Colorectal cancer in regional ileitis

Six patients, with overt Crohn's disease of the small bowel developed colorectal cancer. Three distinct clinical patterns were observed. Three patients had advanced rectal adenocarcinoma and a relatively long duration of Crohn's disease, two patients had an early adenocarcinoma and a short antecedent history, and a sixth patient had advanced cloacogenic cancer of the anorectum. The prognosis for a patient with carcinoma in association with regional enteritis was poor when there was advanced disease at the time of diagnosis. The late diagnosis of the cancer may have been the result of three erroneous assumptions. First, scepticism as to the association of Crohn's disease and cancer despite the evidence to the contrary; second, misinterpretation of the intestinal symptoms of the carcinoma as those of the underlying inflammatory bowel disease; and third, confusing the clinical picture of colorectal cancer with that of benign perianal disease with stricture formation. Increased awareness of the association of cancer and Crohn's disease, particularly the development of cancer in apparently normal bowel, and careful evaluation of all new symptoms should improve the prognosis of this potentially lethal complication of inflammatory bowel disease.     

Colorectal Cancer in Regional Ileitis

Six patients, with overt Crohn's disease of the small boweldeveloped colorectal cancer. Three distinct clinical patternswere observed. Three patients had advanced rectal adenocarcinomaand a relatively long duration of Crohn's disease, two patientshad an early adenocarcinoma and a short antecedent history,and a sixth patient had advanced cloacogenic cancer of the anorectum. The prognosis for a patient with carcinoma in association withregional enteritis was poor when there was advanced diseaseat the time of diagnosis. The late diagnosis of the cancer mayhave been the result of three erroneous assumptions. First,scepticism as to the association of Crohn's disease and cancerdespite the evidence to the contrary; second, misinterpretationof the intestinal symptoms of the carcinoma as those of theunderlying inflammatory bowel disease; and third, confusingthe clinical picture of colorectal cancer with that of benignperianal disease with stricture formation. Increased awareness of the association of cancer and Crohn'sdisease, particularly the development of cancer in apparentlynormal bowel, and careful evaluation of all new symptoms shouldimprove the prognosis of this potentially lethal complicationof inflammatory bowel disease.     

Morphologic features of ulcerative colitis

Ulcerative colitis(UC) is an ulcero inflammatory disorder of unknown etiology affecting only the mucosa and submucosa of colon and, with Crohn's disease, is included in the term idiopathic inflammatory bowel disease. The macroscopic and microscopic features vary according to the stage of the disease process, and an acute phase and a chronic or resolving phase can be recognized. The main differential diagnosis of UC is with colorectal Crohn's disease. The most feared long-term complication of UC is cancer. The progression of UC to carcinoma is closely associated with dysplasia arising in multiple sites. The dysplastic changes should be distinguished from the epithelial changes resulting from regenerative atypia, and the evaluation of these changes is difficult. P53 immunohistochemical staining is helpful in confirming the presence of dysplasia. Molecular events in colorectal carcinogenesis of UC may be somewhat different from those of so-called adenoma-carcinoma sequence.     

Typhlitis as a rare cause of a psoas abscess

Typhlitis is a life-threatening necrotizing process of the cecum associated with leukemia patients who have undergone chemotherapy. We present a rare complication of typhlitis in a boy with leukemia, in whom a right psoas abscess developed secondary to the inflammatory process of the cecum, with an emphasis on the computed tomographic findings of this severe and potentially life-threatening complication. Typhlitis should be added to conditions of the gastrointestinal tract that cause a psoas abscess such as Crohn's disease, diverticulitis, appendicitis, colorectal carcinoma, and appendiceal tumor. Received: 18 May 2001/Accepted: 15 June 2001     

Crohn's disease and urinary bladder mass

The presence of a bladder mass in a patient with inflammatory bowel disease poses a diagnostic dilemma. We present the case of a 26-year-old male with a bladder mass who had not previously been diagnosed with Crohn's disease. Initial biopsies of the bladder mass were consistent with inflammatory changes, but superficial transitional cell carcinoma could not be reliably excluded. Subsequent evaluation confirmed the presence of Crohn's disease with bladder involvement, and the patient underwent bowel resection and partial cystectomy. Pathologic evaluation demonstrated Crohn's disease and no evidence of malignancy. Accurate differentiation of benign and malignant bladder masses in patients with inflammatory bowel disease may be difficult and requires cooperation between pathologists and clinicians.     

