AIM: To assess the prevalence of clinically signifi cant lesions in patients with minimal bright red bleeding per rectum (BRBPR). METHODS: Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim H...AIM: To assess the prevalence of clinically signifi cant lesions in patients with minimal bright red bleeding per rectum (BRBPR). METHODS: Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defi ned as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded: Positive personal history of colorectal neoplasms or inflamma-tory bowel disease (IBD), positive fi rst degree family history of colorectal neoplasms, history of altered bow- el habits, recent signifi cant weight loss, and presence of iron defi ciency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were def ined as signif icant lesions. RESULTS: A total of 402 patients (183 female and 219 male, aged 43.6 ± 15.7 years) were studied. Hemorrhoids (54.2%), anal fi ssures (14.2%) and ul-cerative colitis (14.2%) were the most common lesions and colonoscopy was normal in 8.0%. Signifi cant le-sions were found in 121 (30.1%) patients, including 26 patients (6.5%) with adenocarcinoma and 30 (7.5%) with adenomatous polyps. Almost all patients with signifi cant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids. CONCLUSION: Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. Thechoice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.展开更多
Background & Aims: To date, computed tomographic (CT)colonography has been compared with an imperfect test,colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Th...Background & Aims: To date, computed tomographic (CT)colonography has been compared with an imperfect test,colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Therefore, the available data may not apply to screening of patients with a personal or family history of colorectal polyps or cancer (increased risk). We prospectively investigated the ability of CT colonography to identify individuals with large (≥ 10 mm) colorectal polyps in consecutive patients at increased risk for colorectal cancer. Methods: A total of 249 consecutive patients at increased risk for colorectal cancer underwent CT colonography before colonoscopy. Two reviewers interpreted CT colonography examinations independently. Sensitivity, specificity, and predictive values were determined after meticulous matching of CT colonography with colonoscopy. Unexplained large falsepositive findings were verified with a second-look colonoscopy.Results: In total, 31 patients (12% ) had 48 large polyps at colonoscopy.This included 8 patients with 8 large polyps that were overlooked initially and detected at the second-look colonoscopy.In 6 of 8 patients, the missed polyp was the only large lesion. With CT colonography, 84% of patients (26/31)with large polyp(s) were identified, paired for a specificity of 92% (200-201/218). Positive and negative predictive values were 59%-60% (26/43-44) and 98% (200-201/205-206), respectively.CT colonography detected 75%-77% (36-37/48) of large polyps, with 9 of the missed lesions being flat. Conclusions:CT colonography and colonoscopy have a similar ability to identify individuals with large polyps in patients at increased risk for colorectal cancer. The large proportion of missed flat lesions warrants further study.展开更多
AIM:To investigate the distribution of the placental form of glutathione-S-transferase (GST) in colon polyps in order to evaluate the role of GST-pi in these tissues. METHODS: Sixteen polyp tissues removed at colonosc...AIM:To investigate the distribution of the placental form of glutathione-S-transferase (GST) in colon polyps in order to evaluate the role of GST-pi in these tissues. METHODS: Sixteen polyp tissues removed at colonoscopy were examined. Tissues were investigated histologically and ultrastructurally. GST-pi expression was also analysed immunohistochemically, using peroxidase anti-peroxidase (PAP) method and immunogold labelling method, for light and electron microscope respectively. RESULTS: All polyp tissues examined were adenoma of low, mild and high-grade dysplasia as shown in the histopathological reports. Nevertheless, the examination of the above specimens with electron microscope revealed that 3 of 9 adenoma of mild dysplasia had ultrastuctural features similar to high-grade dysplasia adenoma. GST-pi was variably expressed in adenoma, with the lowest relative levels occurring in low-gradeadenoma and the highest levels found in high-grade adenoma. GST-pi was located mainly in undifferentiated epithelial cells. GST-pi positive particles were found in the cytoplasm and especially in the nucleus adjacent to the nuclear membrane of these cells. CONCLUSION:The overexpression of GST-pi in mildgrade adenomas with significant subcellular changes and in the majority of high-grade dysplasia adenoma suggests that this might be related to the carcinogenetic proceeding. Immunohistochemical localization of GST-pi in combination with ultrastructural changes indicate that GST-pi might be a sensitive agent for the detection of preneoplastic transformations in adenoma.展开更多
