A lumbar hernia presenting as an obstructing lesion of the colon

A patient with a lumbar hernia of Petit, presenting as an obstructing lesion of the ascending colon and concomitant acute cholecystitis is described. The anatomy, cause, and surgical treatment of lumbar hernia are reviwed.     

Laparoscopic resection of adult colon duplication causing intussusception

Gastrointestinal duplications are uncommon congenital malformations that can occur anywhere along the gastrointestinal tract. Most cases are recognized before the age of 2 years, and those encountered in adults are rare. We describe here a case of ascending colon duplication in a 20-year-old male that caused intussusception and was treated laparoscopically. Although computed tomography revealed a cystic mass filled with stool-like material, the preoperative diagnosis was a submucosal tumor of the ascending colon. We performed a laparoscopic right colectomy, and the postoperative pathological diagnosis was duplication of the ascending colon, both cystic and tubular components. We conclude that gastrointestinal duplications, although rare, should be considered in the differential diagnosis of all abdominal and submucosal cystic lesions and that laparoscopy is a preferred approach for the surgical treatment of gastrointestinal duplications.     

Malignant schwannoma of the pancreas involving transversal colon treated with en-bloc resection

Pancreatic schwannoma is a very uncommon tumor of the pancreas,with only 27 cases reported.Most pancreatic schwannomas are benign,with only four malignant tumors reported.We describe a case of giant malignant schwannoma of the pancreatic body and tail,which involved the transverse colon.The tumor was treated successfully with en bloc distal splenopancreatectomy and colon resection.This is believed to be the first reported radical operation for malignant schwannoma of the pancreatic body,with infiltration of...     

Malignant schwannoma of the pancreas involving transversal colon treated with en-bloc resection

Pancreatic schwannoma is a very uncommon tumor of the pancreas,with only 27 cases reported.Most pancreatic schwannomas are benign,with only four malignant tumors reported.We describe a case of giant malignant schwannoma of the pancreatic body and tail,which involved the transverse colon.The tumor was treated successfully with en bloc distal splenopancreatectomy and colon resection.This is believed to be the first reported radical operation for malignant schwannoma of the pancreatic body,with infiltration of...     

Tube cecostomy and staged resection for obstructing carcinoma of the left colon

Over a 17-year period, all patients presenting with acute obstruction of the left colon due to carcinoma were treated by emergency tube cecostomy. There were 57 patients aged between 35 and 93 years. After the decompressive procedure, eight died, 34 had complications, and eight were left with permanent cecostomies. Forty-one underwent secondary procedures of which 35 had resections. Seven patients died postoperatively and 15 had complications. Of the 34 survivors, in 23 the cecostomy closed spontaneously, and 11 had operative cecostomy closure. Of the latter, four died postoperatively, and nine had complications. Thus, 30 survived the entire treatment program. Reasons for the high morbidity and mortality are discussed. Comparison is made with other forms of treatment in the literature. A treatment program is suggested, using tube cecostomy for poor-risk patients and primary resection without anastomosis for patients in better condition.     

Polypoid pleomorphic sarcoma of the colon

In contrast to common colonic epithelial neoplasms, polypoid mesenchymal tumors of the colon are extremely rare. The majority of uncommon gastrointestinal mesenchymal tumors are associated with the so-called gastrointestinal stromal tumors (GIST). We present a case of a rare colonic pleomorphic sarcoma, macroscopically mimicking a common epithelial colonic polyp, which did not match the criteria of GIST. In this case report we discuss the clinical and pathological characteristics of a rare polypoid-shaped, pleomorphic colonic sarcoma and refer a mark-off to other rare mesenchymal neoplasms of the gut.     

Age and sex differences in right colon cancer

In a prospective study of 402 colorectal cancer patients, 133 patients (46 men and 87 women) presented with right colon cancer. There was no significant difference between men and women in right colon cancer incidence. Common presenting features were abdominal pain, weight loss, and anemia. Ninety-one patients underwent resection with curative intent. There were significantly fewer Dukes' A tumors in the right colon cancer series (P<0.05). Significantly more women in the right colon cancer group were over 70 years old (P<0.05). The findings of peritoneal metastases and poorly differentiated lesions at initial surgery also were associated significantly with women who had right colon cancer (P<0.05). This study confirms previous reports of more advanced tumors in the right colon. The need for age, sex, and subsite differences to be taken into account when assessing treatment outcomes or survival is emphasized. Supported by the Auckland Division of the Cancer Society of New Zealand.     

