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Minimally Invasive Therapy & Allied... Apr 2024Since the early1990s, laparoscopic right colon resections have been the most performed advanced laparoscopic procedures just after laparoscopic left colectomies and...
Since the early1990s, laparoscopic right colon resections have been the most performed advanced laparoscopic procedures just after laparoscopic left colectomies and sigmoid resections. Indications for laparoscopic right colectomies are either benign or malignant diseases. Despite its many indications, a laparoscopic right or extended right colectomy is mostly performed for cancer of the caecum, the ascending colon, the hepatic flexure or the proximal transverse colon. Worldwide, colorectal cancer is the third most diagnosed cancer: an estimated 1,880,725 people were diagnosed with colorectal cancer in 2020, out of which 1,148,515 were colon cancer cases and 40% were located in the right colon. These figures make an oncologic sound surgery for right colon cancer of the utmost relevance. More recently, complete mesocolic excision has been advocated as the optimal choice in term of radicality, especially in node-positive patients with right colon cancer. Laparoscopic standard right colectomy and extended right colectomy with or without CME should be performed according to defined principles based on a close knowledge of key anatomical landmarks. This knowledge will allow to trace anatomical structures and drive instruments along the correct surgical planes and has its foundations in teachings from surgeons and scientists of past and present time.
PubMed: 38587468
DOI: 10.1080/13645706.2024.2332880 -
The American Journal of Surgical... Jul 2024Isolated hypoganglionosis (IHG) is histologically characterized by small numbers of myenteric ganglion cells and small myenteric ganglia; however, no numerical...
Isolated hypoganglionosis (IHG) is histologically characterized by small numbers of myenteric ganglion cells and small myenteric ganglia; however, no numerical diagnostic criteria for IHG have been established. Therefore, this study aimed to develop quantitative pathologic criteria for IHG. We evaluated 160 resected intestinal tissue specimens from 29 pediatric autopsies and 10 IHG cases. These specimens were obtained from the jejunum, ileum, ascending colon, transverse colon, and rectum. Morphologic features of the myenteric ganglion cells and myenteric ganglia were quantified and analyzed in digitized HuC/HuD-immunostained and CD56-immunostained sections, respectively. Quantitative criteria were developed with a scoring system that used parameters with the area under the receiver operating characteristic curve (AUC) values >0.7 and sensitivity and specificity exceeding 70%. The selected parameters were the number of myenteric ganglion cells per cm and the number of myenteric ganglia with an area >2500 µm 2 per cm. The score for each parameter ranged from -1 to 2, and the total score of the scoring system ranged from -2 to 4. With a cutoff value of ≥2 (AUC, 0.98; 95% CI: 0.96-1.00), the scoring system had a sensitivity of 96% (95% CI: 0.82-1.00) and a specificity of 99% (95% CI: 0.95-1.00). We devised a novel pathologic criterion based on the quantification of the number of myenteric ganglion cells and ganglia. Furthermore, this criterion showed high diagnostic accuracy and could lead to a definitive diagnosis of IHG in clinical practice.
Topics: Humans; Male; Female; Myenteric Plexus; Infant; Child, Preschool; Child; Predictive Value of Tests; Immunohistochemistry; Infant, Newborn; Autopsy; Biomarkers; ROC Curve; Adolescent; Cell Count; Area Under Curve
PubMed: 38726836
DOI: 10.1097/PAS.0000000000002243 -
Chemosphere Nov 2023Tris (2-chloroethyl) phosphate (TCEP) has been widely used, and its health risk has received increasing attention. However, the rare research has been conducted on the...