A Survey of Vitamin D Deficiency in Gastrointestinal and Liver Disorders

A survey of vitamin D status in 152 patients with chronic gastrointestinalconditions and 104 patients with chronic liver diseases is presented.Mild deficiency was common and severe deficiency, as judgedby plasma 25-OHD levels less than 8 nmol/1, was encounteredin every disease category tested. In the gastrointestinal disease patients, deficiency was significantlymore common in patients following gastroenterostomy than othergastric surgery, in patients with active Crohn's disease thanin those with inactive disease and in patients with chronicpancreatitis or pancreatic carcinoma with cholestatic featuresthan in those without cholestatic features. Deficiency was ascommon in patients with Crohn's disease who had not been treatedsurgically as in those who had. There was no significant correlationbetween plasma 25-OHD levels and any laboratory index of malabsorptionor malnutrition except for serum albumin in the gastric surgerypatients, haemoglobin and ESR in the Crohn's disease patientsand albumin and vitamin E in the group of patients with gastrointestinaldisorders taken as a whole. In the chronic liver disease patients, those with late primarybiliary cirrhosis had lower plasma 25-OHD levels than thosewith histological Stage I and II disease who all had normallevels, and those with pruritus and jaundice were more commonlyseverely deficient. Whatever the underlying disease process,patients with other coincidental medical conditions were muchmore likely to be deficient as were patients with cholestasis. Evidence of secondary hyperparathyroidism and osteomalacia onbone histology indicated the clinical relevance of the vitaminD deficiency. This study showed no relationship between abnormalplasma vitamin D binding protein levels and vitamin deficie     

Analysis of direct tissue isoelectric focused protein profiles of resected intestinal mucosa and endoscopic biopsies from patients with inflammatory bowel disease.

Direct tissue isoelectric focusing was used as a procedure to analyze differences in soluble tissue protein profiles of resected intestinal segments and endoscopic biopsies from patients with ulcerative colitis, Crohn's disease, and colonic cancer. Extraction of tissue proteins was accomplished by electrophoresis of mucosal cryostat sections on agarose gels across a broad pH gradient. The inflamed colonic mucosa from Crohn's disease patients showed similar isoelectric focusing protein patterns. Small bowel mucosa from a patient with both colonic diverticular disease and Crohn's disease showed protein patterns identical with that of the mucosa from a patient with only Crohn's disease. The inflamed mucosae from ulcerative colitis patients revealed identical protein patterns but were distinct from those of non-inflamed ulcerative colitis mucosa and from the inflamed mucosae from Crohn's disease patients. Non-inflamed small bowel mucosae from cancer, ulcerative colitis, and Crohn's disease patients showed distinct protein patterns which were absent in the non-inflamed large bowel mucosae. The inflamed resected ileum of a Crohn's disease patient exhibited protein patterns similar to those of the biopsy of an inflamed mid-transverse large bowel. Mucosal biopsies from inflamed sigmoid colon of a Crohn's disease patient showed different protein patterns than those in biopsies from the inflamed mid-transverse colon. Thus, distinctive isoelectric focusing protein patterns may be useful in differentiating Crohn's colitis and ulcerative colitis when granulomata are absent, and in resolving indeterminant colitis to one of these classic inflammatory bowel diseases.     

