Inhibition of colon cancer precursors in the rat by sulindac sulphone is not dependent on inhibition of prostaglandin synthesis

The non-steroidal anti-inflammatory drug, sulindac, inhibits the growth of colorectal tumours in animal models of colon cancer and causes regression of polyps in patients with familial adenomatous polyposis. The mechanism by which sulindac exerts this inhibitory effect is not known, but it has been postulated to be via the inhibition of prostaglandin synthesis. However, two recent studies have indicated that sulindac sulphone, the non-prostaglandin inhibiting metabolite of sulindac, may be important in tumour inhibition. In the present study, we examined the effect of sulindac sulphone on the formation of aberrant crypt foci, the earliest identifiable lesions in the development of colorectal cancer, in the rat colon. We have previously shown that sulindac causes a dose dependent inhibition of aberrant crypt formation in this model. Aberrant crypt foci were induced with two oral doses of 1,2–dimethyl hydrazine at 25 mg/kg per dose. Treatment with sulindac sulphone at either 10 mg/kg b.d., or 20 mg/kg, b.d., was started on the day following administration of the first carcinogen dose and was continued for 3 weeks. Colons were then removed and examined for aberrant crypt foci. Colonic crypts were visualized by staining the unsectioned colon in 0.2% methylene blue solution. There was a significant reduction in the number of aberrant foci in rats treated with sulindac sulphone at 20 mg/kg, b.d. (ANOVA, P= 0.0054). The mechanism by which non-steroidal anti-inflammatory drugs inhibit formation of aberrant crypt foci is not clear; however, these data suggest that it is not due to the inhibition of prostaglandin synthesis.     

An investigation of colon cancer associated with urinary diversion

The mechanism by which ureterocolic anastomoses promote cancer of the colon is uncertain. To investigate the role of anastomotic healing, rats were exposed to the colon carcinogen azoxymethane after which they had either 1) a sham operation, 2) colotomy with suture, or 3) colovesical anastomosis, performed randomly. The first two groups had an equally low frequency of colon cancers, whereas rats with colovesical fistulas had a significantly higher frequency, and cancers were concentrated at the anastomotic site. It was concluded that prompt healing does not promote cancer in this model. It is probably not responsible for suture-line recurrences seen clinically, nor for the increased frequency of cancer at the site of urinary diversion into the colon.     

Cholecystectomy and the risk of colon cancer

Objective: The relationship between cholecystectomy and the occurrence of subsequent colon cancer has been controversial. Using data collected as part of an incident case-control study of colon cancer conducted in northern California, Minnesota, and Utah, we evaluated this association. Methods: Participants were between 30 and 79 yr of age and had a first primary colon cancer diagnosed between October 1, 1991 and September 30, 1994. Analyses were adjusted for age, gender, family history of colorectal cancer, body mass index, dietary energy and fiber intake, use of aspirin or nonsteroidal antiinflammatory drugs, and long-term leisure-time vigorous physical activity. Results: A weak positive association between cholecystectomy and proximal colon cancer (odds ratio [OR] and 95% confidence interval [CI] 1.3 [1.0–1.6]) was observed. This was counterbalanced by a weak, nonsignificant negative association (OR 0.8, 95% CI 0.6–1.1) with distal colon cancer leading to no overall association (OR 1.0, 95% CI 0.9–1.2). The association between colon cancer and cholecystectomy did not differ by gender or race, but it did differ by study area, with most of the increased association being attributed to the Minnesota population. The elevated risk of proximal colon cancer increased after cholecystectomy but disappeared after 14 years. Conclusions: Our results suggest that cholecystectomy or the underlying gallstone disease that prompts it may be related weakly to the risk of subsequent proximal colon cancer. However, the association may differ by geographic area of the country, and may be artifactual at least in part.     