Tris (2-chloroethyl) phosphate (TCEP) has been widely used, and its health risk has received increasing attention. However, the rare research has been conducted on the effects of TCEP exposure on changes in the structure of the human gut microbiome and metabolic functions. In this experiment, Simulator of the human intestinal microbial ecosystem (SHIME) was applied to explore the influences of TCEP on the human gut bacteria community and structure. The results obtained from high-throughput sequencing of 16S rRNA gene have clearly revealed differences among control and exposure groups. High-dose TCEP exposure increased the Shannon and Simpson indexes in the results of α-diversity of the gut microbiome. At phylum level, Firmicutes occupied a higher proportion of gut microbiota, while the proportion of Bacteroidetes decreased. In the genus-level analysis, the relative abundance of Bacteroides descended with the TCEP exposure dose increased in the ascending colon, while the abundances of Roseburia, Lachnospira, Coprococcus and Lachnoclostridium were obviously correlated with exposure dose in each colon. The results of short chain fatty acids (SCFAs) showed a remarkable effect on the distribution after TCEP exposure. In the ascending colon, the control group had the highest acetate concentration (1.666 ± 0.085 mg⋅mL), while acetate concentrations in lose-dose medium-dose and high-doseTCEP exposure groups were 1.119 ± 0.084 mg⋅mL, 0.437 ± 0.053 mg⋅mL and 0.548 ± 0.106 mg⋅mL, respectively. TCEP exposure resulted in a decrease in acetate and propionate concentrations, while increasing butyrate concentrations in each colon. Dorea, Fusicatenibacter, Kineothrix, Lachnospira, and Roseburia showed an increasing tendency in abundance under TCEP exposure, while they had a negatively correlation with acetate and propionate concentrations and positively related with butyrate concentrations. Overall, this study confirms that TCEP exposure alters both the composition and metabolic function of intestinal microbial communities, to arouse public concern about its negative health effects.
Topics: Humans; Gastrointestinal Microbiome; Propionates; RNA, Ribosomal, 16S; Microbiota; Clostridiales; Butyrates; Phosphates
PubMed: 37634589
DOI: 10.1016/j.chemosphere.2023.139969 -
Molecular and Cellular Endocrinology Dec 2023The lining of our intestinal surface contains an array of hormone-producing cells that are collectively our bodies' largest endocrine cell reservoir. These...
The lining of our intestinal surface contains an array of hormone-producing cells that are collectively our bodies' largest endocrine cell reservoir. These "enteroendocrine" (EE) cells reside amongst the billions of absorptive epithelial and other cell types that line our gastrointestinal tract and can sense and respond to the ever-changing internal environment in our gut. EE cells release an array of important signalling molecules that can act as hormones, including glucagon-like peptide (GLP-1) and peptide YY (PYY) which are co-secreted from L cells. While much is known about the effects of these hormones on metabolism, insulin secretion and food intake, less is understood about their secretion from human intestinal tissue. In this study we assess whether GLP-1 and PYY release differs across human small and large intestinal tissue locations within the gastrointestinal tract, and/or by sex, body weight and the age of an individual. We identify that the release of both hormones is greater in more distal regions of the human colon, but is not different between sexes. We observe a negative correlation of GLP-1 and BMI in the small, but not large, intestine. Increased aging correlates with declining secretion of both GLP-1 and PYY in human large, but not small, intestine. When the data for large intestine is isolated by region, this relationship with age remains significant for GLP-1 in the ascending and descending colon and in the descending colon for PYY. This is the first demonstration that site-specific differences in GLP-1 and PYY release occur in human gut, as do site-specific relationships of L cell secretion with aging and body mass.
PubMed: 37739120
DOI: 10.1016/j.mce.2023.112072 -
Scientific Reports May 2024Medullary Carcinoma of the Colon (MCC) is a rare histological subtype of colon cancer, and there is currently no recognized optimal treatment plan for it, with its...
