) is common. We correlated the dimensions of rectal pouch before PSARP with the postoperative bowel habit. Classical PSARP was modified with tapering of rectal pouch by plication of its walls thus preserving the internal sphincter because we believe that this preserves continence and lead to better results. It was observed that a distinct relationship exists between the preoperative size of the rectal pouch and constipation. Aim?The aim of this study is to correlate the dimensions of preoperative rectal pouch with postoperative constipation. Materials and Methods?PSARP was performed (n: 45) in anorectal malformations using an indigenous muscle stimulator. Before PSARP, a distal cologram via high sigmoid colostomy was performed. All the distal cologram were performed by a single senior radiologist and the pressure was kept constant between 15 and 20 cm of water while filling to rule out the confounding factor related to incomplete filling. Rectum index was calculated as follows: The maximum radiological diameter of the rectum within the pelvis in the sagittal plane was multiplied by the maximum diameter of the rectum in the frontal plane. The result of this calculation was divided by the product of multiplying the distance between the ischial spines and the distance between the posterior surface of the pubic symphysis and the anterior surface of the last sacral vertebrae. Results?Symptomatic constipation requiring treatment developed in 25 patients (48%). None of these patients had anal stenosis or stricture. Constipation was managed by dietary measures and laxatives. Fifteen patients (60%) had grade 1 constipation and responded favorably. Eight and two patients had grades 2 and 3 constipation, respectively. Those patients who had a rectal pouch index of less than 0.8 had mild constipation grades 0 and 1, whereas those in whom the rectal pouch index was more than 0.8 had severe degrees of constipation (grades 2 and 3). Conclusion?Measuring the rectal pouch index can help in identifying the group which is likely to develop constipation after PSARP. These patients can be put on bowel training early on, after the colostomy closure, instead of waiting. PMID:23686665

Sharma, Nitin; Pratap, Akshay; Bajpai, Minu

2014-08-01

261

Dose-distance metric that predicts late rectal bleeding in patients receiving radical prostate external-beam radiotherapy  

NASA Astrophysics Data System (ADS)

The relationship between rectal dose distribution and the incidence of late rectal complications following external-beam radiotherapy has been previously studied using dose-volume histograms or dose-surface histograms. However, they do not account for the spatial dose distribution. This study proposes a metric based on both surface dose and distance that can predict the incidence of rectal bleeding in prostate cancer patients treated with radical radiotherapy. One hundred and forty-four patients treated with radical radiotherapy for prostate cancer were prospectively followed to record the incidence of grade ?2 rectal bleeding. Radiotherapy plans were used to evaluate a dose-distance metric that accounts for the dose and its spatial distribution on the rectal surface, characterized by a logistic weighting function with slope a and inflection point d0. This was compared to the effective dose obtained from dose-surface histograms, characterized by the parameter n which describes sensitivity to hot spots. The log-rank test was used to determine statistically significant (p < 0.05) cut-off values for the dose-distance metric and effective dose that predict for the occurrence of rectal bleeding. For the dose-distance metric, only d0 = 25 and 30 mm combined with a > 5 led to statistical significant cut-offs. For the effective dose metric, only values of n in the range 0.07-0.35 led to statistically significant cut-offs. The proposed dose-distance metric is a predictor of rectal bleeding in prostate cancer patients treated with radiotherapy. Both the dose-distance metric and the effective dose metric indicate that the incidence of grade ?2 rectal bleeding is sensitive to localized damage to the rectal surface.

Lee, Richard; Chan, Elisa K.; Kosztyla, Robert; Liu, Mitchell; Moiseenko, Vitali

2012-12-01

262

The experience of pain and anxiety in rectal cancer patients during high-dose-rate brachytherapy  

PubMed Central

Background Pain and anxiety have been reported as primary concerns for patients with head-and-neck, gynecologic, and prostate cancers undergoing high dose rate (hdr) brachytherapy. However, almost no research has been published on the degree to which these symptoms are experienced by rectal cancer patients undergoing hdr brachytherapy. We conducted a pilot study examining the experiences of rectal cancer patients during hdr brachytherapy, specifically the intensity and trajectory of their anxiety and pain. Methods Rectal cancer patients (n = 25) who received hdr brachytherapy treatment at a hospital in Montreal, Quebec, completed verbal analog scales for pain and anxiety at 4 time points over 4 treatment days. Results On all 4 days, a subset of patients reported moderate-to-severe anxiety before applicator insertion. Pain increased significantly from the time patients were lying on the table to immediately after insertion of the applicator (p < 0.001). Insertion of the applicator appears to be the most painful part of the procedure, and although anxiety declined to below baseline after applicator removal, pain remained somewhat elevated. Some patients required conscious sedation; however, reports of moderate-to-severe pain were more frequent from patients who received pain medications than from patients who did not receive such medication (p < 0.05). Conclusions Most patients with rectal cancer tolerated hdr rectal brachytherapy well, although the procedure is stressful and painful for some. Insertion of the applicator was found to be the point of maximal pain, and medication was not always completely successful at alleviating the pain, suggesting that additional psychosocial interventions might be needed, with particular emphasis on the time of applicator insertion. PMID:24523626

Neron, S.; Perez, S.; Benc, R.; Bellman, A.; Rosberger, Z.; Vuong, T.

2014-01-01

263

Risk Factors of Synchronous Inguinal Lymph Nodes Metastasis for Lower Rectal Cancer Involving the Anal Canal  

PubMed Central

Purpose The aim of the study is to identify the risk factors of synchronous ILN metastasis for lower rectal cancer involving the anal canal. Methods Patients with lower rectal cancer who underwent radical resection at the Fudan University Shanghai Cancer Center were retrospectively analyzed. The synchronous ILN metastasis was defined as the metastasis occurring within 6 months after the diagnosis of rectal cancer. Patients’ gender, age, tumor diameter, dentate line invasion, differentiation level, histological type, depth of invasion, perirectal LN metastasis, lymphovascular invasion or perineural invasion were analyzed in the study. The correlation between synchronous ILN involvement and clinicopathological features were analyzed with Chi-square test/fisher’s exact test. Variables with p<0.05 in univariate analysis were then analyzed in a multivariate logistic model. Odds ratio (OR) along with 95% confidence intervals (95% CI) were calculated. Results A total of 325 patients (182 men and 143 women) with lower rectal cancer met the criteria and were enrolled in the study. Among them, 20 patients (6.2%) had synchronous ILN metastasis. Both univariate and multivariate analysis showed the invasion of the dentate line had a strong correlation with synchronous ILN metastasis with the odds ratio (OR) of 23.558 [95% confidence interval (CI) 6.380–86.982] (p<0.001). The presence of lymphovascular invasion also showed a significant correlation synchronous ILN metastasis with odds ratio (OR) of 5.260 [95% confidence interval (CI) 1.818–15.212] (p?=?0.002). Conclusions The invasion of dentate line and lymphovascular invasion are two independent risk factors of inguinal lymph node metastasis for lower rectal cancer involving the anal canal. PMID:25409168

Shi, Debing; Zheng, Hongtu; Huang, Liyong; Gu, Weilie; Xu, Ye; Cai, Sanjun; Cai, Guoxiang

2014-01-01

264

Rectal Motion in Patients Receiving Preoperative Radiotherapy for Carcinoma of the Rectum  

SciTech Connect

Purpose: To assess the movement of rectum, mesorectum, and rectal primary during a course of preoperative chemoradiotherapy. Methods and Materials: Seventeen patients with Stage II or III rectal cancer had a planning CT scan with rectal contrast before commencement of preoperative chemoradiation. The scan was repeated during Weeks 1, 3, and 5 of chemoradiation. The rectal primary (gross tumor volume), rectum, mesorectum, and bladder were contoured on all four scans. An in-house biomechanical model-based deformable image registration technique, Morfeus, was used to measure the three-dimensional spatial change in these structures after bony alignment. The required planning target volume margin for this spatial change, after bone alignment, was also calculated. Results: Rectal contrast was found to introduce a systematic error in the position of all organs compared with the noncontrast state. The largest change in structures during radiotherapy was in the anterior and posterior directions for the mesorectum and rectum and in the superior and inferior directions for the gross tumor volume. The planning target volume margins required for internal movement for the mesorectum based on the three scans acquired during treatment are 4 mm right, 5 mm left, 7 mm anterior, and 6 mm posterior. For the rectum, values were 8 mm right, 8 mm left, 8 mm anterior, and 9 mm posterior. The greatest movement of the rectum occurred in the upper third. Conclusions: Contrast is no longer used in CT simulation. Assuming bony alignment, a nonuniform margin of 8 mm anteriorly, 9 mm posteriorly, and 8 mm left and right is recommended.

Brierley, James D., E-mail: james.brierley@rmp.uhn.on.c [Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Dawson, Laura A. [Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Sampson, Elliott [Department of Medical Science, University of Calgary, Calgary, AB (Canada); Bayley, Andrew [Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Scott, Sandra; Moseley, Joanne L. [Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Craig, Timothy; Cummings, Bernard; Dinniwell, Robert; Kim, John J.; Ringash, Jolie; Wong, Rebecca; Brock, Kristy K. [Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

2011-05-01

265

Tumor deposits in rectal adenocarcinoma after neoadjuvant chemoradiation are associated with poor prognosis  

PubMed Central

Although tumor deposits have been associated with poor prognosis in colorectal carcinoma, the prevalence and clinical significance of tumor deposits in rectal adenocarcinoma following neoadjuvant chemoradiation are relatively unexplored. The aims of this study are to assess the clinical significance of tumor deposits in rectal adenocarcinoma patients, including those receiving neoadjuvant therapy. Pathology slides and medical records from 205 consecutive patients who underwent resection for rectal adenocarcinoma between 1990 and 2010 at a single tertiary care center were reviewed. Patients with tumor deposits had higher tumor grade (P=0.006) and worse tumor stage (P<0.001) at presentation than patients without tumor deposits. Among 110 patients who underwent neoadjuvant chemoradiation, tumor deposits were associated with higher rates of lymph node involvement (P=0.035) and distant metastases (P=0.006), and decreased survival (P=0.027). These patients had a trend toward lower treatment response scores (P=0.285) and higher local recurrence (P=0.092). Of 52 patients with tumor deposits, those who underwent neoadjuvant chemoradiation had significantly worse pretreatment stage by endoscopic ultrasound (P=0.001) but interestingly had significantly lower rates of lymphovascular invasion on resection (P<0.001) compared with those who had not received neoadjuvant chemoradiation. Despite treatment with neoadjuvant chemoradiation, tumor deposits were present in over one-fifth of rectal adenocarcinoma patients. Overall, the outcome of patients with tumor deposits in treated and untreated patients were similar, however the association of tumor deposits with deeply invasive tumors and less tumor regression when comparing with treated patients without tumor deposits raises the possibility that these tumors could have a more aggressive biology, possibly explaining the association of tumor deposits with higher rates of recurrence and lower survival after neoadjuvant chemoradiation. Overall, tumor deposits appear to be a poor prognostic marker among rectal adenocarcinoma patients following neoadjuvant chemoradiation and may identify a subset of patients who require aggressive adjuvant therapy to prevent recurrence. PMID:24434897

Gopal, Purva; Lu, Pengcheng; Ayers, Gregory D; Herline, Alan J; Washington, Mary K

2014-01-01

266

Evaluation of Clinical Outcomes after Abdominal Rectopexy and Delorme's Procedure for Rectal Prolapse: A Prospective Study  

PubMed Central

Background: Complete rectal prolapse is characterized by protrusion of full thickness rectal wall through the anal orifice. Despite its rarity more than 100 surgical procedures have been described and there are no good evidence based recommendations for selection of a surgical procedure. This study was conducted to evaluate the clinical outcomes of commonly used procedures for rectal prolapse at our hospital. Materials and Methods: Twenty seven patients presenting with complete rectal prolapse between May 2011 to May 2013 were included in this prospective study. Patients underwent either Abdominal rectopexy or Delorme’s procedure after evaluation, based on clinical judgment of experienced surgeons. Patient characteristics, complications, post-operative length of hospitalization and clinical outcomes were assessed. Patients were followed up for a mean duration of 14 months. Results: Seventeen patients underwent Abdominal rectopexy (Posterior mesh rectopexy), ten patients underwent Delorme’s procedure. No postoperative mortalities or major complications were noted. Post operative morbidity (minor) was 17% in Abdominal rectopexy group and 10% in Delormes group 0%. Incontinence improved in all six patients (100%) in rectopexy group, four patients (80%) in Delorme’s procedure group. Two patients (11%) in rectopexy group reported increase in constipation post operatively. There was one recurrence in Delorme’s procedure group with no recurrences in Abdominal rectopexy group. Conclusion: The treatment of rectal prolapse should be individualized to achieve best results. Abdominal rectopexy can be safely applied in most of patients with minimal post operative increase in constipation and recurrence by using posterior mesh rectopexy technique. Delorme’s procedure can be performed with minimal morbidity and shorter hospital stay and good functional results with acceptable recurrence rate. Delorme’s can be considered as an alternative to rectopexy not only in patients unfit for laparotomy but also in individuals with a short prolpase, avoiding a laparotomy. PMID:24995208

Makineni, Hemanth; Rai, B.K. Shivprasad

2014-01-01

267

Measurement of in vivo rectal mucosal cytokine and eicosanoid production in ulcerative colitis using filter paper  

PubMed Central

BACKGROUND—Excessive mucosal generation of cytokines and eicosanoids has been reported in vitro in ulcerative colitis (UC) using traumatising biopsy techniques, and in vivo using time consuming rectal dialysis.?AIMS—To validate a simple filter paper technique to profile rectal mucosal production of cytokines and eicosanoids in vivo in patients with UC compared with controls.?PATIENTS—Forty one patients with UC (21 with active disease) and 16 controls were studied.?METHODS—In vitro, recovery of known concentrations of cytokine or mediator applied to filter papers was measured by ELISA following incubation in buffer. In vivo, patients and controls had filter papers apposed to the rectal mucosa briefly through a rigid sigmoidoscope. Filter papers were then incubated prior to assay by ELISA.?RESULTS—In vitro validation studies showed that the filter paper technique could be used to measure mucosal release of interleukin-1? (IL-1?), tumour necrosis factor ? (TNF-?), thromboxane B2 (TXB2), and prostaglandin E2 (PGE2), but not interferon ? (IFN-?). Mucosal release of IL-1?, TNF-?, TXB2 and PGE2 were significantly increased in active UC (p=0.001) and correlated directly with disease activity (p=0.02).?CONCLUSIONS—The filter paper technique confirmed increased rectal mucosal release of cytokines and eicosanoids in UC, in proportion to disease activity. The simplicity, safety and speed of the technique make it a practicable option for use in the outpatient clinic to study the pathogenesis of inflammatory bowel disease, and potentially its response to treatment.???Keywords: cytokines; eicosanoids; ulcerative colitis; rectal dialysis PMID:10716677

Carty, E; De Brabander, M; Feakins, R; Rampton, D

2000-01-01

268

Dose mapping of the rectal wall during brachytherapy with an array of scintillation dosimeters  

SciTech Connect

Purpose: In pelvic brachytherapy treatments, the rectum is an organ at risk. The authors have developed an array of scintillation dosimeters suitable for in vivo use that enables quality assurance of the treatment delivery and provides an alert to potential radiation accidents. Ultimately, this will provide evidence to direct treatment planning and dose escalation and correlate dose with the rectal response. Methods: An array of 16 scintillation dosimeters in an insertable applicator has been developed. The dosimeters were calibrated simultaneously in a custom designed circular jig before use. Each dosimeter is optically interfaced to a set of pixels on a CCD camera located outside the treatment bunker. A customized software converts pixel values into dose rate and accumulates dose for presentation during treatment delivery. The performance of the array is tested by simulating brachytherapy treatments in a water phantom. The treatment plans were designed to deliver a known dose distribution on the surface of the rectal applicator, assumed to represent the dose to the rectal wall. Results: The measured doses were compared to those predicted by the treatment plan and found to be in agreement to within the uncertainty in measurement, usually within 3%. The array was also used to track the progression of the source as it moved along the catheter. The measured position was found to agree with the position reported by the afterloader to within the measurement uncertainty, usually within 2 mm. Conclusions: This array is capable of measuring the actual dose received by each region of the rectal wall during brachytherapy treatments. It will provide real time monitoring of treatment delivery and raise an alert to a potential radiation accident. Real time dose mapping in the clinical environment will give the clinician additional confidence to carry out dose escalation to the tumor volume while avoiding rectal side effects.

Cartwright, L. E.; Suchowerska, N.; Yin, Y.; Lambert, J.; Haque, M.; McKenzie, D. R. [School of Physics, University of Sydney, New South Wales 2006 (Australia) and Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050 (Australia); School of Physics, University of Sydney, New South Wales 2006 (Australia); School of Physics, University of Sydney, New South Wales 2006 (Australia) and Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050 (Australia); Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050 (Australia); School of Physics, University of Sydney, New South Wales 2006 (Australia)

2010-05-15

269

Surgery for Rectal Prolapse: Orr-Loygue Ventral Rectopexy With Limited Dissection Prevents Postoperative-Induced Constipation Without Increasing Recurrence  

Microsoft Academic Search

\\u000a Purpose  Abdominal rectopexy is the preferred surgical technique for the treatment of total rectal prolapse. In many reported series,\\u000a its results are impaired by induced constipation. Lateral rectal ligaments preservation could prevent constipation but increase\\u000a recurrence rates. We report anatomic and functional results of abdominal Orr-Loygue ventral rectopexy with dissection limited\\u000a to anterior and posterior rectal wall.\\u000a \\u000a \\u000a \\u000a Methods  Consecutive patients with total

Guillaume Portier; Francesco Iovino; Franck Lazorthes

2006-01-01

270

DIGITAL RECTAL EXAMINATION FOR DETECTING PROSTATE CANCER AT PROSTATE SPECIFIC ANTIGEN LEVELS OF 4 NG.\\/ML. OR LESS  

Microsoft Academic Search

PurposeWe evaluated the detection rate of prostate cancer in men with suspicious digital rectal examination findings and serum prostate specific antigen (PSA) 4 ng.\\/ml. or less. We also evaluated the stage and grade of cancers detected.

GUSTAVO F. CARVALHAL; DEBORAH S. SMITH; DOUGLAS E. MAGER; CHRISTIAN RAMOS; WILLIAM J. CATALONA

1999-01-01

271

Rectal Swabs Are Suitable for Quantifying the Carriage Load of KPC-Producing Carbapenem-Resistant Enterobacteriaceae  

PubMed Central

It is more convenient and practical to collect rectal swabs than stool specimens to study carriage of colon pathogens. In this study, we examined the ability to use rectal swabs rather than stool specimens to quantify Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE). We used a quantitative real-time PCR (qPCR) assay to determine the concentration of the blaKPC gene relative to the concentration of 16S rRNA genes and a quantitative culture-based method to quantify CRE relative to total aerobic bacteria. Our results demonstrated that rectal swabs are suitable for quantifying the concentration of KPC-producing CRE and that qPCR showed higher correlation between rectal swabs and stool specimens than the culture-based method. PMID:23295937

Lerner, A.; Romano, J.; Chmelnitsky, I.; Navon-Venezia, S.; Edgar, R.

2013-01-01

272

Molecular, Pathologic and MRI Investigation of the Prognostic and Redictive Importance of Extramural Venous Invasion in Rectal Cancer (MARVEL) Trial  

ClinicalTrials.gov

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

2013-11-26

273

Interferon-signaling pathway: associations with colon and rectal cancer risk and subsequent survival.  

PubMed

Interferons (IFNs) are proteins involved in many functions including antiviral and antimicrobial response, apoptosis, cell cycle control and mediating other cytokines. IFN gamma (IFNG) is a proinflammatory cytokine that modulates many immune-related genes. In this study we examine genetic variation in IFNG, IFNGR1, IFNGR2 and interferon regulatory factors (IRFs) to determine associations with colon and rectal cancer and survival after diagnosis. We include data from two population-based incident studies of colon cancer (1555 cases and 1956 controls) and rectal cancer (754 cases and 959 controls). Five tagSNPs in IFNG, IRF2 and IRF3 were associated with colon cancer and eight tagSNPs in IFNGR1, IFNGR2, IRF2, IRF4, IRF6 and IRF8 were associated with rectal cancer. IRF3 rs2304204 was associated with the strongest direct association and IRF2 3775554 with the strongest inverse association for colon cancer [odds ratios (ORs) 1.43, 95% confidence interval (CI) 1.12-1.82 for recessive model and 0.52, 95% CI 0.28-0.97 for unrestricted model]. For rectal cancer, IFNGR1 rs3799488 was directly associated with risk (OR 2.30, 95% CI 1.04-5.09 for recessive model), whereas IRF6 rs861020 was inversely associated with risk (OR 0.57, 95% CI 0.34-0.95). Several single-nucleotide polymorphisms interacted significant with both NF-?B1 and IL6 and with aspirin/non-steroidal anti-inflammatory drugs and cigarette smoking. Using a summary score to estimate mutational load, we observed a hazard rate ratio (HRR) close to 5.00 (95% CI 2.73-8.99) for both colon and rectal (HRR 4.83, 95% CI 2.34-10.05) cancer for those in the category having the most at-risk genotypes. These data suggest the importance of IFN-signaling pathway on colon and rectal cancer risk and survival after diagnosis. PMID:21859832

Slattery, Martha L; Lundgreen, Abbie; Bondurant, Kristina L; Wolff, Roger K

2011-11-01

274

Association of statin use with a pathologic complete response to neoadjuvant chemoradiation for rectal cancer  

SciTech Connect

Purpose: To assess whether 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, might enhance the efficacy of neoadjuvant chemoradiation in rectal cancer. Methods and Materials: Between 1996 and 2001, 358 patients with clinically resectable, nonmetastatic rectal cancer underwent surgery at Memorial Sloan-Kettering Cancer Center after neoadjuvant chemoradiation for either locally advanced tumors or low-lying tumors that would require abdominoperineal resection. We excluded 9 patients for radiation therapy dose <45 Gy or if statin use was unknown, leaving 349 evaluable patients. Median radiation therapy dose was 50.4 Gy (range, 45-55.8 Gy), and 308 patients (88%) received 5-flurouracil-based chemotherapy. Medication use, comorbid illnesses, clinical stage as assessed by digital rectal examination and ultrasound, and type of chemotherapy were analyzed for associations with pathologic complete response (pCR), defined as no microscopic evidence of tumor. Fisher's exact test was used for categoric variables, Mantel-Haenszel test for ordered categoric variables, and logistic regression for multivariate analysis. Results: Thirty-three patients (9%) used a statin, with no differences in clinical stage according to digital rectal examination or ultrasound compared with the other 324 patients. At the time of surgery, 23 nonstatin patients (7%) were found to have metastatic disease, compared with 0% for statin patients. The unadjusted pCR rates with and without statin use were 30% and 17%, respectively (p = 0.10). Variables significant univariately at the p = 0.15 level were entered into a multivariate model, as were nonsteroidal anti-inflammatory drugs (NSAIDs), which were strongly associated with statin use. The odds ratio for statin use on pCR was 4.2 (95% confidence interval, 1.7-12.1; p = 0.003) after adjusting for NSAID use, clinical stage, and type of chemotherapy. Conclusion: In multivariate analysis, statin use is associated with an improved pCR rate after neoadjuvant chemoradiation for rectal cancer. The low prevalence of statin use limits the power to detect a significant difference at a type I error threshold of p = 0.05 in this analysis. Although no definitive conclusions can be drawn on the basis of this retrospective study, the unusually high incidence of pCR after chemoradiation suggests that the use of statins in the treatment of rectal cancer warrants further evaluation.

