Sample records for digital rectal examination

  1. Digital rectal examination in the evaluation of rectovaginal septal defects.

    Rachaneni, Suneetha; Atan, Ixora Kamisan; Shek, Ka Lai; Dietz, Hans Peter


    The objective was to evaluate the diagnostic potential of digital rectal examination in the identification of a true rectocele. This is a retrospective observational study utilising 187 archived data sets of women presenting with lower urinary tract symptoms and/or pelvic organ prolapse between August 2012 and November 2013. Evaluation included a standardised interview, ICS-POPQ, rectal examination and 4D translabial ultrasound. The main outcome measure was the diagnosis of rectocele by digital rectal palpation on Valsalva manoeuvre. This diagnosis correlated with the sonographic diagnosis of rectocele to determine agreement between digital examination and ultrasound findings. Complete data sets were available for 180 participants. On imaging, the mean position of the rectal ampulla was 11.07 (-36.3 to 44.3) mm below the symphysis pubis; 42.8% (77) had a rectocele of a depth of ≥10 mm. On palpation, a rectocele was detected in 60 women (33%). Agreement between palpation and imaging was observed in 77%; the kappa was 0.52 (CI 0.39-0.65). On receiver operator characteristic analysis, the area under the curve was 0.854 for the relationship between rectocele pocket depth and the detection of rectocele on palpation. Moderate agreement was found between digital rectal examination for rectocele and translabial ultrasound findings of a "true rectocele". Digital rectal examination may be used to identify these defects in clinical practice. Extending the clinical examination of prolapse to include rectal examination to palpate defects in the rectovaginal septum may reduce the need for defecatory proctograms for the assessment of obstructive defecation and may help triage patients in the management of posterior compartment prolapse.

  2. Digital rectal examination and transrectal ultrasonography in staging of rectal cancer

    Rafaelsen, Søren Rafael; Kronborg, Ole; Fenger, Claus


    Staging of rectal carcinoma before surgical treatment was performed in a prospective blind study, comparing digital rectal exploration and transrectal linear ultrasonography (TRUS) with the resulting pathological examination. TRUS underestimated depth of penetration in 3 of 33 patients and overes......Staging of rectal carcinoma before surgical treatment was performed in a prospective blind study, comparing digital rectal exploration and transrectal linear ultrasonography (TRUS) with the resulting pathological examination. TRUS underestimated depth of penetration in 3 of 33 patients...... and overestimation resulted in 9 of 74. The figures for digital examination were 5 of 18 and 20 of 76, respectively. Penetration of the rectal wall was correctly identified in 56 of 61 patients by digital examination and in 59 of 61 by TRUS. Specimens without penetration of the rectal wall were identified in 26...... of 33 patients by TRUS, but in not more than 13 of 33 by digital examination. Regional lymph node metastases were present in 19 patients; none were diagnosed by digital examination, but TRUS identified 11 of the 19. It is concluded that TRUS will result in more patients having the possibility of local...

  3. Digital rectal exam

    ... this page: // Digital rectal exam To use the sharing features on this page, please enable JavaScript. A digital rectal exam is an examination of the lower ...

  4. Estimation of clinically significant prostate volumes by digital rectal examination: a comparative prospective study.

    Ahmad, Sarfraz


    Reliable quantification of prostate volume is important to correctly select patients with benign prostatic hyperplasia (BPH) most likely to benefit from medical therapy [e.g. 5 alpha-reductase inhibitors (5-ARIs)] and in selecting appropriate surgical approach. We aim to determine the reliability of digital rectal examination (DRE) in estimation of prostate volume which may be helpful in patient selection for 5-ARIs therapy.

  5. A Survey of Digital Rectal Examination Training in Canadian Medical Schools

    Alysha Nensi


    Full Text Available BACKGROUND: The digital rectal examination (DRE is important for the diagnosis of a variety of gastrointestinal, urological and gynecological disorders. However, it appears that Canadian medical students may not be adequately taught nor provided the opportunity to practice their skills often enough. The present study was an analysis of the current practices in DRE teaching and evaluation in undergraduate medicine programs across Canada.

  6. Asynchronous teaching of psychomotor skills through VR annotations: evaluation in digital rectal examination.

    Rissanen, Mikko J; Kume, Naoto; Kuroda, Yoshihiro; Kuroda, Tomohiro; Yoshimura, Koji; Yoshihara, Hiroyuki


    Many VR technology based training systems use expert's motion data as the training aid, but would not provide any short-cut to teaching medical skills that do not depend on exact motions. Earlier we presented Annotated Simulation Records (ASRs), which can be used to encapsulate experts' insight on psychomotor skills. Annotations made to behavioural parameters in training simulators enable asynchronous teaching instead of just motion training in a proactive way to the learner. We evaluated ASRs for asynchronous teaching of Digital Rectal Examination (DRE) with 3 urologists and 8 medical students. The ASRs were found more effective than motion-based training with verbal feedback.

  7. Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men.

    Catalona, William J; Richie, Jerome P; Ahmann, Frederick R; Hudson, M'Liss A; Scardino, Peter T; Flanigan, Robert C; DeKernion, Jean B; Ratliff, Timothy L; Kavoussi, Louis R; Dalkin, Bruce L; Waters, W Bedford; MacFarlane, Michael T; Southwick, Paula C


    To compare the efficacy of digital rectal examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and digital rectal examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l. or digital rectal examination was suspicious, even if transrectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 μg./l., 15% had a suspicious digital rectal examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than digital rectal examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for digital rectal examination, 4.6% for PSA and 5.8% for the 2 methods combined. Positive predictive value was 32% for PSA and 21% for digital rectal examination. Of 160 patients who underwent radical prostatectomy and pathological staging 114 (71%) had organ confined cancer: PSA detected 85 (75%) and digital rectal examination detected 64 (56%, p = 0.003). Use of the 2 methods in combination increased detection of organ confined disease by 78% (50 of 64 cases) over digital rectal examination alone. If the performance of a biopsy would have required suspicious transrectal ultrasonography findings, nearly 40% of the tumors would have been missed. We conclude that the use of PSA in conjunction with digital rectal examination enhances early prostate cancer detection. Prostatic biopsy should be considered if either the PSA level is greater than 4 μg./l. or digital rectal examination is suspicious for cancer, even in the absence of abnormal transrectal ultrasonography findings.

  8. Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients.

    Nikendei, Christoph; Diefenbacher, Katja; Köhl-Hackert, Nadja; Lauber, Heike; Huber, Julia; Herrmann-Werner, Anne; Herzog, Wolfgang; Schultz, Jobst-Hendrik; Jünger, Jana; Krautter, Markus


    Physical clinical examination is a core clinical competence of medical doctors. In this regard, digital rectal examination (DRE) plays a central role in the detection of abnormalities of the anus and rectum. However, studies in undergraduate medical students as well as newly graduated doctors show that they are insufficiently prepared for performing DRE. Training units with Standardized Patients (SP) represent one method to deliver DRE skills. As yet, however, it is little known about SPs' attitudes. This is a qualitative study using a grounded theory approach. Interviews were conducted with 4 standardized patients about their experiences before, during and after structured SP training to deliver DRE competencies to medical students. The resulting data were subjected to thematic content analysis. Results show that SPs do not have any predominant motives for DRE program participation. They participate in the SP training sessions with relatively little prejudice and do not anticipate feeling highly vulnerable within teaching sessions with undergraduate medical students. The current study examined SPs' motives, views, expectations and experiences regarding a DRE program during their first SP training experiences. The results enabled us to derive distinct action guidelines for the recruitment, informing and briefing of SPs who are willing to participate in a DRE program.

  9. Prostate cancer diagnosis in a resource-poor setting: the changing role of digital rectal examination.

    Ahmed, Muhammed


    We undertook this study in order to determine the current role of digital rectal examination (DRE) in the diagnosis of prostate cancer in a resource-poor setting. The diagnosis of prostate cancer has been revolutionized by the introduction of prostate-specific antigen (PSA), transrectal ultrasound (TRUS) for biopsy guidance and more efficient biopsy equipment, but they are not readily available in most developing countries. This is a prospective study of 131 patients with suspected prostate cancer based on clinical presentation, DRE and elevated PSA. The presence or absence of cancer was confirmed by biopsy and histologic examination. Patients with screen- or incidentally-detected prostate cancer were excluded. The most common symptom was the development of lower urinary tract symptoms (LUTS). All patients had abnormal DRE and indurated prostate was the most frequent finding (50%). The mean PSA was 33.9 ng/mL: of the 131 patients, 80 (61.1%) had a malignant histology following biopsy, 47 (35.9%) were benign and four (3.0%) were prostate intraepithelial neoplasia (PIN). The low specificity of DRE in the diagnosis of prostate cancer requires that it should be combined with other diagnostic modalities such as PSA and TRUS-guided prostate biopsy. Thus government and health-care providers in resource-poor countries must strive to make these facilities available in order to improve prostate cancer diagnosis.

  10. Characterizing the range of simulated prostate abnormalities palpable by digital rectal examination.

    Baumgart, Leigh A; Gerling, Gregory J; Bass, Ellen J


    Although the digital rectal exam (DRE) is a common method of screening for prostate cancer and other abnormalities, the limits of ability to perform this hands-on exam are unknown. Perceptible limits are a function of the size, depth, and hardness of abnormalities within a given prostate stiffness. To better understand the perceptible limits of the DRE, we conducted a psychophysical study with 18 participants using a custom-built apparatus to simulate prostate tissue and abnormalities of varying size, depth, and hardness. Utilizing a modified version of the psychophysical method of constant stimuli, we uncovered thresholds of absolute detection and variance in ability between examiners. Within silicone-elastomers that mimic normal prostate tissue (21kPa), abnormalities of 4mm diameter (20mm(3) volume) and greater were consistently detectable (above 75% of the time) but only at a depth of 5mm. Abnormalities located in simulated tissue of greater stiffness (82kPa) had to be twice that volume (5mm diameter, 40mm(3) volume) to be detectable at the same rate. This study finds that the size and depth of abnormalities most influence detectability, while the relative stiffness between abnormalities and substrate also affects detectability for some size/depth combinations. While limits identified here are obtained for idealized substrates, this work is useful for informing the development of training and allowing clinicians to set expectations on performance.

  11. A comparison of virtual touch tissue quantification and digital rectal examination for discrimination between prostate cancer and benign prostatic hyperplasia

    Zheng, Xiaozhi; Ji, Ping; Mao, Hongwei; Hu, Jianqun


    Background Virtual touch tissue quantification (VTTQ) is a new, promising technique for detecting the stiffness of tissues. The aim of this study is to compare the performance of VTTQ and digital rectal examination (DRE) in discrimination between prostate cancer and benign prostatic hyperplasia (BPH). Patients and methods VTTQ was performed in 209 prostate nodular lesions of 107 patients with BPH and suspected prostate cancer before the prostate histopathologic examination. The shear wave vel...

  12. Interobserver consistency of digital rectal examination in clinical staging of localized prostatic carcinoma.

    Angulo, J C; Montie, J E; Bukowsky, T; Chakrabarty, A; Grignon, D J; Sakr, W; Shamsa, F H; Edson Pontes, J


    A prospective study was undertaken to determine the reproducibility of clinical staging based on digital rectal examination (DRE) in prostate carcinoma. We evaluated 48 consecutive patients diagnosed with localized prostatic cancer. Four urologists performed DRE and sorted the patients according to the 1992 American Joint Committee on Cancer Classification for prostate cancer. Both the percentage observed total agreement among each couple of two different observers and the interobserver variability (Kappa index) were analyzed. The percentage observed total agreement among observers in distinguishing five clinical subcategories (T1c, T2a, T2b, T2c, and T3a) ranged between 38-60% (mean 49%) and the Kappa index showed interobserver agreement was poor (overall Kappa = 0.3 1). All four examiners agreed in assigning the same subcategory in only 21 % of cases, and 90% of them were T I. If only categories are distinguished (T I, T2, or T3), the percentage observed total agreement rises to 60-71% (mean 66%) and the interexaminer agreement improves to good (overall Kappa = 0.4 1). Accurate pathologic staging was obtained in every patient and the percentage observed agreement between every examiner and the pathologist was calculated, excluding cases interpreted as T I c. Regarding subcategories, clinicopathologic agreement ranges between 17-46%. If only categories T2 and9T3 are distinguished, agreement rises to 57-69%. In summary, the ability to reproduce clinical staging based on DRE among multiple examiners is disappointingly low and understandably correlates poorly with pathologic stage.

  13. Creencias de hombres de Cali, Colombia, sobre el examen digital rectal: hallazgos de un estudio exploratorio Beliefs of men from Cali, Colombia, about digital rectal examination: findings of an exploratory study

    Diego Iván Lucumí-Cuesta


    Full Text Available Usando el Modelo de Creencias en Salud se exploraron creencias sobre el examen digital rectal como tamiz para cáncer en la próstata, antecedente e intención de práctica en hombres de 45 a 64 años de edad de Cali, Colombia. A los 267 participantes se les aplicó un cuestionario, previa selección mediante muestreo proporcional por cuotas. Después de un análisis univariado y bivariado se estableció que sólo un 25,8% de los participantes se había sometido previamente al examen digital rectal y 68,1% tenía intención de hacerlo en los siguientes 12 meses. Diferencias significativas (p This study used the Health Beliefs Model to explore beliefs on digital rectal examination (DRE to screen for prostrate cancer, prior to intent to submit to the examination, in men 45 to 64 years of age in Cali, Colombia. The 267 participants answered a questionnaire by means of prior selection through proportional sampling by quotas. A univariate and bivariate analysis showed that only 25.8% of the participants had submitted previously to digital rectal examination and that 68.1% intended to do so in the following 12 months. Significant differences (p < 0.05 were found between a history of DRE and schooling, socioeconomic status, health system coverage, perception of susceptibility to the disease, and perception of barriers and benefits. Significant differences (p < 0.05 were found between intent to submit to DRE and health system coverage, perception of severity of the disease, and perception of barriers. Given the low level of history of DRE and intent to submit to the examination, the results could help improve strategies to increase this practice at the local level.

  14. A comparison of virtual touch tissue quantification and digital rectal examination for discrimination between prostate cancer and benign prostatic hyperplasia.

    Zheng, Xiaozhi; Ji, Ping; Mao, Hongwei; Hu, Jianqun


    Virtual touch tissue quantification (VTTQ) is a new, promising technique for detecting the stiffness of tissues. The aim of this study is to compare the performance of VTTQ and digital rectal examination (DRE) in discrimination between prostate cancer and benign prostatic hyperplasia (BPH). VTTQ was performed in 209 prostate nodular lesions of 107 patients with BPH and suspected prostate cancer before the prostate histopathologic examination. The shear wave velocity (SWV) at each nodular lesion was quantified by implementing an acoustic radiation force impulse (ARFI). The performance of VTTQ and DRE in discrimination between prostate cancer and BPH was compared. The diagnostic value of VTTQ and DRE for prostate cancer was evaluated in terms of the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Prostate cancer was detected in 57 prostate nodular lesions by histopathologic examination. The SWV values (m/s) were significantly greater in prostate cancer and BPH than in normal prostate (2.37 ± 0.94, 1.98 ± 0.82 vs. 1.34 ± 0.47). The area under the receiver operating characteristic curve (AUC) for VTTQ (SWV>2.5m/s) to differentiate prostate nodules as benign hyperplasia or malignancy was 0.86, while it was 0.67 for DRE. The diagnostic sensitivity, specificity, PPV, NPV and accuracy were 71.93 %, 87.5 %, 68.33 %, 89.26 %, 83.25 %, respectively for VTTQ (SWV>2.5m/s), whereas they were 33.33 %, 81.57 %, 40.43 %, 76.54 %, 68.42 % respectively for DRE. VTTQ can effectively detect the stiffness of prostate nodular lesions, which has a significantly higher performance than DRE in discrimination between prostate cancer and BPH.

  15. The role of the digital rectal examination as diagnostic test for prostate cancer detection in obese patients.

    Dell'Atti, Lucio


    Digital rectal examination (DRE) is a routine part of prostate cancer Purpose: Digital rectal examination (DRE) is a routine part of prostate cancer (PCa) screening and provides important prognostic information. The purpose of this study was to analyse the potential association between obese patients and DRE findings for PCa detection. We retrospectively reviewed the medical records of patients who underwent an initial prostate needle biopsy for abnormal DRE, high prostate specific antigen (PSA) levels (≥4 ng/mL), or both at the Department of Urology. Patients with a history of biopsy, surgical treatment of prostatic disease, or incomplete clinical data were excluded from this study. A total of 1113 patients were included in the analysis. Before the biopsy procedure body mass index (BMI) was calculated. Age, PSA, BMI, DRE findings, prostate volume and Gleason score were analysed to assess the potential association between obesity and PCa detection. The mean + SD BMI was 28.3 + 4.1 kg/m2. A total of 373 (33.5%) patients were classified as obese (BMI ≥30 kg/m2). No significant difference was noted in the number of biopsy cores between obese and non obese patients. The obese men were older, had a lower PSA concentration, a large prostate volume, and were less likely to have abnormal DRE findings. Patients with high grade prostate cancer (HGPCa) had higher BMI. Age, PSA and prostate volume were not significantly associated with a higher risk of cancer at biopsy. Our data demonstrated that obese patients have lower PSA levels, larger prostates and abundant perirectal fat. Lower PSA serum levels and large prostate size associated with high BMI, indicated a potential risk for delayed diagnosis and poor pathological outcomes.PCa) screening and provides important prognostic information. The purpose of this study was to analyse the potential association between obese patients and DRE findings for PCa detection. We retrospectively reviewed the medical records of patients

  16. Digital rectal examination (DRE does not influence total serum levels of prostate specific antigen (tPSA, in individuals without prostate pathology

    Maria de F. Figueirêdo


    Full Text Available OBJECTIVE: To evaluate if the digital rectal examination (DRE performed before determination of total serum prostate specific antigen (tPSA influences the levels of this protein. MATERIALS AND METHODS: Forty-eight men without a diagnosis of prostate pathology were assessed for tPSA levels, before and 30 minutes after DRE examination. Values of tPSA in the individuals' serum were measured by the electrochemoluminescence (ECLIA, in Roche's Elecys 1010 analyzer. RESULTS: DRE examination induced a modest elevation in tPSA values in 34 of the 48 men, with a variation in mean elevation from 2.19% in the age range ³ 70 years to 11.96% in the age range of 60-69 years. Additionally, moderate decreases in values were detected in 11 individuals and 3 did not present any alteration following the procedure. Differences in mean values of tPSA, pre- and post-DRE were not statistically significant, neither in the total sample of individuals or in the age range groups. CONCLUSION: DRE examination does not significantly influence the tPSA values in individuals under study.

  17. Prostate cancer detection upon transrectal ultrasound-guided biopsy in relation to digital rectal examination and prostate-specific antigen level: what to expect in the Chinese population?

    Jeremy YC Teoh


    Full Text Available We investigated the prostate cancer detection rates upon transrectal ultrasound (TRUS-guided biopsy in relation to digital rectal examination (DRE and prostate-specific antigen (PSA, and risk factors of prostate cancer detection in the Chinese population. Data from all consecutive Chinese men who underwent first TRUS-guided prostate biopsy from year 2000 to 2013 was retrieved from our database. The prostate cancer detection rates with reference to DRE finding and PSA level of 50 ng ml−1 were investigated. Multivariate logistic regression analyses were performed to investigate for potential risk factors of prostate cancer detection. A total of 2606 Chinese men were included. In patients with normal DRE, the cancer detection rates were 8.6%, 13.4%, 21.8%, 41.7% and 85.2% in patients with PSA 50 ng ml−1 respectively. In patients with abnormal DRE, the cancer detection rates were 12.4%, 30.2%, 52.7%, 80.6% and 96.4% in patients with PSA 50 ng ml−1 respectively. Older age, smaller prostate volume, larger number of biopsy cores, presence of abnormal DRE finding and higher PSA level were associated with increased risk of prostate cancer detection upon multivariate logistic regression analyses (P < 0.001. Chinese men appeared to have lower prostate cancer detection rates when compared to the Western population. Taking the different risk factors into account, an individualized approach to the decision of TRUS-guided biopsy can be adopted.

  18. Clinico-pathological correlation of digital rectal examination findings amongst Nigerian men with prostatic diseases: A prospective study of 236 cases

    Rufus W Ojewola


    Full Text Available Aims and Objective: This study aims at correlating different digital rectal examination (DRE abnormalities with histopathological results in patients with prostatic diseases. Materials and Methods: A prospective study of 236 patients who underwent prostate needle biopsy (PNB. Inclusion criteria were presence of abnormal DRE findings or elevated prostate specific antigen above 4 ng/ml or both. They all had 10-core extended transrectal biopsy and specimens were sent for histopathological examination. Correlations were made between DRE findings and histopathology results. Two separate multivariate logistic regression models were created; the first evaluated the relationship of predictors (DRE findings to the likelihood of detecting cancer and the second explored predictors of high-grade cancer on PNB. Results: Two hundred and thirty-six patients were enrolled with a mean age of 66.9 years and range of 43-90 years. Histopathology results were malignant in 102 (43.2% and benign in 134 (56.8%. Ninety-one (38.6% and 145 (61.4% had normal DRE and abnormal DRE findings with cancer detection rates of 23.1% and 55.8% respectively. Nodular prostate is the most common abnormality in 63.4% patients with abnormal DRE. Each sign of DRE had different predictive value with enhanced positive predictive value when combinations of abnormalities are present. Abnormal DRE is an independent predictor of high-grade tumor. Mean Gleason scores were 4.7 and 7.1 in patients with normal and abnormal DRE respectively. Conclusion: DRE is a useful and important tool in assessing patients with suspected prostate diseases who need prostate biopsy. An abnormal DRE correlated well with prostate cancer and independently predicted high-grade disease in these men.

  19. A nomogram based on age,prostate-specific antigen level,prostate volume and digital rectal examination for predicting risk of prostate cancer

    Ping Tang; Hui Chen; Matthew Uhlman; Yu-Rong Lin; Xiang-Rong Deng; Bin Wang; Wen-Jun Yang; Ke-Ji Xie


    Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort.In the present study,we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population.A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included.Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy.Age,prostate-specific antigen (PSA),prostate volume (PV),digital rectal examination (DRE) status,% free PSA and transrectal ultrasound (TRUS) findings were included in the analysis.A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy.A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy.The rate for positive initial prostate biopsy was 41.7% (223/535).The independent variables used to predict a positive initial prostate biopsy were age,PSA,PV and DRE status.The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%,respectively.Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram.The nomogram can be used to identify and Counsel patients who should consider a prostate biopsy,ultimately enhancing accuracy in diagnosing prostate cancer.

  20. Comparison of Digital Rectal and Microchip Transponder Thermometry in Ferrets (Mustela putorius furo)

    Maxwell, Branden M; Brunell, Marla K; Olsen, Cara H; Bentzel, David E


    Body temperature is a common physiologic parameter measured in both clinical and research settings, with rectal thermometry being implied as the ‘gold standard.’ However, rectal thermometry usually requires physical or chemical restraint, potentially causing falsely elevated readings due to animal stress. A less stressful method may eliminate this confounding variable. The current study compared 2 types of digital rectal thermometers—a calibrated digital thermometer and a common digital thermometer—with an implantable subcutaneous transponder microchip. Microchips were implanted subcutaneously between the shoulder blades of 16 ferrets (8 male, 8 female), and temperatures were measured twice from the microchip reader and once from each of the rectal thermometers. Results demonstrated the microchip temperature readings had very good to good correlation and agreement to those from both of the rectal thermometers. This study indicates that implantable temperature-sensing microchips are a reliable alternative to rectal thermometry for monitoring body temperature in ferrets. PMID:27177569

  1. Parasitological diagnosis of schistosomiasis mansoni: fecal examination and rectal biopsy

    Ana Lúcia Teles Rabello


    Full Text Available Even with all progress in the search of sensitive and methods for the immunological diagnosis of schistosomiasis, the microscopic detection of eggs of the parasite in the stool still remains the most widely used tool for the actual diagnosis of active infection. Among the coproscopic methods, Kato's technic modified by Katz et al (Kato/Katz has the advantages of higher sensitivity, the possibility of egg quantification, its low operational cost and its feasibility in areas with minimal infra-structure. The oorgram of the rectal mucosa is valuable in initial clinical trials of schistosomicides, when it is needed to observe egg morphology in tissue. It could be an alternative method for individual diagnosis, being more sensitive than a single stool exam in low intensity infection. However, the increased sensitivity of a higher number of fecal exams makes that invasiveprocedure unnecessary. In the assessment of cure of schistosomiasis, Kato/Katz method (three fecal samples in one, three and six months after treatment and the rectal biopsy four months after treatment, are equally reliable.

  2. Examining Factors Predicting Students' Digital Competence

    Hatlevik, Ove Edvard; Guðmundsdóttir, Gréta Björk; Loi, Massimo


    The purpose of this study was to examine factors predicting lower secondary school students' digital competence and to explore differences between students when it comes to digital competence. Results from a digital competence test and survey in lower secondary school will be presented. It is important to learn more about and investigate what…

  3. Clinico‑pathological Correlation of Digital Rectal Examination ...

    prostate cancer (PCa), and chronic prostatitis.[2] PCa is the most common ... Materials and Methods: A prospective study of 236 patients who underwent ..... DRE with severe compromise of quality of life like impending paraplegia, treatment ...

  4. Influence of repeated rectal ultrasound examinations on hormone profiles and behaviour around oestrus and ovulation in dairy cattle

    Roelofs, J.B.; Bouwman, E.G.; Dieleman, S.J.; Eerdenburg, van F.J.C.M.; Lansbergen, L.M.T.E.; Soede, N.M.; Kemp, B.


    Frequent rectal ultrasound is often used to assess time of ovulation. This study investigated whether frequent rectal ultrasound examination, affects behavioural oestrus and peri-ovulatory hormone profiles (LH, oestradiol and progesterone). Additionally, the relation between peri-ovulatory hormone p

  5. Examining Factors Predicting Students’ Digital Competence

    Ove Edvard Hatlevik


    Full Text Available The purpose of this study was to examine factors predicting lower secondary school students’ digital competence and to explore differences between students when it comes to digital competence. Results from a digital competence test and survey in lower secondary school will be presented. It is important to learn more about and investigate what characterizes students’ digital competence. A sample of 852 ninth-grade Norwegian students from 38 schools participated in the study. The students answered a 26 item multiple-choice digital competence test and a self-report questionnaire about family background, motivation, and previous grades. Structural equation modeling was used to test a model of the hypothesised relationship between family background, mastery orientation, previous achievements, and digital competence. The results indicate variation in digital competence among the ninth-graders. Further, analyses showed that students’ conditions at home, i.e., language integration and cultural capital, together with mastery orientation and academic achievements predict students digital competence. This study indicates that that there is evidence of digital diversity between lower secondary students. It does not seem like the development of digital competence among the students happens automatically. Students’ family background and school performance are the most important factors. Therefore, as this study shows, it is necessary to further investigate how schools can identify students’ level of competence and to develop plans and actions for how schools can help to try to equalize differences.

  6. Stereomicroscopic examination of stained rectal biopsies in ulcerative colitis and Crohn's disease

    Poulsen, Steen Seier


    Rectal biopsy samples from 22 healthy control subjects, 54 patients with ulcerative colitis, and 34 with Crohn's disease with involvement of the colon or rectum were investigated in a stereomicroscopic study. Samples were stained as whole mounts with Alcian Green before the stereomicroscopic...... the stereomicroscopic findings and the clinical disease activity, the sigmoidoscopic findings, and the histologic activity. Apart from the stereomicroscopic observation of small superficial erosions in one fourth of the biopsies, no changes of diagnostic value were observed in Crohn's disease....

  7. Distribution of mesorectal lymph nodes in rectal cancer: in vivo MR imaging compared with histopathological examination. Initial observations

    Koh, D.M.; Brown, G.; Temple, L.; Blake, H.; Raja, A.; Toomey, P.; Bett, N.; Farhat, S.; Norman, A.R.; Daniels, I.; Husband, J.E. [Royal Marsden Hospital, Academic Department of Radiology, Cancer Research UK Magnetic Resonance Group, Institute of Cancer Research, Sutton (United Kingdom)


    The aim of this work was to determine the distribution of mesorectal lymph nodes using T{sub 2}-weighted magnetic resonance (MR) imaging compared with histopathological findings in patients with rectal carcinoma. Sixteen patients with rectal carcinoma undergoing primary surgery without pre-operative neoadjuvant treatment were evaluated using 3-mm axial T{sub 2}-weighted MR imaging. The position of each visible mesorectal node on imaging was localised by measuring its minimum distance from the mesorectal fascia (d{sub m}), its minimum distance from the rectal wall (d{sub r}) and its distance from the distal tumour margin (d{sub v}). Independent assessment of d{sub m}, d{sub r} and d{sub v} was made at histopathological examination. Eighty-five mesorectal nodes on in vivo MR imaging were matched to histopathological findings. On imaging, 67/85 mesorectal nodes were found at the level of the tumour and 84/85 were identified at or within 5 cm proximal to the tumour. Only one out of 85 nodes was seen below the inferior tumour margin. The mean difference of d{sub m} and d{sub r} obtained on in vivo MR imaging and histopathological examination was 0.7 mm (95% confidence interval, CI, -0.12 to 1.42 mm) and -1.1 mm (95% CI -2.29 to 0.14 mm), respectively. Almost all mesorectal nodes visible on MR imaging were found at the level of tumour or within 5 cm proximal to the tumour. This has implications for the planning of MR imaging and the level of mesorectal transection at surgery. (orig.)

  8. Transitioning towards the Digital Native: Examining Digital Technologies, Video Games, and Learning

    Salomon, John


    Although digital technologies have become commonplace among people who grew up around them, little is known about the effect that such technology will have on learners or its impact on traditional methods of educational delivery. This dissertation examines how certain technologies affect digital natives and seeks to understand specific…

  9. A flight test facility design for examining digital information transfer

    Knox, Charles E.


    Information is given in viewgraph form on a flight test facility design for examining digital information transfer. Information is given on aircraft/ground exchange, data link research activities, data link display format, a data link flight test, and the flight test setup.

  10. Application of radio frequency based digital thermometer for real-time monitoring of dairy cattle rectal temperature

    Tridib Debnath


    Full Text Available Aim: Dairy cattle health monitoring program becomes vital for detecting the febrile conditions to prevent the outbreak of the animal diseases as well as ensuring the fitness of the animals that are directly affecting the health of the consumers. The aim of this study was to validate real-time rectal temperature (RT data of radio frequency based digital (RFD thermometer with RT data of mercury bulb (MB thermometer in dairy cattle. Materials and Methods: Two experiments were conducted. In experiment I, six female Jersey crossbred cattle with a mean (±standard error of the mean body weight of 534.83±13.90 kg at the age of 12±0.52 years were used to record RT for 2 h on empty stomach and 2 h after feeding at 0, 30, 60, 90, and 120 min using a RFD thermometer as well as a MB thermometer. In experiment II, six female Jersey crossbred cattle were further used to record RT for 2 h before exercise and 2 h after exercise at 0, 30, 60, 90, and 120 min. Two-way repeated measures analysis of variance with post hoc comparisons by Bonferroni test was done. Results: Real-time RT data recorded by RFD thermometer as well as MB thermometer did not differ (p>0.05 before and after feeding/exercise. An increase (p<0.05 in RT after feeding/exercise in experimental crossbred cattle was recorded by both RFD thermometer and MB thermometer. Conclusion: The results obtained in the present study suggest that the body temperature recordings from RFD thermometer would be acceptable and thus RFD thermometer could work well for monitoring real-time RT in cattle.

  11. The substitution of digital images for dermatologic physical examination.

    Kvedar, J C; Edwards, R A; Menn, E R; Mofid, M; Gonzalez, E; Dover, J; Parrish, J A


    To investigate the diagnostic accuracy of clinicians viewing a patient's history and static digital image set compared with clinicians who conducted office-based physical examinations of the same patients. Observational study. One hundred sixteen adult patients presenting with dermatologic symptoms in a university-based practice who consented to have their skin conditions documented with a still digital camera according to a standardized protocol. Concordance between office-based dermatologists' diagnoses and 2 remote clinicians' diagnoses using still digital images (resolution, 92 dots per inch) and identical medical history data to render diagnoses. When photographic quality was high and office-based clinician certainty was high, remote clinicians were in agreement more than 75% of the time. Office-based and remote clinicians were in agreement 61% to 64% of the time for all cases. No specific disease category appeared to be more or less amenable to diagnosis based on still digital imagery. The diagnostic certainty of the office-based clinician (reported from 0-10) had the most impact on agreement. When cases with office-based clinician certainty of no more than 7 were compared with cases with certainty of at least 9, agreement increased 54% for remote clinician 1 and 111% for remote clinician 2. As an isolated variable, photographic quality had a modest impact on agreement. Still digital images can substitute for the dermatologic physical examination in up to 83% of cases. This study provides validation of the store-and-forward concept of telemedicine as applied to dermatology. These results serve as the foundation for field testing of the concept in primary care settings.

  12. The Cuban Institute of Oncology and Radiobiology experience on the beliefs and opinions about digital rectal exam in urological patients

    Isabel García Figueredo


    Full Text Available Resumen OBJETIVO Describir las creencias, los conocimientos y opiniones sobre el examen dígito rectal en un grupo de pacientes urológicos. MÉTODOS Se desarrolló un estudio descriptivo transversal donde se evaluó un cuestionario anónimo con 15 preguntas, dividido en tres bloques: 1 variables socio-demográficas; 2 retraso en ir a la consulta de urología y su inconformidad con la práctica del examen dígito rectal; 3 percepción de dolor y malestar durante el examen dígito rectal. El cuestionario fue aplicado a una muestra de conveniencia. RESULTADOS Se analizaron 84 encuestas aplicadas en el Instituto de Oncología y Radiobiología de Cuba. Los resultados mostraron que 70,24% de los participantes conocían en cierta medida sobre el cáncer de próstata y 64,29%, sobre el uso del antígeno prostático específico. Sólo 27% encontró útil realizarse el examen digito rectal. Los mayores impedimentos para asistir a la consulta del urólogo fueron: no someterse a una biopsia (79,76% y evadir la práctica del examen dígito rectal (66,66%. Además, se observó que 52,39% y 36,90% de los hombres se quejaron de dolor moderado y severo respectivamente, siendo traumático el examen dígito rectal en 61,9%. Sin embargo, 88,09% de los pacientes respondió que repetirían el examen al siguiente año y el 94,05% animaría a un amigo para someterse al él. CONCLUSIONES En la muestra de individuos estudiados, más de la mitad afirmó conocer sobre el cáncer de próstata y el antígeno prostático específico, sin embargo, no consideró provechoso someterse a un examen dígito rectal. Evitar someterse a una biopsia o al examen dígito rectal fueron los principales impedimentos para su asistencia al urólogo. A pesar de que en la mayoría de los pacientes, realizarse el examen dígito rectal fue traumático, estos consintieron en repetírselo en el futuro.

  13. An inconclusive digital audio authenticity examination: a unique case.

    Koenig, Bruce E; Lacey, Douglas S


    This case report sets forth an authenticity examination of 35 encrypted, proprietary-format digital audio files containing recorded telephone conversations between two codefendants in a criminal matter. The codefendant who recorded the conversations did so on a recording system he developed; additionally, he was both a forensic audio authenticity examiner, who had published and presented in the field, and was the head of a professional audio society's writing group for authenticity standards. The authors conducted the examination of the recordings following nine laboratory steps of the peer-reviewed and published 11-step digital audio authenticity protocol. Based considerably on the codefendant's direct involvement with the development of the encrypted audio format, his experience in the field of forensic audio authenticity analysis, and the ease with which the audio files could be accessed, converted, edited in the gap areas, and reconstructed in such a way that the processes were undetected, the authors concluded that the recordings could not be scientifically authenticated through accepted forensic practices.

  14. Book Review: Digital Forensic Evidence Examination (2nd ed.)

    Gary Kessler


    Cohen, F. (2010). Digital Forensic Evidence Examination (2nd ed.). Livermore, CA: ASP Press. 452 pages, ISBN: 978-1-878109-45-3, US$79.Reviewed by Gary C. Kessler, Gary Kessler Associates & Edith Cowan University ()On the day that I sat down to start to write this review, the following e-mailcame across on one of my lists:Person A and Person B write back and forth and create an email thread. Person A then forwards the email to Person C, but changes some wording in the e...

  15. To License or Not to License: An Examination of State Statutes Regarding Private Investigators and Digital Examiners

    Thomas Lonardo


    Full Text Available In this paper the authors examine statutes that regulate, license, and enforce investigative functions in each US state. After identification and review of Private Investigator licensing requirements, the authors find that very few state statutes explicitly differentiate between Private Investigators and Digital Examiners. After contacting all state agencies the authors present a distinct grouping organizing state approaches to professional Digital Examiner licensing. The authors conclude that states must differentiate between Private Investigator and Digital Examiner licensing requirements and oversight.

  16. Book Review: Digital Forensic Evidence Examination (2nd ed.

    Gary Kessler


    Full Text Available Cohen, F. (2010. Digital Forensic Evidence Examination (2nd ed.. Livermore, CA: ASP Press. 452 pages, ISBN: 978-1-878109-45-3, US$79.Reviewed by Gary C. Kessler, Gary Kessler Associates & Edith Cowan University (gck@garykessler.netOn the day that I sat down to start to write this review, the following e-mailcame across on one of my lists:Person A and Person B write back and forth and create an email thread. Person A then forwards the email to Person C, but changes some wording in the email exchange between A & B. What is the easiest way (and is it even possible to find out when that earlier email message was altered before sent to Person C?Before you try to answer these questions, read Fred Cohen's Digital Forensic Evidence Examination. His book won't actually tell you how to answer these questions but it will help you understand the difficulty in even trying to answer them with any level of certainty.(see PDF for full review

  17. Relationship among eye and muzzle temperatures measured using digital infrared thermal imaging and vaginal and rectal temperatures in hair sheep and cattle.

    George, W D; Godfrey, R W; Ketring, R C; Vinson, M C; Willard, S T


    Digital infrared thermal imaging (DITI) using a thermal camera has potential to be a useful tool for the production animal industry. Thermography has been used in both humans and a wide range of animal species to measure body temperature as a method to detect injury or inflammation. The objective of these experiments was to compare the temperature of the eye (EYE) or muzzle (MUZ) measured using DITI to vaginal (VT) and rectal temperature (RT) as measures of core body temperature in hair sheep and beef cattle. In Exp.1 EYE, VT and RT were measured in lactating, multiparous hair sheep ewes (St. Croix White, n = 10, and Dorper × St. Croix White, n = 10) in a non-febrile state 5 times over a 48-h period. Data loggers were used to measure VT and a digital veterinary thermometer was used to measure RT. There was a high correlation (P 0.10) between RT or VT and MUZ. The findings of these three studies indicate that temperature of the eye, measured using DITI, can be used as an indicator of core body temperature in hair sheep and beef cattle as an alternative to using vaginal or rectal temperature.

  18. Mesalamine Rectal

    Rectal mesalamine comes as a suppository and an enema to use in the rectum. The suppository and the enema are usually used once a day at bedtime. ... rectal mesalamine without talking to your doctor.Mesalamine suppositories and enemas may stain clothing and other fabrics, ...

  19. Standard practice for radiological examination using digital detector arrays

    American Society for Testing and Materials. Philadelphia


    1.1 This practice establishes the minimum requirements for radiological examination for metallic and nonmetallic material using a digital detector array (DDA) system. 1.2 The requirements in this practice are intended to control the quality of radiologic images and are not intended to establish acceptance criteria for parts or materials. 1.3 This practice covers the radiologic examination with DDAs including DDAs described in Practice E2597 such as a device that contains a photoconductor attached to a Thin Film Transistor (TFT) read out structure, a device that has a phosphor coupled directly to an amorphous silicon read-out structure, and devices where a phosphor is coupled to a CMOS (Complementary metal–oxide–semiconductor) array, a Linear Detector Array (LDA) or a CCD (charge coupled device) crystalline silicon read-out structure. 1.4 The DDA shall be selected for an NDT application based on knowledge of the technology described in Guide , and of the selected DDA properties provided by the manufactu...

  20. To License or Not to License Revisited: An Examination of State Statutes Regarding Private Investigators and Digital Examiners

    Thomas Lonardo


    Full Text Available In this update to the previous year's study, the authors examine statutes that regulate, license, and enforce investigative functions in each US state. After identification and review of Private Investigator licensing requirements, the authors find that very few state statutes explicitly differentiate between Private Investigators and Digital Examiners. After contacting all state agencies the authors present a distinct grouping organizing state approaches to professional Digital Examiner licensing. The authors conclude that states must differentiate between Private Investigator and Digital Examiner licensing requirements and oversight.

  1. Rectal Imaging: Part I, High-Resolution MRI of Carcinoma of the Rectum at 3 T

    Halappa, Vivek Gowdra; Villalobos, Celia Pamela Corona; Bonekamp, Susanne; Gearhart, Susan L.; Efron, Jonathan; Herman, Joseph; Kamel, Ihab R.


    OBJECTIVE MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. CONCLUSION High-resolution MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal involvement, nodes, and distant metastasis. In this article, we will review the utility of rectal MRI in local staging, preoperative evaluation, and surgical planning. MRI at 3 T can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment. PMID:22733930

  2. Digital examination and transvaginal scan - competing or complementary for predicting preterm birth?

    Reiter, Eva; Nielsen, Kurt Aagaard; Fedder, Jens


    The transvaginal ultrasonographic cervix scan has partly replaced digital examination for diagnosing preterm birth; conflicting results are reported about their respective contribution to birth prediction.......The transvaginal ultrasonographic cervix scan has partly replaced digital examination for diagnosing preterm birth; conflicting results are reported about their respective contribution to birth prediction....

