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Sample records for rectal contrast medium

  1. Contrast medium usage reduction in abdominal computed tomography by using high-iodinated concentration contrast medium

    NASA Astrophysics Data System (ADS)

    Suwannasri, A.; Kaewlai, R.; Asavaphatiboon, S.

    2016-03-01

    This study was to determine if administration of a low volume high-concentration iodinated contrast medium can preserve image quality in comparison with regular-concentration intravenous contrast medium in patient undergoing contrast-enhancement abdominal computed tomography (CT). Eighty-four patients were randomly divided into 3 groups of similar iodine delivery rate; A: 1.2 cc/kg of iomeprol-400, B: 1.0 cc/kg of iomeprol-400 and C: 1.5 cc/kg of ioversol-350. Contrast enhancement of the liver parenchyma, pancreas and aorta was quantitatively measured in Hounsfield units and qualitative assessed by a radiologist. T-test was used to evaluate contrast enhancement, and Chi-square test was used to evaluate qualitative image assessment, at significance level of 0.05 with 95% confidence intervals. There were no statistically significant differences in contrast enhancement of liver parenchyma and pancreas between group A and group C in both quantitative and qualitative analyses. Group C showed superior vascular enhancement to group A and B on quantitative analysis.

  2. [Lethal reaction after contrast medium administration].

    PubMed

    Risgaard, Ole; Søe, Charlotte Krabbe; Zejden, Anna

    2008-04-21

    A 49-year-old healthy woman was admitted after a horse-riding accident. On arrival to the emergency department she complained of lower abdominal pain. A CT-scan of the abdomen with non ionic contrast media (iomeprol, 150 ml 4 ml/s) was conducted. The patient died nine hours later due to an anaphylactoid reaction to radio contrast media. The autopsy showed pulmonary oedema and pleural effusion, but did not show any sign of trauma. Early interventions with appropriate therapy had no effect on the fatal outcome. PMID:18462629

  3. Modified CHROMagar Acinetobacter Medium for Direct Detection of Multidrug-Resistant Acinetobacter Strains in Nasal and Rectal Swab Samples

    PubMed Central

    Lee, Jacob; Kim, Taek-Kyung; Park, Min-Jeong; Kim, Han-Sung; Kim, Jae-Seok

    2013-01-01

    This study aimed to investigate whether CHROMagar Acinetobacter medium (CHROMagar, France) in combination with an antimicrobial supplement (modified CHROMagar Acinetobacter; CHROMagar, France) can be used for detecting and isolating multidrug-resistant Acinetobacter species (MRA) in nasal and rectal surveillance cultures. Nasal and rectal swab samples were collected from patients in an intensive care unit at a teaching hospital. The samples were used to inoculate modified CHROMagar Acinetobacter plates, which were examined after 24 and 48 hr of incubation at 37℃. Their susceptibility against the antimicrobial agents meropenem, imipenem, ciprofloxacin, and amikacin was analyzed using the Etest (bioMerieux, France). A total of 406 paired samples (406 nasal swabs and 406 rectal swabs) were obtained from 226 patients, and 120 samples (28 nasal and 28 rectal cultures, 47 nasal cultures only, and 17 rectal cultures only) yielded MRA. Seventy-five MRA isolates (18.5%) were recovered from the 406 nasal samples, and 45 MRA isolates (11.1%) were recovered from the 406 rectal samples. Of the 120 MRA isolates, 3 (2.5%) were detected only after 48 hr of incubation. The use of modified CHROMagar Acinetobacter together with nasal and rectal swabs and 1-day incubation is an effective surveillance tool for detecting MRA colonization. PMID:23667846

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

    PubMed

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

    1988-10-01

    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.

  5. Comparison Between Perfusion Computed Tomography and Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Rectal Cancer

    SciTech Connect

    Kierkels, Roel G.J.; Backes, Walter H.; Janssen, Marco H.M.; Buijsen, Jeroen; Beets-Tan, Regina G.H.; Lambin, Philippe; Lammering, Guido; Oellers, Michel C.; Aerts, Hugo J.W.L.

    2010-06-01

    Purpose: To compare pretreatment scans with perfusion computed tomography (pCT) vs. dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in rectal tumors. Methods and Materials: Nineteen patients diagnosed with rectal cancer were included in this prospective study. All patients underwent both pCT and DCE-MRI. Imaging was performed on a dedicated 40-slice CT-positron emission tomography system and a 3-T MRI system. Dynamic contrast enhancement was measured in tumor tissue and the external iliac artery. Tumor perfusion was quantified in terms of pharmacokinetic parameters: transfer constant K{sup trans}, fractional extravascular-extracellular space v{sub e}, and fractional plasma volume v{sub p}. Pharmacokinetic parameter values and their heterogeneity (by 80% quantile value) were compared between pCT and DCE-MRI. Results: Tumor K{sup trans} values correlated significantly for the voxel-by-voxel-derived median (Kendall's tau correlation, tau = 0.81, p < 0.001) and 80% quantile (tau = 0.54, p = 0.04), as well as for the averaged uptake (tau = 0.58, p = 0.03). However, no significant correlations were found for v{sub e} and v{sub p} derived from the voxel-by-voxel-derived median and 80% quantile and derived from the averaged uptake curves. Conclusions: This study demonstrated for the first time that pCT provides K{sup trans} values comparable to those of DCE-MRI. However, no correlation was found for the v{sub e} and v{sub p} parameters between CT and MRI. Computed tomography can serve as an alternative modality to MRI for the in vivo evaluation of tumor angiogenesis in terms of the transfer constant K{sup trans}.

  6. Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium

    SciTech Connect

    Konno, T. )

    1990-11-01

    Arterially administered Lipiodol Ultrafluid contrast medium selectively remained in various malignant solid tumors because of the difference in time required for the removal of Lipiodol contrast medium from normal capillaries and tumor neovasculature. Although blood flow was maintained in the tumor, even immediately after injection Lipiodol contrast medium remained in the neovasculature of the tumor. To target anti-cancer agents to tumors by using Lipiodol contrast medium as a carrier, the characteristics of the agents were examined. Anti-cancer agents had to be soluble in Lipiodol, be stable in it, and separate gradually from it so that the anti-cancer agents would selectively remain in the tumor. These conditions were found to be necessary on the basis of the measurement of radioactivity in VX2 tumors implanted in the liver of 16 rabbits that received arterial injections of 14C-labeled doxorubicin. Antitumor activities and side effects of arterial injections of two types of anti-cancer agents were compared in 76 rabbits with VX2 tumors. Oily anti-cancer agents that had characteristics essential for targeting were compared with simple mixtures of anti-cancer agents with Lipiodol contrast medium that did not have these essential characteristics. Groups of rabbits that received oily anti-cancer agents responded significantly better than groups that received simple mixtures, and side effects were observed more frequently in the groups that received the simple mixtures. These results suggest that targeting of the anti-cancer agent to the tumor is important for treatment of solid malignant tumors.

  7. Does gadolinium-based contrast material improve diagnostic accuracy of local invasion in rectal cancer MRI? A multireader study.

    PubMed

    Gollub, Marc J; Lakhman, Yulia; McGinty, Katrina; Weiser, Martin R; Sohn, Michael; Zheng, Junting; Shia, Jinru

    2015-02-01

    OBJECTIVE. The purpose of this study was to compare reader accuracy and agreement on rectal MRI with and without gadolinium administration in the detection of T4 rectal cancer. MATERIALS AND METHODS. In this study, two radiologists and one fellow independently interpreted all posttreatment MRI studies for patients with locally advanced or recurrent rectal cancer using unenhanced images alone or combined with contrast-enhanced images, with a minimum interval of 4 weeks. Readers evaluated involvement of surrounding structures on a 5-point scale and were blinded to pathology and disease stage. Sensitivity, specificity, negative predictive value, positive predictive value, and AUC were calculated and kappa statistics were used to describe interreader agreement. RESULTS. Seventy-two patients (38 men and 34 women) with a mean age of 61 years (range, 32-86 years) were evaluated. Fifteen patients had 32 organs invaded. Global AUCs without and with gadolinium administration were 0.79 and 0.77, 0.91 and 0.86, and 0.83 and 0.78 for readers 1, 2, and 3, respectively. AUCs before and after gadolinium administration were similar. Kappa values before and after gadolinium administration for pairs of readers ranged from 0.5 to 0.7. CONCLUSION. On the basis of pathology as a reference standard, the use of gadolinium during rectal MRI did not significantly improve radiologists' agreement or ability to detect T4 disease.

  8. Evaluation of CHROMagar™ StrepB agar, an aerobic chromogenic medium for prepartum vaginal/rectal Group B Streptococcus screening.

    PubMed

    Poisson, Didier-Marc; Evrard, Marie-Liesse; Freneaux, Claire; Vivès, Marie-isabelle; Mesnard, Louis

    2011-03-01

    An aerobic chromogenic medium, CHROMagar™ StrepB agar, designed for isolation of group B Streptococci, was evaluated on 285 prepartum vaginal/rectal swabs from pregnant women. After overnight enrichment in Todd-Hewitt broth containing 15μg/ml nalidixic acid and 10μg/ml colistin, sensitivities were respectively 79% on day 1 and 92% on day 2, and significantly higher than those achieved by blood agar (40% and 58%) and colimycin-nalidixic-acid agar (82% on day 2).

  9. Dynamic contrast-enhanced magnetic resonance imaging of radiation therapy-induced microcirculation changes in rectal cancer

    SciTech Connect

    Lussanet, Quido G. de . E-mail: qdlu@rdia.azm.nl; Backes, Walter H.; Griffioen, Arjan W.; Padhani, Anwar R.; Baeten, Coen I.; Baardwijk, Angela van; Lambin, Philippe; Beets, Geerard L.; Engelshoven, Jos van; Beets-Tan, Regina G.H.

    2005-12-01

    Purpose: Dynamic contrast-enhanced T1-weighted magnetic resonance imaging (DCE-MRI) allows noninvasive evaluation of tumor microvasculature characteristics. This study evaluated radiation therapy related microvascular changes in locally advanced rectal cancer by DCE-MRI and histology. Methods and Materials: Dynamic contrast-enhanced-MRI was performed in 17 patients with primary rectal cancer. Seven patients underwent 25 fractions of 1.8 Gy radiation therapy (RT) (long RT) before DCE-MRI and 10 did not. Of these 10, 3 patients underwent five fractions of 5 Gy RT (short RT) in the week before surgery. The RT treated and nontreated groups were compared in terms of endothelial transfer coefficient (K{sup PS}, measured by DCE-MRI), microvessel density (MVD) (scored by immunoreactivity to CD31 and CD34), and tumor cell and endothelial cell proliferation (scored by immunoreactivity to Ki67). Results: Tumor K{sup PS} was 77% (p = 0.03) lower in the RT-treated group. Histogram analyses showed that RT reduced both magnitude and intratumor heterogeneity of K{sup PS} (p = 0.01). MVD was significantly lower (37%, p 0.03) in tumors treated with long RT than in nonirradiated tumors, but this was not the case with short RT. Endothelial cell proliferation was reduced with short RT (81%, p = 0.02) just before surgery, but not with long RT (p > 0.8). Tumor cell proliferation was reduced with both long (57%, p < 0.001) and short RT (52%, p = 0.002). Conclusion: Dynamic contrast-enhanced-MRI-derived K{sup PS} values showed significant radiation therapy related reductions in microvessel blood flow in locally advanced rectal cancer. These findings may be useful in evaluating effects of radiation combination therapies (e.g., chemoradiation or RT combined with antiangiogenesis therapy), to account for effects of RT alone.

  10. Pretreatment Evaluation of Microcirculation by Dynamic Contrast-Enhanced Magnetic Resonance Imaging Predicts Survival in Primary Rectal Cancer Patients

    SciTech Connect

    DeVries, Alexander Friedrich; Piringer, Gudrun; Kremser, Christian; Judmaier, Werner; Saely, Christoph Hubert; Lukas, Peter; Öfner, Dietmar

    2014-12-01

    Purpose: To investigate the prognostic value of the perfusion index (PI), a microcirculatory parameter estimated from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), which integrates information on both flow and permeability, to predict overall survival and disease-free survival in patients with primary rectal cancer. Methods and Materials: A total of 83 patients with stage cT3 rectal cancer requiring neoadjuvant chemoradiation were investigated with DCE-MRI before start of therapy. Contrast-enhanced dynamic T{sub 1} mapping was obtained, and a simple data analysis strategy based on the calculation of the maximum slope of the tissue concentration–time curve divided by the maximum of the arterial input function was used as a measure of tumor microcirculation (PI), which integrates information on both flow and permeability. Results: In 39 patients (47.0%), T downstaging (ypT0-2) was observed. During a mean (±SD) follow-up period of 71 ± 29 months, 58 patients (69.9%) survived, and disease-free survival was achieved in 45 patients (54.2%). The mean PI (PImean) averaged over the group of nonresponders was significantly higher than for responders. Additionally, higher PImean in age- and gender-adjusted analyses was strongly predictive of therapy nonresponse. Most importantly, PImean strongly and significantly predicted disease-free survival (unadjusted hazard ratio [HR], 1.85 [ 95% confidence interval, 1.35-2.54; P<.001)]; HR adjusted for age and sex, 1.81 [1.30-2.51]; P<.001) as well as overall survival (unadjusted HR 1.42 [1.02-1.99], P=.040; HR adjusted for age and sex, 1.43 [1.03-1.98]; P=.034). Conclusions: This analysis identifies PImean as a novel biomarker that is predictive for therapy response, disease-free survival, and overall survival in patients with primary locally advanced rectal cancer.

  11. Magnetic Resonance Imaging (MRI) with retrograde intralumen contrast enhancement of the rectum in diagnostics of rectovaginal fistulas after combination therapy of rectal cancer. Experience of application

    NASA Astrophysics Data System (ADS)

    Usova, A.; Frolova, I.; Afanasev, S.; Tarasova, A.; Molchanov, S.

    2016-02-01

    Experiment of use of MRI in diagnostics of rectovaginal fistulas after combination therapy of rectal cancer is shown on clinical examples. We used retrograde contrasting of a rectum with 150ml ultrasonic gel to make MRI more informative in case of low diagnostic efficiency of ultrasound, colonoscopy and gynecological examination.

  12. Analysis of thoracic epidurography and correlating factors affecting the extent of contrast medium spread

    PubMed Central

    Oh, Jung Hue; Park, Ki Bum

    2016-01-01

    Background Thoracic epidural anesthesia is frequently used to maintain intraoperative and postoperative analgesia. Frequently, 3 ml of local anesthetic is used as a test dose, or for intermittent epidural injection. We assessed the extent of the spread of 3 ml of contrast medium in the thoracic epidural space and attempted to identify any correlating factors affecting the epidurography. Methods A total of 70 patients were enrolled in the study, and thoracic epidural catheterizations were performed under fluoroscopic guidance. Using 3 ml of contrast medium, epidurography was evaluated to confirm the number of spinal segments covered by the contrast medium. Correlation analysis was performed between patient characteristics (sex, age, body mass index, weight, height, and location of catheter tip) and the extent of the contrast spread. Results The mean number of vertebral segments evaluated by contrast medium was 7.9 ± 2.2 using 3 ml of contrast medium. The contrast spread in the cranial direction showed more extensive distribution than that in the caudal direction, with statistical significance (P < 0.01). Patient height demonstrated a negative correlation with the extent of distribution of contrast medium (r = −0.311, P < 0.05). Conclusions Thoracic epidurography using 3 ml of contrast medium results in coverage of a mean of 7.9 ± 2.2 spinal segments, with more extensive cranial spread, and patient height showed a weak negative correlation with the distribution of contrast medium. PMID:27738504

  13. Speckle contrast diffuse correlation tomography of complex turbid medium flow

    PubMed Central

    Huang, Chong; Irwin, Daniel; Lin, Yu; Shang, Yu; He, Lian; Kong, Weikai; Luo, Jia; Yu, Guoqiang

    2015-01-01

    Purpose: Developed herein is a three-dimensional (3D) flow contrast imaging system leveraging advancements in the extension of laser speckle contrast imaging theories to deep tissues along with our recently developed finite-element diffuse correlation tomography (DCT) reconstruction scheme. This technique, termed speckle contrast diffuse correlation tomography (scDCT), enables incorporation of complex optical property heterogeneities and sample boundaries. When combined with a reflectance-based design, this system facilitates a rapid segue into flow contrast imaging of larger, in vivo applications such as humans. Methods: A highly sensitive CCD camera was integrated into a reflectance-based optical system. Four long-coherence laser source positions were coupled to an optical switch for sequencing of tomographic data acquisition providing multiple projections through the sample. This system was investigated through incorporation of liquid and solid tissue-like phantoms exhibiting optical properties and flow characteristics typical of human tissues. Computer simulations were also performed for comparisons. A uniquely encountered smear correction algorithm was employed to correct point-source illumination contributions during image capture with the frame-transfer CCD and reflectance setup. Results: Measurements with scDCT on a homogeneous liquid phantom showed that speckle contrast-based deep flow indices were within 12% of those from standard DCT. Inclusion of a solid phantom submerged below the liquid phantom surface allowed for heterogeneity detection and validation. The heterogeneity was identified successfully by reconstructed 3D flow contrast tomography with scDCT. The heterogeneity center and dimensions and averaged relative flow (within 3%) and localization were in agreement with actuality and computer simulations, respectively. Conclusions: A custom cost-effective CCD-based reflectance 3D flow imaging system demonstrated rapid acquisition of dense boundary

  14. Speckle contrast diffuse correlation tomography of complex turbid medium flow

    SciTech Connect

    Huang, Chong; Irwin, Daniel; Lin, Yu; Shang, Yu; He, Lian; Kong, Weikai; Yu, Guoqiang; Luo, Jia

    2015-07-15

    Purpose: Developed herein is a three-dimensional (3D) flow contrast imaging system leveraging advancements in the extension of laser speckle contrast imaging theories to deep tissues along with our recently developed finite-element diffuse correlation tomography (DCT) reconstruction scheme. This technique, termed speckle contrast diffuse correlation tomography (scDCT), enables incorporation of complex optical property heterogeneities and sample boundaries. When combined with a reflectance-based design, this system facilitates a rapid segue into flow contrast imaging of larger, in vivo applications such as humans. Methods: A highly sensitive CCD camera was integrated into a reflectance-based optical system. Four long-coherence laser source positions were coupled to an optical switch for sequencing of tomographic data acquisition providing multiple projections through the sample. This system was investigated through incorporation of liquid and solid tissue-like phantoms exhibiting optical properties and flow characteristics typical of human tissues. Computer simulations were also performed for comparisons. A uniquely encountered smear correction algorithm was employed to correct point-source illumination contributions during image capture with the frame-transfer CCD and reflectance setup. Results: Measurements with scDCT on a homogeneous liquid phantom showed that speckle contrast-based deep flow indices were within 12% of those from standard DCT. Inclusion of a solid phantom submerged below the liquid phantom surface allowed for heterogeneity detection and validation. The heterogeneity was identified successfully by reconstructed 3D flow contrast tomography with scDCT. The heterogeneity center and dimensions and averaged relative flow (within 3%) and localization were in agreement with actuality and computer simulations, respectively. Conclusions: A custom cost-effective CCD-based reflectance 3D flow imaging system demonstrated rapid acquisition of dense boundary

  15. [Subclavian artery stenting using gadolinium contrast medium in a case with iodine allergy].

    PubMed

    Miyamoto, Michiyuki; Asano, Takeshi; Osanai, Toshiya; Endo, Shogo; Nakayama, Naoki; Kuroda, Satoshi; Houkin, Kiyohiro

    2012-05-01

    The authors reported a subclavian artery stenting (SAS) using gadolinium contrast medium. The patient was a 65-year-old female who presented dizziness and right upper extremity pain with movement. Digital subtraction angiography revealed right subclavian artery occlusion with subclavian steal phenomenon. We tried to treat this lesion using SAS. However, iodinated contrast medium caused the allergy in this patient and the treatment was discontinued. Therefore, SAS was performed with gadolinium contrast medium. Using gadolinium contrast medium, it is possible to confirm large arteries like innominate artery and subclavian artery. The stenting procedure was performed without complication. The usage of gadolinium contrast medium has the limit and some strategies are important to reduce the usage of gadolinium contrast medium in SAS. First, PercuSurge GuardWire® was placed in the right internal carotid artery to confirm the anatomy, to decide working angle, and to treat the common carotid artery in case of dissection. Second, a "U" shaped guide wire was placed in the distal end from the brachial artery. Guide wire from femoral side was able to pass the lesion at midpoint of the "U" shaped one. SAS using gadolinium contrast medium may be an alternative treatment if a patient with subclavian artery stenosis or occlusion is allergic to iodinated contrast medium.

  16. Repeated injection of contrast medium inducing dysfunction of the blood-brain barrier: case report.

    PubMed

    Iwata, Tomonori; Mori, Takahisa; Tajiri, Hiroyuki; Miyazaki, Yuichi; Nakazaki, Masahito

    2013-01-01

    An early 60s-year-old man suffered reversible dysfunction of the blood-brain barrier (BBB) induced by repeated injection of contrast medium during coil embolization of intracranial unruptured aneurysm. He presented with convulsion during coil embolization, and neurological symptoms of aphasia and right hemiparesis continued for 5 days, and then improved completely. All transient radiological abnormalities were limited to the territory of the left internal carotid artery, where contrast medium was injected repeatedly. Repeated computed tomography, magnetic resonance imaging, single-photon emission computed tomography, and cerebrospinal fluid test findings indicated that temporary dysfunction of the BBB might have occurred. Dysfunction of the BBB in the anterior circulation induced by contrast medium is rare. Tolerance to toxicity of contrast medium may depend on the individual patient, and repeated injection of contrast medium may cause dysfunction of the BBB, leading to toxic dysfunction directly in the brain.

  17. Zero Contrast Coronary Intervention Using Intravascular Ultrasound Guidance in a Patient with Allergy to Contrast Medium.

    PubMed

    Nagaoka, Masakazu; Tsumuraya, Naoko; Nie, Masaki; Ikari, Yuji

    2016-01-01

    The occurrence of allergy to iodinated contrast in certain patients may prevent the use of percutaneous coronary intervention (PCI) in such cases. We present a 53-year-old male with a history of allergic reaction to iodinated contrast who successfully underwent intravascular ultrasound (IVUS) guided PCI. Stent size was determined based on IVUS. After PCI, stent expansion and a lack of edge dissection or incomplete apposition were confirmed by IVUS. Thus, PCI without contrast injection under IVUS may be feasible in selected patients with allergy to iodinated contrast. PMID:27628609

  18. Dual Energy CT Angiography of Peripheral Arterial Disease: Feasibility of Using Lower Contrast Medium Volume

    PubMed Central

    Almutairi, Abdulrahman; Sun, Zhonghua; Poovathumkadavi, Abduljaleel; Assar, Tarek

    2015-01-01

    Objective One of the main drawbacks associated with Dual Energy Computed Tomography Angiography (DECTA) is the risk of developing contrast medium-induced nephropathy (CIN). The aim of the present study was firstly, to design an optimal CT imaging protocol by determining the feasibility of using a reduced contrast medium volume in peripheral arterial DECTA, and secondly, to compare the results with those obtained from using routine contrast medium volume. Methods Thirty four patients underwent DECTA for the diagnosis of peripheral arterial disease. They were randomly divided into two groups: Group 1 (routine contrast volume group) with n = 17, injection rate 4–5 ml/s, and 1.5 ml/kg of contrast medium, and Group 2 ((low contrast volume group), with n = 17, injection rate 4–5ml/s, and contrast medium volume 0.75 ml/kg. A fast kilovoltage—switching 64-slice CT scanner in the dual-energy mode was employed for the study. A total of 6 datasets of monochromatic images at 50, 55, 60, 65, 70 and 75 keV levels were reconstructed with adaptive statistical iterative reconstruction (ASIR) at 50%. A 4-point scale was the tool for qualitative analysis of results. The two groups were compared and assessed quantitatively for image quality on the basis of signal-to-noise ratio (SNR) and contrast-to-noise-ratio (CNR). Radiation and contrast medium doses were also compared. Results The overall mean CT attenuation and mean noise for all lower extremity body parts was significantly lower for the low volume contrast group (p<0.001), and varied significantly between groups (p = 0.001), body parts (p<0.001) and keVs (p<0.001). The interaction between group body parts was significant with CT attenuation and CNR (p = 0.002 and 0.003 respectively), and marginally significant with SNR (p = 0.047), with minimal changes noticed between the two groups. Group 2 (low contrast volume group) displayed the lowest image noise between 65 and 70 keV, recorded the highest SNR and CNR at 65 keV, and

  19. In the eye of the storm: iodinated contrast medium induced thyroid storm presenting as cardiopulmonary arrest.

    PubMed

    Alkhuja, Samer; Pyram, Ronald; Odeyemi, Olutunde

    2013-01-01

    The administration of iodinated contrast medium may lead to excess free thyroid hormone release and cause thyroid storm. A woman presented to the emergency department with dyspnea, hemoptysis, and intermittent bilateral lower extremities edema. Physical examination revealed mildly enlarged thyroid. Patient underwent a computed tomography scan of the chest with intravenous iodinated contrast medium to rule out pulmonary embolism, the patient developed a thyroid storm second to iodinated contrast medium injection. Proper treatment was provided and the patient had a good outcome. We present this case of an unusual presentation of a thyroid storm with cardiac arrest. This case illustrates that evaluating thyroid function tests in patients with an enlarged thyroid prior to the administration of iodinated contrast medium could prevent the development of thyroid storm.

  20. Syringomyelia caused by intrathecal remnants of oil-based contrast medium.

    PubMed

    Kubota, Mayumi; Shin, Masahiro; Taniguchi, Makoto; Terao, Toru; Nakauchi, Jun; Takahashi, Hiroshi

    2008-02-01

    Oily contrast medium had been in use since the early 19th century as a radiographic agent for detecting spinal lesions and spinal cord tumors until the late 20th century. At that point computed tomography scanning and magnetic resonance imaging, or other hydrophilic contrast medium substituted for it. Adverse effects of oil-based dye, both acute and chronic, had been reported since the middle of the 20th century. In this paper the authors report the case of syringomyelia that seemed to be caused mainly by remaining oily contrast medium for 44 years. Syringomyelia secondary to adhesive arachnoiditis caused by oily contrast medium after a long period of time is well known. In the present case, however, surgery revealed only mild arachnoiditis at the level of syringomyelia as well as both solid and liquid remnants of contrast medium. Generally, cerebrospinal fluid (CSF) blockage due to an arachnoid adhesion is considered to cause syringomyelia following adhesive arachnoiditis. The authors speculated that in the present case syringomyelia was induced by a mechanism different from that in the previously reported cases; the oily contrast medium itself seems to have induced the functional block of CSF and impaired the buffer system of the intrathecal pressure. No reports on thoracic adhesive arachnoiditis and syringomyelia caused by oil-based dye referred to this mechanism in reviewing the literature. PMID:18248289

  1. Is contrast medium osmolality a causal factor for contrast-induced nephropathy?

    PubMed

    Bucher, Andreas M; De Cecco, Carlo N; Schoepf, U Joseph; Meinel, Felix G; Krazinski, Aleksander W; Spearman, James V; McQuiston, Andrew D; Wang, Rui; Bucher, Judith; Vogl, Thomas J; Katzberg, Richard W

    2014-01-01

    The exact pathophysiology of contrast-induced nephropathy (CIN) is not fully clarified, yet the osmotic characteristics of contrast media (CM) have been a significant focus in many investigations of CIN. Osmotic effects of CM specific to the kidney include transient decreases in blood flow, filtration fraction, and glomerular filtration rate. Potentially significant secondary effects include an osmotically induced diuresis with a concomitant dehydrating effect. Clinical experiences that have compared the occurrence of CIN between the various classes of CM based on osmolality have suggested a much less than anticipated advantage, if any, with a lower osmolality. Recent animal experiments actually suggest that induction of a mild osmotic diuresis in association with iso-osmolar agents tends to offset potentially deleterious renal effects of high viscosity-mediated intratubular CM stagnation.

  2. Intravenous contrast medium aggravates the impairment of pancreatic microcirculation in necrotizing pancreatitis in the rat.

    PubMed Central

    Schmidt, J; Hotz, H G; Foitzik, T; Ryschich, E; Buhr, H J; Warshaw, A L; Herfarth, C; Klar, E

    1995-01-01

    BACKGROUND: Previous reports demonstrated that radiographic contrast medium, as used in contrast-enhanced computed tomography, increases acinar necrosis and mortality in experimental pancreatitis. The authors studied the possibility that these changes may be related to an additional impairment of pancreatic microcirculation. METHODS: Fifty Wistar rats had acute pancreatitis induced by intraductal glycodeoxycholic acid (10 mmol/L for 10 min) and intravenous cerulein (5 micrograms/kg/hr for 6 hrs). After rehydration (16 mL/kg), pancreatic capillary perfusion was quantified by means of intravital microscopy at baseline before intravenous infusion of contrast medium (n = 25) or saline (n = 25), and 30 and 60 minutes thereafter. In addition to total capillary flow, capillaries were categorized as high- or low-flow (> or < 1.6 nL/min). RESULTS: Pancreatic capillary flow did not change in either high- or low-flow capillaries after saline infusion. However, contrast medium infusion induced a significant decrease of total capillary flow (p < 0.001). Analysis according to the relative flow rate revealed that this was primarily because of a significant additional reduction of perfusion in low-flow capillaries (p < 0.0001). Furthermore, complete capillary stasis was observed in 15.9 +/- 3.4% after contrast medium as compared with 3.2 +/- 1.2% after saline infusion (p < 0.006). CONCLUSION: Radiographic contrast medium aggravates the impairment of pancreatic microcirculation in experimental necrotizing pancreatitis. PMID:7717779

  3. Pharmacokinetic study of ioxaglate, a low osmolality contrast medium, in patients with renal failure.

    PubMed

    Bourin, M; Laporte, V; Guenzet, J; Langlois, S; Pengloan, J; Rouleau, P

    1986-11-01

    Determination of changes in plasma concentration of ioxaglate in patients with renal failure made it possible to demonstrate that distribution and clearance of this contrast medium, as in the case of classic uroangiographic products, conform to an open two-compartment model with clearance from the central compartment. Various pharmacokinetic parameters were calculated. The metabolic clearance of ioxaglate was lower for all 6 patients studied, as compared with results for 3 normal subjects tested, but less marked than with iodamide, a contrast medium involving tubular secretion.

  4. Liver-specific magnetic resonance contrast medium in the evaluation of chronic liver disease

    PubMed Central

    dos Reis, Marcio Augusto Correia Rodrigues; Baroni, Ronaldo Hueb

    2015-01-01

    ABSTRACT The hepatobiliary-specific contrast medium (gadoxetic acid – Primovist®) is primarily used to improve detection and characterization of focal hepatic lesions, such as in chronic liver disease patients with suspected hepatocellular carcinoma. Since the contrast medium is selectively taken up by functioning hepatocytes in the late hepatobiliary phase, it helps to detect typical hepatocellular carcinoma, which show low signal intensity on this phase. This imaging feature also assists in differentiating regenerative/dysplastic nodules from early hepatocellular carcinomas (with over 90% accuracy), as well as hypervascular hepatocellular carcinomas from arterial pseudo-enhancement foci. Future perspectives include its use in quantification of hepatic function and fibrosis. PMID:26154554

  5. A method to evaluate the dose increase in CT with iodinated contrast medium

    SciTech Connect

    Amato, Ernesto; Lizio, Domenico; Settineri, Nicola; Di Pasquale, Andrea; Salamone, Ignazio; Pandolfo, Ignazio

    2010-08-15

    Purpose: The objective of this study is to develop a method to calculate the relative dose increase when a computerized tomography scan (CT) is carried out after administration of iodinated contrast medium, with respect to the same CT scan in absence of contrast medium. Methods: A Monte Carlo simulation in GEANT4 of anthropomorphic neck and abdomen phantoms exposed to a simplified model of CT scanner was set up in order to calculate the increase of dose to thyroid, liver, spleen, kidneys, and pancreas as a function of the quantity of iodine accumulated; a series of experimental measurements of Hounsfield unit (HU) increment for known concentrations of iodinated contrast medium was carried out on a Siemens Sensation 16 CT scanner in order to obtain a relationship between the increment in HU and the relative dose increase in the organs studied. The authors applied such a method to calculate the average dose increase in three patients who underwent standard CT protocols consisting of one native scan in absence of contrast, followed by a contrast-enhanced scan in venous phase. Results: The authors validated their GEANT4 Monte Carlo simulation by comparing the resulting dose increases for iodine solutions in water with the ones presented in literature and with their experimental data obtained through a Roentgen therapy unit. The relative dose increases as a function of the iodine mass fraction accumulated and as a function of the Hounsfield unit increment between the contrast-enhanced scan and the native scan are presented. The data shown for the three patients exhibit an average relative dose increase between 22% for liver and 74% for kidneys; also, spleen (34%), pancreas (28%), and thyroid (48%) show a remarkable average increase. Conclusions: The method developed allows a simple evaluation of the dose increase when iodinated contrast medium is used in CT scans, basing on the increment in Hounsfield units observed on the patients' organs. Since many clinical protocols

  6. Morphine Rectal

    MedlinePlus

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

  7. Management of large volume CT contrast medium extravasation injury: technical refinement and literature review.

    PubMed

    Schaverien, Mark V; Evison, Demetrius; McCulley, Stephen J

    2008-01-01

    The incidence of radiographic contrast medium extravasation is on the rise due to the rapid increase in availability of contrast enhanced imaging. There is no consensus, however, regarding its management. There is a wide spectrum of clinical presentations, ranging from localised erythema and oedema to skin necrosis, which is related to the osmolarity and volume of the extravasated contrast medium. It is not possible to predict the degree of final tissue injury at initial examination. The increase in use of automated bolus injection has led to an increase in incidence of large volume extravasation injuries. Here we present a review of the literature regarding clinical presentation, risk factors, and management of contrast extravasation injuries. We also report the management of a large volume computed tomography contrast extravasation injury following mechanical bolus injection using a combination of liposuction and saline washout as described by Gault, and the use of compression by a Rhys-Davies exsanguinator as a technical refinement to achieve immediate resolution of the soft tissue oedema. PMID:17459795

  8. Experimental study of arachnoiditis from iohexol, an investigational nonionic aqueous contrast medium.

    PubMed

    Haughton, V M; Ho, K C; Lipman, B T

    1982-01-01

    Myelography was performed in 16 monkeys using either metrizamide or iohexol, a new nonionic aqueous contrast medium. Eight of the animals received almost five times the recommended clinical dose of contrast medium per unit of body weight; the other eight received the equivalent of a high clinical dose. The severity of resultant arachnoiditis 12 weeks later was evaluated by repeat myelography and by histologic study of the arachnoid. No animals had severe arachnoiditis. Two of the four animals examined with the higher dose of metrizamide had moderate arachnoiditis and one had mild arachnoiditis; with the lower dose of metrizamide, two of four animals had mild arachnoiditis. No significant evidence of arachnoiditis was seen in any of the eight animals examined with iohexol.

  9. Low contrast medium and radiation dose for hepatic computed tomography perfusion of rabbit VX2 tumor

    PubMed Central

    Zhang, Cai-Yuan; Cui, Yan-Fen; Guo, Chen; Cai, Jing; Weng, Ya-Fang; Wang, Li-Jun; Wang, Deng-Bin

    2015-01-01

    AIM: To evaluate the feasibility of low contrast medium and radiation dose for hepatic computed tomography (CT) perfusion of rabbit VX2 tumor. METHODS: Eleven rabbits with hepatic VX2 tumor underwent perfusion CT scanning with a 24-h interval between a conventional tube potential (120 kVp) protocol with 350 mgI/mL contrast medium and filtered back projection, and a low tube potential (80 kVp) protocol with 270 mgI/mL contrast medium with iterative reconstruction. Correlation and agreement among perfusion parameters acquired by the conventional and low dose protocols were assessed for the viable tumor component as well as whole tumor. Image noise and tumor-to-liver contrast to noise ratio during arterial and portal venous phases were evaluated. RESULTS: A 38% reduction in contrast medium dose (360.1 ± 13.3 mgI/kg vs 583.5 ± 21.5 mgI/kg, P < 0.001) and a 73% decrease in radiation dose (1898.5 mGy • cm vs 6951.8 mGy • cm) were observed. Interestingly, there was a strong positive correlation in hepatic arterial perfusion (r = 0.907, P < 0.001; r = 0.879, P < 0.001), hepatic portal perfusion (r = 0.819, P = 0.002; r = 0.831, P = 0.002), and hepatic blood flow (r = 0.945, P < 0.001; r = 0.930, P < 0.001) as well as a moderate correlation in hepatic perfusion index (r = 0.736, P = 0.01; r = 0.636, P = 0.035) between the low dose protocol with iterative reconstruction and the conventional protocol for the viable tumor component and the whole tumor. These two imaging protocols provided a moderate but acceptable agreement for perfusion parameters and similar tumor-to-liver CNR during arterial and portal venous phases (5.63 ± 2.38 vs 6.16 ± 2.60, P = 0.814; 4.60 ± 1.27 vs 5.11 ± 1.74, P = 0.587). CONCLUSION: Compared with the conventional protocol, low contrast medium and radiation dose with iterative reconstruction has no significant influence on hepatic perfusion parameters for rabbits VX2 tumor. PMID:25954099

  10. Object reconstruction in scattering medium using multiple elliptical polarized speckle contrast projections and optical clearing agents

    NASA Astrophysics Data System (ADS)

    Moshe, Tomer; Firer, Michael A.; Abookasis, David

    2015-05-01

    In this paper, we present a hybrid method for improving the imaging quality of objects obscured within a scattering environment by combining multiple elliptical polarized speckle contrast projections with the use of optical clearing agents (OCAs). Elliptically polarized light enables the probing of subsurface volumes, where OCAs decrease light scattering while increasing photons' penetration depth through the medium. Experiments were conducted on object sample and prostate cancer cells embedded within ex vivo biological samples (chicken breasts) in reflection configuration. After immersion with OCAs, the medium was irradiated with an elliptically polarized laser beam and multiple polarized speckled images obtained from a lens array were first converted to speckled contrast images and then processed using a self-deconvolution shift-and-add algorithm. The conversion to contrast images and multiple perspectives acquisition was found to emphasize contrast. Analysis of image quality indicated improvement in object visualization by the combination of elliptical polarization and OCAs. This enhanced imaging strategy may advance the development of improved methods in biomedicine field, specifically biomedical tomography.

  11. Efficacy of coronary fractional flow reserve using contrast medium compared to adenosine

    PubMed Central

    Tanboğa, Ibrahim Halil; Aksakal, Enbiya; Aksu, Uğur; Gulcu, Oktay; Birdal, Oğuzhan; Arısoy, Arif; Kalaycı, Arzu; Ulusoy, Fatih Rifat; Sevimli, Serdar

    2016-01-01

    Introduction Coronary fractional flow reserve (FFR) is recommended as the gold standard method in evaluating intermediate coronary stenoses. However, there are significant debates concerning the agents and the timing of the measurement. Aim To compare the contrast medium induced Pd/Pa ratio (CMR) with the FFR. Material and methods We enrolled 28 consecutive patients with 34 intermediate lesions who underwent coronary FFR measurement by intracoronary (i.c.) adenosine. After baseline Pd/Pa was calculated, a single contrast medium (Iomeron) injection of 6 ml (3 ml/s) was performed manually. Within 10 s after the contrast medium injection, the CMR was calculated. Bolus injection of i.c. adenosine was performed to induce maximal hyperemia (from 60 µg to 600 µg), and when it was ≤ 0.80, the intermediate lesion was considered as significant. Results After bolus i.c. adenosine, 12 lesions of 34 (35.3%) were identified as significant. The CMR value was 0.86 ±0.06 (range: 0.71–0.97). There were no significant differences between FFR and CMR values (p = 0.108). A substantial positive correlation between adenosine and contrast values was detected (0.886 and p < 0.001). Good agreement in Bland-Altman analysis was revealed (mean bias was 0.027, 95% confidence interval 0.038–0.092). Receiver operating characteristics curve analysis showed 90.9% sensitivity and 91.7% specificity for a cut-off value of 0.85 for the CMR compared to FFR (≤ 0.80). Conclusions Our study showed that measuring the CMR is a feasible method compared to FFR. The CMR may be used in situations where adenosine cannot be administered. PMID:27625683

  12. Imaging Quality Evaluation of Low Tube Voltage Coronary CT Angiography Using Low Concentration Contrast Medium

    PubMed Central

    Zhang, Zaixian; Wang, Qingguo; Zheng, Linfeng; Feng, Yan; Zhou, Zhiguo; Zhang, Guixiang; Li, Kangan

    2015-01-01

    Purpose To compare the image quality of prospectively ECG-gated low voltage coronary computed tomography angiography (CTA) with an administration of low concentration contrast medium. Method and Materials A total of 101 patients, each with a heart rate below 65 beats per minute (BPM), underwent a prospectively ECG-gated axial scan in CT coronary angiography on a 64-slice CT scanner. All patients were allocated in three groups (group A: n=31, 80kVp, 300 mgI/ml; group B: n=34, 100kVp, 300 mgI/ml; group C: n=36, 120kVp, 370 mgI/ml). The CT attenuation values of aortic root (AR), left main coronary artery (LMA), right main coronary artery (RMA) and chest subcutaneous fat tissue were measured. The contrast-to-noise ratio (CNR) of AR, LMA and RMA were calculated according to the formulas below. The values of computed tomography dose index (CTDI) and dose-length product (DLP) were recorded. Image quality was assessed on a 5-point scale. The results were compared using the one-way ANOVA and rank sum tests. Results The values of CNR and SNR for vessels in group A and group B were not significantly different from group C (each p > 0.05). The effective radiation dose in group A (1.51±0.70 mSv) and group B (2.59±1.24 mSv) were both lower than group C (4.92±2.82 mSv) (each p < 0.05). There was no significant difference among the image quality scores of group A (4.10±0.41), group B (3.90±0.48) and group C (4.04±0.36) (each P > 0.05). Conclusion Low tube voltage coronary CT angiography using low concentration contrast medium does not affect the imaging quality for assessing the coronary arteries compared with high voltage coronary CT angiography using high concentration contrast medium. Meanwhile low concentration contrast medium allowed 47-69% of radiation dose reduction. PMID:25811785

  13. [Intravenous urography with a nonionic low osmolality contrast medium (iopamidol) in elderly patients].

    PubMed

    Tanaka, H; Senju, M; Ikeuchi, H; Nakatani, T; Yamamoto, K; Kishimoto, T; Maekawa, M

    1988-12-01

    Intravenous urography was carried out with a nonionic low osmolality contrast medium, iopamidol (Iopamiron 300) in 30 elderly patients (aged 65 to 86; with the mean age of 75 +/- 6), and the safety for the aged and radiopacity were evaluated. Although no purgative was given and water was not restricted in consideration of dehydration and bad influence on renal function, the total urinary system was well visualized. Side-effect was observed in none of 30 patients. This method seems to be useful for patients with a risk of dehydration and elderly patients.

  14. Analytical optimization of digital subtraction mammography with contrast medium using a commercial unit.

    PubMed

    Rosado-Méndez, I; Palma, B A; Brandan, M E

    2008-12-01

    Contrast-medium-enhanced digital mammography (CEDM) is an image subtraction technique which might help unmasking lesions embedded in very dense breasts. Previous works have stated the feasibility of CEDM and the imperative need of radiological optimization. This work presents an extension of a former analytical formalism to predict contrast-to-noise ratio (CNR) in subtracted mammograms. The goal is to optimize radiological parameters available in a clinical mammographic unit (x-ray tube anode/filter combination, voltage, and loading) by maximizing CNR and minimizing total mean glandular dose (D(gT)), simulating the experimental application of an iodine-based contrast medium and the image subtraction under dual-energy nontemporal, and single- or dual-energy temporal modalities. Total breast-entrance air kerma is limited to a fixed 8.76 mGy (1 R, similar to screening studies). Mathematical expressions obtained from the formalism are evaluated using computed mammographic x-ray spectra attenuated by an adipose/glandular breast containing an elongated structure filled with an iodinated solution in various concentrations. A systematic study of contrast, its associated variance, and CNR for different spectral combinations is performed, concluding in the proposal of optimum x-ray spectra. The linearity between contrast in subtracted images and iodine mass thickness is proven, including the determination of iodine visualization limits based on Rose's detection criterion. Finally, total breast-entrance air kerma is distributed between both images in various proportions in order to maximize the figure of merit CNR2/D(gT). Predicted results indicate the advantage of temporal subtraction (either single- or dual-energy modalities) with optimum parameters corresponding to high-voltage, strongly hardened Rh/Rh spectra. For temporal techniques, CNR was found to depend mostly on the energy of the iodinated image, and thus reduction in D(gT) could be achieved if the spectral energy

  15. Clinical cardiovascular experiences with iopamidol: a new non-ionic contrast medium.

    PubMed

    Partridge, J B; Robinson, P J; Turnbull, C M; Stoker, J B; Boyle, R M; Morrison, G W

    1981-07-01

    Iopamidol, a new non-ionic water-soluble contrast medium, has been compared with standard ionic media in a number of cardiovascular applications. It is stable in aqueous solution, is much less viscous and only slightly more osmolar than metrizamide. Compared to sodium meglumine diatrizoate in a series of 40 coronary arteriograms, it produced a consistent and highly significant decrease in the incidence and severity of hypotension and bradycardia following intracoronary injection. In the same group and in 62 children undergoing ventricular or great vessel angiocardiography, a subjective assessment of patient reaction showed that iopamidol was better tolerated than the ionic medium. There was a very strong patient preference for iopamidol in a group of 20 of the adult patients who had also consented to femoral artery injections of both media. Throughout these series there was no detectable difference in arterial image quality between the media. Venous phase opacification during arterioportography was assessed in 11 cases comparing iopamidol with sodium meglumine iothalamate. No significant difference was found. We conclude that iopamidol is clearly preferable to ionic media for routine cardiovascular applications.

  16. [Dynamic contrast medium studies with flash sequences in nuclear magnetic resonance tomography of the breast].

    PubMed

    Heywang, S H; Hilbertz, T; Pruss, E; Wolf, A; Permanetter, W; Eiermann, W; Lissner, J

    1988-03-01

    In this study the dynamic contrast behavior after Gd-DTPA of different breast tissues and tumors has been investigated with a series of T1-weighted FLASH-sequences during the first 5 minutes after the application of Gd-DTPA. The results of these dynamic FLASH-measurements have been compared to the results of the SE-sequences 6-10 and 11-15 minutes after Gd-DTPA in 40 patients with 54 different breast tissues. It could be shown that in a number of cases a better differentiation (e.g. DD between carcinomas and proliferative dysplasia) was possible on FLASH-scans early after contrast medium than on the late SE-scans. Only the distinction between non-proliferative and proliferative dysplasia was better on the late SE-scans. Evaluation of the enhancement dynamics may be helpful in some cases as an additional information. Further investigations are necessary to confirm these findings and to assess their value.

  17. Detecting relative speed changes of moving objects through scattering medium by using wavefront shaping and laser speckle contrast analysis.

    PubMed

    Li, Yangyang; Liu, Rui; Wang, Yang; Wen, Dong; Meng, Liangwei; Lu, Jinling; Li, Pengcheng

    2016-04-18

    Imaging through a scattering medium has been a main challenge in modern optical imaging field. Recently, imaging through scattering medium based on wavefront shaping has been reported. However, it has not been clearly investigated to apply the optical memory effect based iterative wavefront shaping technique in speed estimation of a moving object through scattering medium. Here, we proposed to combine the iterative wavefront shaping technique with laser speckle contrast analysis method to detect the relative speed changes of moving objects through scattering medium. Phantom experiments were performed to validate our method.

  18. Rectal Disorders

    MedlinePlus

    The rectum is the lower part of your large intestine where your body stores stool. Problems with rectum are common. They include hemorrhoids, abscesses, incontinence and cancer. Many people are embarrassed to talk about rectal ...

  19. Mesalamine Rectal

    MedlinePlus

    Rectal mesalamine is used to treat ulcerative colitis (a condition which causes swelling and sores in the lining of the colon [large intestine] and rectum), proctitis (swelling in the rectum), and ...

  20. Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy

    PubMed Central

    Sonhaye, Lantam; Kolou, Bérésa; Tchaou, Mazamaesso; Amadou, Abdoulatif; Assih, Kouméabalo; N'Timon, Bidamin; Adambounou, Kokou; Agoda-Koussema, Lama; Adjenou, Komlavi; N'Dakena, Koffi

    2015-01-01

    The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER) of the Teaching Hospital of Lomé (Togo) during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load) shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619, p value = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26, p value = 0.031). PMID:26576300

  1. Assessment by Using a Water-Soluble Contrast Enema Study of Radiologic Leakage in Lower Rectal Cancer Patients With Sphincter-Saving Surgery

    PubMed Central

    Seo, Seok In; Lee, Jong Lyul; Park, Seong Ho; Ha, Hyun Kwon

    2015-01-01

    Purpose This study evaluated the efficacy of a water-soluble contrast enema (WCE) in predicting anastomotic healing after a low anterior resection (LAR). Methods Between January 2000 and March 2012, 682 consecutive patients underwent a LAR or an ultra-low anterior resection (uLAR) and were followed up for leakage. Clinical leakage was established by using physical and laboratory findings. Radiologic leakage was identified by using retrograde WCE imaging. Abnormal radiologic features on WCE were categorized into four types based on morphology: namely, dendritic, horny, saccular, and serpentine. Results Of the 126 patients who received a concurrent diverting stoma, only two (1.6%) suffered clinical leakage due to pelvic abscess. However, 37 patients (6.7%) in the other group suffered clinical leakage following fecal diversion (P = 0.027). Among the 163 patients who received a fecal diversion, 20 showed radiologic leakage on the first WCE (eight with and 12 without a concurrent diversion); 16 had abnormal features continuously until the final WCE while four patients healed spontaneously. Eleven of the 16 patients (69%), by their surgeon's decision, underwent a stoma restoration based on clinical findings (2/3 dendritic, 3/4 horny, 5/7 saccular, 1/2 serpentine). After stoma reversal, only 2 of the 11 (19%) complained of complications related to the rectal anastomosis. Conclusion WCE is helpful for detecting radiologic leakage before stoma restoration, especially in patients suffering clinical leakage after an uLAR. However, surgeons appear to opt for stoma restoration despite the persistent existence of radiologic leakage in cases with particular features on the WCE. PMID:26361614

  2. Immunoscore in Rectal Cancer

    ClinicalTrials.gov

    2016-03-28

    Cancer of the Rectum; Neoplasms, Rectal; Rectal Cancer; Rectal Tumors; Rectal Adenocarcinoma; Melanoma; Breast Cancer; Renal Cell Cancer; Lung Cancer; Bladder Cancer; Head and Neck Cancer; Ovarian Cancer; Thyroid Cancer

  3. Breviscapine attenuatted contrast medium-induced nephropathy via PKC/Akt/MAPK signalling in diabetic mice

    PubMed Central

    Jiang, Wenbin; Li, Zhengwei; Zhao, Wei; Chen, Hao; Wu, Youyang; Wang, Yi; Shen, Zhida; He, Jialin; Chen, Shengyu; Zhang, Jiefang; Fu, Guosheng

    2016-01-01

    Contrast medium-induced nephropathy (CIN) remains a major cause of iatrogenic, drug-induced renal injury. Recent studies reveal that Breviscapine can ameliorate diabetic nephropathy in mice. Yet it remains unknown if Breviscapine could reduce CIN in diabetic mice. In this study, male C57/BL6J mice were randomly divided into 7 groups: control, diabetes mellitus, CIN, diabetes mellitus+CIN, diabetes mellitus+Breviscapine, CIN+Breviscapine and diabetes mellitus+CIN+Breviscapine. Model of CIN was induced by tail intravenous administration of iopromide and model of diabetes mellitus was induced by Streptozotocin intraperitoneally. Breviscapine was administered intragastrically for 4 weeks. Renal function parameters, kidney histology, markers of renal fibrosis, phosphorylation of protein kinase C/Akt/mitogen activated protein kinases were measured by western blot. We found out that diabetes mellitus aggravated CIN damage. Renal histological analysis showed Breviscapine reduced of renal fibrosis and tubular damage. Breviscapine was also shown markedly to ameliorate CIN fibrotic markers expression, reduced proteinuria and serum creatinine. Furthermore, Breviscapine decreased phosphorylation of PKCβII, Akt, JNK1/2 and p38. Therefore, Breviscapine treatment could ameliorate the development of CIN in diabetic mice, which was partly attributed to its suppression of renal fibrosis via phosphorylation of PKCβII/Akt/JNK1/2/p38 signalling. PMID:27158329

  4. Breviscapine attenuatted contrast medium-induced nephropathy via PKC/Akt/MAPK signalling in diabetic mice.

    PubMed

    Jiang, Wenbin; Li, Zhengwei; Zhao, Wei; Chen, Hao; Wu, Youyang; Wang, Yi; Shen, Zhida; He, Jialin; Chen, Shengyu; Zhang, Jiefang; Fu, Guosheng

    2016-01-01

    Contrast medium-induced nephropathy (CIN) remains a major cause of iatrogenic, drug-induced renal injury. Recent studies reveal that Breviscapine can ameliorate diabetic nephropathy in mice. Yet it remains unknown if Breviscapine could reduce CIN in diabetic mice. In this study, male C57/BL6J mice were randomly divided into 7 groups: control, diabetes mellitus, CIN, diabetes mellitus+CIN, diabetes mellitus+Breviscapine, CIN+Breviscapine and diabetes mellitus+CIN+Breviscapine. Model of CIN was induced by tail intravenous administration of iopromide and model of diabetes mellitus was induced by Streptozotocin intraperitoneally. Breviscapine was administered intragastrically for 4 weeks. Renal function parameters, kidney histology, markers of renal fibrosis, phosphorylation of protein kinase C/Akt/mitogen activated protein kinases were measured by western blot. We found out that diabetes mellitus aggravated CIN damage. Renal histological analysis showed Breviscapine reduced of renal fibrosis and tubular damage. Breviscapine was also shown markedly to ameliorate CIN fibrotic markers expression, reduced proteinuria and serum creatinine. Furthermore, Breviscapine decreased phosphorylation of PKCβII, Akt, JNK1/2 and p38. Therefore, Breviscapine treatment could ameliorate the development of CIN in diabetic mice, which was partly attributed to its suppression of renal fibrosis via phosphorylation of PKCβII/Akt/JNK1/2/p38 signalling.

  5. [General pharmacological study of iodixanol, a new non-ionic isotonic contrast medium].

    PubMed

    Takasuna, K; Kasai, Y; Kitano, Y; Mori, K; Kobayashi, R; Makino, M; Hagiwara, T; Hirohashi, M; Nomura, M; Algate, D R

    1995-10-01

    The general pharmacological study of iodixanol, a non-ionic isotonic contrast medium, was conducted. 1) Iodixanol administered intravenously over a dose range of 320 to 3,200 mgI/kg had little or no effect on the general behavior, spontaneous locomotor activity, hexobarbital sleeping time, pain response, electroshock- or pentylenetetrazol-induced convulsion (mouse), EEG or body temperature (rabbit), gastrointestinal propulsion (mouse) or skeletal muscle contraction (rabbit). Iodixanol had no specific interaction with acetylcholine, histamine, serotonin, nicotin, BaCl2 (ileum), methacholine (trachea), isoprenaline (atrium) or oxytocin (pregnant uterus), nor had any effect on spontaneous contractility (atrium and uterus), or transmural electrostimulation-induced contractility (vas deferens) at concentrations of < or = 3.2 x 10(-3) gI/ml in vitro. Iodixanol had no effect on the cardiovascular system of dog, except that it increased femoral blood flow and respiratory rate at doses of > or = 1,000 mgI/kg. Iodixanol at 3,200 mgI/kg i.v. reduced urine output with a decrease in Na+ and Cl- excretion, whereas at 320 mgI/kg i.v., it slightly increased urine output (rat). 2) Injections of iodixanol into the cerebroventricular (0.96, 9.6 mgI/mouse and 3.2, 32 mgI/rat), left ventricular (1,920, 6,400 mgI/dog) or coronary artery (640, 1,920 mgI/dog) had no conspicuous effect on the central nervous system or the cardiovascular system, respectively. There was no marked difference among iodixanol, iohexol and iopamidol in this respect. Vascular pain during injection into the femoral artery (300-320 mgI/guinea pig) appeared to be less intense with iodixanol, compared with the other contrast media iohexol and iopamidol. These results suggest that intravenous injection of iodixanol is relatively free from pharmacological activity, and effects of iodixanol on the central nervous system (intracerebroventricular injection) and cardiovascular system (intra-left ventricular and -coronary

  6. Fox baiting against Echinococcus multilocularis: contrasted achievements among two medium size cities.

    PubMed

    Comte, S; Raton, V; Raoul, F; Hegglin, D; Giraudoux, P; Deplazes, P; Favier, S; Gottschek, D; Umhang, G; Boué, F; Combes, B

    2013-08-01

    In Europe, most cities are currently colonized by red foxes (Vulpes vulpes), which are considered to be the main definitive host of the zoonotic cestode Echinococcus multilocularis. The risk of transmission to humans is of particular concern where high fox populations overlap with high human populations. The distribution of baits containing praziquantel has successfully reduced the infection pressure in rural areas and in small plots within large cities. The purpose of this study was to assess its efficiency in two medium size cities (less than 100,000 inhabitants) in areas of high human alveolar echinococcosis incidence. From August 2006 to March 2009, 14 baiting campaigns of praziquantel treatment were run in Annemasse and Pontarlier (Eastern France), each of which encompassed 33 km(2), with a density of 40 baits/km(2). The bait consumption appeared to be lower in strictly urban context compared to suburban areas (78.9% vs. 93.4%) and lower in Annemasse than in Pontarlier (82.2% vs. 89.5%). During our study, the prevalence of E. multilocularis, as assessed by EM-ELISA on fox faeces collected in the field in Annemasse, was lower within the treated area than in the rural control area. A "before/during" treatment comparison revealed a significant decrease of spring prevalence from 13.3% to 2.2%. No significant change in prevalence was detected in Pontarlier (stable prevalence: 9.1%) where the contamination of the treated area followed the temporal trend observed in the control area. There, a greater resilience of the parasite's life cycle, probably due to a strong pressure of recontamination from outside the treated area, may have counteracted the prophylaxis treatment. These contrasted outcomes suggest that the frequency of fox anthelmintic treatment should be adapted to the local situation. PMID:23642656

  7. Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know

    PubMed Central

    Saade, Charbel; Deeb, Ibrahim Alsheikh; Mohamad, Maha; Al-Mohiy, Hussain; El-Merhi, Fadi

    2016-01-01

    Over the last decade, exponential advances in computed tomography (CT) technology have resulted in improved spatial and temporal resolution. Faster image acquisition enabled renal CT angiography to become a viable and effective noninvasive alternative in diagnosing renal vascular pathologies. However, with these advances, new challenges in contrast media administration have emerged. Poor synchronization between scanner and contrast media administration have reduced the consistency in image quality with poor spatial and contrast resolution. Comprehensive understanding of contrast media dynamics is essential in the design and implementation of contrast administration and image acquisition protocols. This review includes an overview of the parameters affecting renal artery opacification and current protocol strategies to achieve optimal image quality during renal CT angiography with iodinated contrast media, with current safety issues highlighted. PMID:26728701

  8. Contrast medium accumulation and washout in canine brain tumors and irradiated normal brain: a CT study of kinetics

    SciTech Connect

    Fike, J.R.; Cann, C.E.

    1984-04-01

    Kinetics of an iodinated contrast medium were evaluated quantitatively as a function of time up to one hour after intravenous infusion in the brains of dogs with experimentally induced radiation damage and dogs with spontaneous brain tumor. Radiation damage was characterized by an increase in iodine accumulation soon after the infusion, while tumor concentration of iodine either showed no change or decreased with time. These results suggest that contrast kinetic studies may be useful in differentiating radiation damage to normal brain tissue from a malignant brain tumor.

  9. Does iodinated contrast medium amplify DNA damage during exposure to radiation.

    PubMed

    Riley, Peter

    2015-01-01

    There is a recognized increased risk of cancer following exposure of humans to ionizing radiation; this is felt to be most likely due to damage to DNA strands during exposure. Damage to DNA strands can be demonstrated microscopically following exposure to X-rays, and new evidence is emerging that this effect may be compounded by administration of iodinated contrast agents. PMID:26234959

  10. Thromboelastographic Changes Following Nonionic Contrast Medium Injection During Transfemoral Angiography in Patients with Peripheral Arterial Occlusive Disease

    SciTech Connect

    Shankar, V.K. Handa, A.; Philips-Hughes, J.; Boardman, P.; Uberoi, R.; Hands, L.J.