Katz, Matthew S. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Minsky, Bruce D. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)]. E-mail: minskyb@mskcc.org; Saltz, Leonard B. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Riedel, Elyn [Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Chessin, David B. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Guillem, Jose G. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2005-08-01

275

Pathologic downstaging of T 3–4N x rectal cancer after chemoradiation: 5-fluorouracil vs. Tegafur  

Microsoft Academic Search

Purpose: To describe downstaging effects in locally advanced rectal cancer induced by 2 fluopirimidine radiosensitizing agents given through different routes in conjunction with preoperative radiotherapy.Methods and Materials: From March 1995 to December 1999, two consecutive groups of patients with cT3–4Nx rectal cancer (94% CT scan, 71% endorectal ultrasound) were treated with either (1) 45–50 Gy (1.8 Gy\\/day, 25 fractions) and

Felipe A Calvo; Marina Gómez-Esp??; Juan A D??az-González; Roc??o Cantalapiedra; Pilar Marcos; Arnaldo Alvarado; Pilar Garc??a Alfonso; Rafael Herranz; Emilio Alvarez

2001-01-01

276

Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma  

SciTech Connect

Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ?1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ?25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction.

Yeoh, Eric, E-mail: eric.yeoh@health.sa.gov.au [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia); School of Medicine, University of Adelaide, Adelaide (Australia); Tam, William; Schoeman, Mark [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Gastroenterology, Royal Adelaide Hospital, Adelaide (Australia); Moore, James; Thomas, Michelle [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide (Australia); Botten, Rochelle; Di Matteo, Addolorata [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia)

2013-12-01

277

Accumulation of Dendrobium superbum (orchidaceae) fragrance in the rectal glands by males of the melon fly, Dacus cucurbitae  

Microsoft Academic Search

4-(4-Hydroxyphenyl)-2-butanone was characterized from flowers of the orchidDendrobium superbum as a specific attractant factor for the male melon fly,Dacus cucurbitae. The male flies compulsively licked the flower surface and sequestered the compound in significant quantities in their rectal glands. The compound was detected within 6 hr after ingestion and was retained for more than six days in the rectal gland

Ritsuo Nishida; Osamu Iwahashi; Keng Hong Tan

1993-01-01

278

Gender Differences in Quality of Life of Patients with Rectal Cancer. A Five-Year Prospective Study  

Microsoft Academic Search

To determine how quality of life changes over time and to assess gender-related differences in quality of life of rectal cancer patients we conducted a 5-year study. Little is known about how quality of life (QoL) changes over time in patients after surgery for rectal cancer, and whether gender of the patients is associated with a different perception of QoL.

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

2005-01-01

279

Assessment of Rectal Aberrant Crypt Foci by Standard Chromoscopy and its Predictive Value for Colonic Advanced Neoplasms  

Microsoft Academic Search

BACKGROUND AND AIMS:Aberrant crypt foci (ACF) are thought to be preneoplastic lesions and are assessed by magnifying chromoscopy with methylene blue staining. The aim of this study was to evaluate the predictive value of rectal ACF recognized by conventional chromoscopy for colonic advanced neoplasms.METHODS:Total colonoscopy, involving rectal chromoscopy using indigo carmine with standard colonoscopies, was performed on 386 patients. Patients

Kazuhiro Seike; Keiji Koda; Kenji Oda; Chihiro Kosugi; Kimio Shimizu; Masaki Nishimura; Masanobu Shioiri; Shigetsugu Takano; Hiroshi Ishikura; Masaru Miyazaki

2006-01-01

280

Performing a Digital Rectal Examination on Trauma Patients Does Not Increase the Likelihood of Detecting a Spinal Cord Injury  

Microsoft Academic Search

Background: Current Advanced Trauma Life Support (ATLS) guidelines recommend a digital rectal examination (DRE) as part of the initial evaluation of all trauma patients. The finding of decreased or absent anal sphincter tone during the DRE is suggestive of spinal cord injury.\\u000aHypothesis: The primary goal of this paper was to evaluate whether or not performing a digital rectal exam

Jennifer Byrne

2009-01-01

281

Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men.  

PubMed

Rectal sexually transmitted infections (STIs) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). However, for those individuals not regularly seen by a clinician, screening for rectal STI is not currently a widespread option. Qualitative data and samples (i.e. self-obtained rectal specimens) were collected from 75 MSM in a variety of venues. Upon completion of the rectal self-sampling, each participant completed a brief interview regarding their overall experience with the process. Participants reported an overall high level of acceptability and comfort-level involved with self-sampling for rectal STI. Of the majority of men who agreed to provide a rectal self-sample, all reported that they would provide a sample again in the future. However, many men also appreciated the interaction with a health-care provider that a clinical setting offered. In conclusion, self-sampling is a feasible and acceptable option when offered to MSM in a range of community-based venues. Further research is needed to determine which combinations of STI testing and treatment methods (including self-sampling) are most appropriate for diverse groups of men. PMID:20378897

Dodge, B; Van Der Pol, B; Rosenberger, J G; Reece, M; Roth, A M; Herbenick, D; Fortenberry, J D

2010-04-01

282

Rectal arterio-portal fistula: An unusual cause of persistent bleeding per rectum following a proximal spleno-renal shunt  

PubMed Central

Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal hypertension secondary to portal vein thrombosis. The portal hypertension was initially surgically treated with splenectomy and a proximal splenorenal shunt. However, rectal bleeding persisted even after surgery, presenting us with a diagnostic dilemma. The patient was re-evaluated with a computed tomography mesenteric angiogram which revealed a rectal arterio-portal fistula. Arterio-portal fistulas are a known but rare cause of portal hypertension, and possibly the underlying cause of continued rectal bleeding in this case. This was successfully treated using angiographic localization and super-selective embolization of the rectal arterio-portal venous fistula via the right internal iliac artery.The patient subsequently went on to have a full term pregnancy. Through this case report, we hope to highlight awareness of this unusual condition, discuss the diagnostic workup and our management approach. PMID:23840157

Yap, Hao Yun; Lee, Ser Yee; Chung, Yaw Fui Alexander; Tay, Kiang Hiong; Low, Albert Su-Chong; Thng, Choon Hua; Madhavan, Krishnakumar

2013-01-01

283

Novel Parameter Predicting Grade 2 Rectal Bleeding After Iodine-125 Prostate Brachytherapy Combined With External Beam Radiation Therapy  

SciTech Connect

Purpose: To propose a novel parameter predicting rectal bleeding on the basis of generalized equivalent uniform doses (gEUD) after {sup 125}I prostate brachytherapy combined with external beam radiation therapy and to assess the predictive value of this parameter. Methods and Materials: To account for differences among radiation treatment modalities and fractionation schedules, rectal dose–volume histograms (DVHs) of 369 patients with localized prostate cancer undergoing combined therapy retrieved from corresponding treatment planning systems were converted to equivalent dose-based DVHs. The gEUDs for the rectum were calculated from these converted DVHs. The total gEUD (gEUD{sub sum}) was determined by a summation of the brachytherapy and external-beam radiation therapy components. Results: Thirty-eight patients (10.3%) developed grade 2+ rectal bleeding. The grade 2+ rectal bleeding rate increased as the gEUD{sub sum} increased: 2.0% (2 of 102 patients) for <70 Gy, 10.3% (15 of 145 patients) for 70-80 Gy, 15.8% (12 of 76 patients) for 80-90 Gy, and 19.6% (9 of 46 patients) for >90 Gy (P=.002). Multivariate analysis identified age (P=.024) and gEUD{sub sum} (P=.000) as risk factors for grade 2+ rectal bleeding. Conclusions: Our results demonstrate gEUD to be a potential predictive factor for grade 2+ late rectal bleeding after combined therapy for prostate cancer.

Shiraishi, Yutaka, E-mail: shiraishi@rad.med.keio.ac.jp [Department of Radiology, Keio University School of Medicine, Tokyo (Japan); Hanada, Takashi; Ohashi, Toshio [Department of Radiology, Keio University School of Medicine, Tokyo (Japan); Yorozu, Atsunori; Toya, Kazuhito [Department of Radiology, National Hospital Organization Tokyo Medical Center, Tokyo (Japan); Saito, Shiro [Department of Urology, National Hospital Organization Tokyo Medical Center, Tokyo (Japan); Shigematsu, Naoyuki [Department of Radiology, Keio University School of Medicine, Tokyo (Japan)

2013-09-01

284

What Is the Place of Intersphincteric Resection When Operating on Low Rectal Cancer?  

PubMed Central

Operating on low rectal cancer by performing an intersphincteric resection (ISR) with coloanal anastomosis has been adopted as an alternative to abdominoperineal excision (APE) following Schiessel et al. report in 1994, as it preserves the sphincter and avoids the need for a permanent stoma. We undertook a review of the recent literature specifically focusing on long-term oncologic and functional outcomes of ISR to evaluate whether this operation is a valid alternative to an APE. In conclusion, younger patients with T1 or T2 rectal cancers who require no preoperative therapy are ideal candidates for ISR, given that preoperative chemoradiotherapy may cause long-term severe anal dysfunction after ISR. PMID:22900203

Nagayama, Satoshi; Al-Kubati, Waheeb; Sakai, Yoshiharu

2012-01-01

285

Narrow safety range of intraoperative rectal irradiation exposure volume for avoiding bleeding after seed implant brachytherapy  

PubMed Central

Background & Purpose Rectal toxicity is less common after 125I seed implant brachytherapy for prostate cancer, and intraoperative rectal dose-volume constraints (the constraint) is still undetermined in pioneering studies. As our constraint failed to prevent grade 2 or 3 rectal bleeding (bled-pts) in 5.1% of patients, we retrospectively explored another constraint for the prevention of rectal bleeding. Materials and methods The study population consisted of 197 patients treated with the brachytherapy as monotherapy using real-time intraoperative transrectal ultrasound (US)-guided treatment at a prescribed dose of 145 Gy. Post-implant dosimetry was performed on Day 1 and Day 30 after implantation using computed tomography (CT) imaging. Rectal bleeding toxicity was classified by CTC-AE ver. 3.0 during a mean 29-month (range, 12-48 months) period after implantation. The differences in rV100s were compared among intraoperative, Day 1 and Day 30 dosimetry, and between that of patients with grade 2 or 3 rectal bleeding (the bled-pts) and of the others (the spared-pts). All patients were divided into groups based on provisional rV100s that were increased stepwise in 0.1-cc increments from 0 to 1.0 cc. The difference in the ratios of the bled-pts to the spared-pts was tested by chi-square tests, and their odds ratios were calculated (bled-OR). All statistical analyses were performed by t-tests. Results The mean values of rV100us, rV100CT_1, and rV100CT_30 were 0.31 ± 0.43, 0.22 ± 0.36, and 0.59 ± 0.68 cc, respectively. These values temporarily decreased (p = 0.020) on Day 1 and increased (p = 0.000) on Day 30. There was no significant difference in rV100s between the bled-pts and spared-pts at any time of dosimetry. The maximum bled-OR was identified among patients with an rV100us value above 0.1 cc (p = 0.025; OR = 7.8; 95% CI, 1.4-145.8); an rV100CT_1 value above 0.3 cc (p = 0.014; OR = 16.2; 95% CI, 3.9-110.7), and an rV100CT_30 value above 0.5 cc (p = 0.019; OR = 6.3; 95% CI, 1.5-42.3). Conclusion By retrospective analysis exploring rV100 as intraoperative rectal dose-volume thresholds in 125I seed implant brachytherapy for prostate cancer, it is proved that rV100 should be less than 0.1 cc for preventing rectal bleeding. PMID:22293400

2012-01-01

286

Hypothalamic, rectal, and muscle temperatures in exercising dogs - Effect of cooling  

NASA Technical Reports Server (NTRS)

An experimental investigation of the mechanisms of performance prolongation during exercise is presented. Measurements were obtained of the rectal, muscle, and hypothalamic temperature of dogs during treadmill exercise at an ambient temperature of 22 + or - 1 C, with and without cooling by use of ice packs. In comparison with exercise without cooling, exercise with cooling was found to: (1) increase exercise duration from 90 + or - 14 to 145 + or - 15 min; (2) attenuate increases in hypothalamic, rectal and muscle temperature; (3) decrease respiratory and heart rates; and (4) lower blood lactic acid content. It is shown that although significant differences were found between the brain, core, and muscle temperatures during exercise with and without cooling, an inverse relation was observed between muscle temperature and the total duration of exercise. It is suggested that sustained muscle hyperthermia may have contributed to the limitation of working ability in exercise with and without cooling.

Kruk, B.; Kaciuba-Uscilko, H.; Nazar, K.; Greenleaf, J. E.; Kozlowski, S.

1985-01-01

287

Pituitary gland metastasis from rectal cancer: report of a case and literature review.  

PubMed

Pituitary metastases are unusual complications of malignancies. In about only 2% of patients they origin from colorectal cancer (CRC), with breast and lung as the most common primary tumors. Nevertheless, some authors reported a recent increase of the incidence of metastases in infrequent sites, such as brain or bone, arising from gastrointestinal cancers, probably due to the expanded treatment options and the resulting improved survival. Here, we report the case of a 54-year old woman diagnosed with lung metastases from rectal cancer, who, after several cycles of radio- and chemotherapy, presented symptoms and signs of pituitary disfunction (i.e. diabetes insipidus, hypothyroidism and diplopy). The diagnosis of pituitary metastasis from rectal cancer was histologically confirmed after surgery. PMID:24083114

Ratti, Margherita; Passalacqua, Rodolfo; Poli, Rossana; Betri, Enrico; Crispino, Mario; Poli, Roberto; Tomasello, Gianluca

2013-01-01

288

Design of a rectal probe for diffuse optical spectroscopy imaging for chemotherapy and radiotherapy monitoring  

NASA Astrophysics Data System (ADS)

Diffuse optical spectroscopy imaging (DOSI) has shown great potential for the early detection of non-responding tumors during neoadjuvant chemotherapy in breast cancer, already one day after therapy starts. Patients with rectal cancer receive similar chemotherapy treatment. The rectum geometry and tissue properties of healthy and tumor tissue in the rectum and the requirement of surface contact impose constraints on the probe design. In this work we present the design of a DOSI probe with the aim of early chemotherapy/radiotherapy effectiveness detection in rectal tumors. We show using Monte Carlo simulations and phantom measurements that the colon tissue can be characterized reliably using a source-detector separation in the order of 10 mm. We present a design and rapid prototype of a probe for DOSI measurements that can be mounted on a standard laparoscope and that fits through a standard rectoscope. Using predominantly clinically approved components we aim at fast clinical translation.

van de Giessen, Martijn; Santoro, Ylenia; Mirzaei Zarandi, Soroush; Pigazzi, Alessio; Cerussi, Albert E.; Tromberg, Bruce J.

2014-03-01

289

Rectal leiomyosarcoma: a rare and long-term complication of radiation therapy.  

PubMed

Leiomyosarcoma of the rectum can develop as a late complication in patients with a history of pelvic irradiation. We report the case of a patient who developed rectal leiomyosarcoma 13?years after receiving radiation for treatment of a stage 2 squamous cell cancer of the anus. This was detected on physical examination. Based on a discussion with the patient, we decided to manage conservatively. Overall, leiomyosarcomas constitute 5-12% of radiation-induced sarcomas. Rectal leiomyosarcoma is rare, accounting for 0.1-0.5% of all malignant tumours of the rectum. As radiation therapy plays a major role in the management of anal cancer, it is important that clinicians are aware of the possible development of radiation-induced sarcomas that may occur decades after initial management. PMID:25315801

Futuri, Solaiman; Donohoe, Kelsey; Spaccavento, Colette; Yudelman, Ian

2014-01-01

290

Comparison of abdominal and perineal procedures for complete rectal prolapse: an analysis of 104 patients  

PubMed Central

Purpose Selecting the best surgical approach for treating complete rectal prolapse involves comparing the operative and functional outcomes of the procedures. The aims of this study were to evaluate and compare the operative and functional outcomes of abdominal and perineal surgical procedures for patients with complete rectal prolapse. Methods A retrospective study of patients with complete rectal prolapse who had operations at a tertiary referral hospital and a university hospital between March 1990 and May 2011 was conducted. Patients were classified according to the type of operation: abdominal procedure (AP) (n = 64) or perineal procedure (PP) (n = 40). The operative outcomes and functional results were assessed. Results The AP group had the younger and more men than the PP group. The AP group had longer operation times than the PP group (165 minutes vs. 70 minutes; P = 0.001) and longer hospital stays (10 days vs. 7 days; P = 0.001), but a lower overall recurrence rate (6.3% vs. 15.0%; P = 0.14). The overall rate of the major complication was similar in the both groups (10.9% vs. 6.8%; P = 0.47). The patients in the AP group complained more frequently of constipation than of incontinence, conversely, in the PP group of incontinence than of constipation. Conclusion The two approaches for treating complete rectal prolapse did not differ with regard to postoperative morbidity, but the overall recurrence tended to occur frequently among patients in the PP group. Functional results after each surgical approach need to be considered for the selection of procedure. PMID:24851226

Lee, Jong Lyul; Yang, Sung Soo; Park, In Ja; Yu, Chang Sik

2014-01-01

291

Rectal cancer staging: Correlation between the evaluation with radial echoendoscope and rigid linear probe  

PubMed Central

Background and Objectives: The National Cancer Institute estimated 40,340 new cases of rectal cancer in the United States in 2013. The correct staging of rectal cancer is fundamental for appropriate treatment of this disease. Transrectal ultrasound is considered one of the best methods for locoregional staging of rectal tumors, both radial echoendoscope and rigid linear probes are used to perform these procedures. The objective of this study is to evaluate the correlation between radial echoendoscopy and rigid linear endosonography for staging rectal cancer. Patients and Methods: A prospective analysis of 48 patients who underwent both, radial echoendoscopy and rigid linear endosonography, between April 2009 and May 2011, was done. Patients were staged according to the degree of tumor invasion (T) and lymph node involvement (N), as classified by the American Joint Committee on Cancer. Anatomopathological staging of surgical specimen was the gold standard for discordant evaluations. The analysis of concordance was made using Kappa index. Results: The general Kappa index for T staging was 0.827, with general P < 0.001 (confidence interval [CI]: 95% 0.627-1). The general Kappa index for N staging was 0.423, with general P < 0.001 (CI: 95% 0.214-0.632). Conclusion: The agreement between methods for T staging was almost perfect, with a worse outcome for T2, but still with substantial agreement. The findings may indicate equivalence in the diagnostic value of both flexible and rigid devices. For lymph node staging, there was moderate agreement between the methods. PMID:25184122

Colaiacovo, Rogerio; Assef, Mauricio Saab; Ganc, Ricardo Leite; Carbonari, Augusto Pincke Cruz; Silva, Flavio Amaro Oliveira Bitar; Bin, Fang Chia; Rossini, Lucio Giovanni Baptista

2014-01-01

292

Preoperative combined 5FU, low dose leucovorin, and sequential radiation therapy for unresectable rectal cancer  

Microsoft Academic Search

The authors performed a Phase 1 trial to determine the maximum tolerated dose of combined pre-operative radiation (5040 cGy) and 2 cycles (bolus daily [times] 5) of 5-FU and low dose LV (20 mg\\/m2), followed by surgery and 10 cycles of post-operative LV\\/5-FU in patients with unresectable primary or recurrent rectal cancer. Twelve patients were entered. The initial dose of

Bruce D. Minsky; Alfred M. Cohen; Nancy Kemeny; Warren E. Enker; David P. Kelsen; Gary Schwartz; Leonard Saltz; James Dougherty; Joanne Frankel; Jill Wiseberg

1993-01-01

293

Coupled sodium and chloride transport into plasma membrane vesicles prepared from dogfish rectal gland  

Microsoft Academic Search

A membrane fraction, rich in basal-lateral plasma membranes, was prepared from the rectal gland of the spiny dogfish,Squalus acanthias, and the uptake of22Na into the plasma membrane vesicles was investigated by a rapid filtration technique. Sodium uptake was greatest in the presence of a chloride gradient directed into the vesicles; it was strikingly reduced when chloride was replaced with nitrate

Jill Eveloff; Rolf Kinne; Eva Kinne-Saffran; Heini Murer; Patricio Silva; Franklin H. Epstein; Jeffrey Stoff; William B. Kinter

1978-01-01

294

Cavernous mesenteric lymphangiomatosis mimicking metastasis in a patient with rectal cancer: A case report  

PubMed Central

Lymphangioma usually occurs in children and usually involves the skin. Mesenteric lymphangioma is extremely rare in adults. Typically, lymphangioma appears on computed tomography (CT) as a lower attenuation of a cystic mass, however, some cases appear to be a solid mass. We describe the CT and 18F-FDG positron emission tomography/CT appearance in a case of jejunal and mesenteric cavernous lymphangiomatosis mimicking metastasis in an adult patient with rectal cancer. PMID:19701979

Hwang, Seong Su; Choi, Hyun Joo; Park, Soo Youn

2009-01-01

295

Cavernous mesenteric lymphangiomatosis mimicking metastasis in a patient with rectal cancer: a case report.  

PubMed

Lymphangioma usually occurs in children and usually involves the skin. Mesenteric lymphangioma is extremely rare in adults. Typically, lymphangioma appears on computed tomography (CT) as a lower attenuation of a cystic mass, however, some cases appear to be a solid mass. We describe the CT and 18F-FDG positron emission tomography/CT appearance in a case of jejunal and mesenteric cavernous lymphangiomatosis mimicking metastasis in an adult patient with rectal cancer. PMID:19701979

Hwang, Seong Su; Choi, Hyun Joo; Park, Soo Youn

2009-08-21

296

Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures  

Microsoft Academic Search

Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry\\u000a low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the\\u000a pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the\\u000a expected morbidity following anorectal surgery, such as bleeding, strictures

M. Pescatori; G. Gagliardi

2008-01-01

297

Rubber band ligation of hemorrhoids and rectal mucosal prolapse in constipated patients  

Microsoft Academic Search

Rubber band ligation was used in 160 patients with internal hemorrhoids; 43 of them also had rectal anterior mucosal prolapse;\\u000a 13 had prolapse alone. Two thirds of the patients underwent a single rubber band ligation and one third a double rubber band\\u000a ligation in one session without anesthesia. Ninety-four required repeated ligations. A follow-up of 25±16 months (mean ± SD)

C. Mattana; G. Maria; M. Pescatori

1989-01-01

298

Ethanol sclerotherapy of rectal venous abnormalities in Klippel–Trenaunay syndrome  

PubMed Central

Klippel–Trenaunay syndrome (KTS) is a rare congenital disorder characterized by the triad of capillary malformations, atypical venous malformations and varicosities and bony and/or soft tissue hypertrophy. We present the case of an 18-year-old man with KTS affected by haematochezia secondary to rectal venous malformations that was managed with endoscopic sclerotherapy. In this case, we compared the use of ethanol to phenol as a sclerosant. PMID:25141856

Agostinho, Nelson; Ge, Ludi; Solomon, Michael J.