  3. To License or Not to License Updated: An Examination of State Statutes Regarding Private Investigators and Digital Examiners

    Thomas Lonardo


    Full Text Available In this update to the 2009 year's study, the authors examine statutes that regulate, license, and enforce investigative functions in each US state. After identification and review of Private Investigator licensing requirements, the authors find that very few state statutes explicitly differentiate between Private Investigators and Digital Examiners, but do see a trend of more states making some distinction. The authors contacted all state regulatory agencies where statutory language was not explicit, and as a result, set forth the various state approaches to professional Digital Examiner licensing. As was the case in the previous two iterations of this research, the authors conclude that states must differentiate between Private Investigator and Digital Examiner licensing requirements and oversight.

  4. Diazepam Rectal

    ... serious, life-threatening side effects. Do not drink alcohol or use street drugs during your treatment. ... your doctor if you drink large amounts of alcohol or use or have used street ... using diazepam rectal gel, call your to your doctor about ...

  5. Relationship among eye temperature measured using digital infrared thermal imaging and vaginal and rectal temperatures in hair sheep and cattle

    Digital infrared thermal imaging (DITI) using a thermal camera has potential to be a useful tool for the production animal industry. Thermography has been used in both humans and a wide range of animal species to measure body temperature as a method to detect injury or inflammation. The objective of...

  6. Examining the Effectiveness of Digital Video Recordings on Oral Performance of EFL Learners

    Göktürk, Nazlinur


    This study reports the results of an action-based study conducted in an EFL class to examine whether digital video recordings would contribute to the enhancement of EFL learners' oral fluency skills. It also investigates the learners' perceptions of the use of digital video recordings in a speaking class. 10 Turkish EFL learners participated in…

  7. Examining Digital Literacy Competences and Learning Habits of Open and Distance Learners

    Ozdamar-Keskin, Nilgun; Ozata, Fatma Zeynep; Banar, Kerim; Royle, Karl


    The purpose of the study is to examine digital literacy competences and learning habits of learners enrolled in the open and distance education system of Anadolu University in Turkey. Data were gathered from 20.172 open and distance learners through a survey which included four parts: demographic information, abilities to use digital technologies,…

  8. How Students Communicate Mathematical Ideas: An Examination of Multimodal Writing Using Digital Technologies

    Freeman, Barbara; Higgins, Kristina N.; Horney, Mark


    This article reports the findings of a study designed to examine the influence of multimodal writing on the communication of mathematical ideas. Elementary school students (ages 8-13) were required to write mathematics notes using two digital writing technologies, a personal digital notepad and a social mathematics blog, in the context of a formal…

  9. Legal Issues Regarding Digital Forensic Examiners Third Party Consent to Search

    Thomas Lonardo


    Full Text Available This paper focuses on Federal law as it relates to consent to search relating to Fourth Amendment privacy in the practice of Digital Forensics. In particular, Digital Examiners should be aware of how decisions in Federal Court may impact their ability to acquire evidence in both civil and criminal settings. Digital Forensics, being a relatively new field, is particularly subject to change as cases and appeals are decided. This paper provides an overview of relevant case law relating to issues in Digital Forensics. More importantly, our research provides Digital Forensic Examiners (DFE, as defined by Lonardo, White, and Rea (Lonardo, 2008, 2009, with scenarios that illustrate the various nuances when dealing with the consent to search. From issues of common authority, conflicting consent, apparent authority, and voluntary consent, our research explores court findings and applies them to practical advice and policy formation for DFEs.


    Rakesh Kumar


    Full Text Available : INTRODUCTION: Rectal foreign bodies are common, but foreign body made of glass with uneven sharp distal end and complicated with hypovolemic shock is very rare. It is very challenging to be removed by laparotomy and poses extra difficulty in emergency. PRESENTATION OF CASE: A 45-year-old man with complains of rectal foreign body and bleeding per rectum reported in emergency room. On examination patient was in hypovolemic shock and continuous bleeding through anal opening. Emergency laparotomy was per-formed and foreign body was retrieved successfully. DISCUSSION: Rectal foreign body made of glass with uneven sharp distal end towards distal end of rectum is very rare. Retrieval of these foreign bodies will be very difficult, especially for the emergency cases that are complicated with hypovolemic shock. Emergency laparotomy can be successfully performed to stop the bleeding and minimize rectal and anal canal trauma. To the best of our knowledge, such rectal foreign body has been rarely reported. CONCLUSION: Rectal foreign body with uneven sharp edges towards anal opening are difficult to retrieve trough transanal route. Hypovolemic shock due to bleeding and rectal perforation is major complications of these foreign bodies. Emergency laparotomy should be done in these cases.

  11. Understanding Minor Rectal Bleeding

    ... Home / For Patients / Patient Information Understanding Minor Rectal Bleeding What are the possible causes of minor rectal bleeding? Hemorrhoids Anal fissures Proctitis (inflammation of the rectum) ...

  12. Brazilian young dental practitioners' use and acceptance of digital radiographic examinations

    Rovaris, Karla; De Faria Vasconcelos, Karla; Do Nascimento, Eduarda Helena Leandro; Oliveira, Matheus Lima; Freitas, Deborah Queiroz; Haiter-Neto, Francisco [Div. of Oral Radiology, Dept. of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo (Brazil)


    The aim of this study was to investigate the use and acceptance of digital radiographic examinations by Brazilian dental practitioners in daily practice and to evaluate the advances that have occurred over the past 5 years. Dental practitioners enrolled in extension courses at the Piracicaba Dental School, University of Campinas, Brazil, responded to a self-administered questionnaire in the years 2011 and 2015. They were asked about sociodemographic factors and their knowledge and use of digital radiographic examinations. Descriptive analysis was performed, as well as the chi-square and Fisher exact tests, with a significance level of 5% (α=0.05). A total of 181 participants responded to the questionnaire in the years 2011 and 2015. Most of the respondents worked in private practice, had graduated within the last 5 years, and were between 20 and 30 years old. In 2011, 55.6% of respondents reported having ever used digital radiographic examinations, while in 2015 this number increased significantly to 85.4% (p<.0001), out of which 71.4% preferred it to conventional images. Moreover, 21.4% of respondents reported having used digital radiographic examinations for more than 3 years. A significant increase in use of intraoral digital radiography (p=0.0316) was observed in 2015. In both years, image quality and high cost were indicated, respectively, as the main advantage and disadvantage of digital radiographic examinations. This study showed that digital radiology has become more common in Brazil over the past 5 years. Most of the Brazilian dental practitioners evaluated in 2015 used digital radiographic examinations.

  13. Investigation delayed is justice denied: proposals for expediting forensic examinations of digital evidence.

    Casey, Eoghan; Ferraro, Monique; Nguyen, Lam


    There is an urgent need to reduce the growing backlog of forensic examinations in Digital Forensics Laboratories (DFLs). Currently, DFLs routinely create forensic duplicates and perform in-depth forensic examinations of all submitted media. This approach is rapidly becoming untenable as more cases involve increasing quantities of digital evidence. A more efficient and effective three-tiered strategy for performing forensic examinations will enable DFLs to produce useful results in a timely manner at different phases of an investigation, and will reduce unnecessary expenditure of resources on less serious matters. The three levels of forensic examination are described along with practical examples and suitable tools. Realizing that this is not simply a technical problem, we address the need to update training and establish thresholds in DFLs. Threshold considerations include the likelihood of missing exculpatory evidence and seriousness of the offense. We conclude with the implications of scaling forensic examinations to the investigation.

  14. Examining Student Digital Artifacts during a Year-Long Technology Integration Initiative

    Rodriguez, Prisca M.; Frey, Chris; Dawson, Kara; Liu, Feng; Ritzhaupt, Albert D.


    This study was situated within a year-long, statewide technology integration initiative designed to support technology integration within science, technology, engineering, and math classrooms. It examined the elements used in student artifacts in an attempt to investigate trends in digital artifact creation. Among several conclusions, this…

  15. Examining Online Forum Discussions as Practices of Digital Literacy in College-Level ESL Writing

    Bauler, Clara Vaz


    This research study examines the role of digital media, more specifically online forums, in the development of academic literacy and language learning in English as a Second Language (ESL) college writing. Studies in Second Language Acquisition suggest that participation in online forum discussions can potentially foster collaboration,…

  16. An Examination of Teachers' Ratings of Lesson Plans Using Digital Primary Sources

    Milman, Natalie B.; Bondie, Rhonda


    This mixed method study examined teachers' ratings of 37 field-tested social studies lesson plans that incorporated digital primary sources through a grant from the Library of Congress Teaching with Primary Sources program for K-12 teachers. Each lesson, available in an online teaching materials collection, was field-tested and reviewed by at…

  17. Digital subtraction angiography and intraarterial contrast medium injection for coronary examinations

    Tobio, R.; Kallmeyer, C.; Castello, J.


    Digital subtraction angiography (DSA) is an established method of vasography, most extensively used as i.v. DSA. Intraarterial injection, however, applying selective or non-selective contrast medium injection, seems to be at least as important a technique although it has not yet met with corresponding interest. The article explains advantages of the technique for angiographic examinations, in particular of coronary angiography.

  18. Digital Examination in Higher Education--Experiences from Three Different Perspectives

    Berggren, Björn; Fili, Andreas; Nordberg, Olle


    Assessment through new technology has gained a firm foothold within the university system in the last decade. This paper summarizes the experiences that have been made during the introduction of digital examination over the past two years at the Royal Institute of Technology in Stockholm, Sweden. The experiences are divided between three different…

  19. Examining Online Forum Discussions as Practices of Digital Literacy in College-Level ESL Writing

    Bauler, Clara Vaz


    This research study examines the role of digital media, more specifically online forums, in the development of academic literacy and language learning in English as a Second Language (ESL) college writing. Studies in Second Language Acquisition suggest that participation in online forum discussions can potentially foster collaboration,…

  20. Exploring virtual reality technology and the Oculus Rift for the examination of digital pathology slides

    Farahani, Navid; Post, Robert; Duboy, Jon; Ahmed, Ishtiaque; Kolowitz, Brian J.; Krinchai, Teppituk; Monaco, Sara E.; Fine, Jeffrey L.; Hartman, Douglas J.; Pantanowitz, Liron


    Background: Digital slides obtained from whole slide imaging (WSI) platforms are typically viewed in two dimensions using desktop personal computer monitors or more recently on mobile devices. To the best of our knowledge, we are not aware of any studies viewing digital pathology slides in a virtual reality (VR) environment. VR technology enables users to be artificially immersed in and interact with a computer-simulated world. Oculus Rift is among the world's first consumer-targeted VR headsets, intended primarily for enhanced gaming. Our aim was to explore the use of the Oculus Rift for examining digital pathology slides in a VR environment. Methods: An Oculus Rift Development Kit 2 (DK2) was connected to a 64-bit computer running Virtual Desktop software. Glass slides from twenty randomly selected lymph node cases (ten with benign and ten malignant diagnoses) were digitized using a WSI scanner. Three pathologists reviewed these digital slides on a 27-inch 5K display and with the Oculus Rift after a 2-week washout period. Recorded endpoints included concordance of final diagnoses and time required to examine slides. The pathologists also rated their ease of navigation, image quality, and diagnostic confidence for both modalities. Results: There was 90% diagnostic concordance when reviewing WSI using a 5K display and Oculus Rift. The time required to examine digital pathology slides on the 5K display averaged 39 s (range 10–120 s), compared to 62 s with the Oculus Rift (range 15–270 s). All pathologists confirmed that digital pathology slides were easily viewable in a VR environment. The ratings for image quality and diagnostic confidence were higher when using the 5K display. Conclusion: Using the Oculus Rift DK2 to view and navigate pathology whole slide images in a virtual environment is feasible for diagnostic purposes. However, image resolution using the Oculus Rift device was limited. Interactive VR technologies such as the Oculus Rift are novel tools

  1. Exploring virtual reality technology and the Oculus Rift for the examination of digital pathology slides

    Navid Farahani


    Full Text Available Background: Digital slides obtained from whole slide imaging (WSI platforms are typically viewed in two dimensions using desktop personal computer monitors or more recently on mobile devices. To the best of our knowledge, we are not aware of any studies viewing digital pathology slides in a virtual reality (VR environment. VR technology enables users to be artificially immersed in and interact with a computer-simulated world. Oculus Rift is among the world′s first consumer-targeted VR headsets, intended primarily for enhanced gaming. Our aim was to explore the use of the Oculus Rift for examining digital pathology slides in a VR environment. Methods: An Oculus Rift Development Kit 2 (DK2 was connected to a 64-bit computer running Virtual Desktop software. Glass slides from twenty randomly selected lymph node cases (ten with benign and ten malignant diagnoses were digitized using a WSI scanner. Three pathologists reviewed these digital slides on a 27-inch 5K display and with the Oculus Rift after a 2-week washout period. Recorded endpoints included concordance of final diagnoses and time required to examine slides. The pathologists also rated their ease of navigation, image quality, and diagnostic confidence for both modalities. Results: There was 90% diagnostic concordance when reviewing WSI using a 5K display and Oculus Rift. The time required to examine digital pathology slides on the 5K display averaged 39 s (range 10-120 s, compared to 62 s with the Oculus Rift (range 15-270 s. All pathologists confirmed that digital pathology slides were easily viewable in a VR environment. The ratings for image quality and diagnostic confidence were higher when using the 5K display. Conclusion: Using the Oculus Rift DK2 to view and navigate pathology whole slide images in a virtual environment is feasible for diagnostic purposes. However, image resolution using the Oculus Rift device was limited. Interactive VR technologies such as the Oculus Rift are

  2. Performance of residents using digital images versus glass slides on certification examination in anatomical pathology: a mixed methods pilot study

    Mirham, Lorna; Naugler, Christopher; Hayes, Malcolm; Ismiil, Nadia; Belisle, Annie; Sade, Shachar; Streutker, Catherine; MacMillan, Christina; Rasty, Golnar; Popovic, Snezana; Joseph, Mariamma; Gabril, Manal; Barnes, Penny; Hegele, Richard G.; Carter, Beverley; Yousef, George M.


    Background: It is anticipated that many licensing examination centres for pathology will begin fully digitizing the certification examinations. The objective of our study was to test the feasibility of a fully digital examination and to assess the needs, concerns and expectations of pathology residents in moving from a glass slide-based examination to a fully digital examination. Methods: We conducted a mixed methods study that compared, after randomization, the performance of senior residents (postgraduate years 4 and 5) in 7 accredited anatomical pathology training programs across Canada on a pathology examination using either glass slides or digital whole-slide scanned images of the slides. The pilot examination was followed by a post-test survey. In addition, pathology residents from all levels of training were invited to participate in an online survey. Results: A total of 100 residents participated in the pilot examination; 49 were given glass slides instead of digital images. We found no significant difference in examination results between the 2 groups of residents (estimated marginal mean 8.23/12, 95% confidence interval [CI] 7.72-8.87, for glass slides; 7.84/12, 95% CI 7.28-8.41, for digital slides). In the post-test survey, most of the respondents expressed concerns with the digital examination, including slowly functioning software, blurring and poor detail of images, particularly nuclear features. All of the respondents of the general survey (n = 179) agreed that additional training was required if the examination were to become fully digital. Interpretation: Although the performance of residents completing pathology examinations with glass slides was comparable to that of residents using digital images, our study showed that residents were not comfortable with the digital technology, especially given their current level of exposure to it. Additional training may be needed before implementing a fully digital examination, with consideration for a

  3. Massive lower gastrointestinal bleeding after low anterior resection for middle rectal cancer -case report

    Mircea Beuran; Ionut Negoi; Sorin Paun; Valentina Negoita; Bogdan Stoica; Ioan Tanase; Mihaela Vartic; Ruxandra Irina Negoi; Sorin Hostiuc


    Objective:To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods:A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results: A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding from an internal iliac branch that was successfully angioembolized. Conclusions: Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.

  4. Digital Storytelling in Bhutan: A Qualitative Examination of New Media Tools Used to Bridge the Digital Divide in a Rural Community School

    Gyabak, Khendum; Godina, Heriberto


    This qualitative study examines the use of digital storytelling as an instructional intervention for bridging the digital divide among public school students in rural Bhutan. Primary participants for the study included elementary school children who had never been previously exposed to computer technology and were recipients of a donated classroom…

  5. Dose audit for patients undergoing two common radiography examinations with digital radiology systems.

    İnal, Tolga; Ataç, Gökçe


    We aimed to determine the radiation doses delivered to patients undergoing general examinations using computed or digital radiography systems in Turkey. Radiographs of 20 patients undergoing posteroanterior chest X-ray and of 20 patients undergoing anteroposterior kidney-ureter-bladder radiography were evaluated in five X-ray rooms at four local hospitals in the Ankara region. Currently, almost all radiology departments in Turkey have switched from conventional radiography systems to computed radiography or digital radiography systems. Patient dose was measured for both systems. The results were compared with published diagnostic reference levels (DRLs) from the European Union and International Atomic Energy Agency. The average entrance surface doses (ESDs) for chest examinations exceeded established international DRLs at two of the X-ray rooms in a hospital with computed radiography. All of the other ESD measurements were approximately equal to or below the DRLs for both examinations in all of the remaining hospitals. Improper adjustment of the exposure parameters, uncalibrated automatic exposure control systems, and failure of the technologists to choose exposure parameters properly were problems we noticed during the study. This study is an initial attempt at establishing local DRL values for digital radiography systems, and will provide a benchmark so that the authorities can establish reference dose levels for diagnostic radiology in Turkey.

  6. Temporal Arthery Thermometer versus Cenventional Rectal Thermometer

    Nygaard, Hanne; Maschmann, Christian Peter

    equipment for measuring body temperature is necessary. Various non-invasive and easily used digital thermometers are available including the Temporal Artery Thermometer (TAT). However, there is lack of evidence for using the TAT-measurement as an accurate non-invasive method for measuring body temperature....... Methods: We designed a prospective comparative study of body temperature measurements using the TAT (Exergen TAT-5000 fra Exergen Corporation, Watertown, Massachusett) and a conventional digital rectal thermometer (Omron MC-341-E, OMRON healtcare Europe B.V., Hoofddroop, Holland), respectively...... and negative predictive value was 63.2% (CI: 46.0–78.2) and 96.5% (CL: 94.0–98.2), respectively. Conclusions: The study showed inacceptable wide temperature deviation between measurements performed with the TAT compared with the rectal measurements being performed with a conventional rectal thermometer...

  7. Pain and stress assessment after retinopathy of prematurity screening examination: Indirect ophthalmoscopy versus digital retinal imaging

    Moral-Pumarega M


    Full Text Available Abstract Background Increasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP, and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress. Methods The purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO, or wide-field digital retinal imaging (WFDRI on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70 were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination. Results Changes over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001. Median PIPP score (interquartile interval at baseline was 4 (3–5. At 30 seconds the score was 8 (6–9 for BIO and 6 (5–7 for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006. The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p  Conclusions A transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.

  8. Standard guide for data fields for computerized transfer of digital radiological examination data

    American Society for Testing and Materials. Philadelphia


    1.1 This guide provides a listing and description of the fields that are recommended for inclusion in a digital radiological examination data base to facilitate the transfer of such data. This guide sets guidelines for the format of data fields for computerized transfer of digital image files obtained from radiographic, radioscopic, computed radiographic, or other radiological examination systems. The field listing includes those fields regarded as necessary for inclusion in the data base: (1) regardless of the radiological examination method (as indicated by Footnote C in Table 1), (2) for radioscopic examination (as indicated by Footnote E in Table 1), and (3) for radiographic examination (as indicated by Footnote D in Table 1). In addition, other optional fields are listed as a reminder of the types of information that may be useful for additional understanding of the data or applicable to a limited number of applications. 1.2 It is recognized that organizations may have in place an internal format for the...

  9. Examining the Impact of the Creation of Digital Portfolios by High School Teachers and Their Students on Teaching and Learning

    Kilbane, Clare R.; Milman, Natalie B.


    This mixed methods study examined the perceived impact of the creation and implementation of digital portfolios by 29 high school inservice teachers and their students representing 20 school districts within one state. However, most research on digital portfolios has focused on preservice and not inservice teachers. Findings demonstrated that…

  10. Current concepts in rectal cancer.

    Fleshman, James W; Smallwood, Nathan


    The history of rectal cancer management informs current therapy and points us in the direction of future improvements. Multidisciplinary team management of rectal cancer will move us to personalized treatment for individuals with rectal cancer in all stages.

  11. Are Adult Educators and Learners "Digital Immigrants"? Examining the Evidence and Impacts for Continuing Education

    Smith, Erika


    Over the past decade, Prensky's distinctions between "digital immigrants" and "digital natives" have been oft-referenced. Much has been written about digital native students as a part of the Net generation or as Millennials. However, little work fully considers the impact of digital immigrant discourse within the fields of…

  12. [The preoperative staging of rectal neoplasms: the clinical exam and diagnostic imaging].

    Grande, M; Danza, F M


    The management of rectal cancer remains an important clinical problem. Although there was been great progress in surgical management, the survival of patients with locally advanced disease has not improved significantly during the past decades. Preoperative staging and evaluation of the risk of recurrence may help in the choice of operation. It is difficult for clinicians to quantify reliably with digital examination the degree of fixation of the tumor, and they usually cannot distinguish nodal metastases except in advanced cases. The more frequent overstaging of small tumors within one quadrant of the rectum is a major drawback of digital examination. Computed tomography and magnetic resonance seems to underestimate the extension of rectal tumors, but both can be helpful in selecting patients with advanced tumors for whom preoperative adjuvant treatment is being considered. Endoluminal ultrasound is superior in staging tumors confined to the rectal wall, but is not the ideal tool for staging: the results are examiner dependent, the field of vision in depth is limited, and stricturing tumors cannot be passed by the ultrasound transducer. Imaging diagnostic attendibility confirms the preeminent role of intraoperative exploration in the assessment of neoplastic diffusion in order to plan a correct surgical treatment.

  13. Wind sock deformity in rectal atresia

    Hosseini Seyed


    Full Text Available Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age.

  14. Rectal perforation with an intrauterine device: a case report.

    Eichengreen, Courtney; Landwehr, Haley; Goldthwaite, Lisa; Tocce, Kristina


    A 27-year-old woman presented for routine examination 1 year after intrauterine device (IUD) placement; strings were not visualized. The device was found to be penetrating through the rectal mucosa. It was removed easily through the rectum during an examination under anesthesia. Perforated IUDs with rectal involvement require thoughtful surgical planning to optimize outcomes.

  15. The Need for a New Data Processing Interface for Digital Forensic Examination

    Inikpi O ADEMU


    Full Text Available Digital forensic science provides tools, techniques and scientifically proven methods that can be used to acquire and analyze digital evidence. There is a need for law enforcement agencies, government and private organisations to invest in the advancement and development of digital forensic technologies. Such an investment could potentially allow new forensic techniques to be developed more frequently. This research identifies techniques that can facilitates the process of digital forensic investigation, therefore allowing digital investigators to utilize less time and fewer resources. In this paper, we identify the Visual Basic Integrated Development Environment as an environment that provides set of rich features which are likely to be required for developing tools that can assist digital investigators during digital forensic investigation. Establishing a user friendly interface and identifying structures and consistent processes for digital forensic investigation has been a major component of this research.

  16. Diagnostic value of the stand-alone synthetic image in digital breast tomosynthesis examinations.

    Garayoa, Julia; Chevalier, Margarita; Castillo, Maria; Mahillo-Fernández, Ignacio; Amallal El Ouahabi, Najim; Estrada, Carmen; Tejerina, Alejandro; Benitez, Olivia; Valverde, Julio


    To demonstrate the non-inferiority of synthetic image (SI) mammography versus full-field digital mammography (FFDM) in breast tomosynthesis (DBT) examinations. An observational, retrospective, single-centre, multireader blinded study was performed, using 2384 images to directly compare SI and FFDM based on Breast Imaging Reporting and Data System (BIRADS) categorisation and visibility of radiological findings. Readers had no access to digital breast tomosynthesis slices. Multiple reader, multiple case (MRMC) receiver operating characteristic (ROC) methodology was used to compare the diagnostic performance of SI and FFDM images. The kappa statistic was used to estimate the inter-reader and intra-reader reliability. The area under the ROC curves (AUC) reveals the non-inferiority of SI versus FFDM based on BIRADS categorisation [difference between AUC (ΔAUC), -0.014] and lesion visibility (ΔAUC, -0.001) but the differences were not statistically significant (p=0.282 for BIRADS; p=0.961 for lesion visibility). On average, 77.4% of malignant lesions were detected with SI versus 76.5% with FFDM. Sensitivity and specificity of SI are superior to FFDM for malignant lesions scored as BIRADS 5 and breasts categorised as BIRADS 1. SI is not inferior to FFDM when DBT slices are not available during image reading. SI can replace FFDM, reducing the dose by 45%. • Stand-alone SI demonstrated performance not inferior for lesion visibility as compared to FFDM. • Stand-alone SI demonstrated performance not inferior for lesion BIRADS categorisation as compared to FFDM. • Synthetic images provide important dose savings in breast tomosynthesis examinations.

  17. [Preterm labor: Reproducibility of detection test of PAMG-1 before and after digital examination, and transvaginal ultrasound cervical length].

    Werlen, S; Raia, T; Di Bartolomeo, A; Chauleur, C


    With current diagnostic resources, it is impossible to predict if a patient consulting in the obstetrics emergencies with symptoms of preterm labor, preterm delivery or not. A novel test for the detection of time to spontaneous preterm delivery was developed and would predict imminent delivery in 7 or 14 days from the time of testing. The diagnostic performances of detection test of PAMG-1 have been validated before digital examination. However digital examination is usually made in first line. The objective of this study was to assess the reproducibility of these diagnostic performances after digital examination and transvaginal ultrasound cervical length. A prospective and observational study was conducted in a level 3 maternity (University Hospital of Saint-Etienne), from June 2013 to January 2014. Patients consulted in the obstetrics emergencies for threatened preterm birth between 24-34 weeks were enrolled with written and signed consent. Reproducibility of this test was assessed after digital examination, transvaginal ultrasound cervical length and a long time after all investigations. Forty-one patients were included in our study. Average gestational age was 29 weeks, digital examination was changed in 36 patients, whereas cervical length was less than 26mm for only 17 patients. In our study, 100% of tests results remain negative or positive after digital examination and 95,1% after transvaginal ultrasound. Our results confirmed this excellent specificity (97.5% [IC 95%; 86.8-99.9]) and negative predictive value (97.5% [IC 95%; 86.8-99.9]). This work allowed to demonstrate the reproducibility of detection test of PAMG-1 after a digital examination. An initial management with detection test of PAMG-1 could allow reducing the rate of unnecessary hospitalization. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Robotic rectal surgery: State of the art.

    Staderini, Fabio; Foppa, Caterina; Minuzzo, Alessio; Badii, Benedetta; Qirici, Etleva; Trallori, Giacomo; Mallardi, Beatrice; Lami, Gabriele; Macrì, Giuseppe; Bonanomi, Andrea; Bagnoli, Siro; Perigli, Giuliano; Cianchi, Fabio


    Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words "rectum", "rectal", "cancer", "laparoscopy", "robot". After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.

  19. Rectal cancer: a review

    Fazeli, Mohammad Sadegh; Keramati, Mohammad Reza


    Rectal cancer is the second most common cancer in large intestine. The prevalence and the number of young patients diagnosed with rectal cancer have made it as one of the major health problems in the world. With regard to the improved access to and use of modern screening tools, a number of new cases are diagnosed each year. Considering the location of the rectum and its adjacent organs, management and treatment of rectal tumor is different from tumors located in other parts of the gastrointe...

  20. Rectal culture (image)

    A rectal culture test is performed by inserting a cotton swab in the rectum. The swab is rotated gently, and withdrawn. A smear of the swab is placed in culture media to encourage the growth of microorganisms. The ...

  1. Anal and Rectal Disorders

    ... switch to the Professional version Home Digestive Disorders Anal and Rectal Disorders Overview of the Anus and ... This Article Medical Dictionary Also of Interest (Quiz) Anal Fissure (Video) Overview of Celiac Disease (News) Another ...

  2. Building a Digital Library from the Ground Up: an Examination of Emergent Information Resources in the Machine Learning Community

    Cunningham, Sally Jo

    The current crop of digital libraries for the computing community are strongly grounded in the conventional library paradigm: they provide indexes to support searching of collections of research papers. As such, these digital libraries are relatively impoverished; the present computing digital libraries omit many of the documents and resources that are currently available to computing researchers, and offer few browsing structures. These computing digital libraries were built 'top down': the resources and collection contents are forced to fit an existing digital library architecture. A 'bottom up' approach to digital library development would begin with an investigation of a community's information needs and available documents, and then design a library to organize those documents in such a way as to fulfill the community's needs. The 'home grown', informal information resources developed by and for the machine learning community are examined as a case study, to determine the types of information and document organizations 'native' to this group of researchers. The insights gained in this type of case study can be used to inform construction of a digital library tailored to this community.

  3. Visual Literacy and the Digital Native: An Examination of the Millennial Learner

    Brumberger, Eva


    The so-called millennial learners who currently populate college classrooms are purportedly digital natives whose repeated exposure to a host of new technologies has allegedly resulted in enhanced skills in several areas, including those related to technology and visual communication. By extension, the argument has been made that digital natives…

  4. Technologies, Democracy and Digital Citizenship: Examining Australian Policy Intersections and the Implications for School Leadership

    Kathryn Moyle


    Full Text Available There are intersections that can occur between the respective peak Australian school education policy agendas. These policies include the use of technologies in classrooms to improve teaching and learning as promoted through the Melbourne Declaration on Educational Goals for Young Australians and the Australian Curriculum; and the implementation of professional standards as outlined in the Australian Professional Standard for Principals and the Australian Professional Standards for Teachers. These policies create expectations of school leaders to bring about change in classrooms and across their schools, often described as bringing about ‘quality teaching’ and ‘school improvement’. These policies indicate that Australian children should develop ‘democratic values’, and that school principals should exercise ‘democratic values’ in their schools. The national approaches to the implementation of these policies however, is largely silent on promoting learning that fosters democracy through education, or about making connections between teaching and learning with technologies, school leadership and living in a democracy. Yet the policies promote these connections and alignments. Furthermore, understanding democratic values, knowing what is a democracy, and being able to use technologies in democratic ways, has to be learned and practiced. Through the lens of the use of technologies to build digital citizenship and to achieve democratic processes and outcomes in schools, these policy complexities are examined in order to consider some of the implications for school leadership.

  5. Rectal cancer with synchronous liver metastases: Do we have a clear direction?

    Pathak, S; Nunes, Q M; Daniels, I R; Smart, N J; Poston, G J; Påhlman, L


    Rectal cancer is a common entity and often presents with synchronous liver metastases. There are discrepancies in management guidelines throughout the world regarding the treatment of advanced rectal cancer, which are further compounded when it presents with synchronous liver metastases. The following article examines the evidence regarding treatment options for patients with synchronous rectal liver metastases and suggests potential treatment algorithms.

  6. Expansion and re-examination of Digit Span effort indices on the WAIS-IV.

    Young, J Christopher; Sawyer, R John; Roper, Brad L; Baughman, Brandon C


    The Digit Span subtest was significantly revised for the WAIS-IV as an ordinal sequencing trial was added to increase working memory demands. The present investigation sought to validate an expanded version of Reliable Digit Span (RDS-R) as well as age-corrected scaled score (ACSS) from the recently revised Digit Span. Archival data were collected from 259 veterans completing the WAIS-IV Digit Span subtest and Word Memory Test (WMT). Veterans failing the WMT performed significantly worse (p < .001) on the ACSS, RDS-R, and traditional RDS. Operational characteristics of the ACSS, RDS-R, and RDS were essentially equivalent; however, sensitivity was quite modest when selecting cutoffs with strong specificity. While current results suggest that Digit Span effort indices can contribute to the detection of suboptimal effort, additional symptom validity indicators should be employed to compensate for limited sensitivity.

  7. Masquerading Mycobacterium: Rectal Growth or Tuberculosis?

    Nabajit Choudhury


    Full Text Available A 37-year old male presented to us with history of lower abdominal pain for 6 months. His physical examination revealed a rectal mass of approximately 1centimeter. He was investigated for possible rectal growth with sigmoidoscopy and biopsy. The histopathological examination (HPE showed a non-specific chronic inflammation in the tissue from the mass. Another tissue from the mass was sent for polymerase chain reaction (PCR for tuberculosis, which turned out to be positive. The patient was started on standard anti tubercular (ATT regimen and responded completely to the treatment. We discuss the patient and review some of the available literature on the topic and discuss the issue of considering a diagnosis of tuberculosis in cases with rectal mass specially when it has become a major public health issue with increasing number of HIV (Human Immunodeficiency Virus infected patients.

  8. Digitization

    Finnemann, Niels Ole


    Processes of digitization have for years represented a major trend in the developments of modern society but have only recently been related to processes of mediatization. The purpose of this article is to look into the relation between the concepts of mediatization and digitization and to clarify...... what a concept of digital media might add to the understanding of processes of mediatization and what the concept of mediatization might add to the understanding of digital media. It is argued that digital media open an array of new trajectories in human communication, trajectories which were...... not anticipated in previous conceptualizations of media and mediatization. If digital media are to be included, the concept of mediatization has to be revised and new parameters are to be built into the concept of media. At the same time it is argued that the concept of mediatization still provides a variety...

  9. Timing Is Everything: What Is the Optimal Duration After Chemoradiation for Surgery for Rectal Cancer?

    Goodman, Karyn A


    The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 47-year-old woman was referred for management of a newly diagnosed rectal cancer. She presented with a 2-month history of rectal bleeding and change in bowel habits. She underwent a colonoscopy that demonstrated a 5-cm fungating, friable, and partially obstructing mass in the distal rectum, approximately 5 cm from the anal verge. The tumor was palpable on digital rectal examination on the anterior wall of rectum. The biopsy demonstrated a moderately differentiated invasive adenocarcinoma, microsatellite stable. A staging work-up, including a computed tomography scan of the chest, abdomen, and pelvis, demonstrated rectal wall thickening in the midrectum and small lymph nodes in the left perirectal fat. There was a nonspecific 3-mm right lower lobe pulmonary nodule. Rectal magnetic resonance imaging demonstrated a 3-cm mass arising from mid-distal rectum with minimal extension beyond muscularis propria into the mesorectal fat, but without invasion of mesorectal fascia (Fig 1). There were at least three small mesorectal lymph nodes present; the largest rounded node measured up to 5 mm, and no additional pelvic lymphadenopathy was identified. Her carcinoembryonic antigen was 1.1, and all other laboratory studies were within normal limits. She was seen in the Colorectal Multidisciplinary Conference for a discussion of her treatment options.

  10. Examining the Digital Divide in K-12 Public Schools: Four-Year Trends for Supporting ICT Literacy in Florida

    Hohlfeld, Tina N.; Ritzhaupt, Albert D.; Barron, Ann E.; Kemker, Kate


    While there is evidence that access to computers in schools has increased, there remain questions about whether low socio-economic status (SES) schools provide students with equitable supports for achieving information communication technology (ICT) literacy. This research first presents a theoretical model to examine the digital divide within…

  11. Toward Digital Citizenship: Examining Factors Affecting Participation and Involvement in the Internet Society among Higher Education Students

    Al-Zahrani, Abdulrahman


    The current study aims to understand digital citizenship, based on the assumptions of Ribble (2014), by examining factors affecting participation and involvement in the Internet virtual societies among higher education students. A quantitative approach using a survey questionnaire was implemented. The participants were 174 students from the…

  12. Digital piracy: an examination of low self-control and motivation using short-term longitudinal data.

    Higgins, George E


    The purpose of the present study was to examine the link between low self-control, motivation, and digital piracy. This study used short-term longitudinal data (i.e., once a week for 4 weeks) from undergraduate students (n = 292) and latent trajectory analysis. The results of this study revealed that the students had significant variability in initial levels and rates of change in digital piracy. The results indicated that whether motivation was treated as a time-invariant or time-varying measure, it along with sex (i.e., being male) had a significant link with the initial levels of digital piracy and that sex and low self-control had links with the rate of change. These results are discussed, and policy implications are made.

  13. Examining the Digital Portfolio Conference as Professional Development for Novice Teachers

    Abel, Yolanda; Johnson, Francine W.; Gonsalves, Todd


    The master of arts in teaching (MAT) program is a 39-credit graduate program leading to initial teacher certification at the elementary or secondary level in specific content areas. The goal of the program is to provide candidates with the foundational pedagogy and knowledge base necessary to become successful teachers. The digital portfolio…

  14. Teacher Motivations for Digital and Media Literacy: An Examination of Turkish Educators

    Hobbs, Renee; Tuzel, Sait


    Educators have a variety of beliefs and attitudes about the best ways to support students' critical thinking, creativity, communication and collaboration skills by connecting the classroom to contemporary society, mass media and popular culture. Teachers who advance digital and media literacy may have a complex set of attitudes and habits of mind…

  15. Examination the Digital Competence of Teacher Candidates in Terms of Different Variables

    Korucu, Agâh Tugrul; Yücel, Ahmet; Gündogdu, Mustafa M.; Gençtürk, Tarik


    It has been essential to make use of technology in education as a result of the improvements in information and communication technology in the 21st century. Teachers, who are the organizers and the developers of learning environments, need to have a high level of consciousness with regard to digital competence. Thus, students can acquire digital…

  16. Examining Computational Skills in Prekindergarteners: The Effects of Traditional and Digital Manipulatives in a Prekindergarten Classroom

    Mattoon, Cassandra; Bates, Alan; Shifflet, Rena; Latham, Nancy; Ennis, Sarah


    The authors investigated benefits of digital technology compared with traditional manipulatives in relation to preschoolers' development and learning of computational skills. The sample consisted of twenty four 4-and 5-year old children who attended a half-day prekindergarten program five times a week in a university laboratory school in the…

  17. Teacher Motivations for Digital and Media Literacy: An Examination of Turkish Educators

    Hobbs, Renee; Tuzel, Sait


    Educators have a variety of beliefs and attitudes about the best ways to support students' critical thinking, creativity, communication and collaboration skills by connecting the classroom to contemporary society, mass media and popular culture. Teachers who advance digital and media literacy may have a complex set of attitudes and habits of mind…

  18. The Clinical Utility of Rectal Gas Distension F-18 FDG PET/CT

    Kim, Jin Suk; Lim, Seok Tae; Jeong, Young Jin; Kim, Dong Wook; Jeong, Hwan Jeong; Sohn, Myung Hee [Chonbuk National University Medical School and Hospital, Jeonju (Korea, Republic of)


    The aim of this study was to evaluate the clinical value of rectal gas distension F-18 FDG PET/CT imaging for the differentiation of the rectal focal uptake lesions. Twenty four patients (M:F=11:13, Age 62.8{+-}12.4 years) underwent rectal gas distension F-18 FDG PET/CT, prospectively: initial image at 50-60 min after the intravenous injection of F-18 FDG and rectal distension image after the infusion of air through the anus. Focally increased uptake lesions on initial images but disappeared on rectal distension images defined a physiological uptake. For the differential evaluation of persistent focal uptake lesions on rectal distension images, colonoscopy and histopathologic examination were performed. Among the 24 patients, 27 lesions of focal rectal uptake were detected on initial images of F-18 FDG PET/CT. Of these, 7 lesions were able to judge with physiological uptake because the focal increased uptake disappeared from rectal distension image. Remaining 3 lesions were non-rectal lesions (2 lesions: rectovesical space, 1 lesion: uterine myoma). Among 17 lesions which was showed persistent increased uptake in rectal distension image, 15 lesions were confirmed as the malignant tumor (SUVmax=15.9{+-}6.8) and 2 lesions were confirmed as the benign lesions including adenoma and inflammatory disease. The rectal distension F-18 FDG PET/CT imaging could be an important noninvasive method for the differentiation of malignant and benign focal rectal uptake lesions including physiologic uptake.

  19. Management of rectal cancer: Times they are changing

    Marilia Cravo


    In this review, we critically examine recent advances in staging, surgery, and chemoradiation in the management of patients with rectal cancer which have not typically been incorporated in published treatment guidelines.

  20. Social Support and "Playing Around": An Examination of How Older Adults Acquire Digital Literacy With Tablet Computers.

    Tsai, Hsin-Yi Sandy; Shillair, Ruth; Cotten, Shelia R


    This study examines how older adults learn to use tablet computers. Learning to use new technologies can help older adults to be included in today's digital society. However, learning to use new technologies is not always easy, especially for older adults. This study focuses on how older adults learn to use a specific technology, tablet computers, and the role that social support plays in this process. Data for this project are from 21 in-depth interviews with individuals who own tablet computers. We examine how older adults engage with tablet devices and increase their digital literacy. The findings suggest that, for older adults to start to use tablets, social support plays an important role. In addition, a key way that many participants report gaining expertise with the technology is through "playing around" with the tablets. Suggestions for how to help older adults learn to use new technologies are detailed. © The Author(s) 2015.

  1. Social Support and “Playing Around”: An Examination of How Older Adults Acquire Digital Literacy With Tablet Computers

    Tsai, Hsin-yi Sandy; Shillair, Ruth; Cotten, Shelia R.


