Quality-of-life management of patients with colorectal cancer.

We have reviewed management of the patient with colorectal cancer both after primary treatment and in the palliative setting. Although we have addressed quantitative measures of quality of life as applied to patients with colorectal cancer, the limitations of combining disparate variables that encompass morbidity, an idealized lifestyle, and personal variation in interpretation of that lifestyle into a single number or point on a graph are self-evident. The caring family physician has a better intuitive integration of patient complexity than does the outcomes analyst.

Cyclooxygenase-2 overexpression and tumor formation are blocked by sulindac in a murine model of familial adenomatous polyposis.

Inducible cyclooxygenase (Cox-2), also known as prostaglandin H synthase 2 (PGH-2) is a key enzyme in the formation of prostaglandins and thromboxanes. Cox-2 is the product of an immediate-early gene that is expressed in response to growth factors, tumor promoters, or cytokines. Overexpression of Cox-2 is associated with both human colon cancers and suppression of apoptosis in cultured epithelia] cells, an activity that is reversed by the nonsteroidal anti-inflammatory drug, sulindac sulfide.

Disorders of the rectus abdominis muscle and sheath: a 22-year experience.

Objectives: To determine the spectrum of diseases that can involve the rectus abdominis muscle and sheath (RMS) and to describe the clinical features of these conditions.

Method: A retrospective medical record review of RMS disorders seen at The New York Hospital-Cornell Medical Center from 1971 to 1992.

Results: A total of 40 patients with diseases of the RMS were identified.

MRI for evaluation of perianal inflammation.

Background: We describe the value of using magnetic resonance imaging (MRI) in six distinct clinical settings often encountered in cases of perirectal inflammatory disease.

Methods: MRI was performed on six patients with known perianal inflammatory disease; the number, anatomic extent, location, and signal intensities of various lesions and their associated complications were assessed.

Results: MRI is a noninvasive technique that is useful in the diagnosis and management of perirectal inflammatory disease.

Surgical prophylaxis of familial colon cancer: prevention of death from familial colorectal cancer.

Patients at risk for inherited colorectal cancer constitute a heterogeneous population. A total colectomy is minimal treatment for those patients with invasive cancer or those with established risk factors. For others at risk, predictive genetic markers, correlated with clinical and pathologic determinants, will establish the basis for policies of surveillance and preventive surgery.

Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. The Leeds Castle Polyposis Group (Upper Gastrointestinal Committee).

Aims: To explore the association between duodenal adenoma and carcinoma in patients with familial adenomatous polyposis (FAP).

Methods: A multicentre survey of 1262 patients with FAP yielded 47 cases of duodenal cancer. The association between adenoma and cancer was assessed in these cases.

Colorectal cancer: detection, treatment, and rehabilitation.

In the United States, colorectal cancer is the second most common cause of cancer mortality after lung cancer. However, incidence and mortality rates have been falling, reflecting improvements in primary prevention, early detection, and treatment. This article reviews the major advances in the understanding and management of colorectal cancer.

Gender and colorectal cancer.

Studies of gender differences in colorectal cancer have shown temporal shifts in incidence and site distribution which can be attributed, in part, to environmental and behavioural factors. In high-risk populations, rectal cancer and left-sided colon cancer have been more frequent in older men, whereas right-sided colon cancer has been more commonly found in older women. Among known associations with reduced colorectal cancer risk, women appear to ingest more dietary fibre, seem to benefit more from physical activity and body mass, and consume less alcohol.

Colonic mucosal pH in humans.

Mucosal pH was measured at specific anatomic segments within the colon using a flexible pH probe in patients prepared for colonoscopy. The data revealed similar pH measurements along the length of the colon, irrespective of the presence or absence of colorectal neoplasia. Patients exhibited a relatively acidic right colon; a more alkaline transverse, left, and sigmoid colon; and a relatively acidic rectum.

Treatment options for the patient with colorectal cancer.

Treatment decisions for patients with colorectal cancer depend on the site and extent of the cancer. Medical factors rarely preclude appropriate treatment. For colonic and upper rectal cancer, curative treatment is almost entirely operative.

Loss of colonic HLA antigens in familial adenomatous polyposis.

The loss of HLA antigens by neoplastic cells is considered important for tumor growth and metastasis, since it may allow tumors to escape immune surveillance. We studied the expression of HLA class I and II antigens in the colons of 10 patients with familial adenomatous polyposis (FAP), a condition which leads inevitably to colorectal cancer. Expression of HLA class antigens was studied by immunohistochemistry in (a) adenomas from patients with FAP, (b) histologically normal mucosa distant from the adenomas, and (c) histologically normal colonic mucosa from normal subjects.

Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon.

Eighty consecutive patients presenting with complete large intestinal obstruction from primary carcinoma were evaluated. A multivariate analysis was performed to evaluate perioperative morbidity and mortality. There were five deaths in the immediate postoperative period (30 days).

Clostridial septicemia in an urban hospital.

The records of 56 patients at an urban hospital who had positive blood cultures for clostridia were reviewed. Each patient was classified as immunologically normal or immunosuppressed. Data were collected on clinical history, type of clostridial bacteremia, physical and laboratory determinants of infection, therapeutic intervention, clinical course and outcome.

Sphincter-sparing surgery.

Since World War II, a variety of technical innovations have been introduced to preserve the anal sphincter in patients with chronic ulcerative colitis or tumors of the rectum. Studies of anorectal physiology have yielded guidelines for preserving continence and minimizing morbidity. For example, preservation of the anal rectal angle is essential; the rectal mucosa can be removed without impairing neural mechanisms; construction of a reservoir increases rectal compliance.

Ploidy in invasive colorectal cancer. Implications for metastatic disease.

A retrospective study was performed to determine the ploidy of superficial (above muscularis propria) and deep (below muscularis propria) biopsy specimens from the primary colorectal cancer of 88 patients with Dukes Stage C2 and D colorectal tumors. The ploidy of lymph node and liver metastases was compared with that of the superficial and deep specimen from the corresponding primary tumor. Among the tumors studied, 78% exhibited nondiploid stemlines.

Familial polyposis coli: the spectrum of ocular and other extracolonic manifestations.

Familial polyposis coli (FPC) is hereditary condition that conveys a virtual 100% risk for the development of colon cancer in the untreated patient. A total of 56 patients with FPC underwent complete ophthalmic examination. Highly pleomorphic pigmented retinal lesions were identified bilaterally in 52% (n = 29) and unilaterally in 14% (n = 8) of our subjects.

Reduced expression of HLA class I and II antigens in colon cancer.

The expression of HLA class I and II antigens was studied by immunohistochemistry in (a) specimens of colon cancer from 25 patients, (b) normal colonic mucosa obtained 5-10 cm away from each tumor, and (c) colonic mucosa from 13 normal individuals. Thirteen of the tumor specimens had normal epithelium adjacent to the cancer, which thus served as an internal control. The expression of HLA class I antigens in colon cancer was dramatically reduced compared to control (P less than 0.