Localization of carbonic anhydrase activity in the developing rat colon

Carbonic anhydrase activity was localized histochemically by light and electron microscopy in the proximal and distal colon of developing rats. Fixed tissue was taken for normal morphology and carbonic anhydrase localization from fetal (20-22 days gestation), suckling (1-19 days postnatal), weanling (20-25 days postnatal), and adult rats. The proximal colon had distinct villi at birth which were diminished between days 5 and 11 postnatally. The distal colon lacked villi at birth but had rudimentary crypts (ridges and furrows) which were replaced during the suckling period by a flat mucosa interspersed with true crypts. Carbonic anhydrase first appeared in both proximal and distal colonic epithelial cells on the day of birth (22 days gestation). Goblet cells were nonreactive at each developmental period. In neonatal rats, epithelial cells in the upper half of the villi of the proximal colon and on the surface and upper crypts of the distal colon were positive for carbonic anhydrase throughout the cytoplasm. Cells at the villar base (proximal colon) or in the deep crypt (distal colon) had reaction product in the intercellular spaces but not the cytoplasm. By 11 days postnatal, cytoplasmic reaction product was present in proximal colonic cells in the upper three-fourths of the crypt and was concentrated in a heavy band in the apical cytoplasm. In the distal colon, cytoplasmic positive cells did not extend as deeply into the crypts and the apical banding pattern was weak. Intercellular spaces in the deeper crypt epithelium were positive in both proximal colon and distal colon, suggesting a membrane-bound carbonic anhydrase. It was concluded that carbonic anhydrase appeared suddenly at birth and was continuously present in mid- to upper-crypt (or upper villus in early neonatal proximal colon) non-goblet cells into adulthood. This suggests a functional role for carbonic anhydrase in chloride-bicarbonate exchange across the neonatal and adult colonic mucosa.     

Recurrence patterns after curative resection of colorectal cancer in patients followed for a minimum of ten years

BACKGROUND/AIMS: To investigate the recurrence patterns and interval from initial surgery in patients with curatively resected colorectal cancer followed for a minimum of 10 years. METHODOLOGY: We retrospectively reviewed 418 patients who had undergone curative resection for colon cancer (n = 246) or rectal cancer (n = 169). Follow-up periods ranged from 10 to 23 years. Main outcome measures were interval until recurrence, site of first recurrence, and influence of adjuvant chemotherapy. RESULTS: 26 (6%) had been lost to follow-up by 10 years and 143 (34%) had died. The most common site of recurrence was liver in colon cancer and locoregional in rectal cancer. The cumulative recurrence rate in colon cancer was 100% at 4 years. In rectal cancer, it was 89% at 5 years, 98% at 7 years and 100% at 10 years. The interval until recurrence was longer in rectal cancer (26.0 +/- 24.2 months) than in colon cancer (17.1 +/- 11.0 months) (p = 0.03). It was also longer in patients receiving than in those not receiving adjuvant chemotherapy (p < 0.01). The interval until lung metastasis was longer than that until liver metastasis in colon cancer (p = 0.04), and longer than that until locoregional recurrence in rectal cancer (p = 0.03). The interval until recurrence in the colon cancer was shorter for stage III than for stage II (p = 0.02). CONCLUSIONS: Surveillance for recurrences, particularly for relapses in the liver and lung, should be performed for at least 4 years in colon cancer patients. Patients with rectal cancer should be followed for a longer period than those with colon cancer, focusing on locoregional, liver and lung recurrence. It is particularly noteworthy that adjuvant chemotherapy may prolong the interval until recurrence and the interval until lung metastasis is relatively longer.     

Two cases of inverted hyperplastic polyps of the colon and association with adenoma

Here we report two cases of inverted hyperplastic polyps of the colon. The first patient showed three inverted hyperplastic polyps in the ascending colon, one of which was associated with adenoma. We immunostained this adenoma-associated polyp using anti-beta-catenin antibody and found accumulation of beta-catenin in the cytoplasm of the adenomatous lesion but not in the inverted hyperplastic polyp. This suggested an adenomatous polyposis coli (APC) mutation in the adenomatous region but not in the inverted hyperplastic polyp. The inverted hyperplastic polyp in the second patient was located at the caecum and was studied using magnifying colonoscopy. The polyp appeared to be flat and elevated with a depressed pit in the centre. After spraying with methylene blue dye, the pit pattern of the lesion was observed and small asteroid pits on the polyp were found, consistent with a hyperplastic gland pattern. From these results, we diagnosed inverted hyperplastic polyp of the colon by colonoscopy.     