    This study examines how older adults learn to use tablet computers. Learning to use new technologies can help older adults to be included in today’s digital society. However, learning to use new technologies is not always easy, especially for older adults. This study focuses on how older adults learn to use a specific technology, tablet computers, and the role that social support plays in this process. Data for this project are from 21 in-depth interviews with individuals who own tablet computers. We examine how older adults engage with tablet devices and increase their digital literacy. The findings suggest that, for older adults to start to use tablets, social support plays an important role. In addition, a key way that many participants report gaining expertise with the technology is through “playing around” with the tablets. Suggestions for how to help older adults learn to use new technologies are detailed. PMID:26491029

  2. PSA levels of 4.0 - 10 ng/ml and negative digital rectal examination: antibiotic therapy versus immediate prostate biopsy

    Avraham Shtricker


    Full Text Available Purpose: The management of mildly elevated (4.0-10.0 ng/ml prostate specific antigen (PSA is uncertain. Immediate prostate biopsy, antibiotic treatment, or short term monitoring PSA level for 1-3 months is still in controversy. Material and Methods: We conducted a retrospective chart review of patients in a large community practice (2003 - 2007 who had PSA levels between 4.0-10 ng/mL without any further evidence of infection. Data was gathered regarding patient's age, whether standard antibiotic therapy (10-14 days of ofloxacin or ciprofloxacin had been administered before the second PSA measurement, results of a second PSA test performed at 1- to 2-month intervals, whether a prostate biopsy was performed and its result. Results: One-hundred and thirty-five men met the study inclusion criteria with 65 (48.1% having received antibiotics (group 1; the PSA levels decreased in 39 (60% of which, sixteen underwent a biopsy which demonstrated prostate cancer in 4 (25%. Twenty-six (40% patients of group 1 exhibited no decrease in PSA levels; seventeen of them underwent a biopsy that demonstrated cancer in 2 (12%. The other 70 (51.9% patients were not treated with antibiotics (group 2; the PSA levels decreased in 42 (60% of which, thirteen underwent a biopsy which demonstrated prostate cancer in 4 (31%. In the other 28 (40% patients of group 2 there was no demonstrated decrease in PSA, nineteen of these subjects underwent a biopsy that demonstrated cancer in 8 (42%. Conclusions: There appears to be no advantage for administration of antibacterial therapy with initial PSA levels between 4-10 ng/mL without overt evidence of inflammation.

  3. Evaluation of prostatic cancer prevalence in patients with prostatic-specific antigen between 4 and 10 and normal digital rectal examination

    Farhad Tadayon


    Conclusion: In males with PSA between 4 and 10 and normal DRE, PSA density smaller than 0.12-0.15, and percent of free PSA greater than 18%, the prevalence of prostate cancer is very few and we can safely ignore the TRUS and prostate biopsy in these males and eliminate its costs and side effects.

  4. Stool examination and rectal biopsy in the diagnosis and evaluation of therapy of schistosomiasis mansoni Exame de fezes e biópsia retal no diagnóstico e controle de cura da esquistossomose mansoni

    Ana Lúcia Teles Rabello


    Full Text Available From each of a group of 217 adult males selected through enzyme-immunoassay or skin-test (Group A, six stool samples were examined by both the Lutz/Hoffman, Pons & Janer (Lutz/HPJ and Kato/Katz methods. In addition, one oogram of the rectal mucosa was performed. By these methods, schistosomiasis was detected in 44.7%, 47.5% and 40.1% of the individuals respectively. To evaluate the methods in the assessment of cure, the last 40 patients from group A, treated with a single oral dose of oxamniquine at 15 mg/kg were followed up for six months (Group B. The criteria for parasitological cure included three stool examinations by Kato/Katz and Lutz/HPJ methods, one, three and six months post-treatment and a rectal biopsy between the fourth and sixth months post-treatment. The examinations were negative in 87.5%, 90% and 95% of the patients, respectively. The efficacy of oxamniquine was 82.5% when the three methods were considered together and there was no statistically significant difference between the sensitivity of the individual methods.Em um grupo de 217 adultos do sexo masculino selecionados através de ELISA ou intradermoreação, realizaram-se seis exames de fezes pelos métodos de Lutz/Hoffman, Pons e Janer (Lutz/HPJ e Kato/Katz e um oograma da mucosa retal, observando-se positividade em 44,7%, 47,5% e 40,1%, respectivamente. A análise comparativa dos resultados mostrou: 1 aumento da sensibilidade de ambos os métodos de exames de fezes até a terceira amostra examinada; 2 maior sensibilidade da biópsia retal quando comparada ao exame de uma única amostra fecal pelos métodos de Lutz/HPJ ou Kato/Katz; 3 igual sensibilidade pelo exame de duas a cinco amostras fecais pelo método de Kato/Katz ou duas a seis amostras pelo método de Lutz/HPJ e a biópsia retal; 4 sensibilidade superior de seis amostras fecais pelo método de Kato/Katz, quando comparado à biópsia retal; 5 igual sensibilidade entre o mesmo número de amostras examinadas pelos

  5. Rectal dexmedetomidine in rats: evaluation of sedative and mucosal effects

    Volkan Hanci


    Full Text Available BACKGROUND AND OBJECTIVES: In this study, we investigated the anesthetic and mucosal effects of the rectal application of dexmedetomidine to rats. METHODS: Male Wistar albino rats weighing 250-300 g were divided into four groups: Group S (n = 8 was a sham group that served as a baseline for the normal basal values; Group C (n = 8 consisted of rats that received the rectal application of saline alone; Group IPDex (n = 8 included rats that received the intraperitoneal application of dexmedetomidine (100 µg kg-1; and Group RecDex (n = 8 included rats that received the rectal application of dexmedetomidine (100 µg kg-1. For the rectal drug administration, we used 22 G intravenous cannulas with the stylets removed. We administered the drugs by advancing the cannula 1 cm into the rectum, and the rectal administration volume was 1 mL for all the rats. The latency and anesthesia time (min were measured. Two hours after rectal administration, 75 mg kg-1 ketamine was administered for intraperitoneal anesthesia in all the groups, followed by the removal of the rats' rectums to a distal distance of 3 cm via an abdominoperineal surgical procedure. We histopathologically examined and scored the rectums. RESULTS: Anesthesia was achieved in all the rats in the Group RecDex following the administration of dexmedetomidine. The onset of anesthesia in the Group RecDex was significantly later and of a shorter duration than in the Group IPDEx (p < 0.05. In the Group RecDex, the administration of dexmedetomidine induced mild-moderate losses of mucosal architecture in the colon and rectum, 2 h after rectal inoculation. CONCLUSION: Although 100 µg kg-1 dexmedetomidine administered rectally to rats achieved a significantly longer duration of anesthesia compared with the rectal administration of saline, our histopathological evaluations showed that the rectal administration of 100 µg kg-1 dexmedetomidine led to mild-moderate damage to the mucosal structure of the

  6. An examination of automatic exposure control regimes for two digital radiography systems.

    Marshall, N W


    The influence of two methods of an automatic exposure control (AEC) setup using a simple measure of detectability is examined as a function of x-ray beam quality for a computed radiography (CR) system and for an indirect conversion digital radiography (DR) system. The regimes assessed were constant air kerma at the detector and the constant contrast noise ratio (CNR). A low scatter geometry was employed with x-ray spectra varying from 60 kV and 1 mm Cu to 125 kV and 2 mm Cu. The CNR was measured using a 2 mm thick Al square of dimension 1 cm by 1 cm. Detectability was quantified via a nominal contrast for a fixed beam quality of 70 kV and 1 mm added Cu filtration, taken from c-d curves measured using the Leeds TO20 test object, for the four x-ray spectra. In addition, objective image quality parameters including modulation transfer function (MTF), noise power spectrum (NPS) and detective quantum efficiency (DQE) were also measured for both systems at the four different x-ray spectra. It was found that the constant air kerma strategy did not maintain threshold nominal contrast (simple detectability) constant as the x-ray beam mean energy increased, for either the CR system or the DR system. For the CR detector, the threshold nominal contrast for a 1 mm disc increased by a factor of 4.4 from 3.50% to 15.4% as the tube potential was raised from 60 kV to 125 kV, while for the DR detector, the threshold nominal contrast increased by a factor of 3.4, from 2.27% to 7.67% as the tube potential increased from 60 kV to 120 kV. The constant CNR method was more successful at maintaining constant detectability for the c-d discs. The threshold nominal contrast for the 1 mm disc changed by a factor of 1.2, from 4.80% to 5.70% for the CR system, as the spectrum changed from 60 kV to 125 kV. For the indirect conversion detector, the threshold nominal contrast increased from 2.27% to 5.66% (a factor of 1.4 increase). The constant CNR strategy required an increase in air kerma by

  7. Gastric heterotopia of rectum in a child: a mimicker of solitary rectal ulcer syndrome.

    Al-Hussaini, Abdulrahman; Lone, Khurram; Al-Sofyani, Medhat; El Bagir, Asim


    Bleeding per rectum is an uncommon presentation in pediatric patients. Heterotopic gastric mucosa in the rectum is a rare cause of rectal bleeding. Here, we report a 3-year-old child with a bleeding rectal ulcer that was initially diagnosed and managed as a solitary rectal ulcer syndrome. After 1 month, the patient persisted to have intermittent rectal bleed and severe anal pain. Repeat colonoscopy showed the worsening of the rectal ulcer in size. Pediatric surgeon excised the ulcer, and histopathological examination revealed a gastric fundic-type mucosa consistent with the diagnosis of gastric heterotopia of the rectum. Over the following 18 months, our patient had experienced no rectal bleeding and remained entirely asymptomatic. In conclusion, heterotopic gastric mucosa of the rectum should be considered in the differential diagnosis of a bleeding rectal ulcer.

  8. Pre-slaughter rectal temperature as an indicator of pork meat quality.

    Vermeulen, L; Van de Perre, V; Permentier, L; De Bie, S; Geers, R


    This study investigates whether rectal temperature of pigs, prior to slaughter, can give an indication of the risk of developing pork with PSE characteristics. A total of 1203 pigs were examined, measuring the rectal temperature just before stunning, of which 794 rectal temperatures were measured immediately after stunning. pH30LT (M. Longissimus thoracis) and temperature of the ham (Temp30Ham) were collected from about 530 carcasses, 30 min after sticking. The results present a significant positive linear correlation between rectal temperature just before and after slaughter, and Temp30Ham. Moreover, pH30LT is negatively correlated with rectal temperature and Temp30Ham. Finally, a linear mixed model for pH30LT was established with the rectal temperature of the pigs just before stunning and the lairage time. This model defines that measuring rectal temperature of pigs just before slaughter allows discovery of pork with PSE traits, taking into account pre-slaughter conditions.

  9. Rectal Carcinoma with Heterotopic Bone: Report of a Case

    Yuichi Nagao


    Full Text Available Heterotopic bone is rarely present in malignant tumors of the gastrointestinal tract. We herein report a case of rectal adenocarcinoma with heterotopic bone. A 46-year-old Japanese male presented to our hospital with abdominal distension and constipation. Colonoscopic examination showed an ulcerated polypoid tumor of the rectum which nearly obstructed the rectal lumen. Abdominal computed tomography showed a tumor of the rectum with calcified deposits. Low anterior resection with lateral lymph node dissection was performed under the tentative diagnosis of rectal cancer. Histological examination of the resected specimen showed mucinous carcinoma of the rectum with heterotopic bone. One of the metastatic lymph nodes dissected also showed heterotopic bone. In the present report, we describe this rare tumor and briefly review the pertinent literature regarding rectal cancer with heterotopic bone.

  10. The value of the WISC-IV Digit Span subtest in detecting noncredible performance during pediatric neuropsychological examinations.

    Kirkwood, Michael W; Hargrave, David D; Kirk, John W


    In adult populations, research on methodologies to identify negative response bias has grown exponentially in the last two decades. Far less work has focused on methods appropriate for children. Although several recent studies have demonstrated the appropriateness of using stand-alone symptom validity tests with younger populations, a near absence of pediatric work has investigated embedded validity indicators. The present study examined the classification value of several scores derived from the WISC-IV Digit Span subtest. The sample consisted of 274 clinically referred mild traumatic brain injury patients aged 8 through 16 years. Fourteen percent of the participants failed both the Medical Symptom Validity Test and Test of Memory Malingering, which was used as the criterion for noncredible effort. For age-corrected scaled scores, a score of ≤5 resulted in the optimal cut-score, yielding sensitivity of 51% and specificity of 96%. For Reliable Digit Span, the optimal cut-score was ≤6, with sensitivity of 51% and specificity of 92%. Although only moderately sensitive, Digit Span scores are likely to have good utility in identifying noncredible performance in relatively high-functioning older children and adolescents. Indeed, classification statistics produced in this pediatric sample compare favorably with those produced in many real-world adult patients.

  11. The Prognostic Value of Circumferential Resection Margin Involvement in Patients with Extraperitoneal Rectal Cancer.

    Shin, Dong Woo; Shin, Jin Yong; Oh, Sung Jin; Park, Jong Kwon; Yu, Hyeon; Ahn, Min Sung; Bae, Ki Beom; Hong, Kwan Hee; Ji, Yong Il


    The prognostic influence of circumferential resection margin (CRM) status in extraperitoneal rectal cancer probably differs from that of intraperitoneal rectal cancer because of its different anatomical and biological behaviors. However, previous reports have not provided the data focused on extraperitoneal rectal cancer. Therefore, the aim of this study was to examine the prognostic significance of the CRM status in patients with extraperitoneal rectal cancer. From January 2005 to December 2008, 248 patients were treated for extraperitoneal rectal cancer and enrolled in a prospectively collected database. Extraperitoneal rectal cancer was defined based on tumors located below the anterior peritoneal reflection, as determined intraoperatively by a surgeon. Cox model was used for multivariate analysis to examine risk factors of recurrence and mortality in the 248 patients, and multivariate logistic regression analysis was performed to identify predictors of recurrence and mortality in 135 patients with T3 rectal cancer. CRM involvement for extraperitoneal rectal cancer was present in 29 (11.7%) of the 248 patients, and was the identified predictor of local recurrence, overall recurrence, and death by multivariate Cox analysis. In the 135 patients with T3 cancer, CRM involvement was found to be associated with higher probability of local recurrence and mortality. In extraperitoneal rectal cancer, CRM involvement is an independent risk factor of recurrence and survival. Based on the results of the present study, it seems that CRM involvement in extraperitoneal rectal cancer is considered an indicator for (neo)adjuvant therapy rather than conventional TN status.

  12. Examination of the semi-automatic calculation technique of vegetation cover rate by digital camera images.

    Takemine, S.; Rikimaru, A.; Takahashi, K.

    The rice is one of the staple foods in the world High quality rice production requires periodically collecting rice growth data to control the growth of rice The height of plant the number of stem the color of leaf is well known parameters to indicate rice growth Rice growth diagnosis method based on these parameters is used operationally in Japan although collecting these parameters by field survey needs a lot of labor and time Recently a laborsaving method for rice growth diagnosis is proposed which is based on vegetation cover rate of rice Vegetation cover rate of rice is calculated based on discriminating rice plant areas in a digital camera image which is photographed in nadir direction Discrimination of rice plant areas in the image was done by the automatic binarization processing However in the case of vegetation cover rate calculation method depending on the automatic binarization process there is a possibility to decrease vegetation cover rate against growth of rice In this paper a calculation method of vegetation cover rate was proposed which based on the automatic binarization process and referred to the growth hysteresis information For several images obtained by field survey during rice growing season vegetation cover rate was calculated by the conventional automatic binarization processing and the proposed method respectively And vegetation cover rate of both methods was compared with reference value obtained by visual interpretation As a result of comparison the accuracy of discriminating rice plant areas was increased by the proposed

  13. MRI of rectal stromal tumour

    Dam, Claus; Lindebjerg, Jan; Rafaelsen, Søren Rafael


    to be aware of for the rectal multidisciplinary team. On suspicion of GIST, patients should be referred to a sarcoma centre. The diagnosis of rectal GIST can be suggested on MRI by the presence of a well-defined heterogeneously large mass with a necrotic center associated with a prominent extra...

  14. Rectal carcinoids: a systematic review.

    McDermott, Frank D


    Rectal carcinoids are increasing in incidence worldwide. Frequently thought of as a relatively benign condition, there are limited data regarding optimal treatment strategies for both localized and more advanced disease. The aim of this study was to summarize published experiences with rectal carcinoids and to present the most current data.

  15. Breast metastases from rectal carcinoma

    LI Jia; FANG Yu; LI Ang; LI Fei


    Metastases to the breast from extramammary neoplasms are very rare, constituting 2.7% of all malignant breast tumours. The most common primary tumor metastatic to the breast is primary breast cancer. Rectal cancer metastasizing to the breast is extremely rare. We report a case of aggressive rectal carcinoma with metastasis to the breast.

  16. Older Veteran Digital Disparities: Examining the Potential for Solutions Within Social Networks

    Luger, Tana M; Hogan, Timothy P; Richardson, Lorilei M; Cioffari, Lisa S; Harvey, Kimberly; Houston, Thomas K.


    Background Older adults typically have less access to the Internet than other age groups, and older Veterans may use the Internet even less due to economic and geographic reasons. Objective To explore solutions to this problem, our study examined older Veterans’ reported ability to access technology through their close social ties. Methods Data were collected via mail survey from a sample of Veterans aged 65 years and older (N=266). Results Nearly half (44.0%, 117/266) of the sample reported ...

  17. Decreasing the Dose to the Rectal Wall by Using a Rectal Retractor during Radiotherapy of Prostate Cancer: A Comparative Treatment Planning Study

    Kristina Nilsson


    Full Text Available Aim. The aim of the study was to examine the dosimetric effect of rectal retraction, using a rectal retractor, by performing a comparative treatment planning study. Material and Methods. Treatment plans using volumetric arc therapy (VMAT were produced for ten patients both with and without rectal retraction. A hypofractionation scheme of 42.7 Gy in seven fractions was used. The dose to the rectal wall was evaluated for both methods (with and without retraction using four dose-volume criteria: V40.1 Gy, V38.3 Gy, V36.5 Gy, and V32.6 Gy. Results. The retraction of the rectal wall increased the distance between the rectal wall and the prostate. The rectal wall volume was reduced to zero for all dose-volume values except for V32.6 Gy, which was 0.2 cm3 in average when the rectal retractor was used. Conclusion. There was a significant decrease of V40.1 Gy, V38.3 Gy, V36.5 Gy, and V32.6 Gy when the rectal retractor was used without compromising the dose coverage of planning target volume (PTV.

  18. Prospective comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: air-balloon versus gel for rectal filling

    Francesca, Maccioni; Najwa, Al Ansari; Valeria, Buonocore; Fabrizio, Mazzamurro; Carlo, Catalano [Sapienza University of Rome, Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Rome (Italy); Marileda, Indinnimeo; Massimo, Mongardini [Sapienza University of Rome, Department of Surgical Sciences, Policlinico Umberto I Hospital, Rome (Italy)


    to prospectively compare two rectal filling techniques for dynamic MRI of pelvic floor disorders (PFD). Twenty-six patients with PFD underwent the two techniques during the same procedure, one based on rectal placement of a balloon-catheter filled with saline and air insufflation (air-balloon technique or AB); another based on rectal filling with 180 cc of gel (gel-filling technique or GF). The examinations were compared for assessment and staging of PFD, including rectal-descent, rectocele, cystocele, colpocele, enterocele, rectal invagination. Surgery and clinical examinations were the gold standard. AB showed sensitivity of 96 % for rectal descent, 100 % for both rectocele and colpocele, 86 % for rectal invagination and 100 % for enterocele; understaged 11 % of rectal descents and 19 % of rectoceles. GF showed sensitivity of 100 % for rectal descent, 91 % for rectocele, 83 % for colpocele, 100 % for rectal invagination and 73 % for enterocele; understaged 3.8 % of rectal descent and 11.5 % of rectoceles. Both techniques showed 100 % of specificity. Agreement between air-balloon and gel filling was 84 % for rectal descent, 69 % for rectocele, 88 % for rectal invagination, 84 % for enterocele, 88 % for cystocele and 92 % for colpocele. Both techniques allowed a satisfactory evaluation of PFD. The gel filling was superior for rectal invagination, the air-balloon for rectocele and anterior/middle compartment disorders. (orig.)

  19. Patient discomfort in bitewing examination with film and four digital receptors.

    Jørgensen, P M; Wenzel, A


    The aim was to compare patient discomfort during bitewing examination using five intra-oral receptors: a conventional film, a storage phosphor plate with a new soft cover, an already manufactured and sold sensor with a wire and two square and two rounded corners, a new version of a previously developed sensor with a wire and four square corners, and a newly developed sensor with a wire and four rounded corners. 60 patients participated in the study. The five receptors [a Kodak paper pack film (Eastman Kodak Company, Rochester, NY), a DIGORA® Optime phosphor plate (Soredex, Tuusula, Finland), and SuniRay (Suni Medical Imaging, Inc., San Jose, CA), DIGORA Toto (Soredex) and Snapshot (Instrumentarium Dental, Tuusula, Finland) complementary metal-oxide-semiconductors] with differences in ergonomic shape were placed in the mouth for a bitewing examination for approximately 10 s. The patients rated their discomfort on a 100 mm visual analogue scale after having had each receptor positioned. There was no significant difference in patient discomfort score between the conventional film and the Snapshot sensor (p > 0.05). Both conventional film and Snapshot were significantly less uncomfortable than the other receptors (p 0.05). The storage phosphor plate was significantly less uncomfortable than the DIGORA Toto sensor (p film and an ergonomically shaped wired sensor with rounded corners.

  20. Using digital surveillance to examine the impact of public figure pancreatic cancer announcements on media and search query outcomes.

    Noar, Seth M; Ribisl, Kurt M; Althouse, Benjamin M; Willoughby, Jessica Fitts; Ayers, John W


    Announcements of cancer diagnoses from public figures may stimulate cancer information seeking and media coverage about cancer. This study used digital surveillance to quantify the effects of pancreatic cancer public figure announcements on online cancer information seeking and cancer media coverage. We compiled a list of public figures (N = 25) who had been diagnosed with or had died from pancreatic cancer between 2006 and 2011. We specified interrupted time series models using data from Google Trends to examine search query shifts for pancreatic cancer and other cancers. Weekly media coverage archived on Google News were also analyzed. Most public figures' pancreatic cancer announcements corresponded with no appreciable change in pancreatic cancer search queries or media coverage. In contrast, Patrick Swayze's diagnosis was associated with a 285% (95% confidence interval [CI]: 212 to 360) increase in pancreatic cancer search queries, though it was only weakly associated with increases in pancreatic cancer media coverage. Steve Jobs's death was associated with a 197% (95% CI: 131 to 266) increase in pancreatic cancer queries and a 3517% (95% CI: 2882 to 4492) increase in pancreatic cancer media coverage. In general, a doubling in pancreatic cancer-specific media coverage corresponded with a 325% increase in pancreatic cancer queries. Digital surveillance is an important tool for future cancer control research and practice. The current application of these methods suggested that pancreatic cancer announcements (diagnosis or death) by particular public figures stimulated media coverage of and online information seeking for pancreatic cancer.

  1. The Use Of A Digital Store To Provide Pulsed Fluoroscopy And Stored Images During Gastro-Intestinal Examinations

    Hynes, D. M.; Edmonds, E. W.; Rowlands, J. A.; Pack, W. W.


    A 512 X 512 digital store has replaced a video disc as a storage mechanism during pulsed fluoroscopy. This system, storing 1 TV field from a 1023 line signal following each pulse, is much more stable than the analog disc and can also reduce the fluoroscopic dose by 75%. This stability now makes the concept of pulsed fluoroscopy acceptable from the clinical point of view. Furthermore, the stored images on this matrix can resolve to 1.5 line pairs per mm, which produces useful permanent hard copy. This represents a further extension of clinical videofluorography, already developed by the authors. Its implementation for storage of gastro-intestinal examinations will be discussed, with assessment of the relationship of x-ray dose to image quality.

  2. Laparoscopic Rectopexy in Solitary Rectal Ulcer

    Hassan Salmanroughani


    Full Text Available Patients with Solitary Rectal Ulcer Syndrome (SRUS come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8% was significantly higher than cases without that (P=0.04. Complete recovery rate in cases that had finger defecation (85% was significantly higher than cases without that (50% (P=0.03. Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management.

  3. Fine needle aspiration cytology of rectal masses.

    Kochhar, R; Rajwanshi, A; Wig, J D; Gupta, N M; Kesiezie, V; Bhasin, D K; Malik, A K; Gupta, S K; Mehta, S K


    This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure. Images Figure 1 Figure 2 Figure 3 PMID:2323600

  4. Increasing trend in retained rectal foreign bodies

    Ayantunde, Abraham A; Unluer, Zynep


    AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period. METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed. Patients’ clinical data and yearly case presentation with data relating to hospital episodes were collected. Data analysis was by SPSS Inc. Chicago, IL, United States. RESULTS Twenty-five patients presented over a 5-year period with a mean age of 39 (17-62) years and M: F ratio of 2:1. A progressive rise in cases was noted from 2008 to 2012 with 3, 4, 4, 6, 8 recorded patients per year respectively. The majority of the impacted rectal objects were used for self-/partner-eroticism. The commonest retained foreign bodies were sex vibrators and dildos. Ninty-six percent of the patients required extraction while one passed spontaneously. Two and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for extraction. The mean hospital stay was 19 (2-38) h. Associated psychosocial issues included depression, deliberate self-harm, illicit drug abuse, anxiety and alcoholism. There were no psychosocial problems identified in 15 patients. CONCLUSION There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal. PMID:27830039

  5. Changes in frequency of recall recommendations of examinations depicting cancer with the availability of either priors or digital breast tomosynthesis

    Hakim, Christiane M.; Bandos, Andriy I.; Ganott, Marie A.; Catullo, Victor J.; Chough, Denise M.; Kelly, Amy E.; Shinde, Dilip D.; Sumkin, Jules H.; Wallace, Luisa P.; Nishikawa, Robert M.; Gur, David


    Performance changes in a binary environment when using additional information is affected only when changes in recommendations are made due to the additional information in question. In a recent study, we have shown that, contrary to general expectation, introducing prior examinations improved recall rates, but not sensitivity. In this study, we assessed cancer detection differences when prior examinations and/or digital breast tomosynthesis (DBT) were made available to the radiologist. We identified a subset of 21 cancer cases with differences in the number of radiologists who recalled these cases after reviewing either a prior examination or DBT. For the cases with differences in recommendations after viewing either priors or DBT, separately, we evaluated the total number of readers that changed their recommendations, regardless of the specific radiologist in question. Confidence intervals for the number of readers and a test for the hypothesis of no difference was performed using the non-parameteric bootstrap approach addressing both case and reader-related sources of variability by resampling cases and readers. With the addition of priors, there were 14 cancer cases (out of 15) where the number of "recalling radiologists" decreased. With the addition of DBT, the number of "recalling radiologists" decreased in only five cases (out of 15) while increasing in the remaining 9 cases. Unlike most new approaches to breast imaging DBT seems to improve both recall rates and cancer detection rates. Changes in recommendations were noted by all radiologists for all cancers by type, size, and breast density.

  6. Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback

    Vaizey, C; Roy, A; Kamm, M


    Background—Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. 
Aim—To determine whether biofeedback retraining is a useful treatment for this condition. 
Patients—Thirteen consecutive patients with SRUS (three men, median age 34 years, median duration of symptoms three years) underwent treatment. Previous surgical treatment had failed in five. 
Methods—Patients were evaluated prospectively. Anorectal physiological studies were performed in 11 patients before treatment. A standardised questionnaire was used before and after treatment, and all but two patients were examined after treatment. 
Results—Median follow up was nine months (range 3-22 months). After treatment four patients were asymptomatic, and four felt improved. Symptom improvement or elimination occurred in: need to strain (7/13 patients), digitation (7/11), laxative use (5/9). Time in the toilet (median 30 v 10 minutes, before v after treatment) and number of visits to toilet (6 v 3/day) were also improved. Three patients were able to maintain employment before treatment compared with eight after treatment. The solitary ulcer did not heal completely in any of the nine patients examined after treatment, but improved in four. Previous surgery, the macroscopic appearance of the ulcer, the presence of pelvic floor paradox, and other physiological parameters did not predict outcome. 
Conclusion—Biofeedback retraining is a useful treatment for this condition. Long term studies are now required. 

 Keywords: solitary rectal ulcer syndrome; biofeedback therapy PMID:9462216

  7. Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer. Effect of experience

    Rafaelsen, Søren R; Sørensen, Torben; Jakobsen, Anders


    OBJECTIVE: To evaluate the effect of experience on preoperative staging of rectal cancer using magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS). MATERIAL AND METHODS: From January 2002 to May 2006, 134 consecutive patients with biopsy-proven rectal cancer were examined with a 1....... In addition to this supervision, the person responsible for staging should be trained through a defined training programme....

  8. Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer

    Waage, Jo Erling Riise; Bach, Simon P; Pfeffer, Frank


    AIM: Strain elastography is a novel approach to rectal tumour evaluation. Primary aim of this study was to correlate elastography to pT-stages of rectal tumours and to assess the ability of the method to differentiate rectal adenomas (pT0) from early rectal cancer (pT1-2). Secondary aims were...... to compare elastography with endorectal ultrasonography (ERUS) and to propose a combined strain elastography and ERUS staging algorithm. METHOD: 120 consecutive patients with a suspected rectal tumour were examined in this staging study. Patients receiving surgery without neo-adjuvant radiotherapy were...... included (n=59). All patients were examined with ERUS and elastography. Treatment decisions were made by multidisciplinary team (MDT) assessment, without considering the strain elastography examination. RESULTS: Histopathology identified 21 adenomas, 13 pT1, 9 pT2, 15 pT3 and one pT4. Mean elastography...

  9. Examining e-Health literacy and the digital divide in an underserved population in Hawai'i.

    Connolly, Kathleen Kihmm; Crosby, Martha E


    Seeking health information is one of the leading uses for the Internet and World Wide Web (WWW). Research has found the amount one benefits from e-Health information (health information from electronic sources) is directly related to the level of e-Health literacy. e-Health literacy is defined as "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem." In order to gain a further understanding of the effects and use of technology, the digital divide, and the relationship between technology utilization and health outcomes, focus group interviews were conducted with participants diagnosed with diabetes and currently residing in a Medically Underserved Area. Overall, 25 volunteers participated in the four focus group meetings. Based on the focus group discussions, a general low e-Health literacy rate was identified. This was demonstrated by the lack of access to the Internet and the skills needed to retrieve health information. Of the 25 participants, 64% reported having Internet access at some level, but, only one reported going on the Internet every day. When the barriers to using the Internet were discussed, many participants expressed a lack of knowledge in how to retrieve information. Results of this study further show that having access to technology is not necessarily associated with usage. This dynamic is evolving into a new form of digital divide, gap in information retrieval and usage, versus gap in access. This is the first known study to examine e-Health literacy in an underserved population in Hawai'i. With the proliferation of information and communication technology and the transformation of information retrieval to be mobile and "on demand", a multi-pronged communication and education strategy is needed to explore how technology can improve e-Health literacy and health outcomes among underserved populations.

  10. Rectal balloon use limits vaginal displacement, rectal dose, and rectal toxicity in patients receiving IMRT for postoperative gynecological malignancies.

    Wu, Cheng-Chia; Wuu, Yen-Ruh; Yanagihara, Theodore; Jani, Ashish; Xanthopoulos, Eric P; Tiwari, Akhil; Wright, Jason D; Burke, William M; Hou, June Y; Tergas, Ana I; Deutsch, Israel


    Pelvic radiotherapy for gynecologic malignancies traditionally used a 4-field box technique. Later trials have shown the feasibility of using intensity-modulated radiotherapy (IMRT) instead. But vaginal movement between fractions is concerning when using IMRT due to greater conformality of the isodose curves to the target and the resulting possibility of missing the target while the vagina is displaced. In this study, we showed that the use of a rectal balloon during treatment can decrease vaginal displacement, limit rectal dose, and limit acute and late toxicities. Little is known regarding the use of a rectal balloon (RB) in treating patients with IMRT in the posthysterectomy setting. We hypothesize that the use of an RB during treatment can limit rectal dose and acute and long-term toxicities, as well as decrease vaginal cuff displacement between fractions. We performed a retrospective review of patients with gynecological malignancies who received postoperative IMRT with the use of an RB from January 1, 2012 to January 1, 2015. Rectal dose constraint was examined as per Radiation Therapy Oncology Group (RTOG) 1203 and 0418. Daily cone beam computed tomography (CT) was performed, and the average (avg) displacement, avg magnitude, and avg magnitude of vector were calculated. Toxicity was reported according to RTOG acute radiation morbidity scoring criteria. Acute toxicity was defined as less than 90 days from the end of radiation treatment. Late toxicity was defined as at least 90 days after completing radiation. Twenty-eight patients with postoperative IMRT with the use of an RB were examined and 23 treatment plans were reviewed. The avg rectal V40 was 39.3% ± 9.0%. V30 was65.1% ± 10.0%. V50 was 0%. Separate cone beam computed tomography (CBCT) images (n = 663) were reviewed. The avg displacement was as follows: superior 0.4 + 2.99 mm, left 0.23 ± 4.97 mm, and anterior 0.16 ± 5.18 mm. The avg magnitude of displacement was superior

  11. Assembly and evaluation of a training module and dataset with feedback for improved interpretation of digital breast tomosynthesis examinations

    Gur, David; Zuley, Margarita L.; Sumkin, Jules H.; Hakim, Christiane M.; Chough, Denise M.; Lovy, Linda; Sobran, Cynthia; Logue, Durwin; Zheng, Bin; Klym, Amy H.


    The FDA recently approved Digital Breast Tomosynthesis (DBT) for use in screening for the early detection of breast cancer. However, MQSA qualification for interpreting DBT through training was noted as important. Performance issues related to training are largely unknown. Therefore, we assembled a unique computerized training module to assess radiologists' performances before and after using the training module. Seventy-one actual baseline mammograms (no priors) with FFDM and DBT images were assembled to be read before and after training with the developed module. Fifty examinations of FFDM and DBT images enriched with positive findings were assembled for the training module. Depicted findings were carefully reviewed, summarized, and entered into a specially designed training database where findings were identified by case number and synchronized to the display of the related FFDM plus DBT examinations on a clinical workstation. Readers reported any findings using screening BIRADS (0, 1, or 2) followed by instantaneous feedback of the verified truth. Six radiologists participated in the study and reader average sensitivity and specificity were compared before and after training. Average sensitivity improved and specificity remained relatively the same after training. Performance changes may be affected by disease prevalence in the training set.

  12. Solitary rectal ulcer syndrome: A single-center case series

    Abdulaziz I AlGhulayqah


    Full Text Available Background/Aim: Solitary rectal ulcer syndrome (SRUS is a benign, chronic defecation disorder with varied presentations. The aim of this study is to summarize the clinical features, endoscopic findings, histological appearance, and treatment strategies associated with SRUS. Patients and Methods: This is a retrospective study of all patients diagnosed with SRUS at the King Faisal Specialist Hospital and Research Centre in Riyadh from January 2003 to December 2013. Cases were identified using the Department of Pathology database. Data were obtained from medical records that included clinical manifestation, endoscopic findings, and histopathological features. Results: Twenty patients were identified. The mean age was 42.5 years (±18.5 and 55% were females. Most of the patients presented with bleeding per rectum (85%, constipation (75%, and straining (50%, with a mean symptom duration of 26.7 months. The most common associated factors identified were constipation (75%, history of rectal surgery (25%, digital rectal manipulation (20%, and rectal prolapse (20%. Endoscopic findings included a single ulcer (50% and multiple ulcers (30%; 55% had a polypoidal appearance. On histopathology, there was surface ulceration (95%, fibrosis of the lamina propria (60%, distorted architecture (55%, and muscle hypertrophy with increased mucin production (50%. Patients were treated conservatively and none required surgery. Conclusion: SRUS is a rare disorder with variable clinical presentations. Stool softeners, a high fiber diet in addition to topical mesalamine, and biofeedback proved to be effective in this patient population.

  13. Radiological imaging of rectal cancer

    Lidija Lincender-Cvijetić


    Full Text Available This article discusses the possibilities of diagnosing abdominal imaging in patients with rectal cancer, detecting lesions and assessing the stage of the lesions, in order to select the appropriate therapy. Before the introduction of imaging technologies, the diagnosis of colorectal pathology was based on conventional methods of inspecting intestines with a barium enema, with either a single or double contrast barium enema. Following the development of endoscopic methods and the wide use of colonoscopy, colonoscopy became the method of choice for diagnosing colorectal diseases. The improvement of Computerized Tomography (CT and Magnetic Resonance Imaging (MRI, gave us new possibilities for diagnosing colorectal cancer. For rectal cancer, trans-rectal US (TRUS or endo-anal US (EAUS have a significant role. For staging rectal cancer, the Multi Slice Computed Tomography (MSCT is not the method of choice, but Magnetic Resonance Imaging (MRI is preferred when it comes to monitoring the rectum. Therole of the MRI in the T staging of rectal cancer is crucial in preoperative assessment of: thickness – the width of the tumor, the extramural invasion, the circumference of resection margin (CRM, andthe assessment of the inclusion of mesorectal fascia. For successful execution of surgical techniques, good diagnostic imaging of the cancer is necessary in order to have a low level of recurrence. According to medical studies, the sensitivity of FDG-PET in diagnosing metastatic nodals is low, but for now it is not recommended in routine diagnosis of metastatic colorectal carcinoma.

  14. MR vs CT imaging: low rectal cancer tumour delineation for three-dimensional conformal radiotherapy.

    O'Neill, B D P


    Modern three-dimentional radiotherapy is based upon CT. For rectal cancer, this relies upon target definition on CT, which is not the optimal imaging modality. The major limitation of CT is its low inherent contrast resolution. Targets defined by MRI could facilitate smaller, more accurate, tumour volumes than CT. Our study reviewed imaging and planning data for 10 patients with locally advanced low rectal cancer (defined as < 6 cm from the anal verge on digital examination). Tumour volume and location were compared for sagittal pre-treatment MRI and planning CT. CT consistently overestimated all tumour radiological parameters. Estimates of tumour volume, tumour length and height of proximal tumour from the anal verge were larger on planning CT than on MRI (p < 0.05). Tumour volumes defined on MRI are smaller, shorter and more distal from the anal sphincter than CT-based volumes. For radiotherapy planning, this may result in smaller treatment volumes, which could lead to a reduction in dose to organs at risk and facilitate dose escalation.

  15. Digital Native Preservice Teachers: An Examination of Their Self-Efficacy Beliefs Regarding Technology Integration in Classroom Settings

    Southall, Sarah Parker


    The purpose of this mixed-method study was to investigate digital native preservice teachers' self-efficacy beliefs regarding their technology experiences and skills at the beginning and at the end of their field placement semester. Digital natives, as defined by Prensky (2001), are students born after 1980 who have been raised with digital…

  16. Treatment of locally advanced rectal cancer

    Klaassen, RA; Nieuwenhuijzen, GAP; Martijn, H; Rutten, HJT; Hospers, GAP; Wiggers, T


    Historically, locally advanced rectal cancer is known for its dismal prognosis. The treatment of locally advanced rectal cancer is subject to continuous change due to development of new and better diagnostic tools, radiotherapeutic techniques, chemotherapeutic agents and understanding of the

  17. Cervical assessment at 22 and 27 weeks for the prediction of spontaneous birth before 34 weeks in twin pregnancies: is transvaginal sonography more accurate than digital examination?

    Vayssière, C; Favre, R; Audibert, F; Chauvet, M P; Gaucherand, P; Tardif, D; Grangé, G; Novoa, A; Descamps, P; Perdu, M; Andrini, E; Janse-Marec, J; Maillard, F; Nisand, I


    This study compared the accuracy of ultrasound cervical assessment (cervical length and cervical index) and digital examination (Bishop score and cervical score) in the prediction of spontaneous birth before 34 weeks in twin pregnancies. In a prospective multicenter study, digital examination and transvaginal sonography were performed consecutively in twin pregnancies attending for routine sonography at either 22 weeks (175 women) or 27 weeks (153 women). The digital examination took place first, and the Bishop score and cervical score (cervical length minus cervical dilatation) were calculated. Ultrasound measurements were then made of cervical length and funnel length to yield the cervical index (1 + funnel length/cervical length). The association between each variable and delivery before 34 weeks was tested by the Mann-Whitney U-test. The receiver-operating characteristics (ROC) curves of the ultrasound and digital indicators were determined for both gestational age periods, and the areas under the ROC curves compared. The best cut-off values for each indicator were used to determine predictive values for delivery before 34 weeks. The median gestational age at delivery among the women included in the 22-week examination period was 36.0 (range, 21-40) weeks; 10.9% (19) gave birth spontaneously before 34 weeks. The median cervical length was 40 (range, 6-65) mm. All four parameters were predictors of delivery before 34 weeks. The areas under the ROC curves for cervical index, cervical length, Bishop score and cervical score did not differ significantly. The median gestational age at delivery among the women in the 27-week examination period was 36.0 (range, 27-40) weeks; 9.2% (14) gave birth spontaneously before 34 weeks. The median cervical length was 35 (range, 1-57) mm. All parameters except the Bishop score were predictors of delivery before 34 weeks. The likelihood ratio of the positive and negative tests for cervical length digital examination at the 27-week

  18. Sensor probe for rectal manometry

    Blechschmidt, R.A.; Hohlfeld, O.; Mueller, R.; Werthschuetzky, R. [Technische Univ. Darmstadt (Germany). Inst. fuer Elektromechanische Konstruktionen


    In this paper a pressure sensor probe is presented that is suitable for assessing dynamic rectal pressure profiles. It consists of ten piezoresistive sensors, mounted on low temperature co-fired ceramics. The sensors are coated with a bio-compatible silicone elastomer. It was possible to reduce the size of the ceramic to 4.5 x 5.5 mm with a height of 1.4 mm. The whole probe has a diameter of 9 mm and a length of 20 cm. One healthy test person underwent rectal manometry. The experimental data and the analysis of linearity, hysteresis, temperature stability, and reproducibility are discussed. The presented sensor probe extends the classical anorectal manometry, particularly in view of quantifying disorders of the rectal motility. (orig.)

