血清胆红素及炎症指标与冠心病关系的探讨

目的探索冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉狭窄程度与血清胆红素及炎性指标如超敏C反应蛋白(hs-CRP)的关系。方法回顾性分析2013年4月~2016年2月因胸痛于武汉大学中南医院住院并行冠状动脉造影的患者1055例,其中冠心病组741例,根据Gensini评分或SYNTAX评分中位数进一步分为两组,定义为轻度病变组及重度病变组。314例非冠心病患者作为对照组。结果与对照组相比,冠心病组患者血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素浓度(IBIL)更低,炎症标志物超敏C反应蛋白更高,差异均有统计学意义(P0.05)。轻度病变组与重度病变组相比,TBIL、DBIL及IBIL更高,hs-CRP更低,差异均具有统计学意义(P0.05)。相关分析显示血清胆红素与冠状动脉病变严重程度呈负相关,超敏C反应蛋白与冠状动脉病变严重程度呈正相关。多因素Logistic回归分析显示hs-CRP、LDL-C、高血压、糖尿病和吸烟是重度冠心病的独立危险因素,而TBIL、HDL-C是重度冠心病的独立保护因素。受试者工作特征曲线(ROC曲线)显示TBIL诊断冠心病的曲线下面积为0.758(95%CI:0.731~0.783)。当TBIL诊断临界值取14.7μmol/L时,其诊断效能最高,敏感性为72.0%,特异性为71.6%。结论血清胆红素与冠状动脉病变严重程度呈负相关。总胆红素是重度冠心病的独立保护因素,hs-CRP是重度冠心病的独立危险因素。血清总胆红素水平对冠心病有一定的预测价值。     

超敏C反应蛋白和血清尿酸水平与冠状动脉病变程度的关系的探讨

目的探讨超敏C反应蛋白(hs-CRP)、血清尿酸(UA)与冠状动脉病变程度的关系。方法检测正常对照组和冠状动脉造影确诊的冠心病患者超敏C反应蛋白(hs-CRP)、血清尿酸(UA)、低密度脂蛋白胆固醇(LDL-C),分析检测指标与冠状动脉病变程度的关系。结果冠心病患者hs-CRP、UA和LDL-C水平均高于正常对照组及冠状动脉造影阴性组(P<0.01),后者血清3项指标水平虽然较正常对照组有所升高,但仅超敏C反应蛋白有差异(P<0.01)。hs-CRP、血清UA和LDL-C水平与病变程度相关。结论联合检测hs-CRP、UA和LDL-C有助于对冠状动脉病变的诊断和严重程度的评估。     

外周血内脂素水平与冠心病的相关性

目的 结合血清高敏C反应蛋白,探讨血清内脂素在预测冠心病斑块稳定性及冠状动脉病变程度的价值.方法 对入选对象行冠状动脉造影,同步进行心电图、外周血内脂素、高敏C反应蛋白、肌酸激酶同工酶、心肌肌钙蛋白Ⅰ参数检测和常规身体检查后设正常对照组(25例)和冠心病组(78例);再将冠心病组分为稳定型心绞痛组(34例)、不稳定型心绞痛组(20例)和急性心肌梗死组(24例);同时也将78例冠心病病例分为冠状动脉单支病变(24例)与多支病变(54例).比较组间外周血内脂素、高敏C反应蛋白水平差异,评价两者在冠心病患者中的相关性及其与冠状动脉病变程度的相关性.结果 冠心病组血清内脂素、高敏C反应蛋白水平显著高于正常对照组(P<0.05);血清内脂素、高敏C反应蛋白水平急性心肌梗死组显著高于不稳定型心绞痛组(P<0.05),不稳定型心绞痛组显著高于稳定型心绞痛组(P<0.05);血清内脂素与高敏C反应蛋白水平无明显相关性(P>0.05);多支病变组与单支病变组内脂素水平差异无显著性(P>0.05),而多支病变组高敏C反应蛋白显著高于单支病变组(P<0.05).结论 内脂素和高敏C反应蛋白在预测冠心病中有重要价值,它们在冠心病外周血中浓度的升高可以提示冠状动脉粥样斑块的不稳定,但两者无相关性;高敏C反应蛋白在预测冠状动脉病变程度方面有一定作用,但还不能以内脂素作为预测冠状动脉病变程度的指标.     

