Immune responses in advanced colorectal cancer following repeated intradermal vaccination with the anti-CEA murine monoclonal antibody, PR1A3: results of a phase I study.

Background And Aims: The aim was to determine the toxicity, clinical and immune responses to the murine monoclonal anti-carcinoembryonic antigen (CEA) antibody, PR1A3, in patients with advanced colorectal cancer.

Materials And Methods: Fifteen patients with advanced colorectal cancer received either 0.5-, 1.

Multiplanar anal endosonography--normal anal canal anatomy.

Introduction: Volume acquisition during anal ultrasound enables multiplanar imaging of the anal canal. The normal ultrasonic multiplanar appearance of the anal canal is described and gender differences in canal anatomy are highlighted.

Methods: Ten male and 12 female normal volunteers (mean ages 31.

Alteration of anal sphincter morphology following vaginal delivery revealed by multiplanar anal endosonography.

Objective: To assess morphologic change in the anal sphincters in the absence of endosonographic evidence of trauma after vaginal delivery.

Design: Prospective observational study.

Setting: District general hospital.

Endosonographic anatomy of the normal anal canal compared with endocoil magnetic resonance imaging.

Purpose: This study was designed to clarify the sonographic anatomy of the normal anal canal by comparison with endoanal magnetic resonance imaging, to determine agreement between these imaging modalities and interobserver error in measuring layer thickness.

Methods: Three-dimensional endosonographic and endocoil magnetic resonance images of the anal canal were obtained in four males and five nulliparous females aged 22 to 34 years. Images were analyzed at similar levels throughout the canal using a graphics-overlay technique to compare sonographic with magnetic resonance images.

Assessment of external anal sphincter morphology in idiopathic fecal incontinence with endocoil magnetic resonance imaging.

The failure of external anal sphincter repair may relate to sphincter atrophy where muscle fibers are replaced by fat, seen on MRI due to the differing signals returned by fat and muscle tissue. Manometry, electrophysiology, and MRI with an endocoil were performed on 34 fecally incontinent patients with intact sphincters on endosonography. The area of the external sphincter was measured in the midcoronal plane, and the percentage fat content calculated.

Endocoil magnetic resonance imaging quantification of external anal sphincter atrophy.

Background: Anal function depends on the integrity and quality of the sphincter muscles. The diagnosis of external anal sphincter atrophy on endocoil magnetic resonography has been associated with poor outcome from sphincter repair, although the imaging criteria for atrophy remain unclear.

Methods: Women with intact sphincters on endosonography and either normal (more than 60 cm H(2)O) (n = 9) or low (n = 16) squeeze pressures had endocoil magnetic resonography and electromyography.

Anal sphincter damage after vaginal delivery using three-dimensional endosonography.

Objective: To determine the incidence and functional consequences of external sphincter trauma compared with other perineal structures using a novel imaging technique, three-dimensional endosonography.

Methods: Fifty-five nulliparous women (mean age 30 years, range 18--47 years) had three-dimensional anal endosonography, anal manometry, and questionnaire assessment of continence at a median gestation of 33 weeks (23--42 weeks) and 10 weeks (7--22 weeks) after delivery.

Results: There was ultrasound evidence of postpartum trauma in 13 of 45 women who had a vaginal delivery (29%, confidence interval [CI] 16%, 44%), involving the external sphincter in five (11%, CI 4%, 24%), the puboanalis in nine (20%, CI 10%, 35%), and the transverse perineii in three (7%, CI 1%, 18%).

Gender differences in the longitudinal pressure profile of the anal canal related to anatomical structure as demonstrated on three-dimensional anal endosonography.

Background: Anal canal squeeze pressure is assumed to be due to external sphincter contraction, but the contribution of other muscles has not been explored.

Methods: Ten male and ten nulliparous female asymptomatic subjects had three-dimensional anal endosonography and manometry. Incremental squeeze pressures at 0.

Use of vector volume manometry and endoanal magnetic resonance imaging in the adult female for assessment of anal sphincter dysfunction.

Purpose: This study compared conventional water-perfused and vector volume anal manometry in female patients with neurogenic fecal incontinence and chronic anal fissure and in healthy female volunteers. We used endoanal magnetic resonance (MR) imaging to measure internal and external sphincter lengths and thicknesses and contrasted these with the manometric findings in the different anorectal conditions.

Methods: One hundred thirty-three female subjects were studied over an eight-month period, including 33 control volunteers, 83 patients with neurogenic fecal incontinence, and 17 patients with chronic anal fissure.

Intraobserver and interobserver agreement in anal endosonography.

Background: The aim of this study was to determine intraobserver and interobserver agreement for sonographic measurements of anal canal structures using anal endosonography (AES), and to determine interobserver agreement for the diagnosis of anal sphincter disruption.

Methods: Fifty-one consecutive patients referred for AES for the investigation of possible sphincter abnormality were examined. Studies were reviewed by two observers who measured anal canal structures at defined levels and locations, and recorded an opinion on sphincter integrity.

Three-dimensional endoanal sonography in assessing anal canal injury.

Background: Instrument design limits endosonography of the anal canal to the axial plane, with no capability for longitudinal imaging or measurement. Using three-dimensional reconstructions, the relationship between the radial and linear extent of an anal sphincter tear has been explored, and sex differences in anal canal and sphincter length have been established.

Methods: Three-dimensional reconstructions were performed in 20 controls and 24 patients with faecal incontinence found to have 25 external and five internal sphincter defects.

