Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel

PURPOSE: We have introduced magnifying colonoscopy into clinical practice and analyzed its diagnostic efficacy, especially regarding the ability to distinguish neoplastic from non-neoplastic polyps. METHODS: The materials consisted of 923 polyps. After identifying the lesions during normal colonoscopy, a dye was sprayed, and then the zoom apparatus of the colonoscope was used to make a magnified observation at a maximum 100 times magnification. We classified the crypt orifices into six categories and labeled them A to F as follows: A, a medium round appearance; B, an asteroid appearance; C, an elliptic appearance; D, a small, round appearance; E, a cerebriform appearance; F, no apparent structural appearance. RESULTS: Forty-two of 923 polyps did not reveal any clear images of crypt patterns. The percentage of histologically neoplastic change in the lesions classified as A, B, C, D, E, and F were 10, 15.9, 93.7, 100, 94.8, and 87.5 percent, respectively. When we considered types A and B to represent a crypt pattern of non-neoplastic lesions, and types C, D, E, and F to represent neoplastic lesions, and when the lesions that did not show any clear images were classified as a misjudgment, the diagnostic accuracy of neoplastic lesions (sensitivity) was 92 percent and that of non-neoplastic lesions (specificity) was 73.3 percent. Overall, the diagnostic accuracy in differentiating neoplastic from non-neoplastic lesions was 88.4 percent. Twenty-three neoplastic lesions that were misjudged to be non-neoplastic were histologically adenoma with mild atypia in 22 and adenoma with moderate atypia in 1. CONCLUSION: Magnifying colonoscopy was considered to be useful in determining the indications for colonoscopic removal.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997.     

Acid fibroblast growth factor reduces rat intestinal mucosal damage caused by ischemia-reperfusion insult

AIM: To detect the effects of acid fibroblast growth factor (aFGF) on apoptosis and proliferation of intestinal epithelial cells in differentiation or proliferation status to explore the protective mechanisms of aFGF. METHODS: Wistar rats were randomly divided into sham-operated control group (C, n= 6), intestinal ischemia group (I,n = 6), aFGF treatment group (A, n= 48) and intestinal ischemia-reperfusion group (R,n= 48). Apoptosis of intestinal mucosal cells was determined with terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) technique. Proliferating cell nuclear antigen (PCNA) protein expression and distribution were detected with immunohistochemical method. Plasma levels of D-lactate were determined with modified Brandts method. RESULTS: In A group, administration of exogenous aFGF could improve intestinal histological structure and decrease plasma D-lactate levels at 2-12 h after the reperfusion compared with R group. The apoptotic rates and PCNA protein expressions were not increased until 2 h after reperfusion and were maximal at 12 h. After reperfusion for 2-12 h, the apoptotic rates were gradually augmented along the length of jejunal crypt-villus units. Administration of aFGF could significantly reduce the apoptotic response at 2-12 h after reperfusion (P<0.05). Apoptosis rates in villus and crypt epithelial cells in A group at 12 h after reperfusion were (62.5±5.5)% and (73.2±18.6)% of those in R group, respectively. Treatment of aFGF could apparently induce protein expression of PCNA in intestinal mucosal cells of A group compared with R group during 2-12 h after reperfusion (P<0.05). There were approximately 1.3- and 1.5-times increments of PCNA expression levels in villus and crypt cells in A group at 12 h after reperfusion compared with R group, respectively. CONCLUSION: Intestinal I/R insult could lead to histological structure change and apoptotic rate increment. The protective effects of aFGF against ischemia/reperfusion in rat intestinal mucosa might be partially due to its ability to inhibit ischemia/reperfusion-induced apoptosis and to promote cell proliferation of crypt cells and villus epithelial cells.     

High-magnification chromoscopic pouchoscopy: a novel in vivo technique for surveillance of the anal transition zone and columnar cuff following ileal pouch-anal anastomosis

Abstract Background Persistence of underlying disease in the residual rectal mucosa and anal transition zone (ATZ) following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis and familial adenomatous polyposis provides a site for potential malignancy. For this reason endoscopic surveillance is performed, although conventional assessment may be unreliable. We hypothesized that the novel technique of high-magnification chromoscopic pouchoscopy (HMCP) may permit accurate anatomical localization of this high risk zone in vivo and permit improved biopsy accuracy. Patients and methods We studied 132 patients with IPAA using HMCP. Three distinct zones were defined using magnification endoscopy: ATZ, appearing as a linear cellular marix; columnar cuff, identifiable by a type I crypt pattern; and ileal pouch body, appearing as villous projections. Quadrantic biopsies of these zones were taken in addition to biopsies of any other lesions noted. Results A total of 1586 biopsies were taken from zones 1–3 (median, 12; range, 5–16 per patient). Overall biopsy-targeting accuracies using magnification guidance as compared with histopathology were 82%, 73% and 91% for the ATZ, cuff and pouch body, respectively. No dysplasia was identified in the quadrantic surveillance biopsies. Histologically confirmed columnar metaplasia was visualized in vivo using magnification chromoscopy. Patients with IPAA >3 years duration were more likely to have pouch reservoir columnar metaplasia as compared to those <3 years (p<0.01). Pouch reservoir metaplasia was associated with a pre-morbid diagnosis of high-grade dysplasia or carcinoma within the premorbid colectomy specimen (p<0.001). Conclusions This is the first study to evaluate this novel application of high magnification chromoscopy. Magnification pouchoscopy is a valid predictor of ATZ and cuff anatomy, permitting accurate biopsy targeting. Further randomized studies validating this technique with an emphasis on dysplasia detection in larger cohorts are required.     

