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04/01/1984 12:00 AM
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Familial Polyposis in Children: Early Detection and Preferred Treatment
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colon; Familial polyposis is a disease with high malignant potential. When the diagnosis is established, surgical removal of the premalignant tissue should be complete. Reports of early malignant expression of the disease have led us to recommend early surveillance and treatment of children from affected families. We describe four children who had total colectomy, rectal mucosectomy, and ileoanal anastomosis, and relate our reasons for preferring this modality of therapy for familial polyposis in young patients.
(C) 1984 Southern Medical Association
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09/01/1972 12:00 AM
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Malrotation of the Colon with Prolapsed Ileocolic Intussusception in Familial Polyposis
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This report describes an unusual case of familial polyposis characterized by concomitant malrotation of the colon which presented as a prolapsed ileocolic intussusception.
(C) 1972 Southern Medical Association
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09/01/1991 12:00 AM
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Small Bowel Neoplasia Associated With Familial Polyposis of the Colon
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SMALL BOWEL NEOPLASIA ASSOCIATED WITH FAMILIAL POLYPOSIS OF THE COLON.
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09/01/1992 12:00 AM
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Familial Adenomatous Polyposis: Initial Diagnosis in the Sixth Decade of Life
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FAMILIAL ADENOMATOUS POLYPOSIS :
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12/01/2008 12:00 AM
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Turcot Syndrome (Glioma Polyposis): A Case Report
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Turcot's syndrome (glioma-polyposis) is a rare hereditary disorder characterized by association of colonic polyposis with primary tumors of the central nervous system. We report a case of a 27-year-old male diagnosed with Turcot's syndrome after an autopsy. The patient survived for more than two decades after his initial presentation with medulloblastoma at the age of five years. Such a long survival is exceptional in patients with this syndrome. Based on the genetic mutations, the patients with Turcot's syndrome are classified into adenomatous polypois coli (APC) group or hereditary non-polyposis colon cancer (HNPCC) group. The article highlights the contrasting features of the two groups.
(C) 2008 Southern Medical Association
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02/01/2010 12:00 AM
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Desmoid Tumor Arising in the Site of Previous Surgery in the Left Lower Quadrant of the Abdomen
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A desmoid tumor is a fibroblastic proliferation arising in musculoaponeurotic structures. The pathogenesis is still not clear. A 79-year-old woman who developed a desmoid tumor in the left lower abdomen after surgical resection of an abdominal lipoma seven years previously is presented. Preoperative computed tomography showed a large left lower abdominal mass. Pathology showed the spindle fibroblastic cell pattern typical of desmoids.
(C) 2010 Southern Medical Association
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05/01/1961 12:00 AM
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Polyps of the Colon and Rectum in Children
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Though polyps of the large bowel occur only rarely in childhood, they may give rise to clear-cut symptoms which, however, are not diagnostic thus pointing up the matter of diagnosis. Management is considered. Multiple polyps bring up the familial disease of multiple polyposis with its implications of malignancy.
(C) 1961 Southern Medical Association
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06/01/1984 12:00 AM
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Abdominal Colectomy With Ileorectal Anastomosis
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colon; From 1980 to 1983, 20 patients had abdominal colectomy with primary ileorectal anastomosis. Fourteen operations were elective and six were emergency. Elective indications included familial polyposis (five), inflammatory bowel disease (four), colon cancer associated with multiple polyps (four), and colon cancer associated with diverticulosis and a history of massive hemorrhage (one). Emergency operations were performed for obstructing sigmoid or rectosigmoid cancer (three), massive lower gastrointestinal hemorrhage (two), and right colon cancer associated with obstructing diverticulitis (one). All patients survived the operation; in three patients complications developed in the immediate postoperative period for a morbidity of 15%. Our experience suggests that abdominal colectomy with primary ileorectal anastomosis can be safely performed in carefully selected cases.
(C) 1984 Southern Medical Association
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03/01/1994 12:00 AM
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Loop IleoStomy: A Reliable Method of Diversion
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colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 Southern Medical Association
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05/01/2001 12:00 AM
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Restorative Proctocolectomy: Ochsner Clinic Experience
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Background. Restorative proctocolectomy, a standard operation for ulcerative colitis and familial adenomatous polyposis has significant complications, even in experienced hands.
Methods. We studied surgical outcome by retrospectively reviewing cases of restorative proctocolectomy done at Ochsner Foundation Hospital from 1982 to 1995. Demographic and clinical data from two periods (1982 to 1989 and 1989 to 1995) were compared to determine factors associated with improved outcome.