    2006-12-15

    Background/Purpose. Patients with peripheral arterial occlusive disease (PAOD) are known to be systemically hypercoagulable and there is concern that exposing them to contrast media during angiography may exacerbate that thrombotic tendency. Many in vitro studies in which blood is exposed to contrast media suggest that nonionic contrast medium (NICM) has a weaker anticoagulant effect than ionic contrast medium (ICM) and some studies suggest that NICM can lead to activation of coagulation thus increasing the risk of thrombotic events where it is employed. We have looked at the changes in coagulation adjacent to the site of contrast injection/potential angioplasty to determine the magnitude of change locally. Methods. We measured changes in the coagulability of aortic blood samples immediately before and within 2 min after injection of the last bolus of iohexol (NICM) prior to any intervention procedure in 30 patients with PAOD. Samples were analyzed using thromboelastography (TEG) to identify changes in the coagulability of the aortic blood samples. Results. TEG tracings of samples taken from the aorta after injection of NICM showed a significant increase in R time (time to fibrin formation) (p = 0.036) and in k time (dynamics of clot formation) (p = 0.028) and a reduction in Angle (decreased acceleration of fibrin build-up) (p = 0.013), Maximal amplitude (MA) (reduced ultimate clot strength) (p = 0.018) and Coagulation Index (CI) (p = 0.032). Conclusion. These changes in TEG parameters show that the local effect of NICM is a reduction in coagulation activity rather than the activation suggested by some previous studies.

  11. Nanotoxic profiling of novel iron oxide nanoparticles functionalized with perchloric acid and SiPEG as a radiographic contrast medium.

    PubMed

    Mohamed, Muhamad Idham; Mohammad, Mohd Khairul Amran; Abdul Razak, Hairil Rashmizal; Abdul Razak, Khairunisak; Saad, Wan Mazlina Md

    2015-01-01

    Emerging syntheses and findings of new metallic nanoparticles (MNPs) have become an important aspect in various fields including diagnostic imaging. To date, iodine has been utilized as a radiographic contrast medium. However, the raise concern of iodine threats on iodine-intolerance patient has led to search of new contrast media with lower toxic level. In this animal modeling study, 14 nm iron oxide nanoparticles (IONPs) with silane-polyethylene glycol (SiPEG) and perchloric acid have been assessed for toxicity level as compared to conventional iodine. The nanotoxicity of IONPs was evaluated in liver biochemistry, reactive oxygen species production (ROS), lipid peroxidation mechanism, and ultrastructural evaluation using transmission electron microscope (TEM). The hematological analysis and liver function test (LFT) revealed that most of the liver enzymes were significantly higher in iodine-administered group as compared to those in normal and IONPs groups (P < 0.05). ROS production assay and lipid peroxidation indicator, malondialdehyde (MDA), also showed significant reductions in comparison with iodine group (P < 0.05). TEM evaluation yielded the aberration of nucleus structure of iodine-administered group as compared to those in control and IONPs groups. This study has demonstrated the less toxic properties of IONPs and it may postulate that IONPs are safe to be applied as radiographic contrast medium. PMID:26075217

  12. Nanotoxic Profiling of Novel Iron Oxide Nanoparticles Functionalized with Perchloric Acid and SiPEG as a Radiographic Contrast Medium

    PubMed Central

    Mohamed, Muhamad Idham; Mohammad, Mohd Khairul Amran; Abdul Razak, Hairil Rashmizal; Abdul Razak, Khairunisak; Md Saad, Wan Mazlina

    2015-01-01

    Emerging syntheses and findings of new metallic nanoparticles (MNPs) have become an important aspect in various fields including diagnostic imaging. To date, iodine has been utilized as a radiographic contrast medium. However, the raise concern of iodine threats on iodine-intolerance patient has led to search of new contrast media with lower toxic level. In this animal modeling study, 14 nm iron oxide nanoparticles (IONPs) with silane-polyethylene glycol (SiPEG) and perchloric acid have been assessed for toxicity level as compared to conventional iodine. The nanotoxicity of IONPs was evaluated in liver biochemistry, reactive oxygen species production (ROS), lipid peroxidation mechanism, and ultrastructural evaluation using transmission electron microscope (TEM). The hematological analysis and liver function test (LFT) revealed that most of the liver enzymes were significantly higher in iodine-administered group as compared to those in normal and IONPs groups (P < 0.05). ROS production assay and lipid peroxidation indicator, malondialdehyde (MDA), also showed significant reductions in comparison with iodine group (P < 0.05). TEM evaluation yielded the aberration of nucleus structure of iodine-administered group as compared to those in control and IONPs groups. This study has demonstrated the less toxic properties of IONPs and it may postulate that IONPs are safe to be applied as radiographic contrast medium. PMID:26075217

  13. Injury to the upper extremity caused by extravasation of contrast medium: a true emergency.

    PubMed

    Fallscheer, Philipp; Kammer, Erich; Roeren, Thomas; Meuli-Simmen, Claudia

    2007-01-01

    This retrospective clinical study, over a period of four years, includes 16 patients who had extravasation of iopromidum 623 mg (Ultravist 300) in the upper extremity during computed tomography (CT). Although conservative management is sufficient in most cases, seven patients were operated on. The mean time between extravasation and operation was 155 minutes. The most complicated postoperative course occurred when the operation was delayed 300 minutes after extravasation. When patients were treated early, there was no permanent postoperative impairment. Extravasation of contrast is an increasing cause of potential complications in the forearm as a result of the use of power injectors in CT. Immediate assessment by an experienced plastic surgeon followed by either conservative treatment or quick intervention if necessary may avoid serious damage.

  14. Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation.

    PubMed

    Sun, W M; Read, N W; Prior, A; Daly, J A; Cheah, S K; Grundy, D

    1990-10-01

    Anorectal motor activity and rectal sensation were recorded in 12 normal male subjects during ramp distention of the rectum with water and air at randomized rates of 10, 20, 50, and 100 mL/min and during intermittent rapid distention with air. There were no significant differences between the results of ramp inflation with water or with air, and the repeated infusion of the same medium yielded reproducible results. Ramp distention induced sigmoid pressure-volume profiles. Different sensations occurred at specific points on the pressure-volume curve and were maintained until succeeded by the next sensation. Initial perception of the distention occurred during the initial steep pressure increase, the sensation of wind occurred during the plateau phase, and the desire to defecate occurred at the onset of the final rapid ascent. Rectal sensations were induced at lower volumes at low infusion rates when the slope of the pressure-volume relationship was shallower than at high infusion rates. This suggests that the receptor triggering rectal sensation is not a simple volume or pressure receptor, but is more likely to be a slowly adapting mechanoreceptor lying parallel to the circular muscle of the rectal wall. During rapid intermittent distention, the rectal volumes required to elicit rectal sensations were lower than during ramp distention, although the pressure-volume curve was steeper. Moreover, sensations often only lasted a short period of time but recurred on deflation. These data suggest activation of an additional population of rapidly adapting or high threshold mechanoreceptors. Anal relaxation was always evoked by intermittent rectal distention and was almost always associated with a rectal sensation and an increase in external anal sphincter activity. In contrast, anal relaxation could be absent or delayed during ramp inflation, especially at lower infusion rates, suggesting that internal sphincter can maintain continence for a long period of time while the

  15. Atorvastatin ameliorates contrast medium-induced renal tubular cell apoptosis in diabetic rats via suppression of Rho-kinase pathway.

    PubMed

    Su, Jinzi; Zou, Wenbo; Cai, Wenqin; Chen, Xiuping; Wang, Fangbing; Li, Shuizhu; Ma, Wenwen; Cao, Yangming

    2014-01-15

    Contrast medium-induced acute kidney injury (CI-AKI) remains a leading cause of iatrogenic, drug-induced acute renal failure. This study aimed to investigate the protective effects of atorvastatin against renal tubular cell apoptosis in diabetic rats and the related mechanisms. CI-AKI was induced by intravenous administration of iopromide (12ml/kg) in streptozotocin-induced diabetic rats. Atorvastatin (ATO) was administered intragastrically at the dose of 5, 10 and 30mg/kg/d in different groups, respectively, for 5 days before iopromide injection. Renal function parameters, kidney histology, renal tubular cell apoptosis, the expression of apoptosis regulatory proteins, caspase-3 and Rho-associated protein kinase 1 (ROCK-1), and the phosphorylation of myosin phosphatase target subunit -1 (MYPT-1), were determined. Atorvastatin was shown to notably ameliorate contrast medium induced medullary damage, restore renal function, and suppress renal tubular apoptosis. Meanwhile, atorvastatin up-regulated the expression of Bcl-2, down-regulated the expression of Bax, caspase-3 and ROCK-1, restored the ratio of Bcl-2/Bax, and suppressed the phosphorylation of MYPT-1 in a dose-dependent manner. Thus, atorvastatin pretreatment could dose-dependently ameliorate the development of CI-AKI, which was partly attributed to its suppression of renal tubular cell apoptosis by inhibiting the Rho/ROCK pathway.

  16. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse

    PubMed Central

    van Iersel, Jan J; Paulides, Tim J C; Verheijen, Paul M; Lumley, John W; Broeders, Ivo A M J; Consten, Esther C J

    2016-01-01

    External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented. PMID:27275090

  17. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse.

    PubMed

    van Iersel, Jan J; Paulides, Tim J C; Verheijen, Paul M; Lumley, John W; Broeders, Ivo A M J; Consten, Esther C J

    2016-06-01

    External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.

  18. Clinical analysis of contributors to the delayed gallbladder opacification following the use of water-soluble contrast medium

    PubMed Central

    Ku, Ming-Chang; Kok, Victor C; Lee, Ming-Yung; Hsu, Soa-Min; Lee, Pei-Yu; Chang, Che-Wei; Tyan, Yeu-Sheng; Juan, Chi-Wen

    2016-01-01

    Objectives Gallbladder opacification (GBO) on computed tomography (CT) imaging may obscure certain pathological or emergent conditions in the gallbladder, such as neoplasms, stones, and hemorrhagic cholecystitis. This study aimed to investigate the clinical contributing factors that could predict the presence of delayed GBO determined by CT. Methods This study retrospectively evaluated 243 consecutive patients who received enhanced CT or intravenous pyelography imaging and then underwent abdominal CT imaging within 5 days. According to the interval between imaging, the patients were divided into group A (1 day), group B (2 or 3 days), and group C (4 or 5 days). Three radiologists evaluated CT images to determine GBO. Fisher’s exact test and multivariate backward stepwise elimination logistic regression were performed. Results Positive GBO was significantly associated with the interval between imaging studies, contrast type, contrast volume, renal function, and hypertransaminasemia (P<0.05). Multivariate backward stepwise elimination logistic regression analysis of the three groups identified contrast type and hypertransaminasemia as independent predictors of GBO in group B patients (odds ratio [OR], 13.52, 95% confidence interval [CI], 1.72–106.38 and OR, 3.43, 95% CI, 1.31–8.98, respectively; P<0.05). Hypertransaminasemia was the only independent predictor of GBO in group C patients with an OR of 7.2 (95% CI, 1.62–31.73). Hypertransaminasemia was noted in three patients (100%) who initially underwent imaging 5 days prior to GBO. Conclusion Delayed GBO on CT imaging may be associated with laboratory hypertransaminasemia, particularly in patients receiving contrast medium over a period of ≥4 days. A detailed clinical history, physical examination, and further workup are of paramount importance for investigating the underlying cause behind the hypertransaminasemia.

  19. Clinical analysis of contributors to the delayed gallbladder opacification following the use of water-soluble contrast medium

    PubMed Central

    Ku, Ming-Chang; Kok, Victor C; Lee, Ming-Yung; Hsu, Soa-Min; Lee, Pei-Yu; Chang, Che-Wei; Tyan, Yeu-Sheng; Juan, Chi-Wen

    2016-01-01

    Objectives Gallbladder opacification (GBO) on computed tomography (CT) imaging may obscure certain pathological or emergent conditions in the gallbladder, such as neoplasms, stones, and hemorrhagic cholecystitis. This study aimed to investigate the clinical contributing factors that could predict the presence of delayed GBO determined by CT. Methods This study retrospectively evaluated 243 consecutive patients who received enhanced CT or intravenous pyelography imaging and then underwent abdominal CT imaging within 5 days. According to the interval between imaging, the patients were divided into group A (1 day), group B (2 or 3 days), and group C (4 or 5 days). Three radiologists evaluated CT images to determine GBO. Fisher’s exact test and multivariate backward stepwise elimination logistic regression were performed. Results Positive GBO was significantly associated with the interval between imaging studies, contrast type, contrast volume, renal function, and hypertransaminasemia (P<0.05). Multivariate backward stepwise elimination logistic regression analysis of the three groups identified contrast type and hypertransaminasemia as independent predictors of GBO in group B patients (odds ratio [OR], 13.52, 95% confidence interval [CI], 1.72–106.38 and OR, 3.43, 95% CI, 1.31–8.98, respectively; P<0.05). Hypertransaminasemia was the only independent predictor of GBO in group C patients with an OR of 7.2 (95% CI, 1.62–31.73). Hypertransaminasemia was noted in three patients (100%) who initially underwent imaging 5 days prior to GBO. Conclusion Delayed GBO on CT imaging may be associated with laboratory hypertransaminasemia, particularly in patients receiving contrast medium over a period of ≥4 days. A detailed clinical history, physical examination, and further workup are of paramount importance for investigating the underlying cause behind the hypertransaminasemia. PMID:27660453

  20. Case Report: Atrial Fibrillation After Intravenous Administration of Iodinated Contrast Medium in a Patient With Hepatocellular Carcinoma.

    PubMed

    Maimone, Sergio; Filomia, Roberto; Saitta, Carlo; Raimondo, Giovanni; Squadrito, Giovanni

    2015-09-01

    We describe the case of a 73-year-old woman with liver cirrhosis and hepatocellular carcinoma (HCC) who developed 2 distinct episodes of paroxystic atrial fibrillation (AF) each of which occurred 1 to 4 hours after iodine medium contrast-enhanced computed tomography. Sinus rhythm was restored by amiodarone therapy after the first AF episode and by electrical cardioversion after the second one. A careful clinical, biochemical, and instrumental examination showed that the patient had subclinical hyperthyroidism and moderate mitral insufficiency with mild atrial enlargement.Thus, the coexistence of both subclinical disthyroidism and of cardiac anatomical alterations may have predisposed the patient to AF that in fact occurred when exogenous iodine administration triggered a hyperthyroidism status. PMID:26334896

  1. Case Report: Atrial Fibrillation After Intravenous Administration of Iodinated Contrast Medium in a Patient With Hepatocellular Carcinoma

    PubMed Central

    Maimone, Sergio; Filomia, Roberto; Saitta, Carlo; Raimondo, Giovanni; Squadrito, Giovanni

    2015-01-01

    Abstract We describe the case of a 73-year-old woman with liver cirrhosis and hepatocellular carcinoma (HCC) who developed 2 distinct episodes of paroxystic atrial fibrillation (AF) each of which occurred 1 to 4 hours after iodine medium contrast-enhanced computed tomography. Sinus rhythm was restored by amiodarone therapy after the first AF episode and by electrical cardioversion after the second one. A careful clinical, biochemical, and instrumental examination showed that the patient had subclinical hyperthyroidism and moderate mitral insufficiency with mild atrial enlargement. Thus, the coexistence of both subclinical disthyroidism and of cardiac anatomical alterations may have predisposed the patient to AF that in fact occurred when exogenous iodine administration triggered a hyperthyroidism status. PMID:26334896

  2. Rectal cancer: Neoadjuvant chemoradiotherapy.

    PubMed

    Rödel, Claus; Hofheinz, Ralf; Fokas, Emmanouil

    2016-08-01

    The monolithic approach to apply the same schedule of preoperative 5-fluorouracil (5-FU)- or capecitabine-based chemoradiotherapy (CRT) to all patients with clinically staged TNM stage II/III rectal cancer need to be questioned. Five randomized trials have been completed to determine if the addition of oxaliplatin to preoperative 5-FU/capecitabine-based CRT offers an advantage compared with single-agent CRT. In contrast to the German CAO/ARO/AIO-04 trial, results from the ACCORD 12, STAR-01, PETACC-6 and NSAPB R-04 trials failed to demonstrate a significant improvement of early or late efficacy endpoints with the addition of oxaliplatin. Most of the phase II trials incorporating cetuximab into CRT reported disappointingly low rates of pCR; the combination of CRT with VEGF inhibition showed encouraging pCR rates but at the cost of increased surgical complications. Novel clinical trials currently address (1) the role of induction and consolidation chemotherapy before or after CRT, (2) minimal or omitted surgery following complete response to CRT, or (3) the omission of radiotherapy for selected patients with response to neoadjuvant chemotherapy. The notion of different multimodal treatment concepts according to tumor stage, location, mesorectal fascia margin status, molecular profiles, tumor response, and patients' preferences becomes increasingly popular and will render the multimodal treatment approach of rectal cancer more risk-adapted. PMID:27644910

  3. Estimation of time to peak contrast enhancement of the aorta and liver for dual-phase computed tomography on the basis of contrast medium arrival time, injection duration, and injection technique in dogs.

    PubMed

    Chau, Jennifer; Young, Alex C; Dhand, Navneet; Makara, Mariano A

    2016-10-01

    OBJECTIVE To evaluate the accuracy of estimating time to peak enhancement (TPE) of the aorta and liver parenchyma on the basis of contrast medium arrival time in the aorta, injection duration, and injection technique in dogs. ANIMALS 18 dogs of specific body weight categories (≥ 2 dogs/category) with no liver abnormalities detected via CT. PROCEDURES Dogs were randomly assigned within weight categories to receive contrast medium IV at a fixed injection rate (5 mL/s) or fixed injection duration (20 seconds). Time-contrast attenuation curves were generated from dynamic CT scans acquired at the hepatic hilus. Data collected for contrast medium arrival time and injection duration were used to estimate TPEs of the aorta and liver, and results were compared with the observed TPEs for the aorta and liver. RESULTS Contrast medium arrival time, injection duration, and injection technique were significantly associated with observed values for aortic TPE and explained 96.1% of variation in TPE. For the fixed rate technique, the regression equation for estimating aortic TPE was 0.8 × (injection duration + contrast medium arrival time) + 1.6. For the fixed duration technique, the regression equation changed by only the constant (-2.6). However, the hepatic TPE estimated from the 3 predictor variables was not significantly different from the mean of observed TPEs. CONCLUSIONS AND CLINICAL RELEVANCE Aortic TPE could be accurately estimated from contrast medium arrival time, injection duration, and injection technique in dogs with apparently healthy livers. The regression equations derived from this relationship can be used to improve the efficiency of dual-phase CT of the liver in dogs. PMID:27668580

  4. A study on quantitative analyses before and after injection of contrast medium in spine examinations performed by using diffusion weighted image

    NASA Astrophysics Data System (ADS)

    Cho, Jae-Hwan; Lee, Hae-Kag; Kim, Yong-Kyun; Dong, Kyung-Rae; Chung, Woon-Kwan; Joo, Kyu-Ji

    2013-02-01

    This study examined the changes in the signal-to-noise ratio (SNR), the contrast-to-noise ratio (CNR) and the apparent diffusion coefficient (ADC) of metastatic cancer in the lumbar region by using diffusion weighted image taken with a 1.5 T (Tesla) magnetic resonance (MR) scanner before and after injecting a contrast medium. The study enrolled 30 healthy people and 30 patients with metastatic spine cancer from patients who underwent a lumbar MRI scan from January 2011 to October 2012. A 1.5 T MR scanner was used to obtain the diffusion weighted images (DWIs) before and after injecting the contrast medium. In the group with metastatic spine cancer, the SNR and the CNR were measured in three parts among the L1-L5 lumbar vertebrae, which included the part with metastatic spine cancer, the area of the spine with spine cancer, and the area of spine under the region with cancer. In the acquired ADC map image, the SNRs and the ADCs of the three parts were measured in ADC map images. Among the healthy subjects, the measurements were conducted for the lumbar regions of L3-L5. According to the results, in the group with metastatic spine cancer, the SNR in the DWI before the contrast medium had been injected was lowest in the part with spine cancer. In the DWI after the contrast medium had been injected, the SNR and the CNR were increased in all three parts. In the ADC map image after the contrast medium had been injected, the SNR decreased in all three parts compared to the SNR before the contrast had been injected. The ADC after had been injected the contrast medium was decreased in all three parts compared to that before the contrast medium had been injected. In the healthy group, the SNR was increased in the L3-L5 lumbar regions in the DWI. In the ADC map image, the SNR in all the three parts was decreased in the DWI after injecting the contrast medium had been injected. The ADC in the ADC map image was also decreased in all three parts.

  5. Artifacts caused by insufficient contrast medium filling during C-arm cone-beam CT scans: a phantom study.

    PubMed

    Terabe, Mitsuaki; Ichikawa, Hajime; Kato, Toyohiro; Koshida, Kichiro

    2014-01-01

    We investigated artifacts due to late-arriving contrast medium (CM) during C-arm cone-beam computed tomography. We scanned a phantom filled with water or with 100, 50, or 5% v/v concentrations of CM and then virtually produced CM-delayed projection data by partially replacing the projection images. Artifacts as a function of concentration, percentage of filling time, and size and position of the filling area were assessed. In addition, we used an automatic power injector with different injection delays to inject CM during the scans. A decrease in filling times caused by a lag in CM arrival during the scan resulted in a decrease in pixel values, distortion of the filling area, and appearance of streak artifacts. Even a delay of approximately 20% in CM arrival in the total scan time resulted in obvious distortion of the filling area. The distortion and streak artifacts tended to worsen at higher CM concentrations. Use of a minimum CM concentration based on the purpose of the examination and constant filling at the target region are effective for avoiding these artifacts.

  6. Conventional versus storage phosphor-plate digital images to visualize the root canal system contrasted with a radiopaque medium.

    PubMed

    Naoum, Hani J; Chandler, Nicholas P; Love, Robert M

    2003-05-01

    The pulp tissue was removed from 20 mandibular first molar teeth using 2.5% NaOCl irrigation and hand files. The dried canals were infused with radiopaque contrast medium. Standardized conventional and Digora digital images were obtained of each tooth positioned in a dried mandible at 0- and 30-degree horizontal angulations. Three evaluators rated the image clarity of the 0- and 30-degree original, enhanced, three-dimensional, zoom, and reverse digital image modes as superior, equal, or inferior to corresponding 0- and 30-degree conventional radiographs. The ratings were compared using the Wilcoxon signed rank test. The original, three-dimensional, zoom, or reverse digital images were inferior to the conventional radiographs for clarity of canal anatomy. The enhanced digital images were not always inferior to the conventional radiographs and were the only images superior to the original digital images. Overall, evaluators rated the image clarity of root canal anatomy on conventional radiographs better than on Digora images. However, factors in the experimental design may have contributed to this result. PMID:12775009

  7. SU-C-12A-03: The Impact of Contrast Medium On Radiation Dose in CT: A Systematic Evaluation Across 58 Patient Models

    SciTech Connect

    Sahbaee, P; Samei, E; Segars, W

    2014-06-01

    Purpose: To assess the effect of contrast medium on radiation dose as a function of time via Monte Carlo simulation from the liver CT scan across a library of 5D XCAT models Methods: A validated Monte Carlo simulation package (PENELOPE) was employed to model a CT system (LightSpeed 64 VCT, GE Healthcare). The radiation dose was estimated from a common abdomen CT examination. The dose estimation was performed on a library of adult extended cardiac-torso (5D XCAT) phantoms (35 male, 23 female, mean age 51.5 years, mean weight 80.2 kg). The 5D XCAT models were created based on patient-specific iodine concentration-time results from our computational contrast medium propagation model for different intravenous injection protocols. To enable a dynamic estimation of radiation dose, each organ in the model was assigned to its own time-concentration curve via the PENELOPE package, material.exe. Using the Monte Carlo, for each scan time point after the injection, 80 million photons were initiated and tracked through the phantoms. Finally, the dose to the liver was tallied from the deposited energy. Results: Monte Carlo simulation results of radiation dose delivered to the liver from the XCAT models indicated up to 30% increase in dose for different time after the administration of contrast medium. Conclusion: The contrast enhancement is employed in over 60% of imaging modalities, which not only remarkably affects the CT image quality, but also increases the radiation dose by as much as 70%. The postinjection multiple acquisition in several enhanced CT protocols, makes the radiation dose increment through the use of contrast medium, an inevitable factor in optimization of these protocols. The relationship between radiation dose and injected contrast medium as a function of time studied in this work allows optimization of contrast administration for vulnerable individuals.

  8. Evaluation of the dark-medium objective lens in counting asbestos fibers by phase-contrast microscopy.

    PubMed

    Lee, Eun Gyung; Nelson, John H; Kashon, Michael L; Harper, Martin

    2015-06-01

    A Japanese round-robin study revealed that analysts who used a dark-medium (DM) objective lens reported higher fiber counts from American Industrial Hygiene Association (AIHA) Proficiency Analytical Testing (PAT) chrysotile samples than those using a standard objective lens, but the cause of this difference was not investigated at that time. The purpose of this study is to determine any major source of this difference by performing two sets of round-robin studies. For the first round-robin study, 15 AIHA PAT samples (five each of chrysotile and amosite generated by water-suspended method, and five chrysotile generated by aerosolization method) were prepared with relocatable cover slips and examined by nine laboratories. A second round-robin study was then performed with six chrysotile field sample slides by six out of nine laboratories who participated in the first round-robin study. In addition, two phase-shift test slides to check analysts' visibility and an eight-form diatom test plate to compare resolution between the two objectives were examined. For the AIHA PAT chrysotile reference slides, use of the DM objective resulted in consistently higher fiber counts (1.45 times for all data) than the standard objective (P-value < 0.05), regardless of the filter generation (water-suspension or aerosol) method. For the AIHA PAT amosite reference and chrysotile field sample slides, the fiber counts between the two objectives were not significantly different. No statistically significant differences were observed in the visibility of blocks of the test slides between the two objectives. Also, the DM and standard objectives showed no pattern of differences in viewing the fine lines and/or dots of each species images on the eight-form diatom test plate. Among various potential factors that might affect the analysts' performance of fiber counts, this study supports the greater contrast caused by the different phase plate absorptions as the main cause of high counts for the

  9. Evaluation of the dark-medium objective lens in counting asbestos fibers by phase-contrast microscopy.

    PubMed

    Lee, Eun Gyung; Nelson, John H; Kashon, Michael L; Harper, Martin

    2015-06-01

    A Japanese round-robin study revealed that analysts who used a dark-medium (DM) objective lens reported higher fiber counts from American Industrial Hygiene Association (AIHA) Proficiency Analytical Testing (PAT) chrysotile samples than those using a standard objective lens, but the cause of this difference was not investigated at that time. The purpose of this study is to determine any major source of this difference by performing two sets of round-robin studies. For the first round-robin study, 15 AIHA PAT samples (five each of chrysotile and amosite generated by water-suspended method, and five chrysotile generated by aerosolization method) were prepared with relocatable cover slips and examined by nine laboratories. A second round-robin study was then performed with six chrysotile field sample slides by six out of nine laboratories who participated in the first round-robin study. In addition, two phase-shift test slides to check analysts' visibility and an eight-form diatom test plate to compare resolution between the two objectives were examined. For the AIHA PAT chrysotile reference slides, use of the DM objective resulted in consistently higher fiber counts (1.45 times for all data) than the standard objective (P-value < 0.05), regardless of the filter generation (water-suspension or aerosol) method. For the AIHA PAT amosite reference and chrysotile field sample slides, the fiber counts between the two objectives were not significantly different. No statistically significant differences were observed in the visibility of blocks of the test slides between the two objectives. Also, the DM and standard objectives showed no pattern of differences in viewing the fine lines and/or dots of each species images on the eight-form diatom test plate. Among various potential factors that might affect the analysts' performance of fiber counts, this study supports the greater contrast caused by the different phase plate absorptions as the main cause of high counts for the

  10. Contrast Medium Exposure During Computed Tomography and Risk of Development of End-Stage Renal Disease in Patients With Chronic Kidney Disease

    PubMed Central

    Hsieh, Ming-Shun; Chiu, Chien-Shan; How, Chorng-Kuang; Chiang, Jen-Huai; Sheu, Meei-Ling; Chen, Wen-Chi; Lin, Hsuan-Jen; Hsieh, Vivian Chia-Rong; Hu, Sung-Yuan

    2016-01-01

    Abstract The aim of the study was to investigate the long-term association between contrast medium exposure during computed tomography (CT) and the subsequent development of end-stage renal disease (ESRD) in patients with chronic kidney disease (CKD). We conducted a population-based cohort study using Taiwan's National Health Insurance Research Database. A total of 7100 patients with nonadvanced CKD who underwent contrast medium-enhanced CT were identified and served as the study cohort. To avoid selection bias, we used the propensity score to match 7100 nonadvanced CKD patients, who underwent noncontrast medium-enhanced CT to serve as the comparison cohort. The age, sex, index year, and frequency of undergoing CTs were also matched between the study and comparison cohorts. Participants were followed until a new diagnosis of ESRD or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. Contrast medium exposure was not identified as a risk factor for developing ESRD in nonadvanced CKD patients after confounders adjustment (adjusted HR = 0.91; 95% CI, 0.66–1.26; P = 0.580). We further divided the patients who underwent CTs with contrast medium use into ≤1 exposure per year on average, >1 and <2 exposure per year on average, and ≥2 exposure per year on average. After adjusting for confounders, we identified a much higher risk for developing ESRD in the 2 groups of >1 and <2 exposure per year on average and ≥2 exposure per year on average (adjusted HR = 8.13; 95% CI, 5.57–11.87 and adjusted HR = 12.08; 95% CI, 7.39–19.75, respectively) compared with the patients who underwent CTs without contrast medium use. This long-term follow-up study demonstrated that contrast medium exposure was not associated with an increased risk of ESRD development in nonadvanced CKD patients. PMID:27100424

  11. Hiding an image with a light-scattering medium and use of a contrast-discrimination method for readout.

    PubMed

    Hayasaki, Yoshio; Matsuba, Yoshiaki; Nagaoka, Atsushi; Yamamoto, Hirotsugu; Nishida, Nobuo

    2004-03-01

    Hiding image data with a material such as a light-scattering medium is useful as an initial stage of data protection, because the hidden image can be detected only by observation with a specific technique. A light-scattering medium is used to hide the image data, and a low-temporal-coherence interferometer performs the readout processing. A new readout method for detecting pixel values of the image is proposed to overcome spatial variation of the light intensity and distortion of the interference fringes. The introduction of spatial coding further improves the performance by overcoming spatial variations of the light-scattering medium and variations in the reflectance of given pixels.

  12. Rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction: case report.

    PubMed

    Özçelik, Ümit; Bircan, Hüseyin Yüce; Eren, Eryiğit; Demiralay, Ebru; Işıklar, İclal; Demirağ, Alp; Moray, Gökhan

    2015-01-01

    Although diverticular disease of the colon is common, the occurrence of rectal diverticula is extremely rare with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are seen even less frequently, and surgical intervention is needed for only complicated cases. Here we report the case of a 63-year-old woman presenting with rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction.

  13. MO-E-17A-02: Incorporation of Contrast Medium Dynamics in Anthropomorphic Phantoms: The Advent of 5D XCAT Models

    SciTech Connect

    Sahbaee, P; Samei, E; Segars, W

    2014-06-15

    Purpose: To develop a unique method to incorporate the dynamics of contrast-medium propagation into the anthropomorphic phantom, to generate a five-dimensional (5D) patient model for multimodality imaging studies. Methods: A compartmental model of blood circulation network within the body was embodied into an extended cardiac-torso (4D-XCAT) patient model. To do so, a computational physiologic model of the human cardiovascular system was developed which includes a series of compartments representing heart, vessels, and organs. Patient-specific cardiac output and blood volume were used as inputs influenced by the weight, height, age, and gender of the patient's model. For a given injection protocol and given XCAT model, the contrast-medium transmission within the body was described by a series of mass balance differential equations, the solutions to which provided the contrast enhancement-time curves for each organ; thereby defining the tissue materials including the contrastmedium within the XCAT model. A library of time-dependent organ materials was then defined. Each organ in each voxelized 4D-XCAT phantom was assigned to a corresponding time-varying material to create the 5D-XCAT phantom in which the fifth dimension is blood/contrast-medium within the temporal domain. Results: The model effectively predicts the time-varying concentration behavior of various contrast-medium administration in each organ for different patient models as function of patient size (weight/height) and different injection protocol factors (injection rate and pattern, iodine concentration or volume). The contrast enhanced XCAT patient models was developed based on the concentration of iodine as a function of time after injection. Conclusion: Majority of medical imaging systems take advantage of contrast-medium administration in terms of better image quality, the effect of which was ignored in previous optimization studies. The study enables a comprehensive optimization of contrast

  14. [A pilot study of contrast medium dose reduction using low tube voltage and iterative reconstruction: computed tomography angiography of the head].

    PubMed

    Ihara, Riku; Itou, Kouhei; Terashita, Takayoshi; Fuse, Yoshihiro

    2015-03-01

    This study aimed to reduce contrast medium dose without reducing the diagnostic capability of computed tomography (CT) angiography of the head. We evaluated the advanced statistical iterative reconstruction (ASiR) settings to adjust to low tube voltage CT. A syringe phantom was constructed using dilute contrast medium and was imaged at tube voltages of 80-120 kV. The iodine volumes, CT values, and image noise were measured in these images. The noise-power spectrum and modulation transfer function were measured from quality assurance phantom images that had been obtained using the tube voltage selected after considering the image noise results as described above and reconstructed using different ASiR rate settings and convolution kernels. Our results suggested that imaging at 100 kV could reduce the contrast medium dose by 14%, compared with imaging at 120 kV, and that the resulting image quality could equal that of conventional imaging by performing reconstruction at a 40% ASiR rate and detail kernel.

  15. 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 ...

  16. Understanding Minor Rectal Bleeding

    MedlinePlus

    ... fever or significant rectal bleeding. Laser or infrared coagulation and sclerotherapy (injection of medicine directly into the ... or if symptoms persist despite rubber band ligation, coagulation or sclerotherapy. What are anal fissures? Tears that ...

  17. Rectal cancer: a review

    PubMed Central

    Fazeli, Mohammad Sadegh; Keramati, Mohammad Reza

    2015-01-01

    Rectal cancer is the second most common cancer in large intestine. The prevalence and the number of young patients diagnosed with rectal cancer have made it as one of the major health problems in the world. With regard to the improved access to and use of modern screening tools, a number of new cases are diagnosed each year. Considering the location of the rectum and its adjacent organs, management and treatment of rectal tumor is different from tumors located in other parts of the gastrointestinal tract or even the colon. In this article, we will review the current updates on rectal cancer including epidemiology, risk factors, clinical presentations, screening, and staging. Diagnostic methods and latest treatment modalities and approaches will also be discussed in detail. PMID:26034724

  18. Barium sulfate aspiration: Severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema.

    PubMed

    Zhang, Lin; Yang, Yi; Zhang, Ji; Zhou, Xiaowei; Dong, Hongmei; Zhou, Yiwu

    2015-08-01

    Barium contrast radiography is a conventional procedure aimed at revealing lesions of the alimentary tract using barium sulfate on X-ray irradiation. Although it is widely used in clinics, adverse effects and complications are observed, such as anaphylaxis, granuloma, fecalithes, abdomen-leaking, embolism, bacterial contamination, and aspiration. We report a case of death due to a massive barium sulfate aspiration resulted from an air-barium double contrast enema radiography. A 25-year-old female patient was hospitalized with symptoms of abdominal distention, nausea, vomiting and diarrhea for three days. A progressive respiratory distress presented only 1h after a small bowel air-barium double contrast enema. The patient died 11h later. The result of autopsy revealed the cause of death to be severe chemical pneumonitis induced by gastric fluid which was aspirated into her lungs. Barium sulfate is generally recognized to be chemically inert for the respiratory system, but a mixture of barium sulfate with gastric contents is fatal. Here we intend to suggest that, when determining the potential cause of death, medical examiners should consider a patient's status quo as well as the possible adverse effects and complications caused by the barium sulfate preparation during gastrointestinal radiography.

  19. Rectal Microbicide Development

    PubMed Central

    Dezzutti, Charlene

    2014-01-01

    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

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

    NASA Astrophysics Data System (ADS)

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

    2008-02-01

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

  1. General Information about Rectal Cancer

    MedlinePlus

    ... Research Rectal Cancer Treatment (PDQ®)–Patient Version General Information About Rectal Cancer Go to Health Professional Version ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

  2. Myelography in achondroplasia: value of a lateral C1-2 puncture and non-ionic, water-soluble contrast medium

    SciTech Connect

    Suss, R.A.; Udvarhelyi, G.B.; Wang, H.; Kumar, A.J.; Zinreich, S.J.; Rosenbaum, A.E.

    1983-10-01

    Because of technical difficulties and diagnostic limitations encountered with other myelographic techniques in patients with achondroplasia, the authors employed a lateral C1-2 puncture and non-ionic, water-soluble contrast medium in 18 achondroplastic patients with spinal compression (21 procedures). This technique proved most appropriate for identifying the upper limit of degenerative osteophytes causing exacerbation of congenital spinal stenosis, which is crucial in planning decompressive surgery. A potentially important additional finding was the presence of degenerative lower cervical spine disease in the majority of patients. There were no serious complications. The authors recommend this technique as safe and effective in achondroplastic patients with severe congenital spinal stenosis.

  3. Low kV settings CT angiography (CTA) with low dose contrast medium volume protocol in the assessment of thoracic and abdominal aorta disease: a feasibility study

    PubMed Central

    Talei Franzesi, C; Fior, D; Bonaffini, P A; Minutolo, O; Sironi, S

    2015-01-01

    Objective: To assess the diagnostic quality of low dose (100 kV) CT angiography (CTA), by using ultra-low contrast medium volume (30 ml), for thoracic and abdominal aorta evaluation. Methods: 67 patients with thoracic or abdominal vascular disease underwent multidetector CT study using a 256 slice scanner, with low dose radiation protocol (automated tube current modulation, 100 kV) and low contrast medium volume (30 ml; 4 ml s−1). Density measurements were performed on ascending, arch, descending thoracic aorta, anonymous branch, abdominal aorta, and renal and common iliac arteries. Radiation dose exposure [dose–length product (DLP)] was calculated. A control group of 35 patients with thoracic or abdominal vascular disease were evaluated with standard CTA protocol (automated tube current modulation, 120 kV; contrast medium, 80 ml). Results: In all patients, we correctly visualized and evaluated main branches of the thoracic and abdominal aorta. No difference in density measurements was achieved between low tube voltage protocol (mean attenuation value of thoracic aorta, 304 HU; abdominal, 343 HU; renal arteries, 331 HU) and control group (mean attenuation value of thoracic aorta, 320 HU; abdominal, 339; renal arteries, 303 HU). Radiation dose exposure in low tube voltage protocol was significantly different between thoracic and abdominal low tube voltage studies (490 and 324 DLP, respectively) and the control group (thoracic DLP, 1032; abdomen, DLP 1078). Conclusion: Low-tube-voltage protocol may provide a diagnostic performance comparable with that of the standard protocol, decreasing radiation dose exposure and contrast material volume amount. Advances in knowledge: Low-tube-voltage-setting protocol combined with ultra-low contrast agent volume (30 ml), by using new multidetector-row CT scanners, represents a feasible diagnostic tool to significantly reduce the radiation dose delivered to patients and to preserve renal function

  4. Use of postmortem coronary computed tomography angiography with water-insoluble contrast medium to detect stenosis of the left anterior descending artery in a case of sudden death.

    PubMed

    Takahashi, Yoichiro; Sano, Rie; Takahashi, Keiko; Kominato, Yoshihiko; Takei, Hiroyuki; Kobayashi, Susumu; Shimada, Takehiro; Tokue, Hiroyuki; Awata, Sachiko; Hirasawa, Satoshi

    2016-03-01

    A 40-year-old man was found dead on a sidewalk in an expressway parking area one hour after he had entered the area on a motorcycle. A medicolegal autopsy was performed to reveal the cause of this sudden and unexpected death. Postmortem coronary CT angiography after introduction of 5% gelatin-barium emulsion as a radiopaque contrast medium into the heart demonstrated a significant arterial luminal filling defect in the left anterior descending (LAD) coronary artery. Macroscopic and microscopic examinations revealed that a thrombus had become deposited on ruptured plaque within the LAD artery, and that a small amount of the contrast medium was present between the thrombus and the vessel endothelium. These histological findings were consistent with incomplete occlusion of the LAD artery in the 3D reconstructed image. The cause of death in this case was definitively determined to be ischemic heart disease. Postmortem angiography played a role in screening of a vascular lesion that was subsequently verified by histology to have been responsible for sudden and unexpected death. PMID:26980254

  5. Block-copolymer of polyethylene glycol and polylysine as a carrier of organic iodine: design of long-circulating particulate contrast medium for X-ray computed tomography.

    PubMed

    Trubetskoy, V S; Gazelle, G S; Wolf, G L; Torchilin, V P

    1997-01-01

    In order to obtain small, polymer-stabilized particulate carriers for organic iodine to serve as a contrast agent for X-ray computed tomography (CT) an attempt was made to design a carrier based on polymeric micelles. Here we describe the synthesis of an iodine-containing amphiphilic block-copolymer which can micellize in aqueous solutions. The two blocks of the copolymer consisted of methoxypoly(ethyleneglycol) and poly[epsilon,N-(triiodobenzoyl)-L-lysine]. Upon dispersion in water, the block copolymer formed particles with average diameter 80 nm and iodine content up to 44.7%. The particles start to dissociate to the individual polymeric chains in the concentration range of 0.05-0.5 microM in water at 23 degrees C. Upon intravenous injection at 250 mg of iodine/kg (570 mg of the agent/kg) in rabbits the medium demonstrated exceptional 24 hr half-life in the blood substantiating corona/core structure of the particles with PEG chains protecting the iodine-containing core. The possible use of these particulates as contrast medium for X-ray computed tomography is discussed.

  6. Electromagnetic induction in a conductive strip in a medium of contrasting conductivity: application to VLF and MT above molten dykes

    NASA Astrophysics Data System (ADS)

    Davis, Paul M.

    2014-11-01

    Very low frequency (VLF) electromagnetic waves that penetrate conductive magma-filled dykes generate secondary fields on the surface that can be used to invert for dyke properties. The model used for the interpretation calculates currents induced in a conductive strip by an inducing field that decays exponentially with depth due to the conductivity of the surrounding medium. The differential equations are integrated to give an inhomogeneous Fredholm equation of the second kind with a kernel consisting of a modified Bessel function of the second kind. Numerical methods are typically used to solve for the induced currents in the strip. In this paper, we apply a modified Galerkin-Chebyshev method, which involves separating the kernel into source and field spectra and integrating the source terms to obtain a matrix equation for the unknown coefficients. The incident wave is expressed as a Chebyshev series. The modified Bessel function is separated into a logarithmic singularity and a non-singular remainder, both of which are expanded in complex Chebyshev polynomials. The Chebyshev coefficients for the remainder are evaluated using a fast Fourier transform, while the logarithmic term and incident field have analytic series. The deconvolution then involves a matrix inversion. The results depend on the ratio of strip-size to skin-depth. For infinite skin-depth and a singular conductivity distribution given by τ_0 a/√{a^2 - z^2 } (where τ0 is the conductance, a is the half-length and z the distance from the centre), Parker gives an analytic solution. We present a similar analytic series solution for the finite skin-depth case, where the size to skin depth ratio is small. Results are presented for different ratios of size to skin depth that can be compared with numerical solutions. We compare full-space and half-space solutions. A fit of the model to VLF data taken above a magma filled dykes in Hawaii and Mt Etna demonstrates that while properties such as depth to top

  7. How good is the turbid medium-based approach for accounting for light partitioning in contrasted grass–legume intercropping systems?

    PubMed Central

    Barillot, Romain; Louarn, Gaëtan; Escobar-Gutiérrez, Abraham J.; Huynh, Pierre; Combes, Didier

    2011-01-01

    Background and Aims Most studies dealing with light partitioning in intercropping systems have used statistical models based on the turbid medium approach, thus assuming homogeneous canopies. However, these models could not be directly validated although spatial heterogeneities could arise in such canopies. The aim of the present study was to assess the ability of the turbid medium approach to accurately estimate light partitioning within grass–legume mixed canopies. Methods Three contrasted mixtures of wheat–pea, tall fescue–alfalfa and tall fescue–clover were sown according to various patterns and densities. Three-dimensional plant mock-ups were derived from magnetic digitizations carried out at different stages of development. The benchmarks for light interception efficiency (LIE) estimates were provided by the combination of a light projective model and plant mock-ups, which also provided the inputs of a turbid medium model (SIRASCA), i.e. leaf area index and inclination. SIRASCA was set to gradually account for vertical heterogeneity of the foliage, i.e. the canopy was described as one, two or ten horizontal layers of leaves. Key Results Mixtures exhibited various and heterogeneous profiles of foliar distribution, leaf inclination and component species height. Nevertheless, most of the LIE was satisfactorily predicted by SIRASCA. Biased estimations were, however, observed for (1) grass species and (2) tall fescue–alfalfa mixtures grown at high density. Most of the discrepancies were due to vertical heterogeneities and were corrected by increasing the vertical description of canopies although, in practice, this would require time-consuming measurements. Conclusions The turbid medium analogy could be successfully used in a wide range of canopies. However, a more detailed description of the canopy is required for mixtures exhibiting vertical stratifications and inter-/intra-species foliage overlapping. Architectural models remain a relevant tool for

  8. Rectal Mechano-sensory Function in Patients with Carcinoid Diarrhea

    PubMed Central

    Gregersen, Tine; Brock, Christina; Haase, Anne-Mette; Laurberg, Søren; Drewes, Asbjørn M; Grønbæk, Henning; Krogh, Klaus

    2016-01-01

    Background/Aims In patients with neuroendocrine tumors, excessive production of serotonin and other amines may cause the carcinoid syndrome, which is mainly characterized by diarrhea and flushing. Little is known about the pathophysiology of carcinoid diarrhea. In several other groups of patients, diarrhea may be associated with rectal hypersensitivity and increased rectal tone. Therefore, the aim of the present study was to compare rectal sensitivity and compliance in patients with carcinoid diarrhea and in healthy subjects. Methods Twelve patients (6 males, aged 54–78 years, median 65 years), with carcinoid diarrhea and 19 healthy subjects (7 males, aged 50–78 years, median 61 years) were included. Rectal mechanical and heat stimulation was used for assessment of rectal mechano-sensory properties. Results Overall, 5.3% higher temperatures were needed to elicit sensory responses in patients with carcinoid diarrhea than in healthy subjects (P = 0.015). Posthoc analyses revealed that the sensory threshold to heat was 48.1 ± 3.1°C in patients vs 44.7 ± 4.7°C in healthy subjects (P = 0.041). In contrast, patients and healthy subjects showed no overall differences in rectal sensory response to mechanical distension (P = 0.731) or rectal compliance (P = 0.990). Conclusions Patients with carcinoid diarrhea have higher sensory thresholds to heat stimulation in comparison to healthy subjects, but normal rectal sensation to mechanical distension and normal compliance. Therefore, treatment of carcinoid diarrhea should aim at prolonging gastrointestinal transit and decreasing secretion, rather than modifying rectal mechano-sensory function. PMID:26690884

  9. [Laparoscopic rectal resection technique].

    PubMed

    Anthuber, M; Kriening, B; Schrempf, M; Geißler, B; Märkl, B; Rüth, S

    2016-07-01

    The quality of radical oncological operations for patients with rectal cancer determines the rate of local recurrence and long-term survival. Neoadjuvant chemoradiotherapy for locally advanced tumors, a standardized surgical procedure for rectal tumors less than 12 cm from the anus with total mesorectal excision (TME) and preservation of the autonomous nerve system for sexual and bladder function have significantly improved the oncological results and quality of life of patients. The TME procedure for rectal resection has been performed laparoscopically in Germany for almost 20 years; however, no reliable data are available on the frequency of laparoscopic procedures in rectal cancer patients in Germany. The rate of minimally invasive procedures is estimated to be less than 20 %. A prerequisite for using the laparoscopic approach is implicit adherence to the described standards of open surgery. Available data from prospective randomized trials, systematic reviews and meta-analyses indicate that in the early postoperative phase the generally well-known positive effects of the minimally invasive approach to the benefit of patients can be realized without any long-term negative impact on the oncological results; however, the results of many of these studies are difficult to interpret because it could not be confirmed whether the hospitals and surgeons involved had successfully completed the learning curve. In this article we would like to present our technique, which we have developed over the past 17 years in more than 1000 patients. Based on our experiences the laparoscopic approach can be highly recommended as a suitable alternative to the open procedure. PMID:27277556

  10. High-pitch coronary CT angiography at 70 kVp with low contrast medium volume: comparison of 80 and 100 kVp high-pitch protocols.

    PubMed

    Zhang, Long Jiang; Qi, Li; De Cecco, Carlo N; Zhou, Chang Sheng; Spearman, James V; Schoepf, U Joseph; Lu, Guang Ming

    2014-11-01

    The purpose of this article is to evaluate image quality and radiation dose of prospectively electrocardiogram (ECG)-triggered high-pitch coronary computed tomography angiography (CCTA) at 70 kVp and 30 mL contrast medium.One hundred fifty patients with a heart rate ≤70 beats per minute (bpm) underwent CCTA using a second-generation dual-source computed tomography (CT) scanner and were randomized into 3 groups according to tube voltage and contrast medium volume (370 mg/mL iodine concentration) (100 kVp group, 100 kVp/60 mL, n = 55; 80 kVp group, 80 kVp/60 mL, n = 44; 70 kVp group, 70 kVp/30 mL, n = 51). Objective and subjective image quality along with the effect of heart rate (HR) and body mass index (BMI) was evaluated and compared between the groups. Radiation dose was estimated for each patient.CT attenuation and image noise were higher in the 80 and 70 kVp groups than in the 100 kVp group (all P < 0.001). Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were lower in the 70 kVp group than in the 80 and 100 kVp groups (all P < 0.05). There was no difference for subjective image quality between the groups (P > 0.05). HR did not affect subjective image quality (all P > 0.05), while patients with BMI <23 kg/m had higher image quality than patients with BMI ≥23 kg/m (P < 0.05). Compared with the 100 kVp group, the radiation dose of the 70 kVp group was reduced by 75%.In conclusion, prospectively ECG-triggered high-pitch 70 kVp/30 mL CCTA can obtain diagnostic image quality with lower radiation dose in selected patients with BMI <23 kg/m compared with 80/100 kVp/60 mL CCTA. PMID:25396334

  11. Contrast Medium Exposure During Computed Tomography and Risk of Development of End-Stage Renal Disease in Patients With Chronic Kidney Disease: A Nationwide Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study.

    PubMed

    Hsieh, Ming-Shun; Chiu, Chien-Shan; How, Chorng-Kuang; Chiang, Jen-Huai; Sheu, Meei-Ling; Chen, Wen-Chi; Lin, Hsuan-Jen; Hsieh, Vivian Chia-Rong; Hu, Sung-Yuan

    2016-04-01

    The aim of the study was to investigate the long-term association between contrast medium exposure during computed tomography (CT) and the subsequent development of end-stage renal disease (ESRD) in patients with chronic kidney disease (CKD). We conducted a population-based cohort study using Taiwan's National Health Insurance Research Database. A total of 7100 patients with nonadvanced CKD who underwent contrast medium-enhanced CT were identified and served as the study cohort. To avoid selection bias, we used the propensity score to match 7100 nonadvanced CKD patients, who underwent noncontrast medium-enhanced CT to serve as the comparison cohort. The age, sex, index year, and frequency of undergoing CTs were also matched between the study and comparison cohorts. Participants were followed until a new diagnosis of ESRD or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. Contrast medium exposure was not identified as a risk factor for developing ESRD in nonadvanced CKD patients after confounders adjustment (adjusted HR = 0.91; 95% CI, 0.66-1.26; P = 0.580). We further divided the patients who underwent CTs with contrast medium use into ≤1 exposure per year on average, >1 and <2 exposure per year on average, and ≥2 exposure per year on average. After adjusting for confounders, we identified a much higher risk for developing ESRD in the 2 groups of >1 and <2 exposure per year on average and ≥2 exposure per year on average (adjusted HR = 8.13; 95% CI, 5.57-11.87 and adjusted HR = 12.08; 95% CI, 7.39-19.75, respectively) compared with the patients who underwent CTs without contrast medium use. This long-term follow-up study demonstrated that contrast medium exposure was not associated with an increased risk of ESRD development in nonadvanced CKD patients. PMID:27100424

  12. Rectal bleeding induced by Dipyridamole.

    PubMed

    Bayer, I; Kyzer, S; Creter, D; Lewinski, U H

    1986-02-01

    Nineteen patients treated continuously with Dipyridamole were evaluated for rectal bleeding. Thirteen suffered from overt rectal bleeding and six served as controls. Hemorrhoids were found in all patients. Contact bleeding was found in 16. The bleeding continued despite rubber band ligation, and stopped only on withdrawal of the drug. PMID:3484697

  13. The Evaluation of Rectal Bleeding in Adults

    PubMed Central

    Allen, Elizabeth; Nicolaidis, Christina; Helfand, Mark

    2005-01-01

    BACKGROUND Though primary care patients commonly present with rectal bleeding, the optimal evaluation strategy remains unknown. OBJECTIVE To compare the cost-effectiveness of four diagnostic strategies in the evaluation of rectal bleeding. DESIGN Cost-effectiveness analysis using a Markov decision model. DATA SOURCES Systematic review of the literature, Medicare reimbursement data, Surveillance, Epidemiology, and End Results (SEER) Cancer Registry. TARGET POPULATION Patients over age 40 with otherwise asymptomatic rectal bleeding. TIME HORIZON The patient's lifetime. PERSPECTIVE Modified societal perspective. INTERVENTIONS Watchful waiting, flexible sigmoidoscopy, flexible sigmoidoscopy followed by air contrast barium enema (FS+ACBE), and colonoscopy. OUTCOME MEASURES Incremental cost-effectiveness ratio. RESULTS OF BASE-CASE ANALYSIS The incremental cost-effectiveness ratio for colonoscopy compared with flexible sigmoidoscopy was $5,480 per quality-adjusted year of life saved (QALY). Watchful waiting and FS+ACBE were more expensive and less effective than colonoscopy. RESULTS OF SENSITIVITY ANALYSES The cost of colonoscopy was reduced to $1,686 per QALY when age at entry was changed to 45. Watchful waiting became the least expensive strategy when community procedure charges replaced Medicare costs, when age at entry was maximized to 80, or when the prevalence of polyps was lowered to 7%, but the remaining strategies provided greater life expectancy at relatively low cost. The strategy of FS+ACBE remained more expensive and less effective in all analyses. In the remaining sensitivity analyses, the incremental cost-effectiveness of colonoscopy compared with flexible sigmoidoscopy never rose above $34,000. CONCLUSIONS Colonoscopy is a cost-effective method to evaluate otherwise asymptomatic rectal bleeding, with a low cost per QALY compared to other strategies. PMID:15693933

  14. [Measurement of glomerular filtration rate (GFR) after administration of iodine contrast medium with the Renalyzer PRX90 in healthy cats and cats with kidney diseases].

    PubMed

    Meyer-Lindenberg, A; Westhoff, A; Wohlsein, P; Pohlenz, J; Nolte, I

    1998-09-01

    In the present study, the measurement of the glomerular filtration rate (GFR) in the cat with the aid of an iodine contrast medium clearance with the renalyzer PRX90 is introduced. Investigations on the accuracy of measurement showed that even repeated measurement of plasma samples after two days of storage at room temperature yielded reproducible clearance results. Also, partial dilution of the plasma sample (2 ml with 1 ml Aqua bidest.) to reduce the volume of blood withdrawn still produced reliable results. Further dilution of the plasma volume (1 ml with 2 ml Aqua bidest.) however did not allow for accurate measurements. A total of 59 cats of different age and sex were included in the study. 31 cats had healthy kidneys with urea and creatinine values within the reference range, unchanged urine findings and physiologic urine protein patterns (SDS-PAGE). These cats served as reference group. The GFR reference value ascertained for these animals was 2.1 ml/min/kg BW (mean = 3.45 ml/min/kg with s = +/- 1.0 ml/min/kg). 28 cats had elevated values of urea and creatinine in the blood, as well as partially changed urine findings. For further diagnosis of renal disease, separation of urine proteins was done with the SDS-PAGE in the PhastSystem, which in all cases yielded a pathologic urine protein pattern. In 11 cases the renal disease could be further confirmed by histological investigation. GFR in these patients was clearly lowered compared with healthy cats, with measured values between 0 and 1.8 ml/min/kg. It can be concluded that the renalyzer allows reliable determination of the GFR also in the cat. To what extent measurement of the GFR is also helpful to diagnose nephropathies in the stage of compensation needs to be further investigated. In cats with high grade uremia and a GFR below 1 ml/min however, an exact calculation is not possible, since the accuracy of measurement within this range is inadequate. Thus, in severe disease no correct assessment is possible

  15. Iodinated Contrast Medium Exposure During Computed Tomography Increase the Risk of Subsequent Development of Thyroid Disorders in Patients Without Known Thyroid Disease

    PubMed Central

    Hsieh, Ming-Shun; Chiu, Chien-Shan; Chen, Wen-Chi; Chiang, Jen-Huai; Lin, Shih-Yi; Lin, Meng-Yu; Chang, Shih-Liang; Sheu, Meei-Ling; Hu, Sung-Yuan

    2015-01-01

    Abstract To investigate the association between iodinated contrast medium (ICM) exposure during computed tomography (CT) and the subsequent development of thyroid disorders in patients without known thyroid disease in Taiwan, an iodine-sufficient area. We conducted a population-based cohort study by using data from 1996 to 2012 in the Taiwan National Health Insurance Research Database. A total of 33,426 patients who underwent ICM-enhanced CT were included as the study cohort. To avoid selection bias, we used propensity score and matched for the index year (defined as the year of first ICM exposure) to retrieve 33,426 patients as the comparison cohort. No patients in the 2 cohorts had any known thyroid disease before the index year. Patients with a history of amiodarone treatment or coronary angiography and those with <1 year follow-up were excluded. Participants were followed until a new diagnosis of thyroid disorder or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. An association was identified between ICM exposure and the subsequent development of thyroid disorders after adjustment for potential confounders (adjusted HR = 1.17; 95% CI: 1.07–1.29; P = 0.001). Male patients and patients’ ages ≥40 years in the ICM-exposure cohort had a higher adjusted HR for developing thyroid disorders than did those in the non-ICM-exposure cohort. Hypothyroidism had the highest adjusted HR (HR = 1.37; 95% CI: 1.06–1.78; P < 0.05) among all thyroid disorders and had a higher risk of development or detection during >0.5-year post-ICM exposure compared with that during ≤0.5-year post-ICM exposure (HR = 1.26; 95% CI: 1.01–1.58; P < 0.05). Repeated ICM exposure increased the risk of thyroid disorders in patients who accepted >1 time of ICM per year on average compared with those who accepted ≤1 time per year on average (adjusted HR = 3.04; 95% CI: 2.47

  16. Chemoradiation of rectal cancer.

    PubMed

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

    2013-02-01

    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.

  17. Chemoradiation of rectal cancer.

    PubMed

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

    2013-02-01

    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

  18. Drugs Approved for Colon and Rectal Cancer

    MedlinePlus

    ... Professionals Questions to Ask about Your Treatment Research Drugs Approved for Colon and Rectal Cancer This page ... and rectal cancer that are not listed here. Drugs Approved for Colon Cancer Avastin (Bevacizumab) Bevacizumab Camptosar ( ...

  19. Management of extraperitoneal rectal injuries.

    PubMed

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

    1993-06-01

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

  20. A rare cause of severe rectal bleeding: solitary rectal ulcer syndrome.

    PubMed

    Urganc, Nafiye; Kalyoncu, Derya; Usta, Merve; Eken, Kamile Gulcin

    2014-10-01

    Solitary rectal ulcer syndrome is a rare benign disorder in children which often goes unrecognized or easily misdiagnosed with other common diseases. It usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, and lower abdominal pain. The rectal bleeding varies from a little fresh blood to severe hemorrhage that requires blood transfusion. We report herein a pediatric case of solitary rectal ulcer syndrome who admitted to pediatric emergency department with severe rectal bleeding for reminding this rare syndrome.

  1. Combining cervical and rectal cultures for gonorrhea on a single modified Thayer-Martin plate.

    PubMed

    Chapel, T A; Keane, M B; Gatewood, C

    1976-07-01

    Cultures of the cervix and rectum are recommended for the routine diagnosis of gonorrhea in women. Specimens are usually inoculated on separate plates of selective medium. The present study compares to the recovery rates of N. gonorrhoeae for cervical and rectal specimens plated separately to specimens combined on a single plate of modified Thayer-Martin medium (MTM). No statistically significant difference was detected between the two methods. It is concluded that the practice of combining cervical and rectal specimens on a single MTM plate provides the sensitivity of separately plated specimens at half the cost. Combining specimens could provide a significant cost benefit to gonorrhea control programs.