2014-01-01

299

Early complications after low anterior resection for rectal cancer using the EEA TM stapling device  

Microsoft Academic Search

Complications following 178 low anterior resections for rectal carcinoma with the EEA autosuture device are reported prospectively.\\u000a The operative mortality was 2.8 percent. Clinical anastomotic leakage developed in 27 patients, but in none of the 30 patients\\u000a over 76 years of age. Two of the five hospital deaths were related to leakage. Long-term steroid treatment and previous pelvic\\u000a radiotherapy were

Henning Kold Antonsen; Ole Kronborg

1987-01-01

300

A Combined Disk Test for Direct Differentiation of Carbapenemase-Producing Enterobacteriaceae in Surveillance Rectal Swabs  

PubMed Central

Carbapenemase-producing Enterobacteriaceae (CPE) are rapidly spreading worldwide. Early detection of fecal CPE carriers is essential for effective infection control. Here, we evaluated the performance of a meropenem combined disk test (CDT) for rapidly differentiating CPE isolates directly from rectal swabs. The screening method was applied for 189 rectal swabs from hospitalized patients at high risk for CPE carriage. Swabs were suspended in 1 ml saline and cultured for confluent growth onto a MacConkey agar plate with a meropenem (MER) disk alone, a MER disk plus phenyl boronic acid (PBA), a MER disk plus EDTA, and a MER disk plus PBA and EDTA. An inhibition zone of ?25 mm around the MER disk alone indicated carriage of carbapenem-resistant organisms. Furthermore, ?5-mm differences in the inhibition zone between MER disks without and with the inhibitors (PBA, EDTA, or both) were considered positive results for detecting Klebsiella pneumoniae carbapenemase (KPC), metallo-?-lactamase (MBL), or both carbapenemases, respectively. For comparison, rectal suspensions were tested using MacConkey plates with ertapenem (MacERT) disks and PCR (PCR-S) for carbapenemase genes. Of the 189 samples, 97 were genotypically confirmed as CPE positive by one of the three protocols tested. The CDT, MacERT disks, and PCR-S assays exhibited sensitivities of 94.8%, 96.9%, and 94.8% and specificities of 100%, 98.9%, and 100%, respectively, for detecting CPE-positive swabs. Moreover, the CDT correctly differentiated the production of KPC, MBL, or both carbapenemases in 78 of the 97 (80.4%) CPE-positive rectal swabs. Our results demonstrate that the CDT may provide a simple and inexpensive method for detecting and differentiating the carbapenemase type within a single day without requiring further testing and additional delay, supporting the timely implementation of infection control measures. PMID:23843486

Zarkotou, Olympia; Poulou, Aggeliki; Kristo, Ioulia; Vrioni, Georgia; Themeli-Digalaki, Katerina; Tsakris, Athanassios

2013-01-01

301

Differential Prognostic Impact of uPA and PAI-1 in Colon and Rectal Cancer  

Microsoft Academic Search

Background and Objectives: Degradation of extracellular matrix is important for tumour growth and invasion, which in part is regulated by the plasminogen activation system. The aim of the study was to evaluate the protein expression of urokinase plasminogen activator (uPA) and plasminogen-activating inhibitor-1 (PAI-1) in plasma, tumour-free mucosa and tumour tissue regarding their prognostic value in colon and rectal cancer.

Marcus Langenskiöld; Lena Holmdahl; Eva Angenete; Peter Falk; Svante Nordgren; Marie-Louise Ivarsson

2009-01-01

302

Single incision laparoscopic surgery technique for transanal removal of rectal foreign body  

PubMed Central

A foreign body in the rectum is not a very common surgical emergency case. In the treatment of rectal foreign bodies, the aim is to use the simplest possible method while protecting the integrity of the intestine. Many removal techniques have been described in the literature. Here we report a case in which a transanal technique using a single incision laparoscopic surgery port was successfully used. PMID:24876403

Elias, Bachir; Debs, Tarek; Hage, Said; Bassile, Bashir; Hanna, Philippe; Saint Eve, Patrick

2014-01-01

303

Risk factors of late rectal bleeding after carbon ion therapy for prostate cancer  

SciTech Connect

Purpose: The aim of this study was to determine the risk factors for late gastrointestinal (GI) morbidity after hypofractionated carbon ion radiotherapy (C-ion RT) for prostate cancer. Methods and Materials: Between April 2000 and November 2003, a Phase II clinical trial of C-ion RT with a total dose of 66 GyE in 20 fractions was performed on 175 patients with prostate cancer, and the correlations of clinical and dosimetric parameters with the incidence of late GI toxicity in 172 patients who survived for more than 18 months were investigated. Results: Although no Grade 3-4 late morbidities of the rectum were observed, Grade 1 and 2 morbidities developed in 23 (13%) and 4 (2%) patients, respectively. Dose-volume histogram analysis revealed that the percentage of rectal volume receiving 50% of the prescribed dose (V50) was significantly higher in patients with rectal toxicity than without toxicity (13.2 {+-} 5.6% with toxicity; 11.4 {+-} 4.0% without toxicity, p = 0.046). Multivariate analysis demonstrated that the use of anticoagulation therapy (p = 0.010) and rectal V50 (p = 0.012) were significant risk factors for the occurrence of Grade 1-2 late GI toxicity. Conclusions: Although C-ion RT with hypofractionation yielded favorable results regarding late GI complication, dosimetric parameter was a very important factor in the occurrence of rectal bleeding after C-ion RT as well as photon beam RT. Our results provide useful information for physicians applying charged particle RT in the treatment of prostate cancer.

Ishikawa, Hitoshi [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Tsuji, Hiroshi [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan)]. E-mail: h_tsuji@nirs.go.jp; Kamada, Tadashi [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Hirasawa, Naoki [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Yanagi, Takeshi [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Mizoe, Jun-Etsu [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Akakura, Koichiro [Department of Urology, Graduate School of Medicine, Chiba University, Chiba (Japan); Suzuki, Hiroyoshi [Department of Urology, Graduate School of Medicine, Chiba University, Chiba (Japan); Shimazaki, Jun [Department of Urology, Graduate School of Medicine, Chiba University, Chiba (Japan); Tsujii, Hirohiko [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan)

2006-11-15

304

Rectal irrigation with short-chain fatty acids for distal ulcerative colitis  

Microsoft Academic Search

Colon cells from patients with ulcerative colitis utilize short-chain fatty acids inefficiently and may be exposed to decreased concentrations of these compounds. To test whether irrigation of the inflamed mucosa with short-chain fatty acids is useful, we conducted a six-week preliminary trial in 12 patients with distal colitis. Each patient used twice daily rectal irrigations with 100 ml of a

Richard I. Breuer; Stephen K. Buto; Miriam L. Christ; Judy Bean; Piero Vernia; P. Paoluzi; M. C. Di Paolo; Renzo Caprilli

1991-01-01

305

Bowel dysfunction after rectal cancer treatment: a study comparing the specialist's versus patient's perspective  

PubMed Central

Objectives To investigate how bowel dysfunction after sphincter-preserving rectal cancer treatment, known as low anterior resection syndrome (LARS), is perceived by rectal cancer specialists, in relation to the patient's experience. Design Questionnaire study. Setting International. Participants 58 rectal cancer specialists (45 colorectal surgeons and 13 radiation oncologists). Research procedure The Low Anterior Resection Syndrome Score (LARS score) is a five-item instrument for evaluation of LARS, which was developed from and validated on 961 patients. The 58 specialists individually completed two LARS score-based exercises. In Exercise 1, they were asked to select, from a list of bowel dysfunction issues, five items that they considered to disturb patients the most. In Exercise 2, they were given a list of scores to assign to the LARS score items, according to the impact on quality of life (QOL). Outcome measures In Exercise 1, the frequency of selection of each issue, particularly the five items included in the LARS score, was compared with the frequency of being selected at random. In Exercise 2, the answers were compared with the original patient-derived scores. Results Four of the five LARS score issues had the highest frequencies of selection (urgency, clustering, incontinence for liquid stool and frequency of bowel movements), which were also higher than random. However, the remaining LARS score issue (incontinence for flatus) showed a lower frequency than random. Scores assigned by the specialists were significantly different from the patient-derived scores (p<0.01). The specialists grossly overestimated the impact of incontinence for liquid stool and frequent bowel movements on QOL, while they markedly underestimated the impact of clustering and urgency. The results did not differ between surgeons and oncologists. Conclusions Rectal cancer specialists do not have a thorough understanding of which bowel dysfunction symptoms truly matter to the patient, nor how these symptoms affect QOL. PMID:24448844

Chen, Tina Yen-Ting; Emmertsen, Katrine J?ssing; Laurberg, S?ren

2014-01-01

306

Risk of Metachronous Colon Cancer Following Surgery for Rectal Cancer in Mismatch Repair Gene Mutation Carriers  

PubMed Central

Background Despite regular surveillance colonoscopy, the metachronous colorectal cancer risk for mismatch repair (MMR) gene mutation carriers after segmental resection for colon cancer is high and total or subtotal colectomy is the preferred option. However, if the index cancer is in the rectum, management decisions are complicated by considerations of impaired bowel function. We aimed to estimate the risk of metachronous colon cancer for MMR gene mutation carriers who underwent a proctectomy for index rectal cancer. Methods This retrospective cohort study comprised 79 carriers of germline mutation in a MMR gene (18 MLH1, 55 MSH2, 4 MSH6, and 2 PMS2) from the Colon Cancer Family Registry who had had a proctectomy for index rectal cancer. Cumulative risks of metachronous colon cancer were calculated using the Kaplan–Meier method. Results During median 9 years (range 1–32 years) of observation since the first diagnosis of rectal cancer, 21 carriers (27 %) were diagnosed with metachronous colon cancer (incidence 24.25, 95 % confidence interval [CI] 15.81–37.19 per 1,000 person-years). Cumulative risk of metachronous colon cancer was 19 % (95 % CI 9–31 %) at 10 years, 47 (95 % CI 31–68 %) at 20 years, and 69 % (95 % CI 45–89 %) at 30 years after surgical resection. The frequency of surveillance colonoscopy was 1 colonoscopy per 1.16 years (95 % CI 1.01–1.31 years). The AJCC stages of the metachronous cancers, where available, were 72 % stage I, 22 % stage II, and 6 % stage III. Conclusions Given the high metachronous colon cancer risk for MMR gene mutation carriers diagnosed with an index rectal cancer, proctocolectomy may need to be considered. PMID:23358792

Win, Aung Ko; Parry, Susan; Parry, Bryan; Kalady, Matthew F.; Macrae, Finlay A.; Ahnen, Dennis J.; Young, Graeme P.; Lipton, Lara; Winship, Ingrid; Boussioutas, Alex; Young, Joanne P.; Buchanan, Daniel D.; Arnold, Julie; Le Marchand, Loic; Newcomb, Polly A.; Haile, Robert W.; Lindor, Noralane M.; Gallinger, Steven; Hopper, John L.; Jenkins, Mark A.

2014-01-01

307

The Effect of Hypnosis on Systemic and Rectal Mucosal Measures of Inflammation in Ulcerative Colitis  

Microsoft Academic Search

OBJECTIVES:Hypnotherapy is effective in several diseases with a psychosomatic component. Our aim was to study the effects of one session of hypnosis on the systemic and rectal mucosal inflammatory responses in patients with active ulcerative colitis (UC).METHODS:In total, 17 patients with active UC underwent a 50-min session of gut-focused hypnotherapy. Before and after each procedure, the systemic inflammatory response was

Joel E. Mawdsley; David G. Jenkins; Marion G. Macey; Louise Langmead; David S. Rampton

2008-01-01

308

[Laparoscopic [corrected] Hartmann's reversal procedure and posterior pelvic exenteration for rectal carcinoma].  

PubMed

Hartmann's Reversal procedure is a major surgical procedure and high morbidity rates has been reported. Many institutions has begun to apply the this procedure by laparoscopy achieving low morbidity rates, due to less eventrations, wound infections and less days of hospitalization, among others. We present a case of locally advance rectal cancer that was formerly submitted to a posterior radical pelvic exenteration that received postoperative chemoradiation, followed by a laparoscopic Hartmann reversal without any complications. PMID:18641784

Pilco Castańeda, Paul

2008-01-01

309

Surgical and oncology trials for rectal cancer: who will participate? | accrualnet.cancer.gov  

Cancer.gov

Patients, surgeons, and oncologists were asked whether they would be willing to enter one of five randomized controlled trials for rectal cancer. Patients’ willingness to participate was consistently low (19%-32%). Colorectal surgeons and medical and radiation oncologists also reported low levels of potential participation. The overwhelming reason for refusing to enter each trial was a dislike of the randomization process, followed by the effect of treatment on quality of life.

310

Munchausen's syndrome presenting as rectal foreign body insertion: a case report  

PubMed Central

Background This case report shows that Munchausen's syndrome can present as rectal foreign body insertion. Although the presentation of rectal foreign bodies has frequently been described in the medical literature, the insertion of foreign bodies into the rectum for reasons other than sexual gratification has rarely been considered. Case presentation A 30 year old, unmarried Caucasian male presented with a history of having been sexually assaulted five days earlier in a nearby city by a group of unknown males. He reported that during the assault a glass bottle was forcibly inserted into his rectum and the bottle neck broke. On examination, there was no evidence of external injury to the patient. Further assessment lead to a diagnosis of Munchausen's syndrome. The rationale for this is explained. A description and summary of current knowledge about the condition is also provided, including appropriate treatment approaches. Conclusion This case report is important because assumptions regarding the motivation for insertion of foreign bodies into the rectum may lead to the diagnosis of Munchausen's syndrome being missed. This would result in the appropriate course of action, with regard to treatment, not being followed. It is suggested that clinicians consider the specific motivation for the behaviour in all cases of rectal foreign body insertion, including the possibility of factitious disorder such as Munchausen's syndrome, and avoid any assumption that it has been carried out for the purpose of sexual gratification. Early involvement of psychiatrists is recommended. Cases of Munchausen's syndrome presenting as rectal foreign body insertion may be identified and addressed more effectively using the approach described. PMID:18925957

Khan, Shakeeb A; Davey, Christine A; Khan, Shamsul A; Trigwell, Peter J; Chintapatla, Srinivas

2008-01-01

311

Rectal impalement with bladder perforation: A review from a single institution  

PubMed Central

Context: Impalement injuries of the rectum with bladder perforation have been rarely reported. Such lesions have been associated with increased postoperative morbidity. A well-conducted preoperative evaluation of the lesions tends to prevent such complications. Aims: To increase awareness about patients with rectal impalement that involve bladder injuries and to examine the significance of thorough clinical examination and complementary investigation for these patients’ management. Materials and Methods: Retrospectively, we identified three patients with rectal impalement and bladder perforation treated in University Hospital Hassan II, Fez, Morocco. We recorded the symptoms, subsequent management, and further follow-up for each patient. All available variables of published cases were reviewed and analyzed. Results: Evident urologic symptoms were present in only one patient. Bladder perforation was suspected in two other patients on the basis of anterior rectal perforation in digital exam. Retrograde uroscanner could definitely confirm the diagnosis of bladder perforation. Fecal and urine diversion was the basis of the treatment. No postoperative complications were noted. We have reviewed 14 previous reports. They are presented mainly with urine drainage through the rectum. Radiologic investigation (retrograde cystography and retrograde uroscanner) confirmed bladder perforation in 10 patients (71.4%). Unnecessary laparotomy was performed in six patients (42.8%). Fecal diversion and urinary bladder decompression using urethral catheter were the most performed procedures in bladder perforation [6/14 patients (42.8%)]. No specific postoperative complications were reported. Conclusions: A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. Meticulous preoperative assessment is the clue of successful management. PMID:24311904

Bachir Benjelloun, EI; Ahallal, Youness; Khatala, Khalid; Souiki, Tarik; Kamaoui, Iman; Taleb, Khalid Ati

2013-01-01

312

Characterization of cytokine expression in the rectal mucosa of ulcerative colitis: correlation with disease activity  

Microsoft Academic Search

OBJECTIVE: Mucosal inflammation in ulcerative colitis (UC) is presumed to be regulated by Th2-like cytokines. The aim of this study was to characterize local expression of various cytokines mRNA.METHODS: Total RNA was extracted from rectal biopsy specimens in 61 patients with UC, 18 inflammatory controls, and 16 noninflammatory controls. Reverse-transcription polymerase chain reaction (RT-PCR) was used to determine mRNA expression

Shigeo Inoue; Takayuki Matsumoto; Mitsuo Iida; Mitsuru Mizuno; Fumitoshi Kuroki; Kazunori Hoshika; Michio Shimizu

1999-01-01

313

Characterization of cytokine expression in the rectal mucosa of ulcerative colitis: correlation with disease activity  

Microsoft Academic Search

OBJECTIVE:Mucosal inflammation in ulcerative colitis (UC) is presumed to be regulated by Th2-like cytokines. The aim of this study was to characterize local expression of various cytokines mRNA.METHODS:Total RNA was extracted from rectal biopsy specimens in 61 patients with UC, 18 inflammatory controls, and 16 noninflammatory controls. Reverse-transcription polymerase chain reaction (RT-PCR) was used to determine mRNA expression of interleukin

Shigeo Inoue; Takayuki Matsumoto; Mitsuo Iida; Mitsuru Mizuno; Fumitoshi Kuroki; Kazunori Hoshika; Michio Shimizu

1999-01-01

314

Clinical and pathologic factors associated with delayed diagnosis in solitary rectal ulcer syndrome  

Microsoft Academic Search

Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.2?1. The median duration of incorrect diagnosis was five

Joe J. Tjandra; Victor W. Fazio; Robert E. Petras; Ian C. Lavery; John R. Oakley; Jeffrey W. Milsom; James M. Church

1993-01-01

315

Complete remission of a primary rectal lymphoma on ulcerative colitis, after withdrawal of azathioprine and infliximab  

Microsoft Academic Search

A 45-year-old woman was diagnosed with ulcerative colitis and treated with mesalazine, prednisone and, finally, azathioprine and infliximab. Colonoscopy revealed a rectal ulcer, identified by biopsy as a large cell B-lymphoma, positive for leukocyte common antigen (LCA), CD 20 and LMP-1 and negative for CD 3. Three months after withdrawal of all immunosuppressors, a proctocolectomy was performed. The resection specimen

Antonio López San Román; Manuel Van Domselaar; Miguel Rivero; Clara Redondo; Rosario Arribas; Antonio Rey

2008-01-01

316

Molecular Markers Predict Distant Metastases After Adjuvant Chemoradiation for Rectal Cancer  

SciTech Connect

Purpose: The outcomes of adjuvant chemoradiation for locally advanced rectal cancer are nonuniform among patients with matching prognostic factors. We explored the role of molecular markers for predicting the outcome of adjuvant chemoradiation for rectal cancer patients. Methods and Materials: The study included 68 patients with stages II to III rectal adenocarcinoma who were treated with total mesorectal excision and adjuvant chemoradiation. Chemotherapy based on 5-fluorouracil and leucovorin was intravenously administered each month for 6-12 cycles. Radiation therapy consisted of 54 Gy delivered in 30 fractions. Immunostaining of surgical specimens for COX-2, EGFR, VEGF, thymidine synthase (TS), and Raf kinase inhibitor protein (RKIP) was performed. Results: The median follow-up was 65 months. Eight locoregional (11.8%) and 13 distant (19.1%) recurrences occurred. Five-year locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates for all patients were 83.9%, 78.7%, 66.7%, and 73.8%, respectively. LRFFS was not correlated with TNM stage, surgical margin, or any of the molecular markers. VEGF overexpression was significantly correlated with decreased DMFS (P=.045), while RKIP-positive results were correlated with increased DMFS (P=.025). In multivariate analyses, positive findings for COX-2 (COX-2+) and VEGF (VEGF+) and negative findings for RKIP (RKIP-) were independent prognostic factors for DMFS, DFS, and OS (P=.035, .014, and .007 for DMFS; .021, .010, and <.0001 for DFS; and .004, .012, and .001 for OS). The combination of both COX-2+ and VEGF+ (COX-2+/VEGF+) showed a strong correlation with decreased DFS (P=.007), and the combinations of RKIP+/COX-2- and RKIP+/VEGF- showed strong correlations with improved DFS compared with the rest of the patients (P=.001 and <.0001, respectively). Conclusions: Molecular markers can be valuable in predicting treatment outcome of adjuvant chemoradiation for rectal cancer patients.