Results. We performed 145 ileal pouch-anal procedures. In 56 patients, 104 complications occurred. The more recent group had a greater incidence of inflammatory bowel disease, steroid use, and staged operations; reduced operative times and hospital stays; more general but fewer pouch-related complications. Pouch failures were similar for both groups.
Conclusions. Perioperative outcome appeared to be associated with technical experience, improved perioperative care, exclusion of patients with Crohn's disease, judicious surgical reoperation for pouch complications, and use of a 3-stage procedure in malnourished patients or those with acute or toxic colitis.
(C) 2001 Southern Medical Association
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12/01/2001 12:00 AM
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Colorectal Cancer in Patients 20 Years Old or Less in Taiwan
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Background. Colorectal cancer (CRC) is predominantly a disease of the elderly population, but it sometimes occurs in young patients. The diagnosis of CRC in youngsters is often overlooked by physicians or presentation may be delayed.
Methods. With assistance from the cancer registry center of Taipei Veterans General Hospital, we collected data on all types of colorectal malignancy, including carcinoma, adenocarcinoma, or lymphoma in patients aged 20 or younger. All available medical charts and pathologic specimens were reviewed in detail.
Results. A total of 28 cases were analyzed. The leading presenting symptom was abdominal pain (92%). The locations of the primary tumors were evenly distributed, and the major histologic type was predominantly adenocarcinoma. However, the proportion of mucinous adenocarcinoma was higher than that in the older population. Most of the cases were advanced (11 tumors were classified as Dukes stage C and another 11 as Dukes stage D). The overall 5-year survival rate was 21%.
Conclusions. Despite the rarity of CRC during the first two decades of life, physicians need to be aware of the possibility and to evaluate suggestive signs and symptoms by colonoscopy or barium enema. Family history of CRC, inflammatory bowel disease, previous polyps, or familial polyposis did not play a crucial role in this group of young patients.
(C) 2001 Southern Medical Association
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03/01/2004 12:00 AM
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Detecting and Preventing Colorectal Cancer in Specific Communities
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No abstract available
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04/01/2008 12:00 AM
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Capsule Endoscopy: A Review
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Capsule endoscopy (CE) is a novel technology that allows direct noninvasive visualization of the entire small intestine. CE permits a detailed examination in the ambulatory setting, allowing identification of clinically relevant lesions, and it is appealing to both patients and providers. There are two types of capsules that are currently commercially available: one specifically designed to view the small bowel and the other for the esophagus. Common indications for small bowel CE include obscure gastrointestinal bleeding, initial diagnosis of suspected Crohn's disease, and other small bowel pathology. The esophageal capsule is currently used to evaluate Barrett esophagus and esophageal varices. It is a well-tolerated procedure with relatively few complications. Although CE performance may be superior to existing technologies, its impact on clinical decision-making and patient outcomes are of even greater importance. Herein lies a review of the latest information on CE, its indications, complications, future utilities, and developing technology.
(C) 2008 Southern Medical Association
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03/01/2004 12:00 AM
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Colorectal Carcinoma in Young Females
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Background: We sought to study the clinicopathologic characteristics of colorectal cancer in young female patients. We also wanted to determine the association of colorectal cancer with anemia in these female patients and, finally, to determine the effect of gender on prognosis in young patients with colorectal cancer.
Methods: We performed a retrospective analysis of all young patients diagnosed with colorectal cancer between 1982 and 1999 in two teaching hospitals in New York City.
Results: A total of 3,546 cases of colorectal cancer were diagnosed. Sixty-one (1.63%) of these patients were young patients and 32 (0.85%) were female. Young refers to all patients in the study who were younger than 40 years of age. The clinical presentation and mean age at presentation were very similar in both male and female patients. At presentation, 87.5% of female patients had anemia compared with only 69% of male patients. Males had a statistically significant higher mean hemoglobin level compared with females (12.87 versus 10.29 g) at P = 0.0001. Seventy-nine percent of female patients compared with 86% of male patients presented with left-sided tumors. Fifty-five percent of males presented with late stage disease compared with 68% of females (P = 0.27). Female sex seemed to adversely affect the prognosis, although this did not reach statistical significance (P = 0.08). Stage of disease was associated with worse prognosis and this was independent of sex. Age and hemoglobin were not independent predictors of mortality.
Conclusion: Colorectal cancer does occur in females of childbearing age who might have a tendency to present with late stage disease as evidence from this study. Young female patients with anemia should be questioned about gastrointestinal symptoms, and colorectal cancer should definitely be in the differential diagnoses. This might conceivably allow for earlier diagnosis and potential for cure in this patient group.
(C) 2004 Southern Medical Association
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01/01/2003 12:00 AM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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03/01/2006 12:00 AM
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Colorectal Cancer Screening: Today and Tomorrow
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Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced.
