Miki Shibusawa

Genetic Changes in Primary Colorectal Cancer by Comparative Genomic Hybridization

Comparative genomic hybridization (CGH) is a powerful new technique for the molecular cytogenetic analysis of cancer. In this method, at first the cancer DNA and normal DNA are labeled with biotin and digoxigenin, respectively, and then the labeled DNAs are applied onto normal lymphocyte metaphase preparations in hybridization. After hybridization, they are stained with FITC and rhodamine, respectively, so chromosomal gains and losses in cancer are thus detected by using a green:red ratio. In this study, we analyzed the abnormal chromosomes in nine cases with human primary colon cancer. A gain in chromosomes 11p, 12q, 16p, 20p, and 20q were observed, while a loss of 18q and 22q were discovered. CGH may thus provide us with important information for analyzing the genes in colon cancer.

Implantation on the suture material and efficacy of povidone-iodine solution

Suture implantation of viable exfoliated tumour cells may be responsible for local recurrence of colorectal cancer. Using a colon cancer cell line, we obtained a suture implantation without intraperitoneal metastasis in about 80% of the control animals, when sacrificed on the 2nd postoperative week. The cytotoxic efficacy of povidone-iodine (PVP-I) was tested in vivo by a rat model with viable intracaecal tumour cells, and in vitro by trypan blue exclusion and the MTT assay. In vivo PVP-I at 5% significantly reduced the incidence of tumour growth, while the product at 2.5% had a significant effect in only the monofilament polypropylene group. In an in vitro toxicity study, PVP-I higher than 0.16% was effective at killing almost all tumour cells. PVP-I had effective cytotoxicity in vivo and in vitro, being less cytotoxic in vivo than in vitro.

The effect of vaginal delivery on the pelvic floor

This study was undertaken to determine the effects of vaginal deliveries on anorectal function, and to analyze the possible clinical, physiological, and radiological risk factors predisposing to damage of the pelvic floor musculature. We studied 25 consecutive women with a mean age of 32 years old, 3 months after vaginal delivery, 17 of whom were primiparae and 8, multiparae. The symptoms of anal incontinence were assessed, and anorectal manometry, rectal sensation, and radiological measurements of the anorectal angle and pelvic floor position at rest, on squeezing, and on straining were performed. As a control, six nulliparous women underwent the same examinations. Pelvic floor descent in both the primiparae and multiparae was significantly greater at rest and on squeezing than that in the nulliparous women. Furthermore, pelvic floor descent on straining was greater in the multiparae than in the nulliparous women (P=0.028). An analysis of the 17 primiparae showed that prolonged duration of the second stage of labor and third-degree perineal tears were important factors predisposing to pelvic floor descent. In fact, 3 of the 17 primiparae (17%) had anal incontinence. These findings indicate that vaginal delivery may cause pelvic floor descent, an obtuse anorectal angle, and bowel symptoms.

Recurrent colonic cancer developing at the site of a stapled stump: Report of a case

We report herein the case of a 54-year-old woman who developed a recurrence of carcinoma in a stapled colon stump 2 years after undergoing an anterior resection for carcinoma of the rectosigmoid colon. At this time an end to end anastomosis (EEA) stapler had been used to perform a side-to-end anastomosis. The implantation of cancer cells was thought to have caused the recurrence.

Anorectal function after anterior resection with side-to-side anastomosis for carcinoma of the rectum