Kim, Jun Won; Kim, Yong Bae [Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)] [Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Jun Jeong [Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)] [Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Koom, Woong Sub [Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)] [Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Hoguen [Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)] [Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Nam-Kyu [Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)] [Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Ahn, Joong Bae [Department of Medical Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)] [Department of Medical Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Ikjae; Cho, Jae Ho [Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)] [Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Keum, Ki Chang, E-mail: kckeum@yuhs.ac [Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2012-12-01

317

The pharmacokinetic properties of intramuscular artesunate and rectal dihydroartemisinin in uncomplicated falciparum malaria  

PubMed Central

Aims To obtain pharmacokinetic data for artesunate (ARTS) and its active metabolite dihydroartemisinin (DHA) following i.m. ARTS and rectal DHA administration. Methods Twelve Vietnamese patients with uncomplicated falciparum malaria were randomized to receive either i.v. or i.m. ARTS (120 mg), with the alternative preparation given 8 h later in an open crossover design. A further 12 patients were given i.v. ARTS (120 mg) at 0 h and rectal DHA (160 mg) 8 h later. Results Following i.v. bolus, ARTS had a peak concentration of 42 µm (16 mg l?1), elimination t1/2 = 3.2 min, CL = 2.8 l h?1 kg?1 and V = 0.22 l kg?1. The Cmax for DHA was 9.7 µm (2.7 mg l?1), t1/2 = 59 min, CL = 0.64 l h?1 kg?1 and V = 0.8 l kg?1. Following i.m. ARTS, Cmax was 2.3 µm (3.7 mg l?1), the apparent t1/2 = 41 min, CL = 2.9 l h?1 kg?1 and V = 2.6 l kg?1. The relative bioavailability of DHA was 88%, Cmax was 4.1 µm (1.16 mg l?1) and t1/2 = 64 min. In the rectal DHA study, relative bioavailability of DHA was 16%. Conclusions For patients with uncomplicated falciparum malaria i.m. ARTS is a suitable alternative to i.v. ARTS, at equal doses. To achieve plasma DHA concentrations equivalent to parenteral administration of ARTS, rectal DHA should be given at approximately four-fold higher milligram doses. Further studies are needed to determine whether these recommendations can be applied to patients with severe malaria. PMID:11849191

Ilett, Kenneth F; Batty, Kevin T; Powell, Shane M; Binh, Tran Quang; Thu, Le Thi Anh; Phuong, Hoang Lan; Hung, Nguyen Canh; Davis, Timothy M E

2002-01-01

318

Elasmobranch rectal gland cell: autoradiographic localization of [3H]ouabain-sensitive Na, K-ATPase in rectal gland of dogfish, Squalus acanthias  

PubMed Central

Specific binding of radiolabeled inhibitor was employed to localize the Na-pump sites (Na,K-ATPase) in rectal gland epithelium, a NaCl- secreting osmoregulatory tissue which is particularly rich in pump sites. Slices of gland tissue from spiny dogfish were incubated in suitable [3H]ouabain-containing media and then prepared for Na,K-ATPase assay, measurement of radiolabel binding, or quantitative freeze-dry autoradiography at the light microscope level. Gross freezing or drying artifacts were excluded by comparison with additional aldehyde-fixed slices. Characterization experiments demonstrated high-affinity binding which correlated with Na,K-ATPase inhibition and half-saturated at approximately 5 microM [3H]ouabain. At this concentration, the normal half-loading time was approximately 1 h and low-affinity binding to nonspecific sites was negligible. Autoradiographs from both 1- and 4-h incubated slices showed approximately 85% of the bound [3H]ouabain to be localized within a 1-micrometer wide boundary region where the highly infolded basal-lateral cell membrane are closest to the mitochondria. These results establish that most of the enormous Na,K- ATPase activity associated with rectal gland epithelium is in the basal- lateral cell membrane facing interstitial fluid and not in the luminal membrane facing secreted fluid. Moreover, distribution along the basal- lateral membrane appears to be nonuniform with a higher density of enzyme sites close to mitochondria. PMID:229110

1979-01-01

319

Neoadjuvant Treatment Does Not Influence Perioperative Outcome in Rectal Cancer Surgery  

SciTech Connect

Purpose: To identify the risk factors for perioperative morbidity in patients undergoing resection of primary rectal cancer, with a specific focus on the effect of neoadjuvant therapy. Methods and Materials: This exploratory analysis of prospectively collected data included all patients who underwent anterior resection/low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and October 2006. The study endpoints were perioperative surgical and medical morbidity. Univariate and multivariate analyses of potential risk factors were performed. Results: A total of 485 patients were included in this study; 425 patients (88%) underwent a sphincter-saving anterior resection/low anterior resection, 47 (10%) abdominoperineal resection, and 13 (2%) multivisceral resection. Neoadjuvant chemoradiotherapy was performed in 100 patients (21%), and 168 (35%) underwent neoadjuvant short-term radiotherapy (5 x 5 Gy). Patient age and operative time were independently associated with perioperative morbidity, and operative time, body mass index >27 kg/m{sup 2} (overweight), and resection type were associated with surgical morbidity. Age and a history of smoking were confirmed as independent prognostic risk factors for medical complications. Neoadjuvant therapy was not associated with a worse outcome. Conclusion: The results of this prospective study have identified several risk factors associated with an adverse perioperative outcome after rectal cancer surgery. In addition, neoadjuvant therapy was not associated with increased perioperative complications.

Ulrich, Alexis [Department of Surgery, University of Heidelberg, Heidelberg (Germany); Weitz, Juergen [Department of Surgery, University of Heidelberg, Heidelberg (Germany)], E-mail: juergen_weitz@med.uni-heidelberg.de; Slodczyk, Matthias; Koch, Moritz [Department of Surgery, University of Heidelberg, Heidelberg (Germany); Jaeger, Dirk [Nationales Centrum fuer Tumorerkrankungen, University of Heidelberg, Heidelberg (Germany); Muenter, Marc [Department of Clinical Radiology, Radiooncology and Radiotherapy, University of Heidelberg, Heidelberg (Germany); Buechler, Markus W. [Department of Surgery, University of Heidelberg, Heidelberg (Germany)

2009-09-01

320

Rectal foreign bodies: A case report and review of the literature  

PubMed Central

Introduction Rectal foreign bodies (RFB) present the modern surgeon with a difficult management dilemma, as the type of object, host anatomy, time from insertion, associated injuries and amount of local contamination may vary widely. Reluctance to seek medical help and to provide details about the incident often makes diagnosis difficult. Management of these patients may be challenging, as presentation is usually delayed after multiple attempts at removal by the patients themselves have proven unsuccessful. Presentation of case In this article we report the case of a male who presented with a large ovoid rectal object wedged into his pelvis. As we were unable to extract the object with routine transanal and laparotomy approach, we performed a pubic symphysiotomy that helped widen the pelvic inlet and allow transanal extraction. Discussion We review currently available literature on RFB and propose an evaluation and management algorithm of patients that present with RFB. Conclusion Management of patients with rectal foreign bodies can be challenging and a systematic approach should be employed. The majority of cases can be successfully managed conservatively, but occasional surgical intervention is warranted. If large objects, tightly wedged in the pelvis cannot be removed with laparotomy, pubic symphysiotomy should be considered. PMID:22288061

Kasotakis, G.; Roediger, L.; Mittal, S.

2011-01-01

321

What is colitis? Statistical approach to distinguishing clinically important inflammatory change in rectal biopsy specimens.  

PubMed Central

Measurements of mucosal dimension, architecture, and cell counts in both lamina propria and epithelium were made on rectal biopsy specimens from 20 patients with irritable bowel syndrome ("normal" controls); 54 patients with ulcerative colitis, Crohn's disease, and non-specific proctitis; eight patients with small bowel Crohn's disease; and 34 in whom the rectal biopsy specimen was not diagnostic. Discriminant analysis was applied to multiple variables based on the measurements, and three variables were identified as of high predictive value. The most powerful discriminant was increased lamina propria cellularity in all forms of chronic colitis. The ratios of surface length to mucosal length and of surface epithelial height to crypt epithelial height also emerged as discriminants. Chronic inflammatory bowel disease was distinguished from normal in 95% of cases with a definite pathological diagnosis, and 85% of borderline cases were correctly classified as either normal or inflammatory when judged by the final diagnosis after follow up. This study provides a basis for automated diagnosis of rectal biopsy specimens and provides objectively validated criteria which can also be applied in routine histological diagnosis. Images Fig 2 Fig 3 Fig 4 Fig 5 PMID:3343381

Jenkins, D; Goodall, A; Drew, K; Scott, B B

1988-01-01

322

Nonreproducibility of "Snap-Frozen" Rectal Biopsies for Later Use in Ex Vivo Explant Infectibility Studies  

PubMed Central

Abstract Sexual transmission accounts for the majority of new HIV infections worldwide with sexually exposed cervicovaginal and colorectal mucosae being primary sites of infection. Two recent Phase 1 rectal microbicide trials included, as an ancillary endpoint, suppression of ex vivo HIV infection of in vivo microbicide-exposed rectal mucosal tissue biopsies. Both trials demonstrated significant suppression of biopsy infectibility in drug-exposed versus placebo-exposed tissue. This potential early biomarker of efficacy has raised the feasibility of utilizing “snap-frozen” tissue samples, acquired at multiple trial sites to be shipped for central processing, providing a mechanism to correlate tissue drug concentrations with a functional index of HIV prevention. While previous reports have indicated acceptable comparability of fresh versus freeze-thawed cervicovaginal tissue samples, no similar evaluations with colorectal tissue biopsies have been done. In this study, rectal biopsies from healthy, HIV-seronegative participants were assessed for structural integrity (histology), viability (MTT assays), and tissue infectibility to compare results from fresh versus combinations of freeze/thaw protocols. Results indicated that while all protocols showed equivalent viability with fresh samples (MTT), histology documented poor preservation of tissue integrity following freezing. Infectibility results from freeze-thawed colorectal tissue were markedly lower (usually<25% of fresh samples) and varied greatly and unpredictably. Centralized colorectal tissue infectibility assays using biopsies from remote trial sites cannot currently be supported under these protocols. PMID:22831398

McGowan, Ian; Tanner, Karen; Elliott, Julie; Ibarrondo, Javier; Khanukhova, Elena; McDonald, Charina; Saunders, Terry; Zhou, Ying

2012-01-01

323

Increased Expression of VEGF and CD31 in Postradiation Rectal Tissue: Implications for Radiation Proctitis  

PubMed Central

Background. Inflammation mediators related to radiation proctitis are partially elucidated, and neovascularization is thought to play a key role. Objectives. To investigate the expression of vascular endothelial growth factor (VEGF) and CD31 as angiogenetic markers in postradiation rectal tissue. Methods. Rectal mucosa biopsies from 11 patients who underwent irradiation for prostate cancer were examined immunohistochemically for the expression of VEGF and CD31 at three time settings—before, at the completion of, and 6 months after radiotherapy. VEGF expressing vascular endothelial cells and CD31 expressing microvessels were counted separately in 10 high-power fields (HPFs). VEGF vascular index (VEGF-VI) and microvascular density (MVD) were calculated as the mean number of VEGF positive cells per vessel or the mean number of vessels per HPF, respectively. Histological features were also evaluated. Results. VEGF-VI was significantly higher at the completion of radiotherapy (0.17 ± 0.15 versus 0.41 ± 0.24, P = 0.001) declining 6 months after. MVD increased significantly only 6 months after radiotherapy (7.3 ± 3.2 versus 10.5 ± 3.1, P < 0.005). The histopathological examination revealed inflammatory changes at the completion of radiotherapy regressing in the majority of cases 6 months after. Conclusions. Our results showed that in postradiation rectal biopsy specimens neoangiogenesis seems to be inflammation-related and constitutes a significant postradiation component of the tissue injury. PMID:23737650

Karamanolis, G.; Delladetsima, I.; Kouloulias, V.; Papaxoinis, K.; Panayiotides, I.; Haldeopoulos, D.; Triantafyllou, K.; Kelekis, N.; Ladas, S. D.

2013-01-01

324

Radiation Dose-Volume Effects in Radiation-Induced Rectal Injury  

SciTech Connect

The available dose/volume/outcome data for rectal injury were reviewed. The volume of rectum receiving >=60Gy is consistently associated with the risk of Grade >=2 rectal toxicity or rectal bleeding. Parameters for the Lyman-Kutcher-Burman normal tissue complication probability model from four clinical series are remarkably consistent, suggesting that high doses are predominant in determining the risk of toxicity. The best overall estimates (95% confidence interval) of the Lyman-Kutcher-Burman model parameters are n = 0.09 (0.04-0.14); m = 0.13 (0.10-0.17); and TD{sub 50} = 76.9 (73.7-80.1) Gy. Most of the models of late radiation toxicity come from three-dimensional conformal radiotherapy dose-escalation studies of early-stage prostate cancer. It is possible that intensity-modulated radiotherapy or proton beam dose distributions require modification of these models because of the inherent differences in low and intermediate dose distributions.

Michalski, Jeff M., E-mail: jmichalski@radonc.wustl.ed [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Gay, Hiram [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Jackson, Andrew [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Deasy, Joseph O. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States)

2010-03-01

325

Overt rectal prolapse following repair of stage IV vaginal vault prolapse.  

PubMed

Pelvic organ prolapse is an increasingly common problem as women are living longer. With the growing numbers of surgeries performed to correct this problem, further research is needed to understand the long-term success as well as possible complications of these procedures. One potential complication that needs further study is de novo rectal prolapse after repair of pelvic organ prolapse, specifically after colpocleisis. Defacography may be an important part of the preoperative workup in the patient with pelvic organ prolapse. Currently, there is a controversy as to whether internal, or occult, rectal prolapse on defacography should be repaired at the time of other pelvic reconstructive surgery. We report on a case of overt rectal prolapse after repair of Stage IV vaginal vault prolapse with a colpocleisis, levator ani plication, and a minimally invasive midurethral sling. We discuss the issues surrounding preoperative management of these patients and propose a theory explaining why prolapse in other areas of the pelvis may occur after reconstructive surgery. PMID:16799858

South, Mary; Amundsen, Cindy

2007-04-01

326

Lack of CD44 variant 6 expression in rectal cancer invasive front associates with early recurrence  

PubMed Central

AIM: To investigate the prognostic value of CD44 variant 6 (CD44v6), a membranous adhesion molecule, in rectal cancer. METHODS: Altogether, 210 rectal cancer samples from 214 patients treated with short-course radiotherapy (RT, n = 90), long-course (chemo) RT (n = 53) or surgery alone (n = 71) were studied with immunohistochemistry for CD44v6. The extent and intensity of membranous and cytoplasmic CD44v6 staining, and the intratumoral membranous staining pattern, were analyzed. RESULTS: Membranous CD44v6 expression was seen in 84% and cytoplasmic expression in 81% of the cases. In 59% of the tumors with membranous CD44v6 expression, the staining pattern in the invasive front was determined as “front-positive” and in 41% as “front-negative”. The latter pattern was associated with narrower circumferential margin (P = 0.01), infiltrative growth pattern (P < 0.001), and shorter disease-free survival in univariate survival analysis (P = 0.022) when compared to the “front-positive” tumors. CONCLUSION: The lack of membranous CD44v6 in the rectal cancer invasive front could be used as a method to identify patients at increased risk for recurrent disease. PMID:22969228

Avoranta, Suvi Tuulia; Korkeila, Eija Annika; Syrjanen, Kari Juhani; Pyrhonen, Seppo Olavi; Sundstrom, Jari Toivo Tapio

2012-01-01

327

Liver metastasis of rectal cancer with intraluminal growth in the extrahepatic bile duct.  

PubMed

Metastatic liver tumors are considered to have a tendency for expansive growth and rarely invade the bile duct. We recently encountered a resected case of liver metastasis from rectal cancer with intraluminal growth in the extrahepatic bile duct with a successful left trisegmentectomy of the liver. A 54-year-old woman underwent a posterior total pelvic exenteration for advanced rectal cancer. Ultrasonography and computed tomography four months after the first operation demonstrated a solitary occupied lesion in the liver with dilation of the left hepatic duct. Endoscopic retrograde cholangiopancreatography disclosed a filling defect in the intra- to extrahepatic bile duct. Liver metastasis from rectal cancer with intraluminal growth in the bile duct was suspected despite a consideration of primary bile duct cancer. A left trisegmentectomy of the liver and resection of the extrahepatic bile duct with a right hepatojejunostomy were performed. The tumor had invaded the intrahepatic bile duct and had developed intraluminally in the extrahepatic bile duct. Tumor thrombi were microscopically found in the bile duct of the left caudal lobe. Liver metastasis arising from colorectal cancer with intraluminal growth in the bile duct is rare, however we encountered such a case with a successful resection involving a left trisegmentectomy of the liver. PMID:14571800

Tomizawa, Naoki; Ohwada, Susumu; Tanahashi, Yoshifumi; Ikeya, Toshiro; Ito, Hideaki; Takeyoshi, Izumi; Morishita, Yasuo

2003-01-01

328

[Treatment for intrapelvic recurrence of rectal cancer--resection versus chemotherapy].  

PubMed

This retrospective study was performed to clarify problems associated with surgery for local recurrence of rectal cancer in recent years when new anticancer drugs have come out to be available. We compared the background characteristics and treatment outcomes of patients who underwent resective surgery (resection group, n=9) and those who received chemotherapy comprised of new aniticancer drugs (chemotherapy group, n=5) for intrapelvic recurrence of rectal cancer between 1997 and 2008. In the resection group, the types of surgery included were abdomino-perineal resection in 1, posterior exenteration in 4, total pelvic exenteration in 4 and 5 who underwent sacrectomy. In the chemotherapy group, chemotherapy was continued to second-line treatment in 4 patients and third-line in 1. Oxaliplatin was given to 3 patients, irinotecan to 3, and Leucovorin to 5. The two groups did not significantly differ regarding various background factors including age, sex, stage at resection of the primary lesion, and the interval between resection of the primary lesion and detection of recurrence. The overall survival period after the start of treatment for recurrence did not significantly differ between the two groups (p=0.73). Patient's selection seems to have become a more important factor for resective surgery for intrapelvic recurrence of rectal cancer in recent years when the efficacy of new anticancer drugs is expected. PMID:20037378

Ishibashi, Keiichiro; Hokama, Naoko; Ishiguro, Toru; Ohsawa, Tomonori; Okada, Norimichi; Miyazaki, Tatsuya; Yokoyama, Masaru; Inokuma, Shigehisa; Ishida, Hideyuki

2009-11-01

329

Sphincter-preserving surgery after preoperative radiochemotherapy for T3 low rectal cancers  

PubMed Central

The aim of this study was to evaluate the feasibility and the effectiveness of preoperative radiochemotherapy followed by total mesorectal excision (TME) and sphincter-preserving procedures for T3 low rectal cancer. Patients with rectal cancer and T3 tumors located within 1–6 cm of the dentate line received preoperative radiochemotherapy. Concurrent 5-fluorouracil-based radiochemotherapy was used. Radical resection with TME and sphincter-preserving procedures were performed during the six to eight weeks following radiotherapy. Survival was analyzed using the Kaplan-Meier method. The anal function was evaluated using the Wexner score. The clinical response rate was 83.5%, overall downstaging of T classification was 75.3% and pathological complete response was 15.3%. The anastomotic fistula rate was 4.7%. A median follow-up of 30 months showed the local recurrence rate to be 4.7% and the distant metastasis rate to be 5.9%. The three-year overall survival rate was 87%. The degree of anal incontinence as measured using the Wexner score decreased over time, and the anal sphincter function in the majority of patients gradually improved. Preoperative radiochemotherapy was found to improve tumor downstaging, reduces local recurrence, increase the sphincter preservation rate, and is therefore of benefit to patients with T3 low rectal cancer. PMID:22783445

BAI, XUE; LI, SHIYONG; YU, BO; SU, HONG; JIN, WEISEN; CHEN, GANG; DU, JUNFENG; ZUO, FUYI

2012-01-01

330

Sex Differences Between cT4b and pT4b Rectal Cancers  

PubMed Central

We retrospectively evaluated rectal cancer surgery cases in which resection had been performed for invasion of other organs in terms of pathologic findings from the viewpoint of sex differences. We enrolled 61 consecutive patients with rectal cancer who had undergone curative surgery with resection of invaded adjacent organs. We investigated invasion of adjacent organs in terms of pathologic findings according to sex differences. Among males, 4 cases (13.8%) had received combined radical resections of more than 2 organs, while the number of such female cases was 15 (46.9%). The difference between males and females was statistically significant (P = 0.006). Among male cases, histopathologic invasion was present in 4 (13.8%), while 9 female cases (28.1%) showed this feature. Nevertheless, there was not a statistically significant difference between males and females (P = 0.08); the rate in females was roughly twice that in males. No significant difference was recognized in the overall survival rates between males and females, but more females than males experienced local recurrence. In cases with rectal cancer invading neighboring organs, the effect of the invasion must be carefully determined, and the most appropriate operative approach selected accordingly. PMID:23971770

Komori, Koji; Kimura, Kenya; Kinoshita, Takashi; Sano, Tsuyoshi; Ito, Seiji; Abe, Tetsuya; Senda, Yoshiki; Misawa, Kazunari; Ito, Yuichi; Uemura, Norihisa; Shimizu, Yasuhiro

2013-01-01

331

Rectal cell proliferation and colon cancer risk in patients with hypergastrinaemia  

PubMed Central

Background—The influence of gastrin on the colonic mucosa is still uncertain. Some authors have suggested a stimulating effect on the growth of normal and malignant colonic epithelium, while others have shown no association between gastrin and neoplastic development. ?Aims—To evaluate the effect of gastrin on colorectal cell proliferation, patients with chronic endogenous hypergastrinaemia underwent proctoscopy. Biopsy specimens were taken in order to study rectal cell kinetics. ?Patients and controls—Ten patients with chronic autoimmune gastritis (CAG), six patients with Zollinger-Ellison syndrome (ZES), and 16 hospital controls took part in this study. Patients with CAG and ZES had basal serum gastrin concentrations significantly higher than controls (p<0.001). ?Methods—Immunohistochemistry was performed on 3 µm sections of rectal biopsy specimens incubated with 5'-bromodeoxyuridine. ?Results—The percentage of proliferating cells in the entire crypts (overall labelling index) was similar in all the groups. However, the labelling frequency in the upper two fifths of the glands (?h value) was significantly higher in patients with CAG or ZES compared with controls (p<0.01 in both patient groups versus controls). ?Conclusions—Endogenous hypergastrinaemia is associated with rectal cell proliferation defects, similar to those observed in conditions at high risk for colon cancer. The effect of the increased serum concentrations of gastrin on the colorectal mucosa after treatment with drugs inhibiting gastric acid secretion should be investigated. ?? Keywords: gastrin; cell kinetics; colon cancer; chronic autoimmune gastritis; Zollinger-Ellison syndrome PMID:9378387

Renga, M; Brandi, G; Paganelli, G; Calabrese, C; Papa, S; Tosti, A; Tomassetti, P; Miglioli, M; Biasco, G

1997-01-01

332

Age and Comorbid Illness Are Associated With Late Rectal Toxicity Following Dose-Escalated Radiation Therapy for Prostate Cancer  

SciTech Connect

Purpose: To assess the impacts of patient age and comorbid illness on rectal toxicity following external beam radiation therapy (EBRT) for prostate cancer and to assess the Qualitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) normal tissue complication probability (NTCP) model in this context. Methods and Materials: Rectal toxicity was analyzed in 718 men previously treated for prostate cancer with EBRT (?75 Gy). Comorbid illness was scored using the Charlson Comorbidity Index (CCMI), and the NTCP was evaluated with the QUANTEC model. The influence of clinical and treatment-related parameters on rectal toxicity was assessed by Kaplan-Meier and Cox proportional hazards models. Results: The cumulative incidence of rectal toxicity grade ?2 was 9.5% and 11.6% at 3 and 5 years and 3.3% and 3.9% at 3 and 5 years for grade ?3 toxicity, respectively. Each year of age predicted an increasing relative risk of grade ?2 (P<.03; hazard ratio [HR], 1.04 [95% confidence interval (CI), 1.01-1.06]) and ?3 rectal toxicity (P<.0001; HR, 1.14 [95% CI,1.07-1.22]). Increasing CCMI predicted rectal toxicity where a history of either myocardial infarction (MI) (P<.0001; HR, 5.1 [95% CI, 1.9-13.7]) or congestive heart failure (CHF) (P<.0006; HR, 5.4 [95% CI, 0.6-47.5]) predicted grade ?3 rectal toxicity, with lesser correlation with grade ?2 toxicity (P<.02 for MI, and P<.09 for CHF). An age comorbidity model to predict rectal toxicity was developed and confirmed in a validation cohort. The use of anticoagulants increased toxicity independent of age and comorbidity. NTCP was prognostic for grade ?3 (P=.015) but not grade ?2 (P=.49) toxicity. On multivariate analysis, age, MI, CHF, and an NTCP >20% all correlated with late rectal toxicity. Conclusions: Patient age and a history of MI or CHF significantly impact rectal toxicity following EBRT for the treatment of prostate cancer, even after controlling for NTCP.