  19. Rectal temperatures in postpartum cows

    Silvia Helena Venturolli Perri; Leslie Cristina Scarpelli; Thais Mioto Martinelli; César Esper; Katia Denise Bresciani; Marion Burkhardt de Koivisto


    The purpose of this study was to evaluate parturition data with the rectal temperature in the early postpartum period of dairy cows. One hundred and eighty cows were randomly selected between September 1999 and July 2000, in seven dairy farms located in the Northwest region of São Paulo, Brazil. For the first ten days postpartum, rectal temperature (RT) was taken between 5:00 and 8:00 a.m. using an electronic thermometer (M525 - GLA Agricultural Electronics, San Luis Obispo, CA 93401-7500). C...

  20. The digital divide: Examining socio-demographic factors associated with health literacy, access and use of internet to seek health information.

    Estacio, Emee Vida; Whittle, Rebecca; Protheroe, Joanne


    This article aims to examine the socio-demographic characteristics associated with access and use of Internet for health-related purposes and its relationship with health literacy. Data were drawn from a health literacy survey ( N = 1046) and analysed using logistic regression. Results show a strong association between health literacy, internet access and use. Socio-demographic characteristics particularly age, education, income, perceived health and social isolation also predict internet access. Thus, in addition to widening access, the movement towards digitisation of health information and services should also consider digital skills development to enable people to utilise digital technology more effectively, especially among traditionally hard-to-reach communities.

  1. Sleeping position and rectal temperature.

    Petersen, S A; Anderson, E S; Lodemore, M; Rawson, D; Wailoo, M P


    The effects of sleeping position upon body temperature were assessed by continuous monitoring of rectal temperature in 137 babies sleeping at home under conditions chosen by their parents. There were three groups of subjects: (1) normal babies aged 12-22 weeks whose temperature rhythms were developed, (2) normal babies aged 6-12 weeks who were developing their night time temperature rhythms, and (3) babies the night after diphtheria, pertussis, and tetanus immunisation, whose temperature rhythms were disturbed. Sleeping in the prone position was not associated with higher rectal temperatures at any time of night in young babies, nor did it exaggerate the disturbance of rectal temperature rhythm after immunisation. In older normal babies the prone position did not disturb rectal temperature in the first part of the night, though prone sleepers warmed a little faster prior to walking, especially in warm conditions. Prone sleepers were, however, born earlier in gestation and tended to be of lower birth weight. Normal babies can therefore thermoregulate effectively whatever their sleeping posture, even in warm conditions, though the prone position may make it slightly more difficult to lose heat. It is difficult to see how the prone position, even interacting with warm conditions, could induce lethal hyperthermia in otherwise normal babies. Perhaps the prone position is associated with other risk factors for sudden infant death syndrome.

  2. IQGAP1 in rectal adenocarcinomas

    Holck, Susanne; Nielsen, Hans Jørgen; Hammer, Emilie;


    Treatment of rectal adenocarcinoma includes total mesorectal excision, which is preceded by radiochemotherapy (RCT) in cases of advanced disease. The response to RCT varies from total tumor regression to no effect but this heterogeneous response is unexplained. However, both radiation and treatme...

  3. Digital Culture and Digital Library

    Yalçın Yalçınkaya


    Full Text Available In this study; digital culture and digital library which have a vital connection with each other are examined together. The content of the research consists of the interaction of culture, information, digital culture, intellectual technologies, and digital library concepts. The study is an entry work to integrity of digital culture and digital library theories and aims to expand the symmetry. The purpose of the study is to emphasize the relation between the digital culture and digital library theories acting intersection of the subjects that are examined. Also the perspective of the study is based on examining the literature and analytical evaluation in both studies (digital culture and digital library. Within this context, the methodology of the study is essentially descriptive and has an attribute for the transmission and synthesis of distributed findings produced in the field of the research. According to the findings of the study results, digital culture is an inclusive term that describes the effects of intellectual technologies in the field of information and communication. Information becomes energy and the spectrum of the information is expanding in the vertical rise through the digital culture. In this context, the digital library appears as a new living space of a new environment. In essence, the digital library is information-oriented; has intellectual technology support and digital platform; is in a digital format; combines information resources and tools in relationship/communication/cooperation by connectedness, and also it is the dynamic face of the digital culture in time and space independence. Resolved with the study is that the digital libraries are active and effective in the formation of global knowing and/or mass wisdom in the process of digital culture.

  4. TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler: a prospective multicenter trial

    José Vinicius Cruz


    Full Text Available CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7% and grade 3 (73.3% anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0% and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3% patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%. Forty-nine patients (65.3% required 1 hospitalization day, the remainder (34.7% 2 days. Postoperatively, 3 (4.0% patients complained of persistent rectal pain and 7 (9.3% developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1, endoscopic stricturectomy with hot biopsy forceps (n = 3 and digital dilatation (n = 3. Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%. The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68 (6: n = 6 (7: n = 1 (P<0.0001. CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment

  5. A comparison of vaginal ultrasound and digital examination in predicting preterm delivery in women with threatened preterm labor: a cohort study.

    Pinton, Anne; Severac, François; Meyer, Nicolas; Akladios, Cherif Y; Gaudineau, Adrien; Favre, Romain; Langer, Bruno; Sananes, Nicolas


    The aim of this study is to evaluate the utility of digital examination in addition to ultrasonic measurement of cervical length for predicting spontaneous preterm delivery in women with threatened preterm labor. This was a prospective cohort study in Strasbourg University Hospital, France, between January 2013 and January 2015. All women with a singleton pregnancy hospitalized with threatened preterm labor between 23 and 34 weeks of gestation were included. Cases of iatrogenic preterm delivery were excluded. A multivariable logistic regression model to estimate the significant predictive parameters of spontaneous preterm delivery was performed. The primary endpoint of our study was a preterm birth before 34 weeks of gestation. A total of 395 women were included in our study. The rate of preterm delivery before 34 weeks was 13%. In univariate analysis every single cervical parameter assessed by the digital examination and all the ultrasound parameters were significantly associated with preterm delivery. The final model included five variables predicting preterm birth: visualization of the membranes at the speculum examination (OR 15.8, 95% CI 2.43-146), ultrasound cervical length (OR 0.82, 95% CI 0.75-0.89), signs of inflammation (OR 6.23, 95% CI 2.07-22.9), gestational age on admission (OR 0.84, 95% CI 0.71-1.0), and presence of vaginal infection (OR 4.28, 95% CI 1.52-12.7). None of the cervical parameters assessed by the digital examination provided additional predictive value of preterm delivery. Our study suggests that digital examination does not add to the information given by vaginal ultrasound evaluation in predicting preterm labor. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. What Are Preadolescent Readers Doing Online? An Examination of Upper Elementary Students' Reading, Writing, and Communication in Digital Spaces

    Hutchison, Amy C.; Woodward, Lindsay; Colwell, Jamie


    The online reading, writing, and communication practices of students have been of significant interest to literacy researchers and teachers throughout the last several years, as insights into what students are currently doing in and outside of school can inform what they can be expected to know and be able to do in digital environments. Yet,…

  7. Their Portfolios, Our Role: Examining a Community College Teacher Education Digital Portfolio Program from the Students' Perspective

    Plaisir, Jean Y.; Hachey, Alyse C.; Theilheimer, Rachel


    In the of Fall 2006, our large, urban community college implemented digital portfolio development for all of the preservice early childhood educators registered in the infant-toddler and preschool-early elementary programs. Three years after implementation of the program, we conducted survey research to assess our students' perceptions of their…

  8. Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer

    Lee, Hong Seok; Choi, Doo Ho; Park, Hee Chul; Park, Won; Yu, Jeong Il; Chung, Kwangzoo


    Purpose To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. Materials and Methods We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. Results Average rectal volume and ARA were 11.3 mL and 2.9 cm². After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). Conclusion Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary. PMID:27592514

  9. Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer

    Lee, Hong Seok; Choi, Doo Ho; Park, Hee Chul; Park, Won; Yu, Jeong Il; Chung, Kwang Zoo [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. Average rectal volume and ARA were 11.3 mL and 2.9 cm². After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary.

  10. Primary Rectal Adenocarcinoma Metastasizing to Bilateral Breast - a Rare Case Demonstrated by {sup 18}F-FDG PET/CT

    Soundararajan, Ramya; Arora, Saurabh; Das, Chandan Jyoti; Roy, Maitrayee; Kumar, Rakesh; Bal, Chandrasekhar [All India Institute of Medical Sciences, New Delhi (India)


    A 22-year-old female presented with multiple painless bilateral breast masses for the past 2 months. On Further questioning she had hematochezia and constipation for three months. On digital rectal examination, thickening of rectal mucosa at 5 cm from the anal verge was found. On physical examination, multiple firm, non-tender, nodular lesions were found in bilateral breasts. Metastatic breast disease from extra mammary primaries is uncommon and it constitutes 0.5 - 6% of all breast malignancies. melanomas, lymphomas, leukemias, ands sarcomas are the most common malignancies causing breast metastases. Infrequently, carcinomas of the lung, stomach, ovary, liver, tonsil, pleura, pancreas, cervix, perineum, endometrium, bladder, carcinoid tumors and renal cell carcinomas can cause metastatic breast disease. Metastatic breast disease from colorectal cancer is characterised by disseminated metastatic disease and a poor prognosis. In this case, It was essential to distinguish between metastatic breast disease primary breast carcinoma to plan appropriate management. Because of its rare incidence and high index of clinical suspicion, appropriate radiological investigations and histopathology is essential for accurate diagnosis. {sup 18}F-FDG PET/CT, being a whole-body metabolic functional imaging modality, helped us determine the extent of the primary and metastatic disease. In view of disseminated metastases, the bilateral breast disease was also considered as metastatic involvement, Which was proven by histopathology.

  11. Hemangioma colorretal Colon rectal hemangioma

    João Batista Pinheiro Barreto


    Full Text Available O hemangioma colorretal (HCR é uma lesão vascular benigna rara, com manifestação clínica geralmente entre 5 e 25 anos de idade. Faz parte do diagnóstico diferencial das causas de hemorragia digestiva baixa, sendo confundido, na maioria das vezes, com entidades mais comuns, como hemorróidas e doenças inflamatórias intestinais. O retardo do diagnóstico ocorre freqüentemente devido ao desconhecimento da doença, com taxas de mortalidade alcançando 40 a 50% na presença de sangramento importante. O caso relatado é de uma paciente de 17 anos de idade, admitida no Serviço de Colo-proctologia do Hospital Universitário - HUUFMA, em setembro de 2005, com anemia e sangramento retal, desde a infância, de forma intermitente e não dolorosa. Apresentado sua história clínica e propedêutica diagnóstica, realizada por meio de exames laboratoriais, endoscopia digestiva alta, colonoscopia e arteriografia de mesentéricas e ilíacas internas. O tratamento cirúrgico realizado foi retossigmoidectomia convencional com anastomose colorretal baixa, com boa evolução pós-operatória, tendo o exame histopatológico da peça cirúrgica ressecada, confirmado o diagnostico.The colon and rectum hemangioma is a rare benign vascular lesion, with clinical features usually between 5 and 25 years of age. It is included in the differential diagnose of the lower digestive bleeding causes, and has been frequently misdiagnosed with other more common entities, like hemorrhoids and bowel inflammatory disease. The late diagnose occurs usually because of the rarity of the disease, with mortality rates reaching 40 to 50% in presence of severe bleeding. We report a case of a 17 years old girl who was admitted at the Coloproctology Service of the Academic Hospital - HUUFMA, in September 2005, with anemia and intermittent rectal bleeding since childhood. Laboratorial findings included laboratorial exams, GI endoscopy, colonoscopy and arteriography of mesenteric and

  12. A minimum yield of twelve lymph nodes in rectal cancer remains valid in the era of neo-adjuvant treatment

    Lykke, Jakob; Jess, Per; Roikjær, Ole


    PURPOSE: The purpose of the study was to examine if a minimum of 12 lymph nodes (LNs) is still valid in rectal cancer after neo-adjuvant treatment. METHODS: An analysis was carried out in a nationwide Danish cohort of 6793 patients, treated by curative resection of stage I-III rectal cancer durin...

  13. Rectal Sensitivity in Diabetes Patients with Symptoms of Gastroparesis

    Eirik Søfteland


    Full Text Available In a clinical setting, diabetic autonomic complications (cardiac, gastrointestinal, urogenital, etc. are often handled as separate entities. We investigated rectal sensitivity to heat, mechanical distension, and electrical stimulations in 20 patients with diabetes and symptoms of gastroparesis, to evaluate the extent of visceral neuronal damage. Furthermore, to evaluate the relation between the nervous structures we examined gastric emptying and cardiac autonomic function with the hypothesis being an association between these. We found that 60% of patients had delayed gastric empting. Rectal hyposensitivity was a general finding as they tolerated 67% higher thermal, 42% more mechanical, and 33% higher electrical current intensity compared to healthy controls. In patients, most heart rate variability parameters were reduced; they reported significantly more gastrointestinal symptoms and a reduced quality of life in all SF-36 domains. Shortened RR interval correlated with reduced rectal temperature sensitivity, and gastric retention rate was negatively associated with symptoms of nausea and vomiting. To conclude, in these patients with signs and symptoms of diabetic gastroparesis, rectal sensitivity was reduced, and heart rate variability was impaired. Thus, we suggest regarding diabetic autonomic neuropathy as a diffuse disorder. Symptoms of widespread autonomic dysfunction and sensory disorders should be expected and treated in these patients.

  14. Isolated rectal diverticulum complicating with rectal prolapse and outlet obstruction: Case report

    Chuang-Wei Chen; Shu-Wen Jao; Huang-Jen Lai; Ying-Chun Chiu; Jung-Cheng Kang


    The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently.Treatments of these complicated events range from conservative treatments to major surgical interventions.We present a hitherto unreported occurrence of isolated rectal diverticulum complicated with rectal prolapse and outlet obstruction. Delorme's procedure resulted in subsidence of symptoms and resolution of the diverticulum. It provides a minimal invasive surgical technique to successfully address the reported malady.

  15. An Unusual Cause of Rectal Stenosis

    Maja Gruber


    Full Text Available Solitary rectal ulcer syndrome (SRUS is a benign disease that is often misdiagnosed. It is characterized by a combination of symptoms, endoscopic findings and histology. Patients present with constipation, rectal bleeding, mucous discharge, pain and a sensation of incomplete defecation. There are many different manifestations of this disease, with or without rectal prolapse. We report an unusual presentation of SRUS as a circular stenosis in a middle-aged male.

  16. The role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overview.

    Nagtegaal, I.D.; Krieken, J.H.J.M. van


    Pathological examination of the rectal cancer resection specimen has an increasingly important role in influencing decisions about clinical management. Standardisation of the examination procedures and reporting are necessary. To evaluate the relevant pathological factors, data from randomised clini

  17. Axillary and rectal temperature measurements in infants.

    Morley, C J; Hewson, P H; Thornton, A. J.; Cole, T J


    Rectal and axillary temperatures were measured during the daytime in 281 infants seen randomly at home and 656 at hospital under 6 months old, using mercury-in-glass thermometers. The normal temperature range derived from the babies at home was 36.7-37.9 degrees C for rectal temperature and 35.6-37.2 degrees C for axillary temperature. Rectal temperature was higher than axillary in 98% of the measurements. The mean (SD) difference between rectal and axillary temperatures was 0.7 (0.5) degrees...


    武爱文; 顾晋; 薛钟麒; 王怡; 徐光炜


    To explore the death-related factors of stageⅠrectal cancer patients. Methods: 89 cases of stage I rectal cancer patients between 1985 and 2000 were retrospectively studied for prognostic factors. Factors including age, gender, tumor size, circumferential occupation, gross type, pathological type, depth of tumor invasion, surgical procedure, adjuvant chemotherapy and postoperative complication were chosen for cox multivariate analysis (forward procedure) using Spss software (10.0 version). Results: multivariate analysis demonstrated that muscular invasion was an independent negative prognostic factor for stageⅠrectal cancer patients (P=0.003). Conclusion: Muscular invasion is a negative prognostic factor for stage I rectal cancer patients.

  19. Robotic rectal surgery: what are the benefits?

    Kim, C W; Baik, S H


    Robotic rectal surgery is not a rare event for colorectal surgeons any more. Even patients with colorectal diseases obtain information through the mass media and are asking surgeons about robotic surgery. Since laparoscopic rectal surgery has proved to have some benefits compared to open rectal surgery, many surgeons became interested in robotic rectal surgery. Some of them have reported the advantages and disadvantages of robotic rectal surgery over the last decade. This review will report on the outcomes of robotic rectal surgery. Robotic rectal surgery requires a longer operation time than laparoscopic or open surgery, but many authors reduced the gap as they were accustomed to the robotic system and used various additional techniques. The high cost for purchasing and maintaining the robotic system is still a problem, though. However, except for this reason, robotic rectal surgery shows comparable and even superior results in some parameters than laparoscopic or open surgery. They include pathologic and functional outcomes as well as short-term outcomes such as complication rates, length of hospital stay, time to recover normal bowel function or first flatus, time to start diet, and postoperative pain. Moreover, studies on oncologic outcomes show acceptable results. Robotic rectal surgery is safe and feasible and has a number of benefits. Therefore, it can be an alternative option to conventional laparoscopic and open surgery with strict indications.

  20. Metachronous Bilateral Isolated Adrenal Metastasis from Rectal Adenocarcinoma: A Case Report

    H. Jabir


    Full Text Available We report a case of adrenal metastasis from colorectal cancer in a 54-year-old woman. Nine months after resection for advanced rectal carcinoma, a computed tomography scan revealed bilateral adrenal metastasis. The level of serum carcinoembryonic antigen was normal. A bilateral adrenalectomy was performed after chemotherapy. Histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. Adrenal metastasis should be considered in the patients’ follow-up for colorectal cancer.

  1. Metachronous Bilateral Isolated Adrenal Metastasis from Rectal Adenocarcinoma: A Case Report

    Jabir, H.; Tawfiq, N.; Moukhlissi, M.; Akssim, M.; Guensi, A.; Kadiri, B.; Bouchbika, Z.; Taleb, A.; Benchekroun, N.; Jouhadi, H.; Sahraoui, S.; Zamiati, S.; Benider, A.


    We report a case of adrenal metastasis from colorectal cancer in a 54-year-old woman. Nine months after resection for advanced rectal carcinoma, a computed tomography scan revealed bilateral adrenal metastasis. The level of serum carcinoembryonic antigen was normal. A bilateral adrenalectomy was performed after chemotherapy. Histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. Adrenal metastasis should be considered in the patients' follow-up for colorectal cancer. PMID:24860684

  2. Metachronous bilateral isolated adrenal metastasis from rectal adenocarcinoma: a case report.

    Jabir, H; Tawfiq, N; Moukhlissi, M; Akssim, M; Guensi, A; Kadiri, B; Bouchbika, Z; Taleb, A; Benchekroun, N; Jouhadi, H; Sahraoui, S; Zamiati, S; Benider, A


    We report a case of adrenal metastasis from colorectal cancer in a 54-year-old woman. Nine months after resection for advanced rectal carcinoma, a computed tomography scan revealed bilateral adrenal metastasis. The level of serum carcinoembryonic antigen was normal. A bilateral adrenalectomy was performed after chemotherapy. Histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. Adrenal metastasis should be considered in the patients' follow-up for colorectal cancer.

  3. Rectal inflammation as first manifestation of graft-vs-host disease: radiologic-pathologic findings

    Cantisani, V.; Mortele, K.J.; Viscomi, S.G.; Silverman, S.G.; Ros, P.R. [Division of Abdominal Imaging and Intervention, Dept. of Radiology, Brigham and Women' s Hospital, Boston, MA (United States); Glickman, J. [Dept. of Pathology, Brigham and Women' s Hospital, Boston, MA (United States)


    Graft-vs-host disease (GVHD) is a common, life-threatening complication of bone marrow transplantation that frequently involves the gastrointestinal tract. Since symptoms are typically nonspecific, radiologic examination is often performed to reach a diagnosis. To the best of our knowledge, this is the first reported radiologic description of a case of rectal involvement as the first manifestation of GVHD. The differential diagnosis of segmental rectal wall thickening in a patient following bone marrow transplantation should include GVHD. (orig.)

  4. 全数字化乳腺平板摄影技术探讨%Research of Examination Technique of Digital Mammography Using Digital Flat Panel Detector System

    许静; 袁彩云; 徐莉


    目的:探讨数字化乳腺摄影规范的操作方法,以优化乳腺图像质量,从而提高乳腺病变的检出率和诊断的正确率.方法:回顾性分析4 000例患者的数字化乳腺摄影的图像,对每一个摄影位置的摆位方法进行主观评价,对相应图像质量进行分级,进行相关性总结分析.结果:15 420幅所摄图像中,规范操作获得的Ⅰ级片15 012幅,占97.35%;因患者配合问题、不规范操作、设备引起的图像质量下降等问题导致的Ⅱ级片达376幅,占2.44%:需重新拍摄有32次,占0.21%.结论:在全数字化乳腺摄影中,高质量乳腺片的获得需规范的摄影投照方法、定期的设备质量图像校正.%Objective To research the normative operation method of digital mammography for optimizing image quality, so as to improve the diagnostic accuracy of pathological changes. Methods Four thousand cases of mammography images were analyzed retrospectively. Each radiography operation method was evaluated in image quality classification. The relationship between mammography operation and image quality was analyzed. Results There were 15,012 images classified as class I, which accounted for 97.35% among all 15,420 images, and 376 images(2.44%) were class II, which were caused by patient's bad cooperation, abnormal operation of technician and other causes of equipment problem. Thirty two images (0.21%) needed re-operation of mammography due to severely low image quality. Conclusion For acquisition of high quality of mammography images, normative mammography operation and periodical equipment image quality calibration are essential.[Chinese Medical Equipment Journal.2011,32( 12): 112-113

  5. Rectal mucosal prolapse syndrome as an unusual gastrointestinal manifestation of Sjögren's syndrome: a case report

    Koga Hideki


    Full Text Available Abstract Introduction Rectal mucosal prolapse syndrome, histologically characterized by fibromuscular obliteration in the lamina propria, hyperplastic glands and thickened muscularis mucosa, causes rectal bleeding. Sjögren's syndrome is an autoimmune exocrinopathy that chiefly destroys the salivary and lacrimal glands by lympho-plasmacytic infiltration. Although various gastrointestinal manifestations have been reported in patients with Sjögren's syndrome, there have not been to our knowledge any case reports to date of rectal mucosal prolapse syndrome in association with Sjögren's syndrome. Case presentation A 68-year-old Japanese woman with Sjögren's syndrome and long-term constipation consulted our hospital because of rectal bleeding. Because of dysphagia and xerostomia, she had consistently refused recommendations to take oral medicines including cathartics. Therefore, she frequently strained excessively during defecation. Colonoscopy and radiological examinations disclosed eroded flat protrusions of the rectum. Microscopic examination demonstrated inflamed mucosa with elongated tortuous glands and fibromuscular obliteration. Based on these findings, a diagnosis of rectal mucosal prolapse syndrome was made. Prohibition of straining during defecation and sulfasalazine suppository use were effective. Conclusion This case highlights the importance of defecation control in patients with Sjögren's syndrome. In the case presented, rectal mucosal prolapse syndrome following long-term excessive straining during defecation caused rectal bleeding. Clinicians should consider rectal mucosal prolapse syndrome as a gastrointestinal manifestation of Sjögren's syndrome.

  6. National and international guidelines for rectal cancer

    Nielsen, Liv Bjerre Juul; Wille-Jørgensen, P


    concerning the definition of rectal cancer. Ten of the 11 guidelines use the TNM staging system and there was general agreement regarding the recommendation of MRI and CT in rectal cancer. There was consensus concerning a multidisciplinary approach, preoperative chemoradiotherapy (CRT) and total mesorectal...

  7. Rectal cancer surgery: volume-outcome analysis.

    Nugent, Emmeline


    There is strong evidence supporting the importance of the volume-outcome relationship with respect to lung and pancreatic cancers. This relationship for rectal cancer surgery however remains unclear. We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery.

  8. Multiple rectal carcinoid tumors in monozygotic twins.

    Doi, Momoko; Ikawa, Osamu; Taniguchi, Hiroki; Kawamura, Takuji; Katsura, Kanade


    We report multiple rectal carcinoid tumors in monozygotic twins who, respectively, had 42 and 36 carcinoid tumors in the lower rectum. This is the first report about carcinoid tumors in monozygotic twins. Both twins developed a similar number of rectal carcinoids with a similar distribution. Investigation of their genetic background may provide information about the origin of these tumors.

  9. Comparison of caries detection methods using varying numbers of intra-oral digital photographs with visual examination for epidemiology in children

    Boye Uriana


    Full Text Available Abstract Background This was a method comparison study. The aim of study was to compare caries information obtained from a full mouth visual examination using the method developed by the British Association for the Study of Community Dentistry (BASCD for epidemiological surveys with caries data obtained from eight, six and four intra-oral digital photographs of index teeth in two groups of children aged 5 years and 10/11 years. Methods Five trained and calibrated examiners visually examined the whole mouth of 240 5-year-olds and 250 10-/11-year-olds using the BASCD method. The children also had intra-oral digital photographs taken of index teeth. The same 5 examiners assessed the intra-oral digital photographs (in groups of 8, 6 and 4 intra-oral photographs for caries using the BASCD criteria; dmft/DMFT were used to compute Weighted Kappa Statistic as a measure of intra-examiner reliability and intra-class correlation coefficients as a measure of inter-examiner reliability for each method. A method comparison analysis was performed to determine the 95% limits of agreement for all five examiners, comparing the visual examination method with the photographic assessment method using 8, 6 and 4 intra-oral photographs. Results The intra-rater reliability for the visual examinations ranged from 0.81 to 0.94 in the 5-year-olds and 0.90 to 0.97 in the 10-/11-year-olds. Those for the photographic assessments in the 5-year-olds were for 8 intra-oral photographs, 0.86 to 0.94, for 6 intra-oral photographs, 0.85 to 0.98 and for 4 intra-oral photographs, 0.80 to 0.96; for the 10-/11-year-olds were for 8 intra-oral photographs 0.84 to 1.00, for 6 intra-oral photographs 0.82 to 1.00 and for 4 intra-oral photographs 0.72 to 0.98. The 95% limits of agreement were −1.997 to 1.967, -2.375 to 2.735 and −2.250 to 2.921 respectively for the 5-year-olds and −2.614 to 2.027, -2.179 to 3.887 and −2.594 to 2.163 respectively for the 10-/11-year

  10. Through the lens of the microscope: Examining the addition of traditional and digital microscopes to the study of cell theory in a rural middle school setting

    Ennis, Jackie Strum


    Situated in the classrooms of three middle school teachers in a rural school system in North Carolina, this study examined the variable of microscope use on three levels---no microscopes, analog microscopes, and digital microscopes---during the unit on cells. The study benefited from the use of two complementary parts---a quasi-experimental quantitative part and a qualitative component. The quantitative component of the study utilized two instruments, the Scientific Attitude Inventory II (SAI II) (Moore & Foy, 1997) and a content test developed for this study. Each instrument was administered as a pretest and a posttest to the three groups of students. An analysis of covariance (ANCOVA) was conducted. Results of the ANCOVA on the content test showed that when controlling for the pretest scores, there were no differences between the mean posttest scores of the students. Results of the ANCOVA on the SAI II showed that when controlling for the pretest scores, there was a statistically significant difference (pclassroom observation, teacher interviews, and student interviews as data sources in the three learning environments. Analysis of the data revealed that the students in all three classrooms were engaged in the learning activities and benefited from the learning experiences. However, the students who used the digital microscopes were more engaged than the other groups. These students used technology as a mindtool to help them bridge the concrete experiences to the abstract concepts associated with cell theory. Yet, the teacher who used the digital microscopes missed opportunities for them to use the devices for knowledge construction. Two types of digital microscopes were also compared, revealing a preference for the less expensive tool.

  11. Digital Forensics

    Ψευτέλης, Αθανάσιος Δημήτρης


    A reprint from American Scientist the magazine of Sigma Xi, The Scientific Research Society Since the 1980s, computers have had increasing roles in all aspects of human life—including an involvement in criminal acts. This development has led to the rise of digital forensics, the uncovering and examination of evidence located on all things electronic with digital storage, including computers, cell phones, and networks. Digital forensics researchers and practitione...

  12. [Rectal administration of anesthetic agents].

    Ceriana, P; Maurelli, M


    To collect data in the current literature dealing with the diffusion, the reliability and the effectiveness of the rectal administration of anaesthetic drugs. To evaluate differences with parenteral administration. Pharmacokinetics and clinical studies published in recent years in indexed journals. Based on the study methodology, drugs employed and pharmacokinetic parameters evaluated. Factors involved in absorption of drugs from the rectal mucosa, clinical effect and pharmacokinetic data of the following drugs: diazepam, flunitrazepam, midazolam, ketamin and methohexital, then a brief evaluation of other drugs: thiopental, etomidate, morphine and chloral hydrate. The most widely used drugs are benzodiazepines: they are safe, easy to manage and highly effective; among them midazolam has the best kinetic and dynamic pattern. Ketamin is useful during painful diagnostic procedures; with the use of barbiturates there is a greater risk of respiratory depression and more caution must be employed. Wide intervariability of rate of absorption, achievement of plasma levels and clinical effect is a relevant drawback of this technique, such to make it not preferable to the parenteral route, when both are feasible. It deserves, anyway, more consideration, and maintains its validity for the preparation of the paediatric patient to general anaesthesia.

  13. Shock treatment: using immersive digital realism to restage and re-examine milgram's 'obedience to authority' research.

    Haslam, S Alexander; Reicher, Stephen D; Millard, Kathryn


    Attempts to revisit Milgram's 'Obedience to Authority' (OtA) paradigm present serious ethical challenges. In recent years new paradigms have been developed to circumvent these challenges but none involve using Milgram's own procedures and asking naïve participants to deliver the maximum level of shock. This was achieved in the present research by using Immersive Digital Realism (IDR) to revisit the OtA paradigm. IDR is a dramatic method that involves a director collaborating with professional actors to develop characters, the strategic withholding of contextual information, and immersion in a real-world environment. 14 actors took part in an IDR study in which they were assigned to conditions that restaged Milgrams's New Baseline ('Coronary') condition and four other variants. Post-experimental interviews also assessed participants' identification with Experimenter and Learner. Participants' behaviour closely resembled that observed in Milgram's original research. In particular, this was evidenced by (a) all being willing to administer shocks greater than 150 volts, (b) near-universal refusal to continue after being told by the Experimenter that "you have no other choice, you must continue" (Milgram's fourth prod and the one most resembling an order), and (c) a strong correlation between the maximum level of shock that participants administered and the mean maximum shock delivered in the corresponding variant in Milgram's own research. Consistent with an engaged follower account, relative identification with the Experimenter (vs. the Learner) was also a good predictor of the maximum shock that participants administered.

  14. Congenital cutis laxa with rectal and uterovaginal prolapse

    Sanjiv V Choudhary


    Full Text Available A two-month-old female infant born of a consanguineous marriage, presented with loose, wrinkled and inelastic skin over the neck, axillae, trunk, inguinal region and thighs with slow elastic recoil. Patient also had systemic manifestations in the form of bilateral apical lobe consolidation of lung, bilateral inguinal hernia, rectal and uterovaginal prolapse. Histopathological examination of skin biopsy with special stain for elastic tissue revealed absence of dermal elastic tissue. Genital abnormalities in patients with congenital cutis laxa have been reported rarely. But rectal and uterovaginal prolapse have not been reported at an early age of two months. In the absence of mutational screening, with history and clinical findings our case is likely to be Type I autosomal recessive form of congenital cutis laxa.

  15. Differential radiodiagnosis of draining pararectal cysts and rectal fistulas

    Mushnikova, V.N.; Savvateeva, N.Yu.; Arablinskij, V.M.

    Proceeding from an analysis of multimodality examination and treatment of patients with difficulties in differential diagnosis, it has been established that proctography and fistulography play the most important role in radiodiagnosis. The presence of a multichamber cavity with clear even contours at the level of the medium- or lower ampullar region of the rectum is characteristic of draining pararectal cysts. The fustulous passage is single and unramified. Usually there is no connection between the cavity and fistula with the rectum. In rectal fistulas as a result of chronic periproctites the cavity is single, of uneven shape with unclear irregular contours at the level of the anal canal or lower ampullar region of the rectum. The fustulous passage is ramified, frequently connected with the rectal lumen.

  16. Where Do U.S. Adults Who Do Not Use the Internet Get Health Information? Examining Digital Health Information Disparities From 2008 to 2013.

    Massey, Philip M


    With more people turning to the Internet for health information, a few questions remain: Which populations represent the remaining few who have never used the Internet, and where do they go for health information? The purpose of this study is to describe population characteristics and sources of health information among U.S. adults who do not use the Internet. Data from 3 iterations of the Health Information National Trends Survey (n = 1,722) are used to examine trends in health information sources. Weighted predicted probabilities demonstrate changes in information source over time. Older adults, minority populations, and individuals with low educational attainment represent a growing percentage of respondents who have looked for health information but have never used the Internet, highlighting trends in digital information disparities. However, 1 in 10 respondents who have never used the Internet also indicate that the Internet was their first source of health information, presumably through surrogates. Findings highlight digital disparities in information seeking and the complex nature of online information seeking. Future research should examine how individuals conceptualize information sources, measure skills related to evaluating information and sources, and investigate the social nature of information seeking. Health care organizations and public health agencies can leverage the multifaceted nature of information seeking to better develop information resources to increase information access by vulnerable populations.

  17. Solitary rectal ulcer syndrome: A clinicopathological study of 13 cases

    Al-Brahim Nabeel


    Full Text Available Background/Aims: Solitary rectal ulcer syndrome (SRUS is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. To further characterize the clinical and pathological features, a retrospective, hospital-based clinicopathological study was conducted. Materials and Methods: All cases of SRUS diagnosed at Farwania Hospital, Kuwait, between 2002 and 2007 were retrieved from the computerized filing system. The histological slides were reviewed by two authors to confirm the diagnosis. Immunohistochemical stain for smooth muscle actin (SMA was performed. The clinical files were reviewed for clinical features and endoscopic findings. Results: Thirteen cases were identified: 8 males and 5 females. The age range was 15-85. Rectal bleeding, constipation, and abdominal pain were the most common presenting symptoms and were seen, either alone or in various combinations, in 12 of the 13 cases. Rectal ulceration was the most common endoscopic finding, being seen in 9 of the13 cases; 3 of these cases had multiple ulcerations. Two patients had rectal polyps, with one of them having multiple polyps. The histological examination revealed surface serration, fibromuscular obliteration of the lamina propria, and crypts′ distortion in all the cases. Seven of the cases had diamond crypts. Ectatic mucosal vessels were a common finding. Positivity for SMA in the lamina propria was seen in all examined cases. Conclusion: SRUS is a rare disorder and only 13 cases were diagnosed in Farwania hospital over a 6-year period. The clinical presentation of our patients was variable. The presence of polyps and multiple ulcerations on endoscopy is further evidence that SRUS is a misnomer. Surface serration, fibromuscular obliteration, and crypts′ distortion are the most characteristic features. The presence of diamond crypts is an additional diagnostic feature.

  18. Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection

    Bissessor, Melanie; Whiley, David M; Fairley, Christopher K; Bradshaw, Catriona S; Lee, David M; Snow, Anthony S; Lahra, Monica M; Hocking, Jane S; Chen, Marcus Y

    To guide interpretation of gonorrhea tests of cure using nucleic acid amplification testing, this study examined the persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea...

  19. Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin

    Slater, A. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Halligan, S. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Taylor, S.A. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Marshall, M. [Intestinal Imaging Centre, St Mark' s Hospital, Northwick Park, London (United Kingdom)


    Aim: To determine the effect of rectal distension, used by some workers to facilitate staging, on mesorectal tissues. Subjects and methods: Ninety-seven consecutive rectal cancer staging MRI examinations were identified of which 76 were analysable: 48 studies were performed using rectal insufflation of 100 ml room air and 28 were performed without distension. Median age was 69 and 72 years, respectively. In each patient a single experienced observer measured the distance from the outer rectal wall to the inner margin of the mesorectal fascia at four locations (12, 3, 6 and 9 o'clock), excluding sites of tumour involvement, from the T1-weighted axial image at the level of the sacro-coccygeal junction. The two groups of measurements were compared using Mann-Whitney test statistic, and frequencies then categorized into <5 mm or {>=}5 mm, and compared using Fisher's exact test. Results: The median distance between the rectal wall and mesorectal fascia in the distended group was approximately half that found in the non-distended group, and significantly lower at the 3, 6 and 9 o'clock positions (p<0.001). 68/167 (41%) of measurements were 5 mm or less, compared with 19/104 (18%) in the non-distended group (p<0.001). Conclusion: Rectal distension before MRI significantly reduces the distance between the rectal wall and mesorectal fascia. Although this is advocated to facilitate visualization of the primary tumour, it potentially affects the accuracy with which a clear circumferential resection margin can be predicted.

  20. Human rectal mucosal gene expression after consumption of digestible and non-digestible carbohydrates.

    Schauber, Jürgen; Weiler, Frank; Gostner, Andrea; Melcher, Ralph; Kudlich, Theodor; Lührs, Hardi; Scheppach, Wolfgang


    The effect of regular consumption of the low-digestible and prebiotic isomalt versus the digestible sucrose on gene expression in rectal mucosa was examined in a randomized double-blind crossover trial. Nineteen healthy volunteers received 30 g isomalt per day or 30 g sucrose as part of a controlled diet over two 4-week test periods with a 4-week washout period in between. At the end of each test phase rectal biopsies were obtained. After RNA extraction mucosal gene expression was assayed using GeneChip microarrays. In addition, expression of cathelicidin hCap18/LL37, cellular detoxification enzymes GSTpi, UGT1A1 and CYP3A4, cyclooxygenase 2 and barrier factors MUC2 and ZO-1 were determined by real-time RT-PCR. Microbiological analyses of fecal samples revealed a shift of the gut flora towards an increase of bifidobacteria following consumption of the diet containing isomalt. Isomalt consumption did not affect rectal mucosal gene expression in microarray analyses as compared to sucrose. In addition, the expression of cathelicidin LL37, GSTpi, UGT1A1, CYP3A4, COX-2, MUC2 and ZO-1 was not changed in rectal biopsies. We conclude that gene expression of the human rectal mucosa can reliably be measured in biopsy material taken at endoscopy. Dietary intervention with the low digestible isomalt compared with the digestible sucrose did not affect gene expression in the lining rectal mucosa.

  1. FXYD-3 expression in relation to local recurrence of rectal cancer

    Loftas, Per; Arbman, Gunnar; Sun, Xiao Feng; Hallbook, Olof [Dept. of Clinical and Experimental Medicine, Linkoping University, Norrkoping (Sweden); Edler, David [Dept. of Surgery, Karolinska Institute, Stockholm (Sweden); Syk, Erik [Dept. of Surgery, Ersta Hospital, Stockholm (Sweden)


    In a previous study, the transmembrane protein FXYD-3 was suggested as a biomarker for a lower survival rate and reduced radiosensitivity in rectal cancer patients receiving preoperative radiotherapy. The purpose of preoperative irradiation in rectal cancer is to reduce local recurrence. The aim of this study was to investigate the potential role of FXYD-3 as a biomarker for increased risk for local recurrence of rectal cancer. FXYD-3 expression was immunohistochemically examined in surgical specimens from a cohort of patients with rectal cancer who developed local recurrence (n = 48). The cohort was compared to a matched control group without recurrence (n = 81). Weak FXYD-3 expression was found in 106/129 (82%) of the rectal tumors and strong expression in 23/129 (18%). There was no difference in the expression of FXYD-3 between the patients with local recurrence and the control group. Furthermore there was no difference in FXYD-3 expression and time to diagnosis of local recurrence between patients who received preoperative radiotherapy and those without. Previous findings indicated that FXYD-3 expression may be used as a marker of decreased sensitivity to radiotherapy or even overall survival. We were unable to confirm this in a cohort of rectal cancer patients who developed local recurrence.

  2. Rectal nitric oxide as biomarker in the treatment of inflammatory bowel disease: Responders versus nonresponders

    Tryggve Ljung; Sofie Lundberg; Mark Varsanyi; Catharina Johansson; Peter T Schmidt; Max Herulf; Jon O Lundberg; Per M Hellstr(o)m


    AIM: To explore rectal nitric oxide (NO) as biomarker of treatment response in ulcerative colitis (UC) and Crohn's disease (CD), and examine relationships between rectal NO, mucosal expression of NO synthases (NOS), and pro-inflammatory cytokines.METHODS: Twenty-two patients with UC and 24 with CD were monitored during steroid treatment. Rectal NO levels were measured and clinical activities were assessed on days 1, 3, 7 and 28. Mucosal presence of NOS and pro-inflammatory cytokines were analyzed by immunohistochemistry and RT-PCR.RESULTS: Active UC and CD displayed markedly increased rectal NO levels (10950 ± 7610 and 5 040 ±1 280 parts per billion (ppb), respectively) as compared with the controls (154 ± 71 ppb, P < 0.001). Rectal NO correlated weakly with disease activity in both UC and CD (r = 0.34 for UC and r = 0.48 for CD, P < 0.01). In 12 patients, a steroid-refractory course led to colectomy.These patients had only slightly increased NO levels (UC:620 ± 270 ppb; CD: 1260 ± 550 ppb) compared to those with a therapeutic response (UC: 18860 ± 530 ppb, P <0.001; CD: 10060 ± 3200 ppb, P < 0.05).CONCLUSION: Rectal NO level is a useful biomarker of treatment response in IBD as low NO levels predicts a poor clinical response to steroid treatment.