Medullary Carcinoma of the Colon (MCC) is a rare histological subtype of colon cancer, and there is currently no recognized optimal treatment plan for it, with its prognosis remaining unclear. The aim of this study is to analyze the independent prognostic factors for MCC patients and develop and validate nomograms to predict overall survival (OS). A total of 760 patients newly diagnosed with MCC from 2004 to 2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were randomly allocated to a training group and a validation group in a 7:3 ratio. Univariate and multivariable Cox regression analyses were conducted to identify prognostic factors and construct nomograms. The nomogram prediction model was evaluated and validated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). The study found that elderly women are more susceptible to MCC, and the ascending colon and cecum are the most common sites of involvement. MCC is poorly differentiated, with stages II and III being the most common. Surgery is the primary treatment for MCC. The prognosis for patients with stage IV MCC is poor, with a median survival time of only 10 months. Independent prognostic factors for MCC include age, N stage, M stage, surgery, chemotherapy, and tumor size. Among them, age < 75 years and completion of chemotherapy were protective factors for colon medullary carcinoma, while N2 (HR = 2.18, 95%CI 1.40-3.38), M1 (HR = 3.31, 95%CI 2.01-5.46), no surgery (HR = 27.94, 95%CI 3.69-211.75), and tumor diameter > 7 cm (HR = 1.66, 95%CI 1.20-2.30) were risk factors for colon medullary carcinoma. The results of ROC, AUC, calibration curves, and DCA demonstrate that the nomogram prediction model exhibits good predictive performance. We have updated the demographic characteristics of colon medullary carcinoma and identified age, N staging, M staging, surgery, chemotherapy and tumor size as independent prognostic factors for colon medullary carcinoma. Additionally, we have established nomograms for prognostic prediction. These nomograms can provide personalized predictions and serve as valuable references for clinical decision-making.
Topics: Humans; Nomograms; Female; Male; Colonic Neoplasms; SEER Program; Aged; Middle Aged; Risk Factors; Prognosis; Carcinoma, Medullary; Neoplasm Staging; ROC Curve; Adult
PubMed: 38763982
DOI: 10.1038/s41598-024-61354-2 -
Urology Practice Mar 2024The bowel remains the favored tissue for neo-vaginoplasty (NeoVP) in pediatric patients with vaginal agenesis. In 2001, the first description of NeoVP using the...
INTRODUCTION
The bowel remains the favored tissue for neo-vaginoplasty (NeoVP) in pediatric patients with vaginal agenesis. In 2001, the first description of NeoVP using the Yang-Monti technique with a sigmoid double tubular flap was published. We present our experience of NeoVP with a single Yang-Monti tube (SYMT) flap and report on the use of different segments of colon.
METHODS
We conducted a retrospective review of patients who underwent NeoVP using a bowel SYMT between 2009 and 2021. The procedure was performed under open abdominal surgery by isolating 8 to 12 cm from the rectosigmoid, cecum, or ascending colon. Subsequently, this segment was detubularized near the mesenteric border, folded, and retubularized transversally, leaving the mesentery in a cephalic position. A channel was dissected in the pelvis to accommodate the NeoVP.
RESULTS
Seventeen patients were identified. The median age was 16 years old. The principal diagnosis was Mayer-Rokitansky's syndrome (47.1%). The median follow-up was 50 months. The mean harvested bowel length was 9 cm, and the sigmoid was the preferred site (65%). The cecum-ascending colon was used in 3 (17.6%) patients. Complications were recorded in 6 patients (35%). Of these 6 patients, 4 had introital stenosis. There was 1 case of urethrovaginal fistula and another of left hematometrocolpos. Satisfactory sexual function has been reported in sexually active individuals.
CONCLUSIONS
We described our experience in NeoVP using a large bowel SYMT as a safe and effective technique. It allows decreased tension on the vascular pedicle and the use of shorter colon segments.
Topics: Adolescent; Child; Female; Humans; Colon; Colon, Sigmoid; Plastic Surgery Procedures; Surgical Flaps; Vagina; Retrospective Studies
PubMed: 38154038
DOI: 10.1097/UPJ.0000000000000519 -
The American Journal of Clinical... Dec 2023Clinical and biochemical vitamin B (B) deficiency is lower than anticipated in vegetarians. Extraileal absorption, such as from the colon, as well as reduced daily... (Observational Study)
Observational Study
Bioavailability and daily requirement of vitamin B in adult humans: an observational study of its colonic absorption and daily excretion as measured by [C]-cyanocobalamin kinetics.
