Do young patients have different clinical presentation of colorectal cancer causing delay in diagnosis?

PURPOSE: The incidence of colorectal cancer is increasing among young patients. In these patients, colorectal cancer is believed to have a poorer prognosis because it is more aggressive and diagnosed at later stages; however, the behavior of these tumors in young patients remains to be elucidated. We investigated the impact of time interval between onset of symptoms and diagnosis (TISD) at the pathologic stage of colorectal cancer in young patients. METHODS: The medical records of 215 patients with colorectal adenocarcinoma were reviewed. Patients were divided into two groups according to age. The young group (age < 50 years) consisted of 66 patients, and the older group (age ≥ 50 years) of 149 patients. Clinical variables, TISD, pathologic stage, operative mortality, and oncologic outcomes were compared between groups. RESULTS: The older group had less abdominal pain (74.0 vs. 56.0 %, p = 0.0129). In multivariate analysis, the following variables were independently associated with tumor pathologic stage: personal history of inflammatory bowel disease (p < 0.0001), family history of familial adenomatous polyposis (p = 0.00100), and smoking (p = 0.0070). Both groups had similar rates regarding pathologic stage (I, 15 vs. 22 %; II, 22 vs. 24 %; III, 27 vs. 16 %; IV, 37 vs. 38 %, p = 0.3380). There was no difference in overall survival [45 (69 %) vs. 84 (61 %), p = 0.2482] and cancer-free survival [36 (63 %) vs. 83 (62 %), p = 0.9218] between groups. CONCLUSIONS: Young patients with colorectal cancer had clinical and pathological presentation similar to that of older patients.

Long-term results of the Modified Thal procedure in patients with chagasic megaesophagus.

BACKGROUND: Chagas disease is a serious public health issue in South and Central America due to its high prevalence, morbidity, and mortality. The esophageal form of the disease leads to achalasia and consequent megaesophagus. In advanced or recurrent cases of megaesophagus, there is no consensus for which of three established techniques-the Serra-Dória procedure, subtotal esophagectomy, or Modified Thal cardioplasty-is best. Very few studies have investigated the average efficacy and long-term outcomes of the Thal procedure. The present study sought to bridge this gap. METHODS: The Modified Thal procedure was performed in 29 patients at Hospital Universitário de Brasília between 1998 and 2008. All underwent clinical and nutritional evaluation, upper gastrointestinal endoscopy (UDE) with chromoscopy, esophageal manometry, and 24-h pH monitoring. RESULTS: Overall, 86 % experienced resolution of all symptoms after surgery. Most patients were classified as Visick grade I, II, or III. The average body mass index was 22.7 kg/m(2). UDE showed normal mucosa in 76 % of patients, and 11 % had unstained areas on chromoscopy. Esophageal manometry demonstrated incomplete lower esophageal sphincter (LES) relaxation in 50 % of patients, complete LES relaxation in 21 %, and no LES relaxation in 29 %. All showed complete relaxation of the upper esophageal sphincter. On 24-h pH monitoring, reflux was pathological in 50 % of patients. CONCLUSIONS: Overall, the modified Thal procedure improved symptoms-namely, dysphagia to liquids with resulting weight loss and malnutrition-in patients with megaesophagus. No correlations were found between clinical complaints, endoscopic findings, and degree of manometric abnormality in these patients.

Transmural Migration of Gossypiboma with Intraluminal Small-Bowel Obstruction: A Case Report.

BACKGROUND The term "gossypiboma" refers to a textile matrix surrounded by a foreign-body reaction. Gauze, surgical dressings, and sponges are the most frequently retained materials after abdominal surgeries. The incidence is variable and underreported, mostly due to the legal consequences of their discovery, but also because many patients remain asymptomatic. Retained material can penetrate the bowel or bladder, leading to malabsorption, partial or complete bowel obstruction, and gastrointestinal bleeding secondary to vessel erosion. CASE REPORT A 26-year-old woman with a 10-month history of abdominal pain and distension presented with intraluminal small-bowel obstruction due to transmural migration of a gossypiboma. Prior to presentation at our service, she had undergone an exploratory laparotomy at another hospital due a locally advanced adenocarcinoma of the rectosigmoid junction. CONCLUSIONS Gossypibomas are rare causes of bowel obstruction, but must not be overlooked in the differential diagnosis of patients with a history of laparotomy. Continuous training of medical professionals and strict adherence to proper surgical technique are essential to avoid this problem.

Biomarkers in Colorectal Cancer: The Role of Translational Proteomics Research.

Colorectal cancer is one of the most common cancers in the world, and it is one of the leading causes of cancer-related death. Despite recent progress in the development of screening programs and in the management of patients with colorectal cancer, there are still many gaps to fill, ranging from the prevention and early diagnosis to the determination of prognosis factors and treatment of metastatic disease, to establish a personalized approach. The genetic profile approach has been increasingly used in the decision-making process, especially in the choice of targeted therapies and in the prediction of drug response, but there are still few validated biomarkers of colorectal cancer for clinical practice. The discovery of non-invasive, sensitive, and specific biomarkers is an urgent need, and translational proteomics play a key role in this process, as they enable better comprehension of colorectal carcinogenesis, identification of potential markers, and subsequent validation. This review provides an overview of recent advances in the search for colorectal cancer biomarkers through proteomics studies according to biomarker function and clinical application.

Pneumoretroperitoneum and Sepsis After Transanal Endoscopic Resection of a Rectal Lateral Spreading Tumor.

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.

A comparative study between conventional and liquid-based cytology in screening for anal intraepithelial lesions in HIV-positive patients.