人结肠癌羟基喜树碱多药耐药细胞的蛋白质组学研究

目的对结肠癌羟基喜树碱多药耐药细胞（SW1116／HCPT）及其亲代细胞（SW1116）进行蛋白质组学比较研究，探讨肿瘤细胞的多药耐药机制。方法培养羟基喜树碱多药耐药细胞和亲代细胞，提取蛋白质，以固相pH梯度等电聚焦为第一向，十二烷基磺酸钠-聚丙烯酰胺凝胶垂直电泳为第二向进行双向电泳，图像分析软件分析电泳图谱，基质辅助激光解吸电离飞行时间质谱或基质辅助激光解吸电离飞行时间／飞行时间串联质谱鉴定蛋白质。结果发现9个蛋白质点在SW1116／HCPT细胞中表达量发生改变，4个蛋白质点表达量增加，5个蛋白质点表达量减少。质谱鉴定了6个蛋白质点分别为：琥珀酸脱氢酶复合物（亚单位A）、3-磷酸甘油醛脱氢酶、泛素融合降解1相似蛋白、胞核氯离子通道蛋白、β-微管蛋白和ORF蛋白。结论该研究有助于深入理解结肠癌羟基喜树碱多药耐药机制，并有望在新型耐药逆转剂的开发上发挥作用。     

浅谈中德右半结肠癌CME手术的统一和差异

德国Hohenberger先生提出的结肠癌完整系膜切除(complete mesocolic excision,CME)手术概念,已逐渐得到我国外科医生的认可和重视。但右半结肠癌完整系膜的上缘和内侧缘在哪里更符合CME要求呢？D3手术作为右半结肠CME手术的方法合理吗？是否有更符合CME理念的右半结肠癌根治手术方法呢？笔者将腹腔镜右半结肠CME手术方法与Hohenberger先生的CME进行对比阐述,以探讨右半结肠CME手术方法的合理性。     

Adenosquamous carcinoma of the colon

Two cases of primary adenosquamous carcinomas of the sigmoid colon and rectum are presented. Clinical features and pathologic findings of both primary and metastatic lesions are reported (including immunohistochemistry and electron microscopy). We emphasize that the presence of a metastatic squamous tumor in a patient with an unknown primary does not exclude the possibility of colonic carcinoma. Comparison with other reports in the American medical literature indicates that these are very aggressive tumors that may have a worse prognosis than the more common form of colonic adenocarcinoma. Furthermore, the squamous component, in particular, may have a greater potential for metastasizing and can do so as an undifferentiated-appearing carcinoma. In view of this, the authors suggest that very poorly differentiated areas within colonic adenocarcinomas should be very carefully evaluated by means of immunoperoxidase stains and/or electron microscopy in an attempt to identify squamous features.     

黄连素抑制结肠癌细胞环氧合酶-2的作用

目的 探讨黄连素对结肠癌细胞系HT—29的作用及其相关机制,为阐明黄连素作为一种新的结肠癌化学治疗药物进行理论上的准备并提供相关实验结果。方法 黄连素0．1、0．3、3．0、30．0μmol／L加入到HT—29结肠癌细胞系培养液中,每天测量各有关值。同时以NS—398为环氧合酶(COX-2)活性抑制剂,对比观察黄连素对COX—2活性的影响。采用氮蓝四唑盐实验法检测细胞的生长和增殖,逆转录—PCR法检测COX—2 mRNA,免疫细胞化学法检测COX—2蛋白表达,ELISA法检测前列腺素(PG)E2的含量。结果 黄连素在浓度大于0．3μmol／L时则有明显的量效关系。黄连素在浓度大于0．3μmol／L时对COX—2 mRNA水平和蛋白的表达有明显的抑制作用。黄连素对PGE2的生成有显著抑制作用。结论 黄连素抑制COX—2在mRNA水平和蛋白质水平的表达,同时也抑制COX—2活性,进而抑制PGE2的生成,这可能为黄连素抑制HT—29细胞生长和增殖的机制之一。     

Characterisation and clinicopathological correlates of serum anti-p53 antibodies in breast and colon cancer