BACKGROUND
Clinical and biochemical vitamin B (B) deficiency is lower than anticipated in vegetarians. Extraileal absorption, such as from the colon, as well as reduced daily excretion, may be adaptive mechanisms to maintain B homeostasis with marginal intakes.
OBJECTIVE
To measure the absorption of B from the small and large intestine, and its daily rate of excretion from the body, using a [C]-cyanocobalamin tracer.
METHODS
Oral B bioavailability was measured over 12 h after administration of [C]-cyanocobalamin tracer (2.5 μg) in normal participants. The colonic B bioavailability was evaluated by direct instillation of [C]-cyanocobalamin (5 μg) into the ascending colon. Bioavailability was calculated from 2-compartmental modeling of the tracer appearance in plasma. The excretion rate of B was measured from [C]-cyanocobalamin elimination from the body over 4 wk after oral dosing (5 μg).
RESULTS
The oral B bioavailability (n = 11) was 63% ± 10% measured over 12 h. A late absorption peak, accounting for 12% of the absorption, was observed after an average lag time of 8.7 h from dosing. The colonic B bioavailability (n = 10) was 7% ± 5% over 4 h. The daily B excretion rate (n = 4) was 0.7 ± 0.2 μg/d. The minimum daily requirement of B in these participants was derived at 1 μg /d.
CONCLUSIONS
B is absorbed in the human colon. This observation confirms the potential contribution of the colon in daily B nutriture, and along with a possible lower requirement, could explain the absence of clinical deficiency in populations with marginal B intakes.
TRIAL REGISTRATION NUMBER
This study was registered in Clinical Trials Registry of India (CTRI) with the registration number CTRI/2018/04/012957, available from https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=49319&EncHid=&userName=029108.
Topics: Adult; Humans; Biological Availability; Colon; Vegetarians; Vitamin B 12; Vitamin B 12 Deficiency
PubMed: 38044024
DOI: 10.1016/j.ajcnut.2023.08.020 -
World Journal of Clinical Cases Jul 2023Ischemic colitis (IC) is common, rising in incidence and associated with high mortality. Its presentation, disease behavior and severity vary widely, and there is...
BACKGROUND
Ischemic colitis (IC) is common, rising in incidence and associated with high mortality. Its presentation, disease behavior and severity vary widely, and there is significant heterogeneity in therapeutic strategies and prognosis. The common causes of IC include thromboembolism, hemodynamic insufficiency, iatrogenic factors and drug-induced. However, contrast-induced IC, especially isolated right colon ischemia is rarely reported.
CASE SUMMARY
A 52-year-old man was admitted to the hospital due to intermittent chest distress accompanied by palpitation. Coronary angiography was performed using 60 mL of the iodinated contrast agent iohexol (Omnipaque 300), and revealed moderate stenosis of the left anterior descending artery and right coronary artery. At 3 h post-procedure, he complained of epigastric pain without fever, diarrhea and vomiting. Vital signs remained normal. An iodixanol-enhanced abdominal computed tomography (CT) scan revealed thickening, edema of the ascending and right transverse colonic wall and inflammatory exudate, without thrombus in mesenteric arteries and veins. Following 4 days of treatment with antibiotic and supportive management, the patient had a quick and excellent recovery with disappearance of abdominal pain, normalization of leucocyte count and a significant decrease in C reactive protein. There was no recurrence of abdominal pain during the patient's two-year follow-up.
CONCLUSION
This case emphasizes that contrast-induced IC should be considered in the differential diagnosis of unexplained abdominal pain after a cardiovascular interventional procedure with the administration of contrast media. Timely imaging evaluation by CT and early diagnosis help to improve the prognosis of IC.
PubMed: 37583990
DOI: 10.12998/wjcc.v11.i20.4937 -
Revista Brasileira de Epidemiologia =... 2023To determine 5-year survival in patients with colorectal cancer (CRC) according to patient and tumor characteristics.
