Role of cell kinetics from rectal scrapings in predicting risk of colorectal cancer.

It has been suggested that cells obtained from scrapings of rectal mucosa can be readily analysed by flow cytometry for DNA content. Aneuploidy, if detected in these cells, will indicate a field change in the rectal mucosa. If so, this could provide a convenient means of selective screening for colorectal cancer.

A detailed study of p53 mutations in colorectal cancer in Singapore.

The p53 tumour suppressor gene plays a pivotal role in colorectal cancer formation. Understanding the mechanisms by which p53 is altered in tumour cells could lead to a better understanding of this common cancer. Unfortunately, there is no published information on Chinese patients.

Tumor-suppressor genes in colorectal carcinomas - p53 inactivation is highly associated with allelic loss of chromosome 5q.

Sixty-four colorectal carcinomas were evaluated for allelic loss of chromosomes 17p and 5q, as well as point mutation of the p53 tumor suppressor gene. Allelic loss of chromosomes 5q and 17p were found to be weakly associated, whereas point mutation of the p53 gene was found to be more strongly associated with chromosome 5q allelic loss. Carcinomas in which both alleles of p53 had been inactivated showed a strong association with allelic loss of chromosome 5q (p=2.

Rectal carcinoma during pregnancy.

Rectal carcinoma presenting during pregnancy is rare with a reported incidence of 0.002%. Management of such an emotionally charged condition can be difficult, especially when the twin goals of curing the disease and preserving the pregnancy are divergent.

p53 and behaviour of colorectal cancer.

The tumour suppressor gene p53 is altered in most colorectal tumours. We found that lymphatic dissemination was driven by the presence of mutated p53 whether or not the cell contained wild-type p53. In a total sample of 187 specimens, point mutation of the p53 gene occurred in 70% and 43% of cases with and without lymph-node involvement, respectively.

Successful behavioral intervention to treat children who are reluctant to ambulate.

The authors report two patients with marginal ambulation skills whose severe behavioral problems prevented participation in physical therapy. The problem behavior also limited the patients' participation in activities of daily living and social interaction. Because of the risks of loss of ambulation to overall health, an aggressive behavioral intervention was implemented to decrease problem behavior and to increase participation in physical therapy.

Caecal mass on barium enema study--a case for routine colonoscopy.

Prolapse of the ileal mucosa through the ileo-caecal valve or minor ileo-caecal intussuception is not uncommon and may occasionally be mistaken radiologically for a caecal neoplasm, especially if intestinal obstruction, abdominal pain or rectal bleeding is present. Colonoscopic visualisation and biopsy is important before surgery is advised. We describe a case of ileal mucosa prolapse masquerading as a caecal neoplasm on barium enema study.

The laparoscope: an excellent illumination tool for deep pelvic dissection.

Adequate illumination during deep pelvic dissection in low anterior resection and abdominoperineal resection is sometimes difficult and frustrating, especially in deep narrow pelvises. Various methods of illumination are being used to overcome this problem. We present our technique of using the laparoscope as an excellent illumination tool for deep pelvic dissection in conventional surgery.

Comparison of emergency and elective haemorrhoidectomy.

A total of 704 patients with symptomatic prolapsed haemorrhoids were operated on over a 24-month period. Overall, 500 underwent elective haemorrhoidectomy for symptomatic prolapsed haemorrhoids and 204 emergency haemorrhoidectomy for acutely prolapsed, thrombosed or gangrenous haemorrhoids. The mean age was 43 (range 16-80) years in patients undergoing elective surgery and 42 (range 20-86) years in those receiving emergency procedures.

Unusual rectal perforation--an individualised approach to management.

The management of rectal perforations is controversial. Surgical repair or resection and anastomosis is usually undertaken with faecal diversion in the management of traumatic perforations. Primary repair without colostomy is less commonly employed.

Quantitative comparison of prolactin production by decidua compacta and spongiosa from the first trimester elective termination of pregnancy.

Prolactin (PRL) producing capacity was studied in explants of decidua compacta and decidua spongiosa obtained from 41 patients undergoing termination of pregnancy at gestation 6 to 12 weeks. In vitro PRL producing capacity, expressed as mIU/g protein, of the decidua compacta was significantly higher (P < 0.05) than those of decidua spongiosa.

The ileo-anal reservoir: results from an evolving use of stapling devices.