    D. V. Samsonov


    Full Text Available Total mesorectal excision is the “golden standard” of surgical treatment for rectal cancer. Development of endoscopic technologies allowed to implement the benefits of minimally invasive surgery in early rectal cancer treatment, decrease morbidity and mortality, improve functional outcome and quality of life. Oncological safety of this method is still a subject for discussion due to lack of lymph node harvest. Endoscopic operations for early rectal cancer are being actively implemented in daily practice, but lack of experience does not allow to include this method in national clinical prac-tice guidelines.

  4. [Ultrasonographic study of rectal carcinoid tumors].

    Nomura, M; Fujita, N; Matsunaga, A; Ando, M; Tominaga, G; Noda, Y; Kobayashi, G; Kimura, K; Yuki, T; Ishida, K; Yago, A; Mochizuki, F; Chonan, A


    To compare intraluminal ultrasonographic (ILUS) findings with histological findings of rectal carcinoid tumors, 35 patients with rectal carcinoid tumors were reviewed. The results were as follows: 1) The rectal wall was visualized as a seven- or nine-layer structure by means of ILUS in 81% of the patients. 2) The possibility that the thin hyperechoic third layer above the tumor on ILUS corresponds to the muscularis mucosae and fibrointerstitium above the tumor histologically. 3) In cases with relatively high internal echoes, the amount of fibrointerstitium exceeded that of tumor cells histologically. 4) In cases with nonuniform internal echo patterns, tumor cells were separated by thick fibrointerstitium forming nodular nests.

  5. Local radiological staging of rectal cancer

    Goh, V.; Halligan, S. E-mail:; Bartram, C.I


    Rectal cancer is a common malignancy with a highly variable outcome. Local recurrence is dependent upon tumour stage and surgical technique. The role of pre-operative imaging is to determine which patients may be safely managed by surgery alone and which need additional therapy in order to facilitate surgery and improve outcome. This decision depends on the distinction between those with early and advanced disease. While trans-rectal ultrasound has traditionally been used to answer this question, a role for magnetic resonance imaging (MRI) is increasingly argued. This review will focus on the treatment options for rectal cancer and the clinical questions that subsequently arise for the radiologist to answer.

  6. Transvaginal ultrasonography of rectal endometriosis

    Egekvist, Anne Gisselmann; Seyer-Hansen, Mikkel; Forman, Axel

    Objectives: The aim of this present study was to evaluate the interobserver variation of transvaginal ultrasonographic measurements of endometriosis infiltrating the rectosigmoid wall. Methods: Transvaginal ultrasonography was performed independently by two observers. Observer 1 had several years...... of experience in ultrasonography while observer 2 was a medical student with no prior experience in ultrasonography or endometriosis. In 24 patient length, width and depth of endometriosis infiltrating the rectosigmoid bowel was measured. The differences between the observers were analysed by Bland and Altman...... for a relatively short period gives comparable scanning results between the two observers. It seems that transvaginal ultrasound could be used as a diagnostic tool for rectal endometriosis in most departments. However, the irregular morphology of the lesions makes the measurements very complex, and a strict...

  7. Digital Insights

    Knudsen, Gry Høngsmark

    , by incorporating media as both channel, frame, and apparatus for advertising response, the dissertation brings into attention that more aspects than the text-reader relationship influence ad response. Finally, the dissertation proposes the assemblage approach for exploring big data in consumer culture research......This dissertation forwards the theory of digital consumer-response as a perspective to examine how digital media practices influence consumers’ response to advertising. Digital consumer-response is a development of advertising theory that encompasses how consumers employ their knowledge...... and practices with digital media, when they meet and interpret advertising. Through studies of advertising response on YouTube and experiments with consumers’ response to digitally manipulated images, the dissertation shows how digital media practices facilitate polysemic and socially embedded advertising...

  8. EUS-Assisted Evaluation of Rectal Varices before Banding

    Malay Sharma


    Full Text Available Rectal varices are an important cause of bleed. The bleeding can be sometimes fatal. Endoscopic management is possible and is generally done in emergency situation. Rectal variceal banding is useful. Hemodynamic evaluation has shown that the blood flow in rectal varices is from above downwards; however, the site of banding of rectal varices is unclear. This case series shows that the rectal varices should be banded at the highest point of inflow.

  9. A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.

    Temiz, Abdulkerim; Tander, Burak; Temiz, Muhyittin; Barış, Sancar; Arıtürk, Ender


    Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.

  10. PET-MRI in Diagnosing Patients With Colon or Rectal Cancer


    Recurrent Colon Cancer; Recurrent Rectal Cancer; Stage IIA Colon Cancer; Stage IIA Rectal Cancer; Stage IIB Colon Cancer; Stage IIB Rectal Cancer; Stage IIC Colon Cancer; Stage IIC Rectal Cancer; Stage IIIA Colon Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

  11. Forensic examination of ink by high-performance thin layer chromatography--the United States Secret Service Digital Ink Library.

    Neumann, Cedric; Ramotowski, Robert; Genessay, Thibault


    Forensic examinations of ink have been performed since the beginning of the 20th century. Since the 1960s, the International Ink Library, maintained by the United States Secret Service, has supported those analyses. Until 2009, the search and identification of inks were essentially performed manually. This paper describes the results of a project designed to improve ink samples' analytical and search processes. The project focused on the development of improved standardization procedures to ensure the best possible reproducibility between analyses run on different HPTLC plates. The successful implementation of this new calibration method enabled the development of mathematical algorithms and of a software package to complement the existing ink library.

  12. Ostomies in rectal cancer patients: what is their psychosocial impact?

    Kenderian, S; Stephens, E K; Jatoi, A


    The resection of a low-lying rectal cancer can lead to the creation of an ostomy to discharge fecal material. In view of this reconfiguration of anatomy and life-changing modification of daily bodily functions, it is not surprising that a rapidly growing literature has examined ostomy patients' psychosocial challenges. The current study was designed (1) to systematically review the published literature on these psychosocial challenges and (2) to explore, in a single-institution setting, whether medical oncologists appear to acknowledge the existence of an ostomy during their post-operative evaluations of rectal cancer patients. This systematic review identified that social isolation, sleep deprivation; financial concerns; sexual inhibition; and other such issues are common among patients. Surprisingly, however, in our review of 66 consecutive rectal cancer patients, in 17%, the ostomy was not mentioned at all in the medical record during the first medical oncology visit; and, in one patient, it was never mentioned at all during months of adjuvant chemotherapy. Even in the setting of ostomy complications, the ostomy was not always mentioned. This study underscores the major psychosocial issues cancer patients confront after an ostomy and suggests that healthcare providers of all disciplines should work to remain sensitive to such issues.

  13. Metachronous penile metastasis from rectal cancer after total pelvic exenteration

    Yuta Kimura; Dai Shida; Keiichi Nasu; Hiroki Matsunaga; Masahiro Warabi; Satoru Inoue


    Despite its abundant vascularization and extensive circulatory communication with neighboring organs,metastases to the penis are a rare event.A 57-yearold male,who had undergone total pelvic exenteration for rectal cancer sixteen months earlier,demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography.A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia.No other obvious recurrent site was noted except the penile lesion.Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer.A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor.The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7,which strongly supported a diagnosis of penile metastasis from the rectum.The patient is alive more than two years without any recurrence.

  14. Synchronous Adenocarcinoma of the Colon and Rectal Carcinoid

    Vamshidhar Vootla


    Full Text Available Primary colonic adenocarcinoma and synchronous rectal carcinoids are rare tumors. Whenever a synchronous tumor with a nonmetastatic carcinoid component is encountered, its prognosis is determined by the associate malignancy. The discovery of an asymptomatic gastrointestinal carcinoid during the operative treatment of another malignancy will usually only require resection without additional treatment and will have little effect on the prognosis of the individual. This article reports a synchronous rectal carcinoid in a patient with hepatic flexure adenocarcinoma. We present a case of a 46-year-old Hispanic woman with a history of hypothyroidism, uterine fibroids and hypercholesterolemia presenting with a 2-week history of intermittent abdominal pain, mainly in the right upper quadrant. She had no family history of cancers. Physical examination was significant for pallor. Laboratory findings showed microcytic anemia with a hemoglobin of 6.6 g/dl. CT abdomen showed circumferential wall thickening in the ascending colon near the hepatic flexure and pulmonary nodules. Colonoscopy showed hepatic flexure mass and rectal nodule which were biopsied. Pathology showed a moderately differentiated invasive adenocarcinoma of the colon (hepatic flexure mass and a low-grade neuroendocrine neoplasm (carcinoid of rectum. The patient underwent laparoscopic right hemicolectomy and chemotherapy. In patients diagnosed with adenocarcinoma of the colon and rectum, carcinoids could be missed due to their submucosal location, multicentricity and indolent growth pattern. Studies suggest a closer surveillance of the GI tract for noncarcinoid synchronous malignancy when a carcinoid tumor is detected and vice versa.

  15. Synchronous Adenocarcinoma of the Colon and Rectal Carcinoid

    Vootla, Vamshidhar; Ahmed, Rafeeq; Niazi, Masooma; Balar, Bhavna; Nayudu, Suresh


    Primary colonic adenocarcinoma and synchronous rectal carcinoids are rare tumors. Whenever a synchronous tumor with a nonmetastatic carcinoid component is encountered, its prognosis is determined by the associate malignancy. The discovery of an asymptomatic gastrointestinal carcinoid during the operative treatment of another malignancy will usually only require resection without additional treatment and will have little effect on the prognosis of the individual. This article reports a synchronous rectal carcinoid in a patient with hepatic flexure adenocarcinoma. We present a case of a 46-year-old Hispanic woman with a history of hypothyroidism, uterine fibroids and hypercholesterolemia presenting with a 2-week history of intermittent abdominal pain, mainly in the right upper quadrant. She had no family history of cancers. Physical examination was significant for pallor. Laboratory findings showed microcytic anemia with a hemoglobin of 6.6 g/dl. CT abdomen showed circumferential wall thickening in the ascending colon near the hepatic flexure and pulmonary nodules. Colonoscopy showed hepatic flexure mass and rectal nodule which were biopsied. Pathology showed a moderately differentiated invasive adenocarcinoma of the colon (hepatic flexure mass) and a low-grade neuroendocrine neoplasm (carcinoid of rectum). The patient underwent laparoscopic right hemicolectomy and chemotherapy. In patients diagnosed with adenocarcinoma of the colon and rectum, carcinoids could be missed due to their submucosal location, multicentricity and indolent growth pattern. Studies suggest a closer surveillance of the GI tract for noncarcinoid synchronous malignancy when a carcinoid tumor is detected and vice versa. PMID:27920648

  16. The value of colonoscopy to assess rectal bleeding in patients referred from Primary Care Units Utilidad de la colonoscopia en pacientes derivados desde Atención Primaria por rectorragia

    A. Sánchez


    Full Text Available Objectives: rectal bleeding is very common in the general population. It is produced mainly because of benign disease originating in the anus and the rectum. Our aim was to evaluate the need for colonoscopy in patients presenting with rectal bleeding. Patients and methods: patients referred from Primary Care Units and complaining of rectal bleeding were included prospectively in a three-month study. All patients underwent a careful medical history along with physical examination, laboratory tests, and colonoscopy. Results: 126 patients with a mean age of 49.2 years (range: 19-80 were studied. Rectal digital examination was abnormal in 75 cases (59.5%. Severe disease was encountered in 22 patients (neoplasm, angiodysplasia, and inflammatory bowel disease; 10 patients had polyps, 6 had colorectal cancer, and 6 had inflammatory bowel disease. Out of 63 patients younger than 50 years, 5 had severe disease, all of them in the form of inflammatory bowel disease. Conclusions: a neoplasm of the rectum and colon in patients younger than 50 years is a rare event. A colonoscopy must be performed in this group of patients to rule out inflammatory bowel disease.Objetivos: la rectorragia es frecuente en la población general. En la mayoría de las ocasiones está producida por patología anorrectal benigna. Nuestro objetivo era determinar la necesidad de realizar pruebas endoscópicas en pacientes con rectorragia. Pacientes y métodos: se incluyeron de forma prospectiva durante tres meses todos los pacientes que eran derivados desde la Atención Primaria por rectorragia. En todos los pacientes se realizó historia clínica y exploración física que incluía tacto rectal, analítica básica y una colonoscopia. Resultados: se incluyeron 126 pacientes con una edad media de 49,2 años (19-80. El tacto rectal fue anormal en 75 (59,5%. En 22 pacientes se encontró patología severa o positiva (lesiones neoplásicas, angiodisplasias y enfermedad inflamatoria

  17. Low Rectal Cancer Study (MERCURY II)


    Adenocarcinoma; Adenocarcinoma, Mucinous; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Cystic, Mucinous, and Serous; Colorectal Neoplasms; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Diseases; Rectal Diseases

  18. Drugs Approved for Colon and Rectal Cancer

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for use in colon cancer and rectal cancer. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters.

  19. Contemporary outcomes in the detection of prostate cancer using transrectal ultrasound-guided 12-core biopsy in Singaporean men with elevated prostate specific antigen and/or abnormal digital rectal examination

    Alvin Lee


    Conclusion: In conclusion, using contemporary 12-core biopsy methods, the local prostate cancer detection rate based on serum PSA and DRE findings has increased over the past decade presumably due to multiple genetic and environmental factors. Post-biopsy sepsis remains an important complication worldwide.

  20. Appendiceal Adenocarcinoma Presenting as a Rectal Polyp

    Erin Fitzgerald


    Full Text Available Appendiceal adenocarcinoma typically presents as an incidentally noted appendiceal mass, or with symptoms of right lower quadrant pain that can mimic appendicitis, but local involvement of adjacent organs is uncommon, particularly as the presenting sign. We report on a case of a primary appendiceal cancer initially diagnosed as a rectal polyp based on its appearance in the rectal lumen. The management of the patient was in keeping with standard practice for a rectal polyp, and the diagnosis of appendiceal adenocarcinoma was made intraoperatively. The operative strategy had to be adjusted due to this unexpected finding. Although there are published cases of appendiceal adenocarcinoma inducing intussusception and thus mimicking a cecal polyp, there are no reports in the literature describing invasion of the appendix through the rectal wall and thus mimicking a rectal polyp. The patient is a 75-year-old female who presented with spontaneous hematochezia and, on colonoscopy, was noted to have a rectal polyp that appeared to be located within a diverticulum. When endoscopic mucosal resection was not successful, she was referred to colorectal surgery for a low anterior resection. Preoperative imaging was notable for an enlarged appendix adjacent to the rectum. Intraoperatively, the appendix was found to be densely adherent to the right lateral rectal wall. An en bloc resection of the distal sigmoid colon, proximal rectum and appendix was performed, with pathology demonstrating appendiceal adenocarcinoma that invaded through the rectal wall. The prognosis in this type of malignancy weighs heavily on whether or not perforation and spread throughout the peritoneal cavity have occurred. In this unusual presentation, an en bloc resection is required for a complete resection and to minimize the risk of peritoneal spread. Unusual appearing polyps do not always originate from the bowel wall. Abnormal radiographic findings adjacent to an area of

  1. SU-E-P-57: Radiation Doses Assessment to Paediatric Patients for Some Digital Diagnostic Radiology Examination in Emergency Department in Qatar

    Abdallah, I; Aly, A; Al Naemi, H [Hamad Medical Corporation, Doha (Qatar)


    Purpose: The aim of this study was to evaluate radiation doses to pediatric patients undergoing standard radiographic examinations using Direct Digital Radiography (DDR) in Paediatric emergency center of Hamad General Hospital (HGH) in state of Qatar and compared with regional and international Dose Reference Levels (DRLs). Methods: Entrance Skin Dose (ESD) was measured for 2739 patients for two common X-ray examinations namely: Chest AP/PA, Abdomen. Exposure factors such as kV, mAs and Focal to Skin Distance (FSD) were recorded for each patient. Tube Output was measured for a range of selected kV values. ESD for each individual patient was calculated using the tube output and the technical exposure factors for each examination. The ESD values were compared with the some international Dose Reference Levels (DRL) for all types of examinations. Results: The most performed procedure during the time of this study was chest PA/PA (85%). The mean ESD values obtained from AP chest, PA chest and AP abdomen ranged 91–120, 80–84 and 209 – 659 µGy per radiograph for different age’s groups respectively. Two protocols have been used for chest AP and PA using different radiological parameters, and the different of ESD values for chest PA and were 41% for 1 years old child, 57% for 5 years old for chest AP. Conclusion: The mean ESD were compared with those found in literature and were found to be comparable. The radiation dose can be reduced more for Chest AP and PA examination by optimization of each investigation and hence more studies are required for this task. The results presented will serve as a baseline data needed for deriving local reference doses for pediatric X-ray examinations in this local department and hence it can be applied in the whole Qatar.

  2. The Clinical Significance of Digital Examination-Indicated Cerclage in Women with a Dilated Cervix at 14 0/7 - 29 6/7 Weeks

    Hyun Sun Ko, Yun Seong Jo, Ki Cheol Kil, Ha Kyun Chang, Yong-Gyu Park, In Yang Park, Guisera Lee, Sajin Kim, Jong Chul Shin


    Full Text Available Objective. This study was to compare pregnancy outcomes between cerclage and expectant management in wemen with a dilated cervix. Design. Retrospective multicenter cohort study. Setting. Five hospitals of Catholic University Medical Center Network in Korea. Population. A total of 173 women between 14 0/7 and 29 6/7 weeks' gestation with cervical dilation of 1 cm or greater by digital examination. Methods. Pregnancy outcomes were compared according to cerclage or expectant management, with the use of propensity-score matching. Main Outcome Measures. Primary outcome was time from presentation until delivery (weeks. Secondary outcomes were gestational age at delivery, neonatal survival, morbidity, preterm birth, and so on.Results. Of 173 women, 116 received a cerclage (cerclage group, and 57 were managed expectantly without cerclage (expectant group. Cervical dilation at presentation, and the use of amniocentesis performed to exclude subclinical chorioamnionitis differed between two groups. In the overall matched cohort, there was significant difference in the time from presentation until delivery (cerclage vs. expectant group, 10.6±6.2 vs. 2.9±3.2 weeks, p <0.0001. While there was no significant difference in the neonatal survival between two groups, there werelower neonatal morbidity as well as higher pregnancy maintenance rate at 28, 32, 34 and 37 weeks' gestation in the cerclage group, compared with the expectant group.Conclusion. This study suggests that digital examination-indicated cerclage appears to prolong gestation and decrease neonatal morbidity, compared with expectant management in women with cervical dilation between 14 0/7 and 29 6/7 weeks.

  3. Identification of capsaicin-sensitive rectal mechanoreceptors activated by rectal distension in mice.

    Spencer, N J; Kerrin, A; Singer, C A; Hennig, G W; Gerthoffer, W T; McDonnell, O


    Rodents detect visceral pain in response to noxious levels of rectal distension. However, the mechanoreceptors that innervate the rectum and respond to noxious levels of rectal distension have not been identified. Here, we have identified the mechanoreceptors of capsaicin-sensitive rectal afferents and characterized their properties in response to circumferential stretch of the rectal wall. We have also used the lethal spotted (ls/ls) mouse to determine whether rectal mechanoreceptors that respond to capsaicin and stretch may also develop in an aganglionic rectum that is congenitally devoid of enteric ganglia. In wild type (C57BL/6) mice, graded increases in circumferential stretch applied to isolated rectal segments activated a graded increase in firing of slowly-adapting rectal mechanoreceptors. Identical stimuli applied to the aganglionic rectum of ls/ls mice also activated similar graded increases in firing of stretch-sensitive rectal afferents. In both wild type and aganglionic rectal preparations, focal compression of the serosal surface using von Frey hairs identified mechanosensitive "hot spots," that were associated with brief bursts of action potentials. Spritzing capsaicin (10 microM) selectively onto each identified mechanosensitive hot spot activated an all or none discharge of action potentials in 32 of 56 identified hot spots in wild type mice and 24 of 62 mechanosensitive hot spots in the aganglionic rectum of ls/ls mice. Each single unit activated by both capsaicin and circumferential stretch responded to low mechanical thresholds (1-2 g stretch). No high threshold rectal afferents were ever recorded in response to circumferential stretch. Anterograde labeling from recorded rectal afferents revealed two populations of capsaicin-sensitive mechanoreceptor that responded to stretch: one population terminated within myenteric ganglia, the other within the circular and longitudinal smooth muscle layers. In the aganglionic rectum of ls/ls mice, only the

  4. A Case of Long-term Survival after Curative Resection for Synchronous Solitary Adrenal Metastasis from Rectal Cancer.

    Chen, Linlin; Wang, Da; Mao, Weifang; Huang, Xuefeng; He, Chao


    Clinically curable adrenal metastasis is rare. We report a case of synchronous solitary adrenal metastasis from rectal cancer in a 51-year-old man who underwent curative resection. A right adrenal mass was found by ultrasonography during his routine physical examination and this was confirmed by computed tomography (CT). His serum carcinoembryonic antigen (CEA) level was found elevated, and colonoscopy revealed a rectal tumor located 10cm from anal verge. A simultaneous laparoscopic right adrenalectomy and anterior resection for rectal carcinoma was performed. Histopathological examination revealed well-differentiated rectal adenocarcinoma with adrenal metastasis. The patient is still alive and free from disease 6 years after the surgery. A review in the literature showed that synchronous solitary adrenal metastasis from colorectal carcinoma is very rare. Surgical resection and for selected patients, laparoscopic procedure may provide survival benefit and potential surgical cure for a solitary metastasis.

  5. Tissue-associated bacterial alterations in rectal carcinoma patients revealed by 16S rRNA community profiling

    Andrew Maltez Thomas


    by digital droplet PCR. Our findings point to increased bacterial richness and diversity in rectal cancer, along with several differences in microbial community composition. Our work is the first to present evidence for a possible role of bacteria such as Bacteroides fragilis and the phylum Parcubacteria in rectal cancer, emphasizing the need to study tissue-associated bacteria and specific regions of the gastrointestinal tract in order to better understand the possible links between the microbiota and rectal cancer.

  6. Tissue-Associated Bacterial Alterations in Rectal Carcinoma Patients Revealed by 16S rRNA Community Profiling

    Thomas, Andrew M.; Jesus, Eliane C.; Lopes, Ademar; Aguiar, Samuel; Begnami, Maria D.; Rocha, Rafael M.; Carpinetti, Paola Avelar; Camargo, Anamaria A.; Hoffmann, Christian; Freitas, Helano C.; Silva, Israel T.; Nunes, Diana N.; Setubal, João C.; Dias-Neto, Emmanuel


    Sporadic and inflammatory forms of colorectal cancer (CRC) account for more than 80% of cases. Recent publications have shown mechanistic evidence for the involvement of gut bacteria in the development of both CRC-forms. Whereas, colon and rectal cancer have been routinely studied together as CRC, increasing evidence show these to be distinct diseases. Also, the common use of fecal samples to study microbial communities may reflect disease state but possibly not the tumor microenvironment. We performed this study to evaluate differences in bacterial communities found in tissue samples of 18 rectal-cancer subjects when compared to 18 non-cancer controls. Samples were collected during exploratory colonoscopy (non-cancer group) or during surgery for tumor excision (rectal-cancer group). High throughput 16S rRNA amplicon sequencing of the V4–V5 region was conducted on the Ion PGM platform, reads were filtered using Qiime and clustered using UPARSE. We observed significant increases in species richness and diversity in rectal cancer samples, evidenced by the total number of OTUs and the Shannon and Simpson indexes. Enterotyping analysis divided our cohort into two groups, with the majority of rectal cancer samples clustering into one enterotype, characterized by a greater abundance of Bacteroides and Dorea. At the phylum level, rectal-cancer samples had increased abundance of candidate phylum OD1 (also known as Parcubacteria) whilst non-cancer samples had increased abundance of Planctomycetes. At the genera level, rectal-cancer samples had higher abundances of Bacteroides, Phascolarctobacterium, Parabacteroides, Desulfovibrio, and Odoribacter whereas non-cancer samples had higher abundances of Pseudomonas, Escherichia, Acinetobacter, Lactobacillus, and Bacillus. Two Bacteroides fragilis OTUs were more abundant among rectal-cancer patients seen through 16S rRNA amplicon sequencing, whose presence was confirmed by immunohistochemistry and enrichment verified by digital

  7. Magnetic resonance colonography without bowel cleansing using oral and rectal stool softeners (fecal cracking) - a feasibility study

    Ajaj, Waleed; Lauenstein, Thomas C.; Kuehle, Christiane; Herborn, Christoph U.; Goehde, Susanne C. [University Hospital of Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Schneemann, Hubert [University Hospital of Essen, Institute of Pharmacy and Pharmaceutical Sciences, Essen (Germany); Ruehm, Stefan G. [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States); Goyen, Mathias [University Hospital of Hamburg-Eppendorf, Medical Center, Hamburg (Germany)


    The aim of our study was to assess the effect of oral and rectal stool softeners on dark-lumen magnetic resonance (MR) colonography without bowel cleansing. Ten volunteers underwent MR colonography without colonic cleansing. A baseline examination was performed without oral or rectal administration of stool softeners. In a second set, volunteers ingested 60 ml of lactulose 24 h prior to MR examination. In a third examination, water as a rectal enema was replaced by a solution of 0.5%-docusate sodium (DS). A fourth MR examination was performed, in conjunction with both oral administration of lactulose and rectal application of DS. A T1-weighted data set was acquired at scanning times of 0, 5 and 10 min after colonic filling. A fourth data set was acquired 75 s after i.v. injection of contrast agent. Signal intensity of stool was calculated for all colonic segments. Without oral ingestion of lactulose or rectal enema with DS stool signal intensity was high and did not decrease over time. However, lactulose and DS caused a decrease in stool signal intensity. Both substances together led to a decreasing signal intensity of feces. Combination of lactulose and DS provided the lowest signal intensity of stool. Thus, feces could hardly be distinguished from dark rectal enema allowing for the assessment of the colonic wall. (orig.)

  8. Locally advanced rectal cancer: management challenges

    Kokelaar RF


    Full Text Available RF Kokelaar, MD Evans, M Davies, DA Harris, J Beynon Department of Colorectal Surgery, Singleton Hospital, Swansea, UK Abstract: Between 5% and 10% of patients with rectal cancer present with locally advanced rectal cancer (LARC, and 10% of rectal cancers recur after surgery, of which half are limited to locoregional disease only (locally recurrent rectal cancer. Exenterative surgery offers the best long-term outcomes for patients with LARC and locally recurrent rectal cancer so long as a complete (R0 resection is achieved. Accurate preoperative multimodal staging is crucial in assessing the potential operability of advanced rectal tumors, and resectability may be enhanced with neoadjuvant therapies. Unfortunately, surgical options are limited when the tumor involves the lateral pelvic sidewall or high sacrum due to the technical challenges of achieving histological clearance, and must be balanced against the high morbidity associated with resection of the bony pelvis and significant lymphovascular structures. This group of patients is usually treated palliatively and subsequently survival is poor, which has led surgeons to seek innovative new solutions, as well as revisit previously discarded radical approaches. A small number of centers are pioneering new techniques for resection of beyond-total mesorectal excision tumors, including en bloc resections of the sciatic notch and composite resections of the first two sacral vertebrae. Despite limited experience, these new techniques offer the potential for radical treatment of previously inoperable tumors. This narrative review sets out the challenges facing the management of LARCs and discusses evolving management options. Keywords: rectal cancer, exenteration, pelvic sidewall, sacrectomy

  9. Interleukin genes and associations with colon and rectal cancer risk and overall survival.

    Bondurant, Kristina L; Lundgreen, Abbie; Herrick, Jennifer S; Kadlubar, Susan; Wolff, Roger K; Slattery, Martha L


    Interleukins are a group of cytokines that contribute to growth and differentiation, cell migration, and inflammatory and anti-inflammatory responses by the immune system. In our study, we examined genetic variation in genes from various anti-inflammatory and proinflammatory interleukins to determine association with colon and rectal cancer risk and overall survival. Data from two population-based incident studies of colon cancer (1,555 cases and 1,956 controls) and rectal cancer (754 cases and 954 controls) were used. After controlling for multiple comparisons, single nucleotide polymorphisms (SNPs) from four genes, IL3, IL6R, IL8, IL15, were associated with increased colon cancer risk, and CXCR1 and CXCR2 were significantly associated with increased rectal cancer risk. Only SNPs from genes within the IL-8 pathway (IL8, CXCR1 and CXCR2) showed a significant association with both colon and rectal cancer risk. Several SNPs interacted significantly with IL8 and IFNG SNPs and with aspirin/non-steroidal anti-inflammatory drug (NSAID), cigarette smoking, estrogen use and BMI. For both colon and rectal cancer, increasing numbers of risk alleles were associated with increased hazard of death from cancer; the estimated hazard of death for colon cancer for the highest category of risk alleles was 1.74 (95% confidence interval [CI] 1.18-2.56) and 1.96 (95% CI 1.28-2.99) for rectal cancer. These data suggest that interleukin genes play a role in risk and overall survival for colon and rectal cancer. Copyright © 2012 UICC.

  10. Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study.

    Andriesse, G I; Gooszen, H G; Schipper, M E; Akkermans, L M; van Vroonhoven, T J; van Laarhoven, C J


    To reduce pouch related complications after restorative proctocolectomy, an alternative procedure was developed, the ileo neo-rectal anastomosis (INRA). This technique consists of rectal mucosa replacement by ileal mucosa and straight ileorectal anastomosis. Our study provides a detailed description of the functional results after INRA. Eleven patients underwent an INRA procedure with a temporary ileostomy. Anorectal function tests were performed two months prior to and six and 12 months after closure of the ileostomy and comprised: anal manometry, ultrasound examination, rectal balloon distension, and transmucosal electrical nerve stimulation (TENS). Function was subsequently related to the histopathology of rectal biopsy samples. Median stool frequency decreased from 15/24 hours (10-25) to 6/24 hours (4-11) at one year. All patients reported full continence. Anal sensibility, and resting and squeeze pressures did not change after INRA. Rectal compliance decreased (2.1 (0.7-2.8) v 1.5 (0.4-2.2) and 1.4 (0.8-3.7) ml/mm Hg (p=0.03)) but the maximum tolerated volume increased (70 (50-118) v 96 (39-176) (NS) and 122 (56-185) ml (p=0.03)). Decreasing rectal sensitivity was found: the maximum tolerated pressure increased (14 (8-24) v 22 (8-34) (NS) and 26 (14-40) (p=0.02)) and the rectal threshold for TENS displayed a similar tendency. All patients displayed a low grade chronic inflammatory infiltrate in neorectal biopsy samples before closure of the ileostomy, with no change during follow up. The technique of INRA provides a safe alternative for restorative surgery. Stool frequency after INRA improves with time and seems to be related to decreasing sensitivity and not to histopathological changes in the neorectum. Furthermore, after the INRA procedure, all patients reported full continence.

  11. Preoperative staging of rectal cancer.

    Smith, Neil; Brown, Gina


    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  12. Rectal and colon cancer : Not just a different anatomic site

    Tamas, K.; Walenkamp, A. M. E.; de Vries, E. G. E.; van Vugt, M. A. T. M.; Beets-Tan, R. G.; van Etten, B.; de Groot, D. J. A.; Hospers, G. A. P.


    Due to differences in anatomy, primary rectal and colon cancer require different staging procedures, different neo-adjuvant treatment and different surgical approaches. For example, neoadjuvant radiotherapy or chemoradiotherapy is administered solely for rectal cancer. Neoadjuvant therapy and total

  13. Rectal and colon cancer : Not just a different anatomic site

    Tamas, K.; Walenkamp, A. M. E.; de Vries, E. G. E.; van Vugt, M. A. T. M.; Beets-Tan, R. G.; van Etten, B.; de Groot, D. J. A.; Hospers, G. A. P.

    Due to differences in anatomy, primary rectal and colon cancer require different staging procedures, different neo-adjuvant treatment and different surgical approaches. For example, neoadjuvant radiotherapy or chemoradiotherapy is administered solely for rectal cancer. Neoadjuvant therapy and total

  14. Research and Application of Digital Health Examination Information System%数字化健康体检信息系统的研究与应用

    施洪; 周晓丹; 侯秀敏; 魏峰松; 吴晓辉; 吕诚惠


    介绍了数字化健康体检系统的设计目标,包括:标准化、自动化、智能化、人性化、稳定性、易用性、全面性和安全性;以及实现上述目标所需的关键技术,软件功能设计、数据库设计、运行环境设计思路,及系统维护和完善.系统投入运行后,取得了良好效果,简化了体检流程,杜绝了常见差错,大大提高了工作效率及工作质量:同时,通过与临床信息系统的连接,还实现了病人的资料共享,形成集客户健康管理、健康体检和医疗保健于一体的现代医学保健模式,为全面实现健康管理打下坚实基础.%It introduces the design goal of digital health examination system, including standardization, automation, intelligence, humanization, stabilization, ease of use, comprehensiveness, and security; additionally, the key technique, software function design, database design, design thought of operation environment, as well as system maintenance and perfection which are required to realize the goal above-mentioned are also involved. After the system is applied, it gets good result, which simplifies the health examination procedure, eradicates the common error, and greatly enhances the work efficiency and quality; meanwhile, by connecting with the clinical information system, it fulfills the patient' s information sharing, forms the modern medical care mode integrating with customer' s health management, health examination and medical care, which lays the solid foundation for fully realizing the health management.

  15. Impact of diabetes on oncologic outcome of colorectal cancer patients: colon vs. rectal cancer.

    Justin Y Jeon

    Full Text Available BACKGROUND: To evaluate the impact of diabetes on outcomes in colorectal cancer patients and to examine whether this association varies by the location of tumor (colon vs. rectum. PATIENTS AND METHODS: This study includes 4,131 stage I-III colorectal cancer patients, treated between 1995 and 2007 (12.5% diabetic, 53% colon, 47% rectal in South Korea. Cox proportional hazards modeling was used to determine the prognostic influence of DM on survival endpoints. RESULTS: Colorectal cancer patients with DM had significantly worse disease-free survival (DFS [hazard ratio (HR 1.17, 95% confidence interval (CI: 1.00-1.37] compared with patients without DM. When considering colon and rectal cancer independently, DM was significantly associated with worse overall survival (OS (HR: 1.46, 95% CI: 1.11-1.92, DFS (HR: 1.45, 95% CI: 1.15-1.84 and recurrence-free survival (RFS (HR: 1.32, 95% CI: 0.98-1.76 in colon cancer patients. No association for OS, DFS or RFS was observed in rectal cancer patients. There was significant interaction of location of tumor (colon vs. rectal cancer with DM on OS (P = 0.009 and DFS (P = 0.007. CONCLUSIONS: This study suggests that DM negatively impacts survival outcomes of patients with colon cancer but not rectal cancer.

  16. The importance of rectal cancer MRI protocols on iInterpretation accuracy

    Lindholm Johan


    Full Text Available Abstract Background Magnetic resonance imaging (MRI is used for preoperative local staging in patients with rectal cancer. Our aim was to retrospectively study the effects of the imaging protocol on the staging accuracy. Patients and methods MR-examinations of 37 patients with locally advanced disease were divided into two groups; compliant and noncompliant, based on the imaging protocol, without knowledge of the histopathological results. A compliant rectal cancer imaging protocol was defined as including T2-weighted imaging in the sagittal and axial planes with supplementary coronal in low rectal tumors, alongside a high-resolution plane perpendicular to the rectum at the level of the primary tumor. Protocols not complying with these criteria were defined as noncompliant. Histopathological results were used as gold standard. Results Compliant rectal imaging protocols showed significantly better correlation with histopathological results regarding assessment of anterior organ involvement (sensitivity and specificity rates in compliant group were 86% and 94%, respectively vs. 50% and 33% in the noncompliant group. Compliant imaging protocols also used statistically significantly smaller voxel sizes and fewer number of MR sequences than the noncompliant protocols Conclusion Appropriate MR imaging protocols enable more accurate local staging of locally advanced rectal tumors with less number of sequences and without intravenous gadolinium contrast agents.

  17. Rectal cancer treatment: Improving the picture


    Multidisciplinary approach for rectal cancer treatment is currently well defined. Nevertheless, new and promising advances are enriching the portrait. Since the US NIH Consensus in the early 90's some new characters have been added. A bird's-eye view along the last decade shows the main milestones in the development of rectal cancer treatment protocols. New drugs, in combination with radiotherapy are being tested to increase response and tumor control outcomes. However, therapeutic intensity is often associated with toxicity. Thus, innovative strategies are needed to create a better-balanced therapeutic ratio. Molecular targeted therapies and improved technology for delivering radiotherapy respond to the need for accuracy and precision in rectal cancer treatment.

  18. MRI Findings of Rectal Submucosal Tumors

    Kim, Hon Soul; Kim, Joo Hee; Lim, Joon Seok; Choi, Jin Young; Chung, Yong Eun; Park, Mi Suk; Kim, Myeong Jin; Kim, Ki Whang; Kim, Sang Kyum [Yonsei University Health System, Seoul (Korea, Republic of)


    Rectal submucosal lesions encompass a wide variety of benign and malignant tumors involving the rectum. With optical colonoscopy, any mass-like protrusion covered by normal mucosa, whether the underlying process is intramural or extramural in origin, may be reported as a submucosal lesion. Whereas the assessment of submucosal lesions may be limited with performing optical colonoscopy, cross-sectional imaging such as CT, transrectal ultrasonography and MRI allows the evaluation of perirectal tissues and pelvic organs in addition to the entire thickness of the rectum, and so this is advantageous for the assessment of rectal submucosal tumors. Among these, MRI is the best investigative modality for soft tissue characterization. Therefore, knowledge of the MRI features of rectal submucosal tumors can help achieve accurate preoperative diagnoses and facilitate the appropriate management.

  19. The Great Pretender: Rectal Syphilis Mimic a Cancer

    Andrea Pisani Ceretti


    Full Text Available Rectal syphilis is a rare expression of the widely recognised sexual transmitted disease, also known as the great imitator for its peculiarity of being confused with mild anorectal diseases because of its vague symptoms or believed rectal malignancy, with the concrete risk of overtreatment. We present the case of a male patient with primary rectal syphilis, firstly diagnosed as rectal cancer; the medical, radiological, and endoscopic features are discussed below.

  20. Discrimination of rectal cancer through human serum using surface-enhanced Raman spectroscopy

    Li, Xiaozhou; Yang, Tianyue; Li, Siqi; Zhang, Su; Jin, Lili


    In this paper, surface-enhanced Raman spectroscopy (SERS) was used to detect the changes in blood serum components that accompany rectal cancer. The differences in serum SERS data between rectal cancer patients and healthy controls were examined. Postoperative rectal cancer patients also participated in the comparison to monitor the effects of cancer treatments. The results show that there are significant variations at certain wavenumbers which indicates alteration of corresponding biological substances. Principal component analysis (PCA) and parameters of intensity ratios were used on the original SERS spectra for the extraction of featured variables. These featured variables then underwent linear discriminant analysis (LDA) and classification and regression tree (CART) for the discrimination analysis. Accuracies of 93.5 and 92.4 % were obtained for PCA-LDA and parameter-CART, respectively.

  1. Primary Transanal Management of Rectal Atresia in a Neonate.

    M, Braiek; A, Ksia; I, Krichen; S, Belhassen; K, Maazoun; S, Ben Youssef; N, Kechiche; M, Mekki; A, Nouri


    Rectal atresia (RA) with a normal anus is a rare anomaly. We describe a case of rectal atresia in a newborn male presenting with an abdominal distension and failure of passing meconium. The rectal atresia was primarily operated by transanal route.

  2. VMAT planning study in rectal cancer patients

    Shang, Jun; Kong, Wei; Wang, Yan-Yang; Ding, Zhe; Yan, Gang; Zhe, Hong


    Background To compare the dosimetric differences among fixed field intensity-modulated radiation therapy (IMRT), single-arc volumetric-modulated arc therapy (SA-VMAT) and double-arc volumetric-modulated arc therapy (DA-VMAT) plans in rectal cancer. Method Fifteen patients with rectal cancer previously treated with IMRT in our institution were selected for this study. For each patient, three plans were generated with the planning CT scan: one using a fixed beam IMRT, and two plans using the VM...

  3. [Adjuvant chemotherapy for patients with rectal cancer].

    Qvortrup, Camilla; Mortensen, John Pløen; Pfeiffer, Per


    A new Cochrane meta-analysis evaluated adjuvant chemotherapy (5-fluorouracil (5FU)-based, not modern combination chemotherapy) in almost 10,000 patients with rectal cancer and showed a 17% reduction in mortality corresponding well to the efficacy observed in recent studies, which reported a reduction in mortality just about 20%. The authors recommend adjuvant chemotherapy which is in accordance with the Danish national guidelines where 5-FU-based chemotherapy is recommended for stage III and high-risk stage II rectal cancer.

  4. Massive zosteriform cutaneous metastasis from rectal carcinoma.

    Damin, D C; Lazzaron, A R; Tarta, C; Cartel, A; Rosito, M A


    A 44-year-old man presented with a large and rapidly growing skin lesion approximately six months after resection of a rectal carcinoma. The lesion measured 40 cm in size, extended from the suprapubic area to the proximal half of the left groin, and showed a particular zosteriform aspect. Biopsy confirmed a metastatic skin adenocarcinoma. Cutaneous metastases from rectal cancer are very uncommon. Their gross appearance is not distinctive, although the skin tumors are usually solid, small (less than 5 cm) and painless nodules or papules. Early biopsies for suspicious skin lesions are needed in patients with a history of colorectal cancer.