Colonic motility in innervated and extrinsically denervated loops in dogs

The control mechanism of canine colonic motor activity measured by means of chronically implanted force transducers was studied by comparing diurnal changes and migrating patterns in control dogs and dogs with innervated and extrinsically denervated colonic loops. Five force transducers (C1-C5) were placed on the colon, and the middle colon was transected to construct a loop including C2 and C3 transducers. Colonic continuity was established by an end-to-end anastomosis. In the fasted state, colonic motor complexes of 8-13 minutes' duration were observed to occur at intervals of 22-32 minutes in all three groups, but response to feeding was clearly different; significant enhancement of the colonic motor indexes lasting for 8-16 hours after feeding, which was observed at all recording sites in control dogs, was identified only in the proximal and distal colon in dogs with innervated and extrinsically denervated loops. In the innervated loop, significant enhancement of the motor indexes was observed only in the first 2 hours after feeding. In the extrinsically denervated loop, feeding did not induce any response. In both groups with loops, greater than 40% of the motor complexes that occurred in the proximal colon migrated to the distal colon directly across the anastomosis and less than 20% propagated to the loop. In addition, the migration time between the proximal and the distal colon was greatly reduced in both groups with loops compared with that in the control group. Another change observed within the loop was an increase in numbers of retrograde migrating colonic motor complexes. It is concluded that colonic motor activity is under the predominant control of intraluminal contents in the digestive state but that extrinsic nerves may play an important role in the response observed in the innervated loop in the first 2 hours after feeding, which should be defined as the gastrocolonic response in dogs. In the interdigestive state, the intrinsic nervous system and/or humoral factors may control the occurrence of colonic motor complexes.     

Adult intussusception caused by cystic lymphangioma of the colon： A rare case report

We experienced a case of intussusception caused by cystic lymphangioma of the colon in a 32 years old female who was admitted to our hospital for the chief complaint of bloody stool. In the colonoscopic examination, cystic mass with stalk which had smooth mucosal surface was noted at the descending colon. Abdominal ultrasonography and computed tomography revealed left colon intussusception with a multilocular cystic tumor as a leading point. Emergent operation was performed. On the histopathologic examination, the cystically dilated spaces lined by endothelium and septated by fibrous septa were present. The pathological diagnosis was cystic lymphangioma of the colon. Although intussusception due to lymphangioma in an adult are rare, it should be taken into consideration that it is possible diagnosis.     

Aggressive behavior of carcinoma of the colon associated with nonsecreting plasma cell myeloma. A case report

A patient was diagnosed for nonsecreting myeloma stage IIIA (Salmon-Durie) 6 months after colectomy for adenocarcinoma of the colon, Duke's stage A. The patient had not received chemotherapy for the colonic carcinoma and its clinical course was much more aggressive than expected. Although it might be coincidental, to our knowledge this is the first reported case of an association between a nonsecreting myeloma and adenocarcinoma of the colon.     