(C) 2006 Southern Medical Association
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05/01/2008 12:00 AM
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Diagnosis of Marginal Cell Lymphoma of Small Intestine by Double Balloon Enteroscopy
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A 65-year-old woman with a medical history of diabetes mellitus type 2, hypertension, an old cerebrovascular accident, and seizure disorder presented to the emergency room with lower abdominal pain of 4 weeks duration. Upon physical examination, her abdomen was soft and bowel sounds were present, but there was diffuse tenderness in her lower abdomen with some guarding. A computed tomography scan of her abdomen with oral and intravenous contrast showed significantly thickened small bowel loops with subjacent lymphadenopathy. Biopsies obtained during esophagogastroduodenoscopy and colonoscopy showed acute and chronic inflammation. A double balloon enteroscopy (DBE) was then performed, which showed stricture in the jejunum from which the biopsy was obtained. The biopsy showed marginal cell lymphoma. The patient is presently undergoing chemotherapy. Double balloon enteroscopy is a new elegant endoscopical technique that seems promising, as the endoscopist can reach undiscovered small bowel segments. It seems to be well tolerated and safe. For the first time, it provides the means to endoscopically investigate and treat disorders of the small intestine that have previously been inaccessible to conventional endoscopy.
(C) 2008 Southern Medical Association
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03/01/2007 12:00 AM
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Small Bowel Capsule Endoscopy: A Systematic Review
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Wireless capsule endoscopy offers a revolutionary diagnostic tool for small bowel diseases. Since its formal introduction, it has become an integral part of the diagnostic evaluation for obscure gastrointestinal bleeding. This relatively noninvasive imaging modality offered by small bowel capsule endoscopy is appealing to both patients and providers and consequently, the desire to expand its diagnostic role continues to grow. The use of CE in the diagnosis of Crohn disease and chronic diarrhea is being further investigated, as is the potential of employing this technique as a cancer surveillance mechanism in patients with hereditary polyposis syndromes which may involve the small bowel. This review article discusses the current indications for small bowel capsule endoscopy, the results of capsule endoscopy in patients with obscure gastrointestinal bleeding and small bowel diseases, and patient outcomes following capsule endoscopy. Capsule endoscopy is compared with traditional diagnostic modalities, including small bowel series, enteroclysis, CT, and push enteroscopy. Small bowel capsule endoscopy is the procedure of choice to evaluate obscure gastrointestinal bleeding, and is superior to radiographic procedures in detecting Crohn disease of the small bowel.
(C) 2007 Southern Medical Association
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12/01/2006 12:00 AM
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Advances in the Endoscopic Management of Patients with Pancreatic and Biliary Malignancies
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Major advances in endoscopic techniques to diagnose and manage pancreatic biliary diseases have fundamentally changed the approach to these difficult clinical challenges. The diagnosis of benign and malignant pancreatic-biliary diseases is much more readily obtained through a combination of cross-sectional imaging and endoscopic procedures. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are the most important endoscopic tools for imaging and accessing the pancreatic biliary system. The review summarizes the major imaging methods for providing a diagnosis of bile duct malignancy, including ERCP, transhepatic cholangiography (THC), and magnetic resonance cholangiopancreatography (MRCP). High quality image examples of cholangiocarcinoma are provided. EUS has provided a new imaging modality for the detection of pancreatic and biliary malignancy. EUS is particularly sensitive for the detection of early pancreatic malignancy. Furthermore, EUS excels at the guidance of fine needle aspiration of pancreatic lesions. Diagnostic tissue acquisition for cholangiocarcinoma remains an important challenge. The endoscopic therapy for pancreatic-biliary malignancy involves the use of stenting which relieves the biliary obstruction commonly seen in these patients.
(C) 2006 Southern Medical Association
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03/01/2006 12:00 AM
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Table 4
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Table 4. Screening recommendations for patients with familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC)
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02/01/2010 12:00 AM
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Fig. 3
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Fig. 3 Histopathology reveals elongated, spindle cell proliferation without cellular atypia or mitosis, surrounded by abundant collagen (HE ×100).
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02/01/2010 12:00 AM
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Fig. 2
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Fig. 2 (A) Gross appearance of a specimen of the desmoid tumor is a large ovoid mass measuring 17 cm × 14 cm × 13 cm. (B) The cut surface of the same specimen is glistening white.
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02/01/2010 12:00 AM
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Fig. 1
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Fig. 1 (A) Axial image of precontrast computed tomography scan shows a well-circumscribed mass, 17 cm in size. Surgical clips (white arrows) on the surface of the mass are identified. (B) Coronal image of postcontrast computed tomography scan shows minimal enhancement of the mass.
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