Background and Study Aims: Several endoscopic techniques have been developed t o prevent bleeding after the removal of large pedunculated polyps. Patients and Methods: From January 1995 to December 2002, 488 consecuti...Background and Study Aims: Several endoscopic techniques have been developed t o prevent bleeding after the removal of large pedunculated polyps. Patients and Methods: From January 1995 to December 2002, 488 consecutive patients with pedun culated colorectal polyps, the heads of which were larger than 10 mm in diameter , were randomly assigned to three groups. In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used f or polypectomy. In group B (161 patients), the polyp stalk was injected with a 0 .01%epinephrine solution before conventional snare polypectomy. Group C (a cont rol group including 164 patients) underwent conventional snare polypectomy witho ut preventive measures. Early (< 24 h) and late (> 24 h-30 days) bleeding compl ications were assessed. Each group was divided into two subgroups relative to th e polyp size (polyps 1.0-1.9 cm and polyps ≥2 cm). Results: Overall bleeding c omplications occurred after 4.3%of the polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8%), five in group B (3.1%), and 13 in group C (7.9%). Early bleeding was more frequent than late bleeding (15 vs. six patients). In polyps ≥2 cm (207 patients), postpolypectomy bleeding occurred i n 14 patients (6.7%): two (2.7%) in the detachable snare group, two (2.9%) in the epinephrine injection group, and 10 (15.1%) in the control group. Conclusi ons: These results show that polypectomy of large pedunculated polyps is associa ted with a higher incidence of bleeding. Particularly in polyps larger than 2 cm , preventive measures can significantly reduce bleeding complications after poly pectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine.展开更多
Objectives -The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. Material a...Objectives -The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. Material and methods -Pathologists filled out an identification and histological questionnaire for each biopsy or surgical specimen received between 20/09/02 and 20/12/02, which had at least one colorectal polyp or CRC, taken from a patient of the greater Paris area. Results -The participation rate of pathologists was 73.3%and 10 396 patients with 16 681 lesions were included. Lesions consisted in 1 223 CRC among 1 107 patients, 9 280 AP and 6 178 NAP. Mean age of patients with CRC was 68 years, with at least one AP without CRC 62 years, and with at least one NAP without CRC or AP 58 years. The mean number of polyps per patient was 1.4, and increased with age. Average size of AP was larger than that of NAP and the size increased with age for AP but not NAP. pTNM staging of CRC was: pT0, 1%pT1, 4%pT2, 13%pT3, 63%pT4, 19%N0, 55%N1, 24%N2, 19%Nx, 2%. Conclusion -This study provides detailed data on colorectal polyps and colorectal cancers in the greater Paris region, which does not have a cancer registry. Repeated surveys could be helpful for evaluating the efficacy of screening programs in the general population.展开更多
文摘AIM: To assess the prevalence of clinically signifi cant lesions in patients with minimal bright red bleeding per rectum (BRBPR). METHODS: Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defi ned as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded: Positive personal history of colorectal neoplasms or inflamma-tory bowel disease (IBD), positive fi rst degree family history of colorectal neoplasms, history of altered bow- el habits, recent signifi cant weight loss, and presence of iron defi ciency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were def ined as signif icant lesions. RESULTS: A total of 402 patients (183 female and 219 male, aged 43.6 ± 15.7 years) were studied. Hemorrhoids (54.2%), anal fi ssures (14.2%) and ul-cerative colitis (14.2%) were the most common lesions and colonoscopy was normal in 8.0%. Signifi cant le-sions were found in 121 (30.1%) patients, including 26 patients (6.5%) with adenocarcinoma and 30 (7.5%) with adenomatous polyps. Almost all patients with signifi cant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids. CONCLUSION: Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. Thechoice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.
文摘Background & Aims: To date, computed tomographic (CT)colonography has been compared with an imperfect test,colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Therefore, the available data may not apply to screening of patients with a personal or family history of colorectal polyps or cancer (increased risk). We prospectively investigated the ability of CT colonography to identify individuals with large (≥ 10 mm) colorectal polyps in consecutive patients at increased risk for colorectal cancer. Methods: A total of 249 consecutive patients at increased risk for colorectal cancer underwent CT colonography before colonoscopy. Two reviewers interpreted CT colonography examinations independently. Sensitivity, specificity, and predictive values were determined after meticulous matching of CT colonography with colonoscopy. Unexplained large falsepositive findings were verified with a second-look colonoscopy.Results: In total, 31 patients (12% ) had 48 large polyps at colonoscopy.This included 8 patients with 8 large polyps that were overlooked initially and detected at the second-look colonoscopy.In 6 of 8 patients, the missed polyp was the only large lesion. With CT colonography, 84% of patients (26/31)with large polyp(s) were identified, paired for a specificity of 92% (200-201/218). Positive and negative predictive values were 59%-60% (26/43-44) and 98% (200-201/205-206), respectively.CT colonography detected 75%-77% (36-37/48) of large polyps, with 9 of the missed lesions being flat. Conclusions:CT colonography and colonoscopy have a similar ability to identify individuals with large polyps in patients at increased risk for colorectal cancer. The large proportion of missed flat lesions warrants further study.
