Importance of total colonoscopy in the diagnosis of colonic disorders

The need for colonoscopic examination of the whole colon was determined by evaluating the accuracy of a barium enema X-ray report with particular reference to the right colon. Long colonoscopies were performed on 108 patients. The reports of the barium enema X-ray examination in these patients were compared with the colonoscopy reports. Over all, the barium enema X-ray report was accurate in 47% of cases. The rate of false negative reports was 10% and that of false positive reports 43%. For lesions of the right colon, the barium enema X-ray report was accurate in only 32% of cases, with 68% false positive and 15% false negative reports. False positive reports of carcinoma or polyps result mainly from imperfect preparation. Of the eight right colonic lesions missed in the barium enema X-ray examination, five were polyps and one was carcinoma. Long colonoscopy, rather than short colonoscopy, or flexible sigmoidoscopy and barium enema X-ray examination, would be accompanied by the greatest diagnostic accuracy. Air-contrast barium enema X-ray examination and long colonoscopy together offer the best methods of diagnosis of occult lesions in the right colon.     

Comparative evaluation of investigations for colorectal carcinoma in symptomatic patients.

We studied 154 patients presenting with significant colonic symptoms and subsequently diagnosed to have colorectal carcinoma. They were investigated by faecal occult blood tests, fibresigmoidoscopy, double contrast barium enema (DCBE) and colonoscopy. Faecal occult blood tests (Haemoccult) alone were positive in 26% of patients with Dukes'' A, in 69% with Dukes'' B and in 64% with Dukes'' C lesions. DCBE alone identified the lesion in 32% of Dukes'' A, 79% of Dukes'' B and 81% of Dukes'' C carcinomas. Fibresignoidoscopy diagnosed colorectal malignancy in 84% of patients with Dukes'' A, 90% with Dukes'' B and 81% with Dukes'' C stage. A diagnostic yield of 88% for Dukes'' A, 96% for Dukes'' B and 100% for Dukes'' C carcinomas was seen with colonoscopy. Detection rate for all stages of carcinoma was greater than 95% when fibresigmoidoscopy and DCBE were used together. Faecal occult blood tests and DCBE alone are inadequate in diagnosing early malignancy in symptomatic patients. Fibresigmoidoscopy and DCBE used in conjunction compare favourably with the technically difficult procedure of colonoscopy and should routinely be undertaken in these patients before malignancy can confidently be excluded.     

Diagnosis of colorectal carcinoma--is colonoscopy superior to barium enema?

From January 1984 to December 1987, 520 pathologically proved cases of colorectal carcinomas were treated in Mackay Memorial Hospital - 272 (52.5%) were male and 248 (47.7%) were female. The distribution of carcinomas in the colorectum were caecum 27 (5%), ascending colon 49 (9.1%), transverse colon 70 (13%), descending colon 41 (7.6%), sigmoid colon 93 (17.3%), rectosigmoid colon 19 (3.5%) and rectum 239 (44.4%). Fourteen cases (3.3%) had double carcinomas. When 334 barium enema examinations (210 single contrast, 124 double contrast) and 207 colonoscopies were done, false negative results were found in 31 (14.76%) single contrast barium enema (BaE-S) and eight (6.45%) in double contrast barium enema (BaE-D) examinations, and 7 (3.38%) colonoscopic examinations failed to demonstrate cancer lesions because of incomplete examinations from technical problems. False negative in BaE were mostly due to failure to recognize or misinterpret the lesions especially in the rectum. Colonoscopy is significantly more accurate than BaE-S but not with BaE-D. BaE especially BaE-D can be complementary to colonoscopy in a nearly obstructing colon. Direct biopsy of the lesion makes colonoscopy more useful than BaE. Complete removal of a malignant polyp turns colonoscopy into a therapeutic modality. However, a well-trained endoscopist is essential in making colonoscopy a less suffering and more accurate examination. In a symptomatic patient, a confirmatory examination is always needed after positive BaE finding. Sometimes this can be avoided by having colonoscopy done first.     

