A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodyna...A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodynamic compromise. The source of hemorrhage was found at colonoscopy after careful irrigation and inspection to be a dieulafoy lesion situated just proximal to the anorectal junction. Hemostasis was achieved with epinephrine injection and thermal coagulation.展开更多
The morphology of tissue structures composing the pyloric orifice is thought to play a role in effectively mixing aqueous gastric effluent with duodenal secretions. To understand the physical mechanisms leading to eff...The morphology of tissue structures composing the pyloric orifice is thought to play a role in effectively mixing aqueous gastric effluent with duodenal secretions. To understand the physical mechanisms leading to efficient digestion requires computational models that allow for analyses of the contributions of individual structural components. Thus, we have simulated 2-D channel flows through representative models of the duodenum with moving boundary capabilities in order to quantitatively assess the importance of notable features. A well-tested flow solver was used to computationally isolate and compare geometric and kinematic parameters that lead to various characteristics of fluid motion at the antroduodenal junction. Scalar variance measurement was incorporated to quantify the mixing effectiveness of each component. It was found that the asymmetric geometry of the pyloric orifice in concert with intermittent gastric outflow and luminal constriction is likely to enhance homogenization of gastric effluent with duodenal secretions.展开更多
Narrow-band imaging （NBI） is an innovative optical technology that modifies the center wavelength and bandwidth of an endoscope＇s light into narrow-band illumination of 415 ：1： 30 nm. NBI markedly improves capill...Narrow-band imaging （NBI） is an innovative optical technology that modifies the center wavelength and bandwidth of an endoscope＇s light into narrow-band illumination of 415 ：1： 30 nm. NBI markedly improves capillary pattern contrast and is an in vivo method for visualizing microvessel morphological changes in superficial neoplastic lesions. The scientific basis for NBI is that short wavelength light falls within the hemoglobin absorption band, thereby facilitating clearer visualization of vascular structures. Several studies have reported advantages and limitations of NBI colonoscopy in the colorectum. One difficulty in evaluating results, however, has been nonstandardization of NBI systems （Sequential and nonsequential）. Utilization of NBI technology has been increasing worldwide, but accurate pit pattern analysis and sufficient skill in magnifying colonoscopy are basic fundamentals required for proficiency in NBI diagnosis of colorectal lesions. Modern optical technology without proper image interpretation wastes resources, confuses untrained endoscopists and delays interinstitutional validation studies. Training in the principles of ＂optical image-enhanced endoscopy＂ is needed to close the gap between technological advancements and their clinical usefulness. Currently available evidence indicates that NBI constitutes an effective and reliable alternative to chromocolonoscopy for in vivo visualization of vascular structures, but further study assessing reproducibility and effectiveness in the colorectum is ongoing at various medical centers.展开更多
AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, la...AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma. METHODS: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival. RESULTS: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resum?early activity in the LRH group were significantly shorter than those in the ORH group (2.24±0.56 vs 3.25±1.29 d, 13.94?.5 vs 18.25±5.96 d, 3.94±1.64 vs 5.45±1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%). CONCLUSION: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure.展开更多
Pseudomembranous colitis (PMC) usually manifests asfever and diarrhea in hospitalized patients treated withsystemic antibiotics. We described a case of PMC withintestinal obstruction but without diarrhea. A 60-yearold...Pseudomembranous colitis (PMC) usually manifests asfever and diarrhea in hospitalized patients treated withsystemic antibiotics. We described a case of PMC withintestinal obstruction but without diarrhea. A 60-yearold man was hospitalized for chemotherapy for the treatment of Burkitt lymphoma of the stomach. The patient became febrile and complained of crampy abdominal pain during the post-chemotherapy nadir. Plain abdominal radiography showed some intestinal gas and niveau. Because stool cytotoxin assay for clostridium difficile was positive and colon fiberscopic examination showed a pseudomembrane at the left side of the colon,and a diagnosis of PMC was made. Treatment with intracolonic vancomycin administration by colonoscopy and nasoileus tube was successful. Physicians should take into account the possibility of bowel obstruction due to PMC occurring in patients undergoing chemotherapy and perform emergency colonoscopy examination of suspected cases.展开更多
