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Query: UMLS:C0009324 (ulcerative colitis)
 17,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with ulcerative colitis carry an increased colorectal cancer risk. The cumulative cancer risk for patients with pancolitis is 0.5-0.7% per patient year. Dysplasia as a histologic marker of a neoplastic transformation is used to identify patients with an increased cancer risk during colonoscopic surveillance. Because the classification of dysplasia is subject to inter- and intraobserver variation new methods for the detection of risk patients have been investigated. DNA analysis by flow cytometry seems to be of value for the detection of DNA aneuploidy and the identification of patients who are at risk for neoplastic progression. The significance of DNA aneuploidy is being evaluated in prospective studies. Surveillance guidelines depend on duration and anatomical extent of the colitis as well as on the detection of dysplasia.
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PMID:[Risk of colorectal cancer in ulcerative colitis--monitoring strategies and identification of risk patients]. 144 7

Ultrastructural changes that occurred in chronic active ulcerative colitis and Crohn's disease were investigated and compared to normal as well as to higher grades of dysplasia in adenomas and carcinomas. A greater number of immature absorptive cells, undifferentiated and intermediate cells were seen as compared to normal. One case of Crohn's and two cases of chronic ulcerative colitis including one with coexisting carcinoma showed increased number of vesicles and electron-dense bodies (EDB) in the absorptive cells and increased heterogeneity of mucin droplets in goblet cells and presence of atypical secretory cells (ASC). Higher grades of dysplasia characterised by large numbers of atypical secretory cells were not seen in the present series and provide no relationship between the atypical ultrastructural features and increased risk of malignancy. However, the number of cases investigated is too small and a large series is required to clarify the significance of observations such as increased number of electron-dense bodies and vesicles in the apical cytoplasm and presence of atypical secretory cells.
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PMID:Ultrastructural study of inflammatory bowel disease. 145 81

The double stapling technique for rectal reconstruction after resection involves closing the lower rectal segment with a linear stapler and performing the anastomosis using a circular stapler across the linear staple row. The purpose of this report is to review the results of double stapling, present our experience, and draw conclusions from the material available. We have utilized the double stapling technique in 80 patients for primary anastomoses and in 11 patients for secondary anastomoses following Hartmann procedures. Twenty-one anastomoses were at or near the dentate line. Fifty-six patients had rectal carcinoma, 29 patients had diverticulitis, 3 patients had carcinoma of the ovary, and 1 patient each had traumatic rectal perforation, volvulus, or rectal prolapse. Complications in the total 91 patients included 3 anastomotic leaks (3.3%), 1 postoperative hemoperitoneum (1.1%), and 3 strictures (3.3%). No anastomosis was protected by diverting colostomy. There were no operative deaths. Of 43 patients with cancer available for follow-up, 4 patients have developed local recurrence. The technique has been modified for ileoanal anastomosis during abdominal restorative proctocolectomy for ulcerative colitis and familial polyposis and early results are favorable. The double stapling technique provides a safe method for rectal reconstruction at or near the dentate line and offers the following advantages over other stapler techniques: (1) It eliminates the frustrating distal pursestring; (2) The rectal segment is not opened, minimizing contamination; and (3) It avoids gathering the sometimes generous circumference of the rectum on a pursestring thus allowing a more precise distal donut.
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PMID:Results of the double stapling procedure in pelvic surgery. 146 21

In contrast to reports from Western countries, the incidence of colorectal carcinoma among patients with idiopathic ulcerative colitis is considered to be low in the Indian subcontinent. In order to assess the risk of carcinoma in Indian patients, a retrospective analysis of 436 cases of idiopathic ulcerative colitis seen by us over a period of 12 years was carried out. Eight cases of colitis carcinoma (1.8%) were encountered during the study period. Pancolitis was present in six of them while colitis was of limited extent in two cases. The mean duration of colitis prior to development of carcinoma was 12.1 (range 7-25) years. While four of these patients were on our follow-up list and were diagnosed to have carcinoma at the time of a medical or surgical complication, four others first presented to us with a surgical complication of colitis carcinoma. We conclude that colitis carcinoma is not a rare entity among Indian patients with idiopathic ulcerative colitis. We feel that until proved otherwise, patients with idiopathic ulcerative colitis from the Indian subcontinent should not be denied the benefits of a cancer surveillance programme.
Eur J Cancer Prev 1992 Jun
PMID:Colorectal carcinoma in Indian patients with idiopathic ulcerative colitis. 146 77

Hypertrichosis lanuginosa acquisita is regarded as an obligatory cutaneous paraneoplasm and is defined as the sudden and excessive appearance of lanugo hairs on the entire integument associated with malignant neoplasm of internal organs. We observed such a case of hypertrichosis in a 30-year-old man with a long history of ulcerative colitis who developed carcinoma of the caecum with lymph node metastasis.
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PMID:[Hypertrichosis lanuginosa acquisita in ulcerative colitis with colon cancer]. 146 33