结肠双对比造影对87例溃疡性结肠炎的诊断分析

目的：探讨结肠双对比造影(DCBE)对溃疡性结肠炎的诊断价值,并对其病因及鉴别诊断进行分析。方法：回顾性分析87例由DCBE检查发现经肠镜或手术证实的溃疡性结肠炎的X线表现。结果：溃疡性结肠炎的X线表现为病变自直肠逆行向上连续性发展,早期：结肠边缘见针刺状突出(或棘状突起)及正面的“靶样征”;急性期：出现“锯齿征”、“钮扣征”和“鹅卵石征”;慢性期：局部肠腔呈铅管样狭窄及假息肉形成。结论：对于溃疡性结肠炎,DCBE是目前最佳的X线检查方法,根据病史、进展方式和典型X线征像,本病较易诊断,不难与其他炎性结肠病变鉴别;安全性好,价格低廉。     

血清CEA、CA125、CA19-9检测在大肠癌诊治中的价值

目的探讨血清CEA、CA125、CA19-9检测在大肠癌诊断和治疗中的价值。方法以某院2005-01／2007-05月收治并手术的102例大肠癌病人为研究对象,同时选取40例正常人做为对照组,用微粒子免疫荧光法测定两组血清CEA、CA125、CA19-9的含量。结果三项指标定量检测大肠癌组明显高于对照组,其阳性率与部位、大体类型、组织类型无明显相关。三项指标阳性率DukesC＋D期明显高于DukesA＋B期;CEA、CA125、CA19-9三项指标敏感度分别为34．3％、35．2％、37．2％,特异度均为95．0％;三项联检敏感度为58．9％;特异度为92．5％。而在DukesC＋D期,三项联检敏感度为89．1％,特异度为92．5％。结论血清CEA、CA125、CA19-9三项联检在DukesC、D期大肠癌病人诊断价值较高,有助于判断大肠癌病理分期并指导手术范围。     

MMP-14和TIMP-2在结直肠癌组织中的表达及其临床意义

目的：检测基质金属蛋白酶14(MMP-14)和基质金属蛋白酶抑制因子2(TIMP-2)在结直肠癌组织中的表达情况,探讨MMP-14和TIMP-2在结直肠癌组织中的表达与临床病理指标及二者之间的关系。方法：收集结直肠癌术后石蜡包埋标本60例,正常结直肠组织20例作为对照,采用免疫组织化学SP法检测MMP-14和TIMP-2的表达水平,分析MMP-14和TIMP-2在结直肠癌中的表达与正常结直肠组织的差异及其与临床病理指标和二者之间的关系。结果：MMP-14和TIMP-2在结直肠癌组织中高表达,阳性率分别为86.7%和80.0%,高于正常结直肠组织(P<0.01)。MMP-14的表达与结直肠癌肿瘤的浸润深度、淋巴结转移和Dukes分期密切关联,在浸润浆膜组、有淋巴结转移组和Dukes C＋D期的阳性表达率分别为89.5%、94.1%和94.3%,显著高于未及浆膜组、无淋巴结转移组和Dukes A＋B期的68.2%、73.1%和76.0%（P<0.05）。TIMP-2的表达与结直肠癌肿瘤的浸润深度、淋巴结转移和Dukes分期密切关联,在浸润浆膜组、有淋巴结转移组和Dukes C＋D期的阳性表达率分别为55.3%、64.7%和62.9%,显著低于未及浆膜组、无淋巴结转移组和Dukes A＋B期的81.8%、88.5%和92.0%（P<0.05）。MMP-14和TIMP-2在结直肠癌组织中的表达呈显著负相关（rs＝－1.0,P<0.05)。结论：结直肠癌组织中MMP-14的高表达可能促进了肿瘤的浸润和转移,TIMP-2在结直肠癌的发生发展中可能起抑制作用,二者之间的平衡失调可能是肿瘤侵袭和转移的重要机制之一。
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诱导型一氧化氮合酶在结肠癌组织中表达及其与p53增殖细胞核抗原的相关关系

目的 :探讨诱导型一氧化氮合酶 (iNOS)的产物一氧化氮 (NO)在结肠癌癌变过程中可能作用机制 ,进一步研究结肠癌中iNOS、p5 3及增殖细胞核抗原 (PCNA)表达的相关关系。方法 :应用免疫组织化学检测 60例结肠癌、3 0例癌旁组织及 3 0例正常结肠粘膜中iNOS蛋白表达 ,同时检测 60例结肠癌中p5 3、PCNA蛋白表达。应用原位分子杂交方法检测 60例结肠癌中iNOSmRNA表达。结果 :60例结肠癌组织中iNOS表达阳性率为 75 % (4 5 60 ) ,3 0例癌旁组织中iNOS阳性表达率为 2 0 % (6 3 0 ) ,3 0例正常结肠粘膜组织中iNOS呈阴性表达。结肠癌组织中iNOS表达明显高于癌旁组织 ,统计学分析有显著性差异 (P <0 .0 1)。DukesA、B期iNOS蛋白及iNOSmRNA的表达明显高于DukesC、D期 ,差异有显著性 (P <0 .0 1)。iNOS表达与p5 3表达呈正相关 (r =0 .743 2 ,P <0 .0 0 1) ,iNOS表达与PCNA表达呈正相关 (r =0 .612 2 ,P <0 .0 5 )。结论 :iNOS在结肠癌组织中表达上调 ,提示iNOS可能在结肠粘膜细胞癌变过程中起重要作用。iNOS表达可促进结肠癌细胞增殖。iNOS的异常表达及抑癌基因p5 3的失活在结肠癌的癌变过程中起协同作用。     