  2. Sleeping position and rectal temperature.

    PubMed

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

    1991-08-01

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

  3. Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer

    PubMed Central

    Lee, Hong Seok; Choi, Doo Ho; Park, Hee Chul; Park, Won; Yu, Jeong Il; Chung, Kwangzoo

    2016-01-01

    Purpose To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. Materials and Methods We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. Results Average rectal volume and ARA were 11.3 mL and 2.9 cm². After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). Conclusion Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary. PMID:27592514

  4. Dominance hierarchies, diversity and species richness of vascular plants in an alpine meadow: contrasting short and medium term responses to simulated global change

    PubMed Central

    Little, Chelsea J.; Jägerbrand, Annika K.; Molau, Ulf

    2014-01-01

    We studied the impact of simulated global change on a high alpine meadow plant community. Specifically, we examined whether short-term (5 years) responses are good predictors for medium-term (7 years) changes in the system by applying a factorial warming and nutrient manipulation to 20 plots in Latnjajaure, subarctic Sweden. Seven years of experimental warming and nutrient enhancement caused dramatic shifts in dominance hierarchies in response to the nutrient and the combined warming and nutrient enhancement treatments. Dominance hierarchies in the meadow moved from a community being dominated by cushion plants, deciduous, and evergreen shrubs to a community being dominated by grasses, sedges, and forbs. Short-term responses were shown to be inconsistent in their ability to predict medium-term responses for most functional groups, however, grasses showed a consistent and very substantial increase in response to nutrient addition over the seven years. The non-linear responses over time point out the importance of longer-term studies with repeated measurements to be able to better predict future changes. Forecasted changes to temperature and nutrient availability have implications for trophic interactions, and may ultimately influence the access to and palatability of the forage for grazers. Depending on what anthropogenic change will be most pronounced in the future (increase in nutrient deposits, warming, or a combination of them both), different shifts in community dominance hierarchies may occur. Generally, this study supports the productivity–diversity relationship found across arctic habitats, with community diversity peaking in mid-productivity systems and degrading as nutrient availability increases further. This is likely due the increasing competition in plant–plant interactions and the shifting dominance structure with grasses taking over the experimental plots, suggesting that global change could have high costs to biodiversity in the Arctic. PMID

  5. [The acute bleeding rectal ulcer].

    PubMed

    Hansen, H

    1985-06-14

    An acute bleeding rectal ulcer was the solitary condition in four patients. The cause of such an ulcer, which always results in heavy arterial bleeding, remains unknown. The source of bleeding is demonstrated by rectoscopy which may at times be difficult because of the large amount of blood in the rectum and the hidden position of the small ulcer. Sclerosing or circumferential suturing of the ulcer provides immediate cessation of bleeding and cure.

  6. Rectal Ischemia Mimicked Tumor Mass

    PubMed Central

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

    2013-01-01

    Ischemic proctitis is a rare disease which is usually encountered in elderly with comorbidities. We present a case of an 80-year old man with severe coronary disease who presented with severe hematochezia and hypotension. Endoscopy revealed a rectal mass 3-4 cm above the dental line and rectosigmoid mucosal inflammation compatible with ischemic colitis. The rectal insult was so intense that it resembled a neoplasmatic lesion. We discuss the causes, the prognostic factors, and the clinical and therapeutic challenges of this rare, albeit life-threatening entity, and we review the relative literature. A percentage of 10%–20% of patients with ischemic colitis usually have a distal potentially obstructing lesion or disorder such as cancer, diverticulitis or fecal impaction. Ischemic colitis, when mucosal and submucosal edema is severe and hemorrhagic nodules are large enough, can mimic a neoplasmatic lesion. The best treatment approach is a conservative management initially with a close clinical followup and after stabilization a repetition of rectal endoscopy with new biopsies. Early recognition of this clinical entity is of paramount importance to implement appropriate therapy (conservative or surgical) and avoid potentially fatal treatment of presumed inflammatory or infectious bowel diseases. PMID:24109523

  7. Optimizing Treatment for Rectal Prolapse.

    PubMed

    Hrabe, Jennifer; Gurland, Brooke

    2016-09-01

    Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexistence of vaginal prolapse, severe constipation, surgical fitness, and whether the patient has had a previous prolapse procedure. Consideration of a multidisciplinary approach is critical in patients with concomitant vaginal prolapse. Surgeons must weigh their familiarity with each approach and should have in their armamentarium both perineal and abdominal approaches. Previous barriers to abdominal procedures, such as age and comorbidities, are waning as minimally invasive approaches have gained acceptance. Laparoscopic ventral rectopexy is one such approach offering relatively low morbidity, low recurrence rates, and good functional improvement. However, proficiency with this procedure may require advanced training. Robotic rectopexy is another burgeoning approach which facilitates suturing in the pelvis. Successful rectal prolapse surgeries improve function and have low recurrence rates, though it is important to note that correcting the prolapse does not assure functional improvement. PMID:27582654

  8. An Unusual Cause of Rectal Stenosis

    PubMed Central

    Gruber, Maja; Füglistaler, Ida; Zettel, Andreas; Fox, Mark; Manz, Michael

    2016-01-01

    Solitary rectal ulcer syndrome (SRUS) is a benign disease that is often misdiagnosed. It is characterized by a combination of symptoms, endoscopic findings and histology. Patients present with constipation, rectal bleeding, mucous discharge, pain and a sensation of incomplete defecation. There are many different manifestations of this disease, with or without rectal prolapse. We report an unusual presentation of SRUS as a circular stenosis in a middle-aged male.

  9. Chemoradiotherapy response in recurrent rectal cancer

    PubMed Central

    Yu, Stanley K T; Bhangu, Aneel; Tait, Diana M; Tekkis, Paris; Wotherspoon, Andrew; Brown, Gina

    2014-01-01

    The efficacy of response to preoperative chemoradiotherapy (CRT) in recurrent versus primary rectal cancer has not been investigated. We compared radiological downsizing between primary and recurrent rectal cancers following CRT and determined the optimal size reduction threshold for response validated by survival outcomes. The proportional change in tumor length for primary and recurrent rectal cancers following CRT was compared using the independent sample t-test. Overall survival (OS) was calculated using the Kaplan–Meier product limit method and differences between survival for tumor size reduction thresholds of 30% (response evaluation criteria in solid tumors [RECIST]), 40%, and 50% after CRT in primary and recurrent rectal cancer groups. A total of 385 patients undergoing CRT were analyzed, 99 with recurrent rectal cancer and 286 with primary rectal cancer. The mean proportional reduction in maximum craniocaudal length was significantly higher for primary rectal tumors (33%) compared with recurrent rectal cancer (11%) (P < 0.01). There was no difference in OS for either primary or recurrent rectal cancer when ≤30% or ≤40% definitions were used. However, for both primary and recurrent tumors, significant differences in median 3-year OS were observed when a RECIST cut-off of 50% was used. OS was 99% versus 77% in primary and 100% versus 42% in recurrent rectal cancer (P = 0.002 and P = 0.03, respectively). Only patients that demonstrated >50% size reduction showed a survival benefit. Recurrent rectal cancer appears radioresistant compared with primary tumors for tumor size after CRT. Further investigation into improving/intensifying chemotherapy and radiotherapy for locally recurrent rectal cancer is justified. PMID:24403010

  10. The Role of Virtual Cystoscopy, after Multidetector Computed Tomography Imaging Reconstruction without the Use of Contrast Medium, in the Diagnosis and Evaluations of Bladder Tumors: Preliminary Study.

    PubMed

    Kalokairinou, Kyriaki; Ploumidis, Achilles; Kalogeropoulos, Theodoros; Vlachos, Lampros; Stringaris, Kyriakos; Tavernaraki, Ageliki; Thanos, Anastasios; Papacharalampous, Xenofon; Koutoulidis, Vasilios; Letendre, Julien; Traxer, Olivier; Gouliamos, Athanasios

    2014-01-01

    Introduction. Although conventional cystoscopy is considered to be the gold standard for diagnosis and follow-up of bladder tumors, it remains an invasive and costly procedure. With the advent of the multidetector CT (MDCT) scanners supported by specialized software virtual cystoscopy (VC) is possible. We assess the role of VC in diagnosing and evaluating bladder lesions. Materials and Methods. Between September 2010 and October 2011, 25 consecutive patients with cystoscopically confirmed bladder tumor underwent VC. The radiologists involved in this prospective study were blinded to the exact findings. After draining any residual urine with a catheter, the bladder was retrogradely insufflated with 200-600 cc of air. No intravenous or intravesical contrast was used. MDCT scan was performed in supine and prone positions and three-dimensional reconstruction of the urinary bladder was performed. Results. The examination was well tolerated by all patients with no complications. In total, 43 lesions were detected both with conventional cystoscopy and VC. Tumor size measured by CT ranged from 3 to 80 mm in diameter. The pathological report revealed noninvasive transitional cell carcinomas in all cases. Conclusion. VC has promising results in detecting exophytic bladder lesions. In the future it could be part of the diagnostic algorithm for bladder tumors. PMID:24799894

  11. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

    PubMed Central

    Mazzei, Maria Antonietta; Guerrini, Susanna; Mazzei, Francesco Giuseppe; Cioffi Squitieri, Nevada; Notaro, Dario; de Donato, Gianmarco; Galzerano, Giuseppe; Sacco, Palmino; Setacci, Francesco; Volterrani, Luca; Setacci, Carlo

    2016-01-01

    AIM: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard. METHODS: For this prospective study we enrolled 163 patients (123 men; mean age, 65.7 years) referred for CTA for EVAR follow-up. CTA, DTA and CEUS were performed at 1 and 12 mo in all patients, with a maximum time interval of 2 d. RESULTS: Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33 (96.96%) patients and for the absence of complications in 127/130 (97.69%) patients; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33 (57.57%) patients and for the absence of complications in 129/130 (99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivity, specificity and accuracy of combining DTA and CEUS together in detecting EVAR complications were 77%, 98% and 95%, respectively. CONCLUSION: Combining DTA and CEUS in EVAR follow-up has the potential to limit the use of CTA only in doubtful cases. PMID:27247719

  12. Rectal mucocoele following subtotal colectomy for colitis.

    PubMed

    Appleton, N; Day, N; Walsh, C

    2014-09-01

    We present a unique case of a rectal mucocoele affecting a patient several years after his subtotal colectomy for ulcerative colitis. This was secondary to both a benign anorectal stenosis and a benign mucus secreting rectal adenoma. This case highlights the importance of surveillance in such patients.

  13. 21 CFR 876.5450 - Rectal dilator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Rectal dilator. 876.5450 Section 876.5450 Food and Drugs 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...

  14. 21 CFR 876.5450 - Rectal dilator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Rectal dilator. 876.5450 Section 876.5450 Food and Drugs 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...

  15. 21 CFR 876.5450 - Rectal dilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Rectal dilator. 876.5450 Section 876.5450 Food and Drugs 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...

  16. 21 CFR 876.5450 - Rectal dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Rectal dilator. 876.5450 Section 876.5450 Food and Drugs 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...

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

    ClinicalTrials.gov

    2015-10-24

    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

  18. The surgical anatomy of rectocele and anterior rectal wall intussusception.

    PubMed

    Abendstein, B; Petros, P E P; Richardson, P A; Goeschen, K; Dodero, D

    2008-05-01

    The aim of the study was to analyse the dynamic anatomical supports of the posterior vaginal wall from the perspective of rectocele and rectal intussusception repair. Two groups of patients were studied. Group 1 (n = 24) with genuine stress incontinence but no major vault prolapse had vagino/proctomyograms and transperineal ultrasound examinations. Group 2 with vaginal vault prolapse, clinical rectoceles and obstructive defecation symptoms (n = 19 had single-contrast defecating proctography before and after posterior-sling surgery. The posterior vaginal wall is suspended between perineal body, which underlies half its length, and uterosacral ligaments, which also support the anterior wall of rectum. Muscle forces stretch the vagina and rectum against the perineal body and uterosacral ligaments, creating shape and strength, like a suspension bridge. Postoperative proctogram studies indicated that anterior rectal wall intussusception has the same etiology as rectocele, deficient recto-vaginal ligamentous support. Repair to uterosacral ligaments and perineal body should be considered with large rectoceles, anterior rectal wall intussusception and obstructive defecation disorders. PMID:18074069

  19. HOSPITAL VARIATION IN SPHINCTER PRESERVATION FOR ELDERLY RECTAL CANCER PATIENTS

    PubMed Central

    Dodgion, Christopher M.; Neville, Bridget A; Lipsitz, Stuart R.; Schrag, Deborah; Breen, Elizabeth; Zinner, Michael J.; Greenberg, Caprice C.

    2014-01-01

    Purpose To evaluate hospital variation in the use of low anterior resection (LAR), local excision (LE) and abdominoperineal resection (APR) in the treatment of rectal cancer in elderly patients. Methods Using SEER-Medicare linked data, we identified 4,959 stage I–III rectal cancer patients over age 65 diagnosed from 2000–2005 who underwent operative intervention at one of 370 hospitals. We evaluated the distribution of hospital-specific procedure rates and used generalized mixed models with random hospital effects to examine the influence of patient characteristics and hospital on operation type, using APR as a reference. Results The median hospital performed APR on 33% of elderly rectal cancer patients. Hospital was a stronger predictor of LAR receipt than any patient characteristic, explaining 32% of procedure choice, but not a strong predictor of LE, explaining only 3.8%. Receipt of LE was primarily related to tumor size and tumor stage, which, combined, explained 31% of procedure variation. Conclusions Receipt of local excision is primarily determined by patient characteristics. In contrast, the hospital where surgery is performed significantly influences whether a patient undergoes an LAR or APR. Understanding the factors that cause this institutional variation is crucial to ensuring equitable availability of sphincter preservation. PMID:24750983

  20. Nonoperative management of rectal cancer.

    PubMed

    Torok, Jordan A; Palta, Manisha; Willett, Christopher G; Czito, Brian G

    2016-01-01

    Surgery has long been the primary curative modality for localized rectal cancer. Neoadjuvant chemoradiation has significantly improved local control rates and, in a significant minority, eradicated all disease. Patients who achieve a pathologic complete response to neoadjuvant therapy have an excellent prognosis, although the combination treatment is associated with long-term morbidity. Because of this, a nonoperative management (NOM) strategy has been pursued to preserve sphincter function in select patients. Clinical and radiographic findings are used to identify patients achieving a clinical complete response to chemoradiation, and they are then followed with intensive surveillance. Incomplete, nonresponding and those demonstrating local progression are referred for salvage with standard surgery. Habr-Gama and colleagues have published extensively on this treatment strategy and have laid the groundwork for this approach. This watch-and-wait strategy has evolved over time, and several groups have now reported their results, including recent prospective experiences. Although initial results appear promising, several significant challenges remain for NOM of rectal cancer. Further study is warranted before routine implementation in the clinic.

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

    ClinicalTrials.gov

    2015-09-03

    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

  2. Magnetic Resonance (MR) rectography in diagnostics of small-size rectal neoplasms

    NASA Astrophysics Data System (ADS)

    Usova, AV; Frolova, IG; Trukhacheva, NG; Cheremisina, OV; Afanas'ev, SG

    2016-02-01

    Purpose was the assessment of diagnostic efficiency of MR-rectography in diagnostics of small-size rectal neoplasms. 12 patients with polyps and small tumors of a rectum are examined, the size of detected neoplasms varied in the range 3-18 mm. Native MRI and MRI with retrograde contrasting by ultrasonic gel was carried out. Results of MRI are compared with results of videocolonoscopy. Sensitivity of native MRT was 24%, MR- rectography was 88%. MR-rectography can be used in diagnostics of small-size rectal neoplasms.

  3. Rectal Duplication Cyst: A Rare Cause of Rectal Prolapse in a Toddler.

    PubMed

    Khushbakht, Samreen; ul Haq, Anwar

    2015-12-01

    Rectal duplication cysts are rare congenital anomalies. They constitute only 4% of the total gastrointestinal anomalies. They usually present in childhood. The common presenting symptoms are mass or pressure effects like constipation, tenesmus, urinary retention, local infection or bleeding due to presence of ectopic gastric mucosa. We are reporting a rare presenting symptom of rectal duplication cyst in a 4-year-old boy/toddler who presented with rectal prolapse. He also had bleeding per rectum. Rectal examination revealed a soft mass palpable in the posterior rectal wall. CT scan showed a cystic mass in the posterior wall of the rectum. It was excised trans-anally and the postoperative recovery was uneventful. Biopsy report showed rectal duplication cyst. PMID:26691370

  4. PET-MRI in Diagnosing Patients With Colon or Rectal Cancer

    ClinicalTrials.gov

    2015-11-25

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

  5. [Ultrasonographic study of rectal carcinoid tumors].

    PubMed

    Nomura, M; Fujita, N; Matsunaga, A; Ando, M; Tominaga, G; Noda, Y; Kobayashi, G; Kimura, K; Yuki, T; Ishida, K; Yago, A; Mochizuki, F; Chonan, A

    1996-11-01

    To compare intraluminal ultrasonographic (ILUS) findings with histological findings of rectal carcinoid tumors, 35 patients with rectal carcinoid tumors were reviewed. The results were as follows: 1) The rectal wall was visualized as a seven- or nine-layer structure by means of ILUS in 81% of the patients. 2) The possibility that the thin hyperechoic third layer above the tumor on ILUS corresponds to the muscularis mucosae and fibrointerstitium above the tumor histologically. 3) In cases with relatively high internal echoes, the amount of fibrointerstitium exceeded that of tumor cells histologically. 4) In cases with nonuniform internal echo patterns, tumor cells were separated by thick fibrointerstitium forming nodular nests.

  6. MRI staging of low rectal cancer.

    PubMed

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

    2009-03-01

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

  7. [Perianal and rectal impalement injuries].

    PubMed

    Joos, A K; Herold, A; Palma, P; Post, S

    2006-09-01

    Perianal impalement injuries with or without involvement of the anorectum are rare. Apart from a high variety of injury patterns, there is a multiplicity of diagnostic and therapeutic options. Causes of perianal impalement injury are gunshot, accidents, and medical treatment. The diagnostic work-up includes digital rectal examination followed by rectoscopy and flexible endoscopy under anaesthesia. We propose a new classification for primary extraperitoneal perianal impalement injuries in four stages in which the extension of sphincter and/or rectum injury is of crucial importance. Therapeutic aspects such as wound treatment, enterostomy, drains, and antibiotic treatment are discussed. The proposed classification encompasses recommendations for stage-adapted management and prognosis of these rare injuries. PMID:16896899

  8. Rectal temperature after marathon running.

    PubMed Central

    Maughan, R J; Leiper, J B; Thompson, J

    1985-01-01

    Rectal temperature was measured in 62 male runners who competed in the 1983 Dundee marathon race: all measurements were made immediately after the race. Competitors' times were noted at 5, 10, 15 and 20 miles (8.0, 16.1, 24.1, 32.2 km) and at the finish (26.2 miles, 42.2 km). Mean finishing time of the group was 3 hr 33 min +/- 48 min (mean +/- S.D.; range = 2 hr 17 min-5 hr 11 min). Mean running speed of the group decreased progressively as the distance covered increased. Mean post-race rectal temperature was 38.7 +/- 0.9 degrees C (range 35.6-40.3 degrees C). The post-race temperature was correlated (p less than 0.01) with the time taken to cover the last 6.2 miles (10 km) of the race, but not with the overall finishing time (p greater than 0.05). Only the fastest runners were able to maintain an approximately constant pace throughout the race, whereas the slower runners slowed down progressively. The runners with the highest post-race temperature, although not necessarily the fastest runners, also tended to maintain a steady pace throughout. The runners with the lowest post-race temperature slowed down markedly only over the last 6.2 mile section of the race. The results clearly indicate that runners forced by fatigue or injury to slow down in the latter stages of races held at low ambient temperatures may already be hypothermic or at serious risk of hypothermia. Images p192-a p192-b p192-c PMID:4092138

  9. Calretinin immunohistochemistry versus acetylcholinesterase histochemistry in the evaluation of suction rectal biopsies for Hirschsprung Disease.

    PubMed

    Kapur, Raj P; Reed, Robyn C; Finn, Laura S; Patterson, Kathleen; Johanson, Judy; Rutledge, Joe C

    2009-01-01

    Diagnosis of Hirschsprung disease (HSCR) relies on histologic and/or histochemical staining of sections from suction rectal biopsies. Acetylcholinesterase histochemistry (AChE) facilitates diagnosis but is not universally employed, in part because it requires special tissue handling. Calretinin immunohistochemistry (IHC) may be a useful alternative, because loss of calretinin immunoreactive nerves reportedly correlates spatially with aganglionosis. We investigated the patterns of calretinin IHC in suction rectal biopsies from HSCR and non-HSCR patients and compared the diagnostic value of calretinin IHC with a widely used rapid AChE method. In suction rectal biopsies that contain ganglion cells, small nerves in the lamina propria, muscularis mucosae, and superficial submucosa contain granular aggregates of calretinin immunoreactivity. Immunolabeling of these nerves is completely absent in the aganglionic biopsies of HSCR patients. Multiple observers independently reviewed calretinin IHC and AChE sections of suction rectal biopsies from 14 HSCR patients and 17 non-HSCR controls. Five observers, blinded to the correct diagnosis, scored each patient's calretinin IHC and AChE slides as HSCR, not HSCR, or equivocal. The frequencies of major and minor discrepant diagnoses were compared. Calretinin IHC yielded no misdiagnoses or major discrepancies between observers. In contrast, 2 misdiagnoses and significantly more interobserver disagreement resulted from the AChE-stained sections. Calretinin IHC appears to be a reasonable, and potentially superior, alternative to AChE as an adjunctive diagnostic method for evaluating suction rectal biopsies for HSCR.

  10. 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.

  11. Low Rectal Cancer Study (MERCURY II)

    ClinicalTrials.gov

    2016-03-11

    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

  12. Scrotal cooling increases rectal temperature in man.

    PubMed

    Vash, Peter D; Engels, Thomas M; Kandeel, Fouad R; Greenway, Frank

    2002-02-01

    The aim of this study was to evaluate the effect of scrotal cooling on rectal temperature in man. Pilot studies suggested that immersing the scrotum in a 30 degrees C water bath increased rectal temperature, but immersing the scrotum in a 0 degree C water bath did not. Six healthy young men immersed their scrotums in a 35 degrees C water bath for 11 min followed by 21 min at 30 degrees C. Rectal temperature rose by 0.38 +/- 0.04 degrees C (P < 0.01) in response to the 30 degrees C water bath. Repetition of the study by immersing the hands instead of the scrotum in the water bath had no effect on rectal temperature. The scrotum appears to play a role in human temperature regulation.

  13. Problems in family practice. Rectal bleeding.

    PubMed

    Graham, J

    1978-07-01

    The diagnosis and management of rectal bleeding problems varies with the urgency of the situation, the age of the patient, and the applicability of available diagnostic methods. Every instance of rectal bleeding is a problem that demands investigation by endoscopic, radiographic, and laboratory means. A physician can be misled by the patient's understatement or underobservance of bleeding. A good history obtained as quickly as possible in urgent circumstances and in great detail under more relaxed circumstances is of immeasurable diagnostic value.

  14. Locally advanced rectal cancer: management challenges

    PubMed Central

    Kokelaar, RF; Evans, MD; Davies, M; Harris, DA; Beynon, J

    2016-01-01

    Between 5% and 10% of patients with rectal cancer present with locally advanced rectal cancer (LARC), and 10% of rectal cancers recur after surgery, of which half are limited to locoregional disease only (locally recurrent rectal cancer). Exenterative surgery offers the best long-term outcomes for patients with LARC and locally recurrent rectal cancer so long as a complete (R0) resection is achieved. Accurate preoperative multimodal staging is crucial in assessing the potential operability of advanced rectal tumors, and resectability may be enhanced with neoadjuvant therapies. Unfortunately, surgical options are limited when the tumor involves the lateral pelvic sidewall or high sacrum due to the technical challenges of achieving histological clearance, and must be balanced against the high morbidity associated with resection of the bony pelvis and significant lymphovascular structures. This group of patients is usually treated palliatively and subsequently survival is poor, which has led surgeons to seek innovative new solutions, as well as revisit previously discarded radical approaches. A small number of centers are pioneering new techniques for resection of beyond-total mesorectal excision tumors, including en bloc resections of the sciatic notch and composite resections of the first two sacral vertebrae. Despite limited experience, these new techniques offer the potential for radical treatment of previously inoperable tumors. This narrative review sets out the challenges facing the management of LARCs and discusses evolving management options. PMID:27785074

  15. Management of rectal varices in portal hypertension

    PubMed Central

    Al Khalloufi, Kawtar; Laiyemo, Adeyinka O

    2015-01-01

    Rectal varices are portosystemic collaterals that form as a complication of portal hypertension, their prevalence has been reported as high as 94% in patients with extrahepatic portal vein obstruction. The diagnosis is typically based on lower endoscopy (colonoscopy or sigmoidoscopy). However, endoscopic ultrasonography has been shown to be superior to endoscopy in diagnosing rectal varices. Color Doppler ultrasonography is a better method because it allows the calculation of the velocity of blood flow in the varices and can be used to predict the bleeding risk in the varices. Although rare, bleeding from rectal varices can be life threatening. The management of patients with rectal variceal bleeding is not well established. It is important to ensure hemodynamic stability with blood transfusion and to correct any coagulopathy prior to treating the bleeding varices. Endoscopic injection sclerotherapy has been reported to be more effective in the management of active bleeding from rectal varices with less rebleeding rate as compared to endoscopic band ligation. Transjugular intrahepatic portsystemic shunt alone or in combination with embolization is another method used successfully in control of bleeding. Balloon-occluded retrograde transvenous obliteration is an emerging procedure for management of gastric varices that has also been successfully used to treat bleeding rectal varices. Surgical procedures including suture ligation and porto-caval shunts are considered when other methods have failed. PMID:26730278

  16. Identification of capsaicin-sensitive rectal mechanoreceptors activated by rectal distension in mice.

    PubMed

    Spencer, N J; Kerrin, A; Singer, C A; Hennig, G W; Gerthoffer, W T; McDonnell, O

    2008-05-01

    Rodents detect visceral pain in response to noxious levels of rectal distension. However, the mechanoreceptors that innervate the rectum and respond to noxious levels of rectal distension have not been identified. Here, we have identified the mechanoreceptors of capsaicin-sensitive rectal afferents and characterized their properties in response to circumferential stretch of the rectal wall. We have also used the lethal spotted (ls/ls) mouse to determine whether rectal mechanoreceptors that respond to capsaicin and stretch may also develop in an aganglionic rectum that is congenitally devoid of enteric ganglia. In wild type (C57BL/6) mice, graded increases in circumferential stretch applied to isolated rectal segments activated a graded increase in firing of slowly-adapting rectal mechanoreceptors. Identical stimuli applied to the aganglionic rectum of ls/ls mice also activated similar graded increases in firing of stretch-sensitive rectal afferents. In both wild type and aganglionic rectal preparations, focal compression of the serosal surface using von Frey hairs identified mechanosensitive "hot spots," that were associated with brief bursts of action potentials. Spritzing capsaicin (10 microM) selectively onto each identified mechanosensitive hot spot activated an all or none discharge of action potentials in 32 of 56 identified hot spots in wild type mice and 24 of 62 mechanosensitive hot spots in the aganglionic rectum of ls/ls mice. Each single unit activated by both capsaicin and circumferential stretch responded to low mechanical thresholds (1-2 g stretch). No high threshold rectal afferents were ever recorded in response to circumferential stretch. Anterograde labeling from recorded rectal afferents revealed two populations of capsaicin-sensitive mechanoreceptor that responded to stretch: one population terminated within myenteric ganglia, the other within the circular and longitudinal smooth muscle layers. In the aganglionic rectum of ls/ls mice, only the

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

    SciTech Connect

    Brierley, James D.; Dawson, Laura A.; Sampson, Elliott; Bayley, Andrew; Scott, Sandra; Moseley, Joanne L.; Craig, Timothy; Cummings, Bernard; Dinniwell, Robert; Kim, John J.; Ringash, Jolie; Wong, Rebecca; Brock, Kristy K.

    2011-05-01

    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.

  18. Californium-252 brachytherapy for anal and ano-rectal carcinoma

    SciTech Connect

    Cross, B.; Maruyama, Y.; Proudfoot, W.; Malcolm, A.

    1986-01-01

    Surgery has historically been the standard treatment for anal, ano-rectal and rectal carcinoma but is prone to local or regional failure. Over the past 15 years there has been increasing interest in and success with radiation therapy and combined chemoradiotherapy for treatment of anal and ano-rectal cancers. Cf-252 brachytherapy combined with external beam teletherapy has been investigated for anal and ano-rectal lesions at the Univ. of Kentucky with encouraging results.

  19. Stapled transanal rectal mucosectomy ten years after.

    PubMed

    Pescatori, M; Aigner, F

    2007-03-01

    Stapled mucosectomy (SM) was first proposed for the management of patients with rectal internal mucosal prolapse and obstructed defecation, but gained popularity worldwide for the treatment of hemorrhoids. The present review highlights the advantages and disadvantages of the operation. SM tends to decrease postoperative pain and shortens convalescence after hemorrhoid surgery, but may be followed by severe complications, e.g. rectal obliteration and pelvic sepsis requiring a diverting stoma, more frequently than after standard hemorrhoidectomy. Moreover it carries a higher recurrence rate in the treatment of fourth-degree piles. A recent Cochrane metaanalysis demonstrated that SM is less effective than standard hemorrhoidectomy since it carries a higher recurrence rate (OR=3.6) and reintervention rate (OR=2.3). When used for rectal mucosal prolapse and obstructed defecation, SM is reported to have variable results. A better outcome is likely to be achieved in patients without anismus and psychoneurosis operated on by specialists trained with this technique.

  20. Management and imaging of low rectal carcinoma.

    PubMed

    Salerno, Gisella; Daniels, Ian; Heald, R J; Brown, Gina; Moran, B J

    2004-01-01

    Large variations in recurrence rates have been reported with the best results following total mesorectal excision (TME) surgery for low and middle rectal cancers. However, the low rectal cancers still have higher rates of local recurrence (up to 30%) whether operated by low anterior resection or abdominoperineal excision (APE) due to high rates of circumferential margin involvement. The treatment of choice for low rectal cancers that encroach upon the potential circumferential resection margin is surgery combined with preoperative neoadjuvant treatment. Preoperative chemotherapy combined with long-term radiotherapy reduces recurrence rates and preoperative loco-regional staging can help to select the patients more likely to benefit from neo-adjuvant therapy. Surface coil MRI is the most promising modality for patient selection, which can provide good views of the circumferential resection margin especially the presence or absence of tumour encroaching the intersphincteric plane. PMID:15572087

  1. Rectal mucosa in cows' milk allergy.

    PubMed Central

    Iyngkaran, N; Yadav, M; Boey, C G

    1989-01-01

    Eleven infants who were suspected clinically of having cows' milk protein sensitive enteropathy were fed with a protein hydrolysate formula for six to eight weeks, after which they had jejunal and rectal biopsies taken before and 24 hours after challenge with cows' milk protein. When challenged six infants (group 1) developed clinical symptoms and five did not (group 2). In group 1 the lesions developed in both the jejunal mucosa (four infants at 24 hours and one at three days), and the rectal mucosa, and the injury was associated with depletion of alkaline phosphatase activity. Infants in group 2 were normal. It seems that rectal injury that develops as a direct consequence of oral challenge with the protein in reactive infants may be used as one of the measurements to confirm the diagnosis of cows' milk protein sensitive enteropathy. Moreover, ingestion of such food proteins may injure the distal colonic mucosa without affecting the proximal small gut in some infants. PMID:2817945

  2. Silicone elastomer sling for rectal prolapse in cats

    PubMed Central

    Corgozinho, Katia Barão; Belchior, Cristiane; de Souza, Heloisa Justen Moreira; Ferreira, Ana Maria; Resende, Carolina; Damico, Brandão; Cunha, Simone

    2010-01-01

    This study reports 2 cases of recurrent rectal prolapse secondary to anal abnormality in cats. In both cases the anus was wide, leading to a rectal mucosal prolapse during defecation. A silicone elastomer sling was introduced around the anus, and the rectal prolapse was definitively resolved. PMID:20676293

  3. Primary Transanal Management of Rectal Atresia in a Neonate.

    PubMed

    M, Braiek; A, Ksia; I, Krichen; S, Belhassen; K, Maazoun; S, Ben Youssef; N, Kechiche; M, Mekki; A, Nouri

    2016-01-01

    Rectal atresia (RA) with a normal anus is a rare anomaly. We describe a case of rectal atresia in a newborn male presenting with an abdominal distension and failure of passing meconium. The rectal atresia was primarily operated by transanal route.

  4. Primary Transanal Management of Rectal Atresia in a Neonate

    PubMed Central

    M, Braiek; A, Ksia; I, Krichen; S, Belhassen; K, Maazoun; S, Ben youssef; N, Kechiche; M, Mekki; A, Nouri

    2016-01-01

    Rectal atresia (RA) with a normal anus is a rare anomaly. We describe a case of rectal atresia in a newborn male presenting with an abdominal distension and failure of passing meconium. The rectal atresia was primarily operated by transanal route. PMID:27123404

  5. Can insulated skin temperature act as a substitute for rectal temperature when studying circadian rhythms?

    PubMed

    Bogh, M; Minors, D S; Waterhouse, J M

    1994-10-01

    We measured rectal, lateral chest wall, and axillary temperature every half hour for at least 24 h while subjects were living normal life-styles and keeping a sleep/activity diary. We then used a purification method to estimate the decrease of temperature due to sleep and the increases due to sitting, standing, walking, or exercising, as well as the parameters of the cosine curve that described the "purified data." Cosinor analysis of raw and purified data showed that the acrophases from both skin sites were much more variable and up to 8 h later than were those from the rectum (particularly if exercise had been taken), even though the acrophases from the two skin sites were similar to each other. For rectal temperature, there was an increase in the size of the masking effect as activity progressed through the sequence: sitting, standing or walking, exercising. In contrast, for both chest wall and axillary temperatures, although sitting produced masking effects similar to those for rectal temperature, masking effects due to standing or walking and exercising were much smaller, and sometimes they were even less than the masking effects due to sitting. These results indicate that our measurements of cutaneous temperature did not act as a substitute for rectal temperature, particularly when the subject was physically active rather than sedentary.

  6. A new method of assessing the surgical margin in rectal carcinoma—using nonlinear optical microscopy

    NASA Astrophysics Data System (ADS)

    Li, Lianhuang; Chen, Zhifen; Kang, Deyong; Deng, Tongxin; Jiang, Liwei; Zhou, Yi; Liu, Xing; Jiang, Weizhong; Zhuo, Shuangmu; Guan, Guoxian; Chi, Pan; Chen, Jianxin

    2016-06-01

    Nowadays, surgical resection is still the most effective treatment strategy for rectal carcinoma and one of the most important factors affecting whether the operation is successful or not is the surgical margin determination, especially in the distal rectal carcinoma which should take the sphincter-preserving issue into consideration. However, until recently no reliable evaluation method has been developed for this purpose. There are some shortcomings in intraoperative negative surgical margin assessment such as either lack of enough detailed information of biological tissues or the fact that it is time-consuming. Multiphoton microscopy (MPM)—nonlinear optical microscopy, which is based on the nonlinear optical process two-photon excited fluorescence (TPEF) and second harmonic generation (SHG), has the ability to label freely and noninvasively visualize tissue micro-architecture at the sub-cellular level. The advantage of providing high contrast and high resolution biomedical image in real time makes MPM have a wide range of applications in life sciences. In this study, we introduced MPM to identify the boundary between normal and abnormal rectal tissues. MPM images clearly exhibit biological tissue microstructure and its morphological changes in the regions of our interest, which enable it to determine the surgical margin in rectal carcinoma. It can be foreseen that once MPM imaging system is used in clinical examination, it will greatly improve the accuracy of surgical resection.

  7. 21 CFR 876.5450 - Rectal dilator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Rectal dilator. 876.5450 Section 876.5450 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening...

  8. Iodinated Contrast Medium Exposure During Computed Tomography Increase the Risk of Subsequent Development of Thyroid Disorders in Patients Without Known Thyroid Disease: A Nationwide Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study.

    PubMed

    Hsieh, Ming-Shun; Chiu, Chien-Shan; Chen, Wen-Chi; Chiang, Jen-Huai; Lin, Shih-Yi; Lin, Meng-Yu; Chang, Shih-Liang; Sheu, Meei-Ling; Hu, Sung-Yuan

    2015-12-01

    To investigate the association between iodinated contrast medium (ICM) exposure during computed tomography (CT) and the subsequent development of thyroid disorders in patients without known thyroid disease in Taiwan, an iodine-sufficient area. We conducted a population-based cohort study by using data from 1996 to 2012 in the Taiwan National Health Insurance Research Database. A total of 33,426 patients who underwent ICM-enhanced CT were included as the study cohort. To avoid selection bias, we used propensity score and matched for the index year (defined as the year of first ICM exposure) to retrieve 33,426 patients as the comparison cohort. No patients in the 2 cohorts had any known thyroid disease before the index year. Patients with a history of amiodarone treatment or coronary angiography and those with <1 year follow-up were excluded. Participants were followed until a new diagnosis of thyroid disorder or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. An association was identified between ICM exposure and the subsequent development of thyroid disorders after adjustment for potential confounders (adjusted HR = 1.17; 95% CI: 1.07-1.29; P = 0.001). Male patients and patients' ages ≥40 years in the ICM-exposure cohort had a higher adjusted HR for developing thyroid disorders than did those in the non-ICM-exposure cohort. Hypothyroidism had the highest adjusted HR (HR = 1.37; 95% CI: 1.06-1.78; P < 0.05) among all thyroid disorders and had a higher risk of development or detection during >0.5-year post-ICM exposure compared with that during ≤0.5-year post-ICM exposure (HR = 1.26; 95% CI: 1.01-1.58; P < 0.05). Repeated ICM exposure increased the risk of thyroid disorders in patients who accepted >1 time of ICM per year on average compared with those who accepted ≤1 time per year on average (adjusted HR = 3.04; 95% CI: 2.47-3.73; P < 0

  9. Contrastive Lexicology.

    ERIC Educational Resources Information Center

    Hartmann, R. R. K.

    This paper deals with the relation between etymologically related words in different languages. A survey is made of seven stages in the development of contrastive lexicology. These are: prelinguistic word studies, semantics, lexicography, translation, foreign language learning, bilingualism, and finally contrastive analysis. Concerning contrastive…

  10. N-acetyltransferase 1 in colon and rectal cancer cases from an industrialized area.

    PubMed

    Roemer, Hermann C; Weistenhofer, Wobbeke; Lohlein, Dietrich; Geller, Frank; Blomeke, Brunhilde; Golka, Klaus

    2008-01-01

    Colon and rectal cancers are both associated with genetic as well as nutritional, occupational, and environmental factors. Aromatic amines and heterocyclic amines are established colorectal carcinogens. The polymorphic enzyme N-acetyltransferase 1 (NAT1) contributes to heterocyclic amine metabolism in the human colon. Thereby, NAT1 may influence the risk for development of colorectal cancer. The distribution of NAT1 genotypes was determined in 107 colon cancer cases, 77 rectal cancer cases, and 185 controls (suffering from nonmalignant diseases) by standard methods. In addition, possible occupational and nonoccupational risk factors were determined by a personal interview. Cancer cases and controls were derived from an area of former coal, iron, and steel industries, which is known for elevated colon cancer mortality. The proportions of NAT1*4/*4 genotype were 72% in controls, 75% in rectal cancer cases, and 72% in colon cancer cases. The proportions of the NAT1*4/*10 genotype were 17.8% in controls, 12.9% in rectal cancer cases, and 14% in colon cancer cases. Combinations of the determined NAT1 alleles *3/*3, *3/*10, *4/*3, *4/*11, *10/*10 and *11/*11 contributed to 10.2% of the genotypes in controls, 12.1% in rectal cancer cases, and 14% in colon cancer cases. In contrast to another study on healthy German volunteers, the NAT1*4/*4 genotype (wild type) is overrepresented. This might be due to the variation in the proportion of NAT1 alleles in the general population. The present study does not support a relevant impact of the NAT1 genotype on colorectal cancer risk development in the study area.

  11. Contrast Materials

    MedlinePlus

    ... or other reactions to contrast materials are rare, radiology departments are well-equipped to deal with them. ... is given. However, both the American College of Radiology (ACR) and the European Society of Urogenital Radiology ...

  12. Transanal Evisceration Caused by Rectal Laceration

    PubMed Central

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

    2014-01-01

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

  13. MicroRNA in rectal cancer

    PubMed Central

    Azizian, Azadeh; Gruber, Jens; Ghadimi, B Michael; Gaedcke, Jochen

    2016-01-01

    In rectal cancer, one of the most common cancers worldwide, the proper staging of the disease determines the subsequent therapy. For those with locally advanced rectal cancer, a neoadjuvant chemoradiotherapy (CRT) is recommended before any surgery. However, response to CRT ranges from complete response (responders) to complete resistance (non-responders). To date we are not able to separate in advance the first group from the second, due to the absence of a valid biomarker. Therefore all patients receive the same therapy regardless of whether they reap benefits. On the other hand almost all patients receive a surgical resection after the CRT, although a watch-and-wait procedure or an endoscopic resection might be sufficient for those who responded well to the CRT. Being highly conserved regulators of gene expression, microRNAs (miRNAs) seem to be promising candidates for biomarkers. Many studies have been analyzing the miRNAs expressed in rectal cancer tissue to determine a specific miRNA profile for the ailment. Unfortunately, there is only a small overlap of identified miRNAs between different studies, posing the question as to whether different methods or differences in tissue storage may contribute to that fact or if the results simply are not reproducible, due to unknown factors with undetected influences on miRNA expression. Other studies sought to find miRNAs which correlate to clinical parameters (tumor grade, nodal stage, metastasis, survival) and therapy response. Although several miRNAs seem to have an impact on the response to CRT or might predict nodal stage, there is still only little overlap between different studies. We here aimed to summarize the current literature on rectal cancer and miRNA expression with respect to the different relevant clinical parameters. PMID:27190581

  14. [Multidisciplinary treatment of locally advanced rectal cancer].

    PubMed

    Faes, Seraina; Gié, Olivier; Demartines, Nicolas; Hahnloser, Dieter

    2016-06-15

    Treatment of patients with locally advanced rectal cancer remains challenging. Preoperative imaging with pelvic MRI allows to identify patients for multimodal treatment including induction chemothe- rapy or neoadjuvant radio-chemotherapy and an extended surgical resection. With multidisciplinary approach and an experienced team, excellent oncologic results may be achieved, as well as a good function and quality of life, even with preservation of the anus in the majority of patients. PMID:27487624

  15. Importance of surgical margins in rectal cancer.

    PubMed

    Mukkai Krishnamurty, Devi; Wise, Paul E

    2016-03-01

    Distal resection margin (DRM) and circumferential resection margin (CRM) are two important considerations in rectal cancer management. Although guidelines recommend a 2 cm DRM, studies have shown that a shorter DRM is adequate, especially in patients receiving neoadjuvant chemoradiation. Standardization of total mesorectal excision has greatly improved quality of CRM. Although more patients are undergoing sphincter-saving procedures, abdominoperineal resection is indicated for very distal tumors, and pelvic exenteration is often necessary for tumors involving pelvic organs. PMID:27094456

  16. Acute rectal obstruction after PPH stapled haemorrhoidectomy.

    PubMed

    Cipriani, S.; Pescatori, M.

    2002-09-01

    An unusual case of acute intestinal obstruction following a PPH stapled haemorrhoidectomy is reported: the complication was due to an almost complete interruption of the rectal lumen tightened by a purse-string suture anchored by staples. The stricture was dilated and the suture released thus restoring intestinal continuity. Surgeons should be aware that such troublesome complication may occur and can be treated successfully by a transanal approach.

  17. Spiral rectal valves: Anatomy, eponyms, and clinical significance.

    PubMed

    Ikard, Robert W

    2015-05-01

    Rectal wall valves are obscure anatomic parts that rarely are considered in current medical practice. Yet from the seminal analysis of them in the early nineteenth century by the Irish anatomist and surgeon, John Houston, their structure, purpose, and clinical significance were topics of surprising disagreement. Were they true structures? What function might they have? Did disease originate in rectal valves? Were special operations required for any such diseases? Because Houston's anatomic analyses of rectal valves were substantiated, they came to be known in the English literature as the Spiral Rectal Valves of Houston. In the mid-nineteenth century, a single mid-rectal valve was described by the Hanoverian, Otto Kohlrausch., creating confusion with the established eponym "Houston's Valves." Many hypotheses about rectal valves have been discredited; and their physiologic functions are still unknown.

  18. Akt Inhibitor MK2206 in Treating Patients With Previously Treated Colon or Rectal Cancer That is Metastatic or Locally Advanced and Cannot Be Removed by Surgery

    ClinicalTrials.gov

    2016-06-10

    Colon Mucinous Adenocarcinoma; Colon Signet Ring Cell Adenocarcinoma; Rectal Mucinous Adenocarcinoma; Rectal Signet Ring Cell Adenocarcinoma; Recurrent Colon Carcinoma; Recurrent Rectal Carcinoma; Stage IIIA Colon Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

  19. Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children

    PubMed Central

    Sharif, Mohammad Reza; Haji Rezaei, Mostafa; Aalinezhad, Marzieh; Sarami, Golbahareh; Rangraz, Masoud

    2016-01-01

    Background Fever is the most common complaint in pediatric medicine and its treatment is recommended in some situations. Paracetamol is the most common antipyretic drug, which has serious side effects such as toxicity along with its positive effects. Diclofenac is one of the strongest non-steroidal anti-inflammatory (NSAID) drugs, which has received little attention as an antipyretic drug. Objectives This study was designed to compare the antipyretic effectiveness of the rectal form of Paracetamol and Diclofenac. Patients and Methods This double-blind controlled clinical trial was conducted on 80 children aged six months to six years old. One group was treated with rectal Paracetamol suppositories at 15 mg/kg dose and the other group received Diclofenac at 1 mg/kg by rectal administration (n = 40). Rectal temperature was measured before and one hour after the intervention. Temperature changes in the two groups were compared. Results The average rectal temperature in the Paracetamol group was 39.6 ± 1.13°C, and 39.82 ± 1.07°C in the Diclofenac group (P = 0.37). The average rectal temperature, one hour after the intervention, in the Paracetamol and the Diclofenac group was 38.39 ± 0.89°C and 38.95 ± 1.09°C, respectively (P = 0.02). Average temperature changes were 0.65 ± 0.17°C in the Paracetamol group and 1.73 ± 0.69°C in the Diclofenac group (P < 0.001). Conclusions In the first one hour, Diclofenac suppository is able to control the fever more efficient than Paracetamol suppositories. PMID:26889398

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

    PubMed

    Højgaard, Helle Manfeld; Rahr, Hans

    2012-06-25

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

  1. Contrast lipocryolysis

    PubMed Central

    Pinto, Hernán; Melamed, Graciela

    2014-01-01

    Alternative crystal structures are possible for all lipids and each different crystal structure is called a polymorphic form. Inter-conversion between polymorphisms would imply the possibility of leaning crystal formation toward the most effective polymorphism for adipocyte destruction. Food industry has been tempering lipids for decades. Tempering technology applied to lipocryolysis gave birth to “contrast lipocryolysis”, which involves pre- and post-lipocryolysis fat layer heating as part of a specific tempering protocol. In this study, we evaluated the skinfold thickness of 10 subjects after a single contrast lipocryolysis session and witnessed important and fast reductions. PMID:25068088

  2. Aspiration of Barium Contrast

    PubMed Central

    Fuentes Santos, Cristina; Steen, Bárbara

    2014-01-01

    The aspiration of barium contrast is a rare complication that may occur during studies of the digestive tract. Barium is an inert material that can cause anywhere from an asymptomatic mechanical obstruction to serious symptoms of respiratory distress that can result in patient death. We present the case of a 79-year-old male patient in whom we observed the presence of contrast medium residue in the lung parenchyma as an incidental finding during hospitalization. When the patient's medical file was reviewed, images were found of a barium swallow study that the patient had undergone months earlier, and we were able to observe the exact moment of the aspiration of the contrast material. The patient had been asymptomatic since the test. PMID:25309769

  3. Case report: Sigmoid strangulation from evisceration through a perforated rectal prolapse ulcer – An unusual complication of rectal prolapse

    PubMed Central

    Li, Jennifer Z.; Kittmer, Tiffaney; Forbes, Shawn; Ruo, Leyo

    2015-01-01

    Introduction Rectal prolapse occurs particularly in elder females and presentation can sometimes lead to complications such as strangulation and evisceration of other organs through the necrotic mucosa. Presentation of case This is a case of a 61 year-old female with rectal prolapse complicated by rectal perforation through which a segment of sigmoid colon eviscerated and became strangulated. This patient initially presented with sepsis requiring ICU admission, but fully recovered following a Hartmann’s procedure with a sacral rectopexy. Discussion Complications of rectal prolapse include incarceration, strangulation, and rarely, perforation with evisceration of other viscera requiring urgent operation. This report provides a brief overview of complications associated with rectal prolapse, reviews similar cases of transrectal evisceration, and discusses the management of chronic rectal prolapse. Conclusion Prompt surgical consult is warranted if any signs or symptoms suggestive of complications from prolapse are present. PMID:25680532

  4. Endoscopic ultrasound for the characterization and staging of rectal cancer. Current state of the method. Technological advances and perspectives.

    PubMed

    Gersak, Mariana M; Badea, Radu; Graur, Florin; Hajja, Nadim Al; Furcea, Luminita; Dudea, Sorin M

    2015-06-01

    Endoscopic ultrasound is the most accurate type of examination for the assessment of rectal tumors. Over the years, the method has advanced from gray-scale examination to intravenous contrast media administration and to different types of elastography. The multimodal approach of tumors (transrectal, transvaginal) is adapted to each case. 3D ultrasound is useful for spatial representation and precise measurement of tumor formations, using CT/MR image reconstruction; color elastography is useful for tumor characterization and staging; endoscopic ultrasound using intravenous contrast agents can help study the amount of contrast agent targeted at the level of the tumor formations and contrast wash-in/wash-out time, based on the curves displayed on the device. The transvaginal approach often allows better visualization of the tumor than the transrectal approach. Performing the procedure with the rectal ampulla distended with contrast agent may be seen as an optimization of the examination methodology. All these aspects are additional methods for gray-scale endoscopic ultrasound, capable of increasing diagnostic accuracy. This paper aims at reviewing the progress of transrectal and transvaginal ultrasound, generically called endoscopic ultrasound, for rectal tumor diagnosis and staging, with emphasis on the current state of the method and its development trends.

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

    PubMed Central

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

    2014-01-01

    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

  6. Ferrimagnetic susceptibility contrast agents.

    PubMed

    Bach-Gansmo, T

    1993-01-01

    Contrast agents based on superparamagnetic particles have been in clinical development for more than 5 years, and the complexity of their effects is still not elucidated. The relaxivities are frequently used to give an idea of their efficacy, but these parameters can only be used if they are concentration independent. For large superparamagnetic systems, the evolution of the transverse magnetization is biexponential, after an initial loss of magnetization. Both these characteristics of large superparamagnetic systems should lead to prudence in using the relaxivities as indicators of contrast medium efficacy. Susceptibility induced artefacts have been associated with the use of superparamagnetic contrast agents since the first imaging evaluation took place. The range of concentrations where good contrast effect was achieved without inducing artefacts, as well as blurring and metal artefacts were evaluated. The influence of motion on the induction of artefacts was studied, and compared to the artefacts induced by a paramagnetic agent subject to motion. With a suitable concentration of a negative contrast agent, a signal void could be achieved in the region prone to motion, and no artefacts were induced. If the concentration was too high, a displacement of the region close to the contrast agent was observed. The artefacts occurred in a volume surrounding the contrast agent, i.e., also outside the imaging plane. In comparison a positive, paramagnetic contrast agent induced heavy artefacts in the phase encoding direction, appearing as both high intensity regions and black holes, in a mosaic pattern. Clinical trials of the oral contrast agent OMP for abdominal MR imaging showed this agent to be safe and efficacious. OMP increased the diagnostic efficacy of abdominal MR imaging in 2 of 3 cases examined, with a significant decrease in motion artefacts. Susceptibility contrast agents may also be of use in the evaluation of small lesions in the liver. Particulate material

  7. [Contrast media in echography].

    PubMed

    Derchi, L E; Rizzatto, G; Solbiati, L

    1992-09-01

    In medical US, the use of specific contrast media to increase the echogenicity of structures and organs changes their absorption of the US beam, and modifies the through-transmission velocity. This can be of great diagnostic value. Contrast media can help depict vessels and cavities, increase the sensitivity of Doppler examination, and make the differentiation of normal and pathologic tissues easier. The products which are currently available do not completely fulfill the needs of clinical researchers. The first papers reporting on some clinical applications of these contrast media in humans are now appearing in literature. Contrast media for diagnostic US can be classified in five groups: 1) free gas bubbles; 2) stabilized gas bubbles; 3) colloidal suspensions; 4) emulsions; 5) aqueous solutions. These agents are quite different, as to both chemical and physical features and distribution within living tissues. Different clinical applications are thus possible for each of them; a unique contrast medium which will meet all the needs of the various clinical situations seems inconceivable at present. Most probably, a variety of products will develop, each with its own application field; in clinical practice, it seems likely that different products will be used, according to the specific clinical needs.

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

    PubMed Central

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

    2012-01-01

    Background An objective method for determining the location of the cancer with respect to peritoneal reflection would be helpful to decide the treatment modality for rectal cancer. This study was designed to evaluate the accuracy and usefulness of rectal MRI to determine spatial relations between the peritoneal reflection and rectal cancer and to compare these with operative findings. Patients and methods Patients that underwent a rectal cancer operation after a rectal MRI check between November 2008 and June 2010 were considered for the study. The patients that received preoperative concurrent chemoradiation or trans-anal local excision were excluded. Results Fifty-four patients constituted the study cohort. By comparing surgical and radiologic findings, the accuracy for predicting tumour location in relation to the peritoneal reflection by rectal MRI in all patients was 90.7%. In terms of tumour location in relation to peritoneal reflection, the accuracy of rectal MRI was 93.5% in patients with a tumour located above the peritoneal reflection, 90.0% in patients with a tumour located on the peritoneal reflection, and 84.6% in patients with a tumour located below the peritoneal reflection (p=0.061). When the cohort was subdivided by gender, body mass index (BMI), operative findings, or tumour size, no significant difference was observed among subgroups. Conclusions Rectal MRI could be a useful tool for evaluating the relation between rectal cancer and peritoneal reflection especially when tumour size is less than 8cm. Rectal MRI can provide information regarding the location of rectal cancer in relation to the peritoneal reflection for treatment planning purposes. PMID:23411588

  9. "Graciloplasty" in treatment of recurrent complete rectal prolapse: case report.

    PubMed

    Khainga, S O

    2007-08-01

    Gracilis muscle flap was used to treat a seven year old boy with a one year history of recurrent rectal prolapse. Initial perineal surgery in form of Thiersch stitch resulted into failure to control rectal prolapse and damage to anal sphincter. Graciloplasty corrected both problems. PMID:17970009

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

    PubMed Central

    Carballo-Diéguez, Alex; Bauermeister, José; Ventuneac, Ana; Dolezal, Curtis; Mayer, Kenneth

    2009-01-01

    Rationale To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk. Methods In Stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in Stage 2 to 105 MSM. Results More than half of participants who completed Stage 1 douched during the trial despite having been advised not to do so. Of the 105 HIV uninfected participants in Stage 2, 51% reported using rectal douches in the prior six months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about two hours prior to or one hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent STIs. Conclusion Rectal douching appears to be a popular behavior among men who have RAI. It is necessary to identify harmless douches. If HIV/STI preventive douches can be developed, rectal douching prior to or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of one type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use). PMID:19959973

  11. A new 'enterocompressor' to facilitate rectal anastomosis.

    PubMed

    Barraza, R P

    1990-02-01

    A newly devised enterocompressor facilitates low rectal anastomosis in children with Hirschsprung's disease. This simple surgical instrument, composed of two semicylindrical valves, a hinge, and a regulating screw, maintains intestinal anastomoses properly placed and produces spur crushing. In addition, it is inexpensive and reusable. The enterocompressor, used in 33 primary and 15 secondary Duhamel operations, and applied to normalize intestinal transit in 10 colectomies, provided adequate anastomosis and prevented leakage of intestinal contents. This enterocompressor can be used safely in children as young as six months of age. PMID:2298104

  12. Screening prostate cancer using a portable near infrared scanning imaging unit with an optical fiber-based rectal probe

    NASA Astrophysics Data System (ADS)

    Pu, Yang; Wang, Wubao; Tang, Guichen; Budansky, Yury; Sharonov, Mikhail; Xu, Min; Achilefu, Samuel; Eastham, James A.; Alfano, Robert R.

    2012-01-01

    A portable near infrared scanning polarization imaging unit with an optical fiber-based rectal probe, namely Photonic Finger, was designed and developed o locate the 3D position of abnormal prostate site inside normal prostate tissue. An inverse algorithm, Optical Tomography using Independent Component Analysis (OPTICA) was improved particularly to unmix the signal from targets (cancerous tissue) embedded in a turbid medium (normal tissue) in the backscattering imaging geometry. Photonic Finger combined with OPTICA was tested to characterize different target(s) inside different tissue medium, including cancerous prostate tissue embedded by large piece of normal tissue.

  13. Adjuvant Chemotherapy in Rectal Cancer after Chemoradiotherapy.

    PubMed

    Boustani, J; Caubet, M; Bosset, J-F

    2016-02-01

    The aim of this overview was to investigate whether adjuvant chemotherapy has a favourable effect on the outcome of patients with rectal cancer who had preoperative (chemo)radiotherapy. A review of randomised clinical trials that allocated patients between fluorouracil-based and observation or between fluorouracil-based and oxaliplatin-based adjuvant chemotherapy after preoperative (chemo)radiotherapy was carried out, including their corresponding meta-analyses. None of the five randomised trials has shown a significant benefit of fluorouracil-based adjuvant chemotherapy for overall survival or disease-free survival. Also, the three corresponding meta-analyses failed to show a benefit of adjuvant treatment. Of three randomised trials - two phase III and one phase II with a 3-year disease-free survival end point - two showed a small benefit of adding oxaliplatin to fluorouracil, one failed. The corresponding meta-analyses showed that the pooled difference was not significant. In conclusion, the use of postoperative 5-fluorouracil-based chemotherapy with or without oxaliplatin in patients with rectal cancer after preoperative (chemo)radiotherapy is not scientifically proven.

  14. Transsacral rectopexy for recurrent complete rectal prolapse.

    PubMed

    Araki, Y; Isomoto, H; Tsuzi, Y; Matsumoto, A; Yasunaga, M; Yamauchi, K; Hayashi, K; Kodama, T

    1999-01-01

    The aim of this study was to examine the functional outcome of transsacral rectopexy performed with Dexon mesh for recurrent complete rectal prolapse. Anorectal function was assessed by anorectal manometry and defecography, before and from 1 year after surgery in five patients who were followed up for 1-3 years. The fecal incontinence score recovered from a preoperative mean score of 3.8 to a postoperative mean score of 1.2, and constipation was improved in four patients (80%). The straining anorectal angle (S-ARA), measured by defecography, improved from a preoperative value of 120.6 degrees +/- 6.9 degrees to a postoperative value of 98.5 degrees +/- 3.5 degrees (P < 0.05), and the perineal descent (PD) improved from a preoperative value of 16.2 +/- 2.5 cm to a postoperative value of 8.1 +/- 1.3 cm (P < 0.05). The maximal resting pressure (MRP) increased from a preoperative value of 20.5 +/- 3.7 cmH2O to a postoperative value of 40.5 +/- 4.8 cmH2O (P < 0.05). These findings indicate that transsacral rectopexy with Dexon mesh can achieve good control of recurrent complete rectal prolapse. PMID:10489150

  15. Rectal examination in paediatric trauma care.

    PubMed

    Winnett, M

    1999-01-01

    When providing trauma care, there is a danger that staff might forget what a frightening and confusing experience it can be for the patient, particularly if that patient is a child. As part of an academic exercise in reflection, I recently examined a critical incident involving the trauma care of a 9-year-old boy. In Accident and Emergency (A&E) the doctor inappropriately performed a rectal examination, which I witnessed in horror. The doctor failed to consider the effect of his actions on the child, the legal necessity for consent and the importance of a full explanation. Deeply disturbed by this incident and determined to avoid any repetition, I set out to find documented evidence to support my assertion that no child should be subjected to such intimate examinations, unless absolutely unavoidable. It is hoped that discussion of this incident will serve to raise the awareness of A&E staff working throughout the country with regard to paediatric rectal examination, as has been the case in my own workplace.

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

    PubMed

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

    2014-01-01

    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.

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

    PubMed

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

    2014-01-01

    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.