Aneuploid cell populations can be defined as those that contain an abnormal number of chromosomes or an abnormal amount of DNA. Aneuploidy can be reliably detected by flow cytometric analysis of DNA content. This technique not only identifies aneuploid cell populations but can also quantify the percent of cells in various phases of the cell cycle, thus giving an indication of the proliferative activity of a tissue. Aneuploidy occurs in approximately 60% of established colorectal cancers, and many studies have demonstrated that patients with aneuploid tumors have a poorer prognosis than patients with diploid colon cancers. Some studies have suggested that the proliferative rate of tumors, as assessed by the percent of cells in S phase, also has prognostic significance. Until recently, aneuploidy was thought to occur only in malignant tissues, but it has been clearly shown that aneuploid cell populations can be identified in benign adenomatous polyps as well as in non-neoplastic-appearing mucosa of patients with chronic ulcerative colitis and Barrett's esophagus. In chronic ulcerative colitis, aneuploidy occurs more frequently in patients with dysplasia or cancer than in those with no evidence of neoplasia. Similarly, dysplastic and malignant biopsies are more commonly aneuploid than non-neoplastic biopsies. Patients who have undergone colectomy for cancer or dysplasia in the setting of chronic ulcerative colitis frequently have multiple areas of aneuploidy throughout the remainder of their colon. Whether aneuploidy can be useful as a marker of cancer risk in patients with chronic ulcerative colitis deserves further investigation.
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PMID:Abnormal DNA content as a biomarker of large bowel cancer risk and prognosis. 146 94

The risk of colorectal carcinoma is increased among patients with longstanding ulcerative colitis and Crohn's disease. The development of cancer in inflammatory bowel disease is hypothesized to evolve by a multistep process involving genetic instability, clonal expansion and the development of a malignant phenotype. The contribution of nutritional factors such as folate deficiency is of great interest; molecular genetic mechanisms are under study. In contrast to sporadic colorectal carcinoma, carcinomas in ulcerative colitis are associated with a long prior history of chronic inflammation and the subsequent development of epithelial dysplasia. Dysplasia is defined as an unequivocal neoplastic alteration of the colonic mucosa. The object of surveillance is prevention of death from cancer by detection at a premalignant or early curable stage. Patients at greatest risk of cancer who customarily undergo endoscopic surveillance are those with extensive colitis of more than 8 years duration. Dysplastic epithelium may occur in flat mucosa, and may produce a plaque or a nodular/villiform appearance. Dysplasia is not present in all patients with cancer in colitis. It is important to develop more sensitive and specific markers for the presence of precancer or cancer in colitis. Under study are proliferation-associated markers detected by immunohistochemistry, lectin binding, flow cytometry and laser-induced fluorescence coupled with endoscopy.
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PMID:Ulcerative colitis and colon cancer: biology and surveillance. 146 4

Measurements of epithelial cell proliferation in the mucosa of the gastrointestinal tract pointed out the existence of cell kinetic abnormalities which can be involved in the first steps of carcinogenesis. In particular, an increase in the cell proliferation rate and an abnormal distribution of proliferating cells were found both in animals exposed to carcinogens and in human subjects at high risk of gastrointestinal cancer. In some diseases which predispose to cancer (i.e., chronic atropic gastritis, hereditary gastrointestinal cancer, sporadic colorectal neoplasia, chronic ulcerative colitis) we observed an expansion of the proliferative compartment even when the mucosa was not affected by morphological abnormalities. This proliferative feature seems to be associated with the presence of defects in cell differentiation. The abnormality is well detected by the histological examination of the proliferative pattern using microautoradiography after incorporation of tritiated thymidine, or using immunohistochemistry after bromodeoxyuridine uptake. The literature, and our own results, indicate that the search for abnormalities of epithelial cell proliferation can be useful in studying the earliest mechanisms leading to gastrointestinal cancer, in detecting subjects at high cancer risk, and for pilot chemoprevention studies using these abnormalities as intermediate biomarkers of gastrointestinal cancer risk.
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PMID:Cell proliferation biomarkers in the gastrointestinal tract. 146 7

Cell renewal in the large intestine mucosa is normally tied to a rigidly compartmentalized model. Immunohistochemical identification of cells in S phase through uptake of bromodeoxyuridine is the method of choice for detailed compartmental mapping of proliferation, while immunohistochemical detection of proliferation-associated antigens (Ki-67, PCNA, DNA polymerase alpha) provides information in advanced tumor cases. Mucosal hyperproliferation due to inflammation may be transient (self-limited colitis, Crohn's disease, acute radiation damage) or lasting (ulcerative colitis). Progressive shifting of the proliferation zone to the crypt surface (Stage II abnormality) is a late feature of irradiated rectal mucosa and subgroups of ulcerative colitis patients at high risk for cancer. Hyperproliferation and Stage II abnormality coexist in the mucosa of patients with colorectal neoplasia, but are mutually independent and correlated to different clinical and pathological features of the disease. These cytokinetic abnormalities are highly predictive markers of the adenoma-carcinoma sequence, but are not associated with de novo adenocarcinoma. Proliferation increases progressively in the subsequent steps of this sequence, except in early cancer.
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PMID:Cell proliferation in colorectal tumor progression: an immunohistochemical approach to intermediate biomarkers. 146 8

The controversy in the treatment of inflammatory bowel disease is how to decide surgical vs. medical management in each case. Of 309 patients with ulcerative colitis in our department, 63 (20%) patients had received surgical treatment. The mean age was 33.5 +/- 13.7 years old and the mean duration from onset to operation was 6.72 +/- 5.51 years. The indications for surgical treatment were 47 (75%) resistant cases against medical treatment, 9 (14%) severe cases and 7 (11%) cancer or dysplasia cases. In surgical cases compared with medical ones, the ratio of total duration (months)/number of admission showed below 10, and the total amount of used steroid was over 300 mg per month. These ratios were considered to be the useful markers for surgical indication. Operative procedures were 15 total proctocolectomy+ileostomy, 29 total colectomy+ileorectal anastomosis, 13 total proctocolectomy+ileoanal anastomosis and 6 others. Restorative proctocolectomy using double stapling method with two stage operation was chosen in 8 patients because of easier and safer operative procedure and a few complications. We conclude that early surgical treatment for the patients resistant against medical management is considered to improve the patients' quality of life.
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PMID:[Controversy--surgical vs. medical management of inflammatory bowel disease]. 147 Jan 22


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