Immunological studies in Crohn's disease. I. Association with HLA systems in the Japanese

We attempted to clarify the association between HLA and Crohn's disease. HLA-A, -B, -C and -DR locus antigens in 62 Japanese patients with Crohn's disease were analyzed and the results were compared with findings of 231 healthy Japanese. In the patients with Crohn's disease there was a strong association with HLA-DR4 and -DR5 (chi2 = 14 . 013, RR = 4 . 77 and chi2 = 9 . 345, RR = 5 . 04) and a weak association with HLA-Bw46 and -Bw51 (chi2 = 7 . 077, RR = 2 . 63, and chi2 = 5 . 401, RR = 2 . 52). There was a close association between HLA-DR5 in those with the ileocaecal type, and the -Bw51 and small intestine type. Therefore susceptibility to Crohn's disease may relate to specific allotypes on the human major histocompatibility complex. The correlation was weaker than the other diseases such as ankylosing spondylitis and Coeliac disease.     

An investigation into the validity of the present classification of inflammatory bowel disease

To assess the validity of the present subdivision of patients with inflammatory bowel disease into those with Crohn's disease of the small bowel or of the colon and those with ulcerative colitis, 252 patients with inflammatory bowel disease have been studied by questionnaire and case note review. One hundred and seventy-two variables concerning the nature and frequency of symptoms in remission and relapse, the incidence of complications and results of investigation have been analysed by computer. As expected, there were many highly significant variables between patients with ulcerative colitis and those with Crohn's disease of the small bowel. The latter showed evidence of a more severe disease course with more complications. There were similar, although less marked, differences between patients with Crohn's disease of the colon and those with Crohn's disease of the small bowel. There were very few differences in disease course between patients with Crohn's disease of the colon and those with ulcerative colitis. The results suggest that while separate classification of patients with Crohn's disease of the small bowel is justified on clinical grounds, the present separation of patients with disease confined to the colon into groups labelled ulcerative colitis or Crohn's disease of the colon is not. Alternative methods of classification should therefore be investigated.     

克隆病及其异型增生与癌变的临床病理学分析

探讨克隆病（ｃｒｏｈｎ’ｓ ｄｉｓｅａｓｅ，ＣＤ）肠粘膜上皮增生，异型增生，癌变的临床病理特点及意义。方法收集５到ＣＤ患者的临床病理资料，光镜观察肠粘膜活检及手术肠切除的病理组织学特点，应用国际炎性肠 的分标准对上皮增生进行分类，部分切片行ＣＥＡ、ＰＣＮＡ免疫组化染色。结果３例肠为膜活检未发现特异性为。５例手术标本均可见非干酪样坏死肉芽肿或巨细胞；３例有典型裂隙状溃疡形成。４例次上皮有局灶未定型异     

Impaired fatty-meal-stimulated gallbladder contractility in patients with Crohn's disease.

1. The incidence of gallstones in patients with Crohn's disease is increased compared with that in healthy control subjects. This is in part due to reduced terminal ileal bile salt absorption and consequent increased cholesterol saturation in bile. The aim of this study was to evaluate gallbladder contractility, a second important factor in the pathogenesis of gallstones, in Crohn's disease. 2. Thirty patients with Crohn's disease and no known biliary tract disease and nine healthy control subjects were studied. After an overnight fast, gallbladder volume was determined by real-time ultrasonography before and 10, 20, 30, 40, and 50 min after ingestion of a standard liquid fatty meal. 3. Compared with healthy control subjects, patients with Crohn's disease had similar fasting gallbladder volumes (control, 18.7 +/- 2.3 ml; Crohn's disease, 18.2 +/- 2.3 ml). Percentage emptying was significantly impaired at 30, 40 and 50 min in patients with Crohn's disease compared with control subjects. Patients with Crohn's disease limited to the small bowel had gallbladder contractility that was comparable with that of control subjects, whereas in those with large-bowel disease, minimum residual gallbladder volume was significantly smaller than in control subjects. Patients with both large- and small-bowel Crohn's disease demonstrated the most marked abnormalities, with gallbladder volumes significantly larger than those of control subjects at 30, 40 and 50 min. Likewise, patients with Crohn's disease who had undergone previous bowel resection had impaired emptying at 30, 40 and 50 min.(ABSTRACT TRUNCATED AT 250 WORDS)     

