[The comparative analysis of the surgical treatment of the familial adenomatosis of the colon with the use of cell transplantation].

Authors represent the surgical technique of colectomy with preserving the natural intestinal passage in the treatment of the familial colic adenomatosis. The technique is based on the preserving the distal part of the rectum with its demucosation and connecting with the ileal conduit. The rectal mucosa reconstruction is performed with the use of allogenic transplantation of fetal intestinal cells. 27 patients were operated on. The rectal mucosa reconstruction was registered in all cases range 4-12 weeks postoperatively. The long-term follow-up showed no disease recurrence within 5 years. The method demonstrated better intermediate and long-term functional results.

[Nonspecific granulomatous inflammation in Crohn's disease].

A comparative morphological study of intestinal wall tissues in such chronic colonic diseases, such as Crohn's disease, ulcerative colitis, and catarrhal rectal fistulas, allows the formation of giant cells of foreign bodies and their granulomas and sarcoid-type ones to be nonspecific. Their spread through and outside the colon is due to the migration of foreign bodies along the lymphatic vessels. Foreign inclusions of different shapes and structures in the cytoplasm of giant cells suggest that the colon contains the multiple particles of varying antigenic nature, which induce a unified morphological response medicated by innate and adaptive immunity cells. Consequently, the universally accepted substantiation of the diagnosis of Crohn's disease by the presence of granulomas is unconvincing.

Cell transplantation in surgical treatment of familial adenomatous polyposis coli.

We developed a method of surgical treatment of familial adenomatous polyposis coli giving an opportunity to prevent the growth of new polyps in the preserved part of the rectum and consisting in transplantation of fetal cells of the epithelial origin into the rectum wall after mucosectomy. Since the rectum is partially preserved, ileorectal anastomosis can be formed after colectomy, which preserves natural bowel passage. Complex examination 4 weeks after surgery revealed the formation of normal rectal mucosa. No new polyps were detected in the rectum 1-3 years after surgery.

[Role of vascular disorders in the pathogenesis of ulcerative colitis and its complications].

Mucous membrane circulatory disorders in ulcerative colitis (UC) are accompanied by significant capillary plethora with endothelial nuclear swelling in the capillaries and minor veins. Some cases show the development of secondary endophlebitis with thrombi occurring in individual veins. Occasionally, there is deep vein thrombosis in the leg with pulmonary embolism. Portal vein thromboembolism is very rarely observed during autopsy. The development of extensive deep mucous membrane ulcers gives rise to destruction of the vessels of the submucous plexis and its recurrent branchlets feeding the circular muscle layer. Impaired microcirculation is confirmed by the presence of myocytic dystrophic or necrotic changes. There are large transmural ischemic necroses in the area of toxic dilatation. Connective tissue foci develop in chronic UC at the site of ischemic necroses. Long longitudinal ulcers seen in nonspecific UC and Crohn's disease are likely to be ischemic, the course of which is long contraction of tenia with vein compression.

[The extension of a physiologic hypoganglionic area in adults and its significance in the diagnosis of Hirschprung's disease].

The purpose of the investigation was to study the extension of a physiologic hypoganglionic area in the distal rectum in adults and to define its implication in diagnosing Hirschprung's disease. Thirty-five cadaver distal rectal portions were examined. The extension of a physiologic hypoganglionic area in adults ranged from 7.5 to 50.0 mm (24.4+/-10.9 mm). The authors could determine any element of the intramural nervous system to a level of 40 mm where there was a compact ganglionic deposit with nerve commissures, which is typical of the normal structure of an intermuscular nerve plexus. The extension of a physiologic hypoganglionic area was as large as 40.0 mm in 4 of the 35 cases and 50.0 mm in 1 case. By taking into account these data, it is expedient to use the modified O. Swenson transanal biopsy.

[The clinicomorphological characterization of segmental lesion in ulcerous colitis].

The authors analyzed the clinical picture in 18 patients with distal lesion of the colon and an inflammatory focus in the cecum (segmentary lesion), and five patients with distal lesion of the colon revealed with endoscopy and pathomorphological signs of inflammation in visually intact cecum. The analysis shows that in a range of cases the extent of lesion in ulcerous colitis (UC) cannot be determined correctly with colonoscopy. An apparent segmentary character of lesion (inflammation in the distal colon and an inflammatory focus in the cecum) is an additional criterion of unfavorable prognosis of transformation into disseminated UC forms. Such patients need application of the same treatment regimens as in patients with disseminated UC forms.

[Small-cell rectal carcinoma coexisted with tubular-villous adenoma].

The paper describes a case of small-cell high-grade endocrine carcinoma of the rectum concurrent with tubular-villous adenoma in a 58 year-old woman. All epithelial cells of adenoma have been ascertained to be "mixed" exoendocrine endocrinocytes (secrete mucus and contain neuroendocrine granules), contain progesterone receptors, and express CK 8, 18, and 19. Some high-grade neuroendocrine carcinoma cells also secrete mucus. The presence of mitotic activity (Ki-67, 35%), high p53 protein expression (more than 50%), marked CK 18 expression, and clinical data confirm high malignancy of this histological type of the tumor.