PURPOSE: The aim of this study is to demonstrate whether anorectal function after anterior resection with side-to-side anastomosis results in better clinical outcomes than endo-to-end anastomosis in patients with carcinoma of the upper half of the rectum. METHODS: Anorectal function was studied in two groups of patients who had anterior resection, those with end-to-end anastomosis (Group E; n=11) and those with side-to-side anastomosis (Group S; n=11). Eight control subjects who had sigmoid colectomy for carcinoma were also studied. Each patient underwent manometric study and was questioned about clinical bowel symptoms before the operation and 3, 6, and 12 months postoperatively. RESULTS: The median length of residual rectum in both Group S and Group E was 7 cm. No significant difference was observed in maximum anal resting pressure and maximum squeeze pressure between the groups before and after operation. Maximum tolerable volume in Group S was significantly higher than that in Group E and was close to that in the control group at each postoperative interval. Median volumes in Group S were 200 ml (3 months), 220 ml (6 months), and 220 ml (12 months). Median volumes in Group E were 140 ml (3 months), 150 ml (6 months), and 175 ml (12 months). Bowel frequency per 24 hours at three and six months postoperatively was significantly greater in Group E than in Group S or the control group. Median frequency in Group E was four times (3 months) and three times (6 months) per 24 hours. Median frequency in both Group S and the control group was two times (3 months) and two times (6 months) per 24 hours. Postoperative urgency of defecation was not found in Group S, significantly less frequent than in Group E at three months. CONCLUSION: Side-to-side anastomosis may lead to a better clinical outcome than end-to-end anastomosis for carcinoma of the upper half of the rectum in the adaptation phase.

Anal Endosonography in the Diagnosis and Management of Perianal Endometriosis: Report of a Case

We report a rare case of perianal endometriosis, diagnosed in a 39-year-old woman who presented with a several-day history of a painful mass in the perineum. Perianal examination showed redness and swelling in the right anterior direction. A soft tumor was palpated, but there was no evidence of an episiotomy scar, or of fistula orifices. An anal endosonography in the right anterior direction revealed a sharply defined lesion, 17 × 14 mm in diameter, with high echoic enhancement at its center. The lesion was located along the edge of the external anal sphincter but did not involve it. Based on these endosonographic findings, the tumor was not considered to be an abscess or fistula. We detected its location, and judged it possible to enucleate the tumor under local anesthesia without injuring the anal sphincter. The operation was performed uneventfully and a histological diagnosis of endometriosis was confirmed. Using anal endosonography, we were able to determine the exact anatomic relationship of the lesion in the internal and external sphincter, which substantially influenced the diagnosis and operative procedures.

Iodine absorption after intraoperative bowel irrigation with povidone-iodine.

PURPOSE: Povidone-iodine is a commonly used intrarectal tumoricidal agent in patients undergoing colorectal surgery. The aim of this study was to assess systemic absorption of total iodine and its effect on thyroid function after intrarectal application. METHODS: Twenty patients with carcinoma of the rectum received intraoperative irrigation with either povidone-iodine (Group A; n=10) or physiologic saline (Group B; n=10). Ten patients with carcinoma of the sigmoid colon (group C) were treated the same as Group A. Electrolyte, total iodine, triiodothyronine, thyroxine, and thyroid-stimulating hormone values were measured in serum preoperatively and before intraoperative irrigation and immediately, ten minutes, 1 hour, 6 hours, 24 hours, and two weeks after irrigation. RESULTS: No significant changes occurred in serum electrolytes. A significant uptake of the total iodine was demonstrated in each group. Total iodine levels examined immediately, ten minutes, and one hour after irrigation in Group C were significantly higher than those examined in Group B. Maximum values were obtained one hour after irrigation in Groups A and B and six hours after irrigation in Group C. No significant changes occurred in triiodothyronine, thyroxine, and thyroid-stimulating hormone levels among the three groups. The decrease in triiodothyronine levels after surgery was demonstrated in each group. We noted a decrease after surgery in thyroxine levels for Groups A and B and in thyroid-stimulating hormone levels for Group B. Those hormones were not affected by the administration of povidone-iodine. CONCLUSION: High serum levels of iodine did not cause organ toxicity, suggesting that a single use of intraoperative bowel irrigation with povidone-iodine may be performed with practically negligible risk.

Synergistic Effect of CGS16949A and 5-Fluorouracil on a Human Breast Cancer Cell Line

The effects of the aromatase inhibitor, CGS16949A, and the fluoropyrimidine, 5-fluorouracil (5-FU), on cell cycle distribution and growth were studied using FACS analysis and MTT assay in the human breast cancer cell line, SK-BR-3. CGS16949A induced an increase in the G0–G1 fraction on SK-BR-3 cells, and the growth inhibition rate of the combination of both (65.7 ± 3.0%) was significantly higher than 10 nM CGS16949A (37.9 ± 6.9%) or 100 µg/ml 5-FU (45.6 ± 4.5%); p < 0.01). Administering 5-FU after preincubation with CGS16949A significantly increased the combined cytotoxic efficacy, suggesting that clinical therapy using this combined therapy may be more efficient.