文摘AIM:To investigate the distribution of the placental form of glutathione-S-transferase (GST) in colon polyps in order to evaluate the role of GST-pi in these tissues. METHODS: Sixteen polyp tissues removed at colonoscopy were examined. Tissues were investigated histologically and ultrastructurally. GST-pi expression was also analysed immunohistochemically, using peroxidase anti-peroxidase (PAP) method and immunogold labelling method, for light and electron microscope respectively. RESULTS: All polyp tissues examined were adenoma of low, mild and high-grade dysplasia as shown in the histopathological reports. Nevertheless, the examination of the above specimens with electron microscope revealed that 3 of 9 adenoma of mild dysplasia had ultrastuctural features similar to high-grade dysplasia adenoma. GST-pi was variably expressed in adenoma, with the lowest relative levels occurring in low-gradeadenoma and the highest levels found in high-grade adenoma. GST-pi was located mainly in undifferentiated epithelial cells. GST-pi positive particles were found in the cytoplasm and especially in the nucleus adjacent to the nuclear membrane of these cells. CONCLUSION:The overexpression of GST-pi in mildgrade adenomas with significant subcellular changes and in the majority of high-grade dysplasia adenoma suggests that this might be related to the carcinogenetic proceeding. Immunohistochemical localization of GST-pi in combination with ultrastructural changes indicate that GST-pi might be a sensitive agent for the detection of preneoplastic transformations in adenoma.
文摘Background and Study Aims: Several endoscopic techniques have been developed t o prevent bleeding after the removal of large pedunculated polyps. Patients and Methods: From January 1995 to December 2002, 488 consecutive patients with pedun culated colorectal polyps, the heads of which were larger than 10 mm in diameter , were randomly assigned to three groups. In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used f or polypectomy. In group B (161 patients), the polyp stalk was injected with a 0 .01%epinephrine solution before conventional snare polypectomy. Group C (a cont rol group including 164 patients) underwent conventional snare polypectomy witho ut preventive measures. Early (< 24 h) and late (> 24 h-30 days) bleeding compl ications were assessed. Each group was divided into two subgroups relative to th e polyp size (polyps 1.0-1.9 cm and polyps ≥2 cm). Results: Overall bleeding c omplications occurred after 4.3%of the polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8%), five in group B (3.1%), and 13 in group C (7.9%). Early bleeding was more frequent than late bleeding (15 vs. six patients). In polyps ≥2 cm (207 patients), postpolypectomy bleeding occurred i n 14 patients (6.7%): two (2.7%) in the detachable snare group, two (2.9%) in the epinephrine injection group, and 10 (15.1%) in the control group. Conclusi ons: These results show that polypectomy of large pedunculated polyps is associa ted with a higher incidence of bleeding. Particularly in polyps larger than 2 cm , preventive measures can significantly reduce bleeding complications after poly pectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine.
文摘Objectives -The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. Material and methods -Pathologists filled out an identification and histological questionnaire for each biopsy or surgical specimen received between 20/09/02 and 20/12/02, which had at least one colorectal polyp or CRC, taken from a patient of the greater Paris area. Results -The participation rate of pathologists was 73.3%and 10 396 patients with 16 681 lesions were included. Lesions consisted in 1 223 CRC among 1 107 patients, 9 280 AP and 6 178 NAP. Mean age of patients with CRC was 68 years, with at least one AP without CRC 62 years, and with at least one NAP without CRC or AP 58 years. The mean number of polyps per patient was 1.4, and increased with age. Average size of AP was larger than that of NAP and the size increased with age for AP but not NAP. pTNM staging of CRC was: pT0, 1%pT1, 4%pT2, 13%pT3, 63%pT4, 19%N0, 55%N1, 24%N2, 19%Nx, 2%. Conclusion -This study provides detailed data on colorectal polyps and colorectal cancers in the greater Paris region, which does not have a cancer registry. Repeated surveys could be helpful for evaluating the efficacy of screening programs in the general population.