Flexible sigmoidoscopy screening for colorectal cancer in average-risk people: update of a community-based project

OBJECTIVES: To analyse results of a screening program for colorectal cancer using flexible sigmoidoscopy. DESIGN: Survey of results of screening program and follow-up colonoscopies and identification of missed cases from State cancer registry data. PARTICIPANTS: Asymptomatic, average-risk people aged 55-64 years who were either mailed invitations after random selection from the electoral roll or volunteered after hearing about the program. SETTING: Fremantle Hospital, Western Australia (a public teaching hospital), July 1995 to November 1999 (first 4.5 years of the screening program). MAIN OUTCOME MEASURES: Participation rates; lesions detected; stage of colorectal cancers diagnosed at the hospital before and after the screening program began (1989-1995 versus 1996-1999); and diagnoses of colorectal cancer in previously screened individuals (from State cancer registry data). RESULTS: 6446 people were mailed invitations, and 1483 were screened (23% participation rate). Another 1122 people volunteered, giving 2605 people screened overall. Flexible sigmoidoscopy showed adenomatous polyps in 352 people (14%), and colonoscopy was recommended in 399 (15%) on the basis of clinically suspicious lesions. Colonoscopy was performed in 302 (76% participation rate). Screening and follow-up colonoscopy detected 14 colorectal cancers (10 invasive, with eight of these Dukes stage A). One participant was diagnosed with colorectal cancer 12 months after sigmoidoscopy gave normal results. Incidence of colorectal cancer was 119 per 100000 per year, and prevalence was 0.5%. Before the screening program, 12% of cancers diagnosed at our hospital were Dukes stage A, compared with 28% after (P<0.001). CONCLUSIONS: Flexible sigmoidoscopy screening is an acceptable strategy in asymptomatic, average-risk people which detects colorectal cancer and adenomatous polyps. Screening has been associated with a trend to earlier presentation of cancer in our institution.     

直肠钡剂排放技术在结肠双对比钡灌肠检查中的应用效果

目的 提高结肠双对比钡灌肠检查(DCBE)中直肠-乙状结肠部位的双对比效果.方法 对研究组连续267例患者,均采用我科设计的一次性结肠双对比检查用塑料袋及直肠钡剂排放技术进行DCBE.同时,随机抽取我们以往没有采用直肠钡剂排放技术的DCBE 300例作为对照研究.结果 两组病例在直肠-乙状结肠区的双对比效果差异有统计学意义(P＜0.01):(1)直肠钡剂排放技术能有效地减少直肠-乙状结肠内的过多积钡;直肠和乙状结肠内有过多积钡的病例,研究组分别占4%和19%,对照组分别占65%和44%.(2)双对比造影X线片优良率,研究组平均为87%,明显高于对照组的38%.结论 在DCBE中采用直肠钡剂排放技术可显著提高直肠-乙状结肠部位的双对比效果,从而有利于该部位小病灶的检出及诊断.     

结肠癌性梗阻的诊断与治疗

作者重点讨论了结肠癌性梗阻的诊断和鉴别诊断。３ｏ例临床分析表明，梗阻的发生主要取决于癌肿的生物学行为及其部位，浸润性生长及左侧结肠癌容易引起梗阻。结肠癌性梗阻中３０％属于ＤｕｋｅｓＡ期和Ｂ期；临床误诊率高达７３．３％，其中主要误诊为粘连性肠梗阻和急慢性胃肠炎；Ｘ线钡剂灌肠的诊断符合率达９５．２％。左侧结肠癌性梗阻急诊一期切除吻合是可行的，少数病情严重者应施行改良Ｈａｒｔｍａｎｎ＇ｓ术。     

Endoscopic evaluation of the colorectum in patients presenting with haematochezia at korle-bu teaching hospital accra