冠心病患者血清同型半胱氨酸、胱抑素C和C反应蛋白水平与冠脉病变相关性分析

目的探讨血清同型半胱氨酸、胱抑素C和C反应蛋白在冠心病患者中的表达及与冠脉病变的相关性。方法取2013年6月-2015年3月医院收治老年冠心病患者80例,设为观察组。根据病变血管数分为单支病变组(n=22)、双支病变组(n=32)与多支病变组(n=26);取同期入院冠状动脉造影术检查示无狭窄者30例,设为对照组。采用E601电化学发光自动免疫分析仪测定血清同型半胱氨酸水平,采用免疫比浊法测定患者胱抑素C和C反应蛋白水平。结果观察组血清同型半胱氨酸,胱抑素C和C反应蛋白水平,高于对照组(P0.05)。多支病变组血清同型半胱氨酸,胱抑素C和C反应蛋白水平高于单支病变组与多支病变组(P0.05);双支病变组血清同型半胱氨酸,胱抑素C和C反应蛋白水平高于单支病变组(P0.05);Pearson相关性研究显示:血清同型半胱氨酸,胱抑素C和C反应蛋白与冠脉病变呈正相关性(P0.05)。结论冠心病患者测定血清同型半胱氨酸,胱抑素C和C反应蛋白效果理想,能预测冠脉狭窄病变情况,值得推广应用。     

血尿酸、胱抑素C、脂蛋白(a)与急性冠脉综合征冠脉病变的相关性研究

目的探讨急性冠脉综合征病人血清尿酸、胱抑素C、血浆脂蛋白(a)水平与冠状动脉病变支数的相关性。方法纳入2016年12月—2017年12月以胸部不适为主要症状于山西医科大学第一医院心内科住院的119例病人,对其临床资料进行回顾性分析,按照冠状动脉造影的结果分为单支病变组36例、双支病变组25例、多支病变组22例和对照组39例,并对4组病人的血尿酸、胱抑素C、血浆脂蛋白(a)的水平及冠状动脉病变程度进行比较。结果 (1)急性冠脉综合征病人与对照组健康人群性别、合并糖尿病及低密度脂蛋白的含量比较差异无统计学意义(P0.05),高血压、吸烟史、年龄比较,差异有统计学意义(P0.05);(2)单支病变组、双支病变组、多支病变组血尿酸、胱抑素C、脂蛋白(a)水平较对照组均增高,差异均有统计学意义(P0.05);(3)在急性冠脉综合征各亚组中,单支病变组、双支病变组、多支病变组的血尿酸、胱抑素C、脂蛋白(a)的水平均依次递增,差异均有统计学意义(P0.05);(4)相关分析显示:血尿酸、胱抑素C、脂蛋白(a)与冠状动脉病变支数均呈正相关(P0.01)。结论血清尿酸、胱抑素C、血浆脂蛋白(a)水平升高与急性冠脉综合征病人冠状动脉病变程度呈正相关。     

青年人血清尿酸水平与冠心病的相关性研究

目的 探讨青年人血清尿酸水平与冠心病的关系.方法 2005年1月至2008年4月在北京大学第一医院接受冠状动脉造影检查的年龄≤45岁的住院患者共156例.按照造影结果,分为冠心病组(96例)和对照组(60例).冠心病组又分为单支病变亚组(55例)、双支病变亚组(21例)和三支病变亚组(20例).分析血清尿酸水平与冠心病及冠状动脉病变严重程度的关系.结果 冠心病组血清尿酸水平显著高于对照组(347.3±77.8 mmol/L比306.1±76.6 mmol/L,P＜0.01),并且随着冠状动脉受累支数的增多,血清尿酸水平逐渐增高(单支病变亚组322.8±74.6 mmol/L,双支病变亚组373.8±59.3 mmol/L,三支病变亚组383.6±82.1 mmol/L,P＜0.01).经 Cumulative Logit 模型分析,在调整了其他危险因素后,血清尿酸水平仍与冠状动脉病变支数独立相关(OR=1.008,95%CI:1.003～1.013,P＜0.01).结论 在本组青年人群中,血清尿酸水平升高与冠心病及冠心病的严重程度具有显著相关性,而且在青年人群中,血清尿酸水平升高是冠心病发病的独立危险因素.     