  5. Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders

    Ivano Biviano; Danilo Badiali; Laura Candeloro; Fortunee Irene Habib; Massimo Mongardini; Angelo Caviglia; Fiorella Anzini; Enrico S Corazziari


    AIM: To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR. METHODS: Thirty patients (Female, 28; age: 51 ± 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 ± 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol, were assessed. Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment. A responder was defined as an absence of the Rome El diagnostic criteria for functional constipation. Defecography and recto-anal manometry were performed before and after the STARR procedure in 16 and 12 patients, respectively. RESULTS: After STARR, 53% of patients were re-sponders; during conservative treatment, 75% were responders. After STARR, 30% of the patients reported the use of laxatives, 17% had intermittent anal pain, 13% had anal leakage, 13% required digital facilitation, 6% experienced defecatory urgency, 6% experienced fecal incontinence, and 6% required re-intervention. During macrogol therapy, 23% of the patients complained of abdominal bloating and 13% of borborygmi, and 3% required digital facilitation.No preoperative symptom, defecographic, or manometric finding predicted the outcome of STARR. Post-operative defecography showed a statistically significant reduction (P < 0.05) of the rectal diameter and rectocele. The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified, and that rectal compliance was reduced (P = 0.01). CONCLUSION: STARR is not better and is less safe than macrogol in the treatment of defecation disorders. It

  6. Digital equity in education: A Multilevel examination of differences in and relationships between computer access, computer use and state-level technology policies.

    Jonathan D. Becker


    Full Text Available Using data from the National Assessment of Educational Progress (NAEP state assessment and a survey of state-level technology policies, this study examined digital equity in education as a multilevel organizational phenomenon with data from 70,382 students in 3,479 schools and 40 states. Students in rural schools or schools with higher percentages of African American students were likely to have less access to computers. With respect to computer use, girls and students eligible for free or reduced-price lunch were more likely to use computers more frequently when computers are available in the classroom. With respect to relationships between computer access and computer use, having computers available in a lab increases the likelihood of higher levels of computer use. The results suggested that no more than 5% of the variance in computer access can be attributed to state factors, and less than 1% of the variance in computer use was between states. The findings suggested that where student technology standards are integrated into subject-area standards, computer use was likely lower than in other states. In states where pre-service teachers must meet technology-related requirements to receive their teaching credential and states where funds earmarked for technology are distributed as competitive grants, computer use was likely to be higher.

  7. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer

    Emmertsen, Katrine Jøssing; Laurberg, S


    Bowel dysfunction after sphincter-preserving surgery for rectal cancer is a common complication, with the potential to affect quality of life (QoL) strongly. The aim of this study was to examine the extent of bowel dysfunction and impact on health-related QoL after curative sphincter-preserving r...

  8. Results of radical surgery for rectal cancer.

    Heald, R J; Karanjia, N D


    This paper examines the hypothesis that a reduction in the distal mural margin during anterior resection for sphincter conservation in rectal cancer excision is safe, provided total mesorectal excision is undertaken with wash-out of the clamped rectum. One hundred ninety-two patients underwent anterior resection and 21 (less than 10%) patients underwent abdomino-perineal excision (APE) by one surgeon (RJH). Anterior resections were classified as "curative" (79%) and "non-curative" (21%); in the "curative" sub-group less than 4% of patients developed local recurrence. The series was retrospectively analyzed for the effect of mural margins on local recurrence with 152 patients undergoing "curative" anterior resections and 40 patients undergoing "non-curative" resections. In the 152 specimens from curative resections, 110 had a resection margin greater than 1 cm and 42 had a resection margin less than 1 cm. Four patients developed local recurrence in the greater than 1 cm margin group (95% confidence interval: 0.8%-7.8%) and no patients developed local recurrence in the less than or equal to 1 cm margin group (95% confidence interval: 0%-5.9%). In each patient with local recurrence a cause for failure was apparent. There was no statistically significant difference in local recurrence rate between the less than or equal to 1 cm margin group and the greater than 1 cm margin group. A reduction in resection margin therefore did not compromise survival after anterior resection. The significance of lateral resection margins is discussed. The role of deep radiotherapy and cytotoxics are considered.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience

    Kilius, Alfredas; Petrulis, Kestutis; Samalavicius, Narimantas E.


    Purpose The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM). Methods Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences. Results The average tumor size was 2.8 ± 1.5 cm (range, 0.5–8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days. Conclusion TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.

  10. Clinical study on treatment of rectal carcinoma with Chinese herbal medicine and high dose fluorouracil emulsion via rectal infusion.



    Objective: To study the clinical significance of rectal infusion of Chinese herbal medicine (CHM) plus high dose fluorouracil emulsion in treating rectal carcinoma. Methods: 86 patients of rectal carcinoma were randomly divided into CHM plus chemotherapy group and single chemotherapy group, and the

  11. Becoming digital

    Pors, Anja Svejgaard


    The purpose of this paper is to examine the impact of e-government reforms on street-level bureaucrats’ professionalism and relation to citizens, thus demonstrating how the bureaucratic encounter unfolds in the digital era. Design/methodology/approach: The paper is based on an ethnographic study....... An ethnographic account of how digital reforms are implemented in practice shows how street-level bureaucrat’s classic tasks such as specialized casework are being reconfigured into educational tasks that promote the idea of “becoming digital”. In the paper, the author argues that the work of “becoming digital....... Originality/value: The study contributes to ethnographic research in public administration by combining two separate subfields, e-government and street-level bureaucracy, to discern recent transformations in public service delivery. In the digital era, tasks, control and equality are distributed in ways...

  12. Rectal temperature-based death time estimation in infants.

    Igari, Yui; Hosokai, Yoshiyuki; Funayama, Masato


    In determining the time of death in infants based on rectal temperature, the same methods used in adults are generally used. However, whether the methods for adults are suitable for infants is unclear. In this study, we examined the following 3 methods in 20 infant death cases: computer simulation of rectal temperature based on the infinite cylinder model (Ohno's method), computer-based double exponential approximation based on Marshall and Hoare's double exponential model with Henssge's parameter determination (Henssge's method), and computer-based collinear approximation based on extrapolation of the rectal temperature curve (collinear approximation). The interval between the last time the infant was seen alive and the time that he/she was found dead was defined as the death time interval and compared with the estimated time of death. In Ohno's method, 7 cases were within the death time interval, and the average deviation in the other 12 cases was approximately 80 min. The results of both Henssge's method and collinear approximation were apparently inferior to the results of Ohno's method. The corrective factor was set within the range of 0.7-1.3 in Henssge's method, and a modified program was newly developed to make it possible to change the corrective factors. Modification A, in which the upper limit of the corrective factor range was set as the maximum value in each body weight, produced the best results: 8 cases were within the death time interval, and the average deviation in the other 12 cases was approximately 80min. There was a possibility that the influence of thermal isolation on the actual infants was stronger than that previously shown by Henssge. We conclude that Ohno's method and Modification A are useful for death time estimation in infants. However, it is important to accept the estimated time of death with certain latitude considering other circumstances.

  13. Effect of Suboptimal Chemotherapy on Preoperative Chemoradiation in Rectal Cancer

    Lee, Ji Hye; Kang, Hyun Cheol; Chie, Eui Kyu; Kang, Gyeong Hoon; Park, Jae Gahb; Oh, Do Youn; Im, Seock Ah; Kim, Tae You; Bang, Yung Jue; Ha, Sung Whan [Yonsei University College of Medicine, Seoul (Korea, Republic of)


    To examine the effect of suboptimal chemotherapy in patients undergoing preoperative chemoradiotherapy for the treatment of rectal cancer. The medical records of 43 patients who received preoperative concurrent chemoradiotherapy, followed by radical surgery for the treatment of pathologically proven adenocarcinoma of the rectum from April 2003 to April 2006 were retrospectively reviewed. The delivered radiation dose ranged from 41.4 to 50.4 Gy. The standard group consisted of patients receiving two cycles of a 5-FU bolus injection for three days on the first and fifth week of radiotherapy or twice daily with capecitabine. The standard group included six patients for each regimen. The non-standard group consisted of patients receiving one cycle of 5-FU bolus injection for three days on the first week of radiotherapy. The non-standard group included 31 patients. Radical surgery was performed at a median of 58 days after the end of radiotherapy. A low anterior resection was performed in 36 patients, whereas an abdominoperineal resection was performed in 7 patients. No significant difference was observed between the groups with respect to pathologic responses ranging from grades 3 to 5 (83.3% vs. 67.7%, p=0.456), downstaging (75.0% vs. 67.7%, p=0.727), and a radial resection margin greater than 2 mm (66.7% vs. 83.9%, p=0.237). The sphincter-saving surgery rate in low-lying rectal cancers was lower in the non-standard group (100% vs. 75%, p=0.068). There was no grade 3 or higher toxicity observed in all patients. Considering that the sphincter-saving surgery rate in low-lying rectal cancer was marginally lower for patients treated with non-standard, suboptimal chemotherapy, and that toxicity higher than grade 2 was not observed in the both groups, suboptimal chemotherapy should be avoided in this setting.

  14. Circulating levels of vitamin D and colon and rectal cancer: the Physicians' Health Study and a meta-analysis of prospective studies.

    Lee, Jung Eun; Li, Haojie; Chan, Andrew T; Hollis, Bruce W; Lee, I-Min; Stampfer, Meir J; Wu, Kana; Giovannucci, Edward; Ma, Jing


    It remains unknown whether increased risk with low levels of vitamin D is present for colon and/or rectal cancer. To investigate the association between circulating vitamin D levels and colon and rectal cancer, we examined the associations between plasma levels of 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] and colon and rectal cancer in the Physicians' Health Study and then conducted a meta-analysis of eight prospective studies of circulating levels of 25(OH)D and colon and rectal cancers, including the Physicians' Health Study. Study-specific ORs and 95% CIs were pooled by using a random-effects model. A total of 1,822 colon and 868 rectal cancers were included in the meta-analysis. We observed a significant inverse association for colorectal cancer (OR = 0.66; 95% CI, 0.54-0.81), comparing top versus bottom quantiles of circulating 25(OH)D levels. The inverse association was stronger for rectal cancer (OR = 0.50 for top versus bottom quantiles; 95% CI, 0.28-0.88) than colon cancer (OR = 0.77; 95% CI, 0.56-1.07; P value for difference between colon and rectal cancer = 0.20). These data suggest an inverse association between circulating 25(OH)D levels and colorectal cancer, with a stronger association for rectal cancer.

  15. Expression and role of Tie-2 in rectal carcinoma


    Objective To investigate the expression of Tie-2 in rectal carcinoma and its relationship with invasion and metastasis in rectal carcinoma.Materials S-P immunohistochemical assay was used to detect the expression of Tie-2 in 40 cases of rectal carcinoma and 10 cases of normal rectal tissues.Results Tie-2 was mainly localized in the cytoplasm and nucleus of vascular endothelial cells in cancerous tissues and partly in the cytoplasm of some cancerous cells.The expression of Tie-2 in rectal carcinoma was signi...

  16. 'Microerosions' in rectal biopsies in Crohn's disease

    Poulsen, Steen Seier


    Small (less than 1 mm), superficial erosions ('microerosions') have been observed stereo-microscopically in surface-stained rectal biopsies in Crohn's disease (CD). Biopsy specimens from 97 patients with CD, 225 with ulcerative colitis (UC), and a control material of 161 patients were investigated...

  17. Management of rectal varices in portal hypertension


    Rectal varices are portosystemic collaterals that form asa complication of portal hypertension, their prevalencehas been reported as high as 94% in patients withextrahepatic portal vein obstruction. The diagnosis istypically based on lower endoscopy (colonoscopy orsigmoidoscopy). However, endoscopic ultrasonographyhas been shown to be superior to endoscopy in diagnosingrectal varices. Color Doppler ultrasonography isa better method because it allows the calculation of thevelocity of blood flow in the varices and can be used topredict the bleeding risk in the varices. Although rare,bleeding from rectal varices can be life threatening. Themanagement of patients with rectal variceal bleedingis not well established. It is important to ensurehemodynamic stability with blood transfusion and tocorrect any coagulopathy prior to treating the bleedingvarices. Endoscopic injection sclerotherapy has beenreported to be more effective in the management ofactive bleeding from rectal varices with less rebleedingrate as compared to endoscopic band ligation. Transjugularintrahepatic portsystemic shunt alone or incombination with embolization is another method usedsuccessfully in control of bleeding. Balloon-occludedretrograde transvenous obliteration is an emergingprocedure for management of gastric varices that hasalso been successfully used to treat bleeding rectalvarices. Surgical procedures including suture ligationand porto-caval shunts are considered when othermethods have failed.

  18. Current management of locally recurrent rectal cancer

    Nielsen, Mette Bak; Laurberg, Søren; Holm, Thorbjörn


    ABSTRACT Objective: A review of the literature was undertaken to provide an overview of the surgical management of locally recurrent rectal cancer (LRRC) after the introduction of total mesorectal excision (TME). Method: A systematic literature search was undertaken using PubMed, Embase, Web...

  19. Management of synchronous rectal and prostate cancer.

    Kavanagh, D O


    Although well described, there is limited published data related to management on the coexistence of prostate and rectal cancer. The aim of this study was to describe a single institution\\'s experience with this and propose a treatment algorithm based on the best available evidence.

  20. [Rectal cancer: diagnosis, screening and treatment].

    Decanini-Terán, César Oscar; González-Acosta, Jorge; Obregón-Méndez, Jorge; Vega-de Jesús, Martín


    Rectal cancer is one of the primary malignant neoplasms occurring in Mexican patients of reproductive age. Unfortunately, randomized studies in rectal cancer do not exist as they do with well-recognized colon cancer. We must individualize the epidemiology, risk factors, diagnostic approach, staging and treatment because management is different in rectal cancers affecting the mid- and lower third of the rectum than in the upper third and in colon cancers. Histological staging is the primary prognostic factor. TNM staging (tumor, node, and metastasis) is used internationally by the American Joint Committee on Cancer (AJCC). Staging is done with the assistance of endorectal ultrasound, which is best used in early-stage cancer; however, there are certain disadvantages in detecting node involvement. Magnetic resonance, on the other hand, allows for the evaluation of stenotic tumors and node involvement. Once the correct diagnosis and staging have been made, the next step is correct treatment. Neoadjuvant treatment has demonstrated to be better than adjuvant treatment. Abdominoperineal resection is rarely practiced currently, with sphincter preservation being the preferred procedure. Laparoscopic approach has conferred the advantages of the approach itself when performed by experts in the procedure but there is insufficient evidence to make it the "gold standard." Rectal cancer is a complex pathology that must be considered totally different from colon cancer for diagnosis and treatment. The patient must be staged completely and appropriately for individualizing correct treatment. More long-term studies are needed for optimizing treatment modalities.

  1. Evidence and research in rectal cancer.

    Valentini, V.; Beets-Tan, R.; Borras, J.M.; Krivokapic, Z.; Leer, J.W.H.; Pahlman, L.; Rodel, C.; Schmoll, H.J.; Scott, N.; Velde, C.V.; Verfaillie, C.


    The main evidences of epidemiology, diagnostic imaging, pathology, surgery, radiotherapy, chemotherapy and follow-up are reviewed to optimize the routine treatment of rectal cancer according to a multidisciplinary approach. This paper reports on the knowledge shared between different specialists inv

  2. Surgery for local recurrence of rectal carcinoma

    T. Wiggers (Theo); M.R. de Vries (Mark); B. Veeze-Kuypers (Bernadette)


    textabstractPURPOSE: This study was designed to evaluate results, especially mortality and morbidity, of surgical resection with curative intent for patients with a local recurrence of rectal cancer, in combination with radiotherapy. METHODS: Consecutive medical records of 163 patients with local re

  3. Combined radical retropubic prostatectomy and rectal resection.

    Klee, L W; Grmoljez, P


    To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

  4. Rectal cancer radiotherapy: Towards European consensus

    Valentini, Vincenzo (Cattedra di Radioterapia, Univ. Cattolica S.Cuore, Rome (Italy)), E-mail:; Glimelius, Bengt (Dept. of Oncology, Radiology and Clinical Immunology, Uppsala Univ., Uppsala (Sweden))


    Background and purpose. During the first decade of the 21st century several important European randomized studies in rectal cancer have been published. In order to help shape clinical practice based on best scientific evidence, the International Conference on 'Multidisciplinary Rectal Cancer Treatment: Looking for an European Consensus' (EURECA-CC2) was organized. This article summarizes the consensus about imaging and radiotherapy of rectal cancer and gives an update until May 2010. Methods. Consensus was achieved using the Delphi method. Eight chapters were identified: epidemiology, diagnostics, pathology, surgery, radiotherapy and chemotherapy, treatment toxicity and quality of life, follow-up, and research questions. Each chapter was subdivided by topic, and a series of statements were developed. Each committee member commented and voted, sentence by sentence three times. Sentences which did not reach agreement after voting round no 2 were openly debated during the Conference in Perugia (Italy) December 2008. The Executive Committee scored percentage consensus based on three categories: 'large consensus', 'moderate consensus', 'minimum consensus'. Results. The total number of the voted sentences was 207. Of the 207, 86% achieved large consensus, 13% achieved moderate consensus, and only three (1%) resulted in minimum consensus. No statement was disagreed by more than 50% of members. All chapters were voted on by at least 75% of the members, and the majority was voted on by >85%. Considerable progress has been made in staging and treatment, including radiation treatment of rectal cancer. Conclusions. This Consensus Conference represents an expertise opinion process that may help shape future programs, investigational protocols, and guidelines for staging and treatment of rectal cancer throughout Europe. In spite of substantial progress, many research challenges remain

  5. Endoscopic MR imaging using 3D-fast SPGR sequence for local staging of rectal carcinoma

    Murano, Akihiko (Tokyo Women' s Medical Coll. (Japan))


    In order to stage the degree of infiltration of rectal carcinomas by means of an endorectal surface coil, it is essential to place the coil in the lesion's center. Existing methods are not very precise and are potentially dangerous, because the coil is placed blindly. In this study we staged rectal carcinomas with a prototype MR endoscope jointly developed by Yokogawa Medical and Olympus Optical Co. and a superconductive 1.5-T Signa Advantage system (GE Medical Systems). With the MR endoscope we could locate the lesion and place the coil accurately and safely in its center in all 11 cases examined. In 2 of the 11 cases with severe circumferential stenosis the tip of the coil was inserted into the stenosis and precise MR images were obtained, while a conventional fiberscope could not be advanced past the stenotic site. A 3D-fast SPGR sequence produced 16 2-mm slices in 20 seconds, which showed the bowel wall with a hyperintense mucosa, a hypointense submucosa and muscularis propria of moderate intensity. Tumors presented moderately intense structures which were approximately similar in intensity to the muscularis propria. Advanced tumors were heterogeneous and showed both intermediate intensity and hypointensity. In nine of 11 patients, post-operative pathohistology showed accurate staging of mural invasion of rectal carcinoma using MR endoscopy, while in two invasion was overestimated. In one case of overstimation direct invasion of rectal carcinoma into the vaginal wall was suspected but pathological findings showed only inflammatory adhesion caused by invasion. Although the other case was diagnosed pathologically as a rectal carcinoma invading the muscularis propria, a fibrotic change at the outer margin of tumor invasion was recognized. Our results suggest that this method may be useful in accurately staging the degree of invasion in rectal carcinoma patients. (author).

  6. Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery.

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Harper, Mick; Parvaiz, Amjad


    To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: "rectal cancer" or "colorectal cancer" and robot* or "da Vinci" and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

  7. Functional brain imaging in irritable bowel syndrome with rectal balloon-distention by using fMRI

    Yao-Zong Yuan; Ran-Jun Tao; Bin Xu; Jing Sun; Ke-Min Chen; Fei Miao; Zhong-Wei Zhang; Jia-Yu Xu


    AIM: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation leveldependent functional magnetic resonance imaging (BOLDfMRI) in visceral pain center and to compare the distribution,extent, and intensity of activated areas between IBS patients and normal controls. METHODS: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLDfMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects. RESULTS: Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37),prefrontal cortex (37/37), and thalamus (35/37) in most cases.At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls. CONCLUSION: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.

  8. Probe-based confocal laser endomicroscopy for in vivo evaluation of the tumor vasculature in gastric and rectal carcinomas.

    Spessotto, Paola; Fornasarig, Mara; Pivetta, Eliana; Maiero, Stefania; Magris, Raffaella; Mongiat, Maurizio; Canzonieri, Vincenzo; De Paoli, Paolo; De Paoli, Antonino; Buonadonna, Angela; Serraino, Diego; Panato, Chiara; Belluco, Claudio; Cannizzaro, Renato


    Probe-based Confocal Laser Endomicroscopy (pCLE) is a powerful imaging technique that allows to perform gastrointestinal endomicroscopy at subcellular resolution. The aim of this study was to assess the use of pCLE to evaluate tumor angiogenesis in rectal and gastric cancers. A total of 35 consecutive patients with gastric and 91 with rectal carcinomas underwent endoscopy and pCLE during the same examination. Vascular assessment was based on vessel shape and size, vessel permeability and blood flow, and allowed the creation of an angiogenic score ranging from 0, for normal vasculature, to 4, for aberrant vasculature. A significant difference for the presence of vessels with large diameter and defective blood flow was found between rectal and gastric cancers. Overall, rectal cancers displayed a higher angiogenic score compared to gastric cancers. Conventional therapy induced a striking reduction in the angiogenic score only in rectal cancer patients. Taken together, our findings suggest that the pCLE technology is suitable for the evaluation of the tumor microvasculature abnormalities. Therefore, the real-time assessment of the vasculature status may represent a promising approach to predict the efficacy of the treatments and improve the clinical management of patients with gastric or rectal carcinomas.

  9. [A case report of pathologically complete response of locally advanced rectal cancer after neoadjuvant chemoradiotherapy with XELOX and bevacizumab].

    Miyazawa, Tomonori; Ebe, Kazuyu; Fujita, Nobuhiro; Koide, Norihiko; Honma, Kenji; Ikarashi, Toshihiko


    A 70-year-old man was admitted to our hospital for constipation. A clinical examination showed locally advanced rectal cancer with possible invasion to the prostate gland and pelvic wall. After performing colostomy, he underwent neoadjuvant radiation therapy (40 Gy) and six courses of a XELOX and bevacizumab regimen. A subsequent examination demonstrated significant reduction of the tumor, so we performed super low anterior resection and colo-anal anastomosis. Pathological examination revealed no residual cancer cells and showed pathological CR. Neoadjuvant chemoradiotherapy with XELOX and bevacizumab were useful for down staging and function-preserving surgery in patients with locally advanced rectal cancer.

  10. Watch and wait approach to rectal cancer: A review

    Marcos; E; Pozo; Sandy; H; Fang


    In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage Ⅲ(node-positive) disease. For stage Ⅱ and Ⅲ colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluationthis is known as complete clinical response(cC R). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with c CR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.

  11. Prognostic Aspects of DCE-MRI in Recurrent Rectal Cancer

    Gollub, M.J.; Gultekin, D.H.; Sohn, M. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Cao, K. [Peking University Cancer Hospital and Institute, Department of Radiology, Beijing (China); Kuk, D.; Gonen, M. [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Schwartz, L.H. [Columbia University Medical Center/New York Presbyterian Hospital, Department of Radiology, New York, NY (United States); Weiser, M.R.; Temple, L.K.; Nash, G.M.; Guillem, J.G.; Garcia-Aguilar, J.; Paty, P.B. [Memorial Sloan-Kettering Cancer Center, Department of Surgery, New York, NY (United States); Wang, M. [Fudan University Shanghai Cancer Center, Department of Colorectal Surgery, Shanghai (China); Goodman, K. [Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY (United States)


    To explore whether pre-reoperative dynamic contrast-enhanced (DCE)-MRI findings correlate with clinical outcome in patients who undergo surgical treatment for recurrent rectal carcinoma. A retrospective study of DCE-MRI in patients with recurrent rectal cancer was performed after obtaining an IRB waiver. We queried our PACS from 1998 to 2012 for examinations performed for recurrent disease. Two radiologists in consensus outlined tumour regions of interest on perfusion images. We explored the correlation between K{sup trans}, K{sub ep}, V{sub e}, AUC90 and AUC180 with time to re-recurrence of tumour, overall survival and resection margin status. Univariate Cox PH models were used for survival, while univariate logistic regression was used for margin status. Among 58 patients with pre-treatment DCE-MRI who underwent resection, 36 went directly to surgery and 18 had positive margins. K{sup trans} (0.55, P = 0.012) and K{sub ep} (0.93, P = 0.04) were inversely correlated with positive margins. No significant correlations were noted between K{sup trans}, K{sub ep}, V{sub e}, AUC90 and AUC180 and overall survival or time to re-recurrence of tumour. K{sup trans} and K{sub ep} were significantly associated with clear resection margins; however overall survival and time to re-recurrence were not predicted. Such information might be helpful for treatment individualisation and deserves further investigation. (orig.)

  12. Presacral venous bleeding during mobilization in rectal cancer

    Casal Núñez, Jose Enrique; Vigorita, Vincenzo; Ruano Poblador, Alejandro; Gay Fernández, Ana María; Toscano Novella, Maria Ángeles; Cáceres Alvarado, Nieves; Pérez Dominguez, Lucinda


    AIM To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer. METHODS A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined. RESULTS This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication. CONCLUSION A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

  13. Digital books.

    Wink, Diane M


    In this bimonthly series, the author examines how nurse educators can use the Internet and Web-based computer technologies such as search, communication, and collaborative writing tools; social networking and social bookmarking sites; virtual worlds; and Web-based teaching and learning programs. This article describes digital books.

  14. The change of radiation doses to the patient when switching from conventional technique to digital technique without films in barium enema and IVU examinations. Final report SSI research project P933

    Sjöholm, B


    X-ray examinations of the colon (barium enema) and the kidneys (IVU) are combined with rather high radiation doses to the patients when using analogue technique with film-screen systems. It is therefore of great interest to see if the change from analogue to digital technique involves a reduction of doses. Barium enema and IVU examinations were monitored with DAP-meters before and after the X-ray department changed to digital techniques. For IVU also the change from storage phosphor plates to a Direct Digital detector is included. The study comprises between 53 and 87 patients for each modality of the two examinations. A considerable dose reduction was observed. In barium enema the overview images with large field sizes were omitted when using digital technique. On the other hand the number of spot images was increased from 6 to 22. The fluoroscopy time was increased from 4 minutes to 6 minutes. The DAP value was reduced from 54,3 Gy cm sup 2 to 21,9 Gy cm sup 2. For IVU a dose reduction from 44,5 Gy cm sup 2...

  15. Digital forensics digital evidence in criminal investigations

    Marshall, Angus McKenzie


    The vast majority of modern criminal investigations involve some element of digital evidence, from mobile phones, computers, CCTV and other devices. Digital Forensics: Digital Evidence in Criminal Investigations provides the reader with a better understanding of how digital evidence complements "traditional" scientific evidence and examines how it can be used more effectively and efficiently in a range of investigations. Taking a new approach to the topic, this book presents digital evidence as an adjunct to other types of evidence and discusses how it can be deployed effectively in s

  16. Postmortem diagnosis of preclinical and clinical scrapie in sheep by the detection of disease-associated PrP in their rectal mucosa.

    González, L; Dagleish, M P; Bellworthy, S J; Sisó, S; Stack, M J; Chaplin, M J; Davis, L A; Hawkins, S A C; Hughes, J; Jeffrey, M


    Samples of tissue from the central nervous system (cns), the lymphoreticular system (lrs) and the rectal mucosa of a large number of scrapie-exposed sheep, with and without signs of clinical disease, were examined immunohistochemically for evidence of disease-associated prion protein (PrP(d)). The rectal mucosa has received almost no attention so far in scrapie diagnosis, despite its abundant rectoanal mucosa-associated lymphoid tissue, and its accessibility. The scrapie-confirmed cases included 244 with clinical disease, of which 237 (97.1 per cent) were positive in the rectal mucosa, and 121 apparently healthy sheep, of which 104 (86 per cent) were positive in the rectal mucosa. PrP(d) was detected in 86.4 to 91.5 per cent of the other lrs tissues of the healthy sheep examined and in 77.7 per cent of their cns tissues. The stage of infection, therefore, affected the probability of a positive result in the rectal mucosa, whereas the breed, PrP genotype, age and sex had little or no independent effect. Accumulations of PrP(d) were observed in the rectal mucosa and other lrs tissues of vrq/arr sheep with preclinical and clinical scrapie, albeit with a lower frequency and magnitude than in sheep of other PrP genotypes. Western immunoblotting analyses of samples of rectal mucosa gave the characteristic PrP glycoprofile, with a sensitivity similar to that of immunohistochemistry.

  17. Learning Curves in Robotic Rectal Cancer Surgery: A literature Review



    Full Text Available Background Laparoscopic rectal cancer surgery offers several advantages over open surgery, including quicker recovery, shorter hospital stay and improved cosmesis. However, laparoscopic rectal surgery is technically difficult and is associated with a long learning curve. The last decade has seen the emergence of robotic rectal cancer surgery. In contrast to laparoscopy, robotic surgery offers stable 3D views with advanced dexterity and ergonomics in narrow spaces such as the pelvis. Whether this translates into a shorter learning curve is still debated. The aim of this literature search is to ascertain the learning curve of robotic rectal cancer surgery. Methods This review analyses the literature investigating the learning curve of robotic rectal cancer surgery. Using the Medline database a literature search of articles investigating the learning curve of robotic rectal surgery was performed. All relevant articles were included. Results Twelve original studies fulfilled the inclusion criteria. The current literature suggests that the learning curve of robotic rectal surgery varies between 15 and 44 cases and is probably shorter to that of laparoscopic rectal surgery. Conclusions There are only a few studies assessing the learning curve of robotic rectal surgery and they possess several differences in methodology and outcome reporting. Nevertheless, current evidence suggests that robotic rectal surgery might be easier to learn than laparoscopy. Further well designed studies applying CUSSUM analysis are required to validate this motion.

  18. Digital filters

    Hamming, Richard W


    Digital signals occur in an increasing number of applications: in telephone communications; in radio, television, and stereo sound systems; and in spacecraft transmissions, to name just a few. This introductory text examines digital filtering, the processes of smoothing, predicting, differentiating, integrating, and separating signals, as well as the removal of noise from a signal. The processes bear particular relevance to computer applications, one of the focuses of this book.Readers will find Hamming's analysis accessible and engaging, in recognition of the fact that many people with the s

  19. Transanal Evisceration Caused by Rectal Laceration

    Torres Sánchez, María Teresa; Richart Aznar, Jose Manuel; Martí Martínez, Eva María; Martínez-Abad, Manuel


    Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained. PMID:24639971

  20. UFT (tegafur-uracil) in rectal cancer

    Casado, E; Pfeiffer, P; Feliu, J


    BACKGROUND: Major achievements in the treatment of localised rectal cancer include the development of total mesorectal excision and the perioperative administration of radiotherapy in combination with continuous infusion (CI) 5-fluorouracil (5-FU). This multimodal approach has resulted in extended...... survival and lower local relapse rates, with the potential for sphincter-preserving procedures. However, CI 5-FU is inconvenient for patients and is costly. Oral fluoropyrimidines like UFT (tegafur-uracil) offer a number of advantages over 5-FU. METHODS: We undertook a review of published articles...... and abstracts relating to clinical studies of UFT in the treatment of locally advanced rectal cancer (LARC). Pre- and postoperative studies carried out in patients with newly diagnosed or recurrent disease were included. RESULTS: The combination of UFT and radiotherapy was effective and well tolerated...

  1. Synchronous rectal adenocarcinoma and anal canal adenocarcinoma

    GU Jin; LI Jiyou; YAO Yunfeng; LU Aiping; WANG Hongyi


    It is difficult to distinguish a tectal carcinoma with anal metastases from coexistent synchronous anorectal carcinomas.The therapeutic strategy for rectal and anal carcinoma is so different that it should be clearly identified.Here,we report on the case of a 63-year-old man who presented with an upper-third rectal adenocarcinoma.Five months after resection,he developed an adenocarcinoma in the anal canal.The histological slides of both tumors were reviewed and immunohistochemical studies for cytokeratins(CKs)7 and 20 were performed.The index tumor demonstrated CK 7-/CK 20+and the second showed CK7+/CK20+.For this reason,we believe the present case had synchronous adenocarcinomas arising from anal canal and the rectum separately.It is very important to difierentiate the anorectal lesions pathologically because of the impact on the therapeutic options available,especially for the lesion arising in the anal canal.

  2. Improved survival after rectal cancer in Denmark

    Bülow, S; Harling, H; Iversen, L H


    treated from 1994 to 2006. Method The study was based on the National Rectal Cancer Registry and the National Colorectal Cancer Database, supplemented with data from the Central Population Registry. The analysis included actuarial overall and relative survival. Results A total of 10 632 patients were......Objective In 1995, an analysis showed an inferior prognosis after rectal cancer in Denmark compared with the other Scandinavian countries. The Danish Colorectal Cancer Group (DCCG) was established with the aim of improving the prognosis, and in this study we present a survival analysis of patients...... operated on. The overall 5-year survival increased from 0.37 in 1994 to 0.51% in 2006; the improvement was greater in men (20% points) than in women (10% points), and greatest in stage III (20% points). The relative 5-year survival increased from 0.46 to 0.62, including an improvement of 23% points in men...

  3. Mercury toxicity in the shark (Squalus acanthias) rectal gland: apical CFTR chloride channels are inhibited by mercuric chloride.

    Ratner, Martha A; Decker, Sarah E; Aller, Stephen G; Weber, Gerhard; Forrest, John N


    In the shark rectal gland, basolateral membrane proteins have been suggested as targets for mercury. To examine the membrane polarity of mercury toxicity, we performed experiments in three preparations: isolated perfused rectal glands, primary monolayer cultures of rectal gland epithelial cells, and Xenopus oocytes expressing the shark cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel. In perfused rectal glands we observed: (1) a dose-dependent inhibition by mercury of forskolin/3-isobutyl-1-methylxanthine (IBMX)-stimulated chloride secretion; (2) inhibition was maximal when mercury was added before stimulation with forskolin/IBMX; (3) dithiothrietol (DTT) and glutathione (GSH) completely prevented inhibition of chloride secretion. Short-circuit current (Isc) measurements in monolayers of rectal gland epithelial cells were performed to examine the membrane polarity of this effect. Mercuric chloride inhibited Isc more potently when applied to the solution bathing the apical vs. the basolateral membrane (23 +/- 5% and 68 +/- 5% inhibition at 1 and 10 microM HgCl2 in the apical solution vs. 2 +/- 0.9% and 14 +/- 5% in the basolateral solution). This inhibition was prevented by pre-treatment with apical DTT or GSH; however, only the permeant reducing agent DTT reversed mercury inhibition when added after exposure. When the shark rectal gland CFTR channel was expressed in Xenopus oocytes and chloride conductance was measured by two-electrode voltage clamping, we found that 1 microM HgCl2 inhibited forskolin/IBMX conductance by 69.2 +/- 2.0%. We conclude that in the shark rectal gland, mercury inhibits chloride secretion by interacting with the apical membrane and that CFTR is the likely site of this action.

  4. Technological advances in radiotherapy of rectal cancer

    Appelt, Ane L; Sebag-Montefiore, David


    PURPOSE OF REVIEW: This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques. RECENT FINDINGS: The dosimetric....... Overall results are encouraging, as toxicity levels - although varying across reports - appear lower than for 3D conformal radiotherapy. Innovative treatment techniques and strategies which may be facilitated by the use of IMRT/VMAT include simultaneously integrated tumour boost, adaptive treatment...

  5. Primary rectal melanoma - a case report

    Somak Das


    Full Text Available The most common site for malignant melanoma is skin, then eye and third is anorectal region. Primary anorectal malignant melanoma is still very uncommon. It is usually very aggressive and presents with altered bowel habit and rectal bleeding. Proctoscopy shows non-pigmented or lightly pigmented polypoid lesion. Histopathology is confirmatory. Early radical excision is mandatory. A 56 year-old female was presented with malignant melanoma of the lower third of rectum. We report this case for its rarity.

  6. [Tuberculous prostato-rectal fistula].

    Rabii, Redouane; Fekak, Hamid; el Manni, Ahmed; Joual, Abdenbi; Benjelloun, Saad; el Mrini, Mohammed


    In a 60-year-old man admitted for right epididymo-orchitis with scrotal fistula and urine leak via the rectum, the diagnosis of tuberculosis was based on histological examination of a tissue sample of the scrotal fistula. The fistula was successfully treated with tuberculostatic drugs and cystostomy.

  7. A new method of assessing the surgical margin in rectal carcinoma—using nonlinear optical microscopy

    Li, Lianhuang; Chen, Zhifen; Kang, Deyong; Deng, Tongxin; Jiang, Liwei; Zhou, Yi; Liu, Xing; Jiang, Weizhong; Zhuo, Shuangmu; Guan, Guoxian; Chi, Pan; Chen, Jianxin


    Nowadays, surgical resection is still the most effective treatment strategy for rectal carcinoma and one of the most important factors affecting whether the operation is successful or not is the surgical margin determination, especially in the distal rectal carcinoma which should take the sphincter-preserving issue into consideration. However, until recently no reliable evaluation method has been developed for this purpose. There are some shortcomings in intraoperative negative surgical margin assessment such as either lack of enough detailed information of biological tissues or the fact that it is time-consuming. Multiphoton microscopy (MPM)—nonlinear optical microscopy, which is based on the nonlinear optical process two-photon excited fluorescence (TPEF) and second harmonic generation (SHG), has the ability to label freely and noninvasively visualize tissue micro-architecture at the sub-cellular level. The advantage of providing high contrast and high resolution biomedical image in real time makes MPM have a wide range of applications in life sciences. In this study, we introduced MPM to identify the boundary between normal and abnormal rectal tissues. MPM images clearly exhibit biological tissue microstructure and its morphological changes in the regions of our interest, which enable it to determine the surgical margin in rectal carcinoma. It can be foreseen that once MPM imaging system is used in clinical examination, it will greatly improve the accuracy of surgical resection.

  8. Serum 25-hydroxyvitamin D and risks of colon and rectal cancer in Finnish men.

    Weinstein, Stephanie J; Yu, Kai; Horst, Ronald L; Ashby, Jason; Virtamo, Jarmo; Albanes, Demetrius


    Prospective investigations of circulating vitamin D concentrations suggest inverse associations with colorectal cancer risk, although inconsistencies remain and few studies have examined the impact of season. The authors conducted a prospective case-control study of 239 colon cancer cases and 192 rectal cancer cases (diagnosed in 1993-2005) and 428 controls matched on age and blood collection date within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a cohort study of Finnish male smokers. Baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations were categorized using a priori defined cutpoints of colon cancer and 0.64, 0.58, 0.84, 1.00, and 0.76 for rectal cancer, respectively (all 95% confidence intervals included 1.00). Colon cancer risks were significantly elevated for the highest season-specific and season-standardized quartiles versus the lowest quartiles (OR = 2.11 (95% CI: 1.20, 3.69) and OR = 1.88 (95% CI: 1.07, 3.28), respectively), while rectal cancer risk estimates were null. These results provide no evidence to support an inverse association between vitamin D status and colon or rectal cancer risk; instead, they suggest a positive association for colon cancer.

  9. Abdominal and perineal approaches in the surgical treatment of rectal prolapse

    Mesut Gül


    Full Text Available Introduction: Rectal prolapse is a disease, which is an important cause of social and functional problems and has a continuing debate about the ideal surgical treatment of itself. In this study, we aimed to investigate the abdominal and perineal approaches with early and late postoperative result in the patients undergoing surgery for rectal prolapse.Materials and methods: Between 2006-2011, the records of 21 patients undergoing surgery with the diagnosis of rectal prolapse were reviewed, retrospectively. The demographic and physical examination findings, surgical procedures, early and late postoperative complications, recurrence and mortality rates were recorded.Results: The median age was 43 years and female/male ratio was 1.63/1. The most common presenting complaint was gas control failure and often wetting with mucus. Stage 1 and stage 3 rectal prolapses was detected in 19% and 81% of the patients, respectively. The most common surgical procedure was Notaras (54%. Early postoperative complications were seen in 14.3% of the patients. There were no postoperative recurrence, mortality and complication requiring re-exploration. Advanced age and shorter duration of hospital stay were determined and often performed under regional anesthesia in the patients undergoing perineal approach. No statistical differences were observed in terms of early postoperative complications and recurrence.Conclusion: Results of abdominal and perineal approaches were similar, when they were applied with taking into account the risk factors for surgical treatment, findings of the patients and the surgeon’s experience.

  10. Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

    Al-Sukhni, Eisar; Attwood, Kristopher; Mattson, David M.; Gabriel, Emmanuel; Nurkin, Steven J.