Summary BACKGROUND: Colorectal endoscopy is the gold standard investigation of the large bowel in patients with rectal bleeding and is employed as a means of secondary prevention of colorectal cancer. AIM: To determine the frequency of benign lesions and carcinomas in patients who underwent colorectal endoscopy because of rectal bleeding and to evaluate the role of endoscopy in secondary prevention of colorectal carcinoma in our centre. METHOD: A retrospective study was undertaken on patients who underwent colorectal endoscopy between January 1995 and December 2000 for rectal bleeding. RESULTS: Five hundred and ninety six (596) patients were studied. Males were 403 and females 93, mean age 50.9 (SD 7.07). Three hundred and ten patients (52%) had rigid proctosigmoidoscopy, flexible sigmoidoscopy 105 (17.6%) and colonoscopy 181 (30.4%). Of those who had colonoscopy complete examination of the colon was achieved in 55 patients (30.4%). Those in whom colonoscopy was incomplete had double contrast barium enema. Haemorrhoids were the commonest disease diagnosed, 316 patients (53%). Colorectal carcinoma 39 patients (6.7%), non-specific colitis 34 patients (5.7%), diverticular disease 27 patients (4.5%) and adenomatous polyps 17 patients (2.9%) were the next common disease. Less common conditions were ulcerative colitis, rectal schistosomiasis and angiodysplasia. In 125 patients (21.0) the cause of bleeding could not be found. CONCLUSION: An appreciable number of the patients with rectal bleeding had serious pathology that was diagnosed early by endoscopy confirming the important role of endoscopy in secondary prevention of colorectal carcinoma. The low success rate of full colonoscopy underscores the need for training in this procedure.     

Advanced colonic carcinoma in children.

We report two cases of colorectal carcinoma in children with a delay in diagnosis due to the low index of suspicion of this pathology as the cause of presenting symptoms. We conclude that any child presenting with unexplained rectal bleeding and abdominal pain should be investigated with endoscopy and barium enema.     

结肠非低张双重造影的应用

本文应用结肠非低张双重对比灌肠造影诊断结肠病变,这是一种简单的方法。本文根据150例的实践径验介绍了技术、病人的准备、有关造影剂的问题和正常所见,并通过具体的病例阐述了结肠非低张双重对比检查的临床应用价值,并指出了本法的不足之处。     

西咪替丁在体外对大肠癌细胞的敏感性

目的探讨西咪替丁在体外对大肠癌细胞药物敏感性。方法采用MTT法体外检测西咪替丁对54例大肠癌患者癌细胞的药物敏感性，依其性别、年龄、部位、Dukes分期、p53蛋白表达分组，统计分析各组病例的敏感药物的差异。结果西咪替丁在54例大肠癌患者中有14例敏感，敏感率为25．9％；结肠癌的敏感率为46．2％，显著高于直肠癌（7．1％）；p53阳性表达者的敏感率为40％，显著高于p53阴性者（8．3％）；性别、年龄、Dukes分期与药物的敏感率无关。结论西咪替丁在体外对部分大肠癌患者癌细胞有抑制作用，特别是对结肠癌和p53阳性表达的患者。     

K-ras基因与c-myc基因在大肠癌中的表达及相关性研究

目的 通过研究k-ras基因与c-mye基因在大肠癌中的表达情况,初步探讨二者在大肠癌发生、发展过程中的作用及可能的分子机制.方法 采用S-P免疫组织化学方法 检测80例结直肠癌组织及15例正常大肠黏膜中k-ras基因与c-myc基因的表达情况.结果 大肠癌组织中k-ras阳性表达率65.0%(52/80),c-myc阳性表达率52.50%(42/80).k-ras基因与c-myc基因在正常组织中未见表达,在大肠癌组织中呈阳性表达.随着分化程度的降低k-ras基因与c-myc基因的阳性表达率也明显增高(P<0.05);k-ras突变与年龄、性别、有无淋巴结转移无相关性.c-mye阳性表达与大肠癌的临床分期、淋巴结转移密切相关(P<0.05);k-ras基因与c-myc基因之间存在明显的相关性(P<0.05).结论 k-ras基因在大肠癌中的表达与细胞分化程度、Dukes分期有密切关系;c-myc在大肠癌中的表达与细胞分化程度、Dukes分期及有无淋巴结转移有密切关系;而k-ras基因与c-myc基凼的表达与年龄、性别无明显关系.k-ras基凼与c-myc基因的表达存在明显的止相关关系.     