The humoral immune response to p53 was determined in 54 individuals with colon or breast cancer and 50 healthy subjects, in an attempt to better understand the origin and significance of anti-p53 serum antibodies. The presence of anti-p53 antibodies in serum was determined by enzyme-linked immunosorbent assay using purified recombinant human p53, and results were validated by immunoprecipitation of radiolabelled p53. Immunohistochemical analysis of 28 tumours was performed to detect the accumulation of p53 protein. Antibodies against p53 were significantly more common in patients with colorectal (10 of 42) and breast (2 of 12) cancer than in healthy individuals (2 of 50). They were of both the IgM (7 of 11) and IgG (4 of 11) isotypes. There was no significant difference in prevalence of serum antibodies against p53 with respect to the p53 immunohistochemical status of the tumour or to other pathological features, including the presence of lymph node and distant metastases. These findings provide indirect evidence that, rather than arising as a result of a specific immune response, anti-p53 antibodies in individuals with cancer may represent elevated levels of naturally occurring polyreactive antibodies.Abbreviations BSA bovine serum albumin - PBS phosphate-buffered saline - TBS TRIS-buffered saline The work was carried out with the aid of grant support from St Vincent's Clinic Foundation     

直肠异常隐窝病灶对结肠肿瘤的预警作用

目的 评判内镜下直肠异常隐窝病灶(ACF)与结肠病变及高癌变潜能肿瘤(AN)的关系.方法 接受全结肠镜检查的正常、息肉、腺瘤及癌的患者212例,在退镜时用0.4%靛胭脂对直肠进行染色,根据直肠ACF的数目对患者分级,无ACF者为0级,ACF数目为1～4,5～9,≥10者分别为Ⅰ、Ⅱ、Ⅲ级,统计分析ACF级别与结肠病变(息肉、腺瘤和癌),高癌变潜能肿瘤(≥1 cm,绒毛状、管状绒毛状,高度异型增生或浸润癌)的关系.结果 212例患者中,72例直肠ACF为0级,48例为Ⅰ级,41例为Ⅱ级,51例为Ⅲ级.直肠有ACF(包括Ⅰ、Ⅱ、Ⅲ级)的患者发生结肠病变及结肠高癌变潜能肿瘤的概率较无ACF者明显升高,其OR值(95%CI)分别为22.352(6.716～74.395),7.982(1.838～34.672).结论 直肠ACF对结肠病变及高癌变潜能肿瘤有预示作用.     

结肠癌CME与D3根治术：平面与血管之争

目前,大量的回顾性研究证实对结肠癌患者行结肠癌完整系膜切除（CME）和D3根治术是可行的并且均有较理想的预后,可降低肿瘤复发率以及提高五年生存率。较传统手术,患者从结肠癌CME和D3根治术中可获得更大受益。但结肠癌CME和D3根治术两者由于概念与手术强调重点不同,在临床应用中存在着争议。本文主要根据结肠癌CME和D3根治术的方法以及国内外大量相关文献的报道进行阐述。     

人结肠癌细胞胃泌素-黏着斑激酶通路的研究

目的研究胃泌素对人结肠癌细胞信号分子黏着斑激酶(FAK)酪氨酸磷酸化和蛋白质表达的影响。方法使用胆囊收缩素2受体(CCK2R)的真核表达载体pCR3.1/CCK2R,转染人结肠癌细胞株Colo320,上调胃泌素作用;使用胃泌素拮抗剂下调胃泌素作用。使用胃泌素按浓度和时间梯度刺激细胞,以免疫沉淀和蛋白质印迹法检测FAK酪氨酸磷酸化和蛋白质表达情况。结果胃泌素能够引起FAK酪氨酸磷酸化,具有时间和剂量依赖性;CCK2R表达上调可以增强此作用;胃泌素拮抗剂具有相反作用。结论FAK是胃泌素发挥效应的下游信号分子,以酪氨酸磷酸化的形式发挥作用。胃泌素CCKRFAK信号通路在胃泌素引起的肿瘤细胞增殖过程中发挥重要作用。     