Anti-peptide monoclonal antibodies to intestinal mucin 3

Second generation anti-peptide monoclonal antibodies were produced using synthetic peptide SIB35 (C-HSTPSFTSSITTTETTSHSTPSFTSSITTTETTS) as an antigen which contains two of the MUC3 tandem repeats. Three monoclonal antibodies were produced (M3.1, M3.2 and M3.3) which reacted with the immunizing peptide, but also reacted strongly with colon tissues. Using the immunoperoxidase staining technique, two of the monoclonal antibodies, M3.1 and M3.2, reacted with both colon carcinoma and normal colon tissue whereas the antibody M3.3 reacted with normal colon tissues but very weakly, if not at all, with colon carcinoma. MUC3 was found to be distributed in colon and rectum, and was also present to a lesser extent in breast, lung and salivary gland tissues. Analysis of mucin molecules by Western blotting, revealed the antigen detected by the antibodies (M3.1 and M3.2) to be of a high relative molecular mass. M3.1 and M3.3 reacted with epitopes SITTTE and PSFTSS, respectively. M3.2 did not react with any of the 6-mer peptides, even though it reacted with the full length VNTR (2 repeat peptide—SIB35). Anti-MUC3 peptide antibodies appear to react with colon, rectum, breast, salivary gland and lung tissues, and represent a new method of producing antitumour antibodies.     

Where was Crohn's colitis in 1932?

Crohn's disease first received widespread recognition in the United States as a syndrome involving the terminal ileum in 1932. Within a few years it was recognized that the primary process could involve any part of the ileum and jejunum. It was not until 1965, however, that Crohn's colitis was recognized in the United States. There were many reasons for the delay of nearly 35 years: accounts documenting this affliction from the early part of this century were ignored and Crohn's colitis was confused with other diseases of the large intestine. More important, authorities in the field were skeptical that Crohn's disease involved the colon and failed to investigate fully that possibility. The belief that Crohn's disease stopped at the ileocecal valve was so entrenched in American medicine that after the British first documented Crohn's colitis in 1959, it took doctors in the United States another 6 years to believe it.     

Spontaneous regression of colorectal liver metastasis

A 72-year-old woman with advanced ascending colon cancer and an intraductal papillary mucinous neoplasm (IPMN) of the pancreatic head was treated by right hemicolectomy (RHC) and pylorus-preserving pancreaticoduodenectomy (PpPD). Adjuvant chemotherapy was not administered. Multimodal examinations at 5 months after surgery detected a solitary metastatic liver tumor derived from cancer of the ascending colon. Liver resection proceeded at 7 months after the first surgery. A pathological study of a surgical specimen of the liver identified a necrotic nodule that did not contain viable tumor cells. However, an immunohistological study of the hepatic mass indicated metastasis derived from cancer of the ascending colon. These findings were consistent with total necrosis of a liver metastasis of colorectal cancer. The mechanism of spontaneous regression of tumors remains unexplained. In our case, pancreaticoduodenectomy was performed at the same time as right hemicolectomy, which involved a risk of continuous biliary infection after biliary tract reconstruction. A host immune response to chronic biliary tract infection might have been involved in the spontaneous regression of liver metastasis. Spontaneous regression of colorectal liver metastasis is rare, and the mechanism remains unknown. This needs to be investigated in more tissues from patients who have experienced this phenomenon.     

The usefulness of intraoperative needle decompression of the colon during radical gastrectomy--a prospective and randomized trial

BACKGROUND/AIMS: Intraoperative colonic distension is associated with postoperative ileus, which contributes to delayed hospital discharge. A randomized and prospective study was conducted, to evaluate the usefulness of intraoperative needle decompression of the colon during radical gastrectomy for gastric cancer. METHODOLOGY: Fifty patients that had received subtotal or total gastrectomy for gastric cancer were randomly assigned to either a non-decompression (n=27) or a decompression group (n=23). Prior to the main procedure, the transverse or right colon was pulled up, and a 19-gauge disposable needle connected to suction was introduced to the colon through the taenia site of anterior wall. Gas collected in the colon was aspirated out. The time to the first postoperative passage of flatus or feces was measured precisely to evaluate the restoration of bowel function. Additional measures of outcome were the operation time, the complication rate, and hospital stay. RESULTS: Demographic details, pathologic features, operation time, complication rate and hospital stay were not different between the two groups. A collapsed colon was required for good surgical exposure and easy manipulation. No unexpected complication related to this procedure was found. The first flatus was 6.8 hours sooner in the decompression group than in the non-decompression, though this result was not statistically significant. CONCLUSIONS: This technique is a simple and safe procedure for intraoperative colon decompression during radical gastrectomy.     