Hamstra, Daniel A. [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States)] [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Stenmark, Matt H.; Ritter, Tim [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States) [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Department of Radiation Oncology, Veterans Affairs Medical Center, Ann Arbor, Michigan (United States); Litzenberg, Dale; Jackson, William; Johnson, Skyler; Albrecht-Unger, Liesel; Donaghy, Alex; Phelps, Laura; Blas, Kevin; Halverson, Schuyler; Marsh, Robin; Olson, Karin [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States)] [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Feng, Felix Y., E-mail: ffeng@med.umich.edu [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States)

2013-04-01

333

Images in medicine: Diagnosis and pre-surgical triage of transanal rectal injury using multidetector CT with water-soluble contrast enema  

PubMed Central

Transanal rectal injuries caused by foreign body insertion, sexual abuse, or iatrogenic procedures represent a very uncommon surgical emergency. Morbidity may be further increased by patient's embarrassment and delayed presentation. Since management decisions largely depend on anatomic and severity assessment, multidetector Computed tomography with rectally administered water-soluble iodinated contrast medium is highly valuable to accurately depict traumatic rectal injuries, and to distinguish between intraperitoneal vs extraperitoneal injuries that require different surgical approaches. PMID:23960381

Tonolini, Massimo

2013-01-01

334

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

PubMed Central

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 study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Methods/design Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma ? 3 cm, located between 1–15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months. Secondary outcome measures are: 2) number of days not spent in hospital from initial treatment until 2 years afterwards; 3) major and minor morbidity; 4) disease specific and general quality of life; 5) anorectal function; 6) health care utilization and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year as outcome measures. Based on comparable recurrence rates for TEM and EMR of 3.3% and considering an upper-limit of 10% for EMR to be non-inferior (beta-error 0.2 and one-sided alpha-error 0.05), 89 patients are needed per group. Discussion The TREND study is the first randomized trial evaluating whether TEM or EMR is more cost-effective for the treatment of large rectal adenomas. Trial registration number (trialregister.nl) NTR1422 PMID:19284647

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

2009-01-01

335

Pharmacokinetics and plasma concentrations of acetylsalicylic acid after intravenous, rectal, and intragastric administration to horses  

PubMed Central

Six healthy adult horses (5 mares and 1 stallion) were given a single dose of acetylsalicylic acid (ASA), 20 mg/kg of body weight, by intravenous (IV), rectal, and intragastric (IG) routes. Serial blood samples were collected via jugular venipuncture over a 36-h period, and plasma ASA and salicylic acid (SA) concentrations were determined by high-performance liquid chromatography. After IV administration, the mean elimination rate constant of ASA (± the standard error of the mean) was 1.32 ± 0.09 h?l, the mean elimination half-life was 0.53 ± 0.04 h, the area under the plasma concentration-versus-time curve (AUC) was 2555 ± 98 ?g · min/mL, the plasma clearance was 472 ± 18.9 mL/h/kg, and the volume of distribution at steady state was 0.22 ± 0.01 L/kg. After rectal administration, the plasma concentration of ASA peaked at 5.05 ± 0.80 ?g/mL at 0.33 h, then decreased to undetectable levels by 4 h; the plasma concentration of SA peaked at 17.39 ± 5.46 ?g/mL at 2 h, then decreased to 1.92 ± 0.25 ?g/mL by 36 h. After rectal administration, the AUC for ASA was 439.4 ± 94.55 ?g · min/mL and the bioavailability was 0.17 ± 0.037. After IG administration, the plasma concentration of ASA peaked at 1.26 ± 0.10 ?g/mL at 0.67 h, then declined to 0.37 ± 0.37 ?g/mL by 36 h; the plasma concentration of SA peaked at 23.90 ± 4.94 ?g/mL at 4 h and decreased to 0.85 ± 0.31 ?g/mL by 36 h. After IG administration, the AUC for ASA was 146.70 ± 24.90 ?g · min/mL and the bioavailability was 0.059 ± 0.013. Administration of a single rectal dose of ASA of 20 mg/kg to horses results in higher peak plasma ASA concentrations and greater bioavailability than the same dose given IG. Plasma ASA concentrations after rectal administration should be sufficient to inhibit platelet thromboxane production, and doses lower than those suggested for IG administration may be adequate. PMID:14620867

Broome, Ted A.; Brown, Murray P.; Gronwall, Ronald R.; Casey, Matthew F.; Meritt, Kelly A.

2003-01-01

336

Analysis of rectal Chlamydia trachomatis serovar distribution including L2 (lymphogranuloma venereum) at the Erasmus MC STI clinic, Rotterdam  

PubMed Central

Objectives Compared to urogenital infections, little is known of serovar distribution in rectal chlamydial infection. The aim of this study was to explore possible relations between demographics, sexual behaviour, clinical manifestations, rectal symptoms, and chlamydial serovars including L2 (lymphogranuloma venereum). Methods Genotyping was done prospectively in all rectal chlamydial infections since the outbreak of proctitis caused by lymphogranuloma venereum in February 2003. 33 (15.1%) rectal Chlamydia trachomatis infections from the years 2001 and 2002 were genotyped retrospectively. Results Of all 219 rectal chlamydial infections, detected in the period July 2001 to August 2005, a total of 149 (68.0%) were successfully genotyped including 21 (14.1%) infections with serovar L2. In univariable and multivariable analyses, L2 serovar positive patients were significantly more often HIV positive (p?=?0.002; OR: 6.5; 95% CI: 2.0 to 21.1), and had had sex in the past 6?months with more partners compared to other serovars. Furthermore, patients with L2 proctitis presented far more often with self reported rectal symptoms (p<0.005; OR: 19.4; 95% CI: 4.9 to 77.0) and clinical manifestations (p<0.005; OR: 15.4; 95% CI: 4.5 to 52.5). Conclusions Chlamydial infections with serovar L2 show a different clinical and epidemiological pattern compared to serovar D?K. LGV proctitis is significantly associated with HIV positivity and a high number of sexual partners and causes more rectal symptoms and clinical manifestations. Neither young age nor ethnicity were identified as risk factors for any of the serovars investigated in this study. PMID:16731669

Waalboer, R; van der Snoek, E M; van der Meijden, W I; Mulder, P G H; Ossewaarde, J M

2006-01-01

337

Smoking increases rectal cancer risk to the same extent in women as in men: results from a Norwegian cohort study  

PubMed Central

Background Smoking has recently been established as a risk factor for rectal cancer. We examined whether the smoking-related increase in rectal cancer differed by gender. Methods We followed 602,242 participants (49% men), aged 19 to 67 years at enrollment from four Norwegian health surveys carried out between 1972 and 2003, by linkage to Norwegian national registries through December 2007. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fitting Cox proportional hazard models and adjusting for relevant confounders. Heterogeneity by gender in the effect of smoking and risk of rectal cancer was tested with Wald ?2. Results During a mean follow-up of 14 years, 1,336 men and 840 women developed invasive rectal cancer. Ever smokers had a significantly increased risk of rectal cancer of more than 25% for both men (HR?=?1.27, 95% CI?=?1.11-1.45) and women (HR?=?1.28, 95%?CI?=?1.11-1.48) compared with gender-specific never smokers. Men smoking ?20 pack-years had a significantly increased risk of rectal cancer of 35% (HR?=?1.35, 95% CI?=?1.14-1.58), whereas for women, it was 47% (HR?=?1.47, 95% CI?=?1.13-1.91) compared with gender-specific never smokers. For both men and women, we observed significant dose–response associations between the risk of rectal cancer for four variables [Age at smoking initiation in years (both ptrend <0.05), number of cigarettes smoked per day (both ptrend <0.0001), smoking duration in years (ptrend <0.05, <0.0001) and number of pack-years smoked (both ptrend <0.0001)]. The test for heterogeneity by gender was not significant between smoking status and the risk of rectal cancer (Wald ?2, p -value; current smokers?=?0.85; former smokers?=?0.87; ever smokers?=?1.00). Conclusions Smoking increases the risk of rectal cancer to the same extent in women as in men. PMID:24884601

2014-01-01

338

A Multi-Compartment Single and Multiple Dose Pharmacokinetic Comparison of Rectally Applied Tenofovir 1% Gel and Oral Tenofovir Disoproxil Fumarate  

PubMed Central

This Phase 1, randomized, two-site (United States), double-blind, placebo-controlled study enrolled 18 sexually abstinent men and women. All received a single 300-mg dose of oral tenofovir disoproxil fumarate (TDF) and were then randomized 2?1 to receive single and then seven daily rectal exposures of vaginally-formulated tenofovir (TFV) 1% gel or a hydroxyethyl cellulose (HEC) placebo gel. Blood, colonic biopsies and rectal and vaginal mucosal fluids were collected after the single oral TDF, the single topical TFV gel dose, and after 7 days of topical TFV gel dosing for extracellular analysis of TFV and intracellular analysis of the active metabolite tenofovir diphosphate (TFVdp) in peripheral blood mononuclear cells (PBMCs) and isolated mucosal mononuclear cells (MMC), including CD4+ and CD4- cell subsets. With a single rectal dose, TFV plasma concentrations were 24–33 fold lower and half-life was 5 h shorter compared to a single oral dose (p?=?0.02). TFVdp concentrations were also undetectable in PBMCs with rectal dosing. Rectal tissue exposure to both TFV and TFVdp was 2 to 4-log10 higher after a single rectal dose compared to a single oral dose, and after 7 daily doses, TFVdp accumulated 4.5 fold in tissue. TFVdp in rectal tissue homogenate was predictive (residual standard error, RSE ?=?0.47) of tissue MMC intracellular TFVdp concentration, with the CD4+ cells having a 2-fold higher TFVdp concentration than CD4- cells. TFV concentrations from rectal sponges was a modest surrogate indicator for both rectal tissue TFV and TFVdp (RSE ?=?0.67, 0.66, respectively) and plasma TFV (RSE ?=?0.38). TFV penetrates into the vaginal cavity after oral and rectal dosing, with rectal dosing leading to higher vaginal TFV concentrations (p<0.01). Trial Registration ClinicalTrials.gov NCT00984971 PMID:25350119

Yang, Kuo-Hsiung; Hendrix, Craig; Bumpus, Namandje; Elliott, Julie; Tanner, Karen; Mauck, Christine; Cranston, Ross; McGowan, Ian; Richardson-Harman, Nicola; Anton, Peter A.; Kashuba, Angela D. M.

2014-01-01

339

Molecular Genetic Changes Associated With Colorectal Carcinogenesis Are Not Prognostic for Tumor Regression Following Preoperative Chemoradiation of Rectal Carcinoma  

SciTech Connect

Purpose: Preoperative chemotherapy and radiation has become the standard of care for many patients with rectal cancer. The therapy may have toxicity and delays definitive surgery. It would therefore be desirable to identify those cancers that will not regress with preoperative therapy. We assessed a series of rectal cancers for the molecular changes of loss of heterozygosity of the APC and DCC genes, K-ras mutations, and microsatellite instability, changes that have clearly been associated with rectal carcinogenesis. Methods and Materials: Diagnostic colonoscopic biopsies from 53 patients who received preoperative chemotherapy and radiation were assayed using polymerase chain reaction techniques followed by single-stranded conformation polymorphism and DNA sequencing. Regression of the primary tumor was evaluated using the surgically removed specimen. Results: Twenty-three lesions (45%) were found to have a high degree of regression. None of the molecular changes were useful as indicators of regression. Conclusions: Recognized molecular changes critical for rectal carcinogenesis including APC and DCC loss of heterozygosity, K-ras mutations, and microsatellite instability are not useful as indicators of tumor regression following chemoradiation for rectal carcinoma.

Zauber, N. Peter [Department of Medicine, Saint Barnabas Medical Center, Livingston, NJ (United States)], E-mail: pzauber@gmail.com; Marotta, Steven P.; Berman, Errol [Department of Pathology, Saint Barnabas Medical Center, Livingston, NJ (United States); Grann, Alison [Department of Radiation Oncology, Saint Barnabas Medical Center, Livingston, NJ (United States); Rao, Maithili; Komati, Naga; Ribiero, Kezia [Department of Medicine, Saint Barnabas Medical Center, Livingston, NJ (United States); Bishop, D. Timothy [Genetic Epidemiology Division, St. James's University Hospital, Leeds (United Kingdom)

2009-06-01

340

Rectal epithelial apoptosis in familial adenomatous polyposis patients treated with sulindac  

PubMed Central

BACKGROUND—Sulindac regresses colorectal adenomas in patients with familial adenomatous polyposis (FAP), although the mechanism of polyp regression is unclear.?AIMS—To determine whether differences occur in alteration of rectal epithelial apoptotic index and expression of apoptosis related proteins in FAP patients treated with sulindac compared with placebo.?PATIENTS—Twenty one FAP patients; 12 had not undergone colectomy.?METHODS—Patients with FAP were treated with sulindac 150 mg orally twice a day for three months (n=10) or placebo (n=11). Colorectal polyp number was determined and biopsies of the normal rectal mucosa were performed before and after three months of treatment. Response to treatment and alteration of the apoptotic ratio (index in base of crypt divided by index in surface epithelium) were evaluated. Bcl-2, bax, p21/WAF-1, and p53 proteins were assessed semiquantitatively by immunohistochemistry.?RESULTS—Significant decreases in polyp number and in the apoptotic ratio were seen in patients treated with sulindac compared with controls. The mean percentage change in polyp number from baseline was ?46% in the sulindac group and +13% in the placebo group (p=0.005). Mean percentage change in the apoptotic ratio was ?8% and +25% in the sulindac and placebo treated patients, respectively (p=0.004). No differences in expression or compartmentalisation of apoptosis related proteins were noted between treatment groups.?CONCLUSIONS—Sulindac regression of colorectal adenomas is accompanied by alteration of the rectal epithelial apoptotic ratio with relative increase in apoptosis in surface cells compared with the deeper crypt. The utility of the apoptotic ratio as an intermediate biomarker for colorectal tumorigenesis deserves further study.???Keywords: apoptosis; familial adenomatous polyposis; sulindac; intermediate biomarker; tumorigenesis PMID:10562579

Keller, J; Offerhaus, G; Polak, M; Goodman, S; Zahurak, M; Hylind, L; Hamilton, S; Giardiello, F

1999-01-01

341

The Quality-of-Life Effects of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer  

SciTech Connect

Purpose: Existing studies that examine the effect of neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer on patient quality of life (QOL) are limited. Our goals were to prospectively explore acute changes in patient-reported QOL endpoints during and after treatment and to establish a distribution of scores that could be used for comparison as new treatment modalities emerge. Methods and Materials: Fifty patients with locally advanced rectal cancer were prospectively enrolled at 2 institutions. Validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) and colorectal cancer-specific (EORTC QLQ-CR38 and EORTC QLQ-CR 29) QOL questionnaires were administered to patients 1 month before they began CRT, at week 4 of CRT, and 1 month after they had finished CRT. The questionnaires included multiple symptom scales, functional domains, and a composite global QOL score. Additionally, a toxicity scale was completed by providers 1 month before the beginning of CRT, weekly during treatment, and 1 month after the end of CRT. Results: Global QOL showed a statistically significant and borderline clinically significant decrease during CRT (-9.50, P=.0024) but returned to baseline 1 month after the end of treatment (-0.33, P=.9205). Symptoms during treatment were mostly gastrointestinal (nausea/vomiting +9.94, P<.0001; and diarrhea +16.67, P=.0022), urinary (dysuria +13.33, P<.0001; and frequency +11.82, P=.0006) or fatigue (+16.22, P<.0001). These symptoms returned to baseline after therapy. However, sexual enjoyment (P=.0236) and sexual function (P=.0047) remained persistently diminished after therapy. Conclusions: Rectal cancer patients undergoing neoadjuvant CRT may experience a reduction in global QOL along with significant gastrointestinal and genitourinary symptoms during treatment. Moreover, provider-rated toxicity scales may not fully capture this decrease in patient-reported QOL. Although most symptoms are transient, impairment in sexual function may persist after the completion of therapy and merits further investigation.

Herman, Joseph M., E-mail: jherma15@jhmi.edu [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Narang, Amol K. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)] [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Griffith, Kent A. [Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)] [Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Zalupski, Mark M. [Department of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)] [Department of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Reese, Jennifer B. [Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)] [Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Gearhart, Susan L. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States) [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Azad, Nolifer S. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)] [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Chan, June; Olsen, Leah [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)] [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Efron, Jonathan E. [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)] [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Lawrence, Theodore S.; Ben-Josef, Edgar [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)] [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)

2013-01-01

342

Recent Advances in the Treatment and Outcome of Locally Advanced Rectal Cancer  

PubMed Central

Objective To compare the outcomes of treatment of locally advanced rectal cancer of the early era (1975–1990) with those of the late era (1991–1997). Background Preoperative therapy has been used in locally advanced rectal cancer to preserve sphincter function, decrease local recurrence, and improve survival. At the University of Florida, preoperative radiation has been used since 1975, and it was combined with chemotherapy beginning in 1991. Methods The records of 328 patients who underwent preoperative radiation or chemoradiation followed by complete resection for locally advanced rectal cancer defined as tethered, annular, or fixed tumors were reviewed. The clinicopathologic characteristics, adjuvant treatment administered, surgical procedures performed, and local recurrence-free and overall survival rates were analyzed. Results There were 219 patients in the early era and 109 in the late era. No significant differences were seen in patients (age, gender, race) or tumor characteristics (mean distance from the anal verge, annularity, fixation). Preoperative radiation regimens were radiobiologically comparable. No patient in the early era received preoperative chemotherapy, compared with 64 in the late era. Of those receiving any pre- or postoperative chemotherapy, three patients received chemotherapy in the early era, compared with 76 in the late era. Sphincter-preserving procedures increased from 13% in the early era to 52% in the late era. Pathologic downstaging for depth of invasion increased from 42% to 58%, but lymph node negativity remained similar. The 1-, 3-, and 5-year local recurrence-free survival rates were comparable. However, in the late era, 1-, 3-, and 5-year overall survival rates improved significantly compared with those of the early era, and also compared with each of the preceding 5-year intervals. Conclusion The addition of a chemotherapy regimen to preoperative radiation therapy improves survival over radiation therapy alone. Likewise, an improvement in downstaging is associated with an increase in sphincter-preserving procedures. PMID:10235534

Vauthey, Jean-Nicolas; Marsh, Robert de W.; Zlotecki, Robert A.; Abdalla, Eddie K.; Solorzano, Carmen C.; Bray, Elizabeth J.; Freeman, Mark E.; Lauwers, Gregory Y.; Kubilis, Paul S.; Mendenhall, William M.; Copeland, Edward M.

1999-01-01

343

High-dose-rate intraluminal brachytherapy during preoperative chemoradiation for locally advanced rectal cancers  

PubMed Central

AIM: To determine the feasibility and safety of high dose rate intraluminal brachytherapy (HDR-ILBT) boost during preoperative chemoradiation for rectal cancer. METHODS: Between 2008 and 2009, thirty-six patients with locally advanced rectal cancer (? T3 or N+), were treated initially with concurrent capecitabine (825 mg/m2 oral twice daily) and pelvic external beam radiotherapy (EBRT) (45 Gy in 25 fractions), then were randomized to group A; HDR-ILBT group (n = 17) to receive 5.5-7 Gy × 2 to gross tumor volume (GTV) and group B; EBRT group (n = 19) to receive 5.4 Gy × 3 fractions to GTV with EBRT. All patients underwent total mesorectal excision. RESULTS: Grade 3 acute toxicities were registered in 12 patients (70.6%) in group A and in 8 (42.1%) in group B. Complete pathologic response of T stage (ypT0) in group A was registered in 10 patients (58.8%) and in group B, 3 patients (15.8%) had ypT0 (P < 0.0001). Sphincter preservation was reported in 6/9 patients (66.7%) in group A and in 5/10 patients (50%) in group B (P < 0.01). Overall radiological response was 68.15% and 66.04% in Group A and B, respectively. During a median follow up of 18 mo, late grade 1 and 2 sequelae were registered in 3 patients (17.6%) and 4 patients (21.1%) in the groups A and B, respectively. CONCLUSION: HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers, with higher response rates, downstaging and with manageable acute toxicities. PMID:20845511

Tunio, Mutahir Ali; Rafi, Mansoor; Hashmi, Altaf; Mohsin, Rehan; Qayyum, Abdul; Hasan, Mujahid; Sattar, Amjad; Mubarak, Muhammad

2010-01-01

344

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

PubMed Central

The role of DC-SIGN on human rectal mucosal dendritic cells is unknown. Using highly purified human rectal mucosal DC-SIGN+ cells and an ultrasensitive real-time reverse transcription-PCR assay to quantify virus binding, we found that HLA-DR+/DC-SIGN+ cells can bind and transfer more virus than the HLA-DR+/DC-SIGN? cells. Greater than 90% of the virus bound to total mucosal mononuclear cells (MMCs) was accounted for by the DC-SIGN+ cells, which comprise only 1 to 5% of total MMCs. Significantly, anti-DC-SIGN antibodies blocked 90% of the virus binding when more-physiologic amounts of virus inoculum were used. DC-SIGN expression in the rectal mucosa was significantly correlated with the interleukin-10 (IL-10)/IL-12 ratio (r = 0.58, P < 0.002; n = 26) among human immunodeficiency virus (HIV)-positive patients. Ex vivo and in vitro data implicate the role of IL-10 in upregulating DC-SIGN expression and downregulating expression of the costimulatory molecules CD80/CD86. Dendritic cells derived from monocytes (MDDCs) in the presence of IL-10 render the MDDCs less responsive to maturation stimuli, such as lipopolysaccharide and tumor necrosis factor alpha, and migration to the CCR7 ligand macrophage inflammatory protein 3?. Thus, an increased IL-10 environment could render DC-SIGN+ cells less immunostimulatory and migratory, thereby dampening an effective immune response. DC-SIGN and the IL-10/IL-12 axis may play significant roles in the mucosal transmission and pathogenesis of HIV type 1. PMID:15827191

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

2005-01-01

345

Viremia and Nasal and Rectal Shedding of Rotavirus in Gnotobiotic Pigs Inoculated with Wa Human Rotavirus  

PubMed Central

Respiratory symptoms with rotavirus shedding in nasopharyngeal secretions have been reported in children with and without gastrointestinal symptoms (Zheng et al., 1991, J. Med. Virol. 34:29-37). To investigate if attenuated and virulent human rotavirus (HRV) strains cause upper respiratory tract infections or viremia in gnotobiotic pigs, we inoculated them with attenuated or virulent HRV intranasally, intravenously, or orally or via feeding tube (gavage) and assayed virus shedding. After oral or intranasal inoculation with attenuated HRV, the pigs remained asymptomatic, but 79 to 95% shed virus nasally and 5 to 17% shed virus rectally. After inoculation by gavage, no pigs shed virus nasally or rectally, but all pigs seroconverted with antibodies to HRV. No viremia was detected through postinoculation day 10. Controls inoculated intranasally with nonreplicating rotavirus-like particles or mock inoculated did not shed virus. In contrast, 100% of pigs inoculated with virulent HRV (oral, intranasal, or gavage) developed diarrhea, shed virus nasally and rectally, and had viremia. The infectivity of sera from the viremic virulent HRV-inoculated pigs was confirmed by inoculating gnotobiotic pigs orally with pooled HRV-positive serum. Serum-inoculated pigs developed diarrhea and fecal and nasal virus shedding and seroconverted with serum and intestinal HRV antibodies. Pigs inoculated intravenously with serum or intestinal contents from the viremic virulent HRV-inoculated pigs developed diarrhea, virus shedding, and viremia, similar to the orally inoculated pigs. This study provides new evidence that virulent HRV causes transient viremia and upper respiratory tract infection in addition to gastrointestinal infection in gnotobiotic pigs, confirming previous reports of rotavirus antigenemia (Blutt et al., Lancet 362:1445-1449, 2003). Our data also suggest that intestinal infection might be initiated from the basolateral side of the epithelial cells via viremia. Additionally, virus shedding patterns indicate a different pathogenesis for attenuated versus virulent HRV. PMID:15827157

Azevedo, M. S.; Yuan, L.; Jeong, K.-I.; Gonzalez, A.; Nguyen, T. V.; Pouly, S.; Gochnauer, M.; Zhang, W.; Azevedo, A.; Saif, L. J.