Questionnaire on Effect of Vaginal Deliveries on Anorectal Function

女性にとって妊娠や分娩が直腸肛門部に影響を及ぼすことは容易に想像できるが,分娩後急速に症状が改善する例が多いことから,関心がはらわれていない.経膣分娩後数年を経た婦人を対象に,妊娠分娩の排便機能障害および肛門症状に及ぼす影響をアンケート調査から検討した.経膣分娩群と帝王切開群を対照として比較したところ,肛門部の「痛み」や「腫れ」など痔症状は経膣群で有意に悪化していた.また分娩回数が増すにつれ排便症状や肛門症状の悪化する率が高くなり,3,501gr以上の児の分娩は有意に「便失禁」を悪化させていた.初産年齢が35歳以上の鉗子吸引分娩は「痛み」「腫れ」など肛門症状の悪化因子となっていた.会陰切開もまた「ガス失禁」「痛み」「腫れ」の悪化因子であった.産後数年を経てもなお不快感や不自由さを感じている婦人が多く,今後出産後のフォローが婦人のQOLを高めていくものと思われた.6) 雨宮章,斉藤馨,小杉一弘ほか:便秘,痔疾・脱肛.周産期医学 26 : 1105-1110, 19967) Keighley MRB, Williams NS : Surgery of the anus, rectum and colon. Vol. 1, London, Saunders, 1993, p516-6088) Read NW, Bartolo DCC, Read MG Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 71 : 39-42, 1984.9) Parks AG, Swash M, Urish H : Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18 : 656-665, 197710) Snooks SJ, Swash M, Henry MM, et al Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colore Dis 1 : 20-24, 198611) Snooks SJ, Swash M, Mathers SE, et al : Effect of vaginal delivery on the pelvic floor : a 5-year follow-up. Br J Surg 77 : 1358-1360, 199012) Sultan AH, Kamm MA : Pudendal nerve damage during labour : prospective study before and after childbirth. Br J Obstet Gynecol 101 : 22-28, 1913) Ryhammer AM, Kaurberg S, Hermann AP : Long-Term Effect of Vaginal Deliveries on Anorectal Function in Normal Perimenopausal Women. Dis Colon Rectum 39 : 852-859, 199614) Goligher JC : Surgery of the anus and colon 3rd ed. London, Billiere Tindall ＆ Cassel, 1975, p346.15) 寺本龍生,小平進,北島政樹:便失禁症の手術.手術 46 : 957-963, 199216) 角田明良,澁澤三喜,神山剛一ほか:経膣分娩の骨盤底機能に及ぼす影響日本大腸肛門病会誌 50 : 923, 1997

A case of ileovesical fistula due to Crohn's disease.

尿路感染症として発症した回腸膀胱瘻を伴う回盲部Crohn病の1例を経験した.症例は63歳の女性で, 腎孟腎炎から慢性腎不全となり血液透析を受けていたがその後も膿尿が続き, 腸管膀胱瘻が疑われ入院した.注腸造影にて回盲部Crohn病と診断, さらに膀胱への瘻孔も確認され開腹術を施行した.回腸末端より約10cm口側に膀胱腸瘻を認め, 回盲部切除および膀胱部分切除を施行した.切除標本では終末回腸は全周性に肥厚し, 瘻孔付近にはcobble-stone appearanceが, さらに口側に約25cmにわたり縦走潰瘍が認められた.組織学的にも全層性の炎症性変化, 裂溝形成がみられCrohn病と診断された.著者の調べえた限りでは, 本邦におけるCrohn病による腸管膀胱瘻の報告例は本症例を含め33例で女性は2例に過ぎない.本症例はCrohn病としては比較的高齢の女性であり, 慢性腎不全を併発した例は報告がない.