Diminutive Colonic Polyps: Histopathology, Spatial Distribution, Concomitant Significant Lesions, and Treatment Complications

Objectives : Our objectives in this study were to determine diminutive colonic polyp histology, distribution, frequency of significant synchronous neoplastic lesions, and treatment complications. Methods : We evaluated consecutive colonoscopic examinations in which one or more diminutive polyps were detected over a 36-month period; these examinations had been entered into an endoscopy database at the time of colonoscopy. Results : A total of 1964 diminutive polyps were found and removed in 753 colonoscopies; 1525 were removed by hot biopsy, 436 were removed by cold biopsy, and three were removed by snare. Of the diminutive polyps, 40.7% were adenomatous, 37.2% were hyperplastic, 17.9% were mu-cosal tags or lymphoid aggregates, and 4.3% were mixed; 0.26% contained atypia, and none were cancerous. In the right colon and transverse colon, diminutive polyps were more likely to be neoplastic ( p < 0.0001), but in the left colon they were more likely to be nonneoplastic ( p < 0.0001). The prevalence of synchronous neoplastic lesions was 21.5%. No perforations were seen; however, significant hemorrhages occurred in six cases in which hot biopsy was used. The risk of a significant hemorrhage from hot biopsy of diminutive polyps was 0.39%. The risk of hot biopsy-induced hemorrhage was significantly higher in the right colon than in the transverse colon and left colon ( p < 0.05). The risk in the cecum was 1.33%; in the ascending colon it was 1.03%, and for the remainder of the colon it was 0.24%. Conclusions : Most diminutive polyps proximal to the left colon are neoplastic. The decision to use the hot biopsy or cold biopsy technique to eradicate diminutive polyps should take into account the location of the polyp because of the significantly increased risk of hemorrhage with hot biopsies in the right colon.     

Inhibition of tryptase release from human colon mast cells by protease inhibitors

AIM: To investigate the ability of protease inhibitors to modulate tryptase release from human colon mast cells.METHODS: Enzymatically dispersed cells from human colon were challenged with anti-IgE or calcium ionophore A23187 in the absence or presence of tryptase and chymase inhibitors,and tryptase release was determined.RESULTS:IgE dependent tryptase release from colon mast cells was inhibited by up to approximately 37%, 40% and 36.6% by chymase inhibitors Z-Ile-Glu-Pro-Phe-CO2Me (ZIGPFM), N-tosyI-L-phenylalanyl-chloromethyl ketone (TPCK), and α1-antitrypsin, respectively. Similarly, the inhibitors of tryptase leupeptin, N-tosyI-L-lysine chloromethyl ketone (TLCK) and lactoferrin were also able to inhibit anti-IgE induced tryptase release by a maximum of 39.4%,47.6% and 36.6%, respectively. The inhibitory actions of chymase inhibitors, but not tryptase inhibitors on colon mast cells were enhanced by preincubation of them with cells for 20min before challenged with anti-IgE. At a concentration of 10μg/mL, protamine was able to inhibit anti-IgE and calcium ionophore induced tryptase release. However, at 100μg/mL, protamine elevated tryptase levels in supematants.A specific inhibitor of aminopeptidase amastatin had no effect on anti-IgE induced tryptase release. The significant inhibition of calcium ionophore induced tryptase release was also observed with the inhibitors of tryptase and chymase examined. The inhibitors tested by themselves did not stimulate tryptase release from colon mast cells.CONCLUSION:It was demonstrated for the first time that both tryptase and chymase inhibitors could inhibit IgE dependent and calcium ionophore induced tryptase release from dispersed colon mast cells in a concentration dependent of manner, which suggest that they are likely to be developed as a novel class of anti-inflammatory drugs to treat chronic of colitis in man.     