Anal intraepithelial neoplasia (AIN) is associated with HPV infection and can be detected by cytological screening. While conventional exfoliative cytology (CC) is a low-cost and nonaggressive method, liquid-based cytology (LBC) tends to give clearer readings. Although studies of the efficacy of anal cancer screening methods would be of great importance for groups at high risk for AIN, few such studies have been conducted. The aim of the present study was to assess the concordance of CC and LBC in diagnosing anal pre-neoplastic lesions, and to compare cytological results with anoscopy, histopathological, and molecular biology findings. Comparative study involving 33 HIV-positive patients, who underwent anoscopy and biopsy of suspected lesions. Concordance between the two cytology methods was calculated, as were the associations between cytology results and findings from other screening methods. A total of 54.5% of cases were considered AIN-negative by CC and LBC, and concordance between the two methods was statistically significant (P < 0.05). Anoscopy was negative in 15 of the 18 CC- and LBC-negative cases. CC identified 75% of patients with positive biopsy, while LBC identified 85.71% of these patients. Molecular biology results showed that patients with LSIL tested positive for the highest number of HPV subtypes. The associations between positive biopsy and high grade HPV, HPV 16, and multiple HPV infections were not statistically significant. Conventional and liquid-based cytology are equally effective in screening for anal preneoplastic lesions.

Uncovering the neuroenteric-pulmonary axis: vagal nerve stimulation prevents acute lung injury following hemorrhagic shock.

AIMS: Trauma/hemorrhagic shock (T/HS) induced gut injury is known to initiate a systemic inflammatory response which can lead to secondary lung injury. We have shown that vagal nerve stimulation (VNS) protects intestinal epithelial integrity after a severe burn insult. We hypothesize that VNS will protect the lung from injury following T/HS by preventing intestinal barrier failure. MAIN METHODS: Male Balb/c mice were subjected to a T/HS model with and without cervical VNS. Intestinal injury was evaluated by measuring changes in gut barrier function and tight junction protein localization. Lung injury was evaluated using histology and markers of lung inflammation. Using NF-kB-luciferase (NF-kB-luc) transgenic mice, NF-kb-DNA binding was measured by photon emission analysis at 4 after injury. KEY FINDINGS: T/HS is associated gut injury characterized by histologic injury, increased epithelial permeability, and altered localization of gut tight junction proteins. Cervical VNS prevented the T/HS-induced changes in gut barrier integrity. Gut injury after T/HS was associated with acute lung injury at 24 h characterized by histologic injury, increased number of MPO positive stained cells and MPO enzymatic activity, and increased ICAM-1 expression in lung endothelium. VNS decreased T/HS-induced lung injury with a marked decrease in lung inflammation compared to T/HS alone. Lungs harvested from NF-kB-luc mice at 4h post VNS+T/HS demonstrated decreased DNA binding of NF-kB compared to T/HS alone as measured by changes in bioluminescence. SIGNIFICANCE: VNS is effective in protecting against acute lung injury caused by hemorrhagic shock through its ability to prevent gut barrier dysfunction.

Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder.

BACKGROUND: Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM: To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS: Twenty-five adult women (mean age 45.5 ± 11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9 ± 10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS: Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION: Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.

Value of human papillomavirus typing for detection of anal cytological abnormalities.

PURPOSE: The objective of this study was to evaluate anal cytology and human papillomavirus (HPV) typing in patients with human immunodeficiency virus infection. MATERIALS AND METHODS: Anal samples were collected from 61 patients (44 men and 17 women) and analyzed by PapilloCheck test and conventional cytology. RESULTS: Of all anal samples, 37.7% had cytological abnormalities, 47.54% were negative and 14.75% were unsatisfactory. High-risk HPV, multiple high-risk HPV and HPV 16 infection was detected in 91.13%, 78.26% and 47.82% of the samples with cytological abnormalities and in 47.54%, 6.89% and 3.44% of the negative samples, respectively. High-risk HPV infection was significantly more frequent in anal samples with cytological abnormalities than in negative samples (P = 0.0005, Fisher's test), particularly multiple high-risk HPV infection (P < 0.0001) and HPV 16 infection (P = 0.0002). CONCLUSIONS: High-risk HPV, multiple high-risk HPV and HPV 16 infections are significantly associated with anal cytological abnormalities. Furthermore, the frequency of HPV infection in anal cytological samples suggests that high-risk HPV detection has high sensitivity, but low specificity for detection of anal cytological abnormalities, but multiple high-risk HPV typing and HPV 16 typing have a lower sensitivity and high specificity. Results suggest that HPV typing may be useful as an adjunct to cytology to screen patients for high-resolution anoscopy and biopsy.

Effects of bromopride on the healing of left colon anastomoses of rats.

OBJECTIVE: To evaluate the effects of bromopride on the formation of adhesions and anastomotic healing in the left colon of rats. METHODS: We divided 40 rats into two groups of 20 animals, administration of bromopride (study group-E) or saline (control group-C). Each group was divided into subgroups containing 10 animals each for euthanasia in the third (C3 and E3) or the seventh (E7 and C7) postoperative days. The rats were submitted to section of the left colon and end-to-end anastomosis. On the day of reoperation, we evaluated the total amount of adhesions and removed a colonic segment containing the anastomosis for histopathological analysis, assessment of rupture strength and hydroxyproline concentration. RESULTS: There was no difference between groups in relation to clinical outcome. Two animals in the study group had blocked anastomotic leakage. The animals that received bromopride had the number of intracavitary adhesions and adhesions to the anastomosis similar to the control group. The anastomoses from the group E3 animals showed lower resistance to rupture the one from the C3 group (p = 0.04). This effect did not occur on the seventh postoperative day (p = 0.37). There was no significant difference between groups in relation to histopathology and hydroxyproline concentration in the anastomoses. CONCLUSION: The use of bromopride was associated with decreased tensile strength of left colon anastomosis in rats in the third postoperative day.