血尿酸与超敏C反应蛋白水平检测在高血压病情评估中的应用分析

目的探讨在高血压病情评估中运用血尿酸与超敏C反应蛋白水平检测的效果。方法将内科80例高血压患者(2017年1月到2018年10月间收治)设为高血压组,将同期80例健康体检人员设为健康组,对所有人员均实施血尿酸、超敏C反应蛋白水平检测,分析总结不同人员的检测结果。结果高血压组患者血尿酸、超敏C反应蛋白水平显著高于健康组(P0.05)。高血压组中分级Ⅰ级、Ⅱ级、Ⅲ级患者血尿酸、超敏C反应蛋白水平差异显著(P0.05)。高血压组中颈动脉内膜正常、内膜增厚、斑块形成、管腔狭窄患者血尿酸、超敏C反应蛋白水平差异显著(P0.05)。结论在高血压中运用血尿酸与超敏C反应蛋白水平检测可有效辅助患者病情评估,且通过血尿酸与超敏C反应蛋白水平了解患者血管病变状况,辅助并发症风险评估。     

冠心病患者血浆内脂素、C反应蛋白和同型半胱氨酸水平与冠状动脉病变的相关性

目的:观察冠心病患者血浆内脂素、C反应蛋白(CRP)和同型半胱氨酸(HCY)水平,探讨其与冠状动脉病变的相关性。方法:89例经冠状动脉造影确诊的冠心病患者(冠心病组),根据冠状动脉病变支数分为单支病变亚组(34例)、双支病变亚组(36例)和多支病变亚组(19例);另选41例正常健康者作为对照组。分别检测入选人群的血浆内脂素、CRP和HCY水平;同时检测各组空腹血糖(FPG)、TG、TC、LDL-C、HDL-C;计算体质指数(BMI)。结果:①与对照组比较,冠心病组血浆内脂素、CRP和HCY水平明显升高,差异有统计学意义(P0.05)。②冠心病组各亚组间比较,血浆内脂素、CRP和HCY水平随冠状动脉病变支数的增加而升高,各亚组间比较差异有统计学意义(P0.05)。③冠心病组血浆内脂素水平与BMI、FPG、TG、LDL-C和冠状动脉病变支数呈明显正相关(P0.05)。结论:血浆内脂素、CRP和HCY水平在冠心病患者中明显升高,并与冠状动脉病变程度密切相关,提示上述指标可能共同参与或介导了动脉粥样硬化的形成,并可用于预测动脉粥样硬化的严重程度。     

老年冠心病患者血浆Klotho水平测定的临床意义

目的探讨老年冠心病患者血浆Klotho蛋白测定的临床意义。方法随机选取60岁以上的老年住院患者,根据冠状动脉造影或冠状动脉CTA结果分为冠心病组138例(根据病变冠状动脉数目又分为单支病变组和多支病变组两个亚组)和对照组(140例),分别对各组进行血浆Klotho蛋白检测,并对冠心病组患者的冠状动脉狭窄程度与其血浆Klotho蛋白水平进行相关性分析。结果冠心病组患者血浆Klotho蛋白水平显著低于对照组,多支病变组患者血清Klotho蛋白水平低于单支病变组。冠心病组患者的冠状动脉狭窄程度与血浆Klotho蛋白水平呈负相关。结论血浆Klotho蛋白水平一定程度上可以反映冠状动脉狭窄程度,其可以作为评价冠状动脉狭窄程度的指标之一。     

T2DM冠脉病变与胆红素、血脂及尿酸水平的关系

目的探讨老年2型糖尿病患者冠脉病变的程度与血清胆红素、血脂及尿酸水平的关系。方法符合条件并经冠状动脉造影的老年糖尿病患者170例，根据其冠脉狭窄的程度分为5组，A组：无狭窄；B组：狭窄＜50％；C组：狭窄在50％～79％；D组：狭窄在80％～99％；E组：完全闭塞。再将D E组病人分为3组：单支、双支和三支病变组。均测定其血清胆红素，尿酸及血脂水平并计算Tc／(HDL-C 胆红素)，LDL-C／(HDL-C 胆红素)，比值用统计学软件进行比较。结果B～E组病人的总胆红素和间接胆红素水平明显低于A组，TC／(HDL-C BIL)和LDL-C／(HDL-C TBIL)比值明显高于A组(P＜O．01)；B～E组的尿酸水平明显高于A组(B组P＜O．05，C～E组P＜0．01)。双支和三支病变组的各种胆红素均明显低于单支病变组(P＜O．01)，TC、LDL、TC／(HDL TBIL)和LDL／(HDL TBIL)均明显升高(P＜O．01)；三支病变组的总胆红素，间接胆红素明显下降(P＜O．01)，TC、TG、TC／(HDL-C TBIL)和LDL-C／(HDL-C TBIL)明显高于双支病变组(P＜O．01)；三支病变组较双支和单支病变组尿酸明显升高(P＜O．05)。结论胆红素、血脂及尿酸等生化指标，可能与冠脉病变严重程度有相关性。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.