Proximal Location of Colon Cancer Is a Risk Factor for Development of Metachronous Colorectal Cancer: A Population-Based Study

PURPOSE This study was undertaken to assess the incidence of 1) metachronous colorectal cancer and 2) subsequent extracolonic cancers, in relation to the location (proximal or distal to the splenic flexure) of the first primary colorectal tumor.METHODS In this population-based study, a cancer registry database was used to identify patients diagnosed with colorectal adenocarcinoma between 1970 and 1999. Patients with familial adenomatous polyposis and those with hereditary nonpolyposis colorectal cancer syndrome were excluded from the study, as were patients with nonepithelial tumors. Location of the first tumor was established according to International Classification of Diseases-Oncology-02 classification. The registry covers a population of 500,000 residents.RESULTS A total of 5,006 patients had sporadic adenocarcinoma of the colon or rectum during this period of time, with 1,703 first primary tumors (34 percent) being located proximal to the splenic flexure. One hundred twenty occurrences of second primary colorectal cancer were observed in this population (2.39 percent). The risk for developing a second incidence of primary colorectal cancer was higher in patients whose initial tumor was located in the proximal colon (3.4 percent vs. 1.8 percent; odds ratio, 1.92; 95 percent confidence interval, 1.33–2.77; P < 0.001). The risk for each segment of the large bowel was as follows: cecum, 3.4 percent; right colon, 3 percent; transverse colon, 3.8 percent; left colon, 2.8 percent; sigmoid colon, 1.7 percent; and rectum, 1.8 percent. By contrast, the risk for developing a second, extracolonic tumor did not differ between patients with proximal and distal tumors (13.7 percent vs. 13.4 percent, P = 0.73).CONCLUSION Patients with a first tumor located within the proximal colon are at twice the risk for developing metachronous colorectal cancer. From an epidemiologic standpoint, these data are in accordance with 1) the increasing incidence and 2) the better prognosis of proximal colon cancer in various populations. Our results confirm that proximal colon cancer is a distinct entity, which justifies the reporting of cases of colon cancer according to their location proximal or distal to the splenic flexure.© The American Society of Colon and Rectal SurgeonsPublished online: 28 January 2005.Presented at the meeting of the American Gastroenterological Association, Orlando, Florida, May 17 to 22, 2003..     

Squamous-cell carcinoma of the colon responsive to combination chemotherapy

PURPOSE: The majority of colorectal neoplasms diagnosed are adenocarcinomas. Other histologies such as squamous, adenosquamous, carcinoid tumors, or lymphoid tumors are occasionally identified. Given the rarity of squamous-cell tumors, it is very difficult to study their natural course and response to therapy. An attempt is made to describe the frequency, anatomic location, and response to therapy with a review of the literature. METHODS: From the Cancer Registry at the University of Missouri-Columbia Ellis Fischel Cancer Center, tumors of the colon identified above the dentate line were selected for chart review. Data were extracted from cases between the years 1940 and 1996. The key terms used to identify cases were epidermoid, squamous cell, and cancer of the rectum or colon. Using this approach, forty patients were identified and each record was reviewed. RESULTS: The majority of these cases were anal cancers with proximal extension into the rectum and were excluded. Of 4,561 cases of epithelial colon and rectal cancers identified, only one additional case of squamouscell cancer could be verified. In this report we describe a patient with a primary squamous-cell carcinoma of the sigmoid colon with metastatic disease to the liver at diagnosis who responded to systemic chemotherapy. We believe this to be the first reported case of this rare tumor type in which the patient's tumor responded to systemic chemotherapy. Two cases with a thorough review of literature are presented. CONCLUSIONS: Primary squamous-cell carcinoma of the colon is a rare malignancy of unknown cause and pathogenesis. Metastatic tumors to the colon should be ruled out in all cases before therapy. Early detection and surgery remain the main therapeutic options, but as presented in our case, response to chemotherapy in advanced disease is encouraging.     