2005-01-01

346

Quality of life in rectal cancer patients after radical surgery: a survey of Chinese patients  

PubMed Central

Background We aimed to investigate the impact of sociodemographic and clinical characteristics on health-related quality of life (HRQoL) in disease-free survivors after radical surgery for rectal cancer in a Chinese mainland population. Methods We performed a cross-sectional survey from August 2002 to February 2011 by use of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaires of 438 patients who underwent curative surgery for rectal cancer. Patients who were followed up for a minimum of 6 months, had no relevant major comorbidities and whose disease had not recurred were asked to complete both questionnaires. The impact of sociodemographic and clinical characteristics on HRQoL were compared by univariate and multivariate regression analyses. Results In total, 285 patients responded to the survey (response rate, 65.1%). Psychological-related HRQoL variables such as emotional function (P?=?0.021) and future perspectives (P?=?0.044) were poorer for younger patients than for older patients; and physiological-related HRQoL was reflected by physical function (P?=?0.039), which was poorer for older patients than for younger patients. In terms of physiologic function and symptoms concerning HRQoL, such as pain (P?=?0.002) and insomnia (P?=?0.018), females had lower values than males. Low education and unemployment were associated with a worse HRQoL. HRQoL was worse for patients with stomas compared to those without, especially in psychosocial areas such as role function (P?=?0.025), social function (P <0.001) and body image (P?=?0.004). Financial HRQoL was worse for younger patients and patients with stoma. Conclusions HRQoL aspects and degrees to which they were impaired after curative surgery for rectal cancer were different when compared by many sociodemographic and clinical factors in Chinese mainland patients. PMID:24886668

2014-01-01

347

Prognostic role of sensitive-to-apoptosis gene expression in rectal cancer  

PubMed Central

AIM: To investigate the association between prognosis of rectal cancer treated with chemoradiotherapy (CRT) and expression of sensitive-to-apoptosis (SAG), B-cell lymphoma-extra large (Bcl-XL) and Bcl-2 homologous antagonist/killer (Bak). METHODS: Real-time quantitative polymerase chain reaction was used to determine the expression of proteins of interest, namely SAG, Bcl-XL, Bak and ?-actin, in rectal carcinoma patients who had a follow-up period of 3 years after CRT. Biopsy specimens were excised from the rectal tumor preceding CRT. RESULTS: SAG, Bcl-XL and Bak proteins showed significant correlations with each other. In multivariate analysis, patients with high vs low SAG expression showed a statistically significant difference in 2-year survival rates: 56% vs 73%, respectively (P = 0.056). On the other hand, there were no significant correlations between the expression levels of all three genes and metastatic rates or tumor responses to CRT. Mean overall survival in the patients with elevated SAG expression was 27.1 mo ± 3.9 mo [95% confidence interval (CI): 19.3-34.9], and in patients with reduced expression, it was 32.1 mo ± 2.5 mo (95% CI: 27.3-36.9). The corresponding values for Bcl-XL were 28.0 mo ± 4.1 mo (95% CI: 19.9-36.1) and 31.7 mo ± 2.9 mo (95% CI: 26.0-37.5), and those for Bak were 29.8 mo ± 3.7 mo (95% CI: 22.5-37.2) and 30.6 mo ± 2.4 mo (95% CI: 25.5-35.0), respectively. CONCLUSION: Two-year survival rates significantly correlated with low SAG expression, and SAG may be a candidate gene for good prognosis, independent of therapeutic response of different individuals. PMID:22171132

Ozden, Sevgi A; Ozyurt, Hazan; Ozgen, Zerrin; Kilinc, Olca; Oncel, Mustafa; Gul, Aylin E; Karadayi, Nimet; Serakinci, Nedime; Kan, Beki; Orun, Oya

2011-01-01

348

Massive presacral bleeding during rectal surgery: From anatomy to clinical practice  

PubMed Central

AIM: To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system. METHODS: A retrospective review was performed in 1628 patients with middle or low rectal carcinoma who were treated surgically in the Department of Colorectal Surgery, Changhai Hospital, Shanghai, China from January 2008 to December 2012. In four of these patients, the presacral venous plexus (n = 2) or basivertebral veins (n = 2) were injured with massive presacral bleeding during mobilization of the rectum. The first two patients with low rectal carcinoma were operated upon by a junior associate professor and the source of bleeding was the presacral venous plexus. The other two patients with recurrent rectal carcinoma were both women and the source of bleeding was the basivertebral veins. RESULTS: Two different techniques were used to control the bleeding. In the first two patients with massive bleeding from the presacral venous plexus, we used suture ligation around the venous plexus in the area with intact presacral fascia that communicated with the site of bleeding (surrounding suture ligation). In the second two patients with massive bleeding from the basivertebral veins, the pelvis was packed with gauze, which resulted in recurrent bleeding as soon as it was removed. Following this, we used electrocautery applied through one epiploic appendix pressed with a long Kelly clamp over the bleeding sacral neural foramen where was felt like a pit Electrocautery adjusted to the highest setting was then applied to the clamp to “weld” closed the bleeding point. Postoperatively, the blood loss was minimal and the drain tube was removed on days 4-7. CONCLUSION: Surrounding suture ligation and epiploic appendices welding are effective techniques for controlling massive presacral bleeding from presacral venous plexus and sacral neural foramen, respectively. PMID:23840150

Lou, Zheng; Zhang, Wei; Meng, Rong-Gui; Fu, Chuan-Gang

2013-01-01

349

Patterns of Locoregional Recurrence After Surgery and Radiotherapy or Chemoradiation for Rectal Cancer  

SciTech Connect

Purpose: To identify patterns of locoregional recurrence in patients treated with surgery and preoperative or postoperative radiotherapy or chemoradiation for rectal cancer. Methods and Materials: Between November 1989 and October 2001, 554 patients with rectal cancer were treated with surgery and preoperative (85%) or postoperative (15%) radiotherapy, with 95% receiving concurrent chemotherapy. Among these patients, 46 had locoregional recurrence as the first site of failure. Computed tomography images showing the site of recurrence and radiotherapy simulation films were available for 36 of the 46 patients. Computed tomography images were used to identify the sites of recurrence and correlate the sites to radiotherapy fields in these 36 patients. Results: The estimated 5-year locoregional control rate was 91%. The 36 patients in the study had locoregional recurrences at 43 sites. There were 28 (65%) in-field, 7 (16%) marginal, and 8 (19%) out-of-field recurrences. Among the in-field recurrences, 15 (56%) occurred in the low pelvis, 6 (22%) in the presacral region, 4 (15%) in the mid-pelvis, and 2 (7%) in the high pelvis. Clinical T stage, pathologic T stage, and pathologic N stage were significantly associated with the risk of in-field locoregional recurrence. The median survival after locoregional recurrence was 24.6 months. Conclusions: Patients treated with surgery and radiotherapy or chemoradiation for rectal cancer had a low risk of locoregional recurrence, with the majority of recurrences occurring within the radiation field. Because 78% of in-field recurrences occur in the low pelvic and presacral regions, consideration should be given to including the low pelvic and presacral regions in the radiotherapy boost field, especially in patients at high risk of recurrence.

Yu, T.-K. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Bhosale, Priya R. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Crane, Christopher H. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Iyer, Revathy B. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Skibber, John M. M.D.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Eng, Cathy; Wolff, Robert A. [Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Janjan, Nora A.; Delclos, Marc E.; Krishnan, Sunil [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Das, Prajnan [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: PrajDas@mdanderson.org

2008-07-15

350

Two-marker protein profile predicts poor prognosis in patients with early rectal cancer.  

PubMed

The aim of this study was to establish an immunohistochemical protein profile to complement preoperative staging and identify rectal cancer patients at high-risk of adverse outcome. Immunohistochemistry was performed on a tissue microarray including 482 rectal cancers for APAF-1, EphB2, MST1, Ki67, p53, RHAMM, RKIP and CD8(+) tumour infiltrating lymphocytes (TILs). After resampling of the data and multivariable analysis, the most reproducible markers were combined and prognosis evaluated as stratified by pT and pN status. In multivariable analysis, only positive RHAMM (P<0.001; HR=1.94 (1.44-2.61)) and loss of CD8(+) TILs (P=0.006; HR=0.63 (0.45-0.88)) were independent prognostic factors. The 5-year cancer-specific survival rate for RHAMM+/TIL- patients was 30% (95% CI 21-40%) compared to 76% (95% CI: 66-84%) for RHAMM-/TIL+ patients (P<0.001). The 5-year cancer-specific survival of T1/T2/RHAMM+/TIL- patients was 48% (20-72%) and significantly worse compared to T3/T4/RHAMM-/TIL+ patients (71% 95% CI 56-82%); P=0.039). Stratifying by nodal status, only N+/RHAMM+/TIL- patients demonstrated a significantly worse prognosis than N0/RHAMM+/TIL- patients (P=0.005). Loss of CD8(+) TILs was predictive of local recurrence in RHAMM+ tumours (P=0.009) only. RHAMM and CD8(+) TILs may assist in identifying early stage rectal cancer patients facing a particularly poor prognosis and who may derive a benefit from preoperative therapy. PMID:18985041

Zlobec, I; Baker, K; Terracciano, L; Peter, S; Degen, L; Beglinger, C; Lugli, A

2008-11-18

351

Polo-Like Kinase 1 as Predictive Marker and Therapeutic Target for Radiotherapy in Rectal Cancer  

PubMed Central

The ability to predict tumor sensitivity toward radiotherapy may significantly impact the selection of patients for preoperative combined-modality therapy. The aim of the present study was to test the predictive value of Polo-like kinase 1 (PLK1) in rectal cancer patients and to investigate whether PLK1 plays a direct role in mediating radiation sensitivity. PLK1 expression was evaluated by immunohistochemistry (n = 76) or Affymetrix HG133 microarray (n = 20) on pretreatment biopsies of patients with advanced rectal cancer. Expression was correlated with both tumor regression in the resected specimen and long-term clinical outcome. Furthermore, we used small interfering RNAs (siRNAs) to down-regulate PLK1 expression in colorectal cancer cells and analyzed the effects of PLK1-specific siRNAs by Western blot and quantitative real-time PCR analysis, FACScan analysis, caspase 3/7 assays, and colony-forming assays. We observed that increased PLK1 protein expression was significantly related to a poorer tumor regression and a higher risk of local recurrence in uni- and multivariate analysis. A significant decrease of PLK1 expression by siRNAs in combination with ionizing radiation induced an increased percentage of apoptotic cells and increased caspase 3/7 activity. Furthermore, enhanced G2-M levels, decreased cellular viability, and reduced clonogenic survival were demonstrated, indicating a radiosensitizing effect of PLK1 depletion. Therefore, PLK1 may be a novel predictive marker for radiation response as well as a promising therapeutic target in rectal cancer patients. PMID:20581060

Rodel, Franz; Keppner, Sarah; Capalbo, Gianni; Bashary, Robina; Kaufmann, Manfred; Rodel, Claus; Strebhardt, Klaus; Spankuch, Birgit

2010-01-01

352

Tumor markers and rectal cancer: support for an inflammation-related pathway  

PubMed Central

Inflammation may be a key element in the etiology of colorectal cancer (CRC). In this study we examine associations between factors related to inflammation and specific rectal cancer mutations. A population-based study of 750 rectal cancer cases with interview and tumor DNA were compared to 1205 population-based controls. Study participants were from Utah and the Northern California Kaiser Permanente Medical Care Program. Tumor DNA was analyzed for TP53 and KRAS2 mutations and CpG Island methylator phenotype (CIMP). We assessed how these tumor markers were associated with use of anti-inflammatory drugs, polymorphisms in the IL6 genes (rs1800795 and rs1800796), and dietary antioxidants. Ibuprofen-type drugs, IL6 polymorphisms (rs1800796), and dietary alpha tocopherol and lycopene significantly altered likelihood of having a TP53 mutation. This was especially true for TP53 transversion mutations and dietary antioxidants (OR for beta carotene 0.51 95% CI 0.27,0.97, p trend 0.03; alpha tocopherol 0.41 95% CI 0.20,0.84, p trend 0.02) Beta carotene and ibuprofen significantly altered risk of KRAS2 tumors. The associations between lutein and tocopherol and TP53 and KRAS2 mutations were modified by IL6 genotype. These results suggest that inflammation-related factors may have unique associations with various rectal tumor markers. Many factors involved in an inflammation related pathway were associated with TP53 mutations and some dietary factors appeared to be modified by IL6 genotype. PMID:19452524

Slattery, Martha L.; Wolff, Roger K.; Herrick, Jennifer; Caan, Bette J.; Samowitz, Wade

2009-01-01

353

Anatomic Segmentation of the Intestinal Immune Response in Nonhuman Primates: Differential Distribution of B Cells after Oral and Rectal Immunizations to Sites Defined by Their Source of Vascularization  

Microsoft Academic Search

We show that the distribution of specific antibodies and antibody-secreting cells in the intestine after oral and rectal immunizations corresponds to the vascularization and lymph drainage patterns of the gut. Oral immunizations induce antibody responses along the parts of the intestine connected to the superior mesenteric vessels and lymph ducts, whereas rectal immunizations induce antibody responses along the parts of

KRISTINA ERIKSSON; MARIANNE QUIDING-JARBRINK; JACEK OSEK; INGER NORDSTROM; MARIA HJULSTROM; JAN HOLMGREN; CECIL CZERKINSKY

1999-01-01

354

[Postoperative management of the preserved rectal segment in patients with familial polyposis: the use of 5-fluorouracil suppositories and green tea extract to inhibit tumor growth].  

PubMed

We report the clinical details of seven patients with familial polyposis. They underwent subtotal colectomy with ileorectostomy, and were treated with 5-fluorouracil suppositories and green tea extract after surgery. Some regression of the polyps in the preserved rectal segment was observed, and no rectal cancer developed in any of these patients. PMID:9695078

Ichikawa, D; Takahashi, T; Adachi, T; Kimura, A; Shirasu, M; Matsumoto, H; Kitamura, K; Yamane, T; Yamaguchi, T

1998-06-01

355

Cytologic detection of Strongyloides stercoralis in a 55-year-old Hispanic man with routine rectal/anal pap smear.  

PubMed

The anal-rectal cytology is introduced recently to evaluate human-papillomavirus related cellular changes in the cells of anal canal. It is especially useful in high risk patients such as HIV patients. Very few reports were published regarding cytomorphological findings in anal cytology. Strongyloides stercoralis is an enteric helminthic parasite with particular significance in immunocompromised patients. The infection is asymptomatic or manifests as mild gastrointestinal symptoms in normal hosts. The infection can be devastating in immunocompromised persons, and carries a high mortality rate. The presence of S. stercoralis larva in anal-rectal pap smears is rare. We report a case in a routine anal-rectal Pap smear with Strongyloides, and discuss the clinical significance and life cycle of S. stercoralis. PMID:19582805

Zhou, Jianhong; Ferrer, Hector; Cleveland, Ronald; Ganesan, Santhi

2009-12-01

356

Role of chemotherapy in the management of primary rectal lymphoma: a case report and review of the literature  

PubMed Central

Introduction Primary rectal lymphoma is a rare disease. In this paper we present an unusual case of primary rectal lymphoma which was managed with chemotherapy and discussed by a thorough review of the related literature. Cases presentation An 85-years-male patient was diagnosed in Sidi Mohammed Ben Abdellah Hospital as having diffuse large B-cell lymphoma of the rectum at a bulky stage two. This patient was managed successfully with 8 treatment cycles of Cyclophosphamide 750 mg/m2 at day 1 of each cycle, Doxorubicin (50 mg/m2 in the first 4 cycles and 25 mg/m2 in the subsequent cycles) at day 1 of each cycle, Vincristine 1.4 mg/m2 at day 1 of each cycle, and prednisone 50 mg/m2 at day 1 to 5 of each cycle. Conclusion The optimal treatment of primary rectal lymphoma needs more research studying to be achieved. PMID:20062547

2009-01-01

357

Les tumeurs ano-rectales rares: l’endosonographie hors des sentiers battus…  

Microsoft Academic Search

\\u000a Résumé  Le carcinome épidermoďde de l’anus et l’adénocarcinome du rectum, représentent l’immense majorité des indications de l’endosonographie\\u000a en pathologie tumorale proctologique. Cela étant dit, des tumeurs ano-rectales rares ont également bénéficié de l’apport de\\u000a l’endosonographie. Il en est ainsi du mélanome malin, du lymphome malin, des tumeurs conjonctives sous-muqueuses, de la linite\\u000a plastique, de la tumeur carcinoďde, de l’hémangiome caverneux, des

V. De Parades; F. Daniel; Isabelle Etienney; P. Atienza

2006-01-01

358

Naproxen plasma levels in volunteers after single-dose administration by oral and rectal routes.  

PubMed

The bioavailability (plasma concentrations, AUC) of a rectal formulation (suppository) of naproxen was investigated in six healthy volunteers by comparison with an oral preparation (tablets). Plasma half-lives after both formulations were identical 10 hr 15 min+/-25 min (S.D.). Determined by the AUC the bioavailability of naproxen in the suppositories was 94.8%+/-6.3% of the bioavailability of naproxen in the tablets. This paper describes also a new gas-liquid chromatographic method for determining unchanged naproxen in human plasma which is quick, sensitive, and specific. PMID:1262531

Desager, J P; Vanderbist, M; Harvengt, C

1976-04-01

359

Lymphogranuloma venereum in an Italian MSM: concurrent pharyngeal and rectal infection.  

PubMed

An Italian HIV-positive man having sex with men (MSM) attended the STIs Outpatients Clinic of Sant'Orsola Hospital in Bologna complaining of anal pain and constipation. According to patient's sexual history and repertoires, NAAT testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) was performed. Pharyngeal and anal swabs resulted positive for CT DNA detection and the following molecular genotyping identified a L2 serovar, coming to the final diagnosis of pharyngeal and rectal lymphogranuloma venereum (LGV) infection. After an antibiotic therapy with doxycycline 100 mg twice a day for 3 weeks, the patient completely recovered and the test of cure was negative for LGV infection. PMID:25180857

Foschi, Claudio; Filippini, Andrea; D'Antuono, Antonietta; Compri, Monica; Macca, Francesca; Banzola, Nicoletta; Marangoni, Antonella

2014-07-01

360

Functional Results After the Orr-Loygue Transabdominal Rectopexy for Complete Rectal Prolapse  

Microsoft Academic Search

PURPOSE: The aim of this study was to assess functional results after Orr-Loygue transabdominal rectopexy for complete\\u000arectal prolapse. METHODS: Thirty-one consecutive\\u000apatients operated on for complete rectal prolapse between\\u000a1995 and 1998 were evaluated preoperatively and postoperatively\\u000awith regard to anal incontinence, constipation,\\u000aevacuation difficulties, and overall satisfaction with a standardized\\u000aquestionnaire. Anal continence assessment was\\u000abased on a

Richard Douard; Pascal Frileux; Martin Brunel; Emmanuel Attal; Emmanuel Tiret; Rolland Parc

2003-01-01

361

Feasibility study on the design of a probe for rectal cancer detection  

NASA Technical Reports Server (NTRS)

Rectal examination techniques are considered in terms of detection capability, patient acceptance, and cost reduction. A review of existing clinical techniques are considered in terms of detection capability, patient acceptance, and cost reduction. A review of existing clinical techniques and of relevant aerospace technology included evaluation of the applicability of visual, thermal, ultrasound, and radioisotope modalities of examination. The desired improvements can be obtained by redesigning the proctosigmoidoscope to have reduced size, additional visibility, and the capability of readily providing a color photograph of the entire rectosigmoid mucosa in a single composite view.

Anselm, V. J.; Frazer, R. E.; Lecroisset, D. H.; Roseboro, J. A.; Smokler, M. I.

1977-01-01

362

Assessment of pharmacokinetics and tolerability of intranasal diazepam relative to rectal gel in healthy adults.  

PubMed

Diazepam rectal gel (RG) is currently the only approved rescue therapy for outpatient management of seizure clusters in the United States. There is an unmet medical need for an alternative rescue therapy for seizure clusters that is effective, and more convenient to administer with a socially acceptable method of delivery. An intranasal diazepam formulation has been developed, and this study evaluates the tolerability and bioavailability of diazepam nasal spray (NS) relative to an equivalent dose of diazepam-RG in healthy adults. Twenty-four healthy adults were enrolled in a phase 1, open-label, 3-period crossover study. Plasma diazepam and metabolite concentrations were measured by serial sampling. Dose proportionality for 5- and 20-mg intranasal doses and the bioavailability of 20mg diazepam-NS relative to 20mg diazepam-RG were assessed by maximum plasma concentration (Cmax) and systemic exposure parameters (AUC0-? and AUC0-24). The mean Cmax values for 20mg diazepam-NS and 20mg diazepam-RG were 378 ± 106 and 328 ± 152 ng/mL, achieved at 1.0 and 1.5h, respectively. Subjects administered intranasal and rectal gel formulations experienced nasal and rectal leakage, respectively. Diazepam absorption following intranasal administration was consistent but 3 subjects with diazepam-RG had low plasma drug levels at the earliest assessment of 5 min, due to poor retention, and were excluded from analysis. Excluding them, the treatment ratios (20mg diazepam-NS:20mg diazepam-RG) and 90% confidence intervals for diazepam Cmax and AUC0-24 were 0.98 (0.85-1.14) and 0.89 (0.80-0.98), respectively, suggesting that the bioavailability was comparable between the two formulations. Dose proportionality was observed between the lowest and highest dose-strengths of intranasal formulation. Both intranasal and rectal treatments were well tolerated with mild to moderate adverse events. Results suggest that a single-dose of 20mg diazepam-NS is tolerable and comparable in bioavailability to that of diazepam-RG. The intranasal formulation may provide caregivers and patients with a more socially acceptable and convenient alternative rescue therapy in the acute treatment of seizure clusters. PMID:24934774

Henney, Herbert R; Sperling, Michael R; Rabinowicz, Adrian L; Bream, Gary; Carrazana, Enrique J

2014-09-01

363

Use of Surgical Procedures and Adjuvant Therapy in Rectal Cancer Treatment  

PubMed Central

Objective To assess the use of surgical procedures by tumor location and compliance with adjuvant therapy recommendations by tumor stage. The study was conducted in a population-based setting to identify target patient groups for improved care. Summary Background Data Rectal cancer therapy potentially involves similar patients receiving different treatments. Low anterior resection (LAR), sparing the anal sphincter, and abdominoperineal resection (APR), ablating the anal sphincter, offer equivalent local recurrence and survival rates but may differ in quality of life measurements. The 1990 NIH Consensus Conference recommended that patients with stage II and III rectal cancer receive radiation and chemotherapy in conjunction with surgical resection, but this is not uniformly applied. To interpret the use of these therapies, information on tumor location in the rectum, which is rarely known in population-based studies, is necessary. Patient, hospital, or surgeon characteristics may influence which procedure is performed and whether adjuvant therapy is given. Methods Information about primary, invasive rectal adenocarcinomas diagnosed between 1994 to 1996 in 13 California counties was obtained from the regional cancer registry. Tumor location, determined from abstracted medical text, was divided into the upper, middle, and lower rectum. Hospitals were characterized by teaching status, number of beds, and cancer center designation. Surgeons were categorized as general or colorectal surgeons. Factors associated with a higher use of LAR versus APR in patients with middle and lower rectum tumors and factors associated with a higher use of NIH-recommended therapy in patients with stage II and III disease were separately analyzed. Results Among 637 eligible patients, APR was used in 22% of those with middle rectum tumors and 55% of those with lower rectum tumors. Factors significantly associated with a higher use of LAR included female gender, middle rectum location, and treatment in a major teaching hospital versus a nonteaching hospital. Recommended therapy was received by 44% of patients with stage II disease and 60% of those with stage III disease. Factors significantly associated with higher compliance with NIH recommendations included age younger than 60 versus older than 75, age 60 to 75 years versus older than 75, tumor location in the middle or lower rectum versus the upper rectum, stage III disease, and treatment at a teaching hospital versus a nonteaching hospital. Conclusions Patients with similar rectal cancers receive different treatments independent of tumor stage or location. This may result in more APRs performed for middle and lower rectum tumors than necessary and less adequate treatment for stage II and III tumors than recommended. PMID:11685027

Schroen, Anneke T.; Cress, Rosemary D.