  18. Rectal HSV-2 Infection May Increase Rectal SIV Acquisition Even in the Context of SIVΔnef Vaccination.

    PubMed

    Guerra-Pérez, Natalia; Aravantinou, Meropi; Veglia, Filippo; Goode, Diana; Truong, Rosaline; Derby, Nina; Blanchard, James; Grasperge, Brooke; Gettie, Agegnehu; Robbiani, Melissa; Martinelli, Elena

    2016-01-01

    Prevalent HSV-2 infection increases the risk of HIV acquisition both in men and women even in asymptomatic subjects. Understanding the impact of HSV-2 on the mucosal microenvironment may help to identify determinants of susceptibility to HIV. Vaginal HSV-2 infection increases the frequency of cells highly susceptible to HIV in the vaginal tissue of women and macaques and this correlates with increased susceptibility to vaginal SHIV infection in macaques. However, the effect of rectal HSV-2 infection on HIV acquisition remains understudied. We developed a model of rectal HSV-2 infection in macaques in combination with rectal SIVmac239Δnef (SIVΔnef) vaccination and our results suggest that rectal HSV-2 infection may increase the susceptibility of macaques to rectal SIVmac239 wild-type (wt) infection even in SIVΔnef-infected animals. Rectal SIVΔnef infection/vaccination protected 7 out of 7 SIVΔnef-infected macaques from SIVmac239wt rectal infection (vs 12 out of 16 SIVΔnef-negative macaques), while 1 out of 3 animals co-infected with SIVΔnef and HSV-2 acquired SIVmac239wt infection. HSV-2/SIVmac239wt co-infected animals had increased concentrations of inflammatory factors in their plasma and rectal fluids and a tendency toward higher acute SIVmac239wt plasma viral load. However, they had higher blood CD4 counts and reduced depletion of CCR5+ CD4+ T cells compared to SIVmac239wt-only infected animals. Thus, rectal HSV-2 infection generates a pro-inflammatory environment that may increase susceptibility to rectal SIV infection and may impact immunological and virological parameters during acute SIV infection. Studies with larger number of animals are needed to confirm these findings. PMID:26886938

  19. Rectal HSV-2 Infection May Increase Rectal SIV Acquisition Even in the Context of SIVΔnef Vaccination

    PubMed Central

    Veglia, Filippo; Goode, Diana; Truong, Rosaline; Derby, Nina; Blanchard, James; Grasperge, Brooke; Gettie, Agegnehu; Robbiani, Melissa; Martinelli, Elena

    2016-01-01

    Prevalent HSV-2 infection increases the risk of HIV acquisition both in men and women even in asymptomatic subjects. Understanding the impact of HSV-2 on the mucosal microenvironment may help to identify determinants of susceptibility to HIV. Vaginal HSV-2 infection increases the frequency of cells highly susceptible to HIV in the vaginal tissue of women and macaques and this correlates with increased susceptibility to vaginal SHIV infection in macaques. However, the effect of rectal HSV-2 infection on HIV acquisition remains understudied. We developed a model of rectal HSV-2 infection in macaques in combination with rectal SIVmac239Δnef (SIVΔnef) vaccination and our results suggest that rectal HSV-2 infection may increase the susceptibility of macaques to rectal SIVmac239 wild-type (wt) infection even in SIVΔnef-infected animals. Rectal SIVΔnef infection/vaccination protected 7 out of 7 SIVΔnef-infected macaques from SIVmac239wt rectal infection (vs 12 out of 16 SIVΔnef-negative macaques), while 1 out of 3 animals co-infected with SIVΔnef and HSV-2 acquired SIVmac239wt infection. HSV-2/SIVmac239wt co-infected animals had increased concentrations of inflammatory factors in their plasma and rectal fluids and a tendency toward higher acute SIVmac239wt plasma viral load. However, they had higher blood CD4 counts and reduced depletion of CCR5+ CD4+ T cells compared to SIVmac239wt-only infected animals. Thus, rectal HSV-2 infection generates a pro-inflammatory environment that may increase susceptibility to rectal SIV infection and may impact immunological and virological parameters during acute SIV infection. Studies with larger number of animals are needed to confirm these findings. PMID:26886938

  20. Lymphangiogenesis in Regional Lymph Nodes Is an Independent Prognostic Marker in Rectal Cancer Patients after Neoadjuvant Treatment

    PubMed Central

    Jakob, Christiane; Aust, Daniela E.; Liebscher, Birgit; Baretton, Gustavo B.; Datta, Kaustubh; Muders, Michael H.

    2011-01-01

    One of the major prognostic factors in rectal cancer is lymph node metastasis. The formation of lymph node metastases is dependent on the existence of a premetastatic niche. An important factor preceding metastasis are lymph vessels which are located in the lymph node. Accordingly, the occurrence of intranodal lymphangiogenesis is thought to indicate distant metastasis and worse prognosis. To evaluate the significance of lymph node lymphangiogenesis, we studied formalin fixed, paraffin embedded adenocarcinomas and regional lymph nodes of 203 rectal cancer patients who were treated with neoadjuvant radiochemotherapy and consecutive curative surgery with cancer free surgical margins (R0). Regional lymph node lymph vessels were detected by immunohistochemistry for podoplanin (D2-40). Our results show that the presence of lymphatic vessels in regional lymph nodes significantly affects the disease-free survival in univariate and multivariate analyses. In contrast, there was no correlation between peritumoral or intratumoral lymph vessel density and prognosis. Indeed, our study demonstrates the importance of lymphangiogenesis in regional lymph nodes after neoadjuvant radiochemotherapy and consecutive surgery as an independent prognostic marker. Staining for intranodal lymphangiogenesis and methods of intravital imaging of lymphangiogenesis and lymphatic flow may be a useful strategy to predict long-term outcome in rectal cancer patients. Furthermore, addition of VEGF-blocking agents to standardized neoadjuvant treatment schemes might be indicated in advanced rectal cancer. PMID:22087309

  1. Rectal and colon cancer: Not just a different anatomic site.

    PubMed

    Tamas, K; Walenkamp, A M E; de Vries, E G E; van Vugt, M A T M; Beets-Tan, R G; van Etten, B; de Groot, D J A; Hospers, G A P

    2015-09-01

    Due to differences in anatomy, primary rectal and colon cancer require different staging procedures, different neo-adjuvant treatment and different surgical approaches. For example, neoadjuvant radiotherapy or chemoradiotherapy is administered solely for rectal cancer. Neoadjuvant therapy and total mesorectal excision for rectal cancer might be responsible in part for the differing effect of adjuvant systemic treatment on overall survival, which is more evident in colon cancer than in rectal cancer. Apart from anatomic divergences, rectal and colon cancer also differ in their embryological origin and metastatic patterns. Moreover, they harbor a different composition of drug targets, such as v-raf murine sarcoma viral oncogene homolog B (BRAF), which is preferentially mutated in proximal colon cancers, and the epidermal growth factor receptor (EGFR), which is prevalently amplified or overexpressed in distal colorectal cancers. Despite their differences in metastatic pattern, composition of drug targets and earlier local treatment, metastatic rectal and colon cancer are, however, commonly regarded as one entity and are treated alike. In this review, we focused on rectal cancer and its biological and clinical differences and similarities relative to colon cancer. These aspects are crucial because they influence the current staging and treatment of these cancers, and might influence the design of future trials with targeted drugs.

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

    PubMed

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

    2014-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-11-01

    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).

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

    SciTech Connect

    Starzewski, Jacek J.; Pajak, Jacek T.; Pawelczyk, Iwona; Lange, Dariusz; Golka, Dariusz . E-mail: dargolka@wp.pl; Brzeziska, Monika; Lorenc, Zbigniew

    2006-03-01

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

  5. Comparison of digital rectal and microchip transponder thermometry in cats.

    PubMed

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

    2009-07-01

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

  6. Anorectal avulsion: Management of a rare rectal trauma

    PubMed Central

    Rispoli, C.; Andreuccetti, J.; Iannone, L.; Armellino, M.; Rispoli, G.

    2012-01-01

    INTRODUCTION Traumatic injuries of the rectum are unusual even though their treatment is challenging and often lead to high morbidity and mortality rate. PRESENTATION OF CASE This paper reports a rare case of complete rectal avulsion with multiple fracture and hemoperitoneum treated with a multistep approach in our department. DISCUSSION The anorectal avulsion is a rare rectal trauma; only few reports are available. Treatment key points of rectal trauma are: direct repair, diverting stoma and sacral drainage. CONCLUSION We reported a case of anorectal avulsion with complete detachment of external sphincter muscle. A multidisciplinary approach was mandatory in this kind of lesions. PMID:22554940

  7. Disseminated lung cancer presenting as a rectal mass.

    PubMed

    Noergaard, Mia M; Stamp, Inger M H; Bodtger, Uffe

    2016-01-01

    Primary lung cancer is the leading cause of cancer-related deaths globally, and approximately 50% had metastatic disease at the time of diagnosis. A rectal mass and unintended weight loss are common manifestations of rectal cancer. Our case presented with a rectal mass, but workup revealed a metastatic lesion from lung cancer. Lung cancer metastases to the lower gastrointestinal tract imply reduced survival compared with the already poor mean survival of stage IV lung cancer. Despite relevant therapy, the patient died 5 months after referral. PMID:27683028

  8. Endorectal sonography in the evaluation of rectal and perirectal disease.

    PubMed

    St Ville, E W; Jafri, S Z; Madrazo, B L; Mezwa, D G; Bree, R L; Rosenberg, B F

    1991-09-01

    Endorectal sonography initially was developed for evaluation of the prostate and now has been adapted for evaluation of rectal and perirectal disease. We used endorectal sonography to evaluate a spectrum of diseases, including primary and recurrent rectal carcinoma, metastases, villous adenoma, leiomyosarcoma, endometriosis, sacrococcygeal teratoma, chordoma, retroperitoneal cystic hamartoma, pelvic lipomatosis, diverticulitis, and perirectal abscess. The technique has been useful in localization of perirectal abscesses and in sonographically guided biopsy of perirectal masses. Knowledge of normal sonographic anatomy of the rectum is essential in the evaluation of rectal and perirectal disease. In this essay, we describe the technique of endorectal sonography and illustrate the sonographic findings in a variety of diseases.

  9. Transanal Endoscopic Microsurgery for Rectal Tumors: A Review

    PubMed Central

    Kunitake, Hiroko; Abbas, Maher A

    2012-01-01

    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

  10. [The treatment of locally recurrent rectal cancer].

    PubMed

    Alberda, Wijnand J; Verhoef, Cornelis; Nuyttens, Joost J; Rothbarth, Joost; Burger, Jacobus W A

    2015-01-01

    Its incidence has decreased in recent decades due to advances in the treatment of patients with primary rectal cancer, but LRRC still occurs in 6-10% of these patients. LRRC is often accompanied by severe, progressive pain and has a major impact on quality of life. Curative treatment is possible based on surgical resection combined with chemoradiotherapy. Radical resection is the most important prognostic factor in curative treatment. Neo-adjuvant systemic therapy may further improve outcomes in LRRC patients. Many patients are not eligible for surgical treatment due to the presence of metastases or irresectability of the local recurrence. These patients should receive optimal palliative care for the disabling pain. Radiotherapy is effective against local pain in around 75% of patients but the duration of palliation is limited.

  11. Rectal Douching and Implications for Rectal Microbicides among Populations Vulnerable to HIV in South America: A Qualitative Study

    PubMed Central

    Galea, Jerome T.; Kinsler, Janni J.; Imrie, John; Nureña, César R.; Sánchez, Jorge; Cunningham, William E.

    2014-01-01

    Objective While gel-formulated Rectal Microbicides (RM) are the first to enter clinical trials, rectal douching in preparation for anal intercourse is a common practise, thus RMs formulated as douches may be a convenient alternative to gels. Nonetheless, little is known about potential users’ thoughts regarding douche-formulated RMs or rectal douching practises, data needed to inform the advancement of douche-based RMs. This qualitative study examined thoughts regarding douches, their use as a RM and current douching practises among men who have sex with men and transgender women. Methods Ten focus groups and 36 in-depth interviews were conducted (N=140) to examine the overall acceptability of RM, of which one component focused on rectal douching. Focus groups and interviews were recorded, transcribed verbatim and coded; text relating to rectal douching was extracted and analysed. Sociodemographic information was collected using a self-administered questionnaire. Results Support for a douche-formulated RM centred on the possibility of combined pre-coital hygiene and HIV protection, and it was believed that a deeply-penetrating liquid douche would confer greater HIV protection than a gel. Drawbacks included rectal dryness; impracticality and portability issues; and, potential side effects. Non-commercial douching apparatus use was common and liquids used included detergents, vinegar, bleach, lemon juice and alcohol. Conclusions A douche-formulated RM while desirable and perceived as more effective than a gel-formulated RM also generated questions regarding practicality and side-effects. Of immediate concern were the non-commercial liquids already being used which likely damage rectal epithelia, potentially increasing HIV infection risk. Pre-coital rectal douching is common and a RM formulated as such is desirable, but education on rectal douching practices is needed now. PMID:23966338

  12. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

    PubMed Central

    Ippolito, Davide; Drago, Silvia Girolama; Franzesi, Cammillo Talei; Fior, Davide; Sironi, Sandro

    2016-01-01

    AIM: To assess the diagnostic accuracy of multidetector-row computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients. METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner (ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 mAs. Imaging data were reviewed as axial and as multiplanar reconstructions (MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images (DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed. RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91 (41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged (45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images

  13. In vivo trans-rectal ultrasound-coupled optical tomography of a transmissible venereal tumor model in the canine pelvic canal

    NASA Astrophysics Data System (ADS)

    Jiang, Zhen; Holyoak, G. Reed; Bartels, Kenneth E.; Ritchey, Jerry W.; Xu, Guan; Bunting, Charles F.; Slobodov, Gennady; Piao, Daqing

    2009-05-01

    In vivo trans-rectal near-infrared (NIR) optical tomography was performed concurrently with, albeit reconstructed without spatial a prior of, trans-rectal ultrasound (US) on transmissible venereal tumor (TVT) developed as a model in the canine pelvic canal. Studies were taken longitudinally at prior to, 14 days after, and 35 days after the TVT injection. As the tumor grew, the nodules became increasingly hyperabsorptive and moderately hyperscattering on NIR. The regions of strong NIR contrast, especially on absorption images, correlated well with those of US hypoechoic masses indicative of tumors. Combining the information of trans-rectal NIR and US detected the tumor more accurately than did the US alone at 14 days postinjection.

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

    PubMed

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

    2005-01-01

    The use of an air-filled rectal balloon has been shown to decrease prostate motion during prostate radiotherapy. However, the perturbation of radiation dose near the air-tissue interfaces has raised clinical concerns of underdosing the prostate gland. The aim of this study was to investigate the dosimetric effects of an air-filled rectal balloon on the rectal wall/mucosa and prostate gland. Clinical rectal toxicity and dose-volume histogram (DVH) were also assessed to evaluate for any correlation. A film phantom was constructed to simulate the 4-cm diameter air cavity created by a rectal balloon. Kodak XV2 films were utilized to measure and compare dose distribution with and without air cavity. To study the effect in a typical clinical situation, the phantom was computed tomography (CT) scanned on a Siemens DR CT scanner for intensity-modulated radiation therapy (IMRT) treatment planning. A target object was drawn on the phantom CT images to simulate the treatment of prostate cancer. Because patients were treated in prone position, the air cavity was situated superiorly to the target. The treatment used a serial tomotherapy technique with the Multivane Intensity Modulating Collimator (MIMiC) in arc treatment mode. Rectal toxicity was assessed in 116 patients treated with IMRT to a mean dose of 76 Gy over 35 fractions (2.17-Gy fraction size). They were treated in the prone position, immobilized using a Vac-Loktrade mark bag and carrier-box system. Rectal balloon inflated with 100 cc of air was used for prostate gland immobilization during daily treatment. Rectal toxicity was assessed using modifications of the Radiation Therapy Oncology Group (RTOG) and late effects Normal Tissue Task Force (LENT) scales systems. DVH of the rectum was also evaluated. From film dosimetry, there was a dose reduction at the distal air-tissue interface as much as 60% compared with the same geometry without the air cavity for 15-MV photon beam and 2x2-cm field size. The dose beyond the

  15. [Rectal prolapse revealing a tumor: The role of abdominal ultrasound].

    PubMed

    Bequet, E; Stiennon, L; Lhomme, A; Piette, C; Hoyoux, C; Rausin, L; Guidi, O

    2016-07-01

    Rectal prolapse is rare in children and usually benign. However, there are various diseases that can be associated with it, such as cystic fibrosis or other causes of increased abdominal pressure. Here, we review the various underlying conditions that pediatricians or pediatric gastroenterologists should consider in the case of rectal prolapse. We report on three cases of children with a rectal prolapse and intra-abdominal tumors. Current recommendations and practice do not include a systematic check via abdominal imaging in cases of rectal prolapse. However, in some situations, imaging is indicated to detect a possible expansive process. Thus, in the presence of recurrent prolapse or of associated urinary or neurological signs, imaging is justified so as to allow for an early diagnosis and treatment of these neoplasms. Given its lack of radiation exposure and good sensitivity in children, ultrasound imaging is the first choice. PMID:27265581

  16. Refining Preoperative Therapy for Locally Advanced Rectal Cancer

    Cancer.gov

    In the PROSPECT trial, 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 nonresponders.

  17. Using rectal irrigation for faecal incontinence in children.

    PubMed

    Bohr, Clare

    Claire Bohr describes how she introduced rectal irrigation as a treatment for children with faecal incontinence who had failed to respond to conservative treatment. She won a Nursing Times Award in the continence care category for this service in 2008.

  18. High Rate of Sexual Dysfunction Following Surgery for Rectal Cancer

    PubMed Central

    Ertekin, Caglar; Tinay, Ilker; Yegen, Cumhur

    2014-01-01

    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

  19. [Rectal impalement with rupture of the small intestine].

    PubMed

    Wahnschaff, F; Gerstorfer, M; Roder, J

    2011-06-01

    We report the case of a 44-year-old farmer who fell from a ladder onto the handle of a wheelbarrow and sustained a rectal impalement with rupture of the small intestine. After the clinical diagnostics an emergency laparotomy was carried out with primary suturing of the rectal perforation. Furthermore there were two perforations of the small intestine which were treated with an ileostomy. The replacement of the ileostomy was carried out after 7 weeks. PMID:21113567

  20. Laparoscopic resection of rectal cancer in the elderly

    PubMed Central

    Peters, Walter R.

    2016-01-01

    Recent published trials have failed to demonstrate that laparoscopic resection is not inferior to open resection of rectal cancer in terms of pathologic outcomes. However, there have been numerous studies showing the benefit of laparoscopic resection in terms of short-term complications and quality of life. Fewer complications and shorter hospital stays improve the chance of maintaining functional status, which is very important for the elderly population. Thus, laparoscopic resection of rectal cancer remains a viable option for the elderly.

  1. A monte carlo comparison of three different media for contrast enhanced radiotherapy of the prostate.

    PubMed

    Garnica-Garza, H M

    2010-06-01

    Contrast-enhanced radiotherapy makes use of a kilovoltage X-ray beam, either from a diagnostic X-ray tube or modified megavoltage linear accelerator, in conjunction with a high-Z contrast medium deposited into the target volume to enhance the absorption of radiation. In this work, using the Monte Carlo code PENELOPE and the voxelized Zubal phantom to model a prostate radiotherapy treatment, a comparison between the physical absorbed dose distributions rendered by three different enhancing agents namely bismuth, gadolinium, and iodine is performed. It is assumed that there exists a concentration of 10 mg of enhancing agent per 1 g of tissue in the target volume while in the background a concentration of 1.5 mg per 1 g of tissue is present. The X-ray beam energy spectrum was obtained by means of Monte Carlo simulation of a tungsten target upon which a 220 keV mono-energetic electron pencil beam is made to impinge, and the resultant photon beam is heavily filtrated by 0.2 cm of copper. The treatment delivery is simulated as a 3608 arc collimated to conform to the target from every direction. Cumulative dose-volume histograms and isodose curves are presented for the target as well as five organs-at-risk, namely rectal wall, bladder, femoral heads, skin, and bone marrow. It is shown that under these conditions clinically acceptable treatment plans are obtained for all three contrast agents. A 72 Gy dose to 100% of the target volume results in maximum absorbed doses to the above mentioned organs-at-risk of 65, 56, 44, 32 and 65 Gy respectively when bismuth is used as the contrast agent, but the results obtained with gadolinium follow closely.

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

    PubMed Central

    2011-01-01

    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

  3. Trans-rectal interventional MRI: initial prostate biopsy experience

    NASA Astrophysics Data System (ADS)

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

    2010-02-01

    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.

  4. Rectal suppository: commonsense and mode of insertion.

    PubMed

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

    1991-09-28

    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.

  5. Rectal suppository: commonsense and mode of insertion.

    PubMed

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

    1991-09-28

    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

  6. Pediatric Rectal Exam: Why, When, and How.

    PubMed

    Orenstein, Susan R; Wald, Arnold

    2016-01-01

    The digital rectal examination (DRE) is performed in children less often than is indicated. Indications for the pediatric DRE include diarrhea, constipation, fecal incontinence, abdominal pain, gastrointestinal bleeding, and anemia. Less well-recognized indications may include abdominal mass, urinary symptoms, neurologic symptoms, urogenital or gynecologic symptoms, and anemia. Indeed, we believe that it should be considered part of a complete physical examination in children presenting with many different complaints. Physicians avoid this part of the physical examination in both children and adults for a number of reasons: discomfort on the part of the health care provider; belief that no useful information will be provided; lack of adequate training and experience in the performance of the DRE; conviction that planned "orders" or testing can obviate the need for the DRE; worry about "assaulting" a patient, particularly one who is small, young, and subordinate; anticipation that the exam will be refused by patient or parent; and concern regarding the time involved in the exam. The rationale and clinical utility of the DRE will be summarized in this article. In addition, the components of a complete pediatric DRE, along with suggestions for efficiently obtaining the child's consent and cooperation, will be presented. PMID:26739462

  7. Effects of radiotherapy and chemotherapy on angiogenesis and leukocyte infiltration in rectal cancer

    SciTech Connect

    Baeten, Coen . E-mail: C.Baeten@surgery.azm.nl; Castermans, Karolien; Lammering, Guido; Hillen, Femke; Wouters, Bradly G.; Hillen, Harry; Griffioen, Arjan W.; Baeten, Cornelius G.M.I.

    2006-11-15

    Background: We and others have shown that angiogenesis and leukocyte infiltration are important prognostic factors in rectal cancer. However, little is known about its possible changes in response to radiotherapy (RTX), which is frequently given to rectal tumors as a neoadjuvant treatment to improve the prognosis. We therefore investigated the biologic effects of RTX on these parameters using fresh-frozen biopsy samples of tumor and normal mucosa tissue before and after RTX. Methods: Biopsy samples were taken from a total of 34 patients before and after either a short course or long course of RTX combined with chemotherapy. The following parameters were analyzed by immunohistochemistry, flow cytometry, or quantitative real-time polymerase chain reaction: Microvessel density, leukocyte infiltration, proliferating epithelial and tumor cells, proliferating endothelial cells, adhesion molecule expression on endothelial cells, and the angiogenic mRNA profile. Results: The tumor biopsy samples taken after RTX treatment demonstrated a significant decrease in microvessel density and the number of proliferating tumor cells and proliferating endothelial cells (p < 0.001). In contrast, the leukocyte infiltration, the levels of basic fibroblast growth factor in carcinoma tissue, and the adhesion molecule expression on endothelial cells in normal as well as carcinoma tissue increased significantly (p < 0.05). Conclusion: Our data show that together with an overall decrease in tumor cell and endothelial cell proliferation, RTX results in an increase in the expression of adhesion molecules that stimulate leukocyte infiltration. This suggests the possibility that, in addition to its direct cytotoxic effect, radiation may also stimulate an immunologic tumor response that could contribute to the documented improvement in local tumor control and distal failure rate of rectal cancers.

  8. Circadian gene expression predicts patient response to neoadjuvant chemoradiation therapy for rectal cancer.

    PubMed

    Lu, Haijie; Chu, Qiqi; Xie, Guojiang; Han, Hao; Chen, Zheng; Xu, Benhua; Yue, Zhicao

    2015-01-01

    Preoperative neoadjuvant chemoradiation therapy may be useful in patients with operable rectal cancer, but treatment responses are variable. We examined whether expression levels of circadian clock genes could be used as biomarkers to predict treatment response. We retrospectively analyzed clinical data from 250 patients with rectal cancer, treated with neoadjuvant chemoradiation therapy in a single institute between 2011 and 2013. Gene expression analysis (RT-PCR) was performed in tissue samples from 20 patients showing pathological complete regression (pCR) and 20 showing non-pCR. The genes analyzed included six core clock genes (Clock, Per1, Per2, Cry1, Cry2 and Bmal1) and three downstream target genes (Wee1, Chk2 and c-Myc). Patient responses were analyzed through contrast-enhanced pelvic MRI and endorectal ultrasound, and verified by histological assessment. pCR was defined histologically as an absence of tumor cells. Among the 250 included patients, 70.8% showed regression of tumor size, and 18% showed pCR. Clock, Cry2 and Per2 expressions were significantly higher in the pCR group than in the non-pCR group (P<0.05), whereas Per1, Cry1 and Bmal1 expressions did not differ significantly between groups. Among the downstream genes involved in cell cycle regulation, c-Myc showed significantly higher expression in the pCR group (P<0.05), whereas Wee1 and Chk2 expression did not differ significantly between groups. Circadian genes are potential biomarkers for predicting whether a patient with rectal cancer would benefit from neoadjuvant chemoradiation therapy. PMID:26617816

  9. Rectal reservoir and sensory function studied by graded isobaric distension in normal man.

    PubMed Central

    Akervall, S; Fasth, S; Nordgren, S; Oresland, T; Hultén, L

    1989-01-01

    The rectal expansion and concomitant sensory function on graded, isobaric, rectal distension within the interval 5-60 cm H2O was investigated in 36 healthy young volunteers. Anal pressure and electromyography (EMG) from the external anal sphincter were simultaneously recorded. Rectal distension caused an initial rapid expansion followed by transient, often repeated, reflex rectal contractions and a slow gradual increase of rectal volume. The maximal volume displaced by the first reflex rectal contraction was 18 (13) ml, which was less than 10% of the volume at 60 s. The pressure threshold for appreciation of rectal filling was 12 cm H2O (95% CL 5-15 cm H2O) and coincided with the threshold for rectoanal inhibition. Urge to defecate was experienced at 28 cm H2O (15-50 cm H2O) distension pressure, which was close to the threshold for maximal rectal contraction, also coinciding with the appearance of the external anal sphincter reflex. The interindividual variation of rectal volume on distension with defined pressures varied widely, indicating a considerable variation of rectal compliance in normal man. No correlation was found between rectal volume and sex or anthropometric variables. The relative variations in pressure thresholds for eliciting rectal sensation and rectoanal reflexes were less than the corresponding threshold volumes. It was concluded that the dynamic rectal response to distension reflects a well graded reflex adjustment ideal for a reservoir. PMID:2714682

  10. Patterns of metastasis in colon and rectal cancer

    PubMed Central

    Riihimäki, Matias; Hemminki, Akseli; Sundquist, Jan; Hemminki, Kari

    2016-01-01

    Investigating epidemiology of metastatic colon and rectal cancer is challenging, because cancer registries seldom record metastatic sites. We used a population based approach to assess metastatic spread in colon and rectal cancers. 49,096 patients with colorectal cancer were identified from the nationwide Swedish Cancer Registry. Metastatic sites were identified from the National Patient Register and Cause of Death Register. Rectal cancer more frequently metastasized into thoracic organs (OR = 2.4) and the nervous system (1.5) and less frequently within the peritoneum (0.3). Mucinous and signet ring adenocarcinomas more frequently metastasized within the peritoneum compared with generic adenocarcinoma (3.8 [colon]/3.2 [rectum]), and less frequently into the liver (0.5/0.6). Lung metastases occurred frequently together with nervous system metastases, whereas peritoneal metastases were often listed with ovarian and pleural metastases. Thoracic metastases are almost as common as liver metastases in rectal cancer patients with a low stage at diagnosis. In colorectal cancer patients with solitary metastases the survival differed between 5 and 19 months depending on T or N stage. Metastatic patterns differ notably between colon and rectal cancers. This knowledge should help clinicians to identify patients in need for extra surveillance and gives insight to further studies on the mechanisms of metastasis. PMID:27416752

  11. Rectal Cancer Magnetic Resonance Imaging: Imaging Beyond Morphology.

    PubMed

    Prezzi, D; Goh, V

    2016-02-01

    Magnetic resonance imaging (MRI) has in recent years progressively established itself as one of the most valuable modalities for the diagnosis, staging and response assessment of rectal cancer and its use has largely focused on accurate morphological assessment. The potential of MRI, however, extends beyond detailed anatomical depiction: aspects of tissue physiology, such as perfusion, oxygenation and water molecule diffusivity, can be assessed indirectly. Functional MRI is rapidly evolving as a promising non-invasive assessment tool for tumour phenotyping and assessment of response to new therapeutic agents. In spite of promising experimental data, the evidence base for the application of functional MRI techniques in rectal cancer remains modest, reflecting the relatively poor agreement on technical protocols, image processing techniques and quantitative methodology to date, hampering routine integration into clinical management. This overview outlines the established strengths and the critical limitations of anatomical MRI in rectal cancer; it then introduces some of the functional MRI techniques and quantitative analysis methods that are currently available, describing their applicability in rectal cancer and reviewing the relevant literature; finally, it introduces the concept of a multi-parametric quantitative approach to rectal cancer.

  12. Lamellipodin-Deficient Mice: A Model of Rectal Carcinoma

    PubMed Central

    Miller, Cassandra L.; Muthupalani, Sureshkumar; Shen, Zeli; Drees, Frauke; Ge, Zhongming; Feng, Yan; Chen, Xiaowei; Gong, Guanyu; Nagar, Karan K.; Wang, Timothy C.; Gertler, Frank B.; Fox, James G.

    2016-01-01

    During a survey of clinical rectal prolapse (RP) cases in the mouse population at MIT animal research facilities, a high incidence of RP in the lamellipodin knock-out strain, C57BL/6-Raph1tm1Fbg (Lpd-/-) was documented. Upon further investigation, the Lpd-/- colony was found to be infected with multiple endemic enterohepatic Helicobacter species (EHS). Lpd-/- mice, a transgenic mouse strain produced at MIT, have not previously shown a distinct immune phenotype and are not highly susceptible to other opportunistic infections. Predominantly male Lpd-/- mice with RP exhibited lesions consistent with invasive rectal carcinoma concomitant to clinically evident RP. Multiple inflammatory cytokines, CD11b+Gr1+ myeloid-derived suppressor cell (MDSC) populations, and epithelial cells positive for a DNA damage biomarker, H2AX, were elevated in affected tissue, supporting their role in the neoplastic process. An evaluation of Lpd-/- mice with RP compared to EHS-infected, but clinically normal (CN) Lpd-/- animals indicated that all of these mice exhibit some degree of lower bowel inflammation; however, mice with prolapses had significantly higher degree of focal lesions at the colo-rectal junction. When Helicobacter spp. infections were eliminated in Lpd-/- mice by embryo transfer rederivation, the disease phenotype was abrogated, implicating EHS as a contributing factor in the development of rectal carcinoma. Here we describe lesions in Lpd-/- male mice consistent with a focal inflammation-induced neoplastic transformation and propose this strain as a mouse model of rectal carcinoma. PMID:27045955

  13. Rectal Cancer Magnetic Resonance Imaging: Imaging Beyond Morphology.

    PubMed

    Prezzi, D; Goh, V

    2016-02-01

    Magnetic resonance imaging (MRI) has in recent years progressively established itself as one of the most valuable modalities for the diagnosis, staging and response assessment of rectal cancer and its use has largely focused on accurate morphological assessment. The potential of MRI, however, extends beyond detailed anatomical depiction: aspects of tissue physiology, such as perfusion, oxygenation and water molecule diffusivity, can be assessed indirectly. Functional MRI is rapidly evolving as a promising non-invasive assessment tool for tumour phenotyping and assessment of response to new therapeutic agents. In spite of promising experimental data, the evidence base for the application of functional MRI techniques in rectal cancer remains modest, reflecting the relatively poor agreement on technical protocols, image processing techniques and quantitative methodology to date, hampering routine integration into clinical management. This overview outlines the established strengths and the critical limitations of anatomical MRI in rectal cancer; it then introduces some of the functional MRI techniques and quantitative analysis methods that are currently available, describing their applicability in rectal cancer and reviewing the relevant literature; finally, it introduces the concept of a multi-parametric quantitative approach to rectal cancer. PMID:26586163

  14. Voiding Dysfunction after Total Mesorectal Excision in Rectal Cancer

    PubMed Central

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

    2011-01-01

    Purpose The aim of this study was to assess the voiding dysfunction after rectal cancer surgery with total mesorectal excision (TME). Methods This was part of a prospective study done in the rectal cancer patients who underwent surgery with TME between November 2006 and June 2008. Consecutive uroflowmetry, post-voided residual volume, and a voiding questionnaire were performed at preoperatively and postoperatively. Results A total of 50 patients were recruited in this study, including 28 male and 22 female. In the comparison of the preoperative data with the postoperative 3-month data, a significant decrease in mean maximal flow rate, voided volume, and post-voided residual volume were found. In the comparison with the postoperative 6-month data, however only the maximal flow rate was decreased with statistical significance (P=0.02). In the comparison between surgical methods, abdominoperineal resection patients showed delayed recovery of maximal flow rate, voided volume, and post-voided residual volume. There was no significant difference in uroflowmetry parameters with advances in rectal cancer stage. Conclusions Voiding dysfunction is common after rectal cancer surgery but can be recovered in 6 months after surgery or earlier. Abdominoperineal resection was shown to be an unfavorable factor for postoperative voiding. Larger prospective study is needed to determine the long-term effect of rectal cancer surgery in relation to male and female baseline voiding condition. PMID:22087426

  15. Sexual Function in Males After Radiotherapy for Rectal Cancer

    SciTech Connect

    Bruheim, Kjersti; Guren, Marianne G.; Dahl, Alv A.; Skovlund, Eva; Balteskard, Lise; Carlsen, Erik; Fossa, Sophie D.; Tveit, Kjell Magne

    2010-03-15

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

  16. Contrast associated nephropathy in the elderly.

    PubMed

    Carrillo-Alvira, Félix; Rivera-Bermúdez, Carlos G; Jiménez-Velázquez, Ivonne Z; Ramos-Romey, Cristina; González-Concepción, Juan J

    2008-01-01

    Contrast medium studies have become an important tool for management and diagnosis in many medical specialties. As we age, the need for such studies increase in presence of multiple comorbidities as coronary artery disease and diabetes mellitus. Nephropathy induced by iodine contrast medium is an important complication of radiological procedures, most common in the aged, and a potentially preventable one. For this reason, the understanding and prevention of contrast associated nephropathy is of prime importance to prevent morbidity and mortality in the geriatric population.

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

    ClinicalTrials.gov

    2015-09-10

    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

  18. [Indications for radiotherapy of rectal cancer].

    PubMed

    Winkler, R; Franke, H D; Dörner, A

    1990-01-01

    Surgery and radiotherapy complete each other in local control of suffering from rectal carcinoma. A radiotherapeutic effect on tumor is secured often. The adjuvant radiotherapy is the most interesting indication, though the most controversial as present too. Analysing all data and with experiences of an own irradiation study we have not any doubt that the indication is qualified for a combined therapy, if the therapeutic aim with priority is to prevent a local relapse as the most frequent and complained of form of therapeutic failure. In this problem, radical irradiation forms, as pre- and accumulating irradiation (sandwich-technique) and after-irradiation, render superior to an exclusive pre irradiation. In result of this study we practise a preirradiation of 25 Gy with immediately following operation and an accumulating irradiation to 50 Gy in proved high-risk-stage (T greater than or equal to 3 NoMo,Tx N1-3 Mo). If there is a primary local incurability by tumor invasion into the neighbourhood a pre-irradiation is done with 50 Gy and following explorative laparatomy within 4-6 weeks. Nearly 60% of these tumors become operable after that. Likewise we practise in unirradiated patients with locoregional tumor recurrence. Also here the extirpation quota of patients with general or systemic incurability, that a stoma construction is required in, we carry out a transanal tumor reduction and irradiate with 50 Gy after that. Especially this therapeutic principle has proved its worth in patients that are past eighty. Here with acceptable living quality and avoiding a stoma construction a survival can be reached that corresponds to the statistical survival of this stage of life. PMID:2101452

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

    PubMed

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

    2009-09-01

    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

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

    NASA Astrophysics Data System (ADS)

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

    2009-09-01

    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

  1. [Role of neoadjuvant radiotherapy for rectal cancer : Is MRI-based selection a future model?].

    PubMed

    Kulu, Y; Hackert, T; Debus, J; Weber, M-A; Büchler, M W; Ulrich, A

    2016-07-01

    Following the introduction of total mesorectal excision (TME) in the curative treatment of rectal cancer, the role of neoadjuvant therapy has evolved. By improving the surgical technique the local recurrence rate could be reduced by TME surgery alone to below 8 %. Even if local control was further improved by additional preoperative irradiation this did not lead to a general survival benefit. Guidelines advocate that all patients in UICC stage II and III should be pretreated; however, the stage-based indications for neoadjuvant therapy have limitations. This is mainly attributable to the facts that patients with T3 tumors comprise a very heterogeneous prognostic group and preoperative lymph node diagnostics lack accuracy. In contrast, in recent years the circumferential resection margin (CRM) has become an important prognostic parameter. Patients with tumors that are very close to or infiltrate the pelvic fascia (positive CRM) have a higher rate of local recurrence and poorer survival. With high-resolution pelvic magnetic resonance imaging (MRI) examination in patients with rectal cancer, the preoperative CRM can be determined with a high sensitivity and specificity. Improved T staging and better prediction of the resection margins by pelvic MRI potentially facilitate the selection of patients for study-based treatment strategies omitting neoadjuvant radiotherapy. PMID:27339645

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

    SciTech Connect

    Chong, Irene; Hawkins, Maria; Hansen, Vibeke; Thomas, Karen; McNair, Helen; O'Neill, Brian; Aitken, Alexandra; Tait, Diana

    2011-11-15

    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.

  3. Smooth muscle pseudotumours: a potentially confusing artefact of rectal biopsy.

    PubMed Central

    Dankwa, E K; Davies, J D

    1988-01-01

    An artefactual smooth muscle lesion was found in seven of 500 consecutive rectal biopsy specimens. The lesions had the deceptive appearance of a genuine tumour although none of the patients with the lesion had presented with a rectal mucosal swelling. The morphology of the lesion and its poor reproducibility under experimental conditions suggested that it was an artefact of the biopsy procedure: it was easily reproduced in resected specimens of large bowel using punch or basket forceps but not when using flat forceps. The presence of the lesion seems to depend on the type of forceps used rather than on differences in deployment and seems to be caused by avulsion of the superficial part of the muscularis propria and its incorporation into the tissues included in rectal biopsy specimens. Images Fig 2 Fig 3 Fig 1 Fig 4 PMID:3045159

  4. Approach to concomitant rectal and uterine prolapse: case report.

    PubMed

    Karateke, Ateş; Batu, Pınar; Asoğlu, Mehmet Reşit; Selçuk, Selçuk; Cam, Cetin

    2012-01-01

    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.

  5. Concurrent Occurrence of Uterovaginal and Rectal Prolapse: An Uncommon Presentation

    PubMed Central

    Umeh, UA; Ugwu, EO; Obi, SN; Nnagbo, JE

    2015-01-01

    Concomitant uterovaginal and rectal prolapse is an uncommon occurrence. Where laparoscopic equipment and skills are lacking, sacrohysteropexy with synthetic mesh and rectopexy can be accomplished by laparotomy, especially in women who desire to retain their uterus for either biological or psychological reasons. A 40-year-old primipara with a history of concomitant mass protruding from both her vagina and anus following a spontaneous unsupervised delivery at home. Following pelvic examination, a diagnosis of uterovaginal and rectal prolapse was made. In view of her parity and desire to retain her reproductive function, she was offered abdominal sacrohysteropexy with synthetic mesh and rectopexy with satisfactory postoperative recovery. In resource-limited settings with concomitant uterine and rectal prolapse, open abdominal sacrohysteropexy with synthetic mesh and rectopexy is an effective and safe alternative to Manchester operation in the absence of laparoscopic equipment and skills. PMID:26500795

  6. Emerging and Evolving Technology in Colon and Rectal Surgery

    PubMed Central

    Bosio, Raul M.; Pigazzi, Alessio

    2015-01-01

    Minimally invasive surgery has changed the way we manage many colon and rectal pathologies. Multiple techniques, from straight laparoscopic procedures, to hand-assisted and single-port techniques are available, requiring surgeons to go through various learning curves. Robotic surgery is a relatively novel technique in general surgery which appears to hold most promise for rectal resection. Laparoscopic rectal procedures are difficult, and even in experienced hands, conversion rates are around 17%. Robotic surgery may be a point of difference in these cases, despite a long learning curve and higher costs. This article will describe the role of robotics in colorectal surgery. Room set up, port placement, and docking strategies will be described for common procedures, with emphasis on a hybrid robotic low anterior resection. PMID:26491407

  7. A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

    PubMed Central

    Li, Yi; Wang, Ji; Ma, Xiaowei; Tan, Li; Yan, Yanli; Xue, Chaofan; Hui, Beina; Liu, Rui; Ma, Hailin; Ren, Juan

    2016-01-01

    Neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer. Neoadjuvant chemoradiotherapy not only can reduce tumor size and recurrence, but also increase the tumor resection rate and anus retention rate with very slight side effect. Comparing with preoperative chemotherapy, preoperative chemoradiotherapy can further reduce the local recurrence rate and downstage. Middle and low rectal cancers can benefit more from neoadjuvant chemradiotherapy than high rectal cancer. It needs to refine the selection of appropriate patients and irradiation modes for neoadjuvant chemoradiotherapy. Different therapeutic reactions to neoadjuvant chemoradiotherapy affect the type of surgical techniques, hence calling for the need of much attention. Furthermore, many problems such as accurate staging before surgery, selection of suitable neoadjuvant chemoradiotherapy method, and sensitivity prediction to preoperative radiotherapy need to be well settled. PMID:27489505

  8. Validation of nonrigid registration for multi-tracer PET-CT treatment planning in rectal cancer radiotherapy

    NASA Astrophysics Data System (ADS)

    Slagmolen, Pieter; Roels, Sarah; Loeckx, Dirk; Haustermans, Karin; Maes, Frederik

    2009-02-01

    The goal of radiotherapy is to deliver maximal dose to the tumor and minimal dose to the surrounding tissue. This requires accurate target definition. In sites were the tumor is difficult to see on the CT images, such as for rectal cancer, PET-CT imaging can be used to better define the target. If the information from multiple PETCT images with different tracers needs to be combined, a nonrigid registration is indispensable to compensate for rectal tissue deformations. Such registration is complicated by the presence of different volumes of bowel gas in the images to be registered. In this paper, we evaluate the performance of different nonrigid registration approaches by looking at the overlap of manually delineated rectum contours after registration. Using a B-spline transformation model, the results for two similarity measures, sum of squared differences and mutual information, either calculated over the entire image or on a region of interest are compared. Finally, we also assess the effect of the registration direction. We show that the combination of MI with a region of interest is best able to cope with residual rectal contrast and differences in bowel filling. We also show that for optimal performance the registration direction should be chosen depending on the difference in bowel filling in the images to be registered.

  9. Short term outcome of laparoscopic ventral rectopexy for rectal prolapse

    PubMed Central

    Naeem, Muhammad; Anwer, Mariyah; Qureshi, Muhammad Shamim

    2016-01-01

    Objective: To find out the short term outcomes of effectiveness and safety of laparoscopic ventral rectopexy for rectal prolapse. Methods: It was a descriptive case series study of 31 consecutive patients of rectal prolapse in Colorectal division of Ward 2, Department of General surgery, Jinnah Post Graduate Medical Center, Karachi, from November 2009 to November 2015. These patients were admitted through outpatient department with complains of something coming out of anus, constipation and per rectal bleeding. All patients were clinically examined and baseline investigations were done. All patients underwent laparoscopic repair with ventral mesh placement on rectum. Results: Among 31 patients, mean age was 45 years range (20 - 72). While females were 14(45%) and males 17(55%). We observed variety of presentations, including solitary rectal ulcers (n=4) and rectocele (n=3) but full thickness rectal prolapse was predominant(n=24). All patients had laparoscopic repair with mesh placement. Average hospital stay was three days. Out of 31 patients, there was one (3.2%) recurrence. Port site minor infection in 3(9.7%) patients, while conversion to open approach was done in two (6.4%), postoperative ileus observed in two (6.4%) patients. one(3.2%) patient developed intractable back pain and mesh was removed six weeks after the operation. one(4.8%) patient complained of abdominal pain off and on postoperatively. No patient developed denovo or worsening constipation while constipation was improved in 21 patients (67%). Sexual dysfunction such as dysperunia in females and impotence in males was not detected in follow up. Conclusions: This study provides the limited evidence that nerve sparing laparoscopic ventral rectopexy is safe and effective treatment of external and symptomatic internal rectal prolapse. It has better cosmetic and functional outcome as advantages of minimal access and comparable recurrence rate.

  10. Human Collagen Injections to Reduce Rectal Dose During Radiotherapy

    SciTech Connect

    Noyes, William R.; Hosford, Charles C.; Schultz, Steven E.

    2012-04-01

    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.

  11. Short term outcome of laparoscopic ventral rectopexy for rectal prolapse

    PubMed Central

    Naeem, Muhammad; Anwer, Mariyah; Qureshi, Muhammad Shamim

    2016-01-01

    Objective: To find out the short term outcomes of effectiveness and safety of laparoscopic ventral rectopexy for rectal prolapse. Methods: It was a descriptive case series study of 31 consecutive patients of rectal prolapse in Colorectal division of Ward 2, Department of General surgery, Jinnah Post Graduate Medical Center, Karachi, from November 2009 to November 2015. These patients were admitted through outpatient department with complains of something coming out of anus, constipation and per rectal bleeding. All patients were clinically examined and baseline investigations were done. All patients underwent laparoscopic repair with ventral mesh placement on rectum. Results: Among 31 patients, mean age was 45 years range (20 - 72). While females were 14(45%) and males 17(55%). We observed variety of presentations, including solitary rectal ulcers (n=4) and rectocele (n=3) but full thickness rectal prolapse was predominant(n=24). All patients had laparoscopic repair with mesh placement. Average hospital stay was three days. Out of 31 patients, there was one (3.2%) recurrence. Port site minor infection in 3(9.7%) patients, while conversion to open approach was done in two (6.4%), postoperative ileus observed in two (6.4%) patients. one(3.2%) patient developed intractable back pain and mesh was removed six weeks after the operation. one(4.8%) patient complained of abdominal pain off and on postoperatively. No patient developed denovo or worsening constipation while constipation was improved in 21 patients (67%). Sexual dysfunction such as dysperunia in females and impotence in males was not detected in follow up. Conclusions: This study provides the limited evidence that nerve sparing laparoscopic ventral rectopexy is safe and effective treatment of external and symptomatic internal rectal prolapse. It has better cosmetic and functional outcome as advantages of minimal access and comparable recurrence rate. PMID:27648031

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

    SciTech Connect

    Wang Zhou; Jaggernauth, Wainwright; Malhotra, Harish K.; Podgorsak, Matthew B.

    2010-01-01

    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.

  13. Rectal cancer with synchronous liver metastases: Do we have a clear direction?

    PubMed

    Pathak, S; Nunes, Q M; Daniels, I R; Smart, N J; Poston, G J; Påhlman, L

    2015-12-01

    Rectal cancer is a common entity and often presents with synchronous liver metastases. There are discrepancies in management guidelines throughout the world regarding the treatment of advanced rectal cancer, which are further compounded when it presents with synchronous liver metastases. The following article examines the evidence regarding treatment options for patients with synchronous rectal liver metastases and suggests potential treatment algorithms.

  14. Robotic Surgery for Rectal Cancer: An Update in 2015

    PubMed Central

    Kwak, Jung Myun; Kim, Seon Hahn

    2016-01-01

    During the last decade, robotic surgery for rectal cancer has rapidly gained acceptance among colorectal surgeons worldwide, with well-established safety and feasibility. The lower conversion rate and better surgical specimen quality of robotic compared with laparoscopic surgery potentially improves survival. Earlier recovery of voiding and sexual function after robotic total mesorectal excision is another favorable outcome. Long-term survival data are sparse with no evidence that robotic surgery offers major benefits in oncological outcomes. Although initial reports are promising, more rigorous scientific evaluation in multicenter, randomized clinical trials should be performed to definitely determine the advantages of robotic rectal cancer surgery. PMID:26875201

  15. Rectal foreign bodies: imaging assessment and medicolegal aspects.

    PubMed

    Pinto, Antonio; Miele, Vittorio; Pinto, Fabio; Mizio, Veronica Di; Panico, Maria Rita; Muzj, Carlo; Romano, Luigia

    2015-02-01

    The amount of patients presenting at the emergency hospitals with retained rectal foreign bodies appears recently to have increased. Foreign objects retained in the rectum may result from direct introduction through the anus (more common) or from ingestion. Affected individuals often make ineffective attempts to extract the object themselves, resulting in additional delay of medical care and potentially increasing the risk of complications. The goals of radiological patient assessment are to identify the type of object retained, its location, and the presence of associated complications. Plain film radiographs still play an important role in the assessment of retained rectal foreign bodies. PMID:25639182

  16. Microstructure imaging of human rectal mucosa using multiphoton microscopy

    NASA Astrophysics Data System (ADS)

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

    2011-01-01

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

  17. [The transphincteric approach excision of rectal villous adenomas].

    PubMed

    Qiu, H; Tang, W; Zhu, Y

    1995-03-01

    Twenty-four patients with rectal villous adenomas were operated on which posterior transphincteric approach. They had benign villous adenona in (13 patients), villous adenomas showing atypia (2), and villous adenomas developed malignancy (9). All the patients gained excellent results, except one with wounded infection after operation. No patient died at operation. No patient developed rectal fistula and incontinence of feces. The different methods of operation with excised villous adenoma of the rectum were discussed and compared. We conclude that the posterior transsphincteric approach is better than others. PMID:7555388

  18. Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier’s procedure)

    PubMed Central

    Sipahi, Mesut; Arslan, Ergin; Börekçi, Hasan; Aytekin, Faruk Önder; Külah, Bahadır; Banlı, Oktay

    2016-01-01

    Perineal procedures have higher recurrence and lower mortality rates than abdominal alternatives for the treatment of rectal prolapse. Presence of incarceration and strangulation also influences treatment choice. Perineal rectosigmoidectomy is one of the treatment options in patients with incarceration and strangulation, with low mortality and acceptable recurrence rates. This operation can be performed especially to avoid general anesthesia in old patients with co-morbidities. We aimed to present perineal rectosigmoidectomy and diverting loop colostomy in a patient with neurological disability due to spinal trauma and incarcerated rectal prolapse. PMID:27528816

  19. Solitary rectal ulcer syndrome in children: A literature review

    PubMed Central

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

    2012-01-01

    Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less in children. It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding, copious mucus discharge, feeling of incomplete defecation, and rarely rectal prolapse. SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings. The current treatments are suboptimal, and despite correct diagnosis, outcomes can be unsatisfactory. Some treatment protocols for SRUS include conservative management such as family reassurance, regulation of toilet habits, avoidance of straining, encouragement of a high-fiber diet, topical treatments with salicylate, sulfasalazine, steroids and sucralfate, and surgery. In children, SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases, however, it is being reported more than in the past. This condition in children is benign; however, morbidity is an important problem as reflected by persistence of symptoms, especially rectal bleeding. In this review, we discuss current diagnosis and treatment for SRUS. PMID:23236227

  20. Surgical Correction of Rectal Prolapse in Laboratory Mice (Mus musculus).

    PubMed

    Uchihashi, Mayu; Wilding, Laura A; Nowland, Megan H

    2015-07-01

    Rectal prolapse is a common clinical problem in laboratory mice. This condition may occur spontaneously, develop after genetic manipulations, result from infections with pathogens such as Citrobacter species, or arise secondary to experimental design such as colitis models. The current standard of care at our institution is limited to monitoring mice until tissue becomes ulcerated or necrotic; this strategy often leads to premature euthanasia of valuable animals prior to the study endpoint. Surgical correction of rectal prolapse is performed routinely and with minimal complications in larger species by using manual reduction with placement of a pursestring suture. In this report, we investigated whether the use of a pursestring suture was an effective treatment for mice with rectal prolapse. The procedure includes anesthetizing mice with isoflurane, manually reducing prolapsed tissue, and placing a pursestring suture of 4-0 polydioxanone. We have performed this procedure successfully in 12 mice. Complications included self-trauma, fecal impaction due to lack of defecation, and mutilation of the surgical site by cage mates. Singly housing mice for 7 d postoperatively, applying multimodal analgesia, and releasing the pursestring when indicated eliminated these complications. The surgical repair of rectal prolapses in mice is a minimally invasive procedure that resolves the clinical symptoms of affected animals and reduces the number of mice that are euthanized prematurely prior to the study endpoint.

  1. Ruptured rectal duplication with urogenital abnormality: Unusual presentation

    PubMed Central

    Solanki, Shailesh; Babu, M Narendra; Jadhav, Vinay; Shankar, Gowri; Santhanakrishnan, Ramesh

    2015-01-01

    Rectal duplication (RD) accounts for 5% of alimentary tract duplication. A varied presentation and associated anomalies have been described in the literature. Antenatal rupture of the RD is very rare. We present an unusual case of a ruptured RD associated with urogenital abnormalities in newborn male. We are discussing diagnosis, embryology, management and literature review of ruptured RD. PMID:25552833

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

    PubMed Central

    2011-01-01

    We present a case that is occasionally seen within emergency departments, namely a rectal foreign body. After presentation of the case, a discussion concerning this entity is given, with practical information on necessity of an accurate and thorough history and removal of the object for clinicians. PMID:22152071

  3. The flexible implant in treatment of rectal carcinomas

    SciTech Connect

    Vider, M.; Lim, N.; Ditlow, R. Jr.; Au, F.; Gennaro, A.R.

    1982-07-01

    A modified technique for removable afterloading Iridium-192 implantation is described. Under local or general anesthesia, a series of flexible tygone tubes are introduced into all the tumor area in the rectum. This technique is especially suitable for palliation in high-risk, elderly patients. No rectal tube is necessary in this technique.

  4. Rectal angiolipoma: a case report and review of literature.

    PubMed

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

    2007-03-01

    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.

  5. Genomic evaluation of rectal temperature in Holstein cattle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Heat stress negatively impacts the production, fertility, and health of dairy cattle. Rectal temperature (RT) has unfavorable genetic correlations with production, longevity, economic merit, and somatic cell score in Holstein cows. The objectives of the current study were to perform a genome-wide as...

  6. Influence of Rectal Decompression on Abdominal Symptoms and Anorectal Physiology following Colonoscopy in Healthy Adults

    PubMed Central

    Yi, Chih-Hsun; Liu, Tso-Tsai; Lei, Wei-Yi; Hung, Jui-Sheng

    2016-01-01

    Background. Postcolonoscopy abdominal discomfort and bloating are common. The aim of this study was to evaluate whether rectal decompression improved distension-induced abdominal symptoms and influenced anorectal physiology. Methods. In 15 healthy subjects, rectal distension was achieved by direct air inflation into the rectum by colonoscopy. Placement of rectal and sham tube was then performed in each subject on a separate occasion. The anorectal parameters and distension-induced abdominal symptoms were recorded. Results. Anorectal parameters were similar between placements of rectal tube and sham tube except for greater rectal compliance with rectal tube than with sham tube (P < 0.05). Abdominal pain and bloating were significantly reduced by rectal tube and sham tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05). After placement of rectal tube, abdominal pain at 3 minutes correlated positively with first sensation (r = 0.53, P = 0.04), and bloating at 3 minutes also correlated positively with urge sensation (r = 0.55, P = 0.03). Conclusions. Rectal decompression with either rectal or sham tube improved distension-induced abdominal symptoms. Our study indicates that the mechanisms that improved abdominal symptoms by rectal decompression might be mediated by a central pathway instead of a peripheral mechanism.

  7. The Expression Level and Prognostic Value of Y-Box Binding Protein-1 in Rectal Cancer

    PubMed Central

    Zhang, Yu; Zhao, Ping-Wu; Feng, Gang; Xie, Gang; Wang, An-Qun; Yang, Yong-Hong; Wang, Dong; Du, Xiao-Bo

    2015-01-01

    The aims of this study were to simultaneously evaluate the expression of Y-box binding protein-1 (YB-1) in non-neoplastic rectal tissue and rectal cancer tissue, and to collect clinical follow-up data for individual patients. Additionally, we aimed to investigate the developmental functions and prognostic value of YB-1 in rectal cancer. We performed immunohistochemical studies to examine YB-1 expression in tissue samples from 80 patients with rectal cancer, 30 patients with rectal tubular adenoma, and 30 patients with rectitis. The mean YB-1 histological scores for rectal cancer, rectal tubular adenoma, and rectitis tissue specimens were 205.5, 164.3, and 137.7, respectively. Shorter disease-free and overall survival times were found in patients with rectal cancer who had higher YB-1 expression than in those with lower expression (38.2 months vs. 52.4 months, P = 0.013; and 44.4 months vs. 57.3 months, P = 0.008, respectively). Our results indicate that YB-1 expression is higher in rectal cancer tissue than in rectal tubular adenoma and rectitis tissue and that it may be an independent prognostic factor for rectal cancer. PMID:25790262

  8. Influence of Rectal Decompression on Abdominal Symptoms and Anorectal Physiology following Colonoscopy in Healthy Adults

    PubMed Central

    Yi, Chih-Hsun; Liu, Tso-Tsai; Lei, Wei-Yi; Hung, Jui-Sheng

    2016-01-01

    Background. Postcolonoscopy abdominal discomfort and bloating are common. The aim of this study was to evaluate whether rectal decompression improved distension-induced abdominal symptoms and influenced anorectal physiology. Methods. In 15 healthy subjects, rectal distension was achieved by direct air inflation into the rectum by colonoscopy. Placement of rectal and sham tube was then performed in each subject on a separate occasion. The anorectal parameters and distension-induced abdominal symptoms were recorded. Results. Anorectal parameters were similar between placements of rectal tube and sham tube except for greater rectal compliance with rectal tube than with sham tube (P < 0.05). Abdominal pain and bloating were significantly reduced by rectal tube and sham tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05). After placement of rectal tube, abdominal pain at 3 minutes correlated positively with first sensation (r = 0.53, P = 0.04), and bloating at 3 minutes also correlated positively with urge sensation (r = 0.55, P = 0.03). Conclusions. Rectal decompression with either rectal or sham tube improved distension-induced abdominal symptoms. Our study indicates that the mechanisms that improved abdominal symptoms by rectal decompression might be mediated by a central pathway instead of a peripheral mechanism. PMID:27651788

  9. Pre-slaughter rectal temperature as an indicator of pork meat quality.

    PubMed

    Vermeulen, L; Van de Perre, V; Permentier, L; De Bie, S; Geers, R

    2015-07-01

    This study investigates whether rectal temperature of pigs, prior to slaughter, can give an indication of the risk of developing pork with PSE characteristics. A total of 1203 pigs were examined, measuring the rectal temperature just before stunning, of which 794 rectal temperatures were measured immediately after stunning. pH30LT (M. Longissimus thoracis) and temperature of the ham (Temp30Ham) were collected from about 530 carcasses, 30 min after sticking. The results present a significant positive linear correlation between rectal temperature just before and after slaughter, and Temp30Ham. Moreover, pH30LT is negatively correlated with rectal temperature and Temp30Ham. Finally, a linear mixed model for pH30LT was established with the rectal temperature of the pigs just before stunning and the lairage time. This model defines that measuring rectal temperature of pigs just before slaughter allows discovery of pork with PSE traits, taking into account pre-slaughter conditions.

  10. Gastric heterotopia of rectum in a child: a mimicker of solitary rectal ulcer syndrome.

    PubMed

    Al-Hussaini, Abdulrahman; Lone, Khurram; Al-Sofyani, Medhat; El Bagir, Asim

    2014-01-01

    Bleeding per rectum is an uncommon presentation in pediatric patients. Heterotopic gastric mucosa in the rectum is a rare cause of rectal bleeding. Here, we report a 3-year-old child with a bleeding rectal ulcer that was initially diagnosed and managed as a solitary rectal ulcer syndrome. After 1 month, the patient persisted to have intermittent rectal bleed and severe anal pain. Repeat colonoscopy showed the worsening of the rectal ulcer in size. Pediatric surgeon excised the ulcer, and histopathological examination revealed a gastric fundic-type mucosa consistent with the diagnosis of gastric heterotopia of the rectum. Over the following 18 months, our patient had experienced no rectal bleeding and remained entirely asymptomatic. In conclusion, heterotopic gastric mucosa of the rectum should be considered in the differential diagnosis of a bleeding rectal ulcer.

  11. Factors affecting rectal temperature measurement using commonly available digital thermometers.

    PubMed

    Naylor, Jonathan M; Streeter, Renee M; Torgerson, Paul

    2012-02-01

    Rectal temperature measurement is an essential part of physical examination of cattle and some physiological experiments. Modern digital thermometers are often used to measure rectal temperatures by students; this study describes their reliability and appropriate use. Students measured rectal temperature on 53 occasions using their personal digital thermometer and techniques gained from previous instruction, rectal temperature was also measured by an experienced person using a Cornell mercury thermometer completely inserted in the rectum. Cornell mercury thermometers values were 38.95±0.05°C (mean±1 SE, n=53). Student rectal temperature measurements using their initial technique were nearly 0.5°C lower, 38.46±0.07°C. After receiving instruction to insert the digital thermometer to the window, student obtained values were 38.77±0.06°C; these are significantly higher than with the student's initial technique and closer to those obtained with a Cornell thermometer. In a series of 53 water bath tests, student owned thermometers recorded similar mean values to those of a traceable (reference) digital thermometer, Cornell mercury thermometer readings were 0.2°C higher. 10 individual digital thermometers were repeatedly tested against a traceable thermometer in a water bath, one was inaccurate. In a separate experiment a trained clinician tested the effect of angle of insertion of a digital thermometer on temperature readings and the affect was <0.1°C. We conclude that accurate temperature measurements using digital thermometers are only likely if the thermometer is inserted to the beginning of the window and the thermometer's accuracy is checked periodically.