Prospective comparison of air-contrast barium enema and colonoscopy in patients with fecal occult blood: a pilot study

BACKGROUND: The utility of air-contrast barium enema and colonoscopy for evaluation of the colon has been debated. Air-contrast barium enema is less expensive and invasive than colonoscopy, but it also is less sensitive and specific. Further, although air-contrast barium enema may be less painful than colonoscopy, it often is poorly tolerated by patients. Thus, this study compared the sensitivity and the specificity of air-contrast barium enema and colonoscopy for detection of colonic lesions in patients with fecal occult blood. METHODS: Over a 30-month period, patients with fecal occult blood were recruited. Patients underwent standard air-contrast barium enema, followed by colonoscopy 7 to 14 days later. Colonoscopists were blinded to the results of air-contrast barium enema until the colonoscopy was completed, after which the results were disclosed. If the findings were discrepant, colonoscopy was repeated. RESULTS: A total of 100 patients were evaluated. Nine air-contrast barium enemas were reported to be inadequate, and the cecum was not intubated at colonoscopy in two patients. In the remaining patients, 5 cancers were identified (1 each cecum, transverse colon, descending colon, sigmoid colon, and rectum) by both studies. Sixty-six polypoid lesions were identified in 30 patients. Diverticula were identified in 42 patients by air-contrast barium enema and in 18 patients by colonoscopy. Air-contrast barium enema detected 3 of 36 polypoid lesions 5 mm or less in diameter, 5 of 15 adenomas 6 to 9 mm in size, and 4 of 15 adenomas 10 mm or greater in diameter (sensitivity 8%, 33%, and 27%, respectively). After excluding patients with diverticula, air-contrast barium enema detected 3 of 7 adenomas 10 mm or greater in size. Overall, 12 polypoid lesions or filling defects were identified by air-contrast barium enema that could not be verified by colonoscopy. The specificity of air-contrast barium enema for lesions 1.0 cm or greater in size was 100%; for those 6 mm or greater, it was 97%. CONCLUSIONS: Air-contrast barium enema accurately detects colon cancer and diverticula. Its sensitivity for detection of polypoid lesions or adenomas is poor and was confounded by the presence of diverticula.     

Sub-acute sensory neuronopathy as a preceding sign of recurrence in colon carcinoma

Subacute sensory neuronopathy is a paraneoplastic syndrome, which occurs mostly in lung, breast, ovarian malignancies and lymphoma. A 75-yr-old woman who was at the twentieth month of her postoperative follow-up owing to colon adenocarcinoma admitted with subacute sensory neuronopathy. Six months later from the first, neuropathic symptoms liver metastases developed. To the best of our literature review subacute sensory neuronopathy as a preceding sign of recurrence in colon adenocarcinoma has not previously been reported. We conclude that, in the case of subacute sensory neuronopathy without an obvious underlying etiological factor, an occult malignity should always be researched in clinical practice.     

Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy

SUMMARY.  For esophageal cancer patients, the gastric tube is the first choice as an esophageal substitute, with the colon or the jejunum being used when the stomach cannot be used. We retrospectively compared these two methods from the viewpoint of peri-operative complications and long-term bodyweight alteration. From 1998 to 2005 53 patients who had undergone subtotal esophagectomy due to thoracic esophageal cancers were given reconstruction with the colon (28 cases) or the jejunum (25 cases). Both intestines were reconstructed via the subcutaneous route and were anastomosed to the internal mammalian artery and vein for a supercharged blood supply. There was no difference in operating time and blood loss. Compared with the colon reconstruction group, the hospital stay of the jejunum reconstruction group was significantly shorter (65 days vs 45 days, P  = 0.0120) and the incidence of anastomotic leakage tended to be less (13 cases, 46% vs 6 cases, 24%, P  = 0.1507), while other operative morbidity did not differ between the two groups. Bodyweight loss, which is a serious postoperative sequela after esophagectomy, was less in the jejunum group than in the colon group, showing a significant difference at 12 months after surgery. Our retrospective study revealed the jejunum to be superior to the colon for the reconstruction after esophagectomy along with gastrectomy, with respect to anastomotic leakage and bodyweight loss. The next step will be to conduct a prospective large cohort study.