    Background Some patients with rectal cancer who receive neoadjuvant chemoradiotherapy (nCRT) achieve a pathologic complete response (pCR) and may be eligible for less radical surgery or non-operative management. The aim of this study was to identify variables that predict pCR after nCRT for rectal cancer and to examine the impact of pCR on postoperative complications. Methods A retrospective review was performed of the NCDB from 2006 to 2011. Patients with rectal cancer who received nCRT followed by radical resection were included in this study. Multivariable analysis of the association between clinicopathologic characteristics and pCR was performed, and propensity-adjusted analysis was used to identify differences in postoperative morbidity between pCR and non-pCR patients. Results A total of 23,747 patients were included in the study. Factors associated with pCR included lower tumor grade, lower clinical T and N stage, higher radiation dose, and delaying surgery by more than 6–8 weeks after the end of radiation, while lack of health insurance was linked with a lower likelihood of pCR. Complete response was not associated with an increased risk of major postoperative complications. Conclusions Several clinical, pathologic, and treatment variables can help to predict which patients are most likely to have pCR after nCRT for rectal cancer. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options. PMID:26668083

  11. Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy

    Gianni Mezzi; Paolo Giorgio Arcidiacono; Silvia Carrara; Francesco Perri; Maria Chiara Petrone; Francesco De Cobelli; Simone Gusmini; Carlo Staudacher; Alessandro Del Maschio; Pier Alberto Testoni


    AIM: To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), in patients with rectal cancer after neoadjuvant chemoradiation therapy.And we compared EUS and MRI data with histological findings from surgical specimens.METHODS: Thirty-nine consecutive patients (51.3% Male; mean age: 68.2 ± 8.9 years) with histologically confirmed distal rectal cancer were examined for staging.All patients underwent EUS and MRI imaging beforeand after neoadjuvant chemoradiation therapy.RESULTS: After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% (18/39) and 44% (17/39) of patients, respectively, in line with their histological T stage ( P > 0.05). These proportions were higher for both techniques when nodal involvement was considered:69% (27/39) and 62% (24/39). When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 (44% vs 33%, P > 0.05) and N0 disease (87% vs 52%, P = 0.013). However, MRI was more accurate than EUS in T and N staging for patients with more advanceddisease after radiotherapy, though these differencesdid not reach statistical significance.CONCLUSION: EUS and MRI are accurate imaging techniques for staging rectal cancer. However, after neoadjuvant RT-CT, the role of both methods in the assessmentof residual rectal tumors remains uncertain.

  12. Prevenção do parto prematuro: emprego do toque vaginal e da ultra-sononografia transvaginal Prevention of preterm birth: use of digital examination and transvaginal ultrasonography

    Arlete Ayako Yamasaki


    Full Text Available Objetivo: avaliar o colo uterino por meio do toque vaginal e da ultra-sonografia transvaginal em gestantes de risco elevado para o parto prematuro. Métodos: durante o período compreendido entre fevereiro de 1995 e setembro de 1997 foram acompanhadas 38 gestantes com elevado risco para o parto prematuro entre a 20ª e 36ª semana de gestação. Estas pacientes foram submetidas semanalmente ao toque vaginal e ao exame ultra-sonográfico transvaginal. O toque vaginal avaliou o colo uterino quanto a dois parâmetros: comprimento e dilatação. A ultra-sonografia transvaginal estudou o comprimento e o diâmetro anteroposterior do colo uterino. Foram analisados os comportamentos destas medidas cervicais ao longo da gestação. Os dois métodos foram comparados quanto à avaliação cervical e à acurácia no diagnóstico do parto prematuro. Resultados: a incidência de partos prematuros foi de 18,4% (7/38. As medidas do comprimento cervical obtidas pela ultra-sonografia foram sempre maiores em relação às medidas obtidas pelo toque vaginal. Mediante análise pelo teste de hipóteses foram observadas uma relação indireta entre o comprimento cervical e a idade gestacional por meio do toque e do estudo ultra-sonográfico (pObjective: to evaluate the uterine cervix by digital and transvaginal ultrasound examinations in pregnant women at high risk of having premature delivery. Methods: during the period between February 1995 and September 1997, 38 pregnant women at high risk of having premature delivery between the 20th and 36th week of gestation were examined. These patients were submitted weekly to both digital and transvaginal ultrasound examinations. The digital examination evaluated the uterine cervix using two parameters: length and dilation. The transvaginal ultrasound studied the length and the anteroposterior diameter of the uterine cervix. The behavior of these cervical measurements was analyzed throughout the pregnancies. The two methods

  13. Patterns of metastasis in colon and rectal cancer

    Matias Riihimäki; Akseli Hemminki; Jan Sundquist; Kari Hemminki


    Investigating epidemiology of metastatic colon and rectal cancer is challenging, because cancer registries seldom record metastatic sites. We used a population based approach to assess metastatic spread in colon and rectal cancers. 49,096 patients with colorectal cancer were identified from the nationwide Swedish Cancer Registry. Metastatic sites were identified from the National Patient Register and Cause of Death Register. Rectal cancer more frequently metastasized into thoracic organs (OR ...

  14. Screening for a raised rectal temperature in Africa.

    Jones, R.J.; O'Dempsey, T J; Greenwood, B. M.


    The main purpose of this study was to compare rectal and axillary temperature measurements in African children. Altogether 573 sick children were seen in an outpatient setting in rural West Africa. Rectal and axillary temperatures were measured and the parent or guardian was asked if they thought that the child had a raised body temperature. Normal ranges were defined from an age matched population of 203 healthy children. A raised axillary temperature predicted a raised rectal temperature wi...

  15. Solitary rectal ulcer syndrome in children: A literature review

    Dehghani, Seyed Mohsen; Malekpour, Abdorrasoul; HAGHIGHAT, MAHMOOD


    Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less in children. It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding, copious mucus discharge, feeling of incomplete defecation, and rarely rectal prolapse. SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings. The current treatments are suboptimal, and despite correct diagnosis, outcomes can ...

  16. Complete perineal tear with rectal prolapse: an unusual case report.

    Mukhopadhyay, Sima; Bhattacharyya, Subir Kumar; Ganguly, Rajendra Prasad; Patra, Kajal Kumar


    The association of complete perineal tear and rectal prolapse is less reported in literature, although isolated complete perineal tear and the combinations of vaginal and rectal prolapse are not so unusual, where multiparity and unsupervised home deliveries are quiet common. An interesting case of long standing complete perineal tear with complete rectal prolapse is reported in a 60 years old lady along with review of literature, discussing the management and follow-up of the condition.

  17. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception


    AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,...

  18. Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions.

    Ferrer-Márquez, Manuel; Rubio-Gil, Francisco; Ortega-Ruiz, Sofía; Blesa-Sierra, Isabel; Álvarez-García, Antonio; Jorge-Cerrudo, Jaime; Vidaña-Márquez, Elisabet; Belda-Lozano, Ricardo; Reina-Duarte, Ángel

    Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. 78 FR 46965 - Draft Guidance for Industry on Bioequivalence Recommendations for Mesalamine Rectal Suppositories...


    ... Recommendations for Mesalamine Rectal Suppositories; Availability AGENCY: Food and Drug Administration, HHS... applications (ANDAs) for mesalamine rectal suppositories. The draft guidance is a revised version of a... on mesalamine (Draft Mesalamine Rectal Suppository BE Recommendations of 2013). CANASA (Mesalamine...

  20. Nitrates in drinking water and the risk of death from rectal cancer: does hardness in drinking water matter?

    Chang, Chih-Ching; Chen, Chih-Cheng; Wu, Deng-Chuang; Yang, Chun-Yuh


    The objectives of this study were to (1) examine the relationship between nitrate levels in public water supplies and increased risk of death from rectal cancer and (2) determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of nitrate on development of rectal cancer. A matched case-control study was used to investigate the relationship between the risk of death from rectal cancer and exposure to nitrate in drinking water in Taiwan. All rectal cancer deaths of Taiwan residents from 2003 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen (NO(3)-N), Ca, and Mg in drinking water was collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was presumed to be the source of the subject's NO(3)-N, Ca, and Mg exposure via drinking water. Relative to individuals whose NO(3)-N exposure level was water with a NO(3)-N exposure > or =0.38 ppm. There was no apparent evidence of an interaction between drinking water NO(3)-N levels with low Mg intake via drinking water. However, evidence of a significant interaction was noted between drinking-water NO(3)-N concentrations and Ca intake via drinking water. Our findings showed that the correlation between NO(3)-N exposure and risk of rectal cancer development was influenced by Ca in drinking water. This is the first study to report effect modification by Ca intake from drinking water on the association between NO(3)-N exposure and risk of rectal cancer occurrence. Increased knowledge of the mechanistic interaction between Ca and NO(3)-N in reducing rectal cancer risk will aid in public policymaking and setting threshold standards.

  1. A clinical trial of single dose rectal and oral administration of diazepam for the prevention of serial seizures in adult epileptic patients.


    The clinical anticonvulsant efficacy of single dose rectal and oral administration of diazepam 20 mg was examined in two double-blind placebo-controlled trials in adult epileptic patients. All subjects suffered from drug resistant epilepsy and frequently experienced serial seizures. Diazepam was administered rectally as a new experimental suppository formulation immediately after a seizure and was highly effective in preventing recurrent fits within a 24 h observation period (p less than 0.00...

  2. Late effects of radiotherapy on rectum; Les complications rectales de la radiotherapie

    Bosset, J.F.; Bontemps, P.; Courvoisier, P. [Centre Hospitalier Universitaire, 25 - Besancon (France)


    Late rectal morbidity has been observed in 2 % - 25 % of patients treated with radiotherapy using curative doses for prostate, cervix and rectal cancers. The major encountered clinical pictures are rectal proctitis, rectal/anal strictures, rectal bleeding, ulcers and fistula. Some may alter the patient`s lifestyle while other may induce death. Recommendations concerning the clinical practice are described. The treatment of these late rectal effects include nutritional recommendations, laser, formalin application, and surgery. (author)

  3. Impact of Recurrence and Salvage Surgery on Survival After Multidisciplinary Treatment of Rectal Cancer.

    Ikoma, Naruhiko; You, Y Nancy; Bednarski, Brian K; Rodriguez-Bigas, Miguel A; Eng, Cathy; Das, Prajnan; Kopetz, Scott; Messick, Craig; Skibber, John M; Chang, George J


    Purpose After preoperative chemoradiotherapy followed by total mesorectal excision for locally advanced rectal cancer, patients who experience local or systemic relapse of disease may be eligible for curative salvage surgery, but the benefit of this surgery has not been fully investigated. The purpose of this study was to characterize recurrence patterns and investigate the impact of salvage surgery on survival in patients with rectal cancer after receiving multidisciplinary treatment. Patients and Methods Patients with locally advanced (cT3-4 or cN+) rectal cancer who were treated with preoperative chemoradiotherapy followed by total mesorectal excision at our institution during 1993 to 2008 were identified. We examined patterns of recurrence location, time to recurrence, treatment factors, and survival. Results A total of 735 patients were included. Tumors were mostly midrectal to lower rectal cancer, with a median distance from the anal verge of 5.0 cm. The most common recurrence site was the lung followed by the liver. Median time to recurrence was shorter in liver-only recurrence (11.2 months) than in lung-only recurrence (18.2 months) or locoregional-only recurrence (24.7 months; P = .001). Salvage surgery was performed in 57% of patients with single-site recurrence and was associated with longer survival after recurrence in patients with lung-only and liver-only recurrence ( P recurrence ( P = .353). Conclusion We found a predilection for lung recurrence in patients with rectal cancer after multidisciplinary treatment. Salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence, but not in those with locoregional recurrence, which demonstrates a need for careful consideration of the indications for resection.

  4. Pelvic lymphoscintigraphy: contribution to the preoperative staging of rectal cancer

    Silva José Hyppolito da


    Full Text Available PURPOSE: Preservation of the anal sphincter in surgery for cancer of the distal rectum in an attempt to avoid colostomy has been a main concern of colorectal surgeons. Various proposed procedures contradict oncological principles, especially with respect to pelvic lymphadenectomy. Therefore, prior knowledge of pelvic lymph node involvement is an important factor in choosing the operative technique, i.e., radical or conservative resection. Introduction of ultrasound, computerized tomography, and magnetic resonance have made preoperative study of the area possible. Nevertheless, these resources offer information of an anatomical nature only. Lymphoscintigraphy enables the morphological and functional evaluation of the pelvic area and contributes toward complementing the data obtained with the other imaging techniques. The objective of this prospective study is twofold: to standardize the lymphoscintigraphy technique and to use it to differentiate patients with rectal cancer from those with other coloproctologic diseases. CASUISTIC AND METHODS: Sixty patients with various coloproctologic diseases were studied prospectively. Ages ranged from 21 to 96 years (average, 51 and median, 55 years. Twenty-six patients were male and 34 were female. Thirty patients had carcinoma of the distal rectum as diagnosed by proctologic and anatomic-pathologic examinations, 20 patients had hemorrhoids, 5 had chagasic megacolon, 2 had diverticular disease, 2 had neoplasm of the right colon, and 1 had ulcerative colitis as diagnosed by proctologic exam and/or enema. The lymphoscintigraphy method consisted of injecting 0.25 mL of a dextran solution marked with radioactive technetium-99m into the right and left sides of the perianal region and obtaining images with a gamma camera. The results were analyzed statistically with a confidence level of 95% (P < .05 using the following statistical techniques: arithmetic and medium average, Fisher exact test, chi-square test

  5. Mapping digital media: Netherlands

    de Waal, M.; Leurdijk, A.; Nordeman, L.; Poell, T.


    The Mapping Digital Media project examines the global opportunities and risks created by the transition from traditional to digital media. Covering 60 countries, the project examines how these changes affect the core democratic service that any media system should provide: news about political,

  6. Mapping digital media: Netherlands

    de Waal, M.; Leurdijk, A.; Nordeman, L.; Poell, T.


    The Mapping Digital Media project examines the global opportunities and risks created by the transition from traditional to digital media. Covering 60 countries, the project examines how these changes affect the core democratic service that any media system should provide: news about political, econ

  7. Ageing and digital games

    Iversen, Sara Mosberg


    Digital games are still to a great degree considered a medium mainly for young boys. However, available statistics on Western media use show that this is far from the case. Increasingly, people of all ages and genders play digital games, also older adults in their early 60s and beyond. The aim...... of the book is to examine, analyse and discuss: 1) What older adults do with digital games and what meanings the use of digital games take on in the everyday life of older adults; 2) How older adults are perceived by society in relation to digital games; 3) How play and games can be used both...

  8. [Local excision of giant rectal polypoid neoplasms].

    Cimitan, Andrea; Burza, Antonio; Basile, Ursula; Saputo, Serena; Mingazzini, Pietro; Stipa, Francesco


    Local excision is the best therapeutic option for giant adenomas of the rectum. Parks technique for lower rectal lesions and the T.E.M. technique for lesions localised in the middle and upper rectum offer exceptionally good exposure, allowing radical excision in the case of early low-risk T1 adenocarcinomas (well or moderately differentiated [G1/2] without lymphovascular invasion [L0]). From July 1987 to March 2006, 224 patients were treated by local excision for rectal lesions in our department. In 48 patients (21.4%) a large sessile benign lesion was diagnosed preoperatively. In 3 patients with a preoperative diagnosis of severe dysplasia (Tis) final pathology showed adenoma and for this reason they were included in our study group. A total of 51 patients with giant preoperative benign lesions were treated by local excision (Parks technique, T.E.M. or both). Twenty-five (49%) patients had a definitive diagnosis of adenocarcinoma: in situ (pTis) in 22 patients (88%), pT1 in 2 patients (8%) and pT2 in 1 patient (4%). In 26 patients (51%) the diagnosis was adenoma. The overall local recurrence rate was 9.8% (5/51); the recurrence rate was 7.6% (2/26) for adenomas and 12% (3/25) for carcinomas. The median hospital stay was 7 days (range 3-39). There was no operative mortality. Giant sessile polypoid lesions localized in the middle and upper rectum are best treated with T.E.M., while Parks technique is a good option in lower rectal tumours. These techniques, if correctly indicated and well performed, offer great advantages in terms of safety and radicality. In our experience the operative mortality was nil and the morbidity and recurrence rates were low.

  9. MicroRNA in rectal cancer

    Azadeh Azizian; Jens Gruber; B Michael Ghadimi; Jochen Gaedcke


    In rectal cancer,one of the most common cancers worldwide,the proper staging of the disease determines the subsequent therapy.For those with locally advancedrectal cancer,a neoadjuvant chemoradiotherapy(CRT) is recommended before any surgery.However,response to CRT ranges from complete response(responders) to complete resistance(non-responders).To date we are not able to separate in advance the first group from the second,due to the absence of a valid biomarker.Therefore all patients receive the same therapy regardless of whether they reap benefits.On the other hand almost all patients receive a surgical resection after the CRT,although a watch-and-wait procedure or an endoscopic resection might be sufficient for those who responded well to the CRT.Being highly conserved regulators of gene expression,micro RNAs(mi RNAs) seem to be promising candidates for biomarkers.Many studies have been analyzing the mi RNAs expressed in rectal cancer tissue to determine a specific mi RNA profile for the ailment.Unfortunately,there is only a small overlap of identified mi RNAs between different studies,posing the question as to whether different methods or differences in tissue storage may contribute to that fact or if the results simply are not reproducible,due to unknown factors with undetected influences on mi RNA expression.Other studies sought to find mi RNAs which correlate to clinical parameters(tumor grade,nodal stage,metastasis,survival) and therapy response.Although several mi RNAs seem to have an impact on the response to CRT or might predict nodal stage,there is still only little overlap between different studies.We here aimed to summarize the current literature on rectal cancer and mi RNA expression with respect to the different relevant clinical parameters.

  10. Current trends in staging rectal cancer

    Abdus Samee; Chelliah Ramachandran Selvasekar


    Management of rectal cancer has evolved over the years.In this condition preoperative investigations assist in deciding the optimal treatment.The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis.Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection.Endoanal ultrasound (EUS) is useful for tumor (T) staging;hence EUS is a useful imaging modality for early rectal cancer.Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence.Computerized tomography (CT) of the chest,abdomen and pelvis is used to rule out distant metastasis.Identification of the malignant nodes using EUS,CT and MRI is based on the size,morphology and internal characteristics but has drawbacks.Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor.In this situation,EUS and MRI may provide complementary information to decide further treatment.Functional imaging using positron emission tomography (PET) is useful,particularly PET/CT fusion scans to identify areas of the functionally hot spots.In the current state,imaging has enabled the multidisciplinary team of surgeons,oncologists,radiologists and pathologists to decide on the patient centered management of rectal cancer.In future,functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy.

  11. Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaeco-peritoneography

    Bremmer, S.; Uden, R. [Dept. of Diagnostic Radiology, Karolinska Inst., Danderyd Hospital, Stockholm (Sweden); Mellgren, A.; Holmstroem, B. [Dept. of Surgery, Karolinska Inst., Danderyd Hospital, Stockholm (Sweden)


    Purpose: To study, by means of defaeco-peritoneography, the formation and transformation of the peritoneocele, with and without an enterocele, during rectal evacuation. Material and Methods: Forty-six patients with a peritoneocele at defaecoperitoneography were selected for the study, and examined at three different stages:(1) at the start with a contrast-filled rectum; (2) at maximum straining; and (3) at rest after rectal evacuation. Results: Fourteen patients had a peritoneocele at the start. These peritoneoceles were largest at maximum straining and were all still present at rest after rectal evacuation. In 32 patients defaeco-peritoneography was regarded as normal at the start. At maximum straining these patients developed a peritoneocele and 20 of these were still present after rectal evacuation. No enterocele was seen at the start. At maximum straining 21 patients developed an enterocele and 15 of these were still present after rectal evacuation. Liquid in varying amounts was found in the peritoneoceles. Conclusion: The present study demonstrated that peritoneoceles were present at different stages of the defaeco-peritoneographic investigations. (orig./MG).

  12. Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients

    Dyrberg, D L; Nordentoft, T; Rosenstock, S


    BACKGROUND AND AIMS: The aim of this study is to examine the clinical and functional outcome of laparoscopic posterior rectopexy in a consecutive series of adult patients with full-thickness rectal prolapse. MATERIAL AND METHODS: Preoperative data on demography, life-style practices, medication...... rectopexy is a safe and well-tolerated procedure in older patients and can be done with acceptable complications and recurrence rates and short hospital stays. Laparoscopic posterior rectopexy seems to improve bowel function in many patients....

  13. Technique and short-term outcomes of single-port surgery for rectal cancer

    Bulut, O; Aslak, K K; Rosenstock, S


    Although conventional laparoscopic surgery is less traumatic than open surgery, it does cause tissue trauma and multiple scar formation. The size and number of ports determine the extent of the trauma. Single-port laparoscopic surgery is assumed to minimize and perhaps eliminate the potential...... adverse effects of conventional laparoscopy. The aim of this study was to examine short-term outcomes of single-port laparoscopic surgery for rectal cancer....

  14. Postoperative adjuvant chemoradiotherapy in rectal cancer

    Chang, Sei Kyung; Kim, Jong Woo; Oh, Do Yeun; Chong, So Young; Shin, Hyun Soo [Bundang CHA General Hospital, Pochon CHA University, Seongnam (Korea, Republic of)


    To evaluate the role of postoperative adjuvant chemoradiotherapy in rectal cancer, we retrospectively analyzed the treatment outcome of patients with rectal cancer taken curative surgical resection and postoperative adjuvant chemoradiotherapy. A total 46 patients with AJCC stage II and III carcinoma of rectum were treated with curative surgical resection and postoperative adjuvant chemoradiotherapy. T3 and T4 stage were 38 and 8 patients, respectively. N0, N1, and N2 stage were 12, 16, 18 patients, respectively. Forty patients received bolus infusions of 5-fluorouracil (500 mg/m{sup 2}/day) with leucovorin (20 mg/m{sup 2}/day), every 4 weeks interval for 6 cycles. Oral Uracil/Tegafur on a daily basis for 6 {approx} 12 months was given in 6 patients. Radiotherapy with 45 Gy was delivered to the surgical bed and regional pelvic lymph node area, followed by 5.4 {approx} 9 Gy boost to the surgical bed. The follow up period ranged from 8 to 75 months with a median 35 months. Treatment failure occurred in 17 patients (37%). Locoregional failure occurred in 4 patients (8.7%) and distant failure in 16 patients (34.8%). There was no local failure only. Five year actuarial overall survival (OS) was 51.5% and relapse free survival (RFS) was 58.7%. The OS and RFS were 100%, 100% in stage N0 patients, 53.7%, 47.6% in N1 patients, and 0%, 41.2% in N2 patients ({rho} = 0.012, {rho} = 0.009). The RFS was 55%, 78.5%, and 31.2% in upper, middle, and lower rectal cancer patients, respectively ({rho} = 0.006). Multivariate analysis showed that N stage ({rho} = 0.012) was significant prognostic factor for OS and that N stage ({rho} = 0.001) and location of tumor ({rho} = 0.006) were for RFS. Bowel complications requiring surgery occurred in 3 patients. Postoperative adjuvant chemoradiotherapy was an effective modality for locoregional control of rectal cancer. But further investigations for reducing the distant failure rate are necessary because distant failure rate is still high.

  15. Rectal and appendiceal inflammatory myofibroblastic tumors.

    Khoddami, Maliheh; Sanae, Shahram; Nikkhoo, Bahram


    Inflammatory myofibroblastic tumors are neoplasms characterized by spindle cell proliferation and a fiboinflammatory vascular stroma. Herein, we presented the successful treatment of a rectal inflammatory myofibroblastic tumor in an 11-year-old boy who presented with diarrhea and abdominal pain of 1(1/2) months duration and an appendiceal inflammatory myofibroblastic tumor in a 29-year-old man presented with recurrent abdominal pain of two months duration with associated tenderness and rebound tenderness in the right lower abdomen. Histologically, our cases had inflammatory myofibroblastic tumors very similar to that of other sites; the spindle cells were positive for vimentin and muscle-specific actin.

  16. 数字化的低张双对比造影对早期食道癌的诊断价值%Diagnostic Value of Hypotonic Double Contrast Digital Radiography Examination in Early Esophageal Cancer

    林少波; 吴维颖; 李淳南; 林集荣; 陈滨柱; 温奇敏


    Objective:To study the diagnostic value of hypotonic double contrast digital radiography ex-amination to early esophageal cancer. Method: The digital radiography examination image and pathological data of 72 cases with early esophageal cancer diagnosed in our hospital were reviewed .Then compare it with the traditional single contrast esophageal radiography examination .Result:Esophageal wall relaxation degree slightly worse , 34 cases;the local mucosal disruption and destruction , 64 cases;small filling defect , 22 ca-ses;small niche, 21 cases.The traditional single contrast esophageal radiography examination in 18.6 cases, accounting for 18.1%;the hypotonic double contrast esophageal digital radiography examination in 68 cases, accounting for 94.4%.Conclusion:Hypotonic double contrast digital radiography examination has important value in the diagnosis of early esophageal cancer , reflected in the discovery , locating , qualitative aspects .It is obviously superior to the traditional single contrast radiography examination .%目的:探讨数字化的低张双对比造影对早期食道癌的诊断价值。方法:回顾性分析我院确诊72例早期食道癌的数字化低张双对比造影的影像资料,并与传统单对比食道造影进行比较。结果:数字化低张双对比造影对72例早期食道癌的X线表现分析:食道管壁舒张度稍差,34例;局部粘膜中断破坏,64例;小充盈缺损,22例;小龛影,21例。结论:数字化的低张双对比造影对早期食道癌的发现、定位、定性具有重要诊断价值,明显优于传统单对比造影。

  17. Postoperative adjuvant chemotherapy in rectal cancer operated for cure

    Petersen, Sune Høirup; Harling, Henrik; Kirkeby, Lene Tschemerinsky


    in Dukes´ C (TNM stage III) colon tumours i.e. tumours with metastases in the regional lymph nodes but no distant metastases. In contrast, the evidence for recommendations of adjuvant therapy in rectal cancer is sparse. In Europe it is generally acknowledged that locally advanced rectal tumours receive...

  18. Management of locally advanced primary and recurrent rectal cancer

    J.H.W. de Wilt (Johannes); M. Vermaas (Maarten); F.T.J. Ferenschild (Floris); C. Verhoef (Kees)


    textabstractTreatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Adequate preoperative imaging of the pelvis is therefore important to identify those patients who are candidates for multimodality

  19. Challenges in the multimodality treatment of rectal cancer

    Swellengrebel, Hendrik Albert Maurits


    Remaining questions and current goals in the treatment of rectal cancer include optimizing staging accuracy, establishing the optimal neoadjuvant strategy to be implemented in the different stages of rectal cancer and possibly leading to the evidence-based introduction of organ sparing and non-opera

  20. Laparoscopic versus open surgery for rectal cancer (COLOR II)

    van der Pas, Martijn Hgm; Haglind, Eva; Cuesta, Miguel A


    Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer....

  1. Rectal prolapse: in search of the holy grail

    Iersel, Jan Jeroen


    The treatment of (internal and external) rectal prolapse (IRP/ERP), and its affiliated rectocele and enterocele, has become an increasingly important part of health care over the years. Although benign, rectal prolapse is associated with a myriad of debilitating symptoms including fecal incontinence

  2. Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer.

    Gollins, S; Sebag-Montefiore, D


    Improved surgical technique plus selective preoperative radiotherapy have decreased rectal cancer pelvic local recurrence from, historically, 25% down to about 5-10%. However, this improvement has not reduced distant metastatic relapse, which is the main cause of death and a key issue in rectal cancer management. The current standard is local pelvic treatment (surgery ± preoperative radiotherapy) followed by adjuvant chemotherapy, depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline magnetic resonance imaging, downstaging long-course preoperative chemoradiation (LCPCRT) is generally used. However, for non-CRM-threatened disease, varying approaches are currently adopted in the UK, including straight to surgery, short-course preoperative radiotherapy and LCPCRT. Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating preoperative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full-dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse. Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy-based schedules. Although several measures of neoadjuvant treatment response assessment based on imaging or pathology are promising predictive biomarkers for long-term survival, none has been validated in prospective phase III studies. The phase III setting will enable this, also providing translational opportunities to examine molecular predictors of response and survival. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  3. Post Graduate Multidisciplinary Development Programme – Impact on the Interpretation of Pelvic MRI in Rectal Cancer Patients

    Pedersen, Bodil Ginnerup; Blomqvist, Lennart; Brown, Gina;


    Background: Pelvic magnetic resonance imaging in patients with rectal cancer is an accepted tool for the identification of patients with poor prognostic tumours who may benefit from neo-adjuvant therapy. In Denmark, the examination has been mandatory in the work-up on rectal cancer since 2002....... Objective: To assess the impact of a multidisciplinary team course for doctors in West Denmark on the technical quality, reporting and interpretation of pelvic MRI in rectal cancer. Design: Interventional, observational study. Two expert reviewers served as reference standard in the evaluation...... cancer were enrolled. Interventions: A multidisciplinary team course including on-site-visits. Main Outcome Measures: The MR-scans were evaluated concerning technical performance, reporting, interpretation and the ability to correctly allocate patients to chemo-irradiation based on imaging findings pre...

  4. Immunological Landscape and Clinical Management of Rectal Cancer

    Elísabeth ePérez-Ruiz


    Full Text Available The clinical management of rectal cancer and colon cancer differs due to increased local relapses in rectal cancer. However, the current molecular classification does not differentiate rectal cancer and colon cancer as two different entities. In recent years, the impact of the specific immune microenvironment in cancer has attracted renewed interest, and is currently recognized as one of the major determinants of clinical progression in a wide range of tumors. In colorectal cancer, the density of lymphocytic infiltration is associated with better overall survival. Due to the need for biomarkers of response to conventional treatment with chemoradiotherapy in rectal tumors, the immune status of rectal cancer emerges as a useful tool to improve the management of patients.

  5. Predictive Biomarkers to Chemoradiation in Locally Advanced Rectal Cancer

    Raquel Conde-Muíño


    Full Text Available There has been a high local recurrence rate in rectal cancer. Besides improvements in surgical techniques, both neoadjuvant short-course radiotherapy and long-course chemoradiation improve oncological results. Approximately 40–60% of rectal cancer patients treated with neoadjuvant chemoradiation achieve some degree of pathologic response. However, there is no effective method of predicting which patients will respond to neoadjuvant treatment. Recent studies have evaluated the potential of genetic biomarkers to predict outcome in locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation. The articles produced by the PubMed search were reviewed for those specifically addressing a genetic profile’s ability to predict response to neoadjuvant treatment in rectal cancer. Although tissue gene microarray profiling has led to promising data in cancer, to date, none of the identified signatures or molecular markers in locally advanced rectal cancer has been successfully validated as a diagnostic or prognostic tool applicable to routine clinical practice.

  6. Predictive Biomarkers to Chemoradiation in Locally Advanced Rectal Cancer.

    Conde-Muíño, Raquel; Cuadros, Marta; Zambudio, Natalia; Segura-Jiménez, Inmaculada; Cano, Carlos; Palma, Pablo


    There has been a high local recurrence rate in rectal cancer. Besides improvements in surgical techniques, both neoadjuvant short-course radiotherapy and long-course chemoradiation improve oncological results. Approximately 40-60% of rectal cancer patients treated with neoadjuvant chemoradiation achieve some degree of pathologic response. However, there is no effective method of predicting which patients will respond to neoadjuvant treatment. Recent studies have evaluated the potential of genetic biomarkers to predict outcome in locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation. The articles produced by the PubMed search were reviewed for those specifically addressing a genetic profile's ability to predict response to neoadjuvant treatment in rectal cancer. Although tissue gene microarray profiling has led to promising data in cancer, to date, none of the identified signatures or molecular markers in locally advanced rectal cancer has been successfully validated as a diagnostic or prognostic tool applicable to routine clinical practice.

  7. Comparison of rectal and axillary temperatures in dogs and cats.

    Goic, Joana B; Reineke, Erica L; Drobatz, Kenneth J


    To compare rectal versus axillary temperatures in dogs and cats. Prospective observational study. 94 dogs and 31 cats. Paired axillary and rectal temperatures were measured in random order with a standardized method. Animal signalment, initial complaint, blood pressure, blood lactate concentration, and variables associated with vascular perfusion and coat were evaluated for associations with axillary and rectal temperatures. Axillary temperature was positively correlated with rectal temperature (ρ = 0.75 in both species). Median axillary temperature (38.4°C [101.1°F] in dogs, and 38.4°C [101.2°F] in cats) was significantly different from median rectal temperature in dogs (38.9°C [102.0°F]) but not in cats (38.6°C [101.5°F]). Median rectal-axillary gradient (difference) was 0.4°C (0.7°F; range, -1.3° to 2.3°C [-2.4° to 4.1°F]) in dogs and 0.17°C (0.3°F; range -1.1° to 1.6°C [-1.9° to 3°F]) in cats. Sensitivity and specificity for detection of hyperthermia with axillary temperature were 57% and 100%, respectively, in dogs and 33% and 100%, respectively, in cats; sensitivity and specificity for detection of hypothermia were 86% and 87%, respectively, in dogs and 80% and 96%, respectively, in cats. Body weight (ρ = 0.514) and body condition score (ρ = 0.431) were correlated with rectal-axillary gradient in cats. Although axillary and rectal temperatures were correlated in dogs and cats, a large gradient was present between rectal temperature and axillary temperature, suggesting that axillary temperature should not be used as a substitute for rectal temperature.

  8. [Neoadjuvant and surgical treatment for rectal cancer].

    Rödel, Claus; Knoefel, Wolfram Trudo; Schlitt, Hans J; Staib, Ludger; Höhler, Thomas


    According to the 2008 guidelines on colorectal cancer, whether preoperative therapy is indicated for rectal cancer should be judged based on the T and N categories. A few centres limit the indication for preoperative radio(chemo)therapy to patients with tumours that, according to magnetic resonance tomography (MRT), extend to the fascia mesorectalis or are 1 mm or less away from it - so-called circumferential resection margin-positive or CRM-positive tumours. Omitting preoperative therapy for MRT CRM-negative tumours is, however, a matter that still requires further study in clinical trials. The high rate of distant metastases continues to be a problem. Assuming that pathohistological complete remission (pCR) is a predictive marker of long-term disease-free survival after neoadjuvant radiochemotherapy, attempts are now being undertaken to intensify the neoadjuvant therapy. Phase II trials show improved pCR rates by combining the preoperative radiation with the double combinations oxaliplatin or irinotecan plus infusional or oral 5-FU (capecitabine). In the case of limited T1 rectal cancer without further risk factors, transanal local excision can be used.

  9. Laparoscopic rectopexy for solitary rectal ulcer syndrome without overt rectal prolapse: a case report and review of the literature.

    Menekse, Ebru; Ozdogan, Mehmet; Karateke, Faruk; Ozyazici, Sefa; Demirturk, Pelin; Kuvvetli, Adnan


    Solitary rectal ulcer syndrome is a rare clinical entity. Several treatment options has been described. However, there is no consensus yet on treatment algorithm and standard surgical procedure. Rectopexy is one of the surgical options and it is generally performed in patients with solitary rectal ulcer accompanied with overt prolapse. Various outcomes have been reported for rectopexy in the patients with occult prolapse or rectal intussusception. In the literature; outcomes of laparoscopic non-resection rectopexy procedure have been reported in the limited number of case or case series. No study has emphasized the outcomes of laparoscopic non-resection rectopexy procedure in the patients with solitary rectal ulcer without overt prolapse. In this report we aimed to present clinical outcomes of laparoscopic non-resection posterior suture rectopexy procedure in a 21-year-old female patient with solitary rectal ulcer without overt prolapse.

  10. Laparoscopic rectopexy for solitary rectal ulcer syndrome without overt rectal prolapse. A case report and review of the literature.

    Menekse, Ebru; Ozdogan, Mehmet; Karateke, Faruk; Ozyazici, Sefa; Demirturk, Pelin; Kuvvetli, Adnan


    Solitary rectal ulcer syndrome is a rare clinical entity. Several treatment options has been described. However, there is no consensus yet on treatment algorithm and standard surgical procedure. Rectopexy is one of the surgical options and it is generally performed in patients with solitary rectal ulcer accompanied with overt prolapse. Various outcomes have been reported for rectopexy in the patients with occult prolapse or rectal intussusception. In the literature; outcomes of laparoscopic non-resection rectopexy procedure have been reported in the limited number of case or case series. No study has emphasized the outcomes of laparoscopic non-resection rectopexy procedure in the patients with solitary rectal ulcer without overt prolapse. In this report we aimed to present clinical outcomes of laparoscopic non-resection posterior suture rectopexy procedure in a 21-year-old female patient with solitary rectal ulcer without overt prolapse.

  11. The status and models of digital publishing

    Cong, Ting


    This Thesis examines the current impact of digital technology upon certain aspects of the publishing industry, especially the e-book industry. It reviews the key developments in globally digital publishing and sums up several publishing models of digital contents.

  12. Rectal HSV-2 Infection May Increase Rectal SIV Acquisition Even in the Context of SIVΔnef Vaccination.

    Guerra-Pérez, Natalia; Aravantinou, Meropi; Veglia, Filippo; Goode, Diana; Truong, Rosaline; Derby, Nina; Blanchard, James; Grasperge, Brooke; Gettie, Agegnehu; Robbiani, Melissa; Martinelli, Elena


    Prevalent HSV-2 infection increases the risk of HIV acquisition both in men and women even in asymptomatic subjects. Understanding the impact of HSV-2 on the mucosal microenvironment may help to identify determinants of susceptibility to HIV. Vaginal HSV-2 infection increases the frequency of cells highly susceptible to HIV in the vaginal tissue of women and macaques and this correlates with increased susceptibility to vaginal SHIV infection in macaques. However, the effect of rectal HSV-2 infection on HIV acquisition remains understudied. We developed a model of rectal HSV-2 infection in macaques in combination with rectal SIVmac239Δnef (SIVΔnef) vaccination and our results suggest that rectal HSV-2 infection may increase the susceptibility of macaques to rectal SIVmac239 wild-type (wt) infection even in SIVΔnef-infected animals. Rectal SIVΔnef infection/vaccination protected 7 out of 7 SIVΔnef-infected macaques from SIVmac239wt rectal infection (vs 12 out of 16 SIVΔnef-negative macaques), while 1 out of 3 animals co-infected with SIVΔnef and HSV-2 acquired SIVmac239wt infection. HSV-2/SIVmac239wt co-infected animals had increased concentrations of inflammatory factors in their plasma and rectal fluids and a tendency toward higher acute SIVmac239wt plasma viral load. However, they had higher blood CD4 counts and reduced depletion of CCR5+ CD4+ T cells compared to SIVmac239wt-only infected animals. Thus, rectal HSV-2 infection generates a pro-inflammatory environment that may increase susceptibility to rectal SIV infection and may impact immunological and virological parameters during acute SIV infection. Studies with larger number of animals are needed to confirm these findings.

  13. Relationship between electrical skin resistance and rectal temperature in man during physical exercise.

    Grucza, R


    Electrical skin resistance (ESR) and rectal temperature (Tre) were examined in 13 unacclimated human subjects performing bicycle exercise at an intensity of 50% VO2max. After the beginning of exercise the electrical skin resistance decreased according to an exponential curve with a delay of 4 min and time constant of 9 min. The dynamic parameters of ESR were shorter than those reported for sweating. Statistical analysis showed a correlation between individual time constants of ESR and increases in rectal temperature of the subjects (r = 0.705, p less than 0.01). It is concluded that measurement of dynamics of the electrical skin resistance may be useful for estimation of thermal effects in exercising subjects.

  14. Low risk of pelvic sepsis after intersphincteric proctectomy in patients with low rectal cancer

    Eriksen, Marianne H.; Maina, Pierre; Jensen, Kenneth Højsgaard


    INTRODUCTION: Pelvic sepsis after Hartmann's procedure for low rectal cancer is a frequent complication. It has been reported at a frequency of 12.2-17.2% and has even reached 33% when the transection level of the rectum is ≤ 2 cm from the anal verge. The aim of this study was to examine whether...... intersphincteric proctectomy reduces the frequency of pelvic sepsis in patients operated with an extended Hartmann's procedure for rectal cancer. METHODS: Patients undergoing elective extended Hartmann's procedure with an intersphincteric proctectomy from 2010 until 2014 were reviewed retrospectively. Patient...... (28%), ASA 2 (60%), and ASA 3 (12%); their tumour-node-metastasis (TNM) staging was TNM: ≤ T2 (30%), T3 (50%), and T4 (20%); and 26% had received neoadjuvant radiotherapy, whereas 40% had received chemotherapy. A total of three patients (6%) developed a post-operative pelvic sepsis. The median length...

  15. Elastography and diffusion-weighted MRI in patients with rectal cancer

    Rafaelsen, Søren Rafael; Vagn-Hansen, Chris Aksel; Sørensen, Torben;


    -weighted coefficient (ADC). The purpose of the present study was to compare quantitative elastography based on ultrasound shear wave measurements with MRI ADC. METHODS: We prospectively examined 52 patients with histopathologically proven rectal cancer. The mean age was 67 years (range 42-90 years). Males: 39, females......: 13. Tumour elasticity was measured transgluteally using the acoustic radiation force impulse (ARFI) to generate information on the mechanical properties of the tissue. The objective quantitative elastography shear wave velocity was blindly compared with the ADC measurements using a 1.5-T MRI system.......86), slope = -1.949 (95% CI: -1.31 to -2.59), p measurements in rectal tumours. The relationship between ARFI and ADC measurement was linear in our study population. Advances in knowledge: This work describes...

  16. Health-related Quality of Life after complex rectal surgery for primary advanced rectal cancer and locally recurrent rectal cancer

    Thaysen, Henriette Vind


    L after treatment with COMP-RCS. Seven studies fulfilled the inclusion criteria. Different aspects of HRQoL seemed to be impaired for a shorter or longer period of time after surgery, in disease free patients treated for PARC and LRRC. However, the included studies all had methodological problems, which...... in the study was 164 (86%) patients treated with standard rectal cancer surgery (STAN-RCS). The Danish version showed satisfactory psychometric properties for the scales concerning body image, sexual functioning, male sexual problems and defecations problems. Reduced psychometric properties were found....... The majority of the scales improved or remained stable during the first year after surgery, a decrease was seen only for body image. One year after surgery HRQoL in patients with COMP-RSC was comparable to patients with STAN-RCS and NORM-data with exception of a poorer physical and emotional role function...