Levels of zinc and thymulin in plasma from patients with Crohn's disease

Levels of zinc in plasma from patients with Crohn's disease were significantly lower than those of sex and age matched controls. We also measured the level of plasmic thymulin, a hormone released by the thymus gland, which in its active form binds one zinc molecule. The zinc unbound form of thymulin is biologically inactive and its level in the blood is a very sensitive marker of even marginal zinc deficiency. Levels of active thymulin were significantly reduced in plasma from patients with Crohn's disease, whereas plasma concentrations of the inactive form was higher than in controls. The in vitro addition of zinc ions restored thymulin activity in plasma from patients with Crohn's disease, and induced the disappearance of the inactive form. These findings suggest the existence of a zinc dependent alteration regarding the biological function of thymic hormones in patients with Crohn's disease. Such a defect might explain some of the immunological abnormalities observed in these pathological conditions.     

Colonic dysplasia and cancer in inflammatory bowel disease

Extracolonic malignancies are a relatively rare complication of inflammatory bowel disease. In contrast, colorectal cancer remains a major concern for patients with long-standing UC. The best available evidence suggests that patients with long-standing Crohn's colitis are at similar risk for colorectal cancer as those patients with long-standing UC. In patients with UC, the magnitude of this increased risk appears to be greater in patients with more extensive colonic involvement. It appears that the magnitude of this risk increases with increasing duration of disease, at least in UC. Whether this reflects the increased risk of cancer that occurs with the aging process or a separate phenomena distinct to UC is unclear. To date, the methods available to reduce the risk of cancer are less than optimal. Although surgical procedures eliminate the risk, the mental and physical sequelae of these procedures can be substantial. Surveillance with colonoscopic biopsies is likely effective in reducing although not eliminating the risk of colorectal cancer. Efforts to develop chemopreventative agents and improved surveillance methods remain areas of active investigation.     

Ultrasound findings in Crohn's disease and ulcerative colitis: a prospective study

In a prospective study, 118 patients with Crohn's disease, 51 patients with ulcerative colitis, and 72 patients with no disease of the intestine proximal to the rectum were evaluated by ultrasound. In Crohn's disease, thickening of the bowel wall and inflammatory masses were detected in 72.0% of the patients. With a transducer having optimal imaging properties in the near range, these findings were detected in 87.2% of a group of 47 patients. In ulcerative colitis, bowel wall thickening was detected in 52.9% of all patients. Thickening of the bowel wall was more marked in Crohn's disease than in ulcerative colitis. Most pathologic findings in Crohn's disease were located in the right lower abdomen, whereas those in ulcerative colitis were in the left abdomen, in particular in the lower quadrant. The frequency of wall thickening was correlated to the activity of the disease in ulcerative colitis but not in Crohn's disease. Considerably increased wall thickness, when localized in the right lower quadrant and found in combination with inflammatory masses or an abscess, suggests Crohn's disease.     

Empty right iliac fossa

In the diagnosis of intra-abdominal disease, absence of gas or fecal shadows from the right iliac fossa is an important but nonspecific finding on plain roentgenograms. We found the empty right iliac fossa most commonly associated with acute appendicitis, Crohn's disease, and carcinoma of the cecum. Retrospective analysis of 137 confirmed cases of disease in the right lower quadrant yielded 21 (15.4%) with an empty right iliac fossa. In an additional 21 cases, an empty right iliac fossa was prospectively identified, and 13 of these patients (61.9%) had confirmed disease in a particular area.     