AIM： To estimate the incidence of collagenous colitis （CC） in southern Sweden during 2001-2010. METHODS： Cases were identified by searching for CC in the diagnostic registers at the Pathology Departments in the co...AIM： To estimate the incidence of collagenous colitis （CC） in southern Sweden during 2001-2010. METHODS： Cases were identified by searching for CC in the diagnostic registers at the Pathology Departments in the county of Skane. The catchment area comprised the south-west part of the county （394 307 inhabitants in 2010） and is a mixed urban and rural type with limited migration. CC patients that had under- gone colonoscopy during the defined period and were living in this area were included in the study regardless of where in Skane they had been diagnosed. Medical records were scrutinized and uncertain cases were re- assessed to ensure that only newly diagnosed CC cases were included. The diagnosis of CC was based on both clinical and histopathological criteria. The clinical crite-rion was non-bloody watery diarrhoea. The histopatho- logical criteria were a chronic inflammatory infiltrate in the lamina propria, a thickened subepithelial collagen layer ≥10 micrometers （um） and epithelial damage such as flattening and detachment. RESULTS： During the ten year period from 2001-2010, 198 CC patients in the south-west part of the county of Skane in southern Sweden were newly diagnosed. Of these, 146 were women and 52 were men, i.e., a female： male ratio of 2.8：1. The median age at diag- nosis was 71 years （range 28-95/inter-quartile range 59-81）, for women median age was 71 （range 28-95） years and was 73 （range 48-92） years for men. The mean annual incidence was 5.4/105 inhabitants. During the time periods 2001-2005 and 2006-2010, the mean annual incidence rates were 5.4/105 for both periods [95% confidence interval （CI）： 4.3-6.5 in 2001-2005 and 4.4-6.4 in 2006-2010, respectively, and 4.7-6.2 for the whole period]. Although the incidence varied over the years （minimum 3.7 to maximum 6.7/105） no increase or decrease in the incidence could be identi- fied. The odds ratio （OR） for CC in women compared to men was estimated to be 2.8 （95% CI： 2.0-3.7）. The OR for women 65 years of age or above compared to below 65 years of age was 6.9 （95% CI：5.0-9.7）, and for women 65 years of age or above compared to the whole group the OR was 4.7 （95% CI： 3.6-6.0）. The OR for age in general, i.e., above or 65 years of age compared to those younger than 65 was 8.3 （95% CI： 6.2-11.1）. During the last decade incidence figures for CC have also been reported from Calgary, Canada dur- ing 2002-2004 （4.6/105） and from Terrassa, Spain dur- ing 2004-2008 （2.6/105）. Our incidence figures from southern Sweden during 2001-2010 （5.4/10s） as well as the incidence figures presented in the studies during the 1990s （Terrassa, Spain during 1993-1997 （2.3/10s）, OI- msted, United States during 1985-2001 （3.1/10s）, Orebro, Sweden during 1993-1998 （4.9/10s）, and Iceland during 1995-1999 （5.2/10s） are all in line with a north- south gradient, something that has been suggested be- fore both for CC and inflammatory bowel disease.CONCLUSION： The observed incidence of CC is com- parable with previous reports from northern Europe and America. The incidence is stable but the female： male ratio seems to be decreasing.展开更多
Disseminated signet ring cell carcinomas frequently arise from the stomach. However, primaries in the colon and rectum have also been reported. We present a 68 year old lady who presented with a change in her bowel ha...Disseminated signet ring cell carcinomas frequently arise from the stomach. However, primaries in the colon and rectum have also been reported. We present a 68 year old lady who presented with a change in her bowel habit. Colonoscopy showed a stenosing rectal tumour at 7 cm to 8 cm from the anal verge. Multiple scattered ulcers were also noted along the entire length of the colon. Biopsy of the lesions revealed signet ring cell adenocarcinoma. Gastroscopy showed multiple nodules with ulceration over several areas of the stomach which were similar in appearance to the colonic lesions. However, no primary tumour of the stomach was seen. Biopsy of the gastric lesions also showed signet ring cell adenocarcinoma. Computed tomography scan of the abdomen and pelvis revealed circumferential tumour at the rectosigmoid junction with possible invasion into the left ischiorectal fossa. The overall picture was that of a primary rectal signet ring cell carcinoma with peritoneal dissemination. The patient was referred for palliative chemotherapy in view of the disseminated disease. In the present report, we discuss this interesting pathological entity and review the role of various histolological techniques in helping to identify the primary tumor.展开更多
文摘A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodynamic compromise. The source of hemorrhage was found at colonoscopy after careful irrigation and inspection to be a dieulafoy lesion situated just proximal to the anorectal junction. Hemostasis was achieved with epinephrine injection and thermal coagulation.