  12. [Contrast media in MR mammography].

    PubMed

    Tontsch, P; Bauer, M; Birmelin, G; von Landenberg, E; Moeller, T B; Raible, G

    1997-03-01

    A standardized relationship between concentration of contrast media and normalized signal intensity should be the basis of a diagnostic evaluation of MR-mammography at different sites and with different sequences. In this work we compared the dynamic range of the MR-compatible contrast medium Magnevist at different sequences and machines. For this purpose we made measurements with a phantom, consisting of MR-compatible glass tubes filled with contrast medium of different concentrations. The glass tubes were placed in a water bath. All measurements were made with breast coils. The signal intensity of the glass tubes was normalized to the signal intensity of the native probe (water = 1). These normalized dynamic curves were compared with each other in order to find, for the different machines, the sequence which is nearest to a defined "Standard-Curve". As this task proved not possible for all machines, we measured how the dynamic curves of the different machines related to the "Standard-Curve". For all sequences we made also measurements with a female student to assure the quality of the pictures. Thus the participating radiologists can now compare their dynamic measurements of breast lesions with each other. PMID:9172669

  13. Apparatus for separating particles utilizing engineered acoustic contrast capture particles

    SciTech Connect

    Kaduchak, Gregory; Ward, Michael D

    2014-10-21

    An apparatus for separating particles from a medium includes a capillary defining a flow path therein that is in fluid communication with a medium source. The medium source includes engineered acoustic contrast capture particle having a predetermined acoustic contrast. The apparatus includes a vibration generator that is operable to produce at least one acoustic field within the flow path. The acoustic field produces a force potential minima for positive acoustic contrast particles and a force potential minima for negative acoustic contrast particles in the flow path and drives the engineered acoustic contrast capture particles to either the force potential minima for positive acoustic contrast particles or the force potential minima for negative acoustic contrast particles.

  14. Apparatus for separating particles utilizing engineered acoustic contrast capture particles

    SciTech Connect

    Kaduchak, Gregory; Ward, Michael D.

    2011-12-27

    An apparatus for separating particles from a medium includes a capillary defining a flow path therein that is in fluid communication with a medium source. The medium source includes engineered acoustic contrast capture particle having a predetermined acoustic contrast. The apparatus includes a vibration generator that is operable to produce at least one acoustic field within the flow path. The acoustic field produces a force potential minima for positive acoustic contrast particles and a force potential minima for negative acoustic contrast particles in the flow path and drives the engineered acoustic contrast capture particles to either the force potential minima for positive acoustic contrast particles or the force potential minima for negative acoustic contrast particles.

  15. Apparatus for separating particles utilizing engineered acoustic contrast capture particles

    DOEpatents

    Kaduchak, Gregory; Ward, Michael D

    2016-05-17

    An apparatus for separating particles from a medium includes a capillary defining a flow path therein that is in fluid communication with a medium source. The medium source includes engineered acoustic contrast capture particle having a predetermined acoustic contrast. The apparatus includes a vibration generator that is operable to produce at least one acoustic field within the flow path. The acoustic field produces a force potential minima for positive acoustic contrast particles and a force potential minima for negative acoustic contrast particles in the flow path and drives the engineered acoustic contrast capture particles to either the force potential minima for positive acoustic contrast particles or the force potential minima for negative acoustic contrast particles.

  16. The Prognostic Value of Circumferential Resection Margin Involvement in Patients with Extraperitoneal Rectal Cancer.

    PubMed

    Shin, Dong Woo; Shin, Jin Yong; Oh, Sung Jin; Park, Jong Kwon; Yu, Hyeon; Ahn, Min Sung; Bae, Ki Beom; Hong, Kwan Hee; Ji, Yong Il

    2016-04-01

    The prognostic influence of circumferential resection margin (CRM) status in extraperitoneal rectal cancer probably differs from that of intraperitoneal rectal cancer because of its different anatomical and biological behaviors. However, previous reports have not provided the data focused on extraperitoneal rectal cancer. Therefore, the aim of this study was to examine the prognostic significance of the CRM status in patients with extraperitoneal rectal cancer. From January 2005 to December 2008, 248 patients were treated for extraperitoneal rectal cancer and enrolled in a prospectively collected database. Extraperitoneal rectal cancer was defined based on tumors located below the anterior peritoneal reflection, as determined intraoperatively by a surgeon. Cox model was used for multivariate analysis to examine risk factors of recurrence and mortality in the 248 patients, and multivariate logistic regression analysis was performed to identify predictors of recurrence and mortality in 135 patients with T3 rectal cancer. CRM involvement for extraperitoneal rectal cancer was present in 29 (11.7%) of the 248 patients, and was the identified predictor of local recurrence, overall recurrence, and death by multivariate Cox analysis. In the 135 patients with T3 cancer, CRM involvement was found to be associated with higher probability of local recurrence and mortality. In extraperitoneal rectal cancer, CRM involvement is an independent risk factor of recurrence and survival. Based on the results of the present study, it seems that CRM involvement in extraperitoneal rectal cancer is considered an indicator for (neo)adjuvant therapy rather than conventional TN status.

  17. 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

    Shiraishi, Yutaka; Yorozu, Atsunori; Ohashi, Toshio; Toya, Kazuhito; Seki, Satoshi; Yoshida, Kayo; Kaneda, Tomoya; Saito, Shiro; Nishiyama, Toru; Hanada, Takashi; Shigematsu, Naoyuki

    2011-11-01

    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

  18. Balloon-Occluded Antegrade Transvenous Sclerotherapy to Treat Rectal Varices: A Direct Puncture Approach to the Superior Rectal Vein Through the Greater Sciatic Foramen Under CT Fluoroscopy Guidance

    SciTech Connect

    Ono, Yasuyuki Kariya, Shuji Nakatani, Miyuki Yoshida, Rie Kono, Yumiko Kan, Naoki Ueno, Yutaka Komemushi, Atsushi Tanigawa, Noboru

    2015-10-15

    Rectal varices occur in 44.5 % of patients with ectopic varices caused by portal hypertension, and 48.6 % of these patients are untreated and followed by observation. However, bleeding occurs in 38 % and shock leading to death in 5 % of such patients. Two patients, an 80-year-old woman undergoing treatment for primary biliary cirrhosis (Child-Pugh class A) and a 63-year-old man with class C hepatic cirrhosis (Child-Pugh class A), in whom balloon-occluded antegrade transvenous sclerotherapy was performed to treat rectal varices are reported. A catheter was inserted by directly puncturing the rectal vein percutaneously through the greater sciatic foramen under computed tomographic fluoroscopy guidance. In both cases, the rectal varices were successfully treated without any significant complications, with no bleeding from rectal varices after embolization.

  19. Anal encirclement with polypropylene mesh for rectal prolapse and incontinence.

    PubMed

    Sainio, A P; Halme, L E; Husa, A I

    1991-10-01

    Seventeen selected patients (mean age, 74 years)--14 with rectal prolapse and 3 with persisting anal incontinence after previous operations--underwent high anal encirclement with polypropylene mesh. There was no operative mortality. Prolapse recurred in 2 (15 percent) of the 13 patients followed up for 6 months or more (mean, 3.5 years). Three (27 percent) of the 11 patients with associated anal incontinence improved functionally, as did the three operated on for persisting incontinence, but only one patient regained normal continence. No breakage, cutting out, or infection related to the mesh was observed. Because of the risk of fecal impaction encountered in three of our patients, the procedure is not advocated for severely constipated patients. Despite the somewhat disappointing results regarding restoration of continence, we find this method useful in patients with rectal prolapse who are unfit for more extensive surgery, in controlling the prolapse to an acceptable degree. PMID:1914725

  20. Clinical results of abdominal rectopexy for rectal prolapse.

    PubMed

    Hiltunen, K M; Matikainen, M

    1991-01-01

    Abdominal Marlex-mesh rectopexy was used for surgical treatment of rectal prolapse in 54 consecutive patients. Anal incontinence was observed in 43 patients (80%) before surgical treatment. The degree of anal incontinence was more severe in women as compared with men. Operative treatment corrected the pathologic anatomy effectively as only one recurrent prolapse developed. At the follow-up examination three patients had symptomless anal mucosal prolapse during maximal straining. 75% of the incontinent patients regained continence for faeces and the rest had some improvement in continence. Seventeen patients (31%) had postoperative constipation, that required lactulose treatment. In conclusion, abdominal Marlex-mesh rectopexy can be recommended as safe and effective treatment for rectal prolapse, despite some patients developing constipation and some remaining incontinent. PMID:1759794

  1. Personalized surgery for rectal tumours: the patient's opinion counts.

    PubMed

    Audisio, R A; Filiberti, A; Geraghty, J G; Andreoni, B

    1997-01-01

    In recent times there have been many important changes in the surgical management of rectal cancer. The general thrust of these changes has been towards a less invasive approach with preservation of intestinal continuity and avoidance of the psychological sequelae of a stoma. It is also becoming increasingly apparent that profound sexual and autonomic dysfunction can be associated with abdominoperineal resection. This paper highlights these issues and the conflict between performing an adequate oncological procedure and reducing the incidence of postoperative psychological morbidity. It outlines the great changes there have been in surgical technique and their relevance to psychological problems after surgery for rectal cancer. The need for auditing psychological morbidity when assessing the outcome of surgical series is emphasised, as is the importance of involving the patient in the medical decision making.

  2. Solitary rectal ulcer syndrome: exploring possible management options.

    PubMed

    Bulut, Turker; Canbay, Emel; Yamaner, Sumer; Gulluoglu, Mine; Bugra, Dursun

    2011-01-01

    Solitary rectal ulcer syndrome (SRUS) is a rare condition with various causes that results in ischemic injury. The aim of this study was to assess the clinical findings, diagnosis, and outcomes of treatment in patients with SRUS. Between 1992 and 2006, a retrospective review was undertaken for all patients diagnosed with SRUS. Fifty-eight patients were diagnosed with SRUS. Among patients with paradoxic rectal spasm (PRS), lesions disappeared in 1 of 3 given applied biofeedback treatment, and in 2 of 4 injected with Botulinum toxin (Botox). Twenty-three patients underwent appropriate surgical treatment. Overall, postoperative improvement was seen in 18 patients (78.2%). In conclusion, every patient with SRUS must be assessed for causative disease. Treatment should include conservative approaches such as Botox injection; in patients with pelvic floor disorders, surgical treatment should be considered.

  3. Wild Banana Seed Phytobezoar Rectal Impaction Causing Intestinal Obstruction.

    PubMed

    Chai, Feng Yih; Heng, Sophia Si Ling; Asilah, Siti Mohd Desa; Adila, Irene Nur Ibrahim; Tan, Yew Eng; Chong, Hock Chin

    2016-08-01

    Wild banana (Musa acuminata subsp. microcarpa) seed phytobezoar rectal impaction in adult is a rare entity. Here, we report a 75-year-old male with dementia who presented with lower abdominal pain, per-rectal bleeding and overflow faecal incontinence. Our investigation discovered a large wild banana seed phytobezoar impacted in the rectum causing intestinal obstruction, stercoral ulcer and faecal overflow incontinence. In this article, we discuss the patient's clinical findings, imaging and management. The culprit plant was identified and depicted. This may be the first report of its kind. Public consumption of these wild bananas should be curtailed. It is hoped that this report would increase the awareness of such condition and its identification. PMID:27574355

  4. [Novel techniques in the treatment of rectal cancer].

    PubMed

    Rautio, Tero; Kairaluoma, Matti; Sand, Juhani

    2016-01-01

    Rectal cancer is the eighth and tenth most common kind of cancer in men and women, respectively, with an increasing frequency of occurrence. Together with cancer of the large intestine it forms the third most common cancer entity. Surgical therapy is the most important form of treatment of rectal cancer; in combination with adjuvant therapy it will cure a significant proportion of the patients and provide relief for tumor-induced hemorrhagic and obstructive symptoms. The operation has usually been conducted as an open surgery with the use of simple instruments. In recent times, the operative techniques have become more versatile, and mini-invasive techniques have resulted in quicker recovery of the patients from the operation. PMID:27483632

  5. Efficacy of rectal misoprostol for prevention of postpartum hemorrhage.

    PubMed

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

    2013-01-01

    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 μg 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

  6. Delorme's operation and sphincteroplasty for rectal prolapse and fecal incontinence.

    PubMed

    Pescatori, M; Interisano, A; Stolfi, V M; Zoffoli, M

    1998-01-01

    Clinical and manometric results of Delorme's operation and sphincteroplasty were assessed retrospectively in patients undergoing this procedure for fecal incontinence and rectal prolapse. A series of 33 patients (11 males, 22 females; aged 18-83 years, mean 59) with external rectal prolapse were treated by Delorme's operation between 1989 and 1996. Mean follow-up was 39 months (range 7-84). Sphincteroplasty was associated in 12 cases with severe fecal incontinence due to striated muscle defects. Good results were achieved in 27 patients (79%); prolapse recurrence was observed in 6 (21%), the mean recurrence time being 9 months (range 1-24 months). There were no postoperative deaths. Minor complications occurred in 15 patients. Changes in preoperative and postoperative manometric patterns were as follows (mean +/- SEM): voluntary contraction from 59 +/- 6.9 to 66 +/- 7.1 mmHg (P = 0.05), resting tone from 33 +/- 5 to 32 +/- 4.3 mmHg, rectal sensation from 59 +/- 5 to 61 +/- 5.2 ml of air (n.s.). A solitary rectal ulcer syndrome was detected in five patients. The histological pattern demonstrated pathological changes in 40% of cases. Fecal incontinence was resolved in 6 of 20 cases (30%) and chronic constipation in 4 of 9 (44%). Failure (n = 3) was related primarily to postoperative sepsis. The incontinence score showed a mean improvement of 35% decreasing, from 4.5 +/- 0.39 to 2.9 +/- 0.44 after surgery (P < 0.01). In conclusion, Delorme's procedure did not lead to constipation and improved anal continence when associated with sphincteroplasty.

  7. Rectal prolapse in children: a study of 71 cases

    PubMed Central

    Askarpour, Shahnam; Peyvasteh, Mehran; Javaherizadeh, Hazhir; Mooghehi-Nezhad, Meisam

    2015-01-01

    Introduction Prolapse of the rectum is the herniation of the rectum through the anus, which may be categorised as mucosal or complete. Aim To evaluate the clinical manifestation, treatment, and surgical complications of children with rectal prolapse over a 6-year period. Material and methods This study was carried out on children aged < 14 years who were admitted or referred for rectal prolapse that failed to respond after medical treatment in Imam Khomeini and Abouzar Children's Hospital. Duration of the study was 6 years starting in March 2002. These cases were referred after failure of medical and conservative treatment. Age, sex, clinical manifestation, and type of procedure were recorded. Analysis was done using SPSS version 11.0 (SPSS Inc, Chicago, IL, USA). The χ2 test was used for comparison. Results Seventy-one cases were included in this study. Of these cases, 50 (70.4%) were male and 21 (29.6%) were female (p < 0.0001). Mean age of cases was 4.97 ±3.42 years (range: 2 days to 13 years). Of the male cases, 38% were in the age range of 3–6 years. In female cases, 57.1% were in the range of 1.5–3 years. Of all 71 cases, injection sclerotherapy was done for 50 (70.43%) for the first time. Twenty-one cases had history of injection sclerotherapy and 16 (22.53%) were treated by perineal surgery, and 5 (7.04%) had abdominal surgery. One case experienced recurrent rectal prolapse (1.40%) following injection sclerotherapy. Conclusions In girls, more than half of the cases were in the age range 1.5–3 years. Among male cases, 38% were in the age range of 1.5–3 years. The results of treatment of rectal prolapse in our hospitals was similar to that seen in developed countries. PMID:26557942

  8. Changing approaches to rectal prolapse repair in the elderly

    PubMed Central

    Poylin, Vitaliy; Bensley, Rodney; Nagle, Deborah

    2013-01-01

    Aim: The abdominal approach to rectal prolapse is associated with lower rates of recurrence but a higher chance of complications and has been traditionally reserved for younger patients. However, longer life expectancy and wider use of laparoscopic techniques necessitates another look at the abdominal approach in older patients. Methods: This was a retrospective review of data from patients undergoing abdominal repair of rectal prolapse between 2005 and 2011. Results: Forty-six abdominal repairs (laparoscopic or open suture rectopexy, sigmoidectomy and rectopexy and low anterior resection) were performed during the study period. Twenty-nine repairs (63%) were performed in patients under the age of 70 (average age 51) and 17 (37%) in patients older than 70 (average age 76; range 71–89). Most of the cases performed during the initial 3 years of the study were via laparotomy. However, in the last 4 years, the laparoscopic approach was used in 83% of younger patients and 69% of older patients. Average length of stay was 2.6 days for younger and 3.8 days for older patients. Both groups had similar rates of re-admission: 20% vs 23%. The rate of wound infection was higher in the younger patients (5% vs nil). However, rates of urinary tract infection, two instances (10%) vs four (30%), urinary retention, one instance (5%) vs two (15.4%), ileus, one instance (5%) vs two (15.4%) were higher in the older group. Conclusion: Wider use of laparoscopy has precipitated a change in the approach to rectal prolapse in older patients. Although associated with a slightly higher rate of post-operative complications, the abdominal approach to rectal prolapse is feasible, safe and effective in patients older than 70 years. PMID:24759966

  9. Comparison of Digital Rectal and Microchip Transponder Thermometry in Ferrets (Mustela putorius furo).

    PubMed

    Maxwell, Branden M; Brunell, Marla K; Olsen, Cara H; Bentzel, David E

    2016-01-01

    Body temperature is a common physiologic parameter measured in both clinical and research settings, with rectal thermometry being implied as the 'gold standard.' However, rectal thermometry usually requires physical or chemical restraint, potentially causing falsely elevated readings due to animal stress. A less stressful method may eliminate this confounding variable. The current study compared 2 types of digital rectal thermometers-a calibrated digital thermometer and a common digital thermometer-with an implantable subcutaneous transponder microchip. Microchips were implanted subcutaneously between the shoulder blades of 16 ferrets (8 male, 8 female), and temperatures were measured twice from the microchip reader and once from each of the rectal thermometers. Results demonstrated the microchip temperature readings had very good to good correlation and agreement to those from both of the rectal thermometers. This study indicates that implantable temperature-sensing microchips are a reliable alternative to rectal thermometry for monitoring body temperature in ferrets.

  10. Comparison of Digital Rectal and Microchip Transponder Thermometry in Ferrets (Mustela putorius furo)

    PubMed Central

    Maxwell, Branden M; Brunell, Marla K; Olsen, Cara H; Bentzel, David E

    2016-01-01

    Body temperature is a common physiologic parameter measured in both clinical and research settings, with rectal thermometry being implied as the ‘gold standard.’ However, rectal thermometry usually requires physical or chemical restraint, potentially causing falsely elevated readings due to animal stress. A less stressful method may eliminate this confounding variable. The current study compared 2 types of digital rectal thermometers—a calibrated digital thermometer and a common digital thermometer—with an implantable subcutaneous transponder microchip. Microchips were implanted subcutaneously between the shoulder blades of 16 ferrets (8 male, 8 female), and temperatures were measured twice from the microchip reader and once from each of the rectal thermometers. Results demonstrated the microchip temperature readings had very good to good correlation and agreement to those from both of the rectal thermometers. This study indicates that implantable temperature-sensing microchips are a reliable alternative to rectal thermometry for monitoring body temperature in ferrets. PMID:27177569

  11. Comparison of Digital Rectal and Microchip Transponder Thermometry in Ferrets (Mustela putorius furo).

    PubMed

    Maxwell, Branden M; Brunell, Marla K; Olsen, Cara H; Bentzel, David E

    2016-01-01

    Body temperature is a common physiologic parameter measured in both clinical and research settings, with rectal thermometry being implied as the 'gold standard.' However, rectal thermometry usually requires physical or chemical restraint, potentially causing falsely elevated readings due to animal stress. A less stressful method may eliminate this confounding variable. The current study compared 2 types of digital rectal thermometers-a calibrated digital thermometer and a common digital thermometer-with an implantable subcutaneous transponder microchip. Microchips were implanted subcutaneously between the shoulder blades of 16 ferrets (8 male, 8 female), and temperatures were measured twice from the microchip reader and once from each of the rectal thermometers. Results demonstrated the microchip temperature readings had very good to good correlation and agreement to those from both of the rectal thermometers. This study indicates that implantable temperature-sensing microchips are a reliable alternative to rectal thermometry for monitoring body temperature in ferrets. PMID:27177569

  12. Local staging of rectal cancer: the current role of MRI

    PubMed Central

    Rogalla, Patrik; Taupitz, Matthias

    2006-01-01

    With the advent of powerful gradient coil systems and high-resolution surface coils, magnetic resonance imaging (MRI) has recently extended its role in the staging of rectal cancer. MRI is superior to endorectal ultrasound, the most widely used staging modality in patients with rectal tumors, in that it visualizes not only the intestinal wall but also the surrounding pelvic anatomy. The crucial advantage of MRI is not that it enables exact T-staging but precise evaluation of the topographic relationship of a tumor to the mesorectal fascia. This fascia is the most important anatomic landmark for the feasibility of total mesorectal excision, which has evolved into the standard operative procedure for the resection of cancer located in the middle or lower third of the rectum. MRI is currently the only imaging modality that is highly accurate in predicting whether or not it is likely that a tumor-free margin can be achieved and thus provides important information for planning of an effective therapeutic strategy, especially in patients with advanced rectal cancer. PMID:17008990

  13. Critical appraisal of laparoscopic vs open rectal cancer surgery

    PubMed Central

    Tan, Winson Jianhong; Chew, Min Hoe; Dharmawan, Angela Renayanti; Singh, Manraj; Acharyya, Sanchalika; Loi, Carol Tien Tau; Tang, Choong Leong

    2016-01-01

    AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer. METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared. RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate analysis (P = 0.148). Neither 5-year overall survival (70.5% vs 61.8%, P = 0.217) nor 5-year cancer free survival (64.3% vs 66.6%, P = 0.854) were significantly different between the laparoscopic group and the converted group. CONCLUSION: LRR has equivalent long-term oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis. PMID:27358678

  14. [Causes of local recurrence after curative surgery for rectal cancer].

    PubMed

    Hôhn, József; Varga, László; Baradnay, Gellért; Simonka, Zsolt; Géczi, Tibor; Nagy, Ferenc; Molnár, Tamás; Maráz, Anikó; Kahán, Zsuzsa; Balogh, Adám

    2003-01-01

    The rate of local recurrence (LR) has been 20-40% after resective surgery for rectal cancer by the traditional - Miles or Dixon - operative technics. The authors performed curative resection in 358 patients with rectal cancer in a 10 year period (01.01.1990 - 31.12.2000) in the Surgical Department of Szeged University. Since 01.01.1996 the authors changed this type of surgery for the Heald technics (total mesorectal excision - TME - with sharp dissection, using the UltraCision device) for the surgical treatment of middle or lower third rectal cancer. To compare the results of the two procedures, the authors analysed their material in two periods: Period I: 01.01.1991 - 31.12.1992: 62 patients operated on with the traditional operative technics; LR 15% within 2 years after surgery. Period II: 01.01.1997 - 31.12.1998: 78 patients operated on with the Heald technics (TME with sharp dissection); LR 6.4% within 2 years after surgery. Based on their results, the authors found that the modern operative technics by Heald, used in the second period of the study, was a relevant factor decreasing LR from 15% to 6.4%, while the gender, age of the patients, ratio of the abdominoperineal extirpation versus anterior resection (APRE/AR) and the free margin of more than 3 cm proved to be irrelevant.

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

    PubMed

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

    2014-05-01

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

  16. Endocavitary irradiation for rectal cancer and villous adenomas

    SciTech Connect

    Kovalic, J.J.

    1988-02-01

    Endocavitary irradiation has been used for rectal adenocarcinoma and villous adenoma at St. Joseph's Hospital, Milwaukee, Wisconsin since 1978. The 52 patients treated since that time include 32 patients with adenocarcinoma, 19 patients with villous adenoma, and 1 patient with an adenomatous polyp and associated atypia. The average age of these patients (70.5 years) was a full decade older than the average age of all rectal cancer patients. The treatment was administered by a superficial contact machine with most patients receiving 80 Gy over four treatments in a period of 1.5 months. The overall local recurrence rate was 24% in the cancer group and 32% in the villous adenoma group. The 1-, 2-, and 3-year determinate disease-free survival rates were 90.4%, 78.6%, 74.2% and 80.4%; 60.3%, 45.2% for invasive adenocarcinoma and villous adenoma patients, respectively. There was no mortality and very little morbidity associated with the treatment. It is concluded that endocavitary irradiation is an effective alternative to surgery for the treatment of rectal cancer in selected cases. However, villous adenomas do not respond as well. Better results may be obtained for this group of patients by higher doses than were used in this study.

  17. 75 FR 51080 - Determination That DIASTAT (Diazepam Rectal Gel), 5 Milligrams/Milliliter, 10 Milligrams/2...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-18

    ... HUMAN SERVICES Food and Drug Administration Determination That DIASTAT (Diazepam Rectal Gel), 5... (diazepam rectal gel) (DIASTAT), 5 milligrams (mg)/milliliter (mL), 10 mg/2 mL, 15 mg/3 mL, and 20 mg/4 mL... to approve abbreviated new drug applications (ANDAs) for diazepam rectal gel, 5 mg/mL, 10 mg/2 mL,...

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

    Marshall, J K; Irvine, E J

    1997-01-01

    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

  20. Solitary rectal ulcer: the place of biofeedback and surgery in the treatment of the syndrome.

    PubMed

    Binnie, N R; Papachrysostomou, M; Clare, N; Smith, A N

    1992-01-01

    Thirty-one patients with the solitary rectal ulcer syndrome were studied, the majority of whom presented with fresh blood per rectum and a rectal ulcer, mucorrhoea, or a varying degree of rectal prolapse. Fourteen patients were treated conservatively or with surgery and had a high rate of recurrence of the solitary rectal ulcer syndrome. Seventeen patients were treated with biofeedback for the associated obstructed defecation (anismus) either before or immediately after surgery with a lower recurrence rate. The final symptomatic cure rate was similar in both groups but 15 episodes of recurrence requiring further surgery were encountered in the non-biofeedback group compared to 4 recurrences in the biofeedback group.

  1. In vivo trans-rectal ultrasound coupled trans-rectal near-infrared optical tomography of canine prostate bearing transmissible venereal tumor

    NASA Astrophysics Data System (ADS)

    Jiang, Zhen; Holyoak, G. Reed; Bartels, Kenneth E.; Ritchey, Jerry W.; Xu, Guan; Bunting, Charles F.; Slobodov, Gennady; Krasinski, Jerzy S.; Piao, Daqing

    2009-02-01

    In vivo trans-rectal near-infrared (NIR) optical tomography is conducted on a tumor-bearing canine prostate with the assistance of trans-rectal ultrasound (TRUS). The canine prostate tumor model is made possible by a unique round cell neoplasm of dogs, transmissible venereal tumor (TVT) that can be transferred from dog to dog regardless of histocompatibility. A characterized TVT cell line was homogenized and passed twice in subcutaneous tissue of NOD/SCID mice. Following the second passage, the tumor was recovered, homogenized and then inoculated by ultrasound guidance into the prostate gland of a healthy dog. The dog was then imaged with a combined trans-rectal NIR and TRUS imager using an integrated trans-rectal NIR/US applicator. The image was taken by NIR and US modalities concurrently, both in sagittal view. The trans-rectal NIR imager is a continuous-wave system that illuminates 7 source channels sequentially by a fiber switch to deliver sufficient light power to the relatively more absorbing prostate tissue and samples 7 detection channels simultaneously by a gated intensified high-resolution CCD camera. This work tests the feasibility of detecting prostate tumor by trans-rectal NIR optical tomography and the benefit of augmenting TRUS with trans-rectal NIR imaging.

  2. Excitation and inhibition of neuronal activity in the pontine micturition center by pelvic rectal and pudendal anal afferents in dogs.

    PubMed

    Moda, Y; Yamane, M; Fukuda, H; Okada, H

    1993-04-01

    To examine whether or not the pontine micturition center (PMC) is involved in the inhibition of the micturition reflex by pelvic rectal and pudendal anal afferents, neuronal activity in the PMC was observed during inhibition of this reflex in paralyzed decerebrate dogs. Discharge of pelvic vesical branches (VBs) waxed and waned at a rhythm of about 2 Hz during the micturition reflex, which was activated by continuous stimulation of the contralateral VBs. This rhythmic discharge was modulated by continuous stimulation of contralateral pelvic rectal branches (RBs) superimposed on the VB stimulation. The modulation was composed of three effects; initial inhibition, augmentation and late inhibition. However, not all of the three effects were obvious in some dogs. One-sixth of 118 neurons examined in the pontine area ventromedial to the locus ceruleus exhibited rhythmic burst firings which preceded the rhythmic discharge of VBs by about 150 ms. Therefore, these pontine neurons are assumed to be output neurons of the PMC. The rhythmic firings of pontine neurons were augmented during continuous RB stimulation independent of the inhibitory and/or augmentative effects of the RB stimulation on the reflex discharge of the VBs. In contrast, the rhythmic firings of the pontine neurons and the reflex discharge of VBs were inhibited by mechanical stimulation of the anal canal and perineal hairs. These results suggest that the PMC is involved in the inhibition of the micturition reflex produced via pudendal afferents but not in that produced by pelvic rectal afferents, and that pelvic and pudendal afferents project to the PMC through separate pathways.

  3. Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer; a prospective randomized trial

    PubMed Central

    Løgager, Vibeke B.; Skjoldbye, Bjørn; Møller, Jakob M.; Lorenzen, Torben; Rasmussen, Vera L.; Thomsen, Henrik S.; Mollerup, Talie H.; Okholm, Cecilie; Rosenberg, Jacob

    2016-01-01

    Introduction. Colorectal cancer is one of the most frequent cancers in the world and liver metastases are seen in up to 19% of patients with colorectal cancers. Detection of liver metastases is not only vital for sufficient treatment and survival, but also for a better estimation of prognosis. The aim of this study was to evaluate the feasibility of diffusion weighted MRI of the liver as part of a combined MR evaluation of patients with rectal cancers and compare it with the standard preoperative evaluation of the liver with CT. Methods. Consecutive patients diagnosed with rectal cancers were asked to participate in the study. Preoperative CT and diffusion weighted MR (DWMR) were compared to contrast enhanced laparoscopic ultrasound (CELUS). Results. A total of 35 patients were included, 15 patients in Group-1 having the standard CT evaluation of the liver and 20 patients in Group-2 having the standard CT evaluation of the liver and DWMR of the liver. Compared with CELUS, the per-patient sensitivity/specificity was 50/100% for CT, and for DWMR: 100/94% and 100/100% for Reader 1 and 2, respectively. The per-lesion sensitivity of CT and DWMR were 17% and 89%, respectively compared with CELUS. Furthermore, one patient had non-resectable metastases after DWMR despite being diagnosed with resectable metastases after CT. Another patient was diagnosed with multiple liver metastases during CELUS, despite a negative CT-scan. Discussion. DWMR is feasible for preoperative evaluation of liver metastases. The current standard preoperative evaluation with CT-scan results in disadvantages like missed metastases and futile operations. We recommend that patients with rectal cancer, who are scheduled for MR of the rectum, should have a DWMR of the liver performed at the same time. PMID:26793420

  4. [Contrast sensitivity in glaucoma].

    PubMed

    Bartos, D

    1989-05-01

    Author reports on results of the contrast sensitivity examinations using the Cambridge low-contrast lattice test supplied by Clement Clarke International LTD, in patients with open-angle glaucoma and ocular hypertension. In glaucoma patients there was observed statistically significant decrease of the contrast sensitivity. In patients with ocular hypertension decrease of the contrast sensitivity was in patients affected by corresponding changes of the visual field and of the optical disc. The main advantages of the Cambridge low-contrast lattice test were simplicity, rapidity and precision of its performance. PMID:2743444

  5. Evaluation of Trans-Vag Broth, Colistin-Nalidixic Agar, and CHROMagar StrepB for Detection of Group B Streptococcus in Vaginal and Rectal Swabs from Pregnant Women in South Africa

    PubMed Central

    Kwatra, Gaurav; Madhi, Shabir A.; Cutland, Clare L.; Buchmann, Eckhart J.

    2013-01-01

    Maternal vaginal colonization with group B streptococcus (GBS) is a major risk factor for invasive GBS infection in newborns. The CDC-recommended method for detecting GBS colonization is to culture vaginal and rectal swabs in a selective broth followed by subculture on blood agar or a selective medium. A high incidence of antimicrobial resistance in the fecal microflora can compromise the recovery of GBS from the selective broth. Here, we compared CHROMagar StrepB (CA), Columbia colistin-nalidixic agar (CNA), and Trans-Vag selective broth enrichment for the isolation of GBS from 130 vaginal and 130 rectal swabs from pregnant women. The swabs were randomized for plating first on either CA or CNA, and they then were inoculated in Trans-Vag broth. GBS was cultured from 37.7% of the vaginal swabs and 33.1% of the rectal swabs. There were no differences in the detection rates for the vaginal swabs between CA (31.5%), CNA (26.2%), and the selective broth (30.0%). The sensitivities in relation to a composite score were 83.7%, 69.4%, and 79.6%, respectively. However, recovery of GBS from the rectal swabs was significantly higher from CA (29.2%; P < 0.0001) and CNA (23.8%; P = 0.002) than from the selective broth (9.2%). The sensitivities were 88.4%, 72.1%, and 27.9%, respectively. The order of plating on the solid medium was significant (P = 0.003), with GBS detection rates of 30.8% and 24.6% when swabs were plated first and second, respectively. These findings show that a selective broth is not suitable for the recovery of GBS from rectal swabs in settings such as ours, due to masking of the GBS colonies by persistent microflora. PMID:23698527

  6. Evaluation of Trans-Vag broth, colistin-nalidixic agar, and CHROMagar StrepB for detection of group B Streptococcus in vaginal and rectal swabs from pregnant women in South Africa.

    PubMed

    Kwatra, Gaurav; Madhi, Shabir A; Cutland, Clare L; Buchmann, Eckhart J; Adrian, Peter V

    2013-08-01

    Maternal vaginal colonization with group B streptococcus (GBS) is a major risk factor for invasive GBS infection in newborns. The CDC-recommended method for detecting GBS colonization is to culture vaginal and rectal swabs in a selective broth followed by subculture on blood agar or a selective medium. A high incidence of antimicrobial resistance in the fecal microflora can compromise the recovery of GBS from the selective broth. Here, we compared CHROMagar StrepB (CA), Columbia colistin-nalidixic agar (CNA), and Trans-Vag selective broth enrichment for the isolation of GBS from 130 vaginal and 130 rectal swabs from pregnant women. The swabs were randomized for plating first on either CA or CNA, and they then were inoculated in Trans-Vag broth. GBS was cultured from 37.7% of the vaginal swabs and 33.1% of the rectal swabs. There were no differences in the detection rates for the vaginal swabs between CA (31.5%), CNA (26.2%), and the selective broth (30.0%). The sensitivities in relation to a composite score were 83.7%, 69.4%, and 79.6%, respectively. However, recovery of GBS from the rectal swabs was significantly higher from CA (29.2%; P<0.0001) and CNA (23.8%; P=0.002) than from the selective broth (9.2%). The sensitivities were 88.4%, 72.1%, and 27.9%, respectively. The order of plating on the solid medium was significant (P=0.003), with GBS detection rates of 30.8% and 24.6% when swabs were plated first and second, respectively. These findings show that a selective broth is not suitable for the recovery of GBS from rectal swabs in settings such as ours, due to masking of the GBS colonies by persistent microflora.

  7. SU-E-T-280: Reconstructed Rectal Wall Dose Map-Based Verification of Rectal Dose Sparing Effect According to Rectum Definition Methods and Dose Perturbation by Air Cavity in Endo-Rectal Balloon

    SciTech Connect

    Park, J; Park, H; Lee, J; Kang, S; Lee, M; Suh, T; Lee, B

    2014-06-01

    Purpose: Dosimetric effect and discrepancy according to the rectum definition methods and dose perturbation by air cavity in an endo-rectal balloon (ERB) were verified using rectal-wall (Rwall) dose maps considering systematic errors in dose optimization and calculation accuracy in intensity-modulated radiation treatment (IMRT) for prostate cancer patients. Methods: When the inflated ERB having average diameter of 4.5 cm and air volume of 100 cc is used for patient, Rwall doses were predicted by pencil-beam convolution (PBC), anisotropic analytic algorithm (AAA), and AcurosXB (AXB) with material assignment function. The errors of dose optimization and calculation by separating air cavity from the whole rectum (Rwhole) were verified with measured rectal doses. The Rwall doses affected by the dose perturbation of air cavity were evaluated using a featured rectal phantom allowing insert of rolled-up gafchromic films and glass rod detectors placed along the rectum perimeter. Inner and outer Rwall doses were verified with reconstructed predicted rectal wall dose maps. Dose errors and extent at dose levels were evaluated with estimated rectal toxicity. Results: While AXB showed insignificant difference of target dose coverage, Rwall doses underestimated by up to 20% in dose optimization for the Rwhole than Rwall at all dose range except for the maximum dose. As dose optimization for Rwall was applied, the Rwall doses presented dose error less than 3% between dose calculation algorithm except for overestimation of maximum rectal dose up to 5% in PBC. Dose optimization for Rwhole caused dose difference of Rwall especially at intermediate doses. Conclusion: Dose optimization for Rwall could be suggested for more accurate prediction of rectal wall dose prediction and dose perturbation effect by air cavity in IMRT for prostate cancer. This research was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea

  8. High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

    PubMed Central

    Reese, Patricia Carr; Esber, Allahna; Lahey, Samantha; Ervin, Melissa; Davis, John A.; Fields, Karen; Turner, Abigail Norris

    2015-01-01

    Abstract Background: Testing women for urogenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is common in sexually transmitted disease (STD) clinics. However, women may not be routinely tested for rectal GC/CT. This may lead to missed infections in women reporting anal intercourse (AI). Methods: This was a retrospective review of all women who underwent rectal GC/CT testing from August 2012 to June 2013 at an STD clinic in Columbus, Ohio. All women who reported AI in the last year had a rectal swab collected for GC/CT nucleic acid amplification testing (n=331). Using log-binomial regression models, we computed unadjusted and adjusted associations for demographic and behavioral factors associated with rectal GC/CT infection. Results: Participants (n=331) were 47% African-American, with median age of 29 years. Prevalence of rectal GC was 6%, rectal CT was 13%, and either rectal infection was 19%. Prevalence of urogenital GC and CT was 7% and 13% respectively. Among women with rectal GC, 14% tested negative for urogenital GC. Similarly, 14% of women with rectal CT tested negative for urogenital CT. In unadjusted analyses, there was increased rectal GC prevalence among women reporting sex in the last year with an injection drug user, with a person exchanging sex for drugs or money, with anonymous partners, and while intoxicated/high on alcohol or illicit drugs. After multivariable adjustment, no significant associations persisted, but a trend of increased rectal GC prevalence was observed for women <26 years of age (p=0.06) and those reporting sex while intoxicated/high on alcohol or drugs (p=0.05). For rectal CT, only age <26 years was associated with prevalent infection in unadjusted models; this association strengthened after multivariable adjustment (prevalence ratio: 6.03; 95% confidence interval: 2.29–15.90). Conclusion: Nearly one in five women who reported AI in the last year had rectal GC or CT infection. Urogenital testing alone would have

  9. Factors predictive of persistent or recurrent Crohn's disease in excluded rectal segments.

    PubMed

    Guillem, J G; Roberts, P L; Murray, J J; Coller, J A; Veidenheimer, M C; Schoetz, D J

    1992-08-01

    The fate of the excluded rectal segment after surgery for Crohn's colitis remains poorly defined. To determine prognostic factors relating to the fate of the rectal segment, records of 47 patients who underwent creation of an excluded rectal segment were studied. Disease developed in 33 patients (70 percent) in the excluded rectal segment by five years; 24 patients (51 percent) had completion proctectomy by 2.4 years; and 9 patients (19 percent) retained a rectum with disease at a median follow-up period of five years (range, 2-13 years). At a median follow-up time of six years (range, 2-21 years), 14 patients were without clinical disease. The three groups were equivalent with respect to sex, duration of preoperative disease, indication for operation, distribution of disease, and histologic involvement of the proximal rectal margin. The median age of patients in the proctectomy group at diagnosis tended to be younger than that of patients with a retained excluded rectal segment (22, 30, and 31 years for patients having proctectomy, patients with a diseased excluded rectal segment, and patients with a normal excluded rectal segment, respectively). Neither initial involvement of the terminal ileum nor endoscopic inflammatory changes seen in the rectum predicted eventual disease of the excluded rectal segment. However, initial perianal disease complicating Crohn's colitis was predictive of persistent excluded rectal segment disease and often required proctectomy. Therefore, because the presence of perianal disease and Crohn's colitis predicts persistent or recurrent excluded rectal segment disease, primary total proctocolectomy or early completion proctectomy may be indicated in this subgroup of patients.

  10. Evaluation of BBL CHROMagar VanRE for Detection of Vancomycin-Resistant Enterococci in Rectal Swab Specimens▿

    PubMed Central

    Stamper, Paul D.; Shulder, Stephanie; Bekalo, Pearl; Manandhar, Deepika; Ross, Tracy L.; Speser, Sharon; Kingery, Julie; Carroll, Karen C.

    2010-01-01

    A study was performed on 517 surveillance rectal swabs to evaluate a selective and differential chromogenic medium, the BBL CHROMagar VanRE (CVRE), which enables recovery and identification of VanA- and VanB-containing Enterococcus faecium (ENFM) and Enterococcus faecalis (ENFS) isolates. Compared to BBL Enterococcosel agar, a bile-esculin-azide-vancomycin (BEAV) agar, the initial overall sensitivity, specificity, and positive and negative predictive values of CVRE for the detection of vancomycin-resistant ENFM and ENFS were 99.1% and 94.8% and 84.2% and 99.7%, respectively. Among our patient population, more vancomycin-resistant enterococci (VRE) were recovered with CVRE than BEAV. PMID:20739492

  11. Contrast Intravasation During Hysterosalpingography

    PubMed Central

    Bhoil, Rohit; Sood, Dinesh; Sharma, Tanupriya; Sood, Shilpa; Sharma, Jiten; Kumar, Nitesh; Ahluwalia, Ajay; Parekh, Dipen; Mistry, Kewal A.; Sood, Saurav

    2016-01-01

    Summary Hysterosalpingography is an imaging method to evaluate the endometrial and uterine morphology and fallopian tube patency. Contrast intravasation implies backflow of injected contrast into the adjoining vessels mostly the veins and may be related to factors altering endometrial vascularity and permeability. Radiologists and gynaecologists should be well acquainted with the technique of hysterosalpingography, its interpretation, and intravasation of contrast agents for safer procedure and to minimize the associated complications. PMID:27279925

  12. New Perspectives on Predictive Biomarkers of Tumor Response and Their Clinical Application in Preoperative Chemoradiation Therapy for Rectal Cancer

    PubMed Central

    Hur, Hyuk

    2015-01-01

    Preoperative chemoradiation therapy (CRT) is the standard treatment for patients with locally advanced rectal cancer (LARC) and can improve local control and survival outcomes. However, the responses of individual tumors to CRT are not uniform and vary widely, from complete response to disease progression. Patients with resistant tumors can be exposed to irradiation and chemotherapy that are both expensive and at times toxic without benefit. In contrast, about 60% of tumors show tumor regression and T and N down-staging. Furthermore, a pathologic complete response (pCR), which is characterized by sterilization of all tumor cells, leads to an excellent prognosis and is observed in approximately 10-30% of cases. This variety in tumor response has lead to an increased need to develop a model predictive of responses to CRT in order to identify patients who will benefit from this multimodal treatment. Endoscopy, magnetic resonance imaging, positron emission tomography, serum carcinoembryonic antigen, and molecular biomarkers analyzed using immunohistochemistry and gene expression profiling are the most commonly used predictive models in preoperative CRT. Such modalities guide clinicians in choosing the best possible treatment options and the extent of surgery for each individual patient. However, there are still controversies regarding study outcomes, and a nomogram of combined models of future trends is needed to better predict patient response. The aim of this article was to review currently available tools for predicting tumor response after preoperative CRT in rectal cancer and to explore their applicability in clinical practice for tailored treatment. PMID:26446626

  13. Rectal hemangiopericytoma in a 37-year-old woman: a case report and review of the literature

    PubMed Central

    2011-01-01

    Introduction Hemangiopericytoma is an uncommon perivascular tumor. Rectal Hemangiopericytomas are extremely rare. To the best of our knowledge, only two cases have been reported in the literature. Case presentation We report the case of a 37-year-old Asian woman with an Hemangiopericytoma rising from the anterior wall of her rectum. Abdominopelvic computed tomography showed a 7.4 cm solid mass between her uterus and her rectum. Heterogeneous gradual enhancement after intravenous injection of contrast material was noted with several tortuous vessels around her tumor. Intra-operative findings indicated a capsule and well-circumscribed solid tumor connecting with the anterior wall of her rectum by a small pedicle. With immunohistochemical stains, her tumor cells reacted positive for Bcl-2, CD34, and ki67 and negative for CD10, CD117, S100, and Desmin. Follow-up computed tomography scans have shown no tumor recurrence or metastasis signs. Conclusions Rectal Hemangiopericytoma is a rare tumor with non-specific imaging findings. Hemangiopericytomas should be included in the differential list when a massive tumor with heterogeneously gradual enhancement in the regions of the rectum is encountered. PMID:21819590

  14. Tumor microcirculation during a course of combined chemoradiation in patients with primary rectal carcinoma measured with dynamic T1 mapping

    NASA Astrophysics Data System (ADS)

    Kremser, Christian; Judmaier, Werner; De Vries, Alexander

    2003-05-01

    A recently introduced dynamic T1 mapping technique was used to investigate changes of tumor microcirculatory parameters in 16 patients with clinically staged T3) primary rectal carcinoma during a course of preoperative combined chemoradiation. For dynamic T1 mapping an ultra-fast snapshot FLASH T1 mapping sequence was implemented on a 1.5T whole body MR scanner. Acquiring a series of T1 maps contrast media (CM) uptake and washout over an examination time of 40 min was monitored. From the obtained series of T1-maps perfusion-indices (PI) were calculated as the ratio of maximum slope of the tumor CM curve and the maximum of the arterial CM curve. Using pathologic classification of the resected tumors after therapy the patient group could be divided into patients with and without response to therapy. It was found that mean pre-therapy PI values of tumors showing therapy-response were significantly lower than for tumors without no therapy-response. In addition a different behavior of PI distributions within tumors for both groups was observed. The presented study indicates that PI values and their distributions within a tumor seem to be of predictive value for therapy outcome of preoperative therapy in patients with primary rectal carcinoma.

  15. Causes and outcomes of emergency presentation of rectal cancer.

    PubMed

    Comber, Harry; Sharp, Linda; de Camargo Cancela, Marianna; Haase, Trutz; Johnson, Howard; Pratschke, Jonathan

    2016-09-01

    Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation.

  16. New approach to adjuvant radiotherapy in rectal cancer

    SciTech Connect

    Mohiuddin, M.; Dobelbower, R.R.; Kramer, S.

    1980-02-01

    A sandwich technique of adjuvant radiotherapy was used to treat twenty-three patients with rectal cancer. In this technique, low dose preoperative irradiation (500 rad in one treatment) was given to all patients followed by immediate surgery (usually an A-P resection); on the basis of histopathological findings, patients with stage B/sub 2/ and C rectal cancer were selectively given 4500 rad post-operative irradiation in 5 weeks. Nine patients had early lesions (stage A and B/sub 1/) and did not receive postoperative irradiation. Thirteen patients had stage B/sub 2/ and C disease and hence received the full course of postoperative irradiation. One patient was found to have liver metastasis at the time of surgery, and hence received only palliative therapy. Follow-up of these twenty-three patients ranges from 10 months to 24 months with a median follow-up of 15 months. Treatment was well-tolerated with few side effects. Only two of the twenty-two patients who were treated for cure have failed to date. Both patients had stage C/sub 2/ disease; one patient developed an anterior abdominal wall recurrence in the surgical scar 3 months post-treatment and the second patient developed brain and bone metastases. No patients have failed in the pelvis. We feel this technique of adjuvant therapy is a logical approach to the treatment of rectal cancer and has potential for improving survival. The rationale for this approach to adjuvant radiotherapy is discussed together with implications for survival.

  17. Causes and outcomes of emergency presentation of rectal cancer.

    PubMed

    Comber, Harry; Sharp, Linda; de Camargo Cancela, Marianna; Haase, Trutz; Johnson, Howard; Pratschke, Jonathan

    2016-09-01

    Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation. PMID:27087482

  18. Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer

    PubMed Central

    Ferrari, Linda; Fichera, Alessandro

    2015-01-01

    The management of rectal cancer has evolved significantly in the last few decades. Significant improvements in local disease control were achieved in the 1990s, with the introduction of total mesorectal excision and neoadjuvant radiotherapy. Level 1 evidence has shown that, with neoadjuvant chemoradiation therapy (CRT) the rates of local recurrence can be lower than 6% and, as a result, neoadjuvant CRT currently represents the accepted standard of care. This approach has led to reliable tumor down-staging, with 15–27% patients with a pathological complete response (pCR)—defined as no residual cancer found on histological examination of the specimen. Patients who achieve pCR after CRT have better long-term outcomes, less risk of developing local or distal recurrence and improved survival. For all these reasons, sphincter-preserving procedures or organ-preserving options have been suggested, such as local excision of residual tumor or the omission of surgery altogether. Although local recurrence rate has been stable at 5–6% with this multidisciplinary management method, distal recurrence rates for locally-advanced rectal cancers remain in excess of 25% and represent the main cause of death in these patients. For this reason, more recent trials have been looking at the administration of full-dose systemic chemotherapy in the neoadjuvant setting (in order to offer early treatment of disseminated micrometastases, thus improving control of systemic disease) and selective use of radiotherapy only in non-responders or for low rectal tumors smaller than 5 cm. PMID:26290512

  19. Preoperative infusional chemoradiation therapy for stage T3 rectal cancer

    SciTech Connect

    Rich, T.A.; Skibber, J.M.; Ajani, J.A.

    1995-07-15

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

  20. Palliative Treatment of Rectal Carcinoma Recurrence Using Radiofrequency Ablation

    SciTech Connect

    Mylona, Sophia Karagiannis, Georgios Patsoura, Sofia; Galani, Panagiota; Pomoni, Maria; Thanos, Loukas

    2012-08-15

    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.

  1. Rectal temperature-based death time estimation in infants.

    PubMed

    Igari, Yui; Hosokai, Yoshiyuki; Funayama, Masato

    2016-03-01

    In determining the time of death in infants based on rectal temperature, the same methods used in adults are generally used. However, whether the methods for adults are suitable for infants is unclear. In this study, we examined the following 3 methods in 20 infant death cases: computer simulation of rectal temperature based on the infinite cylinder model (Ohno's method), computer-based double exponential approximation based on Marshall and Hoare's double exponential model with Henssge's parameter determination (Henssge's method), and computer-based collinear approximation based on extrapolation of the rectal temperature curve (collinear approximation). The interval between the last time the infant was seen alive and the time that he/she was found dead was defined as the death time interval and compared with the estimated time of death. In Ohno's method, 7 cases were within the death time interval, and the average deviation in the other 12 cases was approximately 80 min. The results of both Henssge's method and collinear approximation were apparently inferior to the results of Ohno's method. The corrective factor was set within the range of 0.7-1.3 in Henssge's method, and a modified program was newly developed to make it possible to change the corrective factors. Modification A, in which the upper limit of the corrective factor range was set as the maximum value in each body weight, produced the best results: 8 cases were within the death time interval, and the average deviation in the other 12 cases was approximately 80min. There was a possibility that the influence of thermal isolation on the actual infants was stronger than that previously shown by Henssge. We conclude that Ohno's method and Modification A are useful for death time estimation in infants. However, it is important to accept the estimated time of death with certain latitude considering other circumstances.

  2. Generic Planning Target Margin for Rectal Cancer Treatment Setup Variation

    SciTech Connect

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

    2009-08-01

    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.

  3. Techniques and technology evolution of rectal cancer surgery: a history of more than a hundred years.

    PubMed

    Lirici, Marco Maria; Hüscher, Cristiano G S

    2016-10-01

    History of rectal cancer surgery has shown a continuous evolution of techniques and technologies over the years, with the aim of improving both oncological outcomes and patient's quality of life. Progress in rectal cancer surgery depended on a better comprehension of the disease and its behavior, and also, it was strictly linked to advances in technologies and amazing surgical intuitions by some surgeons who pioneered in rectal surgery, and this marked a breakthrough in the surgical treatment of rectal cancer. Rectal surgery with radical intent was first performed by Miles in 1907 and the procedure he developed, abdomino-perineal resection, became a gold standard for many years. In the following years and over the last century other procedures were introduced which became new gold standards: Hartmann's procedure, anterior rectal resection, total mesorectal excision (TME); the last one, developed by Heald in 1982, is the present gold standard treatment of rectal cancer. At the same time, new technologies were developed and introduced into the clinical practice, which enhanced results of surgery and even made possible performing new operations: leg-rests, stapling devices, instruments, appliances and platforms for laparoscopic surgery and transanal rectal surgery. In more recent years the transanal approach to TME has been introduced, which might improve oncologic results of surgery of the rectum. Ongoing randomized studies, future systematic reviews and metanalyses will show whether the transanal approach to TME will become a new gold standard.

  4. Rectal ulcer with an elusive diagnosis: all that ulcers is not Crohn disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A single rectal ulcer is an uncommon finding in children with gastrointestinal disease. Although inflammatory bowel disease (IBD) is foremost among the differential diagnoses, a primary immunological defect should not be forgotten. Because of the paucity of literature on the association of rectal ul...

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

    PubMed Central

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

    2014-01-01

    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

  6. Laparoscopic Rectopexy for Rectal Prolapse: Will it be the Gold Standard?

    PubMed

    Shastri-Hurst, N; McArthur, D R

    2014-12-01

    A review of the current literature is presented regarding the surgical management of full thickness rectal prolapse, comparing laparoscopic rectopexy with open abdominal operations and perineal procedures. Outcome measures include length of stay, short- and long-term outcomes and financial burdens. Current evidence suggests that laparoscopic rectopexy as treatment for full thickness rectal prolapse is a safe alternative to the other options.

  7. Clarifying margins in the multidisciplinary management of rectal cancer: the MERCURY experience.

    PubMed

    Salerno, G; Daniels, I R; Moran, B J; Wotherspoon, A; Brown, G

    2006-11-01

    The Magnetic Resonance Imaging and Rectal Cancer European Equivalence Study (MERCURY) was an observational prospective study involving 11 European centres, to evaluate equivalence between magnetic resonance imaging and histopathology in measuring depth of tumour invasion beyond the bowel and involvement of the circumferential resection margin in rectal cancer specimens. PMID:17018303

  8. Late rectal complications after prostate brachytherapy for localized prostate cancer: incidence and management.

    PubMed

    Phan, Jack; Swanson, David A; Levy, Lawrence B; Kudchadker, Rajat J; Bruno, Teresa L; Frank, Steven J

    2009-05-01

    This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Cancer 2009. (c) 2009 American Cancer Society.

  9. Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

    PubMed Central

    Bruketa, Tomislav; Majerovic, Matea; Augustin, Goran

    2015-01-01

    Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects. PMID:26290629

  10. Development of a Self-contained, Indwelling Rectal Temperature Probe for Cattle Research

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A device was developed to automatically monitor rectal temperature (RT) of cattle for application in research settings. Compared with manual measurement of rectal temperature, this device decreases labor and time requirements, and allows data collection without the influence of animal handling or re...

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

    NASA Astrophysics Data System (ADS)

    Arnold, David A.

    1995-05-01

    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.

  12. Propionate induces cell swelling and K+ accumulation in shark rectal gland

    SciTech Connect

    Feldman, G.M.; Ziyadeh, F.N.; Mills, J.W.; Booz, G.W.; Kleinzeller, A. )

    1989-08-01

    Small organic anions have been reported to induce cell solute accumulation and swelling. To investigate the mechanism of swelling, we utilized preparations of rectal gland cells from Squalus acanthias incubated in medium containing propionate. Propionate causes cells to swell by diffusing across membranes in its nonionic form, acidifying cell contents, and activating the Na+-H+ antiporter. The Na+-H+ exchange process tends to correct intracellular pH (pHi), and thus it maintains a favorable gradient for propionic acid diffusion and allows propionate to accumulate. Activation of the Na+-H+ antiport also facilitates Na+ entry into the cell and Nai accumulation. At the same time Na+-K+-ATPase activity, unaffected by propionate, replaces Nai with Ki, whereas the K+ leak rate, decreased by propionate, allows Ki to accumulate. As judged by {sup 86}Rb+ efflux, the reduction in K+ leak was not due to propionate-induced cell acidification or reduction in Cli concentration. Despite inducing cell swelling, propionate did not disrupt cell structural elements and F actin distribution along cell membranes.

  13. A case of rectal Dieulafoy's ulcer and successful endoscopic sclerotherapy.

    PubMed

    Matsuoka, J; Taniai, K; Kojima, K; Kenmotsu, M; Takai, K; Okabe, T; Tanaka, N

    2000-12-01

    A 54-year-old woman presented a massive hematochezia 7 days after sigmoidectomy. Repeated colonoscopy and angiography failed to locate the site of bleeding and Hartman's operation was performed. Rebleeding from the rectum on the day of operation occurred and pulsate arterial bleeding with minimal surrounding ulcer 1 cm above the pectinate line was observed. Screlotherapy with ethanol and electro coagulation was successfully performed to achieve permanent hemostasis. The importance of detailed rectal examination and an awareness of this clinical entity in life-threatening lower intestinal bleeding is discussed. PMID:11132922

  14. [Laparoscopic Resection Rectopexy for the Treatment of External Rectal Prolapse].

    PubMed

    Axt, S; Falch, C; Müller, S; Kirschniak, A; Glatzle, J

    2015-06-01

    Laparoscopic resection rectopexy is one of the surgical options for the treatment of external rectal prolapse. A standardised and reproducible procedure for this operation is a decisive advantage for such cases. The operation can be divided in 11 substeps, so-called nodal points, which must be reached before further progress can be made and simplify the operation by dividing the procedure into substeps. This manuscript and the accompanying film demonstrate the standardised laparoscopic resection rectopexy as taught in the "Surgical Training Center Tübingen," and performed at the University Hospital of Tübingen.

  15. A case of rectal Dieulafoy's ulcer and successful endoscopic sclerotherapy.

    PubMed

    Matsuoka, J; Taniai, K; Kojima, K; Kenmotsu, M; Takai, K; Okabe, T; Tanaka, N

    2000-12-01

    A 54-year-old woman presented a massive hematochezia 7 days after sigmoidectomy. Repeated colonoscopy and angiography failed to locate the site of bleeding and Hartman's operation was performed. Rebleeding from the rectum on the day of operation occurred and pulsate arterial bleeding with minimal surrounding ulcer 1 cm above the pectinate line was observed. Screlotherapy with ethanol and electro coagulation was successfully performed to achieve permanent hemostasis. The importance of detailed rectal examination and an awareness of this clinical entity in life-threatening lower intestinal bleeding is discussed.

  16. Tumeur stromale rectale: à propos d'une observation

    PubMed Central

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

    2014-01-01

    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

  17. Rectal Carriage of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Selective Preenrichment Increases Yield of Screening

    PubMed Central

    Verhulst, C.; Willemsen, L. E.; Verkade, E.; Bonten, M. J. M.; Kluytmans, J. A. J. W.

    2015-01-01

    This study evaluated the added value of selective preenrichment for the detection of rectal carriage of extended-spectrum-beta-lactamase-producing Enterobacteriaceae (ESBL-E). ESBL-E rectal carriage was identified in 4.8% of hospitalized patients, and 25.9% of ESBL-E rectal carriers were identified with selective preenrichment only. PMID:25994164

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

    ClinicalTrials.gov

    2016-01-22

    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

  19. Melanocytic Nevus on the Rectal Mucosa Removed Using Endoscopic Submucosal Dissection.

    PubMed

    Kim, Seong Min; Shin, Yoon Ji; Sim, Ju Sung; Lee, Beon Jae; Joo, Moon Kyung; Park, Jong-Jae; Bak, Young-Tae

    2016-07-01

    Melanocytic nevus is the benign proliferation of melanocytes. The most common location of melanocytic nevus is the skin of the extremities; however, there are few case reports of melanocytic nevus at the rectal mucosa. No prior case of malignant melanoma from melanocytic nevus at the rectal mucosa has been reported; therefore, it is unclear whether resection should be performed or close observation is sufficient. However, the potential malignant transformation of melanocytic nevus should be considered, including melanocytic nevus on the rectum. Melanocytic nevus of the skin can be removed by surgical excision; however, due to rare incidence on the mucosa of the gastrointestinal tract, the optimal treatment for rectal melanocytic nevus remains controversial. Here, we report the first case of melanocytic nevus on the rectal mucosa that was removed by endoscopic submucosal dissection. This case report provides useful information about the optimal management of rectal melanocytic nevus.