内镜智能分光比色与染色技术对大肠肿瘤诊断价值的研究

目的 探讨内镜智能分光比色技术(FICE)与染色技术鉴别大肠肿瘤及非肿瘤性病变的价值.方法 选择2007年3月至2008年5月间245例入选病例,分别采用常规放大技术、FICE放大技术及染色放大技术对病变进行腺管开口分型及毛细血管形态观察,对病变做出诊断,并与病理组织学诊断相比较.结果 在245例患者中发现新生性病变480个,其中常规放大内镜下发现病变90.0%(432/480),FICE放大模式下发现病变98.8%(474/480),差异有统计学意义(P<0.01).FICE放大内镜比染色放大内镜更能清晰显示黏膜毛细血管结构形态(P<0.01),在显示腺管开口方面两者差异无统计学意义.FICE放大内镜对肿瘤性及非肿瘤性病变判断的符合率为92.2%(437/474),染色放大内镜符合率为81.0%(389/480),前者高于后者(P<0.01).结论 FICE放大内镜可以观察黏膜表面微细结构及毛细血管形态,比普通放大内镜及染色放大内镜对大肠肿瘤性及非肿瘤性病变鉴别诊断的符合率高,操作转换简便,可指导对病变进行靶向活检,有良好的临床实用价值.     

Effects of inositol hexaphosphate on proliferation of HT-29 human colon carcinoma cell line

AIM: To investigate the effects of inositol hexaphosphate (IP6) on proliferation of HT-29 human colon carcinoma cell line. METHODS: Cells were exposed to various concentrations (0, 1.8, 3.3, 5.0, 8.0, 13.0 mmol/L) of IP6 for a certain period of time. Its effect on growth of HT-29 cells was measured by MTT assay. The expressions of cell cycle regulators treated with IP6 for 2 d were detected by immunocytochemistry. RESULTS: IPe inhibited the HT-29 cell growth in a dose- and time-dependent manner. Analysis of cell cycle regulator expression revealed that IPe reduced the abnormal expression of P53 and PCNA and induced the expression of P21. CONCLUSION: IPe has potent inhibitory effect on proliferation of HT-29 cells by modulating the expression of special cell cycle regulators.     

Splenic hemangiopericytoma and serosal cavemous hemangiomatosis of the adjacent colon

A healthy 31-years-old man presented with a three-year history of abdominal discomfort. Radiological examinations revealed multifocal tumoral lesions in the spleen. The patient underwent splenectomy for differantial diagnosis and treatment. During the operation, in addition to the splenic masses, there were also multiple milimetric purpuric-like lesions on the colonic serosal surfaces adjacent to the splenic hilus. One of them was excised.Histologic examination showed hemangiopericytoma of the spleen and cavernous hemangioma of the adjacent colon. This is the first report showing the close association of these two distinct lesions with vascular origin in the literature. Despite not having any apparent evidence, there may be a sequential relationship between the hemangiopericytoma of the spleen and cavernous hemangiomas.     

Splenic hemangiopericytoma and serosal cavernous hemangiomatosis of the adjacent colon

A healthy 31-years-old man presented with a three-year history of abdominal discomfort. Radiological examinations revealed multifocal tumoral lesions in the spleen. The patient underwent splenectomy for differential diagnosis and treatment. During the operation, in addition to the splenic masses, there were also multiple milimetric purpuric-like lesions on the colonic serosal surfaces adjacent to the splenic hilus. One of them was excised. Histologic examination showed hemangiopericytoma of the spleen and cavernous hemangioma of the adjacent colon. This is the first report showing the close association of these two distinct lesions with vascular origin in the literature. Despite not having any apparent evidence, there may be a sequential relationship between the hemangiopericytoma of the spleen and cavernous hemangiomas.     

腹腔镜手术治疗T4期结肠癌进展

随着腔镜技术的发展,腹腔镜治疗结肠癌已经被认为是常规的治疗手段,但目前的NCCN指南对于局部周围组织器官浸润的T4期结肠癌尚不推荐行腹腔镜切除术。近年来,不少同行对T4期结肠癌的腹腔镜和开放手术进行回顾性分析,结果显示两个治疗组在手术安全性、肿瘤学结果及远期生存率方面没有明显差异。腹腔镜手术治疗T4期结肠癌对术者的手术技术有着较高要求,目前尚无前瞻随机对照研究和其他高级别循证依据来评价,腹腔镜手术在T4期结肠癌的治疗应用中依然处于探索阶段。本文就腹腔镜手术治疗T4期结肠癌的进展作一综述。