人群大肠癌筛检的一个数量化方法

本文应用概率论、模糊数学等原理和方法,通过大肠癌危险因子的数量化,建立了用于人群大肠癌筛检的数学模型,并确定判别阈值的隶属度(AD)为0.2。对160名病人和320名正常人进行判别的结果与通常采用的大便潜血试验比较,假阴性率降低到23.75%。本方法的另一优点是简便、易行,有利于获得满意的受检率。     

A survey of colonic pathology with a double contrast method and analysis of the indication for a barium enema

A prospective study of colonic pathology with double contrast method was made of 146 patients sent to the X-ray department of the Black Lion Hospital, Addis Ababa. The barium enemata were done for complaints like constipation, diarrhoea, rectal bleeding and palpable abdominal mass often without any relevant prior physical clinical examinations. Of those examined only 26 (17.8%) patients were found to have radiologically colonic pathology and the rest, 120 (82.2%) patients were reported normal. The policy of prior clinical examination before any barium enema such as rectal digital examination, sigmoidoscopy and stool occult blood studies would reduce the normal barium enema. The survey compared bowel preparation with adequate fluid intake and laxative without cleansing enema serves as a good method of bowel preparation for ambulatory patients.     

血管内皮生长因子和微血管密度在结直肠癌中的意义

目的　探讨血管内皮生长因子 (VEGF)和微血管密度 (MVD)在结直肠癌中的表达以及它们之间的关系。方法　应用免疫组织化学S P法检测 87例结直肠癌组织中血管内皮生长因子的表达以及微血管密度。结果　 87例结直肠癌组织中VEGF的表达阳性率为 6 6 .7% ,MVD为 32 .80± 12 .11。VEGF和MVD在侵及浆膜层的结直肠癌中明显高于侵及肌层者 ,在淋巴结转移阳性组高于淋巴结转移阴性组 ,在DukesC、D期明显高于A、B期 ,差异均有显著性 (P <0 .0 5 ) ,且随着肿瘤分化程度的降低而增高 (P <0 .0 5 ) ;VEGF阳性组中的MVD值显著高于VEGF阴性组 (P <0 .0 1)。结论　VEGF与结直肠癌血管生成密切相关 ,VEGF的表达和MVD可作为判断结直肠癌恶性程度的生物学指标     

多层螺旋CT冠状动脉造影在冠心病患者中的应用

目的:评价多层螺旋CT冠状动脉造影对冠状动脉狭窄性疾患的临床应用价值.方法:对216例以冠心病入院的患者进行了多层螺旋CT冠状动脉造影,以选择性冠状动脉造影结果为金标准进行对照.采用Somatom Volume Zoom (4-detector-row, Siemens, Germany)进行扫描,并对冠状动脉的主干及主要分支进行了重建和诊断,其结果与金标准结果相对照,分析多层螺旋CT冠状动脉造影的敏感性和特异性.结果:多层螺旋CT所显示的1 512支冠状动脉中冠状动脉狭窄160支,正确诊断139支,漏诊21支,误诊9支,敏感性87%,特异性98%,假阳性率2%,假阴性率13%.其中,对左前降支发生的病变敏感最高,达到91%.结论:多层螺旋CT对冠状动脉狭窄诊断有较高的准确性,作为一种无创性检查可用于高危人群的普查筛选,并可作为冠状动脉造影前的常规检查手段.但由于运动伪影的影响其临床应用还存在一定的限度.     

Should colonoscopy be the first investigation for colonic disease?

Many patients with suspected colonic disease undergo rigid sigmoidoscopy, barium enema examination, and ultimately total colonoscopy, but the need for preliminary radiology has not been formally assessed. A total of 168 patients requiring large bowel investigation were therefore randomised to undergo either rigid sigmoidoscopy plus double contrast barium enema examination or total colonoscopy. Disease was found in 56 patients, including 14 with a carcinoma, 11 with polyps, and 16 with inflammatory bowel disease, the remainder having diverticular disease alone. Of the 89 patients allocated to double contrast barium enema examination, nine required a subsequent colonoscopy for suspected tumour or polyps, three because of incomplete radiological examination, and 12 for rectal bleeding for which no cause was found at the radiological examination. In 16 patients this yielded further information or altered treatment. Of the 79 patients undergoing total colonoscopy, only six required subsequent radiology. As both procedures were well tolerated with no major complications total colonoscopy may be the preferred initial investigation where facilities allow.