2001-01-01

364

Tolerability of Combined Modality Therapy for Rectal Cancer in Elderly Patients Aged 75 Years and Older  

SciTech Connect

Purpose: To determine the rate of treatment deviations during combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Methods and Materials: We reviewed the records of consecutively treated patients with rectal cancer aged 75 years and older treated with combined modality therapy at Massachusetts General Hospital and Brigham and Women's Hospital from 2002 to 2007. The primary endpoint was the rate of treatment deviation, defined as a treatment break, dose reduction, early discontinuation of therapy, or hospitalization during combined modality therapy. Patient comorbidity was rated using the validated Adult Comorbidity Evaluation 27 Test (ACE-27) comorbidity index. Fisher's exact test and the Mantel-Haenszel trend test were used to identify predictors of treatment tolerability. Results: Thirty-six eligible patients had a median age of 79.0 years (range, 75-87 years); 53% (19/36) had no or mild comorbidity and 47% (17/36) had moderate or severe comorbidity. In all, 58% of patients (21/36) were treated with preoperative chemoradiotherapy (CRT) and 33% (12/36) with postoperative CRT. Although 92% patients (33/36) completed the planned radiotherapy (RT) dose, 25% (9/36) required an RT-treatment break, 11% (4/36) were hospitalized, and 33% (12/36) had a dose reduction, break, or discontinuation of concurrent chemotherapy. In all, 39% of patients (14/36) completed {>=}4 months of adjuvant chemotherapy, and 17% (6/36) completed therapy without a treatment deviation. More patients with no to mild comorbidity completed treatment than did patients with moderate to severe comorbidity (21% vs. 12%, p = 0.66). The rate of deviation did not differ between patients who had preoperative or postoperative CRT (19% vs. 17%, p = 1.0). Conclusions: The majority of elderly patients with rectal cancer in this series required early termination of treatment, treatment interruptions, or dose reductions. These data suggest that further intensification of combined modality therapy for rectal cancer should be performed with caution in elderly patients, who require aggressive supportive care to complete treatment.

Margalit, Danielle N. [Harvard Radiation Oncology Program, Boston, MA (United States); Mamon, Harvey J. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States); Ancukiewicz, Marek; Kobayashi, Wendy [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Ryan, David P.; Blaszkowsky, Lawrence S.; Clark, Jeffrey [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Hong, Theodore S., E-mail: tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

2011-12-01

365

Using dose-surface maps to predict radiation-induced rectal bleeding: a neural network approach  

NASA Astrophysics Data System (ADS)

The incidence of late-toxicities after radiotherapy can be modelled based on the dose delivered to the organ under consideration. Most predictive models reduce the dose distribution to a set of dose-volume parameters and do not take the spatial distribution of the dose into account. The aim of this study was to develop a classifier predicting radiation-induced rectal bleeding using all available information on the dose to the rectal wall. The dose was projected on a two-dimensional dose-surface map (DSM) by virtual rectum-unfolding. These DSMs were used as inputs for a classification method based on locally connected neural networks. In contrast to fully connected conventional neural nets, locally connected nets take the topology of the input into account. In order to train the nets, data from 329 patients from the RT01 trial (ISRCTN 47772397) were split into ten roughly equal parts. By using nine of these parts as a training set and the remaining part as an independent test set, a ten-fold cross-validation was performed. Ensemble learning was used and 250 nets were built from randomly selected patients from the training set. Out of these 250 nets, an ensemble of expert nets was chosen. The performances of the full ensemble and of the expert ensemble were quantified by using receiver-operator-characteristic (ROC) curves. In order to quantify the predictive power of the shape, ensembles of fully connected conventional neural nets based on dose-surface histograms (DSHs) were generated and their performances were quantified. The expert ensembles performed better than or equally as well as the full ensembles. The area under the ROC curve for the DSM-based expert ensemble was 0.64. The area under the ROC curve for the DSH-based expert ensemble equalled 0.59. This difference in performance indicates that not only volumetric, but also morphological aspects of the dose distribution are correlated to rectal bleeding after radiotherapy. Thus, the shape of the dose distribution should be taken into account when a predictive model for radiation-induced rectal bleeding is developed.

Buettner, Florian; Gulliford, Sarah L.; Webb, Steve; Partridge, Mike

2009-09-01

366

Rectal Dieulafoy Lesions: A Rare Etiology of Chronic Lower Gastrointestinal Bleeding  

PubMed Central

Dieulafoy lesion is rarely seen, yet it can be life-threatening. This lesion makes up to 1-2% of gastrointestinal bleedings and must definitely be considered in gastrointestinal bleedings whose source cannot be identified. In this case study, the 75-year-old woman was suffering from active, fresh, and massive rectal bleeding. Colonoscopy was applied in order to find out the source of bleeding. In the typical endoscopic appearance of the lesion a single round mucosal defect in the rectum and arterial bleeding were observed. To procure hemostasis, epinephrine was injected into the lesion and the bleeding vein was sutured. PMID:25349614

Dogan, Ugur; Gomceli, Ismail; Koc, Umit; Habibi, Mani; Bulbuller, Nurullah

2014-01-01

367

Population Pharmacokinetics of Artesunate and Dihydroartemisinin following Intra-Rectal Dosing of Artesunate in Malaria Patients  

PubMed Central

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 moderately severe malaria were recruited in two Phase II studies (12 adults from Southeast Asia and 11 children from Africa) with intensive sampling protocols, and three Phase III studies (44 children from Southeast Asia, and 86 children and 26 adults from Africa) with sparse sampling. All patients received 10 mg/kg artesunate as a single intra-rectal dose of suppositories. Venous blood samples were taken during a period of 24 h following dosing. Plasma artesunate and dihydroartemisinin (DHA, the main biologically active metabolite) concentrations were measured by high-performance liquid chromatography with electrochemical detection. The pharmacokinetic properties of DHA were determined using nonlinear mixed-effects modelling. Artesunate is rapidly hydrolysed in vivo to DHA, and this contributes the majority of antimalarial activity. For DHA, a one-compartment model assuming complete conversion from artesunate and first-order appearance and elimination kinetics gave the best fit to the data. The mean population estimate of apparent clearance (CL/F) was 2.64 (l/kg/h) with 66% inter-individual variability. The apparent volume of distribution (V/F) was 2.75 (l/kg) with 96% inter-individual variability. The estimated DHA population mean elimination half-life was 43 min. Gender was associated with increased mean CL/F by 1.14 (95% CI: 0.36–1.92) (l/kg/h) for a male compared with a female, and weight was positively associated with V/F. Larger V/Fs were observed for the patients requiring early rescue treatment compared with the remainder, independent of any confounders. No associations between the parasitological responses and the posterior individual estimates of V/F, CL/F, and AUC0–6h were observed. Conclusions The pharmacokinetic properties of DHA were affected only by gender and body weight. Patients with the lowest area under the DHA concentration curve did not have slower parasite clearance, suggesting that rectal artesunate is well absorbed in most patients with moderately severe malaria. However, a number of modelling assumptions were required due to the large intra- and inter-individual variability of the DHA concentrations. PMID:17132053

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

2006-01-01

368

Development of a rectal nicotine delivery system for the treatment of ulcerative colitis.  

PubMed

The aims of this investigation were: i. to develop a rectal nicotine delivery system with bioadhesives for the treatment of ulcerative colitis and ii. to evaluate nicotine transport and cytotoxicity of the delivery system using Caco-2 cell culture systems. Rectal nicotine suppository formulations were prepared in semi-synthetic glyceride bases (Suppocire AM and AI, Gattefosse Inc.) by fusion method. The in vitro release of nicotine was carried out in modified USP dissolution apparatus 1. Differential scanning calorimetry (DSC) and powder X-ray diffraction were used to study the polymorphic changes if any in the formulations. An LC method was used for the assay of nicotine. The effect of bioadhesives (glyceryl monooleate (GMO), and Carbopol) on the nicotine flux was evaluated using Caco-2 cell permeability studies and Caco-2 cell viability was determined using the MTT toxicity assay. In vitro release studies indicated that the low melting AI base was superior to that of the AM base. Presence of GMO in the formulation enhanced the release of nicotine whereas Carbopol showed an opposite effect. The enhanced release of nicotine in the presence of GMO was found to be partly due to the melting point lowering effect of this compound. Caco-2 cell absorption studies showed that there was a decrease in the flux of nicotine in the presence of both the bioadhesives. The flux of the fluorescein marker which is used to study the integrity of the cell monolayers was found to be slightly higher only in the presence of 10% (w/w) Carbopol. Nicotine, Carbopol, and GMO do not have any cytotoxic effect on these cell monolayers within the concentration range used in the formulations. Rectal nicotine formulations containing bioadhesives were developed and characterized. Both in vitro release and cell culture studies have indicated that one can manipulate the nicotine release from these rectal delivery systems by incorporation of various bioadhesives or the use of different bases in the formulation. Nicotine concentration below 2% (w/v) and bioadhesive concentration below 10% (w/w) do not have any cytotoxic effect on Caco-2 cells. PMID:10528093

Dash, A K; Gong, Z; Miller, D W; Huai-Yan, H; Laforet, J

1999-11-10

369

Learning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma  

PubMed Central

Accurate preoperative staging of rectal carcinoma is essential for optimal treatment. This study was designed to evaluate the accuracy and learning curve of endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. We retrospectively analyzed the records of patients with rectal carcinoma who underwent preoperative ERUS followed by curative surgery at the Shanxi Province Tumor Hospital between January, 2007 and March, 2010. The patients were divided into three groups, namely A, B and C, depending on whether the examination was performed between January and December, 2007, between January and December, 2008 or between January, 2009 and March, 2010, respectively. Five physicians with no prior experience in ERUS performed the examinations. We compared the ERUS staging with the pathological findings using the tumor-node-metastasis (TNM) classification. The accuracy of ERUS in T and N staging after each additional consecutive 20 patients was calculated for physicians D, E and F. A total of 319 patients underwent ERUS prior to surgery. There were 38 patients in group A, 135 in group B and 146 in group C. Two of the five physicians performed only 47 of the 319 examinations, whereas the remaining 272 patients were examined by physicians D (n=162), E (n=64) and F (n=46). The overall accuracy in assessing the extent of rectal wall invasion (T) was 67%, with 16% of the cases overstaged and 17% understaged and the accuracy in assessing nodal involvement (N) was 66%, with 11% of the cases overstaged and 23% understaged. The total T and N staging accuracy of physicians D, E and F was 75 and 72%; 59 and 59%; and 50 and 52%, respectively. For physicians D, E and F, the accuracy of T and N staging after each additional 20 patients was calculated and the curve of the accuracy reached a plateau after physician D completed 80 cases. Therefore, ERUS is a valuable tool for assessing the depth of tumor invasion and it appears that after ~80 cases a physician may be considered able to apply it efficiently.

LIU, ZUO-LIANG; ZHOU, TONG; LIANG, XIAO-BO; MA, JUN-JIE; ZHANG, GUANG-JUN

2014-01-01

370

Gangrene of the penis, scrotum, and perineum, occurred after radiotherapy of rectal cancer  

PubMed Central

We present a case of a 58-year-old man hospitalized because of gangrene of the penis and scrotum, after radiochemotherapy for rectal cancer. At the time of the admission the patient presented with extensive gangrene with necrosis affecting the scrotum and the penis. During the first day of hospitalization the patient was operated. Due to the progress of the disease he had to be operated again. The status of the patient, which initially was very bad, was gradually improving. He was discharged from the hospital after 59 days in a good general state with good wound healing. PMID:24707380

Zyczkowski, Marcin; Bryniarski, Piotr; Nowakowski, Krzysztof; Muskala, Bartosz; Paradysz, Andrzej

2013-01-01

371

Caecal schwannoma: a rare cause of per rectal bleeding in a 72-year-old man.  

PubMed

The presence of per rectal (PR) bleeding in elderly people usually alerts us to the possibility of colonic malignancy, particularly if a concomitant altered bowel habit is present, without a history of the symptom. We present a case where the cause of PR bleeding turned out to be a caecal schwannoma. Caecal schwannoma is a rare tumour of the gastrointestinal tract of mesenchymal origin and diagnosis prior to radical surgical resection is difficult. Endoscopic biopsy often fails to provide an adequate specimen and immunohistochemistry is essential to the diagnosis. PMID:25312892

Dickson-Lowe, Richard A; James, Christopher L; Bailey, Charles Mh; Abdulaal, Yasser

2014-01-01

372

Palatine tonsillar metastasis of rectal adenocarcinoma: a case report and literature review  

PubMed Central

Cases of primary colorectal adenocarcinoma metastasized to the palatine tonsil are extremely rare. To the best of our knowledge, only 10 cases have thus far been previously documented in the English literature. A 37-year-old Chinese woman presented with a right palatine tonsil swelling and odynophagia 5 months after a surgical resection of rectal adenocarcinoma was performed. The patient underwent a tonsillectomy, and a metastatic poorly differentiated adenocarcinoma from a colorectal origin was revealed by immunohistochemical analysis. The manner in which tonsillar metastases are involved remains unknown and should be further studied. Here, we report a new case, briefly summarize these 10 cases and review the literature. PMID:23705669

2013-01-01

373

Complete remission of a primary rectal lymphoma on ulcerative colitis, after withdrawal of azathioprine and infliximab.  

PubMed

A 45-year-old woman was diagnosed with ulcerative colitis and treated with mesalazine, prednisone and, finally, azathioprine and infliximab. Colonoscopy revealed a rectal ulcer, identified by biopsy as a large cell B-lymphoma, positive for leukocyte common antigen (LCA), CD 20 and LMP-1 and negative for CD 3. Three months after withdrawal of all immunosuppressors, a proctocolectomy was performed. The resection specimen contained an area of B-cell polymorphic hyperplasia, but no residual tumour. The patient remains well after 2 years of follow-up, without any further antineoplastic therapy. PMID:21172197

López San Román, Antonio; Van Domselaar, Manuel; Rivero, Miguel; Redondo, Clara; Arribas, Rosario; Rey, Antonio

2008-03-01

374

Short-term effects of neoadjuvant chemoradiation therapy on anorectal function in rectal cancer patients: a pilot study  

PubMed Central

Background Neoadjuvant chemoradiation therapy followed by curative surgery has gained acceptance as the therapy of choice in locally advanced rectal cancer. However, deterioration of anorectal function after long-course neoadjuvant chemoradiation therapy combined with surgery for rectal cancer is poorly defined. The aim of this study was to evaluate the physiological and clinical change of anorectal function after neoadjuvant chemoradiation therapy for rectal cancer. Methods We analyzed 30 patients on whom preoperative anorectal manometry data were available both before and after chemoradiation from October 2010 to September 2011. All patients underwent long-course neoadjuvant chemoradiation therapy. We compared manometric parameters between before and after neoadjuvant chemoradiation therapy. Results Of 30 patients, 20 were males and 10 females. The mean age was 64.9?±?9.9 years (range, 48-82). Before nCRT, the rectal compliance was higher in patients with ulceroinfiltrative type (P?=?0.035) and greater involvement of luminal circumference (P?=?0.017). However, there was the tendency of increased rectal sensory threshold for desire to defecate when the patient had decreased circumferential ratio of the tumor (P?=?0.099), down-graded T stage (P?=?0.016), or reduced tumor volume (P?=?0.063) after neoadjuvant chemoradiation. Conclusions Neoadjuvant chemoradiation therapy did not significantly impair overall sphincter function before radical operation. The relationship between tumor response of chemoradiation and sensory threshold for desire to defecate may suggest that neoadjuvant chemoradiation may be helpful for defecatory function as well as local disease control, at least in the short-term period after the radiation in locally advanced rectal cancer patients. PMID:23961877

2013-01-01

375

A Genetically Determined Dose-Volume Histogram Predicts for Rectal Bleeding among Patients Treated With Prostate Brachytherapy  

SciTech Connect

Purpose: To examine whether possession of genetic alterations in the ATM (ataxia telangiectasia) gene is associated with rectal bleeding in a dose-dependent and volume-dependent manner. Methods and Materials: One hundred eight prostate cancer patients who underwent brachytherapy using either an {sup 125}I implant, a {sup 103}Pd implant, or the combination of external beam radiotherapy with a {sup 103}Pd implant and had a minimum of 1 year follow-up were screened for DNA sequence variations in the 62 coding exons of the ATM gene using denaturing high-performance liquid chromatography. Rectal dose was reported as the volume (in cubic centimeters) of rectum receiving the brachytherapy prescription dose. The two-sided Fisher exact test was used to compare differences in proportions. Results: A significant correlation between the presence of any ATM sequence alteration and Grade 1 to 2 proctitis was obtained when the radiation dose to rectal tissue was quantified. Rectal bleeding occurred in 4 of 13 patients (31%) with a variant versus 1 of 23 (4%) without a genetic alteration for patients who had <0.7 cm{sup 3} of rectal tissue receiving the implant prescription dose (p = 0.05). Of patients in whom 0.7-1.4 cm{sup 3} of the rectum received the implant prescription, 4 of 11 (36%) with an ATM alteration exhibited Grade 1 to 2 proctitis, whereas 1 of 21 (5%) without a variant (p = 0.04) developed this radiation-induced late effect. Conclusions: The possession of genetic variants in the ATM gene is associated with the development of radiation-induced proctitis after prostate cancer radiotherapy for patients who receive the full prescription dose to either a low or a moderate volume of rectal tissue.

Cesaretti, Jamie A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)]. E-mail: jamie.cesaretti@msnyuhealth.org; Stock, Richard G. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Atencio, David P. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Peters, Sheila A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Peters, Christopher A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Burri, Ryan J. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Stone, Nelson N. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Rosenstein, Barry S. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY (United States); Department of Dermatology, Mount Sinai School of Medicine, New York, NY (United States); Department of Radiation Oncology, New York University School of Medicine, New York, NY (United States)

2007-08-01

376

Circulating Cell-Free DNA: A Promising Marker of Pathologic Tumor Response in Rectal Cancer Patients Receiving Preoperative Chemoradiotherapy  

Microsoft Academic Search

Purpose  The circulating cell-free DNA (cfDNA) in plasma has been reported to be a marker of cancer detection. The aim of this study\\u000a was to investigate whether the cfDNA has a role as response biomarker in patients receiving preoperative chemoradiotherapy\\u000a (CRT) for rectal cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Sixty-seven patients (median age 61 years; male\\/female 42\\/25) who underwent CRT for rectal cancer were evaluated. After tumor

Marco Agostini; Salvatore Pucciarelli; Maria Vittoria Enzo; Paola Del Bianco; Marta Briarava; Chiara Bedin; Isacco Maretto; Maria Luisa Friso; Sara Lonardi; Claudia Mescoli; Paola Toppan; Emanuele Urso; Donato Nitti

377

Phased surgical treatment of barium enema-induced rectal injury and retention of barium in the pelvic floor space  

PubMed Central

Iatrogenic injuries caused by barium enema are rarely reported. Following a phased surgical protocol for up to one year, we have successfully treated a patient with rectal injury and severe infection of the pelvic floor space complicated with retention of large amounts of barium and vaginal fistula. In this article, the phased surgery planning for the treatment of rectal injury complicated with vaginal fistula is discussed in terms of the pros and cons, and the observed effect and evolution of barium retained in the pelvic floor space are described. PMID:25405155

Yang, Xuefei; Xia, Ligang; Huang, Jun; Wang, Jianping

2014-01-01

378

Clinical and functional outcome of laparoscopic posterior rectopexy (Wells) for full-thickness rectal prolapse. A prospective study  

Microsoft Academic Search

Background  Laparoscopic rectopexy offers the advantages of the open transabdominal approach while decreasing the surgical comorbidity.\\u000a The aim of this prospective study was to assess the clinical and functional outcome of laparoscopic Wells procedure for full-thickness\\u000a rectal prolapse.\\u000a \\u000a \\u000a \\u000a Methods  Between 1999 and 2005, 77 patients underwent laparoscopic modified Wells procedure for full-thickness rectal prolapse. The\\u000a patients were evaluated postoperatively for resolution of

Jean-Louis Dulucq; Pascal Wintringer; Ahmad Mahajna

2007-01-01

379

A Meta-Analysis of Quality of Life for Abdominoperineal Excision of Rectum versus Anterior Resection for Rectal Cancer  

Microsoft Academic Search

Background  Avoiding a permanent stoma following rectal cancer excision is believed to improve quality of life (QoL), but evidence from\\u000a comparative studies is contradictory. The aim of this study was to compare QoL following abdominoperineal excision of rectum\\u000a (APER) with that after anterior resection (AR) in patients with rectal cancer.\\u000a \\u000a \\u000a \\u000a Methods  A literature search was performed to identify studies published between 1966

Julie A. Cornish; Henry S. Tilney; Alexander G. Heriot; Ian C. Lavery; Victor W. Fazio

2007-01-01

380

Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence  

Microsoft Academic Search

Background  Anal inspection and digital rectal examination are routinely performed in fecal incontinent patients but it is not clear to\\u000a what extent they contribute to the diagnostic work-up. We examined if and how findings of anal inspection and rectal examination\\u000a are associated with anorectal function tests and endoanal ultrasonography.\\u000a \\u000a \\u000a \\u000a Methods  A cohort of fecal incontinent patients (n=312, 90% females; mean age 59)

Annette C. Dobben; Maaike P. Terra; Marije Deutekom; Michael F. Gerhards; A. Bart Bijnen; Richelle J. F. Felt-Bersma; Lucas W. M. Janssen; Patrick M. M. Bossuyt; Jaap Stoker