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

    PubMed Central

    Urgancı, Nafiye; Eken, Kamile Gulcin

    2013-01-01

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

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

    PubMed

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

    2014-02-01

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

  2. High-dose-rate pre-operative endorectal brachytherapy for patients with rectal cancer

    PubMed Central

    Devic, Slobodan

    2015-01-01

    High-dose-rate endorectal brachytherapy (HDREBT) is an image guided brachytherapy treatment for patients with rectal cancer. It is based on tumor imaging with magnetic resonance in particular, which is used to choose eligible patients and improve tumor visualization. Treatment planning is performed using 3D CT simulation and treatment planning. The treatment is given on an outpatient basis and requires minimal local anesthesia. The validation of the technique was carried out through a preoperative study and is now explored as part of a radical treatment for early rectal cancer or as a boost modality. We describe technical aspects of the HDREBT and we discuss the ongoing institutional review board approved studies exploring the clinical applications of this treatment modality for patients with rectal cancer: 1) as a neoadjuvant treatment for patients with operable rectal tumor; 2) as a option to improve local control in patients with newly diagnosed rectal cancer but with previous pelvic radiation. PMID:26034500

  3. Synthetic laser medium

    DOEpatents

    Stokowski, Stanley E.

    1989-01-01

    A laser medium is particularly useful in high average power solid state lasers. The laser medium includes a chormium dopant and preferably neodymium ions as codopant, and is primarily a gadolinium scandium gallium garnet, or an analog thereof. Divalent cations inhibit spiral morphology as large boules from which the laser medium is derived are grown, and a source of ions convertible between a trivalent state and a tetravalent state at a low ionization energy are in the laser medium to reduce an absorption coefficient at about one micron wavelength otherwise caused by the divalent cations. These divalent cations and convertible ions are dispersed in the laser medium. Preferred convertible ions are provided from titanium or cerium sources.

  4. Synthetic laser medium

    DOEpatents

    Stokowski, S.E.

    1987-10-20

    A laser medium is particularly useful in high average power solid state lasers. The laser medium includes a chromium dopant and preferably neodymium ions as codopant, and is primarily a gadolinium scandium gallium garnet, or an analog thereof. Divalent cations inhibit spiral morphology as large boules from which the laser medium is derived are grown, and a source of ions convertible between a trivalent state and a tetravalent state at a low ionization energy are in the laser medium to reduce an absorption coefficient at about one micron wavelength otherwise caused by the divalent cations. These divalent cations and convertible ions are dispersed in the laser medium. Preferred convertible ions are provided from titanium or cerium sources.

  5. Behavioral Contrast in Infants.

    ERIC Educational Resources Information Center

    Fagen, Jeffrey W.

    This study used the behavioral contrast paradigm to assess the excitatory and inhibitory capabilities of young infants. Behavioral contrast is described as the phenomenon whereby the rates of responding in the presence of two stimuli, both of which were previously associated with reinforcement, change in opposite directions when only one of them…

  6. Methylene blue injection into the rectal artery as a simple method to improve lymph node harvest in rectal cancer.

    PubMed

    Märkl, Bruno; Kerwel, Therese G; Wagner, Theodor; Anthuber, Matthias; Arnholdt, Hans M

    2007-07-01

    Adequate lymph node assessment in colorectal cancer is crucial for prognosis estimation and further therapy stratification. However, there is still an ongoing debate on required minimum lymph node numbers and the necessity of advanced techniques such as immunohistochemistry or PCR. It has been proven in several studies that lymph node harvest is often inadequate under routine analysis. Lymph nodes smaller than 5 mm are especially concerning as they can carry the majority of metastases. These small, but affected lymph nodes may escape detection in routine analysis. Therefore, fat-clearing protocols and sentinel techniques have been developed to improve accuracy of lymph node staging. We describe a novel and simple method of ex vivo methylene blue injection into the superior rectal artery of rectal cancer specimens, which highlights lymph nodes and makes them easy to detect during manual dissection. Initially, this method was developed for proving accuracy of total mesorectal excision. We performed a retrospective study comparing lymph node recovery of 12 methylene blue stained and an equal number of unstained cases. Lymph node recovery differed significantly with average lymph node numbers of 27+/-7 and 14+/-4 (P<0.001) for the methylene blue and the unstained group, respectively. The largest difference was found in size groups between 1 and 4 mm causing a shift in size distribution toward smaller nodes. Metastases were confirmed in 21 and 19 lymph nodes occurring in five and four cases, respectively. Hence, we conclude that methylene blue injection technique improves accuracy of lymph node staging by heightening the lymph node harvest in rectal resections. In our experience, it is a very simple time and cost effective method that can be easily established under routine circumstances.

  7. YpT1-2N0 rectal cancer after neoadjuvant chemoradiation has lower survival compared with pT1-2N0 rectal cancer

    PubMed Central

    Wan, Jue-feng; Zhu, Ji; Li, Gui-chao; Sun, Wen-jie; Zhang, Zhen

    2015-01-01

    Pathologic T1-2N0 rectal cancer shows an excellent prognosis without preoperative or postoperative chemoradiation. However, oncologic outcome of ypT1-2N0 remains unclear and undetermined. Thus, the aim of this study was to compare the survival of ypT1-2 and pT1-2 rectal cancer patients after radical resection and identify risk factors of ypT1-2 rectal cancer in Surveillance, Epidemiology, and End Results Program (SEER)-registered rectal cancer patients. The results showed that ypT1-2N0 rectal cancer after neoadjuvant chemoradiation has lower survival compared with pT1-2N0 rectal cancer and mucinous/signet-ring cancer and less than 12 lymph nodes retrieval were two risk factors in ypT1-2 patients. These results suggest that ypT1-2 patients with one or two risk factors may benefit from postoperative adjuvant chemotherapy. PMID:26517674

  8. Massive rectal bleeding distant from a blunt car trauma.

    PubMed

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

    2010-09-01

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

  9. [Palliative Care for Rectal Cancer Complicated with Gastric Cancer].

    PubMed

    Furukawa, Takeshi; Takahashi, Hitoshi; Tanaka, Kei; Muto, Takaaki

    2015-11-01

    Medical advancements have led to an increase in the number of elderly people. However, standard treatments may sometimes be difficult to use in elderly people. Here, we report the case of an elderly patient with rectal and gastric cancer who refused radical surgery. The patient was an 83-year-old man who had type-2 diabetes, hypertension, hyperuricemia, mitral valve regurgitation, and mild dementia. Furthermore, he was blind in both eyes owing to glaucoma. He first visited our hospital in 2005. In 2010, he was diagnosed with anemia, but he refused a thorough examination; however, he did consent to take iron supplements. In July 2011, he consulted our hospital for symptoms of frequent diarrhea, and agreed to an examination. After colonoscopy, he was diagnosed with rectal cancer that was becoming obstructive. There were no metastases to other organs, but he was also diagnosed with gastric cancer. As he and his family refused radical surgery, a stoma was constructed. After the operation, he received palliative care but died in September 2013. PMID:26805335

  10. Neoadjuvant Therapy in Rectal Cancer - Biobanking of Preoperative Tumor Biopsies

    PubMed Central

    Jo, Peter; Nietert, Manuel; Gusky, Linda; Kitz, Julia; Conradi, Lena C.; Müller-Dornieden, Annegret; Schüler, Philipp; Wolff, Hendrik A.; Rüschoff, Josef; Ströbel, Philipp; Grade, Marian; Liersch, Torsten; Beißbarth, Tim; Ghadimi, Michael B.; Sax, Ulrich; Gaedcke, Jochen

    2016-01-01

    Translational research relies on high-quality biospecimens. In patients with rectal cancer treated preoperatively with radiochemotherapy tissue based analyses are challenging. To assess quality challenges we analyzed tissue samples taken over the last years in a multicenter setting. We retrospectively evaluated overall 197 patients of the CAO/ARO/AIO-94- and 04-trial with locally advanced rectal cancer that were biopsied preoperatively at the University Medical Center Goettingen as well as in 10 cooperating hospitals in Germany. The cellular content of tumor, mucosa, stroma, necrosis and the amount of isolated DNA and RNA as well as the RNA integrity number (RIN) as quality parameters were evaluated. A high RNA yield (p = 2.75e–07) and the content of tumor (p = 0.004) is significantly associated to high RIN-values, whereas a high content of mucosa (p = 0.07) shows a trend and a high amount of necrosis (p = 0.01) is significantly associated with RNA of poor quality. Correlating biopsies from Goettingen and the cooperating centers showed comparable tumor content results. By taking small sized biopsies we could assess a clear correlation between a good RNA quality and a high amount of RNA and tumor cells. These results also indicate that specimens collected at different centers are of comparable quality. PMID:27752113

  11. The influence of hormone therapies on colon and rectal cancer.

    PubMed

    Mørch, Lina Steinrud; Lidegaard, Øjvind; Keiding, Niels; Løkkegaard, Ellen; Kjær, Susanne Krüger

    2016-05-01

    Exogenous sex hormones seem to play a role in colorectal carcinogenesis. Little is known about the influence of different types or durations of postmenopausal hormone therapy (HT) on colorectal cancer risk. A nationwide cohort of women 50-79 years old without previous cancer (n = 1,006,219) were followed 1995-2009. Information on HT exposures was from the National Prescription Register and updated daily, while information on colon (n = 8377) and rectal cancers (n = 4742) were from the National Cancer Registry. Potential confounders were obtained from other national registers. Poisson regression analyses with 5-year age bands included hormone exposures as time-dependent covariates. Use of estrogen-only therapy and combined therapy were associated with decreased risks of colon cancer (adjusted incidence rate ratio 0.77, 95 % confidence interval 0.68-0.86 and 0.88, 0.80-0.96) and rectal cancer (0.83, 0.72-0.96 and 0.89, 0.80-1.00), compared to never users. Transdermal estrogen-only therapy implied more protection than oral administration, while no significant influence was found of regimen, progestin type, nor of tibolone. The benefit of HT was stronger for long-term hormone users; and hormone users were at lower risk of advanced stage of colorectal cancer, which seems supportive for a causal association between hormone therapy and colorectal cancer. PMID:26758900

  12. Neoadjuvant treatment for locally advanced rectal cancer: a systematic review.

    PubMed

    Uehara, Keisuke; Nagino, Masato

    2016-02-01

    We reviewed the history and the current status of neoadjuvant treatment for locally advanced rectal cancer (LARC) in Western countries and Japan. The introduction of total mesorectal excision (TME) and preoperative radiotherapy (RT) were treatment revolutions that resulted in improved local control after curative resection for rectal cancer. However, local relapses still occur, even in the era of TME, and remain a cause of recurrence worldwide. The high rate of distant metastasis after curative resection remains a problem. Furthermore, the introduction of newly developed cytotoxic agents into the LARC treatment strategy continues to be an ongoing challenge. Shifting part of an adjuvant chemotherapy (CTx) regimen to the preoperative period is a promising strategy. Currently, various novel methods, such as induction CTx, consolidation CTx, concomitant administration with RT, and neoadjuvant CTx without RT, have been attempted worldwide. Although some strategies have shown favorable short-term outcomes, the long-term efficacy of the treatments needs be evaluated. At the same time, we must investigate clinical and/or molecular biomarkers to predict the therapeutic effects of each treatment, which is the fastest route to providing ideal personalized therapy for patients with LARC.

  13. Formulation and Evaluation of Irinotecan Suppository for Rectal Administration

    PubMed Central

    Feng, Haiyang; Zhu, Yuping; Li, Dechuan

    2014-01-01

    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 μg·h/ml and 82.3 ± 9.5 μg·h/ml, respectively. Following rectal administration of 100 mg/kg irinotecan, the plasma irinotecan concentration reached a peak of 5.3 ± 2.5 μg/ml at 4 h. The AUC0–30h and AUC0-∞ were 32.2 ± 6.2 μg·h/ml and 41.6 ± 7.2 μg·h/ml, respectively. It representing ∼50.6% of the absolute bioavailability. PMID:24596626

  14. Robotic Versus Laparoscopic Resection for Mid and Low Rectal Cancers

    PubMed Central

    Salman, Bulent; Yuksel, Osman

    2016-01-01

    Background and Objectives: The current study was conducted to determine whether robotic low anterior resection (RLAR) has real benefit over laparoscopic low anterior resection (LLAR) in terms of surgical and early oncologic outcomes. Methods: We retrospectively analyzed data from 35 RLARs and 28 LLARs, performed for mid and low rectal cancers, from January 2013 through June 2015. Results: A total of 63 patients were included in the study. All surgeries were performed successfully. The clinicopathologic characteristics were similar between the 2 groups. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss (165 vs. 120 mL; P < .05) and higher mean operative time (252 vs. 208 min; P < .05). No significant differences were observed in the time to flatus passage, length of hospital stay, and postoperative morbidity. Pathological examination of total mesorectal excision (TME) specimens showed that both circumferential resection margin and transverse (proximal and distal) margins were negative in the RLAR group. However, 1 patient each had positive circumferential resection margin and positive distal transverse margin in the LLAR group. The mean number of harvested lymph nodes was 27 in the RLAR group and 23 in the LLAR group. Conclusions: In our study, short-term outcomes of robotic surgery for mid and low rectal cancers were similar to those of laparoscopic surgery. The quality of TME specimens was better in the patients who underwent robotic surgery. However, the longer operative time was a limitation of robotic surgery. PMID:27081292

  15. Pilot Study of a Clinical Pathway Implementation in Rectal Cancer

    PubMed Central

    Uña, Esther; López-Lara, Francisco

    2010-01-01

    Background: Rectal cancer is a highly prevalent disease which needs a multidisciplinary approach to be treated. The absence of specific protocols implies a significant and unjustifiable variability among the different professionals involved in this disease. The purpose is to develop a clinical pathway based on the analysis process and aims to reduce this variability and to reduce unnecessary costs. Methods: We created a multidisciplinary team with contributors from every clinical area involved in the diagnosis and treatment in this disease. We held periodic meetings to agree on a protocol based on the best available clinical practice guidelines. Once we had agreed on the protocol, we implemented its use as a standard in our institution. Every patient older than 18 years who was diagnosed with rectal cancer was considered a candidate to be treated via the pathway. Results: We evaluated 48 patients during the course of this study. Every parameter measured was improved after the implementation of the pathway, except the proportion of patients with 12 nodes or more analysed. The perception that our patients had about this project was very good. Conclusions: Clinical pathways are needed to improve the quality of health care. This kind of project helps reduce hospital costs and optimizes the use of limited resources. On the other hand, unexplained variability is also reduced, with consequent benefits for the patients. PMID:21151842

  16. Watch and wait approach to rectal cancer: A review.

    PubMed

    Pozo, Marcos E; Fang, Sandy H

    2015-11-27

    In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leading cause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage III (node-positive) disease. For stage II and III colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluation-this is known as complete clinical response (cCR). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with cCR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.

  17. Rectal prolapse: a search for the "best" operation.

    PubMed

    Azimuddin, K; Khubchandani, I T; Rosen, L; Stasik, J J; Riether, R D; Reed, J F

    2001-07-01

    There is a lack of consensus regarding the optimal operative treatment for full-thickness rectal prolapse. We describe our experience in the management of procidentia and evaluate our current practice for improvement of results. The medical records of patients undergoing surgery for rectal prolapse between 1989 to 1999 were retrospectively reviewed. A total of 36 perineal proctosigmoidectomies (PPSs) and 29 abdominal procedures [17 anterior resections (ARs) and 12 Ripstein procedures (RPs)] were performed during the 10-year period. Patients undergoing PPS were significantly older and had more comorbidities. Mean operating time and length of hospital stay were shorter for the PPS group. Early and late postoperative complication rates were also significantly lower in the PPS group. Six patients (16%) in the PPS group developed recurrence at a mean follow-up of 50 months. Operation under general anesthesia or removal of a longer segment of prolapsed bowel did not reduce recurrence after PPS. No full-thickness recurrence was noted after AR or RP. We conclude that abdominal procedures (AR and RP) have the lowest recurrence but at a significantly higher cost in terms of complications. PPS is a valuable option in selected patients and can be performed with minimal morbidity and a relatively low recurrence rate. PMID:11450773

  18. Current debate in the oncologic management of rectal cancer

    PubMed Central

    Millard, Trish; Kunk, Paul R; Ramsdale, Erika; Rahma, Osama E

    2016-01-01

    Despite the considerable amount of research in the field, the management of locally advanced rectal cancer remains a subject to debate. To date, effective treatment centers on surgical resection with the standard approach of total mesorectal resection. Radiation therapy and chemotherapy have been incorporated in order to decrease local and systemic recurrence. While it is accepted that a multimodality treatment regimen is indicated, there remains significant debate for how best to accomplish this in regards to order, dosing, and choice of agents. Preoperative radiation is the standard of care, yet remains debated with the option for chemoradiation, short course radiation, and even ongoing studies looking at the possibility of leaving radiation out altogether. Chemotherapy was traditionally incorporated in the adjuvant setting, but recent reports suggest the possibility of improved efficacy and tolerance when given upfront. In this review, the major studies in the management of locally advanced rectal cancer will be discussed. In addition, future directions will be considered such as the role of immunotherapy and ongoing trials looking at timing of chemotherapy, inclusion of radiation, and non-operative management. PMID:27795811

  19. Compressive Phase Contrast Tomography

    SciTech Connect

    Maia, Filipe; MacDowell, Alastair; Marchesini, Stefano; Padmore, Howard A.; Parkinson, Dula Y.; Pien, Jack; Schirotzek, Andre; Yang, Chao

    2010-09-01

    When x-rays penetrate soft matter, their phase changes more rapidly than their amplitude. Interference effects visible with high brightness sources creates higher contrast, edge enhanced images. When the object is piecewise smooth (made of big blocks of a few components), such higher contrast datasets have a sparse solution. We apply basis pursuit solvers to improve SNR, remove ring artifacts, reduce the number of views and radiation dose from phase contrast datasets collected at the Hard X-Ray Micro Tomography Beamline at the Advanced Light Source. We report a GPU code for the most computationally intensive task, the gridding and inverse gridding algorithm (non uniform sampled Fourier transform).

  20. Image-guided intensity-modulated radiotherapy for prostate cancer: Dose constraints for the anterior rectal wall to minimize rectal toxicity

    SciTech Connect

    Peterson, Jennifer L.; Buskirk, Steven J.; Heckman, Michael G.; Diehl, Nancy N.; Bernard, Johnny R.; Tzou, Katherine S.; Casale, Henry E.; Bellefontaine, Louis P.; Serago, Christopher; Kim, Siyong; Vallow, Laura A.; Daugherty, Larry C.; Ko, Stephen J.

    2014-04-01

    Rectal adverse events (AEs) are a major concern with definitive radiotherapy (RT) treatment for prostate cancer. The anterior rectal wall is at the greatest risk of injury as it lies closest to the target volume and receives the highest dose of RT. This study evaluated the absolute volume of anterior rectal wall receiving a high dose to identify potential ideal dose constraints that can minimize rectal AEs. A total of 111 consecutive patients with Stage T1c to T3a N0 M0 prostate cancer who underwent image-guided intensity-modulated RT at our institution were included. AEs were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. The volume of anterior rectal wall receiving 5 to 80 Gy in 2.5-Gy increments was determined. Multivariable Cox regression models were used to identify cut points in these volumes that led to an increased risk of early and late rectal AEs. Early AEs occurred in most patients (88%); however, relatively few of them (13%) were grade ≥2. At 5 years, the cumulative incidence of late rectal AEs was 37%, with only 5% being grade ≥2. For almost all RT doses, we identified a threshold of irradiated absolute volume of anterior rectal wall above which there was at least a trend toward a significantly higher rate of AEs. Most strikingly, patients with more than 1.29, 0.73, or 0.45 cm{sup 3} of anterior rectal wall exposed to radiation doses of 67.5, 70, or 72.5 Gy, respectively, had a significantly increased risk of late AEs (relative risks [RR]: 2.18 to 2.72; p ≤ 0.041) and of grade ≥ 2 early AEs (RR: 6.36 to 6.48; p = 0.004). Our study provides evidence that definitive image-guided intensity-modulated radiotherapy (IG-IMRT) for prostate cancer is well tolerated and also identifies dose thresholds for the absolute volume of anterior rectal wall above which patients are at greater risk of early and late complications.

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

    SciTech Connect

    Kochhar, R.; Patel, F.; Dhar, A.; Sharma, S.C.; Ayyagari, S.; Aggarwal, R.; Goenka, M.K.; Gupta, B.D.; Mehta, S.K. )

    1991-01-01

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

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

    PubMed Central

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

    2012-01-01

    Interleukins are a group of cytokines that contribute to growth and differentiation, cell migration, and inflammatory and anti-inflammatory responses by the immune system. In this study we examined genetic variation in genes from various anti-inflammatory and pro-inflammatory interleukins to determine association with colon and rectal cancer risk and overall survival. Data from two population-based incident studies of colon cancer (1555 cases and 1956 controls) and rectal cancer (754 cases and 954 controls) were utilized. After controlling for multiple comparisons, single nucleotide polymorphisms (SNPs) from four genes, IL3, IL6R, IL8, IL15, were associated with increased colon cancer risk and CXCR1, and CXCR2 were significantly associated with increased rectal cancer risk. Only SNPs from genes within the IL-8 pathway (IL8, CXCR1, and CXCR2) showed a significant association with both colon and rectal cancer risk. Several SNPs interacted significantly with IL8 and IFNG SNPs and with aspirin/NSAID, cigarette smoking, estrogen use and BMI. For both colon and rectal cancer, increasing numbers of risk alleles were associated with increased hazard of death from cancer; the estimated hazard of death for colon cancer for the highest category of risk alleles was 1.74 (95% CI 1.18–2.56) and 1.96 (95% CI 1.28–2.99) for rectal cancer. These data suggest interleukin genes play a role in risk and overall survival for colon and rectal cancer. PMID:22674296

  3. Rectal cancer: An evidence-based update for primary care providers

    PubMed Central

    Gaertner, Wolfgang B; Kwaan, Mary R; Madoff, Robert D; Melton, Genevieve B

    2015-01-01

    Rectal adenocarcinoma is an important cause of cancer-related deaths worldwide, and key anatomic differences between the rectum and the colon have significant implications for management of rectal cancer. Many advances have been made in the diagnosis and management of rectal cancer. These include clinical staging with imaging studies such as endorectal ultrasound and pelvic magnetic resonance imaging, operative approaches such as transanal endoscopic microsurgery and laparoscopic and robotic assisted proctectomy, as well as refined neoadjuvant and adjuvant therapies. For stage II and III rectal cancers, combined chemoradiotherapy offers the lowest rates of local and distant relapse, and is delivered neoadjuvantly to improve tolerability and optimize surgical outcomes, particularly when sphincter-sparing surgery is an endpoint. The goal in rectal cancer treatment is to optimize disease-free and overall survival while minimizing the risk of local recurrence and toxicity from both radiation and systemic therapy. Optimal patient outcomes depend on multidisciplinary involvement for tailored therapy. The successful management of rectal cancer requires a multidisciplinary approach, with the involvement of enterostomal nurses, gastroenterologists, medical and radiation oncologists, radiologists, pathologists and surgeons. The identification of patients who are candidates for combined modality treatment is particularly useful to optimize outcomes. This article provides an overview of the diagnosis, staging and multimodal therapy of patients with rectal cancer for primary care providers. PMID:26167068

  4. Ultrastructure of the excretory organs of Bombus morio (Hymenoptera: Bombini): bee without rectal pads.

    PubMed

    Gonçalves, Wagner Gonzaga; Fialho, Maria do Carmo Queiroz; Azevedo, Dihego Oliveira; Zanuncio, José Cola; Serrão, José Eduardo

    2014-02-01

    Bumblebees need to keep bodily homeostasis and for that have an efficient system of excretion formed by the Malpighian tubules, ileum, and rectum. We analyzed the excretory organs of Bombus morio, a bee without rectal pads. In addition, we analyzed the rectal epithelium of Melipona quadrifasciata anthidioides which has rectal pads. The Malpighian tubules exhibited two cell types and the ileum four types. However, comparative analysis of the rectum showed that only cells of the anterior region of the rectal epithelium of B. morio are structurally distinct. We suggest that cells of the Malpighian tubules of B. morio have an excretory feature and that cells of ileum have different functions, such as ion absorption and water, organic compound, and protein secretion. In addition, only the anterior region of the rectum of B. morio showed characteristic absorption. We suggest that Malpighian tubules participate in the excretion of solutes and that the ileum and rectal epithelium are responsible for homeostasis of water and solutes, compensating for the absence of rectal papillae. These results contribute to our understanding of the morphophysiology of the excretory organs of bees without rectal pads.

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

    PubMed Central

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

    2014-01-01

    Rectal prolapses are not life-threatening, however the bleeding and fecal incontinence associated with them significantly erode quality of life and can cause concern among patients’ caregivers in nursing homes. Many procedures have been reported that repair rectal prolapses, and the procedure used depends on the severity of the prolapse; however, the treatments are yet to be established. Here we report a simple and safe procedure to repair rectal prolapse perineally using stapling devices. We performed this procedure on 5 patients within a short time. All patients were followed up for over 24 months and none had any recurrences of their rectal prolapses. No complications occurred during the operations and postoperative periods. Most patients who have prolapses are elderly and fragile, so the treatment must be easy, safe, and rapid. While rectal prolapse is not life-threatening, the goal of treatment is to alleviate its symptoms. The procedure we describe is consistent with this concept. We suggest that this procedure, which uses surgical stapling devices, might be a better option for the treatment of complete rectal prolapse. We will continue to surgically correct complete rectal prolapses and investigate the long-term outcomes of the procedure. PMID:24574948

  6. Comparison of rectal, tympanic membrane and axillary temperature measurement methods in dogs.

    PubMed

    Lamb, V; McBrearty, A R

    2013-11-30

    The aim of this study was to compare axillary and tympanic membrane (TM) temperature measurements to rectal temperature in a large group of clinical canine patients. We also sought to ascertain whether certain factors affected the differences between the measurements and to compare the ease of measurement. Axillary temperatures were easy to obtain but tended to be lower than rectal readings (median difference 0.6°C). In 54.7 per cent of dogs there was a difference of >0.5°C between the two readings. Weight, coat length, body condition score and breed size were significantly associated with the difference between the rectal and axillary temperature. TM temperatures were more similar to rectal temperatures (median difference 0°C) but in 25 per cent of dogs, there was a difference of >0.5°C between rectal and TM readings. TM measurements were less well tolerated than axillary measurements. None of the factors assessed were associated with the difference between the rectal and TM temperature. As a difference of >0.5°C has previously been described as unacceptable for different methods of temperature measurement, neither axillary nor TM temperatures are interchangeable with rectal temperatures for the measurement of body temperature.

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

    PubMed

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

    2012-04-01

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

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

    PubMed Central

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

    2010-01-01

    We here report a 43-year-old male patient with minute liver metastases from a rectal carcinoid. Hepatic nodules were diagnosed during surgery, although they were not diagnosed by preoperative computed tomography or ultrasound examination. The rectal carcinoid was resected together with liver metastases and the patient has had no disease recurrence for 5 years following postoperative treatment of hepatic arterial infusion chemotherapy (HAIC) using 5-fluorouracil (5-FU) and oral administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU). In 2003, a health check examination indicated presence of occult blood in his stool. Barium enema study revealed a rectal tumor in the lower rectum and colonoscopy showed a yellowish lesion with a size of 30 mm in diameter. Pathological examination of the biopsy specimen indicated that the rectal tumor was carcinoid. Although preoperative imaging examinations failed to detect liver metastases, 2 min nodules were found on the surface of liver during surgery. A rapid pathological examination revealed that they were metastatic tumors from the rectal carcinoid. Low anterior resection was performed for the rectal tumor and the pathological report indicated that there were 4 metastatic lymph nodes in the rectal mesentery. The patient received treatment by HAIC using 5-FU plus oral administration of HCFU and survived for 5 years. We also review world-wide current treatments and their efficacy for hepatic metastases of carcinoid tumors. PMID:21160856

  9. Advantages of the robotic approach to deep infiltrating rectal endometriosis: because less is more.

    PubMed

    Araujo, Sergio Eduardo Alonso; Seid, Victor Edmond; Marques, Renato Moretti; Gomes, Mariano Tamura Vieira

    2016-06-01

    For symptomatic deep infiltrating endometriosis, surgery is often required to achieve symptom relief and restore fertility. A minimally invasive approach using laparoscopy is considered the gold standard. However, specific limitations of the laparoscopic approach deep in the pelvis keep challenging even surgeons with a solid experience with minimally invasive techniques. Robotic surgery has the potential to compensate for technical drawbacks inherent in conventional laparoscopic surgery, such as limited degree of freedom, two-dimensional vision, and the fulcrum effect. In the present report, we aim at demonstrating the central role of robotic surgery for deep infiltrating endometriosis, with special emphasis in the ability to practice organ (rectal) preservation. A 45-year-old white female with a 4-month history of chronic pelvic pain, dyschezia, and dysmenorrhea, refractory to hormonal therapy was referred to our unit. MRI findings were diagnostic of deep infiltrating endometriosis (retrocervical and rectovaginal) extending to the anterior rectal serosal layer (partial-thickness rectal invasion). Using a fully robotic approach, appropriate dissection of the rectovaginal septum and of the extraperitoneal rectum followed by complete excision of the endometriotic rectal nodule with organ (rectal) preservation was undertaken. It is our belief that using a robotic approach, the potential to boost rectal preservation might be established. Moreover, it is possible that in many cases, a robotic operation may allow the surgeon to perform the intervention with greater accuracy and comfort. As a result, more patients with deep infiltrating endometriosis may benefit from rectal sparing procedures. PMID:27072152

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

    SciTech Connect

    Taussky, Daniel; Yeung, Ivan; Williams, Theresa; Pearson, Shannon; McLean, Michael; Pond, Gregory; Crook, Juanita . E-mail: Juanita.crook@rmp.uhn.on.ca

    2006-06-01

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

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

    PubMed Central

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

    2013-01-01

    Background/Aims The patients with rectal prolapse suffer from not only a prolapse rectum but also associated dysfunction. However, most surgical techniques are successful regarding the prolapse, but either do not solve or even worsen defecation dysfunction. The purpose of this study was to investigate the functional and physiological results after surgical correction in patients with rectal prolapse. Methods This study is a retrospective review of a single-institution experience. Patients with rectal prolapse who underwent anorectal manometry before and after Delorme's procedure were included. The primary outcomes measured were improvement of clinical symptoms and physiologic study. Results Consecutive 19 patients with rectal prolapse (17 females, mean age of 68.1 ± 10.8 years) underwent anorectal manometry before and after Delorme's procedure. The two most prevalent symptoms before operation were rectal tenesmus (15/19, 78.9%) and excessive straining (13/19, 68.4%). The two most prevalent symptoms after operation were rectal tenesmus (14/19, 73.6%) and excessive straining (13/19, 68.4%). No significant differences in resting anal pressure, squeezing anal pressure, defecation index, and rectal sense were found postoperatively. However, vector asymmetry index before surgery was higher than that after surgery (35.0 vs. 32.0, P = 0.018). Ten patients (52.5%) had type I dyssynergic defecation before surgery. No improvement of dyssynergic pattern occurred after surgery. Conclusions In conclusion, dyssynergic defecation was not improved after reduction of rectal prolapse in patients with rectal prolapse. Further study about combination treatment with biofeedback therapy in these subgroups may be necessary. PMID:23350052

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

    SciTech Connect

    Price, Jeremy G.; Stone, Nelson N.; Stock, Richard G.

    2013-08-01

    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

  13. Heterogeneity of KRAS Mutation Status in Rectal Cancer

    PubMed Central

    Jo, Peter; König, Alexander; Schirmer, Markus; Kitz, Julia; Conradi, Lena-Christin; Azizian, Azadeh; Bernhardt, Markus; Wolff, Hendrik A.; Grade, Marian; Ghadimi, Michael; Ströbel, Philipp; Schildhaus, Hans-Ulrich; Gaedcke, Jochen

    2016-01-01

    Introduction Anti-EGFR targeted therapy is of increasing importance in advanced colorectal cancer and prior KRAS mutation testing is mandatory for therapy. However, at which occasions this should be performed is still under debate. We aimed to assess in patients with locally advanced rectal cancer whether there is intra-specimen KRAS heterogeneity prior to and upon preoperative chemoradiotherapy (CRT), and if there are any changes in KRAS mutation status due to this intervention. Materials and Methods KRAS mutation status analyses were performed in 199 tumor samples from 47 patients with rectal cancer. To evaluate the heterogeneity between different tumor areas within the same tumor prior to preoperative CRT, 114 biopsies from 34 patients (mean 3 biopsies per patient) were analyzed (pre-therapeutic intratumoral heterogeneity). For the assessment of heterogeneity after CRT residual tumor tissue (85 samples) from 12 patients (mean 4.2 tissue samples per patient) were analyzed (post-therapeutic intratumoral heterogeneity) and assessment of heterogeneity before and after CRT was evaluated in corresponding patient samples (interventional heterogeneity). Primer extension method (SNaPshot™) was used for initial KRAS mutation status testing for Codon 12, 13, 61, and 146. Discordant results by this method were reevaluated by using the FDA-approved KRAS Pyro Kit 24, V1 and the RAS Extension Pyro Kit 24, V1 Kit (therascreen® KRAS test). Results For 20 (43%) out of the 47 patients, a KRAS mutation was detected. With 12 out of 20, the majority of these mutations affected codon 35. We did not obtained evidence that CRT results in changes of the KRAS mutation pattern. In addition, no intratumoral heterogeneity in the KRAS mutational status could be proven. This was true for both the biopsies prior to CRT and the resection specimens thereafter. The discrepancy observed in some samples when using the SNaPshot™ assay was due to insufficient sensitivity of this technique upon

  14. [Conversion Therapy of Initially Unresectable Rectal Cancer with Perforation via FOLFOX4 Chemotherapy].

    PubMed

    Yamada, Chizu; Ishikawa, Fumihiko; Nitta, Hiroshi; Fujita, Yoshihisa; Omoto, Hideyuki; Kamata, Shigeyuki; Ito, Hiroshi

    2015-11-01

    We describe a case of perforated rectal cancer that became curatively resectable after FOLFOX4 chemotherapy. An 81- year-old woman was transferred to our hospital with a diagnosis of bowel perforation. She underwent emergency transverse colostomy, peritoneal lavage, and the insertion of indwelling drainage tubes, because the perforated rectal cancer was considered unresectable. After recuperation, she received chemotherapy consisting of FOLFOX4 and bevacizumab. Owing to a good response to the treatment after 4 months, rectal resection was achieved curatively. Wound dehiscence occurred as a postoperative complication. The patient chose not to receive adjuvant chemotherapy. Currently, she has been alive for more than 1 year 3 months after resection without recurrence.

  15. Expect the unexpected: Endometriosis mimicking a rectal carcinoma in a post-menopausal lady

    PubMed Central

    Jakhmola, C. K.; Kumar, Ameet; Sunita, B. S.

    2016-01-01

    Altered bowels habits along with rectal mass in an elderly would point toward a rectal cancer. We report an unusual case of a post-menopausal lady who presented with these complaints. We had difficulties in establishing a pre-operative diagnosis. With a tentative diagnosis of a rectal cancer/gastrointestinal stromal tumor, she underwent a laparoscopic anterior resection. On histopathology, this turned out to be endometriosis. Bowel endometriosis is an uncommon occurrence. That it occurred in a post-menopausal lady was a very unusual finding. We discuss the case, its management, and the relevant literature. PMID:27073315

  16. Psychophysical contrast calibration

    PubMed Central

    To, Long; Woods, Russell L; Goldstein, Robert B; Peli, Eli

    2013-01-01

    Electronic displays and computer systems offer numerous advantages for clinical vision testing. Laboratory and clinical measurements of various functions and in particular of (letter) contrast sensitivity require accurately calibrated display contrast. In the laboratory this is achieved using expensive light meters. We developed and evaluated a novel method that uses only psychophysical responses of a person with normal vision to calibrate the luminance contrast of displays for experimental and clinical applications. Our method combines psychophysical techniques (1) for detection (and thus elimination or reduction) of display saturating nonlinearities; (2) for luminance (gamma function) estimation and linearization without use of a photometer; and (3) to measure without a photometer the luminance ratios of the display’s three color channels that are used in a bit-stealing procedure to expand the luminance resolution of the display. Using a photometer we verified that the calibration achieved with this procedure is accurate for both LCD and CRT displays enabling testing of letter contrast sensitivity to 0.5%. Our visual calibration procedure enables clinical, internet and home implementation and calibration verification of electronic contrast testing. PMID:23643843

  17. Long-Term Results of Local Excision for Rectal Cancer

    PubMed Central

    Paty, Philip B.; Nash, Garrett M.; Baron, Paul; Zakowski, Maureen; Minsky, Bruce D.; Blumberg, David; Nathanson, Daniel R.; Guillem, Jose G.; Enker, Warren E.; Cohen, Alfred M.; Wong, W. Douglas

    2002-01-01

    Objective To review the authors’ experience with local excision of early rectal cancers to assess the effectiveness of initial treatment and of salvage surgery. Summary Background Data Local excision for rectal cancer is appealing for its low morbidity and excellent functional results. However, its use is limited by inability to assess regional lymph nodes and uncertainty of oncologic outcome. Methods Patients with T1 and T2 adenocarcinomas of the rectum treated by local excision as definitive surgery between 1969 to 1996 at the authors’ institution were reviewed. Pathology slides were reviewed. Among 125 assessable patients, 74 were T1 and 51 were T2. Thirty-one patients (25%) were selected to receive adjuvant radiation therapy. Fifteen of these 31 patients received adjuvant radiation in combination with 5-fluorouracil chemotherapy. Median follow-up was 6.7 years. One hundred fifteen patients (92%) were followed until death or for greater than 5 years, and 69 patients (55%) were followed until death or for greater than 10 years. Recurrence was recorded as local, distant, and overall. Survival was disease-specific. Results Ten-year local recurrence and survival rates were 17% and 74% for T1 rectal cancers and 26% and 72% for T2 cancers. Median time to relapse was 1.4 years (range 0.4–7.0) for local recurrence and 2.5 years (0.8–7.5) for distant recurrence. In patients receiving radiotherapy, local recurrence was delayed (median 2.1 years vs. 1.1 years), but overall rates of local and overall recurrence and survival rates were similar to patients not receiving radiotherapy. Among 26 cancer deaths, 8 (28%) occurred more than 5 years after local excision. On multivariate analysis, no clinical or pathologic features were predictive of local recurrence. Intratumoral vascular invasion was the only significant predictor of survival. Among 34 patients who developed tumor recurrence, the pattern of first clinical recurrence was predominantly local: 50% local only

  18. Total mesorectal excision for the treatment of rectal cancer

    PubMed Central

    Zedan, Ali; Salah, Tareq

    2015-01-01

    Introduction In the surgical treatment of rectal cancer, a clear circumferential resection margin and distal resection margin should be obtained. The aim of this study was to determine the morbidity, mortality, survival outcome, and local failure after total mesorectal excision (TME) in the surgical treatment of rectal cancer. Methods This retrospective study was conducted on 101 patients treated for rectal cancer using low anterior resection (LAR), abdominoperinial resection (APR), or Hartmaan’s technique. In all operative procedures, total mesorectal excisions (TMEs) were done. The patients were treated from November 2000 to April 2011 in the South Egypt Cancer Institute (SECI) of Assuit University (Egypt). Neo-adjuvant therapy was given to those patients with serosalin filtration, lymph node involvement, and sexual and urinary function impairment. Data were analyzed using IBM-SPSS version 21, and survival rates were estimated using the Kaplan-Meier method. Results One hundred one patients were evaluable (61 males, 40 females). Regarding the operative procedure used, it was: (APR), LAR, Hartmaan’s technique in 15.8%, 71.3%, and 12.9% of patients, respectively. Operation-related mortality during the 30 days after surgery was 3%. The operations resulted in morbidity in 25% of the patients, anastomotic site leak in 5.9% of the patients, urinary dysfynction in 9.9% of the patients, and erectile dysfunction in 15.8% of the male patients. Regarding safety margin, the median distances were distal/radial margin, 23/12 mm, distal limit 7 cm. Median lymph nodes harvest 19 nodes. Primary tumor locations were anteriorly 23.8%, laterally 13.9%, posteriorly 38.6%, and circumferential 23.8%. Protective stoma 16.8%. Primary Tumor TNM classification (T1, T2, T3, and T4; 3, 28.7, 55.4, and 12.9%, respectively). Nodes Metastases (N0, N1, and N2; 57.4, 31.7, and 10.9%, respectively). TNM staging (I, II, III, and IV; 15.8, 29.7, 46.5, and 7.9%, respectively). Chemotherapy was

  19. Proteogenomic characterization of human colon and rectal cancer

    SciTech Connect

    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; Wang, Sean; Wang, Pei; Kinsinger, Christopher; Rivers, Robert; Rodriguez, Henry; Townsend, Reid; Ellis, Matthew; Carr, Steven A.; Tabb, David L.; Coffey, Robert J.; Slebos, Robbert; Liebler, Daniel

    2014-09-18

    We analyzed proteomes of colon and rectal tumors previously characterized by the Cancer Genome Atlas (TCGA) and performed integrated proteogenomic analyses. Protein sequence variants encoded by somatic genomic variations displayed reduced expression compared to protein variants encoded by germline variations. mRNA transcript abundance did not reliably predict protein expression differences between tumors. Proteomics identified five protein expression subtypes, two of which were associated with the TCGA "MSI/CIMP" transcriptional subtype, but had distinct mutation and methylation patterns and associated with different clinical outcomes. Although CNAs showed strong cis- and trans-effects on mRNA expression, relatively few of these extend to the protein level. Thus, proteomics data enabled prioritization of candidate driver genes. Our analyses identified HNF4A, a novel candidate driver gene in tumors with chromosome 20q amplifications. Integrated proteogenomic analysis provides functional context to interpret genomic abnormalities and affords novel insights into cancer biology.

  20. Rectal bleeding in a 4-month-old boy

    SciTech Connect

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

    1986-10-24

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

  1. The place of radiotherapy in the management of rectal adenocarcinoma

    SciTech Connect

    Sischy, B.

    1982-12-01

    Surgery remains the mainstay in the management of carcinoma of the rectum. However, in spite of many improvements in techniques and anesthesia over the last fifty years, progress as regards increasing survival has been slow. Local recurrence and systemic disease remain the challenge. It appears that radiation therapy has a very definite role in the reduction of local recurrence. The part of radiation therapy presurgically and postsurgically and the incorporation of both in the 'sandwich technique' is reviewed. The use of chemotherapeutic agents for radiosensitization in an effort to improve the results of radiation therapy is described. Consideration is given to management of rectal carcinoma by radiation alone, in particular the endocavitary technique as a viable option to surgery in selected cases. Additional newer techniques such as intraoperative therapy are explained and the role that cooperative studies may take in answering some of the questions concerning the optimum sequence of radiotherapy and surgery are discussed.

  2. Use of Robotics in Colon and Rectal Surgery

    PubMed Central

    Pucci, Michael J.; Beekley, Alec C.

    2013-01-01

    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

  3. Use of robotics in colon and rectal surgery.

    PubMed

    Pucci, Michael J; Beekley, Alec C

    2013-03-01

    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

  4. Clinical Decision Support for Colon and Rectal Surgery: An Overview

    PubMed Central

    McCoy, Allison B.; Melton, Genevieve B.; Wright, Adam; Sittig, Dean F.

    2013-01-01

    Clinical decision support (CDS) has been shown to improve clinical processes, promote patient safety, and reduce costs in healthcare settings, and it is now a requirement for clinicians as part of the Meaningful Use Regulation. However, most evidence for CDS has been evaluated primarily in internal medicine care settings, and colon and rectal surgery (CRS) has unique needs with CDS that are not frequently described in the literature. The authors reviewed published literature in informatics and medical journals, combined with expert opinion to define CDS, describe the evidence for CDS, outline the implementation process for CDS, and present applications of CDS in CRS.CDS functionalities such as order sets, documentation templates, and order facilitation aids are most often described in the literature and most likely to be beneficial in CRS. Further research is necessary to identify and better evaluate additional CDS systems in the setting of CRS. PMID:24436644

  5. Rectal metastasis from Breast cancer: A rare entity

    PubMed Central

    Ng, Cho Ee; Wright, Lucie; Pieri, Andrew; Belhasan, Anas; Fasih, Tarannum

    2015-01-01

    Introduction Breast cancer metastases occurs in around 50% of all presentation. It is the second most common type of cancer to metastasise to the GI tract but this only occurs in less than 1% of cases. Presentation of case We report a case that underwent treatment for invasive lobular cancer (ILC) of the breast and 5 years later was found to have rectal and peritoneal metastasis. She is currently receiving palliative management including chemotherapy in the form of weekly Paclitaxel (Taxol®) and stenting to relieve obstruction. Conclusion There should be high clinical suspicion of bowel metastasis in patients presenting with positive faecal occult blood with or without bowel symptoms even if the incidence is less <1% of metastases, particularly in cases where the initial breast tumour was large, with positive axillary nodes. PMID:26188979

  6. Adjuvant chemotherapy for rectal cancer: Is it needed?

    PubMed Central

    Milinis, Kristijonas; Thornton, Michael; Montazeri, Amir; Rooney, Paul S

    2015-01-01

    Adjuvant chemotherapy has become a standard treatment of advanced rectal cancer in the West. The benefits of adjuvant chemotherapy after surgery alone have been well established. However, controversy surrounds the use adjuvant chemotherapy in patients who received preoperative chemoradiotherapy, despite it being recommended by a number of international guidelines. Results of recent multicentre randomised control trials showed no benefit of adjuvant chemotherapy in terms of survival and rates of distant metastases. However, concerns exist regarding the quality of the studies including inadequate staging modalities, out-dated chemotherapeutic regimens and surgical approaches and small sample sizes. It has become evident that not all the patients respond to adjuvant chemotherapy and more personalised approach should be employed when considering the benefits of adjuvant chemotherapy. The present review discusses the strengths and weaknesses of the current evidence-base and suggests improvements for future studies. PMID:26677436

  7. Combined modality preoperative therapy for unresectable rectal cancer.

    PubMed

    Percarpio, B; Bitterman, J; Sabbath, K; Alfano, F; Ruszkowski, R; Bowen, J

    1992-01-01

    Locally advanced rectal cancer has been a surgical challenge because of fixation of the primary tumor to the boney pelvis or to other pelvic soft tissues. During a 12-month period seven patients with locally advanced adenocarcinoma of the rectum were treated preoperatively with simultaneous pelvic irradiation (4500-5040 cGy) and infusion chemotherapy (5-fluorouracil 1000 mg per m2 per day over 96 hours and mitomycin 10 mg per m2. Tolerance was reasonable and all patients underwent successful resection of the primary lesion. Two patients had a complete response to preoperative combined modality therapy with no cancer found in the surgical specimen. With a short follow-up period, all patients have experienced satisfactory healing and none have suffered local or distant recurrence. The results of this limited series are encouraging for future clinical trials.

  8. Influence of demographic parameters on rectal epithelial proliferation.

    PubMed

    Fireman, Z; Rozen, P; Fine, N; Chetrit, A

    1989-09-15

    Measurement of rectal epithelial proliferation is now being used as a biomarker for assessing risk for colorectal cancer and response within dietary intervention studies. We examined the possible confounding effects of demographic parameters on the proliferation of 52 healthy middle-aged volunteers without known risk factors for colorectal cancer. No significant effects on proliferation of age, sex or ethnic grouping were found other than marked urban-rural differences amongst men. We hypothesise that these could be explained by differences in dietary habits and their deleterious effects in the older male population. Careful matching of controls are probably needed in order to demonstrate the minor changes in mucosal proliferation that could reflect risk for neoplasia. Further human studies are needed to examine the effects of diet and extremes of age on proliferation.

  9. [Endorectal echotomography in assessing the spread of rectal cancer].

    PubMed

    Bilenko, A A; Didarchuk, S P

    1998-01-01

    Endorectal echotomography is one of modern methods to diagnose rectal carcinoma spreading. On the basis of examination of 56 patients with the above pathology the authors have studied the ultrasonic semiotics of tumourous lesion of rectum and its regional lymphatic apparatus during different stages of the illness. The article contains an outline of the methods of investigation. The findings from ultrasonic diagnosis were compared with the results of clinical, endoscopic investigations and histological analysis of the operative material. A high diagnostic value was shown of the method in the assessment of local spread of the tumor: sensitivity--94.6%, specificity--83.3%, general precision--91.8%. Endorectal ultrasonic tomography permits the enlarged pararectal lymphatic nodes to be visualized but the method's demerit is lack of ultrasonic criteria in the differential diagnosis between the metastatic lesion of the lymphatic node and inflammatory type changes.

  10. Survey of contrast media used in coronary angiograph

    SciTech Connect

    Weikl, A.; Hubmann, M.

    1982-01-01

    In recent years, various contrast media have been developed for use in coronary angiography. These contrast media may be divided into ionic contrast media of high osmolality, those of low osmolality, and nonionic contrast materials. We conducted our own clinical studies with 40 patients. In random succession a standard contrast medium (ionic, of high osmolality) and a new-generation contrast medium (either nonionic or ionic with low osmolality) were injected into the right and left coronary arteries. After each injection we measured the systolic and diastolic blood pressure using a liquid-filled coronary catheter. In addition, the change in the length of the cardiac cycle was registered in terms of the R-R interval (in ms) and at the same time, leads I, II, and III of the ECG were recorded. We studied the influence of the various contrast media on the activity of ATPase in in vitro experiments, using Lasser and Lang's. When ionic contrast media of low osmolality and nonionic contrast media were utilized the heart rate showed no change. Disturbances of rhythm such as ventricular tachycardia or fibrillation were not observed. All of the contrast media used produced the same ECG changes. These changes can be ascribed to the inhibition of ATPase. The arterial blood pressure was lowered significantly only by ionic contrast media of high osmolality only.

  11. Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer

    PubMed Central

    Mihmanlı, Mehmet; Kabul Gürbulak, Esin; Akgün, İsmail Ethem; Celayir, Mustafa Fevzi; Yazıcı, Pınar; Tunçel, Deniz; Bek, Tuba Tülin; Öz, Ayhan; Ömeroğlu, Sinan

    2016-01-01

    AIM To investigate the prognostic effect of a delayed interval between neoadjuvant chemoradiotherapy (CRT) and surgery in locally advanced rectal cancer. METHODS We evaluated 87 patients with locally advanced mid- or distal rectal cancer undergoing total mesorectal excision following an interval period after neoadjuvant CRT at Şişli Hamidiye Etfal Training and Research Hospital, Istanbul between January 2009 and January 2014. Patients were divided into two groups according to the interval before surgery: < 8 wk (group I) and ≥ 8 wk (group II). Data related to patients, cancer characteristics and pathological examination were collected and analyzed. RESULTS When the distribution of timing between group I (n = 45) and group II (n = 42) was viewed, comparison of interval periods (median ± SD) of groups showed a significant difference of as 5 ± 1.28 wk in group I and 10.1 ± 2.2 wk in group II (P < 0.001). The median follow-up period for all patients was 34.5 (9.9-81) mo. group II had significantly higher rates of pathological complete response (pCR) than group I had (19% vs 8.9%, P = 0.002). Rate of tumor regression grade (TRG) poor response was 44.4% in group I and 9.5% in group II (P < 0.002). A poor pathological response was associated with worse disease-free survival (P = 0.009). The interval time did not show any association with local recurrence (P = 0.79). CONCLUSION Delaying the neoadjuvant CRT-surgery interval may provide nodal down-staging, improve pCR rate, and decrease the rate of TRG poor response. PMID:27672428

  12. [Research hotspot and progress of preoperative chemoradiotherapy for rectal cancer].

    PubMed

    Peng, Jianhong; Pan, Zhizhong

    2016-06-01

    Preoperative chemoradiotherapy (CRT) has become an important component of comprehensive treatment for rectal cancer. Although local recurrent risk has been remarkably reduced by CRT, distant metastasis remains the main cause of therapeutic failure. Therefore, more and more studies focused on controlling distant metastasis in order to prolong long-term survival. Recently, CRT has achieved certain progression in rectal cancer: (1)Patients with stage T3 should be classified into specific subgroups to formulate individualized treatment regimen. For stage T3a, it is feasible to perform surgery alone or administrate low intensity preoperative CRT; for stage T3b and T3c, conventional preoperative CRT should be performed in order to reduce the risk of recurrence postoperatively. (2)With regard to combined regimen for chemotherapy, oral capecitabine superiors to intravenous bolus 5-fluorouracil (5-FU) and is comparable to continuous intravenous infusion 5-FU with a better safety. Therefore, capecitabine is recommended for older patients and those with poor tolerance to chemotherapy. Compared to single 5-FU concurrent CRT, addition of oxaliplatin into preoperative CRT may result in a higher survival benefit in Chinese patients. As to the application of irinotecan, bevacizumab or cetuximab, unless there are more evidence to confirm their efficacy and safety from randomized controlled trial, they should not be recommended for adding to preoperative CRT routinely. (3)On the optimization in CRT pattern, the application values of induction chemotherapy before concurrent CRT, consolidation chemotherapy after concurrent CRT, neoadjuvant sandwich CRT, neoadjuvant chemotherapy alone and short-course preoperative radiotherapy remain further exploration. (4)On the treatment strategy for clinical complete response (cCR) after CRT, whether "wait and see" strategy is able to be adopted, it is still a hot topic with controversy. PMID:27353093

  13. Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer

    PubMed Central

    Mihmanlı, Mehmet; Kabul Gürbulak, Esin; Akgün, İsmail Ethem; Celayir, Mustafa Fevzi; Yazıcı, Pınar; Tunçel, Deniz; Bek, Tuba Tülin; Öz, Ayhan; Ömeroğlu, Sinan

    2016-01-01

    AIM To investigate the prognostic effect of a delayed interval between neoadjuvant chemoradiotherapy (CRT) and surgery in locally advanced rectal cancer. METHODS We evaluated 87 patients with locally advanced mid- or distal rectal cancer undergoing total mesorectal excision following an interval period after neoadjuvant CRT at Şişli Hamidiye Etfal Training and Research Hospital, Istanbul between January 2009 and January 2014. Patients were divided into two groups according to the interval before surgery: < 8 wk (group I) and ≥ 8 wk (group II). Data related to patients, cancer characteristics and pathological examination were collected and analyzed. RESULTS When the distribution of timing between group I (n = 45) and group II (n = 42) was viewed, comparison of interval periods (median ± SD) of groups showed a significant difference of as 5 ± 1.28 wk in group I and 10.1 ± 2.2 wk in group II (P < 0.001). The median follow-up period for all patients was 34.5 (9.9-81) mo. group II had significantly higher rates of pathological complete response (pCR) than group I had (19% vs 8.9%, P = 0.002). Rate of tumor regression grade (TRG) poor response was 44.4% in group I and 9.5% in group II (P < 0.002). A poor pathological response was associated with worse disease-free survival (P = 0.009). The interval time did not show any association with local recurrence (P = 0.79). CONCLUSION Delaying the neoadjuvant CRT-surgery interval may provide nodal down-staging, improve pCR rate, and decrease the rate of TRG poor response.

  14. Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer.

    PubMed

    Gollins, S; Sebag-Montefiore, D

    2016-02-01

    Improved surgical technique plus selective preoperative radiotherapy have decreased rectal cancer pelvic local recurrence from, historically, 25% down to about 5-10%. However, this improvement has not reduced distant metastatic relapse, which is the main cause of death and a key issue in rectal cancer management. The current standard is local pelvic treatment (surgery ± preoperative radiotherapy) followed by adjuvant chemotherapy, depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline magnetic resonance imaging, downstaging long-course preoperative chemoradiation (LCPCRT) is generally used. However, for non-CRM-threatened disease, varying approaches are currently adopted in the UK, including straight to surgery, short-course preoperative radiotherapy and LCPCRT. Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating preoperative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full-dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse. Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy-based schedules. Although several measures of neoadjuvant treatment response assessment based on imaging or pathology are promising predictive biomarkers for long-term survival, none has been validated in prospective phase III studies. The phase III setting will enable this, also providing translational opportunities to examine molecular predictors of response and survival. PMID:26645661

  15. Longitudinal plication - a surgical strategy for complete rectal prolapse management

    PubMed Central

    2014-01-01

    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

  16. Intra-tumor Genetic Heterogeneity in Rectal Cancer

    PubMed Central

    Hardiman, Karin M.; Ulintz, Peter J.; Kuick, Rork; Hovelson, Daniel H.; Gates, Christopher M.; Bhasi, Ashwini; Grant, Ana Rodrigues; Liu, Jianhua; Cani, Andi K.; Greenson, Joel; Tomlins, Scott; Fearon, Eric R.

    2015-01-01

    Colorectal cancer arises in part from the cumulative effects of multiple gene lesions. Recent studies in selected cancer types have revealed significant intra-tumor genetic heterogeneity and highlighted its potential role in disease progression and resistance to therapy. We hypothesized the existence of significant intra-tumor genetic heterogeneity in rectal cancers involving variations in localized somatic mutations and copy number abnormalities. Two or three spatially disparate regions from each of six rectal tumors were dissected and subjected to next-generation whole exome DNA sequencing, Oncoscan SNP arrays, and targeted confirmatory sequencing and analysis. The resulting data were integrated to define subclones using SciClone. Mutant-allele tumor heterogeneity (MATH) scores, mutant allele frequency correlation, and mutation percent concordance were calculated, and copy number analysis including measurement of correlation between samples was performed. Somatic mutations profiles in individual cancers were similar to prior studies, with some variants found in previously reported significantly mutated genes and many patient-specific mutations in each tumor. Significant intra-tumor heterogeneity was identified in the spatially disparate regions of individual cancers. All tumors had some heterogeneity but the degree of heterogeneity was quite variable in the samples studied. We found that 67–97% of exonic somatic mutations were shared among all regions of an individual’s tumor. The SciClone computational method identified 2 to 8 shared and unshared subclones in the spatially disparate areas in each tumor. MATH scores ranged from 7 to 41. Allele frequency correlation scores ranged from R2 = 0.69 to 0.96. Measurements of correlation between samples for copy number changes varied from R2 = 0.74 to 0.93. All tumors had some heterogeneity, but the degree was highly variable in the samples studied. The occurrence of significant intra-tumor heterogeneity may allow

  17. Radiofrequency thermal treatment with chemoradiotherapy for advanced rectal cancer

    PubMed Central

    SHOJI, HISANORI; MOTEGI, MASAHIKO; OSAWA, KIYOTAKA; OKONOGI, NORIYUKI; OKAZAKI, ATSUSHI; ANDOU, YOSHITAKA; ASAO, TAKAYUKI; KUWANO, HIROYUKI; TAKAHASHI, TAKEO; OGOSHI, KYOJI

    2016-01-01

    We previously reported that patients with a clinical complete response (CR) following radiofrequency thermal treatment exhibit significantly increased body temperature compared with other groups, whereas patients with a clinical partial response or stable disease depended on the absence or presence of output limiting symptoms. The aim of this study was to evaluate the correlation among treatment response, Hidaka radiofrequency (RF) output classification (HROC: termed by us) and changes in body temperature. From December 2011 to January 2014, 51 consecutive rectal cancer cases were included in this study. All patients underwent 5 RF thermal treatments with concurrent chemoradiation. Patients were classified into three groups based on HROC: with ≤9, 10–16, and ≥17 points, calculated as the sum total points of five treatments. Thirty-three patients received surgery 8 weeks after treatment, and among them, 32 resected specimens were evaluated for histological response. Eighteen patients did not undergo surgery, five because of progressive disease (PD) and 13 refused because of permanent colostomy. We demonstrated that good local control (ypCR + CR + CRPD) was observed in 32.7% of cases in this study. Pathological complete response (ypCR) was observed in 15.7% of the total 51 patients and in 24.2% of the 33 patients who underwent surgery. All ypCR cases had ≥10 points in the HROC, but there were no patients with ypCR among those with ≤9 points in the HROC. Standardization of RF thermal treatment was performed safely, and two types of patients were identified: those without or with increased temperatures, who consequently showed no or some benefit, respectively, for similar RF output thermal treatment. We propose that the HROC is beneficial for evaluating the efficacy of RF thermal treatment with chemoradiation for rectal cancer, and the thermoregulation control mechanism in individual patients may be pivotal in predicting the response to RF thermal treatment

  18. Seminal vesicle-rectal fistula secondary to anastomotic leakage after low anterior resection for rectal cancer: a case report and brief literature review.