人大肠癌与肠隐窝结构相关性的研究

目的:从人大肠实体瘤不同远近距离部位取癌旁组织进行体外培养,探讨人大肠组织体外培养条件,以及不同条件下,培养不同时间与肠隐窝结构的相关性。方法:分别从大肠癌恶性肿瘤患者距瘤体旁边(约2cm),手术切除的近端最远处(≥10cm),以及两者的中间位取得手术标本,运用重复贴壁法进行贴壁培养。结果:运用倒置显微镜观测,用无血清进行培养的组织块存活成活率为73.3%,含10%的胎牛血清培养液进行培养的组织块存活率81.7%,含20%的胎牛血清培养液进行培养的组织块存活率86.7%。HE染色观察,无血清培养的标本14天内,可看到隐窝完整结构,含10%和20%的胎牛血清培养的标本7天内,可看到隐窝完整结构。结论:人大肠组织块的存活时间与血清浓度成正相关,而隐窝完整结构的保持时间与血清浓度呈负相关。     

Acidic polysaccharide of Panax ginseng regulates the mitochondria/caspase-dependent apoptotic pathway in radiation-induced damage to the jejunum in mice

Owing to its susceptibility to radiation, the small intestine of mice is valuable for studying radioprotective effects. When exposed to radiation, intestinal crypt cells immediately go through apoptosis, which impairs swift differentiation necessary for the regeneration of intestinal villi. Our previous studies have elucidated that acidic polysaccharide of Panax ginseng (APG) protects the mouse small intestine from radiation-induced damage by lengthening villi with proliferation and repopulation of crypt cells. In the present study, we identified the molecular mechanism involved. C57BL/6 mice were irradiated with gamma-rays with or without APG and the expression levels of apoptosis-related molecules in the jejunum were investigated using immunohistochemistry. APG pretreatment strongly decreased the radiation-induced apoptosis in the jejunum. It increased the expression levels of anti-apoptotic proteins (Bcl-2 and Bcl-X_S/L) and dramatically reduced the expression levels of pro-apoptotic proteins (p53, BAX, cytochrome c and caspase-3). Therefore, APG attenuated the apoptosis through the intrinsic pathway, which is controlled by p53 and Bcl-2 family members. Results presented in this study suggest that APG protects the mouse small intestine from irradiation-induced apoptosis through inhibition of the p53-dependent pathway and the mitochondria/caspase pathway. Thus, APG may be a potential agent for preventing radiation induced injuries in intestinal cells during radio-therapy such as in cancer treatment.     

Correlation of dendritic cell infiltration with active crypt inflammation in ulcerative colitis

The aim of this study was to evaluate the histological localization and phenotypic characteristics of infiltrating dendritic cells (DCs) and to examine the relationship between the degree of DC infiltration and the severity of inflammation in the colonic mucosa in ulcerative colitis (UC). Also explored was the expression of macrophage inflammatory protein-3alpha (MIP-3alpha), and its receptor CC-chemokine receptor 6 (CCR6), to evaluate the significance of immature DCs in the crypt inflammation evident in UC. There was a significant positive correlation between the number of infiltrating DCs and the degree of crypt inflammation, mononuclear cell infiltration, crypt atrophy, and comprehensive active inflammation. No significant correlation between the number of S-100 protein(+) cells and the severity of crypt atrophy was found. S-100 protein(+), MIP-3alpha(+), and CCR6(+) cells were frequently localized in or around the crypt with inflammation. MIP-3alpha(+) neutrophils and S-100 protein(+) CCR6(+) cells with dendritic morphology were detected in or around the crypt inflammation. Both S-100 protein(+) DCs and CCR6(+) cells were frequently clustered in the surface mucosa beneath the surface epithelium when the crypt was not inflamed. CD1a(+) Langerhans-cell-type DCs were not found in any of the tissues examined. These data indicate that DCs participate not only in chronic inflammation but also in active crypt inflammation.     

Radioprotection of mouse intestine by inhibitors of cyclic AMP phosphodiesterase.

The survival of colony-forming units of the jejunal crypt was used to assay the radioprotective capacity of various inhibitors of cyclic AMP phosphodiesterase. DL-152, RO-20-1724 and the methyl xanthines, caffeine, theophylline and methyl isobutyl xanthine (MIX) were all found to have some radioprotective effect. The degree of radioprotection depended on the route of administration of the drug and on the timing of administration with respect to irradiation. Optimum survival of crypt stem cells was found following intraperitoneal administration of DL-152 (60 min before irradiation) or MIX (30 min before irradiation), and following intravenous administration of caffeine (60–120 min before irradiation) or theophylline (60 min before irradiation).When these protocols were used, crypt stem cell survival could be enhanced by a factor of from 6 to 7. All the compounds investigated produced some elevation of cyclic AMP content of the whole jejunum; this was found to be simultaneous with or to precede the period of maximum radioprotection. Cyclic AMP was localized with immunolluorescent staining; following injection of DL-152 it was found to be elevated in all parts of the jejunum but to the greatest extent in the lower part of the crypt. Survival curves for crypt stem cells from MIX and DL-152 treated mice were found to have almost the same exponential slope as the saline-injected control, suggesting that the mechanism of protection does not depend on induction of hypoxia.     

腹腔镜下睾丸复位固定术治疗隐睾症

目的探讨腹腔镜下睾九复位固定术治疗隐睾症的临床疗效。方法回顾分析2年来采用腹腔镜下睾九复位固定术治疗隐睾症16例患儿的临床资料。结果除1例睾丸缺如，1例睾丸切除外，其余14例均在腹腔镜下行睾九复位固定术，手术过程顺利，术后随访6～24个月，睾九固定及血供良好，未见睾丸扭转、回缩等。结论腹腔镜下行睾九复位固定术治疗隐睾症安全可行、创伤小、康复快，特别适合双侧腹腔型隐睾及双侧腹股沟型隐睾。