[Modification of Svenson's biopsy of rectal wall in diagnosis of malformations of intramural nervous system in adults].

Thirty-five autopsied specimens of rectum's distal part and anal canal part were studied. It was revealed that length of physiological hypogangliosis zone ranged from 7.5 to 50.0 mm (mean 24.4+/-10.9 mm). With regard to this wide range the modification of transanal Svenson's biopsy of rectal wall was proposed for diagnosis of malformations of intramural nervous system of the colon. The method was used in 21 patients with megacolon. The results demonstrate accuracy and safety of this diagnostic method.

[Morphological features of cancer in chronic non-specific ulcerative colitis]. / Morfologicheskie osobennosti raka pri khronicheskom nespetsificheskom iazvennom kolite.

27 cases of colon carcinoma developing in non-specific ulcerative colitis are studied. High risk of carcinoma diagnosis is shown if the duration of the disease is more than 20 years. The majority of the tumors were moderately differentiated adenocarcinomas originating from zones of growth at the crypt bottoms in the presence of considerable dysplasia.

[Differential diagnosis of non-epithelial rectal neoplasms]. / Differentsialnaia diagnostika neépitelialnykh opukholei priamoi kishki.

Experience in the treatment of 118 patients with nonepithelial new growths of the rectum has been accumulated at the Scientific Research Institute of Proctology in the period from 1970 to 1991. They accounted for 1.5% of all benign and malignant tumors of this organ. Leiomyoma was diagnosed in 44, leiomyosarcoma in 18, lipoma in 30, fibroma in 17, neurinoma in 7 and rhabdomyoma in 2 of these patients. A differential diagnosis was made between benign and malignant tumors, as well as with other nonepithelial new growth of the rectum. On the basis of the clinical picture and the results of digital and instrumental (radiological, endoscopic, and ultrasonic) examination of the rectum the correct preoperative diagnosis may be established with certain probability. This influences directly the choice of the volume of the operative intervention in various types of nonepithelial rectal tumors. Morphological verification of the tumor is the principal method of examination in establishing the differential diagnosis in the preoperative and postoperative periods.

[Long-term results of formation of smooth muscle sphincter in the perineal colostomy area in patients after rectal extirpation]. / Otdalennye rezul'taty formirovaniia gladkomyshechnogo zhoma v oblasti promezhnostnoi kolostomy u bol'nykh posle ékstirpatsii priamoi kishki.

The authors discuss an original method for formation of a smooth-muscle cuff from the wall of a pulled-through colon in the region of a perineal colostoma. It was applied in 89 patients who had undergone extirpation of the rectum for malignant neoplasms. The smooth-muscle sphincter was formed during removal of the rectum in 72 patients and no earlier than 2 years after the extirpation in 17 patients. Inflammatory complications developed in the region of the perineal colostoa in the early postoperative period in 13.5% of cases. They were due to necrosis of the distal part of the pulled-through intestine in 3.4% of cases. There were no fatal outcomes. The late-term results were studied in follow-up periods of up to 7.5 years. Satisfactory functional results were produced in 83% of the patients. Physiological examination showed the presence of a functioning sphincter in the region of the perineal colostoma.

[Pathomorphology of colonic diverticulosis]. / Patomorfologiia divertikuleza tolstoi kishki.

Two clinico-morphological forms of colon diverticulosis are distinguished on the basis of post-mortem and surgical material (89 observations) studied histologically, neurohistologically and electron-microscopically. The first form is characterized by the disturbance of colon peristalsis, inflammation, segmentation of the colon wall and the presence of staged changes in the colon wall muscles. Disturbances of the vegetative innervation and regional hemodynamic disturbances play a role in the patho- and morphogenesis. The second form develops in aged persons and is characterized by weakness of the colon wall with thinning of the muscle layer. In both forms atrophy of the circular muscle layer develops with dilation of perivascular spaces and formation of "weak sites" in the colonic wall.

Surgical treatment of benign, myomatous rectal tumors.

Between 1972 and 1990, 36 patients with leiomyoma of the rectum underwent surgery at the Proctology Institute (Moscow). There were 13 male (36.1 percent) and 23 female (63.9 percent) patients. Their median age was 52.1 years. Electroexcision of the tumors measuring below 1 cm was performed through the endoscope in 12 patients. Leiomyomas with a diameter of 2.5 to 5 cm were removed transanally in 10 patients. Six patients underwent excision of the tumor through the pararectal approach, whereas leiomyomas located in the rectovaginal wall were removed through the vagina in one patient. Abdominoperineal extirpation and abdominoanal resection of the rectum was performed in seven patients with tumors measuring from 8 to 20 cm. Recurrences were noted in nine patients after transanal, pararectal, or transvaginal excision of leiomyomas. In seven of them, malignant transformation of the tumor occurred at terms ranging from 9 months to 9.5 years.