    PubMed

    Kitazawa, Masato; Hiraguri, Manabu; Maeda, Chika; Yoshiki, Mizukami; Horigome, Naoto; Kaneko, Gengo

    2014-01-01

    We report a case of a patient with seminal vesicle-rectal fistula, an extremely rare complication of low anterior resection of the rectum. A 53-year-old man with rectal adenocarcinoma underwent low anterior resection in our hospital. The patient experienced diarrhea, pneumaturia, and low-grade fever on postoperative day 13. A computed tomography scan showed emphysema in the right seminal vesicle. We concluded that anastomotic leakage induced a seminal vesicle-rectal fistula. The patient underwent conservative therapy with total parenteral nutrition and oral intake of metronidazole. Diarrhea and pneumaturia rapidly improved after metronidazole administration and the patient was successfully cured without invasive therapy such as colostomy or surgical drainage. A seminal vesicle-rectal fistula is a rare complication of low anterior resection, and therapeutic strategies for this condition remain elusive. Our report provides valuable information on the successful conservative treatment of a secondary seminal vesicle-rectal fistula that developed after low anterior resection of the rectum in a patient. PMID:24444264

  19. Contrast image correction method

    NASA Astrophysics Data System (ADS)

    Schettini, Raimondo; Gasparini, Francesca; Corchs, Silvia; Marini, Fabrizio; Capra, Alessandro; Castorina, Alfio

    2010-04-01

    A method for contrast enhancement is proposed. The algorithm is based on a local and image-dependent exponential correction. The technique aims to correct images that simultaneously present overexposed and underexposed regions. To prevent halo artifacts, the bilateral filter is used as the mask of the exponential correction. Depending on the characteristics of the image (piloted by histogram analysis), an automated parameter-tuning step is introduced, followed by stretching, clipping, and saturation preserving treatments. Comparisons with other contrast enhancement techniques are presented. The Mean Opinion Score (MOS) experiment on grayscale images gives the greatest preference score for our algorithm.

  20. Mucosal B Cells Are Associated with Delayed SIV Acquisition in Vaccinated Female but Not Male Rhesus Macaques Following SIVmac251 Rectal Challenge

    PubMed Central

    Musich, Thomas; Miller, Leia; Vargas-Inchaustegui, Diego A.; Demberg, Thorsten; Venzon, David; Kalisz, Irene; Kalyanaraman, V. S.; Pal, Ranajit; Ferrari, Maria Grazia; LaBranche, Celia; Montefiori, David C.; Rao, Mangala; Vaccari, Monica; Franchini, Genoveffa; Barnett, Susan W.; Robert-Guroff, Marjorie

    2015-01-01

    Many viral infections, including HIV, exhibit sex-based pathogenic differences. However, few studies have examined vaccine-related sex differences. We compared immunogenicity and protective efficacy of monomeric SIV gp120 with oligomeric SIV gp140 in a pre-clinical rhesus macaque study and explored a subsequent sex bias in vaccine outcome. Each immunization group (16 females, 8 males) was primed twice mucosally with replication-competent Ad-recombinants encoding SIVsmH4env/rev, SIV239gag and SIV239nefΔ1–13 and boosted twice intramuscularly with SIVmac239 monomeric gp120 or oligomeric gp140 in MF59 adjuvant. Controls (7 females, 5 males) received empty Ad and MF59. Up to 9 weekly intrarectal challenges with low-dose SIVmac251 were administered until macaques became infected. We assessed vaccine-induced binding, neutralizing, and non-neutralizing antibodies, Env-specific memory B cells and plasmablasts/plasma cells (PB/PC) in bone marrow and rectal tissue, mucosal Env-specific antibodies, and Env-specific T-cells. Post-challenge, only one macaque (gp140-immunized) remained uninfected. However, SIV acquisition was significantly delayed in vaccinated females but not males, correlated with Env-specific IgA in rectal secretions, rectal Env-specific memory B cells, and PC in rectal tissue. These results extend previous correlations of mucosal antibodies and memory B cells with protective efficacy. The gp140 regimen was more immunogenic, stimulating elevated gp140 and cyclic V2 binding antibodies, ADCC and ADCP activities, bone marrow Env-specific PB/PC, and rectal gp140-specific IgG. However, immunization with gp120, the form of envelope immunogen used in RV144, the only vaccine trial to show some efficacy, provided more significant acquisition delay. Further over 40 weeks of follow-up, no gp120 immunized macaques met euthanasia criteria in contrast to 7 gp140-immunized and 2 control animals. Although males had higher binding antibodies than females, ADCC and ADCP

  1. Phonation in Tonal Contrasts

    ERIC Educational Resources Information Center

    Kuang, Jianjing

    2013-01-01

    Phonation is used in many tonal languages, but how it should be incorporated into tonal systems is not well understood. The purpose of this dissertation thus is to examine the role of phonation in tonal contrasts, and to investigate how phonation and pitch interact in the tonal space. This dissertation presents close studies of tonal contrasts…

  2. Directionality in Contrastive Analysis.

    ERIC Educational Resources Information Center

    James, Carl

    A contrastive analysis (CA) does not require commitment to directionality. Even asymmetrical interlingual correspondence can be handled by adirectional statements. If well executed, a CA is capable of handling three pairs of L2 learning phenomena: (1) going from language A to language B and vice versa; (2) productive and receptive command; and (3)…

  3. A Pilot Study of the Effect of Daikenchuto on Rectal Sensation in Patients with Irritable Bowel Syndrome

    PubMed Central

    Acosta, Andres; Camilleri, Michael; Linker-Nord, Sara; Busciglio, Irene; Iturrino, Johanna; Szarka, Lawrence A; Zinsmeister, Alan R

    2016-01-01

    Background/Aims Daikenchuto (TU 100), a botanical agent that modulates gastrointestinal nerves, is used in the treatment of motility and functional disorders. Our aim was to study the effects of TU-100 on rectal compliance and sensation in patients with irritable bowel syndrome (IBS). Methods In 20 patients per treatment arm, we conducted a single-center, randomized, parallel-group, double-blind, placebo-controlled, single-dose pharmacodynamics study evaluating the effects of TU-100, 15 g (5 g t.i.d. [means 3 times a day]), for 14–16 consecutive days on rectal compliance and rectal sensation (thresholds and sensation ratings), all measured at baseline and on the last day of medication treatment. The primary endpoint was rectal sensation thresholds and sensation ratings in response to balloon distension at 32 mmHg. Secondary endpoints were rectal compliance, sensation thresholds, ratings and tone (fasting and postprandial), bowel pattern, abdominal pain (average and worst severity) and bloating scores, IBS quality of life and safety profile. Results Rectal sensation ratings post-treatment were significantly associated with baseline (pre-treatment) ratings and with level of anxiety or stress recorded at the time of the sensation testing. There were no effects of TU-100 treatment on rectal sensation ratings, sensation thresholds, rectal fasting or postprandial tone, rectal compliance, bowel function, abdominal pain or bloating scores, or IBS quality of life. Conclusions TU-100 did not significantly affect rectal compliance and sensation in patients with IBS in this study. PMID:26486374

  4. A New Laparoscopic Surgical Procedure to Achieve Sufficient Mesorectal Excision in Upper Rectal Cancer

    PubMed Central

    Ohigashi, Seiji; Taketa, Takashi; Sudo, Kazuki; Shiozaki, Hironori; Onodera, Hisashi

    2011-01-01

    Objective. Mesorectal excision corresponding to the location of a tumor, termed tumor-specific mesorectal excision (TSME), is commonly performed for resection of upper rectal cancer. We devised a new laparoscopic procedure for sufficient TSME with rectal transection followed by mesorectal excision. Operative Technique. After mobilization of the sigmoid colon and ligation of inferior mesenteric vessels, we dissected the mesorectum along the layer of the planned total mesorectal excision. The rectal wall was carefully separated from the mesorectum at the appropriate anal side from the tumor. After the rectum was isolated and transected using an endoscopic linear stapler, the rectal stump drew immediately toward the anal side, enabling the mesorectum to be identified clearly. In this way, sufficient TSME can be performed easily and accurately. This technique has been successfully conducted on 19 patients. Conclusion. This laparoscopic technique is a feasible and reliable procedure for achieving sufficient TSME. PMID:22312519

  5. 78 FR 46965 - Draft Guidance for Industry on Bioequivalence Recommendations for Mesalamine Rectal Suppositories...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-02

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Bioequivalence Recommendations for Mesalamine Rectal Suppositories; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the availability of a...

  6. Total Mesorectal Excision, an erroneous anatomical term for the gold standard in rectal cancer treatment.

    PubMed

    Rodríguez-Luna, María Rita; Guarneros-Zárate, Joaquín E; Tueme-Izaguirre, Jorge

    2015-11-01

    In 1986 Professor R J Heald published in The Lancet his new technique which he called Total Mesorectal Excision; today this is the gold standard for the surgical management of rectal cancer. In Total Mesorectal Excision (TME), the mesorectum is the term used to describe all the peri-rectal connective tissue including the posterior sheath of the endopelvic fascia containing the peri-rectal neurovascular structures. However, the mesenterium is a defined structure composed of a double layer of peritoneum which does not include the endopelvic fascia and the lateral rectal stalks, so these should not be included in the term 'mesorectum'. In our globalized medical culture it is important to use anatomic terms approved by the International Federation of Associations of Anatomists, as contained in the Terminologia Anatomica produced by the Federative International Programme for Anatomical Terminology (FIPAT). The term mesorectum is not listed in the Terminologia Anatomica. PMID:26409653

  7. School nurses' experience with administration of rectal diazepam gel for seizures.

    PubMed

    O'Dell, Christine; O'Hara, Kathryn

    2007-06-01

    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 Association of School Nurses Annual Meeting. Seventy-one (18%) nurses surveyed had administered rectal diazepam gel in a school setting, while 54 (13%) nurses reported that either their state practice act or school district prohibited them from giving rectal medications in the school. Medication administration benefits, such as early intervention for treatment of acute seizure emergencies, were noted. Barriers were also identified, with lack of privacy as the most frequently listed. Scope of practice as it pertains to administering medication in the school and the extent to which delegation of duties can be used in the situation of administering rectal medication in a seizure emergency remain issues for school nurses.

  8. MR imaging for rectal cancer: the role in staging the primary and response to neoadjuvant therapy.

    PubMed

    Battersby, Nick J; Moran, Brendan; Yu, Stanley; Tekkis, Paris; Brown, Gina

    2014-08-01

    Pre-operative staging is an essential aspect of modern rectal cancer management and radiological assessment is central to this process. An ideal radiological assessment should provide sufficient information to reliably guide pre-operative decision-making. Technical advances allow high-resolution imaging to not only provide prognostic information but to define the anatomy, helping the surgeon to anticipate potential pitfalls during the operation. The main imaging modality for local staging of rectal cancer is Magnetic Resonance Imaging (MRI), as it defines the tumour and relevant anatomy providing the most detail on the important prognostic factors that influence treatment choice. In addition, there is an emerging role for MRI in the assessment of the response to neoadjuvant therapy. This article is an evidence-based review of rectal cancer staging focusing on post-treatment assessment of response using MRI. The discussion extends into the implications for reliably assessing response and how this may influence future rectal cancer management. PMID:24954622

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

    SciTech Connect

    Susil, Robert C.; McNutt, Todd R.; DeWeese, Theodore L.; Song, Danny

    2010-03-15

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

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

    SciTech Connect

    Tucker, Susan L.; Dong Lei; Bosch, Walter R.; Michalski, Jeff; Winter, Kathryn; Mohan, Radhe; Purdy, James A.; Kuban, Deborah; Lee, Andrew K.; Cheung, M. Rex; Thames, Howard D.; Cox, James D.

    2010-11-15

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

  11. Prograde dilatation with Tucker bougies: a technique for managing postoperative rectal strictures.

    PubMed

    Gamliel, Z; Wesson, D

    1991-11-01

    Postoperative rectal stricture is an occasional complication of abdominoperineal pull-through and low anterior resection of the rectum. Although the causes and pathogenesis of this phenomenon are poorly understood, various techniques for stricture dilatation have been described. In this article, we present two cases of severe postoperative rectal strictures that were not amenable to conventional methods of dilatation but were successfully managed by a technique of dilatation using Tucker bougies without general anesthesia.

  12. Rectal tone and compliance affected in patients with fecal incontinence after fistulotomy

    PubMed Central

    Awad, Richard Alexander; Camacho, Santiago; Flores, Francisco; Altamirano, Evelyn; García, Mario Antonio

    2015-01-01

    AIM: To investigate the anal sphincter and rectal factors that may be involved in fecal incontinence that develops following fistulotomy (FIAF). METHODS: Eleven patients with FIAF were compared with 11 patients with idiopathic fecal incontinence and with 11 asymptomatic healthy subjects (HS). All of the study participants underwent anorectal manometry and a barostat study (rectal sensitivity, tone, compliance and capacity). The mean time since surgery was 28 ± 26 mo. The postoperative continence score was 14 ± 2.5 (95%CI: 12.4-15.5, St Mark’s fecal incontinence grading system). RESULTS: Compared with the HS, the FIAF patients showed increased rectal tone (42.63 ± 27.69 vs 103.5 ± 51.13, P = 0.002) and less rectal compliance (4.95 ± 3.43 vs 11.77 ± 6.9, P = 0.009). No significant differences were found between the FIAF patients and the HS with respect to the rectal capacity; thresholds for the non-noxious stimuli of first sensation, gas sensation and urge-to-defecate sensation or the noxious stimulus of pain; anal resting pressure or squeeze pressure; or the frequency or percentage of relaxation of the rectoanal inhibitory reflex. No significant differences were found between the FIAF patients and the patients with idiopathic fecal incontinence. CONCLUSION: In patients with FIAF, normal motor anal sphincter function and rectal sensitivity are preserved, but rectal tone and compliance are impaired. The results suggest that FIAF is not due to alterations in rectal sensitivity and that the rectum is more involved than the anal sphincters in the genesis of FIAF. PMID:25852287

  13. Influence of trimebutine on inflammation- and stress-induced hyperalgesia to rectal distension in rats.

    PubMed

    Lacheze, C; Coelho, A M; Fioramonti, J; Buéno, L

    1998-08-01

    The effects of trimebutine and its major metabolite, N-desmethyltrimebutine on inflammation- and stress-induced rectal hyperalgesia have been evaluated in rats fitted with electrodes implanted in the longitudinal striated muscle of the abdomen. Intermittent rectal distension was performed before and 3 days after induction of rectal inflammation by local infusion of trinitrobenzenesulphonic acid (in ethanol). Stress consisted of 2h partial restraint and rectal distension was performed before and 30min after the end of the partial restraint session. The animals were treated intraperitoneally with trimebutine or desmethyltrimebutine (5, 10 or 20mgkg(-1)) or vehicle 15min before rectal distension. Naloxone (1mgkg(-1)) or saline was injected subcutaneously before trimebutine and desmethyltrimebutine. Before treatment trimebutine at the highest dose (20mgkg(-1)) reduced the abdominal response to rectal distension for the highest volume of distension (1.6mL) whereas desmethyltrimebutine was inactive. After rectocolitis the abdominal response to rectal distension was enhanced and trimebutine at 5mgkg(-1) reduced and at 10 mgkg(-1) suppressed inflammation-induced hyperalgesia, an effect reversed by naloxone. Desmethyltrimebutine was inactive. Stress-induced hypersensitivity was attenuated or suppressed, or both, by trimebutine and desmethyltrimebutine at doses of 5, 10 or 20mgkg(-l); greater efficacy was observed for desmethyltrimebutine and the effects were not reversed by naloxone. It was concluded that trimebutine and desmethyltrimebutine are active against inflammation- and stress-induced rectal hyperalgesia but act differently. The effect of trimebutine on inflammation-induced hyperalgesia is mediated through opioid receptors. PMID:9751458

  14. The outcomes of therapeutic decision in lower 3rd rectal cancer patients.

    PubMed

    Chen, Chien-Hsin; Wei, Po-Li; Hsieh, Mao-Chih; Lin, En-Kwang; Chiou, Jeng-Fong; Lu, Yen-Jung; Wu, Szu-Yuan

    2016-09-01

    To investigate the outcomes of the selective neoadjuvant concurrent chemoradiotherapy (CCRT) in lower 3rd rectal cancer patients in different groups (with or without neoadjuvant CCRT), especially in survival rate, local recurrence rate, and sphincter preservation rate.From January 1999 to December 2012, 69 consecutive patients who had histologically proven adenocarcinoma of lower 3rd rectum, defined preoperatively as lower tumor margin within 7 cm from the anal verge as measured by rigid sigmoidoscopy, received total mesorectum excision (TME). Our inclusion criteria of neoadjuvant CCRT are lower 3rd rectal cancer, stage II/III, and large (diameter >5 cm or >1/2 of circumference). Neoadjuvant concurrent CCRT had begun to apply lower 3rd rectal cancer patients or not. The radiation techniques of neoadjuvant CCRT for lower 3rd rectal cancer patients were all conventional fraction intensity modulated radiotherapy (IMRT) and concurrent fluoropyrimidine chemotherapy.Five-year overall survival rate, disease-free survival rate, and local recurrence rate for lower 3rd rectal cancer patients in group I were 51%, 45%, and 25%, respectively. On the contrary, 5-year overall survival rate, disease-free survival rate, and local recurrence rate for lower rectal cancer patients in group II were 70%, 70%, and 3%, respectively. The 5-year sphincter sparing rate was increased from 38.2% to 100% after the beginning of neoadjuvant CCRT. Analyzing local recurrence, overall survival rate, disease-specific survival rate, and sphincter sparing rate in group II were statistically significant superior to group I.Five-year overall survival rate, disease-free survival rate, and sphincter sparing rate for lower 3rd rectal cancer patients were improved after the addition of neoadjuvant CCRT. No unacceptable toxicity was noted after conventional fraction IMRT and concurrent fluoropyrimidine chemotherapy. Our study showed neoadjuvant CCRT could be valuable for lower 3rd rectal cancer patients

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

    PubMed Central

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

    2014-01-01

    We report a case of adrenal metastasis from colorectal cancer in a 54-year-old woman. Nine months after resection for advanced rectal carcinoma, a computed tomography scan revealed bilateral adrenal metastasis. The level of serum carcinoembryonic antigen was normal. A bilateral adrenalectomy was performed after chemotherapy. Histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. Adrenal metastasis should be considered in the patients' follow-up for colorectal cancer. PMID:24860684

  16. Hypermedia as medium

    NASA Technical Reports Server (NTRS)

    Dede, Christopher J.

    1990-01-01

    Claims and rebuttals that hypermedia (the associative, nonlinear interconnection of multimedia materials) is a fundamentally innovative means of thinking and communicating are described. This representational architecture has many advantages that make it a major advance over other media; however, it also has several intrinsic problems that severly limits its effectiveness as a medium. These advantages and limits in applications are discussed.

  17. Holographic recording medium

    NASA Technical Reports Server (NTRS)

    Gange, Robert Allen (Inventor)

    1977-01-01

    A holographic recording medium comprising a conductive substrate, a photoconductive layer and an electrically alterable layer of a linear, low molecular weight hydrocarbon polymer has improved fatigue resistance. An acrylic barrier layer can be interposed between the photoconductive and electrically alterable layers.

  18. Early Proctoscopy is a Surrogate Endpoint of Late Rectal Toxicity in Prostate Cancer Treated With Radiotherapy

    SciTech Connect

    Ippolito, Edy; Massaccesi, Mariangela; Digesu, Cinzia; Deodato, Francesco; Macchia, Gabriella; Pirozzi, Giuseppe Antonio; Cilla, Savino; Cuscuna, Daniele; Di Lallo, Alessandra; Mattiucci, Gian Carlo; Mantini, Giovanna; Pacelli, Fabio; Valentini, Vincenzo; Cellini, Numa; Ingrosso, Marcello; Morganti, Alessio Giuseppe

    2012-06-01

    Purpose: To predict the grade and incidence of late clinical rectal toxicity through short-term (1 year) mucosal alterations. Methods and Materials: Patients with prostate adenocarcinoma treated with curative or adjuvant radiotherapy underwent proctoscopy a year after the course of radiotherapy. Mucosal changes were classified by the Vienna Rectoscopy Score (VRS). Late toxicity data were analyzed according to the Kaplan-Meier method. Comparison between prognosis groups was performed by log-rank analysis. Results: After a median follow-up time of 45 months (range, 18-99), the 3-year incidence of grade {>=}2 rectal late toxicity according to the criteria of the European Organization for Research and Treatment of Cancer and the Radiation Therapy Oncology Group was 24%, with all patients (24/24; 100%) experiencing rectal bleeding. The occurrence of grade {>=}2 clinical rectal late toxicity was higher in patients with grade {>=}2 (32% vs. 15 %, p = 0.02) or grade {>=}3 VRS telangiectasia (47% vs. 17%, p {<=} 0.01) and an overall VRS score of {>=}2 (31% vs. 16 %, p = 0.04) or {>=}3 (48% vs. 17%, p = 0.01) at the 1-year proctoscopy. Conclusions: Early proctoscopy (1 year) predicts late rectal bleeding and therefore can be used as a surrogate endpoint for late rectal toxicity in studies aimed at reducing this frequent complication.

  19. Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors

    PubMed Central

    Kim, Ju Seung; Kim, Yoon Jae; Kim, Jung Ho; Kim, Kyoung Oh; Kwon, Kwang An; Park, Dong Kyun; An, Jung Suk

    2016-01-01

    Background/Aims Rectal neuroendocrine tumors (NETs) are among the most common of gastrointestinal NETs. Due to recent advances in endoscopy, various methods of complete endoscopic resection have been introduced for small (≤10 mm) rectal NETs. However, there is a debate about the optimal treatment for rectal NETs. In our study, we aimed to evaluate the efficacy and feasibility of endoscopic resection using pneumoband and elastic band (ER-BL) for rectal NETs smaller than 10 mm in diameter. Methods A total of 55 patients who were diagnosed with rectal NET from January 2004 to December 2011 at Gil Medical Center were analyzed retrospectively. Sixteen patients underwent ER-BL. For comparison, 39 patients underwent conventional endoscopic mucosal resection (EMR). Results There was a markedly lower deep margin positive rate for ER-BL than for conventional EMR (6% [1/16] vs. 46% [18/39], P=0.029). Four patients who underwent conventional EMR experienced perforation or bleeding. However, they recovered within a few days. On the other hand, patients whounderwent endoscopic resection using a pneumoband did not experience any complications. In multivariate analysis, ER-BL (P=0.021) was independently associated with complete resection. Conclusions ER-BL is an effective endoscopic treatment with regards to deep margin resection for rectal NET smaller than 10 mm. PMID:27175117

  20. Rectal biopsy for diagnosis of intestinal neuronal dysplasia in children: a prospective multicentre study on interobserver variation and clinical outcome

    PubMed Central

    Koletzko, S; Jesch, I; Faus-Kessler, T; Briner, J; Meier-Ruge, W; Muntefering, H; Coerdt, W; Wessel, L; Keller, K; Nutzenadel, W; Schmittenbecher, P; Holschneider, A; Sacher, P

    1999-01-01

    BACKGROUND—Intestinal neuronal dysplasia (IND) of the colonic submucous plexus is considered to be a congenital malformation of the enteric nervous system causing symptoms resembling those of Hirschsprung's disease. In contrast with the established diagnosis of aganglionosis using enzyme histochemistry, controversy exists over the diagnostic criteria of IND on rectal biopsies previously defined by a consensus report and the causal relation between morphological findings and clinical symptoms.
AIMS—The interobserver variability was prospectively investigated with respect to final diagnoses and several histological features in rectal biopsy specimens from children suspected of having colonic motility disturbances.
METHODS—377 biopsy specimens from 108 children aged 4 days to 15 years were independently coded without knowledge of clinical symptoms by three experienced pathologists for 20 histological features, and a final diagnosis was given for every case. Interobserver variation for the different items and the final diagnosis were analysed using Cohen's κ statistic. Clinical data at biopsy and outcome after 12 months were related to morphological findings.
RESULTS—The three pathologists agreed completely with respect to the diagnosis Hirschsprung's disease (κ = 1), but in only 14% of the children without aganglionosis. In 15 (17%) of the 87 children without aganglionosis, at least one pathologist judged the case as normal, while another diagnosed IND. κ values were close to the zero value expected by chance for the diagnoses normal and IND. Young age was related to the presence of several morphological features—for example, acetylcholine esterase staining and presence of giant ganglia. Children with chronic constipation diagnosed as having IND, given no other specific diagnosis by any of the pathologists, were significantly younger (median 8.8 months) and had a higher cure rate after one year (60%) than constipated patients considered

  1. Chromatography: concepts and contrasts

    SciTech Connect

    Miller, J.M.

    1988-01-01

    As the author states in the Preface, this text attempts to provide a unified approach to chromatography (hence the title) by way of contrasting similarities and differences between gas chromatography (GC), column liquid chromatography (LC), and thin-layer chromatography (TLC). This book is also said to be pitched at an elementary level, suitable for most newcomers to the field (e.g., advanced undergraduates and beginning graduate students in the academic world, as well as bench-level chemists in industry).

  2. Polychromatic diffraction contrast tomography

    SciTech Connect

    King, A.; Reischig, P.; Adrien, J.; Peetermans, S.; Ludwig, W.

    2014-11-15

    This tutorial review introduces the use of polychromatic radiation for 3D grain mapping using X-ray diffraction contrast tomography. The objective is to produce a 3D map of the grain shapes and orientations within a bulk, millimeter-sized polycrystalline sample. The use of polychromatic radiation enables the standard synchrotron X-ray technique to be applied in a wider range of contexts: 1) Using laboratory X-ray sources allows a much wider application of the diffraction contrast tomography technique. 2) Neutron sources allow large samples, or samples containing high Z elements to be studied. 3) Applied to synchrotron sources, smaller samples may be treated, or faster measurements may be possible. Challenges and particularities in the data acquisition and processing, and the limitations of the different variants, are discussed. - Highlights: • We present a tutorial review of polychromatic diffraction contrast tomography techniques. • The use of polychromatic radiation allows the standard synchrotron DCT technique to be extended to a range of other sources. • The characteristics and limitations of all variants of the techniques are derived, discussed and compared. • Examples using laboratory X-ray and cold neutron radiation are presented. • Suggestions for the future development of these techniques are presented.

  3. Peripheral venous contrast echocardiography.

    PubMed

    Seward, J B; Tajik, A J; Hagler, D J; Ritter, D G

    1977-02-01

    Contrast echocardiography is the technique of injecting various echo-producing agents into the bloodstream and, with standard echocardiographic techniques, observing the blood flow patterns as revealed by the resulting cloud of echoes. These techniques have only recently been utilized to evaluate various cardiac defects. Two physical properties of these agents characterize their usefulness: (1) clouds of echoes can be observed downstream as well as at the injection site, and (2) the echo-producing quality of these agents is completely lost with a single transit through either the pulmonary or the systemic capillary bed. Thus, detection of resultant echoes in both the venous and the arterial blood pool is indicative of abnormal shunting. In 60 patients with a spectrum of cardiac defects and a wide range in age of presentation, studies were made of (1) the feasibility of performing contrast echocardiography with superficial peripheral venous injections, and (2) the clinical usefulness of this relatively noninvasive technique in detecting and localizing intracardiac right ot left shunting. Most superficial peripheral veins could be utilized, and the resultant contrast echograms were reproducible and similar in quality to those obtained more central (caval) injections. Right to left shunts could be localized in the atrial, ventricular or intrapulmonary level. Characteristic flow patterns were also recognized for tricuspid atresia and common ventricle.

  4. Diagnostic and interventional radiology in the post-operative period and follow-up of patients after rectal resection with coloanal anastomosis.

    PubMed

    Severini, A; Civelli, E M; Uslenghi, E; Cozzi, G; Salvetti, M; Milella, M; Gallino, G; Bonfanti, G; Belli, F; Leo, E

    2000-01-01

    Surgical treatment of carcinoma of the distal third of the rectum with anal sphincter preservation is increasingly used in accredited cancer centers. This study aimed to evaluate the diagnostic usefulness of radiological investigations in the management of patients who had undergone resection with coloanal anastomosis for carcinoma of the rectum, in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. A total of 175 patients who had undergone total rectal resection with end-to-side anastomosis for carcinoma of the distal third of the rectal ampulla, most of whom had received postoperative radiotherapy, were evaluated radiologically. In the postoperative period radiological investigation was ordered only for symptomatic patients to detect pathology of the anastomosis and the pouch sutures and was used direct film abdominal radiography and contrast-enhanced radiography of the rectal stump with a water-soluble radio-opaque agent. Before closure of the colostomy, 2 months after rectal excision or approximately 4 months after if postoperative radiotherapy was given, the anastomosis and pouch of all patients, even asymptomatic ones, were studied with water-soluble contrast enema to check for normal canalization. In the follow-up after recanalization radiological examinations were done to complete the study of the large intestine if the endoscopist was not able to examine it up to the cecum. Of the 175 patients examined radiologically during the postoperative period and/or subsequent follow-up, 95 showed no pathological findings. Seventy-nine patients had fistulas of the coloanal anastomosis or the pouch, 23 of which supplied a presacral collection. In the absence of severe sepsis, the only therapeutic measures were systemic antibiotics and washing of the surgical catheters to maintain efficient operation. In 2 patients in whom transanal drainage was performed radiologically the fistula

  5. Rectal temperature as an indicator for heat tolerance in chickens.

    PubMed

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

    2013-11-01

    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 ΔTn (ΔT6, ΔT18, ΔT30, ΔT42, ΔT54 and ΔT66), and the interval between LRT and initial RT as ΔTT, respectively. A negative correlation was found between HSST and ΔTn as well as ΔTT (rΔ T 18  = -0.28 and rΔ TT  = -0.31, respectively, P < 0.05; rΔT30  = -0.36, rΔ T 42  = -0.38, rΔT54  = -0.56, P < 0.01). Importantly, pullets with low ΔT18 showed a longer HSST (256.0 ± 208.4 min) than those with high ΔT18 (HSST = 123.7 ± 78.3 min). This observation suggested that the ΔT18 or early increment of RT under heat stress might be considered as a reliable indicator for evaluation of heat resistance in chickens.

  6. Intratumoral Heterogeneity of MicroRNA Expression in Rectal Cancer

    PubMed Central

    Andersen, Rikke Fredslund; Nielsen, Boye Schnack; Sørensen, Flemming Brandt; Appelt, Ane Lindegaard; Jakobsen, Anders; Hansen, Torben Frøstrup

    2016-01-01

    Introduction An increasing number of studies have investigated microRNAs (miRNAs) as potential markers of diagnosis, treatment and prognosis. So far, agreement between studies has been minimal, which may in part be explained by intratumoral heterogeneity of miRNA expression. The aim of the present study was to assess the heterogeneity of a panel of selected miRNAs in rectal cancer, using two different technical approaches. Materials and Methods The expression of the investigated miRNAs was analysed by real-time quantitative polymerase chain reaction (RT-qPCR) and in situ hybridization (ISH) in tumour specimens from 27 patients with T3-4 rectal cancer. From each tumour, tissue from three different luminal localisations was examined. Inter- and intra-patient variability was assessed by calculating intraclass correlation coefficients (ICCs). Correlations between RT-qPCR and ISH were evaluated using Spearman’s correlation. Results ICCsingle (one sample from each patient) was higher than 50% for miRNA-21 and miRNA-31. For miRNA-125b, miRNA-145, and miRNA-630, ICCsingle was lower than 50%. The ICCmean (mean of three samples from each patient) was higher than 50% for miRNA-21(RT-qPCR and ISH), miRNA-125b (RT-qPCR and ISH), miRNA-145 (ISH), miRNA-630 (RT-qPCR), and miRNA-31 (RT-qPCR). For miRNA-145 (RT-qPCR) and miRNA-630 (ISH), ICCmean was lower than 50%. Spearman correlation coefficients, comparing results obtained by RT-qPCR and ISH, respectively, ranged from 0.084 to 0.325 for the mean value from each patient, and from -0.085 to 0.515 in the section including the deepest part of the tumour. Conclusion Intratumoral heterogeneity may influence the measurement of miRNA expression and consequently the number of samples needed for representative estimates. Our findings with two different methods suggest that one sample is sufficient for adequate assessment of miRNA-21 and miRNA-31, whereas more samples would improve the assessment of miRNA-125b, miRNA-145, and miRNA-630

  7. Liquid chromatographic extraction medium

    DOEpatents

    Horwitz, E. Philip; Dietz, Mark L.

    1994-01-01

    A method and apparatus for extracting strontium and technetium values from biological, industrial and environmental sample solutions using a chromatographic column is described. An extractant medium for the column is prepared by generating a solution of a diluent containing a Crown ether and dispersing the solution on a resin substrate material. The sample solution is highly acidic and is introduced directed to the chromatographic column and strontium or technetium is eluted using deionized water.

  8. Liquid chromatographic extraction medium

    DOEpatents

    Horwitz, E.P.; Dietz, M.L.

    1994-09-13

    A method and apparatus are disclosed for extracting strontium and technetium values from biological, industrial and environmental sample solutions using a chromatographic column. An extractant medium for the column is prepared by generating a solution of a diluent containing a Crown ether and dispersing the solution on a resin substrate material. The sample solution is highly acidic and is introduced directed to the chromatographic column and strontium or technetium is eluted using deionized water. 1 fig.

  9. Determination of contrast media administration to achieve a targeted contrast enhancement in CT

    NASA Astrophysics Data System (ADS)

    Sahbaee, Pooyan; Li, Yuan; Segars, Paul; Marin, Daniele; Nelson, Rendon; Samei, Ehsan

    2015-03-01

    Contrast enhancement is a key component of CT imaging and offer opportunities for optimization. The design and optimization of new techniques however requires orchestration with the scan parameters and further a methodology to relate contrast enhancement and injection function. In this study, we used such a methodology to develop a method, analytical inverse method, to predict the required injection function to achieve a desired contrast enhancement in a given organ by incorporation of a physiologically based compartmental model. The method was evaluated across 32 different target contrast enhancement functions for aorta, kidney, stomach, small intestine, and liver. The results exhibited that the analytical inverse method offers accurate performance with error in the range of 10% deviation between the predicted and desired organ enhancement curves. However, this method is incapable of predicting the injection function based on the liver enhancement. The findings of this study can be useful in optimizing contrast medium injection function as well as the scan timing to provide more consistency in the way that the contrast enhanced CT examinations are performed. To our knowledge, this work is one of the first attempts to predict the contrast material injection function for a desired organ enhancement curve.

  10. Contrast and depth perception: effects of texture contrast and area contrast.

    PubMed

    Ichihara, Shigeru; Kitagawa, Norimichi; Akutsu, Hiromi

    2007-01-01

    Many objects in natural scenes have textures on their surfaces. Contrast of the texture surfaces (the texture contrast) reduces when the viewing distance increases. Similarly, contrast between the surfaces of the objects and the background (the area contrast) reduces when the viewing distance increases. The texture contrast and the area contrast were defined by the contrast between random dots, and by the contrast between the average luminance of the dot pattern and the luminance of the background, respectively. To examine how these two types of contrast influence depth perception, we ran two experiments. In both experiments two areas of random-dot patterns were presented against a uniform background, and participants rated relative depth between the two areas. We found that the rated depth of the patterned areas increased with increases in texture contrast. Furthermore, the effect of the texture contrast on depth judgment increased when the area contrast became low.

  11. Saphenous Venous Ablation with Hot Contrast in a Canine Model

    SciTech Connect

    Prasad, Amit Qian Zhong; Kirsch, David; Eissa, Marna; Narra, Pavan; Lopera, Jorge; Espinoza, Carmen G.; Castaneda, Wifrido

    2008-01-15

    Purpose. To determine the feasibility, efficacy, and safety of thermal ablation of the saphenous vein with hot contrast medium. Methods. Twelve saphenous veins of 6 dogs were percutaneously ablated with hot contrast medium. In all animals, ablation was performed in the vein of one leg, followed by ablation in the contralateral side 1 month later. An occlusion balloon catheter was placed in the infragenicular segment of the saphenous vein via a jugular access to prevent unwanted thermal effects on the non-target segment of the saphenous vein. After inflation of the balloon, 10 ml of hot contrast medium was injected under fluoroscopic control through a sheath placed in the saphenous vein above the ankle. A second 10 ml injection of hot contrast medium was made after 5 min in each vessel. Venographic follow-up of the ablated veins was performed at 1 month (n = 12) and 2 months (n = 6). Results. Follow-up venograms showed that all ablated venous segments were occluded at 1 month. In 6 veins which were followed up to 2 months, 4 (66%) remained occluded, 1 (16%) was partially patent, and the remaining vein (16%) was completely patent. In these latter 2 cases, an inadequate amount of hot contrast was delivered to the lumen due to a closed balloon catheter downstream which did not allow contrast to displace blood within the vessel. Discussion. Hot contrast medium thermal ablation of the saphenous vein appears feasible, safe, and effective in the canine model, provided an adequate amount of embolization agent is used.

  12. Formulation and Evaluation of Tramadol hydrochloride Rectal Suppositories.

    PubMed

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

    2008-09-01

    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.

  13. Sacrococcygeal chordoma presenting as a retro rectal tumour

    PubMed Central

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

    2014-01-01

    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

  14. Proteogenomic characterization of human colon and rectal cancer

    PubMed Central

    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.

    2014-01-01

    Summary We analyzed proteomes of colon and rectal tumors previously characterized by the Cancer Genome Atlas (TCGA) and performed integrated proteogenomic analyses. Somatic variants displayed reduced protein abundance compared to germline variants. mRNA transcript abundance did not reliably predict protein abundance differences between tumors. Proteomics identified five proteomic subtypes in the TCGA cohort, two of which overlapped with the TCGA “MSI/CIMP” 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, TOMM34 and SRC. Integrated proteogenomic analysis provides functional context to interpret genomic abnormalities and affords a new paradigm for understanding cancer biology. PMID:25043054

  15. Antipyretic therapy. Comparison of rectal and oral paracetamol.

    PubMed

    Keinänen, S; Hietula, M; Similä, S; Kouvalainen, K

    1977-08-17

    The absorption of paracetamol from syrup, tablet and two different suppository bases was compared in six adult volunteers using urinary excretion measurements. The total amount of paracetamol and its metabolites excreted and the peak excretion rates were lower from the suppository bases than from the oral dosage forms. Absorption was a little better from a polyethylene glycol suppository base than from a triglyceride base. The antipyretic efficacy of a paracetamol syrup and suppository at a dose of 10 mg/kg was compared in 30 children between the age of 4 months and 12 years, who had infections and a rectal temperature above 38.5 degrees C. Both dosage forms produced a significant decrease in temperature, the greatest fall being about 2 hours earlier with the oral dosage form. The syrup also seemed to be significantly (p less than 0.05) more effective (maximum fall of temperature 1.58 degrees C) in reducing fever than the suppository, which produced its greatest fall of temperature (1.24 degrees C) six hours after insertion of the suppository. From the practical point of view both forms can be regarded as safe and effective antipyretics. PMID:332506

  16. Proteogenomic characterization of human colon and rectal cancer.

    PubMed

    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

    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.

  17. Biomarkers for Response to Neoadjuvant Chemoradiation for Rectal Cancer

    SciTech Connect

    Kuremsky, Jeffrey G.; Tepper, Joel E.; McLeod, Howard L. Phar

    2009-07-01

    Locally advanced rectal cancer (LARC) is currently treated with neoadjuvant chemoradiation. Although approximately 45% of patients respond to neoadjuvant therapy with T-level downstaging, there is no effective method of predicting which patients will respond. Molecular biomarkers have been investigated for their ability to predict outcome in LARC treated with neoadjuvant chemotherapy and radiation. A literature search using PubMed resulted in the initial assessment of 1,204 articles. Articles addressing the ability of a biomarker to predict outcome for LARC treated with neoadjuvant chemotherapy and radiation were included. Six biomarkers met the criteria for review: p53, epidermal growth factor receptor (EGFR), thymidylate synthase, Ki-67, p21, and bcl-2/bax. On the basis of composite data, p53 is unlikely to have utility as a predictor of response. Epidermal growth factor receptor has shown promise as a predictor when quantitatively evaluated in pretreatment biopsies or when EGFR polymorphisms are evaluated in germline DNA. Thymidylate synthase, when evaluated for polymorphisms in germline DNA, is promising as a predictive biomarker. Ki-67 and bcl-2 are not useful in predicting outcome. p21 needs to be further evaluated to determine its usefulness in predicting outcome. Bax requires more investigation to determine its usefulness. Epidermal growth factor receptor, thymidylate synthase, and p21 should be evaluated in larger prospective clinical trials for their ability to guide preoperative therapy choices in LARC.

  18. Private practice for the colon and rectal surgeon.

    PubMed

    Vargas, H David

    2006-08-01

    Autonomy and independence as a surgeon represent the pinnacle of our training model, and private practice offers the trainee in colon and rectal surgery an opportunity to realize such goals as both a clinical surgeon and a business owner. Personalized care of patients and the immense gratification from providing such expert surgical care continue to be the ultimate reward for us as surgeons. However, private practice ultimately involves responsibilities of functioning as a small business owner. The health care environment in which we find ourselves provides great challenges to the viability and financial success of the private practitioner. Rising overhead expenses, malpractice, reduced reimbursement, and others factors confront the private practitioner as business owner. A career in private practice mandates acquisition of business acumen to preserve the privilege to practice our profession in this very challenging and changing economic environment. The opportunities for such a career vary considerably according to the scope of practice, hospital sophistication, geographic locale, and size of practice. PMID:20011369

  19. The endo-rectal probe prototype for the TOPEM project

    NASA Astrophysics Data System (ADS)

    Musico, Paolo

    2016-07-01

    The TOPEM project was funded by INFN with the aim of studying the design of a TOF-PET system dedicated to prostate imaging. During last year a big effort was put into building the prototype of the endo-rectal probe from all point of view: mechanical, thermal, electrical. A dedicated integrated circuit was adopted to have the minimum dimensions: the TOFPET ASIC. The system is composed by a LYSO pixellated crystal which is seen by a 128 SiPM matrix on both surfaces: this permits Depth Of Interaction (DOI) measurement. The 4 needed ASICs are handled by a FPGA board which transmits the acquired data over an UDP connection. The external container was made using 3-D printing technology: internal channels on the external surface permit the flowing of controlled temperature (≈35 °C) water. Electronic components power is dissipated using an internal air flow kept at lower temperature (≈20 °C). The probe is MR compatible: a dedicated small antenna can be accommodated in the container. This will permit simultaneous imaging in MRI and PET systems.

  20. Automatically-generated rectal dose constraints in intensity-modulated radiation therapy for prostate cancer

    NASA Astrophysics Data System (ADS)

    Hwang, Taejin; Kim, Yong Nam; Kim, Soo Kon; Kang, Sei-Kwon; Cheong, Kwang-Ho; Park, Soah; Yoon, Jai-Woong; Han, Taejin; Kim, Haeyoung; Lee, Meyeon; Kim, Kyoung-Joo; Bae, Hoonsik; Suh, Tae-Suk

    2015-06-01

    The dose constraint during prostate intensity-modulated radiation therapy (IMRT) optimization should be patient-specific for better rectum sparing. The aims of this study are to suggest a novel method for automatically generating a patient-specific dose constraint by using an experience-based dose volume histogram (DVH) of the rectum and to evaluate the potential of such a dose constraint qualitatively. The normal tissue complication probabilities (NTCPs) of the rectum with respect to V %ratio in our study were divided into three groups, where V %ratio was defined as the percent ratio of the rectal volume overlapping the planning target volume (PTV) to the rectal volume: (1) the rectal NTCPs in the previous study (clinical data), (2) those statistically generated by using the standard normal distribution (calculated data), and (3) those generated by combining the calculated data and the clinical data (mixed data). In the calculated data, a random number whose mean value was on the fitted curve described in the clinical data and whose standard deviation was 1% was generated by using the `randn' function in the MATLAB program and was used. For each group, we validated whether the probability density function (PDF) of the rectal NTCP could be automatically generated with the density estimation method by using a Gaussian kernel. The results revealed that the rectal NTCP probability increased in proportion to V %ratio , that the predictive rectal NTCP was patient-specific, and that the starting point of IMRT optimization for the given patient might be different. The PDF of the rectal NTCP was obtained automatically for each group except that the smoothness of the probability distribution increased with increasing number of data and with increasing window width. We showed that during the prostate IMRT optimization, the patient-specific dose constraints could be automatically generated and that our method could reduce the IMRT optimization time as well as maintain the

  1. Solitary rectal ulcer syndrome: Is it really a rare condition in children?

    PubMed Central

    Dehghani, Seyed Mohsen; Bahmanyar, Maryam; Geramizadeh, Bita; Alizadeh, Anahita; Haghighat, Mahmood

    2016-01-01

    AIM To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer. METHODS Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of 11 years from March 2003 to March 2014. All data were collected from the patients, their parents and medical records in the hospital. RESULTS From 55 studied patients, 41 were male (74.5%) and 14 female (25.5%). The mean age of the patients was 10.4 ± 3.7 years and the average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 ± 11.2 mo. The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). The colonoscopic examination revealed 67.3% ulcer, 12.7% polypoid lesions, 10.9% erythema, 7.3% both polypoid lesions and ulcer, and 1.8% normal. Most of the lesions were in the rectosigmoid area at a distance of 4-6 cm from the anal margin. Finally, 69.8% of the patients recovered successfully with conservative, medical and surgical management. CONCLUSION The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis. PMID:27610352

  2. Transanal endoscopic microsurgery as optimal option in treatment of rare rectal lesions: A single centre experience

    PubMed Central

    Ortenzi, Monica; Ghiselli, Roberto; Cappelletti Trombettoni, Maria Michela; Cardinali, Luca; Guerrieri, Mario

    2016-01-01

    AIM To analyze the outcomes of transanal endoscopic microsurgery (TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma. METHODS We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were analyzed. RESULTS Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males (57.7%) and 22 females (42.3%). Mean age was 55 years (median = 60, range = 24-78). This series included 14 (26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors (40.4%), 1 ganglioneuroma (1.9%), 2 solitary ulcers in the rectum (3.8%), 6 cases of rectal endometriosis (11.5%), 6 cases of rectal condylomatosis (11.5%) and 2 rectal melanomas (3.8%). Mean lesion diameter was 2.7 cm (median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm (median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences (3.8%) with an overall survival equal to 97.6% (95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98% (95%CI: 96%-99%). CONCLUSION We could conclude that TEM is an important therapeutical option for rectal rare conditions. PMID:27668073

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

    PubMed

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

    2013-09-01

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

  4. Solitary rectal ulcer syndrome: Is it really a rare condition in children?

    PubMed Central

    Dehghani, Seyed Mohsen; Bahmanyar, Maryam; Geramizadeh, Bita; Alizadeh, Anahita; Haghighat, Mahmood

    2016-01-01

    AIM To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer. METHODS Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of 11 years from March 2003 to March 2014. All data were collected from the patients, their parents and medical records in the hospital. RESULTS From 55 studied patients, 41 were male (74.5%) and 14 female (25.5%). The mean age of the patients was 10.4 ± 3.7 years and the average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 ± 11.2 mo. The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). The colonoscopic examination revealed 67.3% ulcer, 12.7% polypoid lesions, 10.9% erythema, 7.3% both polypoid lesions and ulcer, and 1.8% normal. Most of the lesions were in the rectosigmoid area at a distance of 4-6 cm from the anal margin. Finally, 69.8% of the patients recovered successfully with conservative, medical and surgical management. CONCLUSION The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.

  5. Transanal endoscopic microsurgery as optimal option in treatment of rare rectal lesions: A single centre experience

    PubMed Central

    Ortenzi, Monica; Ghiselli, Roberto; Cappelletti Trombettoni, Maria Michela; Cardinali, Luca; Guerrieri, Mario

    2016-01-01

    AIM To analyze the outcomes of transanal endoscopic microsurgery (TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma. METHODS We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were analyzed. RESULTS Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males (57.7%) and 22 females (42.3%). Mean age was 55 years (median = 60, range = 24-78). This series included 14 (26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors (40.4%), 1 ganglioneuroma (1.9%), 2 solitary ulcers in the rectum (3.8%), 6 cases of rectal endometriosis (11.5%), 6 cases of rectal condylomatosis (11.5%) and 2 rectal melanomas (3.8%). Mean lesion diameter was 2.7 cm (median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm (median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences (3.8%) with an overall survival equal to 97.6% (95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98% (95%CI: 96%-99%). CONCLUSION We could conclude that TEM is an important therapeutical option for rectal rare conditions.

  6. Host Nectin-1 Promotes Chlamydial Infection in the Female Mouse Genital Tract, but Is Not Required for Infection in a Novel Male Murine Rectal Infection Model.

    PubMed

    Slade, Jessica A; Hall, Jennifer V; Kintner, Jennifer; Phillips-Campbell, Regenia; Schoborg, Robert V

    2016-01-01

    Chlamydia trachomatis is the most common bacterial sexually transmitted pathogen, but more than 70% of patients fail to seek treatment due to the asymptomatic nature of these infections. Women suffer from numerous complications from chronic chlamydial infections, which include pelvic inflammatory disease and infertility. We previously demonstrated in culture that host cell nectin-1 knockdown significantly reduced chlamydial titers and inclusion size. Here, we sought to determine whether nectin-1 was required for chlamydial development in vivo by intravaginally infecting nectin-1-/- mice with Chlamydia muridarum and monitoring chlamydial shedding by chlamydial titer assay. We observed a significant reduction in chlamydial shedding in female nectin-1-/- mice compared to nectin-1+/+ control mice, an observation that was confirmed by PCR. Immunohistochemical staining in mouse cervical tissue confirmed that there are fewer chlamydial inclusions in Chlamydia-infected nectin-1-/- mice. Notably, anorectal chlamydial infections are becoming a substantial health burden, though little is known regarding the pathogenesis of these infections. We therefore established a novel male murine model of rectal chlamydial infection, which we used to determine whether nectin-1 is required for anorectal chlamydial infection in male mice. In contrast to the data from vaginal infection, no difference in rectal chlamydial shedding was observed when male nectin-1+/+ and nectin-1-/- mice were compared. Through the use of these two models, we have demonstrated that nectin-1 promotes chlamydial infection in the female genital tract but does not appear to contribute to rectal infection in male mice. These models could be used to further characterize tissue and sex related differences in chlamydial infection. PMID:27486990

  7. Adjuvant Chemotherapy With or Without Pelvic Radiotherapy After Simultaneous Surgical Resection of Rectal Cancer With Liver Metastases: Analysis of Prognosis and Patterns of Recurrence

    SciTech Connect

    An, Ho Jung; Yu, Chang Sik; Yun, Sung-Cheol; Kang, Byung Woog; Hong, Yong Sang; Lee, Jae-Lyun; Ryu, Min-Hee; Chang, Heung Moon; Park, Jin Hong; Kim, Jong Hoon; Kang, Yoon-Koo; Kim, Jin Cheon; Kim, Tae Won

    2012-09-01

    Purpose: To investigate the outcomes of adjuvant chemotherapy (CT) or chemoradiotherapy (CRT) after simultaneous surgical resection in rectal cancer patients with liver metastases (LM). Materials and Methods: One hundred and eight patients receiving total mesorectal excision for rectal cancer and surgical resection for LM were reviewed. Forty-eight patients received adjuvant CRT, and 60 were administered CT alone. Recurrence patterns and prognosis were analyzed. Disease-free survival (DFS) and overall survival (OS) rates were compared between the CRT and CT groups. The inverse probability of the treatment-weighted (IPTW) method based on the propensity score was used to adjust for selection bias between the two groups. Results: At a median follow-up period of 47.7 months, 77 (71.3%) patients had developed recurrences. The majority of recurrences (68.8%) occurred in distant organs. By contrast, the local recurrence rate was only 4.7%. Median DFS and OS were not significantly different between the CRT and CT groups. After applying the IPTW method, we observed no significant differences in terms of DFS (hazard ratio [HR], 1.347; 95% confidence interval [CI], 0.759-2.392; p = 0.309) and OS (HR, 1.413; CI, 0.752-2.653; p = 0.282). Multivariate analyses showed that unilobar distribution of LM and normal preoperative carcinoembryonic antigen level (<6 mg/mL) were significantly associated with longer DFS and OS. Conclusions: The local recurrence rate after simultaneous resection of rectal cancer with LM was relatively low. DFS and OS rates were not different between the adjuvant CRT and CT groups. Adjuvant CRT may have a limited role in this setting. Further prospective randomized studies are required to evaluate optimal adjuvant treatment in these patients.

  8. Host Nectin-1 Promotes Chlamydial Infection in the Female Mouse Genital Tract, but Is Not Required for Infection in a Novel Male Murine Rectal Infection Model

    PubMed Central

    Slade, Jessica A.; Hall, Jennifer V.; Kintner, Jennifer; Phillips-Campbell, Regenia; Schoborg, Robert V.

    2016-01-01

    Chlamydia trachomatis is the most common bacterial sexually transmitted pathogen, but more than 70% of patients fail to seek treatment due to the asymptomatic nature of these infections. Women suffer from numerous complications from chronic chlamydial infections, which include pelvic inflammatory disease and infertility. We previously demonstrated in culture that host cell nectin-1 knockdown significantly reduced chlamydial titers and inclusion size. Here, we sought to determine whether nectin-1 was required for chlamydial development in vivo by intravaginally infecting nectin-1-/- mice with Chlamydia muridarum and monitoring chlamydial shedding by chlamydial titer assay. We observed a significant reduction in chlamydial shedding in female nectin-1-/- mice compared to nectin-1+/+ control mice, an observation that was confirmed by PCR. Immunohistochemical staining in mouse cervical tissue confirmed that there are fewer chlamydial inclusions in Chlamydia-infected nectin-1-/- mice. Notably, anorectal chlamydial infections are becoming a substantial health burden, though little is known regarding the pathogenesis of these infections. We therefore established a novel male murine model of rectal chlamydial infection, which we used to determine whether nectin-1 is required for anorectal chlamydial infection in male mice. In contrast to the data from vaginal infection, no difference in rectal chlamydial shedding was observed when male nectin-1+/+ and nectin-1-/- mice were compared. Through the use of these two models, we have demonstrated that nectin-1 promotes chlamydial infection in the female genital tract but does not appear to contribute to rectal infection in male mice. These models could be used to further characterize tissue and sex related differences in chlamydial infection. PMID:27486990

  9. N-Acetyltransferase 2 and glutathione s-transferase M1 in colon and rectal cancer cases from an industrialized area.

    PubMed

    Golka, Klaus; Roemer, Hermann C; Weistenhöfer, Wobbeke; Blaszkewicz, Meinolf; Hammad, Seddik; Reckwitz, Thomas; Loehlein, Dietrich; Hartel, Mark; Hengstler, Jan G; Geller, Frank

    2012-01-01

    Apart from genetics, nutrition, and environment, occupational factors also play an important role in colon and rectal cancer development. The aim of this study was to examine these cancer types in an area of former coal, iron, and steel industries, which was found to display an increased incidence of colon cancer mortality. N-Acetyltransferase 2 (NAT2) and glutathione S-transferase M1 (GSTM1) genotypes were investigated in 108 colon cancer cases, 80 rectum cancer cases, and 188 controls (suffering from nonmalignant diseases). Further, in a pilot study, 28 colorectal cancer patients were NAT2 phenotyped by the caffeine test. Possible occupational and nonoccupational risk factors were investigated by a personal interview. The frequency of rapid NAT2 genotype was 35% in colon cancer cases, 47% in rectal cancer cases, and 42% in controls (GSTM1 0/0 genotype: 53, 46, and 47%, respectively). In the 29 patients with cancer in the ascending colon, 10% were of the rapid NAT2 genotype. In the pilot study the frequency of the rapid NAT2 phenotype was 49%. The only major professional group with an elevated risk was painters (colon cancer OR 2.48, 95% CI 0.4-15.23; rectal cancer OR 5.65, 95% CI 1.06-30.21). In contrast to early studies, in the present study the slow NAT2 status is overrepresented. As colorectal cancer is associated with nutrition and physical activity, present findings may be due to excessive physical heavy work and the resulting nutrition in this area.

  10. On Establishing Underlying Tonal Contrast

    ERIC Educational Resources Information Center

    Snider, Keith

    2014-01-01

    Phonological field work is largely about establishing contrast in comparable environments. The notion of phonological contrast, however, can be confusing, particularly in its application to tone analysis. Does it mean phonemic contrast in the structuralist sense, or does it mean underlying contrast in the generative sense? Many linguists, in…

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

    PubMed Central

    2013-01-01

    Background Intestinal obstruction secondary to intussusception, occurring simultaneously with complete rectal prolapse, is an unusual entity among young adults. When it occurs the intussusceptum may protrude per anus. Few cases are cited in literature; each with a unique clinical presentation. There is apparently no uniform trend in its clinical and pathological picture. Case presentation A 38-year-old, African-Ugandan man presented with sudden occurrence of rectal prolapse for one day. He had otherwise been in good health. Symptoms were precipitous. A clinical diagnosis of intussusception of the lower gut with rectal prolapse, and intestinal obstruction, was made. The intussusception was found to have a polyp as the ‘lead point’. He was treated by manual reduction of the intussusception and the prolapse under general anesthesia. Histopathologic examination of the polyp showed it to be an adenoma. Definitive surgical treatment of the patient was not completed due to socioeconomic challenges. Conclusions Rectal prolapse and intussusception are commonly childhood conditions. Rectal prolapse alone is commoner in the middle-aged and elderly; females in particular. The finding of this combined clinical entity in a young, adult male is therefore a unique condition with an unusual presentation. It is the first case of its kind reported in East Africa. It is also an example of an adenoma constituting a ‘lead point’ for an intussusception at the gastrointestinal tract’s terminus. Even in the presence of a pre-existing adenoma, a relatively common lesion, other differential diagnoses acting as ‘lead points’ ought to be considered in perspective. This characteristic, along with other features described in this case, is useful knowledge for colorectal surgeons, general surgeons, gastrointestinal pathologists, and gastroenterologists given their involvement in the diagnosis and management of anorectal disease of peculiar presentation. PMID:24093478

  12. On motion in a resisting medium: A historical perspective

    NASA Astrophysics Data System (ADS)

    Hackborn, William W.

    2016-02-01

    This paper examines, compares, and contrasts ideas about motion, especially the motion of a body in a resisting medium, proposed by Galileo, Newton, and Tartaglia, the author of the first text on exterior ballistics, within the context of the Aristotelian philosophy prevalent when these scholars developed their ideas. This historical perspective offers insights on the emergence of a scientific paradigm for motion, particularly with respect to the challenge of incorporating into this paradigm the role played by the medium.

  13. The Local Interstellar Medium

    NASA Astrophysics Data System (ADS)

    Ferlet, Roger

    Substantial progress in the field of the Local Interstellar Medium has been largely due to recent launches of space missions, mostly in the UV and X-ray domains, but also to ground-based observations, mainly in high resolution spectroscopy. However, a clear gap seems to remain between the wealth of new data and the theoretical understanding. This paper gives an overview of some observational aspects, with no attempt of completeness or doing justice to all the people involved in the field. As progress rarely evolves in straight paths, we can expect that our present picture of the solar system surroundings is not definitive.

  14. Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors

    PubMed Central

    Karakayali, Feza Y.; Tezcaner, Tugan; Moray, Gokhan

    2015-01-01

    BACKGROUND: Transanal endoscopic microsurgery is a minimally invasive technique that allows full-thickness resection and suture closure of the defect for large rectal adenomas, selected low-risk rectal cancers, or small cancers in patients who have a high risk for major surgery. Our aim, in the given prospective study was to report our initial clinical experience with TAMIS, and to evaluate its effects on postoperative anorectal functions. MATERIALS AND METHODS: In 10 patients treated with TAMIS for benign and malignant rectal tumors, preoperative and postoperative anorectal function was evaluated with anorectal manometry and Cleveland Clinic Incontinence Score. RESULTS: The mean distance of the tumors from the anal verge was 5.6 cm, and mean tumor diameter was 2.6 cm. All resection margins were tumor free. There was no difference in preoperative and 3-week postoperative anorectalmanometry findings; only mean minimum rectal sensory volume was lower at 3 weeks after surgery. The Cleveland Clinic Incontinence Score was normal in all patients except one which resolved by 6 weeks after surgery.The mean postoperative follow-up was 28 weeks without any recurrences. CONCLUSION: Transanal minimally invasive surgery is a safe and effective procedure for treatment of rectal tumors and can be performed without impairing anorectal functions. PMID:26622116

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

    PubMed

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

    2014-06-06

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

  16. [Total mesorectal excision with ultrasonic coagulation knife ("UltraCision") in surgery of rectal cancer].

    PubMed

    Balogh, A; Zöllei, I; Varga, L; Tiszlavicz, L; Lázár, G; Bagi, R; Palkó, A; Nagy, F

    2000-02-20

    The authors report a total of 62 middle and low third rectal cancer cases operated on by total mesorectal excision by the method of Heald. The oncological basis of this procedure is the horizontal regional metastatization of rectal cancer. The total mesorectal excision facilitates, the low anterior resections and preservation of sphincter with an ultra-low colorectal, or coloanal anastomosis using the double stapling technique. In the authors' experience, the "UltraCision" cutting-coagulating device permits an atraumatic, bloodless and oncologically correct dissection. Using the double stapling technique, we succeeded in 60% of our middle- and low-third rectal cancer patients to perform a sphincter preserving low anterior resection. In 9 (28%) of the low third rectal cancer patients, preservation of the sphincter was possible with oncologically correct anterior resection and an ultra-low colo-anal anastomosis. Three anastomotic insufficiencies occurred, two of them healed on lotion-suction drainage, and one on the application of transient protective ileostomy. The literature data suggest a lower local recurrency rate after radical rectal cancer surgery, if total mesorectal excision is performed.