Thirteen patients had a hand-sewn pouch-anal anastomosis (group A) during restorative proctocolectomy for familial adenomatous polyposis. Median length of follow-up since ileostomy closure was 41.5 months (range 30-56 months).

High frequency of allelic deletion on chromosome 17p in advanced colorectal cancer.

Background: Colorectal cancers often show allelic loss of chromosomes 5q and 17p, regions where the tumor suppressor genes p53 and adenomatous polyposis coli are known to reside. Currently, the inactivation of tumor suppressor genes and the activation of oncogenes are considered major events involved in tumor development. According to a recent genetic model, ras gene mutations and allelic deletion of chromosome 5q are early changes, whereas chromosome 17p and 18q deletions are late changes in colorectal tumorigenesis.

Behavioral persistence and variability during extinction of self-injury maintained by escape.

The self-injurious escape behavior of a developmentally disabled adult was treated with extinction. Results of a reversal design showed substantial bursts of responding when extinction was introduced and reintroduced: self-injury remained at a variable and elevated rate for some time before stable, low rates were observed. Data on aggression, a nontarget behavior during both baseline and treatment, showed a pattern similar to that seen for self-injury during the extinction conditions.

Ischaemic colitis and colorectal cancer: some problems and pitfalls.

Four cases out of 204 new cases of colorectal carcinoma seen in a 24 month period were proven to have concomitant proximal ischaemic colitis. Ischaemic colitis associated with obstructing carcinoma of the colorectum may present dramatically with gangrene or colonic perforation if the acute vascular insufficiency is severe. Less severe degrees of ischaemic insult must be recognised intra-operatively as the incorporation of ischaemic colon in a colonic anastomosis may result in an anastomotic leak.

Synchronous colorectal cancer in an Oriental population.

Thirty-four (4.1%) out of 820 patients operated for colorectal cancer between April 1989 and October 1992 were found to have synchronous cancers. Twenty (59%) were male and 14 (41%) were female.

Level of anastomosis and anorectal manometry in predicting function following anterior resection for adenocarcinoma.

The clinical and physiological consequences of sphincter preservation after resection of rectal carcinoma at various levels were evaluated. Thirty-two patients (mean age 59.2 years; range 31-79 years) who had undergone curative surgery at least one year previously and were not given adjuvant therapy, were studied with 19 normal controls.

Quality control in colonoscopy: a Singapore perspective.

For quality control purposes, a computer based auditing system for colonoscopy has been developed in the Department of Colorectal Surgery, Singapore General Hospital, Singapore. The first year's experience was reviewed to determine both workload patterns and the individual operators' performances. Colonoscopic completion rates, both as raw data and cusum transformations, were used as indices of quality control.

Over-expression of the c-myc proto-oncogene in colorectal carcinoma.

Alterations in the c-myc proto-oncogene in colorectal cancer were studied at the level of RNA expression, gene amplification and rearrangements. One hundred cases of colorectal cancer, stratified by Dukes' stage were examined. The level of messenger RNA expression was measured in tumours and matched normal mucosa from the same patient.

Results of a policy of selective immediate fistulotomy for primary anal abscess.

A prospective study of a policy of selective immediate fistulotomy in the management of acute primary anal abscesses was performed. Eighty-nine patients (74%) underwent simple drainage only, as no internal openings were found during drainage of pus (group A). Thirty-one patients (26%) had drainage of pus and immediate fistulotomy (group B).

Stimulation regimens in Assisted Reproductive Technology (ART) programme: experience in the University Hospital, Singapore.

Ovarian stimulation is critical to the success of patients in Assisted Reproductive Technology (ART) programmes. We compared two stimulation regimes retrospectively for ART in the NUH programme. These were the 2:1 and the GnRHa-FSH/hMG regimes.

A simple and effective treatment for hemorrhagic radiation proctitis using formalin.

Radiation proctitis is a common complication of radiotherapy for pelvic malignancy. In the more severe form, it leads to intractable or massive hemorrhage, which may require repeated hospital admissions and blood transfusions. Medical therapy in patients with radiation proctitis is usually ineffective, whereas surgery is associated with a high morbidity and mortality.

Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids.

Forty-nine consecutive patients with symptomatic prolapsed hemorrhoids were prospectively randomized for conventional scissors excision with ligation (Group A; n = 16) or diathermy excision without ligation (Group B; n = 33). The median time taken to complete the procedure was 20 minutes (range, 10-40 minutes) and 10 minutes (range, 5-35 minutes) in Groups A and B, respectively (P < 0.05).