文摘The morphology of tissue structures composing the pyloric orifice is thought to play a role in effectively mixing aqueous gastric effluent with duodenal secretions. To understand the physical mechanisms leading to efficient digestion requires computational models that allow for analyses of the contributions of individual structural components. Thus, we have simulated 2-D channel flows through representative models of the duodenum with moving boundary capabilities in order to quantitatively assess the importance of notable features. A well-tested flow solver was used to computationally isolate and compare geometric and kinematic parameters that lead to various characteristics of fluid motion at the antroduodenal junction. Scalar variance measurement was incorporated to quantify the mixing effectiveness of each component. It was found that the asymmetric geometry of the pyloric orifice in concert with intermittent gastric outflow and luminal constriction is likely to enhance homogenization of gastric effluent with duodenal secretions.
文摘Narrow-band imaging （NBI） is an innovative optical technology that modifies the center wavelength and bandwidth of an endoscope＇s light into narrow-band illumination of 415 ：1： 30 nm. NBI markedly improves capillary pattern contrast and is an in vivo method for visualizing microvessel morphological changes in superficial neoplastic lesions. The scientific basis for NBI is that short wavelength light falls within the hemoglobin absorption band, thereby facilitating clearer visualization of vascular structures. Several studies have reported advantages and limitations of NBI colonoscopy in the colorectum. One difficulty in evaluating results, however, has been nonstandardization of NBI systems （Sequential and nonsequential）. Utilization of NBI technology has been increasing worldwide, but accurate pit pattern analysis and sufficient skill in magnifying colonoscopy are basic fundamentals required for proficiency in NBI diagnosis of colorectal lesions. Modern optical technology without proper image interpretation wastes resources, confuses untrained endoscopists and delays interinstitutional validation studies. Training in the principles of ＂optical image-enhanced endoscopy＂ is needed to close the gap between technological advancements and their clinical usefulness. Currently available evidence indicates that NBI constitutes an effective and reliable alternative to chromocolonoscopy for in vivo visualization of vascular structures, but further study assessing reproducibility and effectiveness in the colorectum is ongoing at various medical centers.
基金Supported by Science and Technology Development Foundation of Shanghai,No. 024119106
文摘AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma. METHODS: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival. RESULTS: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resum?early activity in the LRH group were significantly shorter than those in the ORH group (2.24±0.56 vs 3.25±1.29 d, 13.94?.5 vs 18.25±5.96 d, 3.94±1.64 vs 5.45±1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%). CONCLUSION: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure.
文摘Pseudomembranous colitis (PMC) usually manifests asfever and diarrhea in hospitalized patients treated withsystemic antibiotics. We described a case of PMC withintestinal obstruction but without diarrhea. A 60-yearold man was hospitalized for chemotherapy for the treatment of Burkitt lymphoma of the stomach. The patient became febrile and complained of crampy abdominal pain during the post-chemotherapy nadir. Plain abdominal radiography showed some intestinal gas and niveau. Because stool cytotoxin assay for clostridium difficile was positive and colon fiberscopic examination showed a pseudomembrane at the left side of the colon,and a diagnosis of PMC was made. Treatment with intracolonic vancomycin administration by colonoscopy and nasoileus tube was successful. Physicians should take into account the possibility of bowel obstruction due to PMC occurring in patients undergoing chemotherapy and perform emergency colonoscopy examination of suspected cases.