VEGFR-3和podoplanin在结直肠癌中的表达及淋巴管生成和转移中的作用

目的观察血管内皮生长因子受体3（VEGFR-3）及肾小球足突细胞膜黏蛋白（podoplanin）在结直肠癌组织中的表达,探讨VEGFR-3及podoplanin在结直肠癌淋巴管生成及转移中的作用。方法应用免疫组织化学法检测52例结直肠癌组织、20例大肠息肉组织和20例正常对照组织中VEGFR-3及podoplanin的表达,分析其与结直肠癌患者的临床病理参数的相关性。结果 VEGFR-3主要表达在结直肠癌细胞胞膜及胞质中,阳性表达率67.30％,明显高于在大肠息肉组织和正常大肠组织中的阳性表达率（χ2分别=6.75、16.77,P均＜0.05）;其在小淋巴管内皮的阳性表达率仅为9.61％。 podoplanin主要表达在癌细胞淋巴管内皮细胞上, podoplanin标记的淋巴管密度（LMVD）明显高于大肠息肉组织和正常大肠组织（t分别=3.15、3.54,P均＜0.05）。 VEGFR-3、podo planin标记的LMVD的表达与Dukes分期、淋巴管转移有关（χ2分别=12.63、13.26,t分别=3.57、3.02,P均＜0.05）。结论 VEGFR-3很少在癌细胞淋巴管内皮表达,VEGFR-3作为淋巴管标记物的依据不足;podoplanin在结直肠癌淋巴管内皮细胞高度表达,可以作为结直肠癌淋巴管标记物。     

结直肠癌患者血清IL-23和IL-10水平的检测及其意义

目的探讨结直肠癌进展过程中,患者血清中几种细胞因子水平的变化及其在肿瘤进程中的意义。方法纳入50例患者及20例健康志愿者,运用ELISA方法检测各组血清IL-23I、L-17I、L-10和IFN-α水平的变化。结果结直肠癌患者血清IL-23和IL-10水平显著高于对照组,而且Ⅳ期患者血清IL-10水平显著高于Ⅰ、Ⅱ、Ⅲ期。结论与IL-17和IFN-α相比,患者血清中IL-23和IL-10表达水平显著增加;此外,患者血清中IL-10的高水平表达可能促进了结直肠癌的发展。     

高龄大肠癌外科治疗85例分析

目的　探讨高龄大肠癌患者的外科治疗方法。方法　回顾性分析 1999年 1月至 2 0 0 3年 12月间收治的 6 5岁以上大肠癌患者 85例外科治疗资料。结果　高龄大肠癌患者入院前误诊率高 (45 8% ) ,并存病多 (6 9 4 % ) ,肿瘤切除率为 92 9% ,围手术期死亡率为 6 3% ,术后并发症发生率为 2 9%。结论　手术切除是高龄大肠癌患者最佳治疗方法。但早期诊断、早期治疗 ,合理处理并存病 ,适当的麻醉和手术方式 ,有效的预防和治疗并发症是提高疗效的关键。     

Colorectal cancer screening: an overview of available methods and current recommendations

BACKGROUND: Screening asymptomatic persons for colorectal cancer may decrease the incidence and mortality of this disease. METHODS: The MEDLINE database was used to identify articles addressing the rationale for colorectal cancer screening, methods used and their effectiveness, and current recommendations. RESULTS: Methods of screening for colorectal cancer include flexible sigmoidoscopy, fecal occult blood tests, barium enema, and colonoscopy. The method used and the frequency of screening are determined by assessing an individual's risk of having colorectal cancer. CONCLUSIONS: Colorectal cancer is a common malignancy in the United States, is curable when detected at an early stage, and is potentially preventable. The acceptance of colorectal cancer screening by patients and physicians has been suboptimal. while there remains little debate about the potential for screening to reduce mortality from colorectal cancer, debate continues about the cost-effectiveness of colorectal cancer screening when applied to the general population.     

Obstructing Crohn's disease of the duodenum: Is surgery always mandatory?

Crohn's disease may involve any part of the alimentary tract. But, Crohn's disease of the duodenum is a very rare condition. Systemic steroid therapy had been shown to be effective in patients with Crohn's disease, and the most common indication for surgical intervention is duodenal obstruction. We report a case with Crohn's disease of the duodenum presenting with duodenal obstruction. Medical treatment option was successful as a first line of therapy because of young age and new diagnosis. The patient was administered mesalazine as a treatment, and the obstruction was resolved. The patient is still in remission for the last 2 years.