[The surgical treatment of benign smooth-muscle tumors of the rectum]. / Khirurgicheskoe lechenie dobrokachestvennykh gladkomyshechnykh opukholei priamoi kishki.

From analysis of the surgical treatment of 36 patients with rectal leiomyoma the authors suggest and substantiate the indications for various types of operative interventions according to the size and location of the tumor. The late-term results of the treatment were studied in all patients who underwent surgery and a brief review of literature on the methods of diagnosis and surgical management of benign smooth-muscle tumors of the rectum is given.

Distribution of individual components of basement membrane in human colon polyps and adenocarcinomas as revealed by monoclonal antibodies.

Double-label immunofluorescence was used to monitor basement-membrane composition and integrity in 22 human colon polyps, 36 adenocarcinomas and 2 metastases. Cryostat sections were stained with polyclonal anti-laminin anti-serum combined with monoclonal antibodies (MAbs) to all major basement-membrane components (laminin, entactin/nidogen, collagen type IV and large heparan sulfate proteoglycan), as well as to keratin 8. In all adenocarcinomas, including mucinous, basement membranes were altered more at the invasive front than in the parenchyma. The degree of this alteration was inversely correlated with the level of tumor differentiation. An uncoordinated loss of basement membrane components (dissociation of markers), previously described by us in rat colon adenocarcinomas, was also found in human tumors. In the great majority of adenocarcinomas a pronounced stromal reaction was seen. It was manifested by the presence of fibrillar deposits of basement-membrane components, mainly of collagen type IV and/or heparan sulfate proteoglycan. This reaction was never observed in polyps and may be derived from myofibroblasts reported to accumulate in colon cancer stroma. The combined use of antibodies to basement-membrane components and to a specific keratin may constitute an adequate immunohistochemical test for the presence of invasion, and may be useful in the histologic analysis of polyps, especially in dubious cases.

[Morphologic characteristics of microadenomas of the large intestine]. / Morfologicheskaia kharakteristika mikroadenom tolstoi kishki.

Tissue and cellular atypia, changes of the mucus chemical composition, protein secreting function, ATPase activity, differentiation of the epithelial cells and DNA replication with the widening of proliferation zone were registered morphologically in colon microadenomas. A pronounced increase of labelled small lymphocytes capable of proliferation is observed in the stroma. Fibrocytes are practically absent, fibroblasts are represented by young 3H-labelled forms. All these changes are considered as dysplastic.

[Hyperplastic changes in the mucosa in colon cancer]. / Giperplasticheskie izmeneniia v slizistoi obolochke pri rake tolstoi kishki.

67 segments of rectum and sigmoid removed surgically because of carcinoma were examined: the surface of intestinal mucosa stained with methylene-blue was studied in order to determine the number and localization of focal changes in the macroscopically unchanged areas. Colon microscopy was performed clinically in 24 patients with carcinoma of the rectum and in 24 control individuals. 28 hyperplastic polyps and 1037 microscopic hyperplastic foci were found in operative material. An active metabolism is established by means of electron autoradiography in the cells of hyperplastic focus. Areas of dysplastic epithelium were rarely found in big hyperplastic polyps. Areas of diffuse hyperplasia (transitional mucosa) with crypt deepening and presence of a high number of goblet cells were found near tumour. A certain role of hyperplastic processes in carcinogenesis is forwarded. Numerous microscopic changes in the mucosa epithelium may testify against the carcinoma development de novo.

Microendoscopic features of the surface epithelium in patients with colonic tumors.

Vital studies of the colonic mucosa in 127 patients using the method of colonomicroscopy have allowed us to establish that the surface epithelium has a heterogeneous structure. It was possible to single out three main types of cell organization. Correlation has also been detected between types of cell organization of surface epithelium and morphological structure of the most common neoplasms of the colon.

[Morphostatistical characteristics of adenomas of the large intestine based on the data from 1915 autopsies]. / Morfostatisticheskaia kharakteristika adenom tolstoi kishki po dan nym 1915 autopsii.

Large intestine polyps have been revealed in 1372 cases of 1915 autopsies. 4.1% of these have been hyperplastic polyps, 86.2% tubular adenomas, 11.1% tubular-villous and 2.7% villous adenomas. Solitary adenomas have been less frequent than multiple one (42 vs. 58%). The adenomas have been equally incident in the right and left portions of the large intestine, but they have been larger and characterized by a higher degree of epithelial dysplasia in the sigmoid and rectum. Malignant adenomas made up 0.8% of the total number of tumors. Adenomas have been revealed twice more frequently in the patients who died in hospital than in the group of forensic medical autopsies. Multifactorial analysis has demonstrated a correlation between adenoma detection rate and some chronic diseases.