OBJECTIVE
To determine 5-year survival in patients with colorectal cancer (CRC) according to patient and tumor characteristics.
METHODS
Longitudinal study based on incident cases of invasive CRC between 2008 and 2017 captured by the Manizales Population-based Cancer Registry (n=850). Patients were followed up to August 24th, 2021. Cause-specific survival and net survival were calculated for sociodemographic and tumor characteristics, and Cox multivariate was fitted.
RESULTS
Fifty-five percent of cases occurred in women. The most frequent histological type was adenocarcinoma (78.2%). The most frequent locations were rectum (32.0%), ascending colon (16.6%), and sigmoid (16.2%). Twenty-five percent of cases were diagnosed in stage IV. There were 567 deaths due to CRC. The 5-year specific survival was 45.8% (95%CI 42.4-49.3), with independent effects for age (HR=1.83; 95%CI 1.26-2.65 age >75 years vs. <50 years) and advanced clinical stage (HR=2.5 and HR 5.7 for stages III and IV vs. stage I, respectively). Lower survival was observed in patients of medium socioeconomic status compared with higher socioeconomic status (HR=1.52; 95%CI 1.08-2.14), but not in patients of low socioeconomic status. No independent effects were observed for the health insurance regime.
CONCLUSIONS
In Manizales, approximately 5 out of 10 patients with invasive CRC die in the first five years after diagnosis, with a lower survival in patients older than 75 years, from medium socioeconomic level and diagnosed in advanced clinical stages.
Topics: Humans; Female; Aged; Colombia; Longitudinal Studies; Brazil; Insurance, Health; Colorectal Neoplasms
PubMed: 37729347
DOI: 10.1590/1980-549720230040 -
Neurogastroenterology and Motility Aug 2023Enterochromaffin (EC) cell-derived 5-hydroxytryptamine (5-HT) is a mediator of toxin-induced reflexes, initiating emesis via vagal and central 5-HT receptors. The amine...
BACKGROUND
Enterochromaffin (EC) cell-derived 5-hydroxytryptamine (5-HT) is a mediator of toxin-induced reflexes, initiating emesis via vagal and central 5-HT receptors. The amine is also involved in gastrointestinal (GI) reflexes that are prosecretory and promotile, and recently 5-HT's roles in chemosensation in the distal bowel have been described. We set out to establish the efficacy of 5-HT signaling, local 5-HT levels and pharmacology in discrete regions of the mouse small and large intestine. We also investigated the inter-relationships between incretin hormones, glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) and endogenous 5-HT in mucosal and motility assays.
METHODS
Adult mouse GI mucosae were mounted in Ussing chambers and area-specific studies were performed to establish the 5-HT and 5-HT pharmacology, the sidedness of responses, and the inter-relationships between incretins and endogenous 5-HT. Natural fecal pellet transit in vitro and full-length GI transit in vivo were also measured.
KEY RESULTS
We observed the greatest level of tonic and exogenous 5-HT-induced ion transport and highest levels of 5-HT in ascending colon mucosa. Here both 5-HT and 5-HT receptors were involved but elsewhere in the GI tract epithelial basolateral 5-HT receptors mediate 5-HT's prosecretory effect. Exendin-4 and GIP induced 5-HT release in the ascending colon, while L cell-derived PYY also contributed to GIP mucosal effects in the descending colon. Both peptides slowed colonic transit.
CONCLUSIONS & INFERENCES
We provide functional evidence for paracrine interplay between 5-HT, GLP-1 and GIP, particularly in the colonic mucosal region. Basolateral epithelial 5-HT receptors mediated both 5-HT and incretin mucosal responses in healthy colon.
Topics: Mice; Animals; Serotonin; Incretins; Gastric Inhibitory Polypeptide; Colon; Intestinal Mucosa; Glucagon-Like Peptide 1
PubMed: 37010838
DOI: 10.1111/nmo.14589