基金Supported by The Swedish Energy Agency, Region Sk ne and Kock’s Foundation in Trelleborg
文摘AIM： To estimate the incidence of collagenous colitis （CC） in southern Sweden during 2001-2010. METHODS： Cases were identified by searching for CC in the diagnostic registers at the Pathology Departments in the county of Skane. The catchment area comprised the south-west part of the county （394 307 inhabitants in 2010） and is a mixed urban and rural type with limited migration. CC patients that had under- gone colonoscopy during the defined period and were living in this area were included in the study regardless of where in Skane they had been diagnosed. Medical records were scrutinized and uncertain cases were re- assessed to ensure that only newly diagnosed CC cases were included. The diagnosis of CC was based on both clinical and histopathological criteria. The clinical crite-rion was non-bloody watery diarrhoea. The histopatho- logical criteria were a chronic inflammatory infiltrate in the lamina propria, a thickened subepithelial collagen layer ≥10 micrometers （um） and epithelial damage such as flattening and detachment. RESULTS： During the ten year period from 2001-2010, 198 CC patients in the south-west part of the county of Skane in southern Sweden were newly diagnosed. Of these, 146 were women and 52 were men, i.e., a female： male ratio of 2.8：1. The median age at diag- nosis was 71 years （range 28-95/inter-quartile range 59-81）, for women median age was 71 （range 28-95） years and was 73 （range 48-92） years for men. The mean annual incidence was 5.4/105 inhabitants. During the time periods 2001-2005 and 2006-2010, the mean annual incidence rates were 5.4/105 for both periods [95% confidence interval （CI）： 4.3-6.5 in 2001-2005 and 4.4-6.4 in 2006-2010, respectively, and 4.7-6.2 for the whole period]. Although the incidence varied over the years （minimum 3.7 to maximum 6.7/105） no increase or decrease in the incidence could be identi- fied. The odds ratio （OR） for CC in women compared to men was estimated to be 2.8 （95% CI： 2.0-3.7）. The OR for women 65 years of age or above compared to below 65 years of age was 6.9 （95% CI：5.0-9.7）, and for women 65 years of age or above compared to the whole group the OR was 4.7 （95% CI： 3.6-6.0）. The OR for age in general, i.e., above or 65 years of age compared to those younger than 65 was 8.3 （95% CI： 6.2-11.1）. During the last decade incidence figures for CC have also been reported from Calgary, Canada dur- ing 2002-2004 （4.6/105） and from Terrassa, Spain dur- ing 2004-2008 （2.6/105）. Our incidence figures from southern Sweden during 2001-2010 （5.4/10s） as well as the incidence figures presented in the studies during the 1990s （Terrassa, Spain during 1993-1997 （2.3/10s）, OI- msted, United States during 1985-2001 （3.1/10s）, Orebro, Sweden during 1993-1998 （4.9/10s）, and Iceland during 1995-1999 （5.2/10s） are all in line with a north- south gradient, something that has been suggested be- fore both for CC and inflammatory bowel disease.CONCLUSION： The observed incidence of CC is com- parable with previous reports from northern Europe and America. The incidence is stable but the female： male ratio seems to be decreasing.
文摘Disseminated signet ring cell carcinomas frequently arise from the stomach. However, primaries in the colon and rectum have also been reported. We present a 68 year old lady who presented with a change in her bowel habit. Colonoscopy showed a stenosing rectal tumour at 7 cm to 8 cm from the anal verge. Multiple scattered ulcers were also noted along the entire length of the colon. Biopsy of the lesions revealed signet ring cell adenocarcinoma. Gastroscopy showed multiple nodules with ulceration over several areas of the stomach which were similar in appearance to the colonic lesions. However, no primary tumour of the stomach was seen. Biopsy of the gastric lesions also showed signet ring cell adenocarcinoma. Computed tomography scan of the abdomen and pelvis revealed circumferential tumour at the rectosigmoid junction with possible invasion into the left ischiorectal fossa. The overall picture was that of a primary rectal signet ring cell carcinoma with peritoneal dissemination. The patient was referred for palliative chemotherapy in view of the disseminated disease. In the present report, we discuss this interesting pathological entity and review the role of various histolological techniques in helping to identify the primary tumor.