2007-01-01

381

Methylenetetrahydrofolate reductase genetic polymorphisms and toxicity to 5-FU-based chemoradiation in rectal cancer  

PubMed Central

Background: There is a large degree of variation in tumour response and host toxicities associated with neoadjuvant chemoradiation for rectal cancer patients. We performed a complimentary pharmacogenetic study to investigate germline polymorphisms of genes involved in 5-fluorouracil (5-FU) and irinotecan pathways and their potential association with clinical outcomes and toxicities from neoadjuvant chemoradiation in patients with rectal cancer treated in a prospective genotype-directed study. Methods: The germline DNA of 131 patients was genotyped for 10 variants in TYMS, MTHFR, DPYD, UGT1A1, ABCC1 and SLCO1B1 genes. Ninety-six patients were treated with 5-FU/radiotherapy (RT) and 35 received 5-FU/RT/irinotecan. Relationships between genetic variants and adverse events, tumour response, overall and disease-free survivals were assessed. Results: MTHFR 1298A>C and MTHFR diplotypes (for 677C>T and 1298A>C) were associated with chemoradiation-related toxicity when 5-FU was used alone. MTHFR haplotypes (677C–1298C) and diplotypes (CA–TA and TA–TA) showed, respectively, a protective and a negative effect on the incidence of severe diarrhoea or mucositis. No association was observed between genetic markers and drug response. Conclusion: MTHFR polymorphisms can potentially predict toxicity in patients treated with 5-FU as a single chemotherapeutic drug. PMID:22045187

Thomas, F; Motsinger-Reif, A A; Hoskins, J M; Dvorak, A; Roy, S; Alyasiri, A; Myerson, R J; Fleshman, J W; Tan, B R; McLeod, H L

2011-01-01

382

Functional outcome after perineal stapled prolapse resection for external rectal prolapse  

PubMed Central

Background A new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up. Methods From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour® Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores. Results 32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (P < 0.0001). No new incidence of constipation was reported. Conclusions The PSP is an elegant, fast and safe procedure, with good functional results. Trial registration ISRCTN68491191 PMID:20205956

2010-01-01

383

The impact of surgically induced ischaemia on protein levels in patients undergoing rectal cancer surgery  

PubMed Central

The goal of targeted therapy has driven a search for markers of prognosis and response to adjuvant therapy. The surgical resection of a solid tumour induces tissue ischaemia and acidosis, both potent mediators of gene expression. This study investigated the impact of colorectal cancer (CRC) surgery on prognostic and predictive marker levels. Tumour expression of thymidylate synthase, thymidine phosphorylase, cyclin A, vascular endothelial growth factor (VEGF), carbonic anhydrase-9, hypoxia inducible factor-1?, and glucose transporter-1 (GLUT-1) proteins was determined before and after rectal cancer surgery. Spectral imaging of tissue sections stained by immunohistochemistry provided quantitative data. Surgery altered thymidylate synthase protein expression (P=0.02), and this correlated with the change in the proliferation marker cyclin A. The expression of hypoxia inducible factor-1?, VEGF, and GLUT-1 proteins was also different following surgery. Colorectal cancer surgery significantly impacts on intratumoral gene expression, suggesting archival specimens may not accurately reflect in situ marker levels. Although rectal cancer was the studied model, the results may be applicable to any solid tumour undergoing extirpation in which molecular markers have been proposed to guide patient therapy. PMID:17016487

Atkin, G K; Daley, F M; Bourne, S; Glynne-Jones, R; Northover, J M A; Wilson, G D

2006-01-01

384

Probiotics for Rectal Volume Variation During Radiation Therapy for Prostate Cancer  

SciTech Connect

Purpose: To investigate the effect of the probiotic Lactobacillus acidophilus on the percentage volume change of the rectum (PVC{sub R}), a crucial factor of prostate movement. Methods and Materials: Prostate cancer patients managed with tomotherapy as a radical treatment were enrolled in the study to take a probiotic capsule containing 1.0 × 10{sup 8} colony-forming units of L acidophilus or a placebo capsule twice daily. Radiation therapy was performed at a dose of 78 Gy in 39 fractions. The PVC{sub R}, defined as the difference in rectal volume between the planning computed tomographic (CT) and daily megavoltage CT images, was analyzed. Results: Forty patients were randomized into 2 groups. The L acidophilus group showed significantly lower median rectal volume and median PVC{sub R} values than the placebo group. L acidophilus showed a significant reduction effect on the PVC{sub R} (P<.001). However, the radiation therapy fraction number did not significantly influence the PVC{sub R}. Conclusions: L acidophilus was useful in reducing the PVC{sub R}, which is the most important determining factor of prostate position, during radiation therapy for prostate cancer.

Ki, Yongkan [Department of Radiation Oncology, Pusan National University School of Medicine, Busan (Korea, Republic of); Kim, Wontaek, E-mail: rokwt@hanmail.net [Department of Radiation Oncology, Pusan National University School of Medicine, Busan (Korea, Republic of); Nam, Jiho; Kim, Donghyun; Lee, Juhye; Park, Dahl; Jeon, Hosang [Department of Radiation Oncology, Pusan National University School of Medicine, Busan (Korea, Republic of); Ha, Honggu; Kim, Taenam [Department of Urology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Kim, Dongwon [Department of Radiation Oncology, Pusan National University School of Medicine, Busan (Korea, Republic of)

2013-11-15

385

Simultaneous Laparoscopic Anterior Resection and Left Hepatic Lobectomy for Stage IV Rectal Cancer  

PubMed Central

We report the case of a 68-year-old female patient affected by rectal cancer and a synchronous metastatic lesion measuring 8cm in diameter in the left hepatic lobe. After a laparoscopic ultrasonography exploration of the liver to detect possible occult metastases, a simultaneous colorectal resection and a left hepatic lobectomy including a partial resection of segment IV were performed. Five ports were used for the entire procedure. The resected specimens were extracted through a Pfannenstiel incision. The procedure was completed laparoscopically. Total operative time was 455 minutes with negligible intraoperative blood loss. The postoperative hospital stay was 12 days. At 4-month follow-up, the patient recovered completely. A computed tomography scan performed at this time showed no signs of recurrent disease. This report confirms the feasibility of the laparoscopic approach to simultaneous hepatic and colorectal resections in stage IV rectal cancer. The known advantages of the mini-invasive approach could make such complex procedures more endurable. PMID:21333199

Famiglietti, Federico; Andorno, Enzo; Di Domenico, Stefano; Ferrari, Chiara; Valente, Professor Umberto

2010-01-01

386

Restaging locally advanced rectal cancer with MR imaging after chemoradiation therapy.  

PubMed

In recent years, preoperative therapy has become standard procedure for locally advanced rectal cancer. Tumor shrinkage due to preoperative chemotherapy-radiation therapy (CRT) is now a reality, and pathologically complete responses are not uncommon. Some researchers are now addressing organ preservation, thus increasing the demand for both functional and morphologic radiologic evaluation of response to CRT to distinguish responding from nonresponding tumors. On magnetic resonance (MR) images, post-CRT tumor morphologic features and volume changes have a high positive predictive value but a low negative predictive value for assessing response. Preliminary results indicate that diffusion-weighted MR imaging, especially at high b values, would be effective for prediction of treatment outcome and for early detection of tumor response. Some authors have reported that the use of apparent diffusion coefficient values in combination with other MR imaging criteria significantly improves discrimination between malignant and benign lymph nodes. Sequential determination of fluorodeoxyglucose uptake at positron emission tomography/computed tomography has proved useful in differentiating responding from nonresponding tumors during and at the end of CRT. However, radionuclide techniques have limitations, such as low spatial resolution and high cost. Large studies will be needed to verify the most effective morphologic and functional imaging modalities for post-CRT restaging of rectal cancer. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.303095085/-/DC1. PMID:20462989

Barbaro, Brunella; Vitale, Renata; Leccisotti, Lucia; Vecchio, Fabio M; Santoro, Luisa; Valentini, Vincenzo; Coco, Claudio; Pacelli, Fabio; Crucitti, Antonio; Persiani, Roberto; Bonomo, Lorenzo

2010-05-01

387

Predicting the pathological features of the mesorectum before the laparoscopic approach to rectal cancer.  

PubMed

Pelvic anatomy and tumour features play a role in the difficulty of the laparoscopic approach to total mesorectal excision in rectal cancer. The aim of the study was to analyse whether these characteristics also influence the quality of the surgical specimen. We performed a prospective study in consecutive patients with rectal cancer located less than 12 cm from the anal verge who underwent laparoscopic surgery between January 2010 and July 2013. Exclusion criteria were T1 and T4 tumours, abdominoperineal resections, obstructive and perforated tumours, or any major contraindication for laparoscopic surgery. Dependent variables were the circumferential resection margin (CMR) and the quality of the mesorectum. Sixty-four patients underwent laparoscopic sphincter-preserving total mesorectal excision. Resection was complete in 79.1 % of specimens and CMR was positive in 9.7 %. Univariate analysis showed tumour depth (T status) (P = 0.04) and promontorium-subsacrum angle (P = 0.02) independently predicted CRM (circumferential resection margin) positivity. Tumour depth (P < 0.05) and promontorium-subsacrum axis (P < 0.05) independently predicted mesorectum quality. Multivariate analysis identified the promontorium-subsacrum angle (P = 0.012) as the only independent predictor of CRM. Bony pelvis dimensions influenced the quality of the specimen obtained by laparoscopy. These measurements may be useful to predict which patients will benefit most from laparoscopic surgery and also to select patients in accordance with the learning curve of trainee surgeons. PMID:24950725

Fernández Ananín, Sonia; Targarona, Eduardo M; Martinez, Carmen; Pernas, Juan Carlos; Hernández, Diana; Gich, Ignasi; Sancho, Francesc J; Trias, Manuel

2014-12-01

388

Microwave prostatic hyperthermia: Interest of urethral and rectal applicators combination -- Theoretical study and animal experimental results  

SciTech Connect

Microwave thermotherapy systems used for benign prostatic hyperplasia treatment generally operate with urethral or rectal applicator to deliver the microwave energy in the prostate. This technique does not allow an efficient heating of all the gland particularly in the case of large adenoma or when the treatment is limited to only one heating session. A solution to this problem is given by using simultaneously the rectal and urethral applicators. A complete 915-MHz microwave thermotherapy system is presented with two applicators which can operate independently or simultaneously to deliver the microwave energy in the prostate. Electromagnetic and thermal modeling have been developed for the applicator antenna optimization, to calculate the specific absorption rate (SAR) and the thermal pattern in the prostate for each applicator alone and when they operate together in phase. Different canine experiments have been performed to prove the interest of using the two applicators simultaneously as compared when they operate alone. Histological examination cuts of the prostate gland after heating have been carried out.

Despretz, D.; Camart, J.C.; Michel, C.; Fabre, J.J. [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France)] [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France); Prevost, B. [Centre Oscar Lambret, Lille (France)] [Centre Oscar Lambret, Lille (France); Sozanski, J.P. [INSERM, Lille (France)] [INSERM, Lille (France); Chive, M. [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France)] [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France); [INSERM, Lille (France)

1996-10-01

389

The role of autofluorescence colonoscopy in diagnosis and management of solitary rectal ulcer syndrome  

NASA Astrophysics Data System (ADS)

Solitary rectal ulcer syndrome (SRUS) is a chronic disease of the rectum. Although SRUS is a benign condition there are studies which suggest that chronic ischaemia which occurs in the SRUS may lead to "transitional mucosa" that is similar to that adjacent to colorectal carcinomas and adenomas and may lead to colorectal dysplasia and carcinoma development. The exclusion of primary or metastatic malignancy is the most important aim in the differential diagnosis of SRUS. In our study we assess the possibilities of autofluorescence colonoscopy (AFC) in diagnosis and management of SRUS. We performed white light colonoscopy first. The tissue samples were taken for pathological examination. When SRUS was histopathologically confirmed AFC was performed by means of Xillix OncoLIFE. During AFC numerical colour value (NCV) of autofluorescence of SRUS lesions was noted. During 1946 colonoscopies eight persons were diagnosed as having solitary rectal ulcer syndrome. We did not observe autofluorescence increase in case of polipoid and flat ulcer lesions (NCV 0,39-0,67; mean 0,525) and little increase of autofluorescence in case of erythema lesion (NCV- 0,94). SRUS is a rare disorder of the rectum but it causes differential diagnosis problems. The most common reason for incorrect diagnosis are inadequate tissue specimens. AFC allows to reveal subtle areas within the lesions of more intense autofluorescence and localizes the potential cancer-transformating dysplasia. In this way the most representative area with highest risk of pre- or cancerous changes, for biopsy specimen is indicated.

Latos, W.; Kawczyk-Krupka, A.; Ledwon, A.; Kosciarz-Grzesiok, A.; Misiak, A.; Sieron-Stoltny, K.; Sieron, A.

2008-02-01

390

Evaluation of Rectal Dose During High-Dose-Rate Intracavitary Brachytherapy for Cervical Carcinoma  

SciTech Connect

High-dose-rate intracavitary brachytherapy (HDR-ICBT) for carcinoma of the uterine cervix often results in high doses being delivered to surrounding organs at risk (OARs) such as the rectum and bladder. Therefore, it is important to accurately determine and closely monitor the dose delivered to these OARs. In this study, we measured the dose delivered to the rectum by intracavitary applications and compared this measured dose to the International Commission on Radiation Units and Measurements rectal reference point dose calculated by the treatment planning system (TPS). To measure the dose, we inserted a miniature (0.1 cm{sup 3}) ionization chamber into the rectum of 86 patients undergoing radiation therapy for cervical carcinoma. The response of the miniature chamber modified by 3 thin lead marker rings for identification purposes during imaging was also characterized. The difference between the TPS-calculated maximum dose and the measured dose was <5% in 52 patients, 5-10% in 26 patients, and 10-14% in 8 patients. The TPS-calculated maximum dose was typically higher than the measured dose. Our study indicates that it is possible to measure the rectal dose for cervical carcinoma patients undergoing HDR-ICBT. We also conclude that the dose delivered to the rectum can be reasonably predicted by the TPS-calculated dose.

Sha, Rajib Lochan [Department of Radiation Physics, Indo-American Cancer Institute and Research Centre, Hyderabad (India); Department of Physics, Osmania University, Hyderabad (India); Reddy, Palreddy Yadagiri [Department of Physics, Osmania University, Hyderabad (India); Rao, Ramakrishna [Department of Radiation Physics, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad (India); Muralidhar, Kanaparthy R. [Department of Radiation Physics, Indo-American Cancer Institute and Research Centre, Hyderabad (India); Kudchadker, Rajat J., E-mail: rkudchad@mdanderson.org [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2011-01-01

391

Absorption enhancement of rectally infused cefoxitin by medium chain monoglycerides in conscious rats.  

PubMed

The enhancing effect of the medium chain monoglycerides glyceryl-1-monoctanoate (GMO), glyceryl-1-monodecanoate (GMD), and glyceryl-1-monododecanoate (GMDD) on rectal absorption of the cephalosporin antibiotic cefoxitin [(6R,7S)-3-hydroxymethyl)-7-methoxy-8-oxo-7-[2-(2-thienyl)acetamido]-5- thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid carbamate (ester)] was investigated in unanesthetized rats. Rectal infusion of 3 mg of cefoxitin sodium without monoglyceride resulted in a mean bioavailability of 31 +/- 18% and a mean residence time (MRT) of 134 +/- 44 min. Coadministration with 53% (w/w) GMO significantly enhanced cefoxitin absorption, resulting in a mean bioavailability of 84 +/- 11% and a mean MRT of 75 +/- 8 min. In a lower concentration, GMD (13% w/w) also significantly promoted cefoxitin bioavailability to 68 +/- 14% and reduced MRT to 70 +/- 11 min. With GMDD only, a trend of increasing bioavailability with increasing monoglyceride concentration was observed, which may be explained by its limited aqueous solubility. Concerning the action of GMO and GMD, the longer monoglyceride is, in terms of effective concentration, more potent in enhancing the extent and rate of cefoxitin absorption. However, a further increase in chain length results in a loss of effect, indicating that the effect of monoglycerides on drug absorption may be determined by their intrinsic absorption enhancing action and solubility. PMID:3236226

Watanabe, Y; van Hoogdalem, E J; de Boer, A G; Breimer, D D

1988-10-01

392

Agreement between auricular and rectal measurements of body temperature in healthy cats.  

PubMed

Measurement of body temperature is a routine part of the clinical assessment of a patient. However, this procedure may be time-consuming and stressful to most animals because the standard site of temperature acquisition remains the rectal mucosa. Although an increasing number of clinicians have been using auricular temperature to estimate core body temperature, evidence is still lacking regarding agreement between these two methods in cats. In this investigation, we evaluated the agreement between temperatures measured in the rectum and ear in 29 healthy cats over a 2-week period. Temperatures were measured in the rectum (using digital and mercury-in-glass thermometers) and ear once a day for 14 consecutive days, producing 406 temperature readings for each thermometer. Mean temperature and confidence intervals were similar between methods, and Bland-Altman plots showed small biases and narrow limits of agreement acceptable for clinical purposes. The interobserver variability was also checked, which indicated a strong correlation between two near-simultaneous temperature readings. Results are consistent with auricular thermometry being a reliable alternative to rectal thermometry for assessing core body temperature in healthy cats. PMID:23090330

Sousa, Marlos G; Carareto, Roberta; Pereira-Junior, Valdo A; Aquino, Monally C C

2013-04-01

393

Performance of chromID® CARBA medium for carbapenemases-producing Enterobacteriaceae detection during rectal screening.  

PubMed

Chromogenic chromID® CARBA medium was compared with CDC method and MacConkey agar with imipenem for its performance in detecting carbapenemase-producing Enterobacteriaceae (CPE) during a faecal screening surveillance program. Double rectal swabs were collected from patients hospitalized in the ICU. One swab was inoculated onto the solid media chromID® CARBA and MacConkey agar with imipenem, while the other was tested according to CDC protocol. Suspected colonies from all procedures were identified to species level and tested for their susceptibility to carbapenems by phenotypic tests. All carbapenem non-susceptible isolates were tested by the modified Hodge test (MHT) and synergy tests. Positive results were confirmed by PCR testing for carbapenemase gene detection. Performance of all three procedures applied was statistically analyzed as compared to MHT and PCR results for the presence of carbapenemase-encoding genes. Out of 177 rectal samples tested, 86 samples were found to contain one or more CPE verified by molecular detection of carbapenemase encoding genes among isolated Enterobacteriaceae. Sensitivity of chromID® CARBA was 96.5 % in clinical samples. Specificity was 91.2 % at the reading level and 100.0 % after Gram staining. chromID® CARBA performed with high accuracy among the phenotypic methods applied, giving early results. PMID:23912722

Papadimitriou-Olivgeris, M; Bartzavali, C; Christofidou, M; Bereksi, N; Hey, J; Zambardi, G; Spiliopoulou, I

2014-01-01

394

Local Recurrence in Rectal Cancer: Anatomic Localization and Effect on Radiation Target  

SciTech Connect

Purpose: To determine the sites of local recurrence after total mesorectal excision for rectal cancer in an effort to optimize the radiation target. Methods and Materials: A total of 155 patients with recurrence after abdominal resection for rectal cancer were identified from a population-based consecutive cohort of 2,315 patients who had undergone surgery by surgeons trained in the total mesorectal excision procedure. A total of 99 cross-sectional imaging studies were retrieved and re-examined by one radiologist. The clinical records were examined for the remaining patients. Results: Evidence of residual mesorectal fat was identified in 50 of the 99 patients. In 83 patients, local recurrence was identified on the imaging studies. All recurrences were within the irradiated volume if the patients had undergone preoperative radiotherapy or within the same volume if they had not. The site of recurrence was in the lower 75% of the pelvis, anatomically below the S1-S2 interspace for all patients. Only 5 of the 44 recurrences in patients with primary tumors >5 cm from the anal verge were in the lowest 20% of the pelvis. Six recurrences involved the lateral lymph nodes. Conclusion: These data suggest that a lowering of the upper limit of the clinical target volume could be introduced. The anal sphincter complex with surrounding tissue could also be excluded in patients with primary tumors >5 cm from the anal verge.

Syk, Erik [Department of Surgery, Ersta Hospital, Stockholm (Sweden); Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm (Sweden)], E-mail: Erik.Syk@erstadiakoni.se; Torkzad, Michael R.; Blomqvist, Lennart [Department of Diagnostic Radiology, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm (Sweden); Nilsson, Per J. [Department of Surgery, Ersta Hospital, Stockholm (Sweden); Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm (Sweden); Glimelius, Bengt [Department of Oncology and Pathology, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm (Sweden); Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala, Uppsala (Sweden)

2008-11-01

395

Multidisciplinary treatment of rectal cancer in 2014: Where are we going?  

PubMed Central

In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended. The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.

Vignali, Andrea; De Nardi, Paola

2014-01-01

396

COX-2 verexpression in pretreatment biopsies predicts response of rectal cancers to neoadjuvant radiochemotherapy  

SciTech Connect

Purpose: To determine the utility of COX-2 expression as a response predictor for patients with rectal cancer who are undergoing neoadjuvant radiochemotherapy (RCT). Methods and Materials: Pretreatment biopsies (PTB) from 49 patients who underwent RCT were included. COX-2 and proliferation in PTB were assessed by immunohistochemistry (IHC) and apoptosis was detected by TUNEL stain. Response to treatment was assessed by a 5-point tumor-regression grade (TRG) based on the ratio of residual tumor to fibrosis. Results: Good response (TRG 1 + 2), moderate response (TRG 3), and poor response (TRG 4 + 5) were seen in 21 patients (42%), 11 patients (22%), and 17 patients (34%), respectively. Patients with COX-2 overexpression in PTB were more likely to demonstrate moderate or poor response (TRG 3 + 4) to treatment than were those with normal COX-2 expression (p = 0.026, chi-square test). Similarly, poor response was more likely if patients had low levels of spontaneous apoptosis in PTBs (p = 0.0007, chi-square test). Conclusions: COX-2 overexpression and reduced apoptosis in PTB can predict poor response of rectal cancer to RCT. As COX-2 inhibitors are commercially available, their administration to patients who overexpress COX-2 warrants assessment in clinical trials in an attempt to increase overall response rates.

Smith, Fraser M. [Departments of Surgery and Histopathology, and Academic Unit of Clinical and Molecular Oncology, St. James's Hospital, Dublin (Ireland); Reynolds, John V. [Departments of Surgery and Histopathology, and Academic Unit of Clinical and Molecular Oncology, St. James's Hospital, Dublin (Ireland)]. E-mail: reynoldsjv@stjames.ie; Kay, Elaine W. [Department of Histopathology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin (Ireland); Crotty, Paul [Department of Histopathology, Adelaide and Meath Hospital, Tallaght, Dublin (Ireland); Murphy, James O. [Departments of Surgery and Histopathology, and Academic Unit of Clinical and Molecular Oncology, St. James's Hospital, Dublin (Ireland); Hollywood, Donal [Departments of Surgery and Histopathology, and Academic Unit of Clinical and Molecular Oncology, St. James's Hospital, Dublin (Ireland); Gaffney, Eoin F. [Departments of Surgery and Histopathology, and Academic Unit of Clinical and Molecular Oncolo