Mutated epithelial cadherin is associated with increased tumorigenicity and loss of adhesion and of responsiveness to the motogenic trefoil factor 2 in colon carcinoma cells.

Epithelial (E)-cadherin and its associated cytoplasmic proteins (alpha-, beta-, and gamma-catenins) are important mediators of epithelial cell-cell adhesion and intracellular signaling. Much evidence exists suggesting a tumor/invasion suppressor role for E-cadherin, and loss of expression, as well as mutations, has been described in a number of epithelial cancers. To investigate whether E-cadherin gene (CDH1) mutations occur in colorectal cancer, we screened 49 human colon carcinoma cell lines from 43 patients by single-strand conformation polymorphism (SSCP) analysis and direct sequencing.

Expression of catenins and E-cadherin during epithelial restitution in inflammatory bowel disease.

Catenins are cytoplasmic proteins associated with E-cadherin, the prime mediator of cell-cell adhesion. Perturbation in any of these molecules results in altered intercellular adhesion, cell differentiation, and increased migration. In this study, the expression and cellular localization of catenins and E-cadherin in inflammatory bowel disease were examined.

'One-stop' rectal bleeding clinics without routine flexible sigmoidoscopy are unsafe.

Over 90% of patients referred to surgeons for investigation of rectal bleeding have haemorrhoids, fissure-in-ano or proctitis. Full investigation of these patients to exclude colonic neoplasia or inflammatory bowel disease imposes a considerable load on a hospital's resources as well as exposing the patient to significant inconvenience and morbidity. A 'one-stop' outpatient clinic was established, with selective use of flexible sigmoidoscopy, based on the judgement and clinical findings of a single experienced surgeon.

Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation.

Purpose: The rectoanal inhibitory reflex is a response of the internal anal sphincter to rectal distention, reflecting the functional nature of the anal sampling mechanism of rectal discrimination. The aim of this study was to assess the parameters of the rectoanal inhibitory reflex in healthy volunteers and incontinent and symptomatically constipated patients.

Methods: The rectoanal inhibitory reflex was recorded in 42 patients using reproducible threshold volumes.

Phosphorylation of beta-catenin and epidermal growth factor receptor by intestinal trefoil factor.

Intestinal trefoil factor (TFF3) is a member of the trefoil family of peptides, which are constitutively expressed in the gastrointestinal tract. TFF3 has been shown to promote migration of intestinal epithelial cells in vitro and to enhance epithelial restitution in vivo. In the present study, we show that the stimulatory effect of TFF3 on the migration of HT29 colonic carcinoma cells requires the perturbation of E-cadherin function, a calcium-dependent cell-cell adhesion molecule in epithelia.

Expression of E-cadherin-associated molecules (alpha-, beta-, and gamma-catenins and p120) in colorectal polyps.

E-cadherin and its associated cytoplasmic proteins alpha-, beta-, and gamma-catenin and p120 protein play a crucial role in the maintenance of normal tissue architecture. Perturbation in any of these molecules results in loss of intercellular adhesion and cell transformation. In this study, we have used immunohistochemistry to localize E-cadherin, alpha-, beta-, and gamma-catenin, and p120 in paraffin-embedded tissues from 60 patients with colonic polyps.

High resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal coil. Comparison of magnetic resonance imaging with surgical findings.

Purpose: To obtain high resolution images of the anal sphincter and adjacent anorectum using an endoanal coil in patients with sepsis, trauma, and low rectal tumors and to compare imaging appearances with findings at time of surgery.

Patients And Methods: A cylindrical saddle geometry coil (diameter, 9 mm; length, 75 mm) was used to examine 30 patients (mean age, 53.6 years).

MRI of the anal sphincter.

Objective: The anal sphincter was imaged with MR using an internal coil to demonstrate its anatomy, contrast enhancement patterns, and appearance in disease.

Materials And Methods: A cylindrical saddle geometry coil was placed in the anal canal. Sixteen volunteers and 18 patients were examined.

High resolution magnetic resonance imaging of the anal sphincter using an internal coil.

An internal receiver coil was used to obtain high resolution transverse and oblique coronal magnetic resonance images of the anal sphincter in five normal volunteers and five patients. The internal sphincter had a high signal intensity on T1 weighted, T2 weighted, and STIR sequences whereas the conjoined longitudinal muscle and external sphincter had a low signal intensity. The internal sphincter (but not the external sphincter) showed contrast enhancement after administration of intravenous gadopentetate dimeglumine.

Cholesterolosis in patients with chronic acalculous biliary pain.

The outcome of patients with cholesterolosis was compared with that of those with chronic cholecystitis operated on for chronic acalculous biliary pain. A total of 55 patients with acalculous biliary pain with a median symptom duration of 24 (range 6-120) months were investigated by dynamic cholescintigraphy and followed for a median of 24 (range 12-60) months. Thirty-five patients underwent cholecystectomy, of whom 22 had a low gallbladder ejection fraction (under 35 per cent), with symptomatic improvement in 21 of these (P < 0.

Surveillance policy for early detection of failing arteriovenous fistulae for haemodialysis.

We have developed a programme of surveillance for arteriovenous fistulae. Indications for investigation were a reduction of thrill or pulsation on the fistula, decreasing flow (< 200 ml/min) and/or increased venous return pressure (> 150 mmHg.) when on haemodialysis.