  17. Anatomic basis of sharp pelvic dissection for curative resection of rectal cancer.

    PubMed

    Kim, Nam Kyu

    2005-12-31

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

  18. Reporting Late Rectal Toxicity in Prostate Cancer Patients Treated With Curative Radiation Treatment

    SciTech Connect

    Faria, Sergio L. Souhami, Luis; Joshua, Bosede; Vuong, Te; Freeman, Carolyn R.

    2008-11-01

    Purpose: Long-term rectal toxicity is a concern for patients with prostate cancer treated with curative radiation. However, comparing results of late toxicity may not be straightforward. This article reviews the complexity of reporting long-term side effects by using data for patients treated in our institution with hypofractionated irradiation. Methods and Materials: Seventy-two patients with localized prostate cancer treated with hypofractionated radiotherapy alone to a dose of 66 Gy in 22 fractions were prospectively assessed for late rectal toxicity according to the Common Toxicity Criteria, Version 3, scoring system. Ninety percent of patients had more than 24 months of follow-up. Results are compared with data published in the literature. Results: We found an actuarial incidence of Grade 2 or higher late rectal toxicity of 27% at 30 months and a crude incidence of Grade 2 or higher late rectal toxicity of 18%. This was mostly severe toxicity documented during follow-up. The incidence of Grade 3 rectal toxicity at the last visit was 3% compared with 13% documented at any time during follow-up. Conclusion: Comparison of late toxicity after radiotherapy in patients with prostate cancer must be undertaken with caution because many factors need to be taken into consideration. Because accurate assessment of late toxicity in the evaluation of long-term outcome after radiotherapy in patients with localized prostate cancer is essential, there is a need to develop by consensus guidelines for assessing and reporting late toxicity in this group of patients.

  19. Quantitative analysis of rectal cancer by spectral domain optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Zhang, Q. Q.; Wu, X. J.; Tang, T.; Zhu, S. W.; Yao, Q.; Gao, Bruce Z.; Yuan, X. C.

    2012-08-01

    To quantify OCT images of rectal tissue for clinic diagnosis, the scattering coefficient of the tissue is extracted by curve fitting the OCT signals to a confocal single model. A total of 1000 measurements (half and half of normal and malignant tissues) were obtained from 16 recta. The normal rectal tissue has a larger scattering coefficient ranging from 1.09 to 5.41 mm-1 with a mean value of 2.29 mm-1 (std:±0.32), while the malignant group shows lower scattering property and the values ranging from 0.25 to 2.69 mm-1 with a mean value of 1.41 mm-1 (std:±0.18). The peri-cancer of recta has also been investigated to distinguish the difference between normal and malignant rectal tissue. The results demonstrate that the quantitative analysis of the rectal tissue can be used as a promising diagnostic criterion of early rectal cancer, which has great value for clinical medical applications.

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

    PubMed

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

    2011-01-01

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

  1. Rectal budesonide and mesalamine formulations in active ulcerative proctosigmoiditis: efficacy, tolerance, and treatment approach

    PubMed Central

    Christophi, George P; Rengarajan, Arvind; Ciorba, Matthew A

    2016-01-01

    Ulcerative colitis (UC) is an immune-mediated disease of the colon that is characterized by diffuse and continuous inflammation contiguous from the rectum. Half of UC patients have inflammation limited to the distal colon (proctitis or proctosigmoiditis) that primarily causes symptoms of bloody diarrhea and urgency. Mild-to-moderate distal UC can be effectively treated with topical formulations (rectal suppositories, enemas, or foam) of mesalamine or steroids to reduce mucosal inflammation and alleviate symptoms. Enemas or foam formulations adequately reach up to the splenic flexure, have a minimal side-effect profile, and induce remission alone or in combination with systemic immunosuppressive therapy. Herein, we compare the efficacy, cost, patient tolerance, and side-effect profiles of steroid and mesalamine rectal formulations in distal UC. Patients with distal mild-to-moderate UC have a remission rate of approximately 75% (NNT =2) after treatment for 6 weeks with mesalamine enemas. Rectal budesonide foam induces remission in 41.2% of patients with mild-to-moderate active distal UC compared to 24% of patient treated with placebo (NNT =5). However, rectal budesonide has better patient tolerance profile compared to enema formulations. Despite its favorable efficacy, safety, and cost profiles, patients and physicians significantly underuse topical treatments for treating distal colitis. This necessitates improved patient education and physician familiarity regarding the indications, effectiveness, and potential financial and tolerability barriers in using rectal formulations. PMID:27274301

  2. Knowledge, Attitudes, and Practices Related to Preoperative Chemoradiotherapy in Rectal Cancer Patients

    PubMed Central

    Chen, Xingxing; Lin, Ruifang; Li, Huifang; Su, Meng; Zhang, Wenyi; Deng, Xia; Zhang, Ping

    2016-01-01

    Background. The aim of this study is to assess the knowledge, attitudes, and practices related to pre-CRT in patients of stage II/III rectal cancer. Materials and Methods. Questionnaires regarding the knowledge, attitudes, and practices of pre-CRT were mailed to 145 rectal cancer patients in II/III stage between January 2012 and December 2014, and 111 agreed to participate and returned completed questionnaires to the researcher. Logistic regression model was used to compare sociodemographic characteristics, knowledge, and attitude with practice, respectively. Results. A total of 145 patients were approached for interview, of which 111 responded and 48.6% (54) had undergone pre-CRT. Only 31.5% of the participants knew that CRT is a treatment of rectal cancer and 39.6% were aware of the importance of CRT. However, the vast majority of participants (68.5%) expressed a positive attitude toward rectal cancer. Multivariate logistic regression analysis revealed that knowledge level (p = 0.006) and attitudes (p = 0.001) influence the actual practice significantly. Furthermore, age, gender, and income were potential predictors of practice (all p < 0.05). Conclusion. This study shows that, despite the fact that participants had suboptimal level of knowledge on rectal cancer, their attitude is favorable to pre-CRT. Strengthening the professional health knowledge and realizing the importance of attitudes may deepen patients' understanding of preoperative therapy. PMID:27761141

  3. Rectal response of cardiac origin in the cat: involvement of nitric oxide and acetylcholine.

    PubMed

    Koley, J; Basak, A K; Das, M; Sinha, S; Koley, B

    1997-05-01

    Local application of nicotine over the surface of the left ventricle and also occlusion of the left anterior descending coronary artery in the lightly anaesthetised, open-chested, artificially ventilated cat resulted a biphasic rectal movement--initial relaxation followed by sustained contraction. However, distension of the atrial appendage did not evoke any change in rectal motility, indicating the non-involvement of atrial volume receptors in initiating this rectal response of cardiac origin. The relaxation phase of this response was not abolished by pretreatment with atropine or with phentolamine or propranolol but was abolished by the nitric oxide inhibitor, N(G)-nitro-L-arginine (LNNA), and this blockade of the relaxation phase by LNNA was reversed by L-arginine. The contraction phase, however, was abolished by atropine. From these observations it is clear that the relaxation phase of the rectal response to coronary occlusion or epicardial nicotine is mediated through neither cholinergic nor adrenergic pathways but through the release of nitric oxide whereas the contraction phase of such a cardio-rectal response is mediated through the release of the neurotransmitter, acetylcholine.

  4. [Three Cases of Stage Ⅳ Low Rectal Cancer with Lateral Pelvic Lymph Node Metastasis].

    PubMed

    Tamura, Hiroshi; Shimada, Yoshifumi; Yagi, Ryoma; Tajima, Yosuke; Okamura, Takuma; Nakano, Masato; Ishikawa, Takashi; Sakata, Jun; Kobayashi, Takashi; Kameyama, Hitoshi; Kosugi, Shin-ichi; Wakai, Toshifumi; Nogami, Hitoshi; Maruyama, Satoshi; Takii, Yasumasa

    2015-11-01

    Case 1: A 61-year-old man who had a diagnosis of low rectal cancer with lateral pelvic lymph node (LPLN) metastasis and multiple liver metastases underwent low anterior resection with LPLN dissection. The initial surgery was followed by chemotherapy, and then an extended right hepatectomy with partial resection of the liver was performed. Subsequently, a lung metastasis was detected, and the lung was partially resected. The patient was alive 9 years and 6 months after the initial operation. Case 2: A 53-year-old man had a diagnosis of low rectal cancer. After 5 courses of mFOLFOX6 plus bevacizumab, he underwent low anterior resection with LPLN dissection and resection of the peritoneal metastasis. The patient was alive 6 years and 3 months after the surgery without any signs of recurrence. Case 3: A 48-year-old man had a diagnosis of low rectal cancer and multiple liver metastases. He underwent low anterior resection with LPLN dissection and right hepatic lobectomy. He subsequently showed liver and lung metastases. The patient received systemic chemotherapy, and is alive with recurrent disease. We report 3 cases of Stage Ⅳ low rectal cancer with LPLN metastasis, and propose that LPLN dissection is important as a part of R0 resection for Stage Ⅳ low rectal cancer. PMID:26805345

  5. Rectal sac distention is induced by 20-hydroxyecdysone in the pupa of Bombyx mori.

    PubMed

    Suzuki, Takumi; Sakurai, Sho; Iwami, Masafumi

    2009-03-01

    Holometabolous insects do not excrete but store metabolic wastes during the pupal period. The waste is called meconium and is purged after adult emergence. Although the contents of meconium are well-studied, the developmental and physiological regulation of meconium accumulation is poorly understood. In Bombyx mori, meconium is accumulated in the rectal sac; thereby, the rectal sac distends at the late pupal stage. Here, we show that rectal sac distention occurs between 4 and 5 days after pupation. The distention is halted by brain-removal just after larval-pupal ecdysis but not by brain-removal 1 day after pupation. In the pupae, brain-removal just after ecdysis kept the hemolymph ecdysteroid titer low during early and mid-pupal stages. An injection of 20-hydroxyecdysone (20E) evoked the distention that was halted by brain-removal in a dose-dependent manner. Therefore, brain-removal caused the lack of ecdysteroid, and rectal sac distention did not appear in the brain-removed pupae because of the lack of ecdysteroid. We conclude that rectal sac distention is one of the developmental events regulated by 20E during the pupal period in B. mori.

  6. Prognostic value of rectal temperature at hospital admission in client-owned rabbits.

    PubMed

    Di Girolamo, Nicola; Toth, Giulia; Selleri, Paolo

    2016-02-01

    OBJECTIVE To determine whether rectal temperature at hospital admission, independently or in conjunction with other parameters, was associated with all-cause mortality in client-owned rabbits. DESIGN Prospective cohort study. ANIMALS 316 client-owned rabbits consecutively hospitalized in an exotics-only animal hospital. PROCEDURES Rectal temperature of each hospitalized rabbit was measured at admission. Individual variables, including survival up to 1 week after hospital discharge, were recorded. Univariate, multivariate, and sensitivity analyses were performed. RESULTS Rabbits with hypothermia at admission had a risk of death before or within 1 week after hospital discharge 3 times that of rabbits without hypothermia (relative risk, 3.09; 95% confidence interval, 2.17 to 4.39). For each 1°C (1.8°F) decrease in admission rectal temperature, the odds of death were doubled (OR, 2.11; 95% confidence interval, 1.69 to 2.64). Sensitivity analyses confirmed the robustness of the finding. Older age, suspected presence of a systemic disease, and presence of gastrointestinal stasis were also significantly associated with an increased risk of death. CONCLUSIONS AND CLINICAL RELEVANCE Rectal temperature was easily measured in rabbits and was a major predictor of death in the present patient cohort. Because of its association with death in both healthy and diseased rabbits in this study, rectal temperature should always be measured during physical examination of rabbits. Treatment of hypothermia in client-owned rabbits requires further research.

  7. Chloride secretagogues stimulate inositol phosphate formation in shark rectal gland tubules cultured in suspension

    SciTech Connect

    Ecay, T.W.; Valentich, J.D. )

    1991-03-01

    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.

  8. Variation in the CYP19A1 gene and risk of colon and rectal cancer

    PubMed Central

    Slattery, Martha L.; Lundgreen, Abbie; Herrick, Jennifer S.; Kadlubar, Susan; Caan, Bette J.; Potter, John D.; Wolff, Roger K.

    2011-01-01

    CYP19A1, or aromatase, influences estrogen-metabolizing enzymes and may influence cancer risk. We examine variation in the CYP19A1 gene and risk of colorectal cancer using data from population-based case–control studies (colon n = 1,574 cases, 1,970 controls; rectal n = 791 cases, 999 controls). Four SNPs were statistically significantly associated with colon cancer and four were associated with rectal cancer. After adjustment for multiple comparisons, the AA genotype of rs12591359 was associated with an increased risk of colon cancer (OR 1.44 95% CI 1.16–1.80) and the AA genotype of rs2470144 was associated with a reduced risk of rectal cancer (OR 0.65 95% CI 0.50–0.84). Variants of CYP19A1 were associated with CIMP+ and CIMP+/KRAS2-mutated tumors. CT/TT genotypes of rs1961177 were significantly associated with an increased likelihood of a MSI+ colon tumor (OR 1.77 95% CI 1.26–2.37). We observed statistically significant interactions between genetic variation in NFκB1 and CYP19A1 for both colon and rectal cancer. Our data suggest the importance of CYP19A1 in the development of colon and rectal cancer and that estrogen may influence risk through an inflammation-related mechanism. PMID:21479914

  9. Noninvasive Temporal Artery Thermometry as an Alternative to Rectal Thermometry in Research Macaques (Macaca spp.)

    PubMed Central

    Woods, Stephanie E; Marini, Robert P; Patterson, Mary M

    2013-01-01

    Obtaining an animal's body temperature is essential for the assessment of its clinical status. For many species, rectal thermometry is the technique used most often; however, this method in macaques typically requires sedation or considerable physical restraint. A noninvasive and inexpensive temporal artery (TA) thermometer was evaluated as an alternative method for collecting body temperature measurements from macaques used in neuroscience research. Rectal and arterial temperatures were obtained from 86 macaques (mean age, 10.2 y) that had received ketamine (10 mg/kg IM) or Telazol (5 mg/kg IM); the arterial measurements were taken from behind the right ear. In addition, arterial temperatures were measured behind both ears in a cohort of awake, chaired macaques with cephalic restraint pedestals only (n = 8) or with cephalic restraint pedestals and recording chambers (n = 14). Within-subject repeatability for TA thermometry and agreement between rectal and arterial temperature measurements were assessed by using the Bland–Altman method. Temperature measurements indicated that values from TA thermometry were lower than those from rectal thermometry by 1.57 °C with a 95% agreement limit of ± 1.27 °C. Results show satisfactory repeatability with TA thermometry and agreement between arterial and rectal temperatures, demonstrating that TA thermometry can be a valuable tool in conscious, chaired macaques with restrained heads. PMID:23849413

  10. Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report

    PubMed Central

    2009-01-01

    Introduction Fournier gangrene is a rare necrotising fascitis of the perineum and genitals caused by a mixture of aerobic and anaerobic microorganisms. The first case was described by Baurienne in 1764 but the condition was named by Fournier in 1883 who reported the cases of five men with the condition with no apparent etiology. Infection most commonly arises from the skin, urethra, or rectal regions. Despite appropriate therapy, mortality in this disease is still high. We report a case of a low rectal malignancy presenting as Fournier gangrene. This case report serves to highlight an extremely unusual presentation of rectal cancer, a common surgical pathology. Case presentation The patient is a 48 years old Afghanian male that admitted with Fournier gangrene. In the course of medical and surgical treatment the presence of extensive rectal adenocarcinoma was discovered. After partial recovery, standard loop colostomy was inserted. Skin grafting of necrotic areas was performed and systemic rectal cancer chemotherapy initiated after full stabilization. Conclusion Fournier gangrene is an uncommon but life threatening condition with high associated mortality and morbidity. Usually there is an underlying cause for the development of Fournier gangrene, that if addressed correctly, can lead to a good outcome. Early diagnosis and treatment decrease the morbidity and mortality of this life threatening condition. Good management is based on aggressive debridement, broad spectrum antibiotics and intensive supportive care. PMID:20062653

  11. DENSE MEDIUM CYCLONE OPTIMIZATON

    SciTech Connect

    Gerald H. Luttrell; Chris J. Barbee; Peter J. Bethell; Chris J. Wood

    2005-06-30

    Dense medium cyclones (DMCs) are known to be efficient, high-tonnage devices suitable for upgrading particles in the 50 to 0.5 mm size range. This versatile separator, which uses centrifugal forces to enhance the separation of fine particles that cannot be upgraded in static dense medium separators, can be found in most modern coal plants and in a variety of mineral plants treating iron ore, dolomite, diamonds, potash and lead-zinc ores. Due to the high tonnage, a small increase in DMC efficiency can have a large impact on plant profitability. Unfortunately, the knowledge base required to properly design and operate DMCs has been seriously eroded during the past several decades. In an attempt to correct this problem, a set of engineering tools have been developed to allow producers to improve the efficiency of their DMC circuits. These tools include (1) low-cost density tracers that can be used by plant operators to rapidly assess DMC performance, (2) mathematical process models that can be used to predict the influence of changes in operating and design variables on DMC performance, and (3) an expert advisor system that provides plant operators with a user-friendly interface for evaluating, optimizing and trouble-shooting DMC circuits. The field data required to develop these tools was collected by conducting detailed sampling and evaluation programs at several industrial plant sites. These data were used to demonstrate the technical, economic and environmental benefits that can be realized through the application of these engineering tools.

  12. Deuterium Abundance in the Local Interstellar Medium

    NASA Technical Reports Server (NTRS)

    Ferlet, R.; Gry, C.; Vidal-Madjar, A.

    1984-01-01

    The present situation of deuterium abundance evaluation in interstellar space is discussed, and it is shown that it should be or = .00001 by studying in more detail lambda the Sco line of sight and by observing two NaI interstellar components toward that star, it can be shown that the D/H evaluation made toward lambda Sco is in fact related to the local interstellar medium (less than 10 pc from the Sun). Because this evaluation is also or = .00001 it is in striking contrast with the one made toward alpha Aur (D/H or = .000018 confirming the fact that the deuterium abundance in the local interstellar medium varies by at least a factor of two over few parsecs.

  13. Neoadjuvant Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Radiation for Rectal Cancer

    SciTech Connect

    Dipetrillo, Tom; Pricolo, Victor; Lagares-Garcia, Jorge; Vrees, Matt; Klipfel, Adam; Cataldo, Tom; Sikov, William; McNulty, Brendan; Shipley, Joshua; Anderson, Elliot; Khurshid, Humera; Oconnor, Brigid; Oldenburg, Nicklas B.E.; Radie-Keane, Kathy; Husain, Syed; Safran, Howard

    2012-01-01

    Purpose: To evaluate the feasibility and pathologic complete response rate of induction bevacizumab + modified infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX) 6 regimen followed by concurrent bevacizumab, oxaliplatin, continuous infusion 5-fluorouracil (5-FU), and radiation for patients with rectal cancer. Methods and Materials: Eligible patients received 1 month of induction bevacizumab and mFOLFOX6. Patients then received 50.4 Gy of radiation and concurrent bevacizumab (5 mg/kg on Days 1, 15, and 29), oxaliplatin (50 mg/m{sup 2}/week for 6 weeks), and continuous infusion 5-FU (200 mg/m{sup 2}/day). Because of gastrointestinal toxicity, the oxaliplatin dose was reduced to 40 mg/m{sup 2}/week. Resection was performed 4-8 weeks after the completion of chemoradiation. Results: The trial was terminated early because of toxicity after 26 eligible patients were treated. Only 1 patient had significant toxicity (arrhythmia) during induction treatment and was removed from the study. During chemoradiation, Grade 3/4 toxicity was experienced by 19 of 25 patients (76%). The most common Grade 3/4 toxicities were diarrhea, neutropenia, and pain. Five of 25 patients (20%) had a complete pathologic response. Nine of 25 patients (36%) developed postoperative complications including infection (n = 4), delayed healing (n = 3), leak/abscess (n = 2), sterile fluid collection (n = 2), ischemic colonic reservoir (n = 1), and fistula (n = 1). Conclusions: Concurrent oxaliplatin, bevacizumab, continuous infusion 5-FU, and radiation causes significant gastrointestinal toxicity. The pathologic complete response rate of this regimen was similar to other fluorouracil chemoradiation regimens. The high incidence of postoperative wound complications is concerning and consistent with other reports utilizing bevacizumab with chemoradiation before major surgical resections.

  14. DuraSeal as a spacer to reduce rectal doses in low-dose rate brachytherapy for prostate cancer.

    PubMed

    Heikkilä, Vesa-Pekka; Kärnä, Aarno; Vaarala, Markku H

    2014-08-01

    The purpose of this study was to evaluate the utility of off-label use of DuraSeal polyethylene glycol (PEG) gel in low-dose rate (LDR) prostate brachytherapy seed implantation to reduce rectal doses. Diluted DuraSeal was easy to use and, in spite of a clearance effect, useful in decreasing D₂cc rectal doses. PMID:25201125

  15. [Rectal temperature in active and passive rats during desynchronosis and under melatonin treatment ].

    PubMed

    Pertsov, S S

    2005-03-01

    Effects of phase shifts in circadian rhythms and of melatonin administration on rectal temperature in rats with different activity were studied in the open-field test on 176 Wistar rats kept under conditions of natural or shifted light-darkness period. Under normal light-darkness conditions, the amplitude of diurnal variation in rectal temperature was higher in active rats as compared with passive ones. A shift in the light-darkness conditions inverted the circadian rhythm of rectal temperature and augmented the difference between daytime and night time temperatures in passive and, particularly, in active rats. Melatonin effect depended on dose and time of administration. 1 mg/kg Melatonin enhanced the amplitude of diurnal rhythms of energy metabolism in behaviourally active rats. These changes seem to contribute to adaptive reconstruction in the organism during desynchronosis. PMID:15881881

  16. [A case of laparoscopic surgery for a rectal carcinoid after ALTA therapy for an internal hemorrhoid].

    PubMed

    Aomatsu, Naoki; Nakamura, Masanori; Hasegawa, Tsuyoshi; Nakao, Shigetomi; Uchima, Yasutake; Aomatsu, Keiho

    2014-11-01

    We report a case of laparoscopic surgery for a rectal carcinoid after aluminum potassium and tannic acid (ALTA) therapy for an internal hemorrhoid. A 66-year-old man was admitted to our hospital because of bleeding during defecation. He was diagnosed via anoscopy with Goligher grade II internal hemorrhoids. Examination via colonoscopy revealed 2 yellowish submucosal tumors in the lower rectum that were 5mm and 10mm in diameter. A rectal carcinoid tumor was diagnosed based on histopathology. Abdominal computed tomography demonstrated no metastases to the liver or lymph nodes. First, we performed ALTA therapy for the internal hemorrhoids. Two weeks later, we performed laparoscopic-assisted low anterior resection (D2) for the rectal carcinoid. The patient was discharged without complications and has not experienced recurrence during the 2 years of follow-up care.

  17. [Rectal temperature trends during 24 hours in a hot climate with and without nutritional support].

    PubMed

    Cisse, F; Seck-Gassama, S; Gueye, L; Seck, D; Samb, A; Ndoye, R; Martineaud, J P

    1997-01-01

    A group of 22 young subjects staying in rest was studied in the aim to follow the nycthemeral evolution of the rectal temperature, according to two situations: 1) normal feeding, 2) absence of feeding. The use of drinking water was not limited. The experimentation was carried out in tropical area, Kédougou (Eastern Senegal), during a high period of temperature. The mean of day temperature was 38 degrees C and the night temperature, 22 degrees C. The skin and rectal temperature, the arterial pressure and the cardiac frequency were measured every three hours. The results showed a significant difference in the nycthemeral rythm of the rectal temperatures. The nocturnal temperatures were not different in the two conditions. We observed a significant elevation (delta = 0.31 +/- 0.18 degree C) of the diurne post prandial temperature. The results supported that the thermic modification observed during the experience were linked to the feed.

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

    PubMed Central

    Kauss, Tina; Gaudin, Karen; Gaubert, Alexandra; Ba, Boubakar; Tagliaferri, Serena; Fawaz, Fawaz; Fabre, Jean-Louis; Boiron, Jean-Michel; Lafarge, Xavier; White, Nicholas J.; Olliaro, Piero L.; Millet, Pascal

    2012-01-01

    The aim of this study was to identify a candidate formulation for further development of a home or near-home administrable paediatric rectal form of a broad-spectrum antibiotic – specially intended for (emergency) use in tropical rural settings, in particular for children who cannot take medications orally and far from health facilities where injectable treatments can be given. Azithromycin, a broad-spectrum macrolide used orally or intravenously for the treatment of respiratory tract, skin and soft tissue infections, was selected because of its pharmacokinetic and therapeutic properties. Azithromycin in vitro solubility and stability in physiologically relevant conditions were studied. Various pharmaceutical forms, i.e. rectal suspension, two different rectal gels, polyethylene glycol (PEG) suppository and hard gelatin capsule (HGC) were assessed for in vitro dissolution and in vivo bioavailability in the rabbit. Azithromycin PEG suppository appears to be a promising candidate. PMID:22868232

  19. Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer.

    PubMed

    Guinet, C; Buy, J N; Ghossain, M A; Sézeur, A; Mallet, A; Bigot, J M; Vadrot, D; Ecoiffier, J

    1990-03-01

    Nineteen patients with middle and lower rectal carcinomas were operated on, with abdominoperineal resection in 10 patients, lower anterior resection with coloanal anastomosis in 6 patients, and colorectal anastomosis in 3 patients. The distance of the lower margin of the tumor to insertion of the levator ani on the rectal wall was correctly evaluated by computed tomography in 12 (63%) of 19 patients and by magnetic resonance imaging in 13 (68%) of 19 patients, while digital examination correctly assessed the distance in 15 (79%) of 19 patients. Computed tomography and magnetic resonance imaging were unable to assess extension through the rectal wall. No significant difference was observed between computed tomography and magnetic resonance imaging in assessing extension to the perivesical fat, adjacent organs, pelvic side wall, or lymph nodes. According to the TNM classification, magnetic resonance imaging correctly staged 74% (14/19) of carcinomas, while computed tomography correctly staged 68% (13/19).

  20. [Current status and novel approach of robotic surgery for rectal cancer].

    PubMed

    Du, Xiaohui

    2015-08-01

    With the development of minimally invasive surgery, laparoscopic technique is now widely used in rectal surgery because of its advantages in terms of pain control, recovery of bowel function, length of hospital stay, short- and long-term outcomes. Total mesorectal excision(TME) is recommended as the standard procedure for rectal cancer. Laparoscopic TME, however, can be challenging due to its two-dimensional vision, restricted instrument movements, and a prolonged learning curve. Robotic surgery overcomes these intrinsic limitations by superior three-dimensional magnified optics, stable retraction platform, and 7 degrees of freedom of instrument movements, and offers an easier operation and shorter learning curve. This review summarizes the advantages as well as the current status of robotic rectal surgery, and explores the novel approach and new techniques with the related literature and the author's own experience. PMID:26303685

  1. Discrimination of rectal cancer through human serum using surface-enhanced Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Li, Xiaozhou; Yang, Tianyue; Li, Siqi; Zhang, Su; Jin, Lili

    2015-05-01

    In this paper, surface-enhanced Raman spectroscopy (SERS) was used to detect the changes in blood serum components that accompany rectal cancer. The differences in serum SERS data between rectal cancer patients and healthy controls were examined. Postoperative rectal cancer patients also participated in the comparison to monitor the effects of cancer treatments. The results show that there are significant variations at certain wavenumbers which indicates alteration of corresponding biological substances. Principal component analysis (PCA) and parameters of intensity ratios were used on the original SERS spectra for the extraction of featured variables. These featured variables then underwent linear discriminant analysis (LDA) and classification and regression tree (CART) for the discrimination analysis. Accuracies of 93.5 and 92.4 % were obtained for PCA-LDA and parameter-CART, respectively.

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

    PubMed

    Kauss, Tina; Gaudin, Karen; Gaubert, Alexandra; Ba, Boubakar; Tagliaferri, Serena; Fawaz, Fawaz; Fabre, Jean-Louis; Boiron, Jean-Michel; Lafarge, Xavier; White, Nicholas J; Olliaro, Piero L; Millet, Pascal

    2012-10-15

    The aim of this study was to identify a candidate formulation for further development of a home or near-home administrable paediatric rectal form of a broad-spectrum antibiotic - specially intended for (emergency) use in tropical rural settings, in particular for children who cannot take medications orally and far from health facilities where injectable treatments can be given. Azithromycin, a broad-spectrum macrolide used orally or intravenously for the treatment of respiratory tract, skin and soft tissue infections, was selected because of its pharmacokinetic and therapeutic properties. Azithromycin in vitro solubility and stability in physiologically relevant conditions were studied. Various pharmaceutical forms, i.e. rectal suspension, two different rectal gels, polyethylene glycol (PEG) suppository and hard gelatin capsule (HGC) were assessed for in vitro dissolution and in vivo bioavailability in the rabbit. Azithromycin PEG suppository appears to be a promising candidate.

  3. Comparative trial of rectal indomethacin and cryoanalgesia for control of early postthoracotomy pain.

    PubMed

    Keenan, D J; Cave, K; Langdon, L; Lea, R E

    1983-11-01

    A randomised double blind trial was carried out over the first two days after thoracotomy to compare the analgesic effects of rectal indomethacin 100 mg administered eight hourly, cryoanalgesia, and a combination of both of these with the effects of conventional intramuscular opiate analgesia. Pain scores were significantly reduced with both rectal indomethacin alone and cryoanalgesia alone; these treatments had an additive effect when used in combination. Pain on movement was significantly increased, and indomethacin was more effective in reducing this than cryoanalgesia. Groups receiving either indomethacin alone or the combination treatment required significantly less opiate on the first day and exhibited improved peak flow values over the first two days. It is concluded that rectal indomethacin, in this dosage, can provide good, safe analgesia after thoracotomy with minimum administrative difficulty. When used as an adjunct to cryoanalgesia it has an additive effect. There are many potential uses for this drug in other branches of surgery. PMID:6416399

  4. The fine structure of the rectal pads of Zorotypus caudelli Karny (Zoraptera, Insecta).

    PubMed

    Dallai, R; Mercati, D; Mashimo, Y; Machida, R; Beutel, R G

    2016-07-01

    The rectal pads of a species of the controversial polyneopteran order Zoraptera were examined using histological sections and TEM micrographs. Six pads are present along the thin rectal epithelium. Each pad consists of a few large principal cells surrounded by flattened junctional cells, which extend also beneath the principal cells. The cells are lined by a thin apical cuticle. No basal cells and no cavity have been observed beneath the pad. Principal cells have a regular layer of apical microvilli and are joined by intercellular septate junctions, which are interrupted by short dilatations of the intercellular space. At these levels the two adjacent plasma membranes are joined by short zonulae adhaerentes. In the cytoplasm, a rich system of strict associations between lateral plasma membranes and mitochondria forms scalariform junctions. Rectal pads share ultrastructural features with similar excretory organs of several neopteran groups, in particular with Blattodea (roaches and termites) and Thysanoptera, and are involved in fluid reabsorption and ion regulation. PMID:27368527

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

    PubMed

    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

    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.

  6. Diffuse and extreme vacuolization of tumour cells in rectal adenocarcinoma after neoadjuvant therapy: an unusual finding.

    PubMed

    Amico, P; Greco, P

    2010-10-01

    We report a case of diffuse and extreme cytoplasmic vacuolization of tumour cells in a rectal adenocarcinoma after neoadjuvant treatment. A 64-year-old man with a moderately differentiated rectal adenocarcinoma, diagnosed by endoscopic rectal biopsy, underwent surgical treatment after chemoradiotherapy. Residual tumour mass was represented by foci of neoplastic cells with the morphological features of conventional type adenocarcinoma, and surprisingly, by numerous areas consisting of several giant vacuoles, variable in size, merging to form multilocular spaces separated by a rim of cell membrane with a "plant-like" appearance. Cytoplasmic vacuolization may represent a distinct form of cell death, and pathologists should carefully consider this unusual and potentially alarming morphological change among the chemoradiotherapy-induced effects on tumour mass.

  7. [A case of laparoscopic surgery for a rectal carcinoid after ALTA therapy for an internal hemorrhoid].

    PubMed

    Aomatsu, Naoki; Nakamura, Masanori; Hasegawa, Tsuyoshi; Nakao, Shigetomi; Uchima, Yasutake; Aomatsu, Keiho

    2014-11-01

    We report a case of laparoscopic surgery for a rectal carcinoid after aluminum potassium and tannic acid (ALTA) therapy for an internal hemorrhoid. A 66-year-old man was admitted to our hospital because of bleeding during defecation. He was diagnosed via anoscopy with Goligher grade II internal hemorrhoids. Examination via colonoscopy revealed 2 yellowish submucosal tumors in the lower rectum that were 5mm and 10mm in diameter. A rectal carcinoid tumor was diagnosed based on histopathology. Abdominal computed tomography demonstrated no metastases to the liver or lymph nodes. First, we performed ALTA therapy for the internal hemorrhoids. Two weeks later, we performed laparoscopic-assisted low anterior resection (D2) for the rectal carcinoid. The patient was discharged without complications and has not experienced recurrence during the 2 years of follow-up care. PMID:25731340

  8. Synchronous prostate and rectal adenocarcinomas irradiation utilising volumetric modulated arc therapy.

    PubMed

    Ng, Sweet Ping; Tran, Thu; Moloney, Philip; Sale, Charlotte; Mathlum, Maitham; Ong, Grace; Lynch, Rod

    2015-12-01

    Cases of synchronous prostate and colorectal adenocarcinomas have been sporadically reported. There are case reports on patients with synchronous prostate and rectal cancers treated with external beam radiotherapy alone or combined with high-dose rate brachytherapy boost to the prostate. Here, we illustrate a patient with synchronous prostate and rectal cancers treated using the volumetric arc therapy (VMAT) technique. The patient was treated with radical radiotherapy to 50.4 Gy in 28 fractions to the pelvis, incorporating the involved internal iliac node and the prostate. A boost of 24 Gy in 12 fractions was delivered to the prostate only, using VMAT. Treatment-related toxicities and follow-up prostate-specific antigen and carcinoembryonic antigen were collected for data analysis. At 12 months, the patient achieved complete response for both rectal and prostate cancers without significant treatment-related toxicities. PMID:27512575

  9. [Current status and novel approach of robotic surgery for rectal cancer].

    PubMed

    Du, Xiaohui

    2015-08-01

    With the development of minimally invasive surgery, laparoscopic technique is now widely used in rectal surgery because of its advantages in terms of pain control, recovery of bowel function, length of hospital stay, short- and long-term outcomes. Total mesorectal excision(TME) is recommended as the standard procedure for rectal cancer. Laparoscopic TME, however, can be challenging due to its two-dimensional vision, restricted instrument movements, and a prolonged learning curve. Robotic surgery overcomes these intrinsic limitations by superior three-dimensional magnified optics, stable retraction platform, and 7 degrees of freedom of instrument movements, and offers an easier operation and shorter learning curve. This review summarizes the advantages as well as the current status of robotic rectal surgery, and explores the novel approach and new techniques with the related literature and the author's own experience.

  10. Comparative trial of rectal indomethacin and cryoanalgesia for control of early postthoracotomy pain.

    PubMed Central

    Keenan, D J; Cave, K; Langdon, L; Lea, R E

    1983-01-01

    A randomised double blind trial was carried out over the first two days after thoracotomy to compare the analgesic effects of rectal indomethacin 100 mg administered eight hourly, cryoanalgesia, and a combination of both of these with the effects of conventional intramuscular opiate analgesia. Pain scores were significantly reduced with both rectal indomethacin alone and cryoanalgesia alone; these treatments had an additive effect when used in combination. Pain on movement was significantly increased, and indomethacin was more effective in reducing this than cryoanalgesia. Groups receiving either indomethacin alone or the combination treatment required significantly less opiate on the first day and exhibited improved peak flow values over the first two days. It is concluded that rectal indomethacin, in this dosage, can provide good, safe analgesia after thoracotomy with minimum administrative difficulty. When used as an adjunct to cryoanalgesia it has an additive effect. There are many potential uses for this drug in other branches of surgery. PMID:6416399

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

    PubMed

    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

    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

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

    PubMed

    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

    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.

  13. Contrastive Rhetoric in the Writing Classroom: A Case Study

    ERIC Educational Resources Information Center

    Petric, Bojana

    2005-01-01

    This note explores the role of contrastive rhetoric in writing pedagogy in the context of a monolingual class, in this case a group of students from the Russian Federation studying at an English medium university in Central Europe. The study compares students' argumentative essays written before and after a short writing course, which aimed to…

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

    SciTech Connect

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

    2010-07-01

    Purpose: To prospectively analyze whether cross-linked hyaluronan gel reduces the mean rectal dose and acute rectal toxicity of radiotherapy for prostate cancer. Methods and Materials: Between September 2008 and March 2009, we transperitoneally injected 9mL of cross-linked hyaluronan gel (Hylaform; Genzyme Corporation, Cambridge, MA) into the anterior perirectal fat of 10 early-stage prostate cancer patients to increase the separation between the prostate and rectum by 8 to 18mm at the start of radiotherapy. Patients then underwent high-dose rate brachytherapy to 2,200cGy followed by intensity-modulated radiation therapy to 5,040cGy. We assessed acute rectal toxicity using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 grading scheme. Results: Median follow-up was 3 months. The anteroposterior dimensions of Hylaform at the start and end of radiotherapy were 13 {+-} 3mm (mean {+-} SD) and 10 {+-} 4mm, respectively. At the start of intensity-modulated radiation therapy, daily mean rectal doses were 73 {+-} 13cGy with Hylaform vs. 106 {+-} 20cGy without Hylaform (p = 0.005). There was a 0% incidence of National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 Grade 1, 2, or 3 acute diarrhea in 10 patients who received Hylaform vs. a 29.7% incidence (n = 71) in 239 historical controls who did not receive Hylaform (p = 0.04). Conclusions: By increasing the separation between the prostate and rectum, Hylaform decreased the mean rectal dose. This led to a significant reduction in the acute rectal toxicity of radiotherapy for prostate cancer.

  15. Short communication: repeatability of measures of rectal temperature in dairy cows.

    PubMed

    Burfeind, O; von Keyserlingk, M A G; Weary, D M; Veira, D M; Heuwieser, W

    2010-02-01

    Although taking body temperature by rectal thermometer is the method most commonly used to identify sick cows in the postpartum period, no data on the repeatability of this measure are available. The overall objective of this study was to evaluate variability of rectal temperatures in dairy cows considering different factors (intra- and interinvestigator repeatability, different thermometers, penetration depth into the rectum, and defecation). High coefficients of correlation (r=0.98) and small differences between values of rectal temperatures (observer A=39.3+/-1.0 degrees C and observer B=39.4+/-1.0 degrees C) provide evidence that rectal temperature was a repeatable measure in dairy cows. Testing was carried out using 4 different digital thermometers: GLA M750 (GLA Agricultural Electronics, San Luis Obispo, CA), MTI8101 (SES Scala Electronics, Stahnsdorf, Germany), MT1831 (Microlife AG, Widnau, Switzerland) and Domotherm TH1 (Uebe Medical GmbH, Wertheim, Germany). Thermometers were inserted into the rectum to a certain depth (GLA M750 and MTI8101=11.5cm; MT1831=8.4cm; Domotherm TH1=7.7cm) and a measure was finished when a visual or acoustic signal was emitted by the thermometer. The measures could be influenced by the procedure itself (up to 0.5 degrees C), type of thermometer (up to 0.3 degrees C), and the penetration depth (11.5cm or 6.0cm in one of the experiments) into the rectum (up to 0.4 degrees C difference between a penetration depth of 11.5cm and 6.0cm in one of the experiments). Differences in rectal temperature before and after defecation were minor (<0.1 degrees C). These results indicate that some care is required in generalizing rectal measures of body temperature.

  16. Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility

    PubMed Central

    2013-01-01

    Background Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. Methods We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Results Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = −0.438 and −0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Conclusions Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials. PMID:23688510

  17. Random Forests to Predict Rectal Toxicity Following Prostate Cancer Radiation Therapy

    SciTech Connect

    Ospina, Juan D.; Zhu, Jian; Chira, Ciprian; Bossi, Alberto; Delobel, Jean B.; Beckendorf, Véronique; Dubray, Bernard; Lagrange, Jean-Léon; Correa, Juan C.; and others

    2014-08-01

    Purpose: To propose a random forest normal tissue complication probability (RF-NTCP) model to predict late rectal toxicity following prostate cancer radiation therapy, and to compare its performance to that of classic NTCP models. Methods and Materials: Clinical data and dose-volume histograms (DVH) were collected from 261 patients who received 3-dimensional conformal radiation therapy for prostate cancer with at least 5 years of follow-up. The series was split 1000 times into training and validation cohorts. A RF was trained to predict the risk of 5-year overall rectal toxicity and bleeding. Parameters of the Lyman-Kutcher-Burman (LKB) model were identified and a logistic regression model was fit. The performance of all the models was assessed by computing the area under the receiving operating characteristic curve (AUC). Results: The 5-year grade ≥2 overall rectal toxicity and grade ≥1 and grade ≥2 rectal bleeding rates were 16%, 25%, and 10%, respectively. Predictive capabilities were obtained using the RF-NTCP model for all 3 toxicity endpoints, including both the training and validation cohorts. The age and use of anticoagulants were found to be predictors of rectal bleeding. The AUC for RF-NTCP ranged from 0.66 to 0.76, depending on the toxicity endpoint. The AUC values for the LKB-NTCP were statistically significantly inferior, ranging from 0.62 to 0.69. Conclusions: The RF-NTCP model may be a useful new tool in predicting late rectal toxicity, including variables other than DVH, and thus appears as a strong competitor to classic NTCP models.

  18. Low thrombospondin 2 expression is predictive of low tumor regression after neoadjuvant chemoradiotherapy in rectal cancer

    PubMed Central

    Lin, Cheng-Yi; Lin, Ching-Yih; Chang, I-Wei; Sheu, Ming-Jen; Li, Chien-Feng; Lee, Sung-Wei; Lin, Li-Ching; Lee, Ying-En; He, Hong-Lin

    2015-01-01

    Background: Neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery is the mainstay of treatment for locally advanced rectal cancer. Several heparin-binding associated proteins have been reported to play a critical role in cancer progression. However, the clinical relevancies of such proteins and their associations with CCRT response in rectal cancer have not yet to be fully elucidated. Methods: The analysis of a public transcriptome of rectal cancer indicated that thrombospondin 2 (THBS2) is a predictive factor for CCRT response. Immunohistochemical analyses were conducted to evaluate the expression of THBS2 in pretreatment biopsy specimens from rectal cancer patients without distant metastasis. Furthermore, the relationships between THBS2 expression and various clinicopathological factors or survival were analyzed. Results: Low expression of THBS2 was significantly associated with advanced pretreatment tumor (P<0.001) and nodal status (P=0.004), post-treatment tumor (P<0.001) and nodal status (P<0.001), increased vascular invasion (P=0.003), increased perineural invasion (P=0.023) and inferior tumor regression grade (P=0.015). In univariate analysis, low THBS2 expression predicted worse outcomes for disease-free survival, local recurrence-free survival and metastasis-free survival (all P<0.001). In multivariate analysis, low expression of THBS2 still served as a negative prognostic factor for disease-free survival (Hazard ratio=3.057, P=0.002) and metastasis-free survival (Hazard ratio=3.362, P=0.012). Conclusion: Low THBS2 expression was correlated with advanced disease status and low tumor regression after preoperative CCRT and that it acted as an independent negative prognostic factor in rectal cancer. THBS2 may represent a predictive biomarker for CCRT response in rectal cancer. PMID:26807188

  19. Comparison between Preoperative Rectal Diclofenac Plus Paracetamol and Diclofenac Alone for PostoperativePain of Hysterectomy

    PubMed Central

    Samimi Sede, Saghar; Davari Tanha, Fateme; Valadan, Mehrnaz; Modaressi, Zeinab

    2014-01-01

    Objective: To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy. Materials and methods: Ninety female patients (American Society of Anesthesiologists (ASA) physical status I-II), scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS ) was used to assess pain intensity at rest. Results: In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg) compared to diclofenac group (16.8± 2.8 mg) and placebo group (20.1 ± 3.6 mg) (p<0.05). VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p<0.05). There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p<0.05). Conclusion: According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone. PMID:25628716

  20. Wave propagation in a strongly heterogeneous elastic porous medium: Homogenization of Biot medium with double porosities

    NASA Astrophysics Data System (ADS)

    Rohan, Eduard; Naili, Salah; Nguyen, Vu-Hieu

    2016-08-01

    We study wave propagation in an elastic porous medium saturated with a compressible Newtonian fluid. The porous network is interconnected whereby the pores are characterized by two very different characteristic sizes. At the mesoscopic scale, the medium is described using the Biot model, characterized by a high contrast in the hydraulic permeability and anisotropic elasticity, whereas the contrast in the Biot coupling coefficient is only moderate. Fluid motion is governed by the Darcy flow model extended by inertia terms and by the mass conservation equation. The homogenization method based on the asymptotic analysis is used to obtain a macroscopic model. To respect the high contrast in the material properties, they are scaled by the small parameter, which is involved in the asymptotic analysis and characterized by the size of the heterogeneities. Using the estimates of wavelengths in the double-porosity networks, it is shown that the macroscopic descriptions depend on the contrast in the static permeability associated with pores and micropores and on the frequency. Moreover, the microflow in the double porosity is responsible for fading memory effects via the macroscopic poroviscoelastic constitutive law. xml:lang="fr"

  1. Phase Contrast Imaging

    SciTech Connect

    Menk, Ralf Hendrik

    2008-11-13

    All standard (medical) x-ray imaging technologies, rely primarily on the amplitude properties of the incident radiation, and do not depend on its phase. This is unchanged since the discovery by Roentgen that the intensity of an x-ray beam, as measured by the exposure on a film, was related to the relative transmission properties of an object. However, recently various imaging techniques have emerged which depend on the phase of the x-rays as well as the amplitude. Phase becomes important when the beam is coherent and the imaging system is sensitive to interference phenomena. Significant new advances have been made in coherent optic theory and techniques, which now promise phase information in medical imaging. The development of perfect crystal optics and the increasing availability of synchrotron radiation facilities have contributed to a significant increase in the application of phase based imaging in materials and life sciences. Unique source characteristics such as high intensity, monochromaticity, coherence and high collimating provide an ideal source for advanced imaging. Phase contrast imaging has been applied in both projection and computed tomography modes, and recent applications have been made in the field of medical imaging. Due to the underlying principle of X-ray detection conventional image receptors register only intensities of wave fields and not their phases. During the last decade basically five different methods were developed that translate the phase information into intensity variations. These methods are based on measuring the phase shift {phi} directly (using interference phenomena), the gradient {nabla}{sub {phi}}, or the Laplacian {nabla}{sup 2}{phi}. All three methods can be applied to polychromatic X-ray sources keeping in mind that the native source is synchrotron radiation, featuring monochromatic and reasonable coherent X-ray beams. Due to the vast difference in the coefficients that are driven absorption and phase effects (factor 1

  2. Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes.

    PubMed

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

    2014-10-21

    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

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

    SciTech Connect

    Akino, Yuichi; Yoshioka, Yasuo; Fukuda, Shoichi; Maruoka, Shintaroh; Takahashi, Yutaka; Yagi, Masashi; Mizuno, Hirokazu; Isohashi, Fumiaki; Ogawa, Kazuhiko

    2013-11-01

    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.

  4. [Solitary ulcer of the rectum: a report of a clinical case associated with rectal prolapse].

    PubMed

    Stolfi, V M; Bacaro, D; Rossi, P; Forlini, A; Quintigliano, D; Prisco, L; Gentileschi, E; Gentileschi, P

    1991-01-01

    Solitary ulcer of the rectum is an unusual condition occurring more often in young adults. Unfortunately the term is rather confusing, since the lesion may not necessarily be solitary, nor be confined to the rectum; moreover, it may be polypoid rather than ulcerating. The etiology is uncertain, but chronic constipation and fecal impaction could play a role. Today most authors believe solitary ulcer syndrome is a distinct clinical inflammatory manifestation associated with rectal prolapse. Surgical treatment of the prolapse is usually followed by a recovery of the solitary rectal ulcer. PMID:1836345

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

    NASA Astrophysics Data System (ADS)

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

    2014-07-01

    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

  6. Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes.

    PubMed

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

    2014-10-21

    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

  7. Intracellular pH in Gastric and Rectal Tissue Post Cardiac Arrest

    NASA Astrophysics Data System (ADS)

    Fisher, Elaine M.; Steiner, Richard P.; LaManna, Joseph C.

    We directly measured pHi using the pH sensitive dye, neutral red. We defined pHi for rectal and gastric tissue in whole tissue and by layer under control and arrest conditions. Fifteen minutes of arrest was not sufficient time to alter the pHi at the rectal or gastric site. On initial inspection, the stomach may be more sensitive to ischemic changes than the rectum. Understanding the mechanism by which PCO2 generation is used to track clinical changes is vital to the early detection of tissue dysoxia in order to effectively treat and manage critically ill patients.

  8. Computational aspects of endoscopic (trans-rectal) near-infrared optical tomography: initial investigations

    NASA Astrophysics Data System (ADS)

    Musgrove, Cameron; Bunting, Charles F.; Dehghani, Hamid; Pogue, Brian W.; Piao, Daqing

    2007-02-01

    Endoscopic near-infrared (NIR) optical tomography is a novel approach that allows the blood-based high intrinsic optical contrast to be imaged for the detection of cancer in internal organs. In endoscopic NIR tomography, the imaging array is arranged within the interior of the medium as opposed to the exterior as seen in conventional NIR tomography approaches. The source illuminates outward from the circular NIR probe, and the detector collects the diffused light from the medium surrounding the NIR probe. This new imaging geometry may involve forward and inverse approaches that are significantly different from those used in conventional NIR tomography. The implementation of a hollow-centered forward mesh within the context of conventional NIR tomography reconstruction has already led to the first demonstration of endoscopic NIR optical tomography. This paper presents some fundamental computational aspects regarding the performance and sensitivity of this endoscopic NIR tomography configuration. The NIRFAST modeling and image reconstruction package developed for conventional circular NIR geometry is used for endoscopic NIR tomography, and initial quantitative analysis has been conducted to investigate the "effective" imaging depth, required mesh resolution, and limit in contrast resolution, among other parameters. This study will define the performance expected and may provide insights into hardware requirements needed for revision of NIRFAST for the endoscopic NIR tomography geometry.

  9. Recognition memory reveals just how CONTRASTIVE contrastive accenting really is

    PubMed Central

    Fraundorf, Scott H.; Watson, Duane G.; Benjamin, Aaron S.

    2010-01-01

    The effects of pitch accenting on memory were investigated in three experiments. Participants listened to short recorded discourses that contained contrast sets with two items (e.g. British scientists and French scientists); a continuation specified one item from the set. Pitch accenting on the critical word in the continuation was manipulated between non-contrastive (H* in the ToBI system) and contrastive (L+H*). On subsequent recognition memory tests, the L+H* accent increased hits to correct statements and correct rejections of the contrast item (Experiments 1–3), but did not impair memory for other parts of the discourse (Experiment 2). L+H* also did not facilitate correct rejections of lures not in the contrast set (Experiment 3), indicating that contrastive accents do not simply strengthen the representation of the target item. These results suggest comprehenders use pitch accenting to encode and update information about multiple elements in a contrast set. PMID:20835405

  10. Maximized Posttest Contrasts: A Clarification.

    ERIC Educational Resources Information Center

    Hollingsworth, Holly

    1980-01-01

    A solution to some problems of maximized contrasts for analysis of variance situations when the cell sizes are unequal is offered. It is demonstrated that a contrast is maximized relative to the analysis used to compute the sum of squares between groups. Interpreting a maximum contrast is discussed. (Author/GK)

  11. Contrastive Analysis and Language Tendencies.

    ERIC Educational Resources Information Center

    Ree, Joe J.

    The purpose of this paper is to show that: (1) language universals have much to offer to students of contrastive linguistics, and (2) in order to make contrastive analysis more meaningful, one ought to go beyond cataloguing mere contrastive structure statements and capture underlying structural tendencies. Some characteristics of word order in…

  12. Iopamidol as a gastrointestinal contrast agent. Lack of peritoneal reactivity.

    PubMed

    Ferrante, S L; Schreiman, J S; Rouse, J W; Rysavy, J A; Cheng, S C; Frick, M P

    1990-02-01

    The ideal contrast agent in patients suspected of having gastrointestinal perforation is an iso-osmolar, or nearly iso-osmolar substance, that causes no peritoneal reaction. Iopamidol is a nonionic water-soluble contrast medium that may be considered in such situations. Intraperitoneal injections of ionic and nonionic contrast agents were compared in rats to study potentially harmful peritoneal inflammation. Only intraperitoneal barium injection produced any significant tissue reaction, such as adhesions and ascites. There was no difference between iopamidol and the other water-soluble contrast agents. Iopamidol may satisfy the need for nonreactive and nearly iso-osmolar contrast agents for evaluating patients with possible bowel perforation. However, the high cost of this agent may make its clinical application impractical.

  13. Perceived contrast in complex images

    PubMed Central

    Haun, Andrew M.; Peli, Eli

    2013-01-01

    To understand how different spatial frequencies contribute to the overall perceived contrast of complex, broadband photographic images, we adapted the classification image paradigm. Using natural images as stimuli, we randomly varied relative contrast amplitude at different spatial frequencies and had human subjects determine which images had higher contrast. Then, we determined how the random variations corresponded with the human judgments. We found that the overall contrast of an image is disproportionately determined by how much contrast is between 1 and 6 c/°, around the peak of the contrast sensitivity function (CSF). We then employed the basic components of contrast psychophysics modeling to show that the CSF alone is not enough to account for our results and that an increase in gain control strength toward low spatial frequencies is necessary. One important consequence of this is that contrast constancy, the apparent independence of suprathreshold perceived contrast and spatial frequency, will not hold during viewing of natural images. We also found that images with darker low-luminance regions tended to be judged as having higher overall contrast, which we interpret as the consequence of darker local backgrounds resulting in higher band-limited contrast response in the visual system. PMID:24190908

  14. Dynamic scheduling of medium-grained processes on multicomputers

    SciTech Connect

    Wei, S.; Kale, L.V. )

    1989-01-01

    This book presents a scheme for dynamic scheduling of medium-grained processes. The basic scheme and its adaptive extensions are described, and contrasted with two other schemes that have been proposed. The performance of all the three schemes on a 64 processor IPSC/2 hypercube is presented and analyzed. The experimental results are shown.

  15. Medium Chain Triglycerides in Paediatric Practice

    PubMed Central

    Gracey, Michael; Burke, Valerie; Anderson, Charlotte M.

    1970-01-01

    Medium chain triglycerides (MCT) bypass the steps necessary for the absorption of long chain fats (LCT), and so have theoretical grounds for their use in various disease states, particularly malabsorptive disorders. In childhood, MCT have particular advantages since they allow restriction of dietary long chain fats without limiting the intake of protein necessary for growth while providing adequate calories. In malabsorptive states, MCT have been used mostly in cystic fibrosis, where they may reduce steatorrhoea. However, the long-term growth patterns of these children are dependent on the extent and severity of their chest disease. MCT may be a useful source of calories for those with anorexia due to infection or liver disease and in babies recovering from meconium ileus. The decrease in offensive stools, flatus, and abdominal discomfort improves well-being and social acceptability which is important for many schoolchildren and adolescents. Rectal prolapse may be helped. Where there is loss of the small intestinal absorptive surface, particularly after massive small bowel resection, MCT can help to maintain weight and nutrition. They may also be a useful supplementary nutritional measure in patients severely affected with coeliac disease while awaiting response to a gluten-free diet, and in patients with regional enteritis. In children with liver disease, MCT provide a ready source of calories while avoiding the loss of fat in their stools. Infants with neonatal hepatitis or biliary atresia remain well nourished, and some older children with liver disease grow more rapidly and have fewer and less offensive stools and less abdominal discomfort. Where an abnormal number of faecal organisms colonize the small intestine (`contaminated small bowel syndrome' or `blind loop syndrome') intraluminal bile salts become deconjugated and cause steatorrhoea. A combination of antibiotic and surgical treatment is usually indicated, but MCT can be used to improve nutrition before

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

    SciTech Connect

    Pachkoria, Ketevan; Zhang Hong; Adell, Gunnar; Jarlsfelt, Ingvar; Sun Xiaofeng . E-mail: xiao-feng.sun@ibk.liu.se

    2005-11-01

    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.

  17. Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure

    PubMed Central

    Silberhumer, Gerd R.; Paty, Philip B.; Temple, Larissa K.; Araujo, Raphael L. C.; Denton, Brian; Gonen, Mithat; Nash, Garret M.; Allen, Peter J.; DeMatteo, Ronald P.; Guillem, Jose; Weiser, Martin R.; D'Angelica, Michael I.; Jarnagin, William R.; Wong, W. Douglas; Fong, Yuman

    2015-01-01

    OBJECTIVE To examine the outcome of simultaneous resection for rectal cancer with synchronous liver metastases. BACKGROUND One quarter of colorectal cancer patients will present with liver metastasis at the time of diagnosis. Recent studies have shown that simultaneous resections are safe and feasible for stage IV colon cancer. Limited data are available for simultaneous surgery in stage IV rectal cancer patients. METHODS One hundred ninety-eight patients underwent surgical treatment for stage IV rectal cancer. In 145 (73%) patients, a simultaneous procedure was performed. Fifty-three (27%) patients underwent staged liver resection. A subpopulation of 69 (35%) patients underwent major liver resection (3 segments or more) and 30 (44%) patients with simultaneous surgery. RESULTS The demographics of the 2 groups were similar. Complication rates were comparable for simultaneous or staged resections, even in the group subjected to major liver resection. Total hospital stay was significantly shorter for the simultaneously resected patients (P < .01). CONCLUSIONS Simultaneous resection of rectal primaries and liver metastases is a safe procedure in carefully selected patients at high-volume institutions, even if major liver resections are required. PMID:25601556

  18. A comparison of rectal and intramuscular codeine phosphate in children following neurosurgery.

    PubMed

    McEwan, A; Sigston, P E; Andrews, K A; Hack, H A; Jenkins, A M; May, L; Llewelyn, N; MacKersie, A

    2000-01-01

    Codeine is frequently used for postoperative analgesia in children. Intramuscular injections are not ideal and the rectal route may be preferable. We compared rectal and intramuscular codeine administered following neurosurgery. 20 children (over 3 months) undergoing elective neurosurgical procedures, were randomized to receive either rectal or intramuscular codeine phospate (1 mg.kg-1) at the end of the procedure. Serum levels of codeine and morphine were assayed at intervals following administration (0, 30, 60, 120, 240 min). Fentanyl was the intraoperative analgesic and postoperative rescue analgesia was paracetamol, diclofenac and intramuscular codeine. The Children's Hospital of Eastern Ontario Pain Scale was used to assess analgesia. Peak codeine levels in both groups were observed at 30 min and morphine levels were consistently low. The plasma codeine levels were significantly greater at 30 and 60 min following intramuscular injection, and were associated with slightly better analgesia scores, but did not reach statistical significance. However, the peak plasma level occurred at similar times in both groups. Codeine is absorbed as rapidly via the rectal route compared with the intramuscular route but the peak levels are lower.

  19. Schistosoma japonicum-like ova in liver and rectal biopsies of three cases in Sabah, Malaysia.

    PubMed

    Kan, S K; Kay, R W; Thomas, I

    1979-03-01

    Three cases of schistosomiasis in 2 Filipinos and one Chinese in Sabah are reported. Diagnosis was based on incidental histological findings of Schistosoma japonicum-like ova in the liver and rectal biopsies. As these 3 patients are immigrants to Sabah, it is assumed that they are imported cases, and that Sabah has been free of the disease from 1970 to 1977.

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

    PubMed Central

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

    2014-01-01

    AIM: To give a comprehensive review of current literature on robotic rectal cancer surgery. METHODS: A systematic review of current literature via PubMed and Embase search engines was performed to identify relevant articles from january 2007 to november 2013. The keywords used were: “robotic surgery”, “surgical robotics”, “laparoscopic computer-assisted surgery”, “colectomy” and “rectal resection”. RESULTS: After the initial screen of 380 articles, 20 papers were selected for review. A total of 1062 patients (male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review. Out of 1062 robotic-assisted operations, 831 (78.2%) anterior and low anterior resections, 132 (12.4%) intersphincteric resection with coloanal anastomosis, 98 (9.3%) abdominoperineal resections and 1 (0.1%) Hartmann’s operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has continued to evolve to its current state with promising results; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost. PMID:24936229