    Full Text Available Acute postoperative pain has adverse effects on the patients moral as well as various physiological functions of the body. We conducted a prospective randomized study to compare the efficacy of preoperative rectal diclofenac and paracetamol for postoperative analgesia in pediatric age group. Sixty children (3 – 13 yrs. undergoing minor surgical procedures were randomly alloc ated into 2 groups, group I comprising of 30 children who received diclofenac suppository post induction and group II comprising of 30 children who received paracetamol suppository post induction. Pain was assessed by the “Hanallah pain scale” which catego rizes pain based on 5 parameters, viz, systolic blood pressure, crying, movements, agitation (confused, excited, and complaints of pain 1 . We concluded that though both, diclofenac sodium and paracetamol are good postoperative analgesics when given by rect al route in pediatric patients undergoing minor surgeries, diclofenac sodium provides better analgesia than paracetamol when given by rectal route in pediatric patients.

  18. The digital computer

    Parton, K C


    The Digital Computer focuses on the principles, methodologies, and applications of the digital computer. The publication takes a look at the basic concepts involved in using a digital computer, simple autocode examples, and examples of working advanced design programs. Discussions focus on transformer design synthesis program, machine design analysis program, solution of standard quadratic equations, harmonic analysis, elementary wage calculation, and scientific calculations. The manuscript then examines commercial and automatic programming, how computers work, and the components of a computer

  19. Digital piracy: Theory

    Belleflamme, Paul; Peitz, Martin


    This article reviews recent theoretical contributions on digital piracy. It starts by elaborating on the reasons for intellectual property protection, by reporting a few facts about copyright protection, and by examining reasons to become a digital pirate. Next, it provides an exploration of the consequences of digital piracy, using a base model and several extensions (with consumer sampling, network effects, and indirect appropriation). A closer look at market-structure implications of end-u...

  20. Rectal and colon cancer: Not just a different anatomic site.

    Tamas, K; Walenkamp, A M E; de Vries, E G E; van Vugt, M A T M; Beets-Tan, R G; van Etten, B; de Groot, D J A; Hospers, G A P


    Due to differences in anatomy, primary rectal and colon cancer require different staging procedures, different neo-adjuvant treatment and different surgical approaches. For example, neoadjuvant radiotherapy or chemoradiotherapy is administered solely for rectal cancer. Neoadjuvant therapy and total mesorectal excision for rectal cancer might be responsible in part for the differing effect of adjuvant systemic treatment on overall survival, which is more evident in colon cancer than in rectal cancer. Apart from anatomic divergences, rectal and colon cancer also differ in their embryological origin and metastatic patterns. Moreover, they harbor a different composition of drug targets, such as v-raf murine sarcoma viral oncogene homolog B (BRAF), which is preferentially mutated in proximal colon cancers, and the epidermal growth factor receptor (EGFR), which is prevalently amplified or overexpressed in distal colorectal cancers. Despite their differences in metastatic pattern, composition of drug targets and earlier local treatment, metastatic rectal and colon cancer are, however, commonly regarded as one entity and are treated alike. In this review, we focused on rectal cancer and its biological and clinical differences and similarities relative to colon cancer. These aspects are crucial because they influence the current staging and treatment of these cancers, and might influence the design of future trials with targeted drugs.

  1. Trihalomethanes in drinking water and the risk of death from rectal cancer: does hardness in drinking water matter?

    Kuo, Hsin-Wei; Chen, Pei-Shih; Ho, Shu-Chen; Wang, Li-Yu; Yang, Chun-Yuh


    The objectives of this study were (1) to examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of rectal cancer development and (2) to determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of TTHM on risk of developing rectal cancer. A matched cancer case-control study was used to investigate the relationship between the risk of death attributed to rectal cancer and exposure to TTHM in drinking water in 53 municipalities in Taiwan. All rectal cancer deaths in the 53 municipalities from 1998 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each cancer case. Data on TTHM levels in drinking water were collected from the Taiwan Environmental Protection Administration. Information on the levels of Ca and Mg in drinking water was obtained from the Taiwan Water Supply Corporation. The municipality of residence for cancer cases and controls was presumed to be the source of the subject's TTHM, Ca, and Mg exposure via drinking water. Relative to individuals whose TTHM exposure level was water with a TTHM exposure >or=4.9 ppb. There was no evidence of an interaction of drinking-water TTHM levels with low Ca intake via drinking water. However, evidence of an interaction was noted between drinking-water TTHM concentrations and Mg intake via drinking water. Our findings showed that the correlation between TTHM exposure and risk of rectal cancer is influenced by Mg in drinking water. Increased knowledge of the interaction between Mg and TTHM in reducing rectal cancer risk will aid in public policymaking and standard setting.

  2. Disseminated lung cancer presenting as a rectal mass

    Noergaard, Mia M; Stamp, Inger M H; Bodtger, Uffe


    Primary lung cancer is the leading cause of cancer-related deaths globally, and approximately 50% had metastatic disease at the time of diagnosis. A rectal mass and unintended weight loss are common manifestations of rectal cancer. Our case presented with a rectal mass, but workup revealed...... a metastatic lesion from lung cancer. Lung cancer metastases to the lower gastrointestinal tract imply reduced survival compared with the already poor mean survival of stage IV lung cancer. Despite relevant therapy, the patient died 5 months after referral....

  3. Rectal bacteriotherapy for recurrent Clostridium difficile-associated diarrhoea

    Tvede, M; Tinggaard, M; Helms, M


    Clostridium difficile infection is one of the most common nosocomial infections. Among other alternatives to standard treatment with vancomycin for recurrent infection are faecal microbiota transplantation and rectal bacteriotherapy with a fixed mixture of intestinal bacterial strains isolated from...... faeces of healthy persons to mimic a theoretical normal microflora. Developed by Dr. Tvede and Dr. Rask-Madsen, the latter method has been in use for selected patients during the last 25 years in Denmark. In this study we reviewed the medical records of patients treated with rectal bacteriotherapy...... that rectal bacteriotherapy is a viable alternative to faecal microbiota transplantation in patients with relapsing C. difficile-associated diarrhoea....

  4. Proforma-based reporting in rectal cancer.

    Taylor, F; Mangat, N; Swift, I R; Brown, G


    The improvements in outcomes associate with the use of preoperative therapy rather than postoperative treatment means that clinical teams are increasingly reliant on imaging to identify high-risk features of disease to determine treatment plans. For many solid tumours, including rectal cancer, validated techniques have emerged in identifying prognostic factors pre-operatively. In the MERCURY study, a standardised scanning technique and the use of reporting proformas enabled consistently accurate assessment and documentation of the prognostic factors. This is now an essential tool to enable our clinical colleagues to make treatment decisions. In this review, we describe the proforma-based reporting tool that enables a systematic approach to the interpretation of the magnetic resonance images, thereby enabling all the clinically relevant features to be adequately assessed.

  5. Significance of thermoradiotherapy for rectal cancer

    Ike, Hideyuki; Fukano, Masahiko; Yamaguchi, Sigeki [Yokohama City Univ. (Japan). School of Medicine] [and others


    In patients with rectal cancer, results of 27 cases receiving thermoradiotherapy and of 68 cases, radiotherapy before operation were compared with those of 119 cases receiving expanded radical operation. Radiotherapy was done with 10 MV X-ray generated by linear-accelerator at 2.0 Gy x 5/week and 60 Gy in total. Hyperthermotherapy was performed with the capacitive heating method with 8 MHz radiofrequency (Thermotoron RF8) twice/week x 5. Every thermotherapy was done for 40 min at 42degC-43degC within 1 hr after the radiotherapy. Good results were observed in cases whose cancer was disappeared by either preoperative therapy. However, results in survival and recurrence rates were not always improved when compared with those receiving surgery alone. (K.H.)

  6. Pouch Techniques in Rectal Cancer Surgery

    Christoph A. Maurer


    Rectal cancer of the middle and distal third of the rectum are nowadays managed by low or ultra-low anterior resection with total mesorectal excision and coloanal anastomosis. Following straight coloanal anastomosis, patients often suffer from high stool frequency, urgency and, occasionally, fecal incontinence. To overcome these problems, several types of colonic reservoirs (pouches) have been proposed. The following article elucidates the indications and contraindications for the creation of a pouch. Furthermore, the paper gives a short overview of the different pouch designs that are widely accepted and currently in use, with special emphasis of the typical advantages, disadvantages and feasibility. Current guide-lines recommend to perform a colonic pouch since it provides functional benefits over straight coloanal anastomosis with no increase in postoperative complications.

  7. Radiotherapy and local control in rectal cancer.

    Valentini, V; Rosetto, M E; Fares, C; Mantini, G; Salvi, G; Turriziani, A


    Recurrence is a stage in the natural history of rectal cancer. Preoperative radiotherapy or postoperative radiochemotherapy lower the rate of recurrence, improving local control. From 1980 to 1997, at the "Divisione di Radioterapia" of the "Università Cattolica del S. Cuore" of Rome 380 patients with rectal cancer of early clinical stage T2-3, candidates for surgery for cure, underwent radiation therapy. 119 patients underwent postoperative radiotherapy (45-50 Gy); 45 patients underwent "sandwich" radiotherapy (45 Gy:27 Gy before and 28 Gy after surgery), of whom 7 were treated with preoperative radiotherapy alone; 145 patients underwent preoperative concomitant radiochemotherapy according to 3 different protocols, radiotherapy (38 Gy) combined with mitomycin C and 5-FU; radiotherapy (50.4 Gy) combined with cisplatin and 5-FU; radiotherapy (45 Gy) combined with 5-FU and folinic acid. 71 patients were treated with preoperative radiotherapy (38 Gy) combined with IORT (10 Gy). Median follow-up was 6 years. Overall local control was 85% at 3 years, 83% at 5 years, 81% at 10 years. The rate of local control at 5 years was: 76% for postoperative radiotherapy, 83% for "sandwich" radiotherapy, 84% for preoperative radiochemotherapy and 93% for preoperative radiotherapy combined with IORT. Local control was shown to be significantly better with preoperative treatment as compared to postoperative treatment (p = 0.02). The incidence of metastases was 35% in the patients with local recurrence and 16% in those with local control. The difference in survival was highly significant in patients with local control as compared to those with local recurrence: at 5 years 87% and 32% respectively. Patients with local control showed a lower incidence of metastasis and a better survival.

  8. Benign (solitary) ulcer of the rectum -- another cause for rectal stricture.

    Chapa, H J; Smith, H J; Dickinson, T A


    Benign rectal ulcer syndrome is an uncommon cause of lower gastrointestinal bleeding. Patients may present with mild, often recurrent, rectal bleeding frequently ascribed to hemorrhoids. Barium enema may be normal during the early, nonulcerative phase of proctitis. Single (or multiple) ulcers with or without rectal stricture are the hallmarks of the radiographic diagnosis. Radiologic demonstration of the ulcer(s) is not required, however, for the diagnosis. Benign rectal ulcer should be included in the differential diagnosis of benign-appearing rectal strictures.

  9. Design and Development of Digitalized Health Physical Examination System in Our Hospital%我院健康体检系统的设计与开发

    郭国斌; 程钦安; 杨保卫; 兰丽云


    本文介绍了我院数字化健康体检系统的功能架构和将体检工作流程转化为数据流程的技术和方法.健康体检系统的使用,使体检预约、缴费、科室检查、检查结果录入、报告生成等形成一个完整的体检流程的数据整合,提高了体检工作效率和质量,降低了医院体检总体成本支出.为医院带来了经济效益和良好的社会效应.%This paper mainly introduces the functional frame, physical examination process of healthy physical examination system in our hospital, also demonstrates the technology and method mat could turn physical examination process into data process. The application of healthy physical examination system integrates the healthy examination appointment, payment, clinical checks, results input, report generation, full review and audit, thus to improve the efficiency and quality of physical work, reduce the total physical costs, and bring economic benefit and social effect for the hospital.

  10. [Different strategies between Japan and other countries for the diagnosis and treatment of rectal cancer].

    Watanabe, Toshiaki


    In the treatment of rectal cancer, various attempts have been made to reduce the local recurrence rate. In Japan, lateral node dissection (LND) has been widely performed as a standard procedure for lower rectal cancers. Studies since the 1980s have shown that LND reduces the local recurrence rate and improves the survival rate. However, significant sexual or urinary dysfunction has been reported due to impairment of autonomic nerves by LND. To overcome these problems, autonomic nerve-preserving LND has been introduced. At present, autonomic nerve-preserving LND is the standard procedure for the treatment of lower rectal cancers in Japan. On the other hand, radiotherapy combined with total mesorectal excision is the standard procedure in other countries. Survival data also differ between Japan and elsewhere. In Japanese series, the postoperative survival rate is higher than those in other countries. This may be due to differences in the method of lymph node examination, surgical technique, etc. However, this is a very important issue in determining the postoperative adjuvant chemotherapy. In Japan, these differences need to be taken into account in determining the postoperative adjuvant chemotherapy regimen.

  11. Xanthogranulomatous prostatitis with prostato-rectal fistula: a case report and review of the literature

    Xing L


    Full Text Available Liyong Xing, Zhifei Liu, Gang Deng, Huan Wang, Yanfeng Zhu, Peng Shi, Bingyue Huo, Yindong Li Department of Urology, Tangshan People’s Hospital, Tangshan, People’s Republic of China Purpose: Xanthogranulomatous prostatitis (XP is a rare form of nonspecific granulomatous prostatitis that can clinically mimic high-grade prostatic carcinoma. It is difficult to diagnose it definitely in clinical settings. Methods: We report a case of XP with prostate-rectal fistula and review the relevant literatures. Result: A 75-year-old man presented with rectal bleeding when he urinated. A locally advanced carcinoma of prostate was suspected initially following the physical, imaging, and hematologic examinations. Subsequently on histopathological and immunohistochemical staining after needle biopsy of the prostate, a diagnosis of XP was made definitely. The patient was catheterized temporarily and treated with tamsulosin and estrogen. The patient underwent uneventful recovery after this conservative therapy. Conclusion: Histologic and immunohistochemical analyses are valuable in differentially diagnosing XP from high-grade prostate carcinoma. Treatment strategy of XP in principle is recommended to be the conservative method. Long-term follow-up earns are highly regarded considering the possibility of coexisting prostate cancer. Keywords: xanthogranulomatous prostatitis, prostate-rectal fistula

  12. The role of MRI with diffusion-weighted imaging in restaging rectal cancers after neoadjuvant chemoradiotherapy

    Irem Bayram


    Full Text Available Background: It is challenging to restage rectal cancer at MRI, in patients who have had neoadjuvant chemoradiotherapy.Objective: To investigate the accuracy of MRI with diffusion-weighted imaging (DWI in the restaging of rectal cancer.Materials and methods: Pre- and post-neoadjuvant chemoradiotherapy MRI examinations of 35 patients diagnosed with locally advanced rectal cancer were evaluated and subsequently compared with post-operative pathology results.Results: The accuracy of MRI with DWI to determine the T-stage status was calculated as 54.28%. Kappa statistics revealed poor concordance with pathology results, with a κ value of 0.212 ± 0.114 (p = 0.028. The apparent diffusion coefficient (ADC values measured after the neoadjuvant chemotherapy revealed a significant increase when compared with pre-treatment ADC values (p < 0.000001. MRI accuracy rate for lymph node involvement was calculated as 57.14% with a κ value of 0.001 (p = 0.989. MRI had 80% sensitivity and 100% specificity in determining mesorectal fascia involvement, with a calculated positive predictive value of 100% and a calculated negative predictive value of 96%. The accuracy of MRI in overall staging according to the TNM staging system was 28%.Conclusion: The accuracy of MRI in restaging rectal cancer is not yet sufficient and is not on par with the accuracy of MRI in the primary staging of the disease. This is attributed to post-treatment changes. Adding DWI to the protocol is promising, but more expanded data are required.

  13. [Nuclear morphology in false negative and negative rectal biopsies (author's transl)].

    Rilke, F; Clemente, C; Pilotti, S


    An typical nuclear structure consisting of a cribriform and condensed chromatin pattern with hyperchromasia, a small nucleolus and a moderately increased nuclear-cytoplasmic ratio was observed in the epithelial cells of the crypts and in the stromal and muscular cells of 51 out of 70 oncologically negative biopsies of the rectal mucosa. The subsequent retrieval of all clinical and histologia data revealed that the 51 cases included 39 of adenocarcinoma of the large intestine either present (15 cases) at a variable distance from the false negative biopsy or removed previously (24 cases), 7 of extra-intestinal malignant tumor (parotid gland, urinary bladder, endometrium, breast, stomach, metastatic, anus) and 5 with benign conditions of the large intestine. Of the remaining 19 cases whose biopsies did not reveal the atypical nuclear structure 16 had benign lesions of the large intestine and nowhere evidence of malignancy, two had an adenocarcinoma of the large bowel (one present and one removed previously) and one a carcinoma of the anus. In the rectal biopsies examined the atypical nuclear structure was detected in 93.9% of the cases with a malignant tumor either present or removed previously and in 19% of the cases with benign conditions. The morphologic evidence indicated that the atypical nuclear structure was compatible with a possible distrubance of the mitotic cycle since the findings were restricted to the generative compartment of rectal epithelium. The results are discussed in connection with their possible practical use as a diagnostic aid in the evaluation and interpretation of false negative and negative rectal biopsies as well as with their possible significance in the biology of tumor-bearing hosts.

  14. Defecography of rectal wall prolapse conditions; Defecografia nelle malattie parietali del retto da prolasso

    Salzano, A.; Muto, M.; De Rosa, A. [Azienda Sanitaria di Rilievo Nazionale A. Cardarelli, Naples (Italy). Servizio di Neuroradiologia; Ginolfi, F.; Carbone, M.; Amodio, F.; Rossi, E. [Naples Univ. Federico 2. (Italy). Ist. di Scienze Radiologiche; Tuccillo, M. [Azienda Sanitaria di Rilirvo Nazionale A. Cardarelli, Naples (Italy). 2. Servizio di Radiologia


    Pelvic floor and rectal prolapse conditions have greatly benefited by new imaging and instrumental diagnostic approaches, and especially defecography, for both pathophysiological interpretation and differential diagnosis. The authors investigated the efficacy of defecography in the assessment of rectal prolapse, and in particular the role of videproctography in diagnosis such dynamic disorders. The dynamic changes of ampulla are well depicted by videoproctography, which showed anorectum normalization and spontaneous reduction of invagination after intussusception. Defecography exhibited good capabilities in showing rectal wall function abnormalities. Finally, some features of videoproctography such as low radiation dose, non-invasiveness and ease of execution, make the examination acceptable to patients with anorectal disorders and for the follow-up of rectal prolapse. [Italian] Le malattie del pavimento pelvico e dei prolassi del retto hanno tratto numerosi vantaggi da nuovi approcci di diagnostica per immagini e strumentali, specialmente dall'esame defecografico, sia nell'interpretazione fisiopatologica che nella diagnostica differenziale dei disordini anorettali. Scopo del lavoro: valutare l'efficacia della metodica defecografica nel riconoscimento delle malattie da prolasso del retto e in particolare il ruolo svolto dalla videoproctografia nella documentazione diagnostica e nel definire i principali elementi semeiologici riscontrabili in tali malattie in modo dinamico. Le fasi dinamiche della valutazione morfologica e posizionale dell'ampolla rettale sono ben evidenti nella viedeoproctografia, che documenta dopo l'intussuscezione la normalizzazione del complesso anorettale e la riduzione spontanea dell'invaginazione parietale. In questo studio si sottolineano le possibilita' diagnostiche della defecografia integrata da videoproctografia nel riconoscimento delle malattie parietali funzionali del retto e alcune peculiarita

  15. Laparoscopic resection for low rectal cancer: evaluation of oncological efficacy.

    Moran, Diarmaid C


    Laparoscopic resection of low rectal cancer poses significant technical difficulties for the surgeon. There is a lack of published follow-up data in relation to the surgical, oncological and survival outcomes in these patients.

  16. Role of magnetic resonance imaging in assessment of rectal neoplasms

    Atef Hammad Teama


    Conclusion: Our study results demonstrate that high resolution MRI has pivotal role in accurate staging of rectal cancer and predicting involvement of the perirectal and pelvic lymph nodes as well as planning of the sphincter sparing surgery.

  17. Caspase-3 activity predicts local recurrence in rectal cancer.

    Heer, P. de; Bruin, E.C. de; Klein-Kranenbarg, E.; Aalbers, R.I.; Marijnen, C.A.M.; Putter, H.; Bont, H.J. de; Nagelkerke, J.F.; Krieken, J.H.J.M. van; Verspaget, H.W.; Velde, C.J. van de; Kuppen, P.J.


    PURPOSE: Radiotherapy followed by total mesorectal excision surgery has been shown to significantly reduce local recurrence rates in rectal cancer patients. Radiotherapy, however, is associated with considerable morbidity. The present study evaluated the use of biochemical detection of enzymatic

  18. Simultaneous laparoscopy-assisted resection for rectal and gastric cancer.

    Wei, Hongbo; Master, Jiafeng Fang; Chen, Tufeng; Zheng, Zongheng; Wei, Bo; Huang, Yong; Huang, Jianglong; Master, Haozhong Xu


    Laparoscopy-assisted surgery for either rectal or gastric cancer has been increasingly performed. However, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is rarely reported in the literature. In our study, 3 cases of patients who received simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer were recorded. The results showed that all 3 patients recovered well, with only 253 minutes of mean operation time, 57 mL of intraoperative blood loss, 5 cm of assisted operation incision, 4 days to resume oral intake, 12 days' postoperative hospital stay, and no complication or mortality. No recurrence or metastasis was found within the follow-up period of 22 months. When performed by surgeons with plentiful experience in laparoscopic technology, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is safe and feasible, with the benefits of minimal trauma, fast recovery, and better cosmetic results, compared with open surgery.


    A. Burgio


    Full Text Available Gastrointestinal (GI tract duplications are rare congenital malformations. Most of them occur in the ileum and only 1-5%, of all duplication, were in the rectum. Different clinical features including chronic constipation, rectal prolapsed or polips. We report on a 4-years-old girl with Down syndrome and anorectal malformation (ARM who was found to have a rectal duplication cyst.

  20. US and CT findings of rectal amebian abscess

    Guelek, B. [Dept. of Radiology, Adana Numune Teaching Hospital, Gar-Adana (Turkey); Oenel, S. [Dept. of General Surgery, Adana Numune Teaching Hospital, Gar-Adana (Turkey)


    An interesting case of rectal amebic abscess is presented. Ultrasound and CT images provided the diagnosis of a cystic intramural mass at the rectal wall of a young man, who complained of pelvic pain, constipation, and fever. His clinical history of amebiasis and the finding of trophozoids and cysts at the stool swap confirmed the diagnosis. Intravenous metronidazole therapy cured the disease and led to total disappearance of the mass, and clinical well-being. (orig.) With 4 figs., 6 refs.

  1. Laparoscopic rectal cancer surgery: Where do we stand?

    Mukta K Krane; Alessandro Fichera


    Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer.In contrast,laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm.While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach,whether the same oncologic clearance,specifically an adequate TME can be obtained is of concern.The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes.The data from 8 RCTs,3 metaanalyses,and 2 Cochrane Database of Systematic Reviews was reviewed.Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss,earlier retum of bowel function,and shorter hospital length of stay.Concerns that laparoscopic rectal cancer surgery compromises shortterm oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature.Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.

  2. Agreement between auricular and rectal measurements of body temperature in healthy cats.

    Sousa, Marlos G; Carareto, Roberta; Pereira-Junior, Valdo A; Aquino, Monally C C


    Measurement of body temperature is a routine part of the clinical assessment of a patient. However, this procedure may be time-consuming and stressful to most animals because the standard site of temperature acquisition remains the rectal mucosa. Although an increasing number of clinicians have been using auricular temperature to estimate core body temperature, evidence is still lacking regarding agreement between these two methods in cats. In this investigation, we evaluated the agreement between temperatures measured in the rectum and ear in 29 healthy cats over a 2-week period. Temperatures were measured in the rectum (using digital and mercury-in-glass thermometers) and ear once a day for 14 consecutive days, producing 406 temperature readings for each thermometer. Mean temperature and confidence intervals were similar between methods, and Bland-Altman plots showed small biases and narrow limits of agreement acceptable for clinical purposes. The interobserver variability was also checked, which indicated a strong correlation between two near-simultaneous temperature readings. Results are consistent with auricular thermometry being a reliable alternative to rectal thermometry for assessing core body temperature in healthy cats.

  3. Digital Preservation.

    Yakel, Elizabeth


    Reviews research on digital preservation issues, including born-digital and digitally recreated documents. Discusses electronic records research; metadata and other standards; electronic mail; Web-based documents; moving images media; selection of materials for digitization, including primary sources; administrative issues; media stability…

  4. 非贲门胃癌63例数字胃肠X线机检查结果分析%Digital gastrointestinal examination results of cardia gastric cancer 63 cases analysis

    赵晋太; 刘宽荣


    目的:探讨非贲门胃癌的数字胃肠X线机表现,提高其检出及诊断水平。方法对2006年1月-2009年12月手术治疗的63例非贲门胃癌患者数字胃肠X线机检查结果进行统计分析。结果46例确诊,3例可疑癌;14例再行双对比造影,11例确诊,3例未确诊,诊断符合率为95.24%(60/63)。35例可见淋巴结转移灶。结论 DR诊断非贲门胃癌,晚期较易确诊,早期需双对比造影方可确诊。临床应结合内窥镜、病检综合判断,提高诊断水平。%Objective To explore the clinical X-ray manifestations of digital gastrointestinal cardia cancer of the stomach, improve the level of X-ray detection and diagnosis of the disease. Methods In January 2006-December 2009, the surgical treatment of 63 cases of cardiac cancer of the stomach by digital gastrointestinal examination results were analyzed. Results 46 cases. diagnosed, 3 cases of suspected cancer;14 cases of double contrast radiography, 11 cases of diagnosed, 3 cases was not confirmed. Diagnosis coincidence rate was 95.24% (60/63), 35 cases of lymph node metastases. Conclusion Digital gastrointestinal diagnosis of non cardiac cancer of the stomach,terminal diagnosis more easily, need double contrast angiography can confirmed early. Clinical and endoscopic, disease screening combination, improve the diagnostic level.

  5. An end-to-end examination of geometric accuracy of IGRT using a new digital accelerator equipped with onboard imaging system.

    Wang, Lei; Kielar, Kayla N; Mok, Ed; Hsu, Annie; Dieterich, Sonja; Xing, Lei


    The Varian's new digital linear accelerator (LINAC), TrueBeam STx, is equipped with a high dose rate flattening filter free (FFF) mode (6 MV and 10 MV), a high definition multileaf collimator (2.5 mm leaf width), as well as onboard imaging capabilities. A series of end-to-end phantom tests were performed, TrueBeam-based image guided radiation therapy (IGRT), to determine the geometric accuracy of the image-guided setup and dose delivery process for all beam modalities delivered using intensity modulated radiation therapy (IMRT) and RapidArc. In these tests, an anthropomorphic phantom with a Ball Cube II insert and the analysis software (FilmQA (3cognition)) were used to evaluate the accuracy of TrueBeam image-guided setup and dose delivery. Laser cut EBT2 films with 0.15 mm accuracy were embedded into the phantom. The phantom with the film inserted was first scanned with a GE Discovery-ST CT scanner, and the images were then imported to the planning system. Plans with steep dose fall off surrounding hypothetical targets of different sizes were created using RapidArc and IMRT with FFF and WFF (with flattening filter) beams. Four RapidArc plans (6 MV and 10 MV FFF) and five IMRT plans (6 MV and 10 MV FFF; 6 MV, 10 MV and 15 MV WFF) were studied. The RapidArc plans with 6 MV FFF were planned with target diameters of 1 cm (0.52 cc), 2 cm (4.2 cc) and 3 cm (14.1 cc), and all other plans with a target diameter of 3 cm. Both onboard planar and volumetric imaging procedures were used for phantom setup and target localization. The IMRT and RapidArc plans were then delivered, and the film measurements were compared with the original treatment plans using a gamma criteria of 3%/1 mm and 3%/2 mm. The shifts required in order to align the film measured dose with the calculated dose distributions was attributed to be the targeting error. Targeting accuracy of image-guided treatment using TrueBeam was found to be within 1 mm. For irradiation of the 3 cm target, the gammas (3%, 1

  6. Primary hepatic leiomyosarcoma with liver metastasis of rectal cancer

    Kiyoto Takehara; Hideki Aoki; Yuko Takehara; Rie Yamasaki; Kohji Tanakaya; Hitoshi Takeuchi


    Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis.Curative resection is currently the only effective treatment,and the efficacy of chemotherapy is unclear.This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma.We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases.He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil,leucovorin and oxaliplatin plus bevacizumab,FOLFIRI consisting of 5-fluorouracil,leucovorin and irinotecan plus bevacizumab,and irinotecan plus cetuximab.One of the liver tumors showed a different response to chemotherapy and was diagnosed as a leiomyosarcoma following histopathological examination.This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas.The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors.

  7. Preoperative hyperthermo-chemo-radiotherapy for patients with rectal cancer

    Matsuda, Hiroyuki; Shimono, Reishi; Inoue, Tetsuya; Mori, Masaki; Kuwano, Hiroyuki; Sugimachi, Keizo


    Between April 1986 and February 1988, 17 patients with rectal cancer were treated with preoperative hyperthermo-chemo-radiotherapy (HCR). Hyperthermia was given 4 or 5 times over a 2-week period before irradiation. X-ray irradiation was given 20 times in 1.5 Gy x 2/day to a total dose of 30 Gy. Two hundred and fifty milligrams of 5 FU was intravenously injected or 400-600 mg of HCFU was orally administered. Of evaluable 16 patients, 6 were roentgenologically evaluated as partial response, 3 as moderate response, and 7 as non-response. Histological examination revealed complete response in 9 (53%), moderate response in 4 (24%), and slight response in 4 (24%). In 9 patients seropositive for CEA, CEA tended to decrease after HCR. Early side effects of HCR was not encountered. Although some of the patients complained of fever in the anal site, defecation desire, and micturition desire attributable to hyperthermia, these complaints were not so severe as to discontinue the treatment. (Namekawa, K).

  8. Cruciferous vegetables and colo-rectal cancer.

    Lynn, Anthony; Collins, Andrew; Fuller, Zoë; Hillman, Kevin; Ratcliffe, Brian


    Cruciferous vegetables have been studied extensively for their chemoprotective effects. Although they contain many bioactive compounds, the anti-carcinogenic actions of cruciferous vegetables are commonly attributed to their content of glucosinolates. Glucosinolates are relatively biologically inert but can be hydrolysed to a range of bioactive compounds such as isothiocyanates (ITC) and indoles by the plant-based enzyme myrosinase, or less efficiently by the colonic microflora. A number of mechanisms whereby ITC and indoles may protect against colo-rectal cancer have been identified. In experimental animals cruciferous vegetables have been shown to inhibit chemically-induced colon cancer. However, the results of recent epidemiological cohort studies have been inconsistent and this disparity may reflect a lack of sensitivity of such studies. Possible explanations for the failure of epidemiological studies to detect an effect include: assessment of cruciferous vegetable intake by methods that are subject to large measurement errors; the interaction between diet and genotype has not been considered: the effect that post-harvest treatments may have on biological effects of cruciferous vegetables has not been taken into account.

  9. Digitally-Driven Architecture

    Henriette Bier


    Full Text Available The shift from mechanical to digital forces architects to reposition themselves: Architects generate digital information, which can be used not only in designing and fabricating building components but also in embedding behaviours into buildings. This implies that, similar to the way that industrial design and fabrication with its concepts of standardisation and serial production influenced modernist architecture, digital design and fabrication influences contemporary architecture. While standardisation focused on processes of rationalisation of form, mass-customisation as a new paradigm that replaces mass-production, addresses non-standard, complex, and flexible designs. Furthermore, knowledge about the designed object can be encoded in digital data pertaining not just to the geometry of a design but also to its physical or other behaviours within an environment. Digitally-driven architecture implies, therefore, not only digitally-designed and fabricated architecture, it also implies architecture – built form – that can be controlled, actuated, and animated by digital means.In this context, this sixth Footprint issue examines the influence of digital means as pragmatic and conceptual instruments for actuating architecture. The focus is not so much on computer-based systems for the development of architectural designs, but on architecture incorporating digital control, sens­ing, actuating, or other mechanisms that enable buildings to inter­act with their users and surroundings in real time in the real world through physical or sensory change and variation.

  10. Concordância entre diagnósticos dermatológicos obtidos por consulta presencial e por análise de imagens digitais Agreement between dermatological diagnoses made by live examination compared to analysis of digital images

    Jonas Ribas


    .3% compared to 81.0% between the physicians who diagnosed by examining images (B1 and B2. Agreement between the principal diagnosis established by live examination and that obtained from examining images ranged from 78.2% to 83.9%, CONCLUSION: Agreement between diagnoses of dermatological diseases reached following examination of digital images and those reached following live examination of the patient was excellent.

  11. Laparoscopy decreases complications for obese patients undergoing elective rectal surgery.

    Vargas, Gabriela M; Sieloff, Eric P; Parmar, Abhishek D; Tamirisa, Nina P; Mehta, Hemalkumar B; Riall, Taylor S


    While there are many reported advantages to laparoscopic surgery compared to open surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery has not been studied. Our goal was to determine whether obese patients undergoing laparoscopic rectal surgery experienced the same benefits as non-obese patients. We identified patients undergoing rectal resections using the National Surgical Quality Improvement Project Participant Use Data File. We performed multivariable analyses to determine the independent association between laparoscopy and postoperative complications. A total of 26,437 patients underwent rectal resection. The mean age was 58.5 years, 32.6 % were obese, and 47.2 % had cancer. Laparoscopic procedures were slightly less common in obese patients compared to non-obese patients (36.0 vs. 38.2 %, p = 0.0006). In unadjusted analyses, complications were lower with the laparoscopic approach in both obese (18.9 vs. 32.4 %, p obese (15.6 vs. 25.3 %, p obesity worsened. The likelihood of experiencing a postoperative complication increased by 25, 45, and 75 % for obese class I, obese class II, and obese class III patients, respectively. A laparoscopic approach was associated with a 40 % decreased odds of a postoperative complication for all patients (OR 0.60, 95 % CI 0.56-0.64). Laparoscopic rectal surgery is associated with fewer complications when compared to open rectal surgery in both obese and non-obese patients. Obesity was an independent risk factor for postoperative complications. In appropriately selected patients, rectal surgery outcomes may be improved with a minimally invasive approach.

  12. Amount, type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: the Cancer Prevention Study II Nutrition Cohort.

    Chao, Ann; Connell, Cari J; Jacobs, Eric J; McCullough, Marjorie L; Patel, Alpa V; Calle, Eugenia E; Cokkinides, Vilma E; Thun, Michael J


    Physical activity has consistently been associated with lower risk of colon cancer, but information is limited on the amount, type, and timing of activities. The relationship between physical activity and rectal cancer is unclear. We examined characteristics of recreational physical activity in relation to colon and rectal cancer in the Cancer Prevention Study II Nutrition Cohort of 70,403 men and 80,771 women (median age, 63 years); 940 colon and 390 rectal cancers were identified from enrollment in 1992 to 1993 through August 1999. The multivariate-adjusted rate ratios (95% confidence intervals) associated with any recreational physical activity compared with none were 0.87 (0.71-1.06) for colon cancer and 0.70 (0.53-0.93) for rectal cancer. Colon cancer risk decreased significantly with increasing total hours (P for trend without reference group = 0.007) and metabolic equivalent hours (P for trend = 0.006) per week of activities. No clear decrease in rectal cancer risk was seen with increasing hours per week of physical activity. Rate ratios (95% confidence intervals) were 0.72 (0.52-0.98) for /=7 hours per week of physical activity compared with none. Past exercise, as reported in 1982, was not associated with risk of either colon or rectal cancer. We conclude that increasing amounts of time spent at recreational physical activity are associated with substantially lower risk of colon cancer and that recreational physical activity is associated with lower risk of rectal cancer in older men and women.

  13. Digital asset ecosystems rethinking crowds and cloud

    Blanke, Tobias


    Digital asset management is undergoing a fundamental transformation. Near universal availability of high-quality web-based assets makes it important to pay attention to the new world of digital ecosystems and what it means for managing, using and publishing digital assets. The Ecosystem of Digital Assets reflects on these developments and what the emerging 'web of things' could mean for digital assets. The book is structured into three parts, each covering an important aspect of digital assets. Part one introduces the emerging ecosystems of digital assets. Part two examines digital asset manag

  14. Limited accuracy of DCE-MRI in identification of pathological complete responders after chemoradiotherapy treatment for rectal cancer

    Gollub, Marc J. [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Tong, Tong [Fudan University Medical Center, Department of Radiology, Shanghai (China); Weiser, Martin [Memorial Sloan Kettering Cancer Center, Department of Surgery, Divison of Colorectal Surgery, New York, NY (United States); Zheng, Junting; Gonen, Mithat [Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Zakian, Kristen L. [Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, NY (United States)


    To examine whether post-chemoradiotherapy (CRT) DCE-MRI can identify rectal cancer patients with pathologic complete response (pCR). From a rectal cancer surgery database 2007-2014, 61 consecutive patients that met the following inclusion criteria were selected for analysis: (1) stage II/III primary rectal adenocarcinoma; (2) received CRT; (3) underwent surgery (4); underwent rectal DCE-MRI on a 1.5-T MRI scanner. Two experienced radiologists, in consensus, drew regions of interest (ROI) on the sagittal DCE-MRI image in the tumour bed. These were exported from ImageJ to in-house Matlab code for modelling using the Tofts model. K{sup trans}, K{sub ep} and v{sub e} values were compared to pathological response. Of the 61 initial patients, 37 had data considered adequate for fitting to obtain perfusion parameters. Among the 13 men and 24 women, median age 53 years, there were 8 pCR (22 %). K{sup trans} could not distinguish patients with pCR. For patients with 90 % or greater response, mean K{sup trans} and K{sub ep} values were statistically significant (p = 0.032 and 0.027, respectively). Using a cutoff value of K{sup trans} = 0.25 min{sup -1}, the AUC was 0.71. K{sup trans} could be used to identify patients with 90 % or more response to chemoradiotherapy for rectal cancer with an AUC of 0.7. (orig.)

  15. Rectal culture screening for vancomycin-resistant enterococcus in chronic haemodialysis patients: false-negative rates and duration of colonisation.

    Park, I; Park, R W; Lim, S-K; Lee, W; Shin, J S; Yu, S; Shin, G-T; Kim, H


    Infection or colonisation with vancomycin-resistant enterococci (VRE) is common in chronic haemodialysis (HD) patients. However, there is limited information on the duration of VRE colonisation or on the reliability of consecutive negative rectal cultures to determine the clearance of VRE in chronic HD patients. Chronic HD patients from whom VRE was isolated were examined retrospectively. Rectal cultures were collected more than three times, at least one week apart, between 1 June 2003 and 1 March 2010. The results of the sequential VRE cultures and patients' data were analysed. Among 812 patients from whom VRE was isolated, 89 were chronic HD patients and 92 had three consecutive negative cultures. It took 60.7 ± 183.9 and 111.4 ± 155.4 days to collect three consecutive negative cultures in the 83 non-chronic haemodialysis patients and nine chronic HD patients, respectively (P = 0.011). The independent risk factors for more than three negative sequential rectal cultures were glycopeptide usage [odds ratio (OR): 2.155; P = 0.003] and length of hospital stay (OR: 1.009; P = 0.001). After three consecutive negative rectal cultures, two of six chronic HD patients and 10 of 36 non-HD patients were culture positive again. In conclusion, a significant proportion of patients colonised with VRE cannot be detected by three-weekly rectal cultures, and the duration of VRE colonisation in chronic haemodialysis patients tends to be prolonged. These results may be contributing to the continued increase in the prevalence of VRE.

  16. Oncologic and Functional Hazards of Obesity Among Patients With Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiation Therapy.

    Park, In J; You, Y Nancy; Skibber, John M; Rodriguez-Bigas, Miguel A; Das, Prajnan; Eng, Cathy; Kopetz, Scott; Wolff, Robert A; Crane, Christopher H; Krishnan, Sunil; Minsky, Bruce; Hu, Chung-Yuan; Nguyen, Sa; Chang, George J


    Obesity is a major health concern and risk factor for colorectal cancer that may also impact cancer treatment and outcomes. Rectal cancer response to chemoradiotherapy (CXRT) is associated with long-term survival and sphincter preservation. The purpose of this study was to evaluate the impact of obesity on treatment outcomes after neoadjuvant CXRT for rectal cancer. A retrospective cohort study of patients diagnosed (1993 to 2010) with cT3-4 or cN+ (by endorectal ultrasound, computed tomography, or magnetic resonance imaging) rectal carcinoma and treated with CXRT and total mesorectal excision was performed. Patients were classified as obese (body mass index ≥30 kg/m) or nonobese (body mass index obesity, tumor response, and sphincter preservation were evaluated using multivariate logistic regression analysis and survival outcomes by Cox regression. A total of 753 patients met criteria and 28.7% (n=216) patients were obese. Obese and nonobese groups did not differ in age, sex, tumor location, grade, or number of examined lymph nodes. However, obesity was associated with a lower rate of pCR (ORmulti=0.60; 95% confidence interval, 0.38-0.94; P=0.04) and among mid to low rectal cancer patients, a lower rate of sphincter preservation (ORmulti=0.67; 95% confidence interval, 0.45-0.99). Among both obese and nonobese patients, CR was associated with more favorable recurrence-free survival than pIR. Considering the increasing obesity prevalence and its association with CXRT response, oncologic outcomes, and sphincter preservation, further study is needed regarding the impact of obesity on neoadjuvant treatment response. Moreover, obesity should be targeted as a modifiable risk factor for adverse outcomes following multimodality treatment for rectal cancer.

  17. Local staging of rectal carcinoma using the first prototype model of MR endoscope; Comparison with endoscopic ultrasonography

    Nakamura, Tsuneya; Suzuki, Takashi; Shirai, Masato; Kashiwagi, Akihito; Kobayashi, Seibi; Murano, Akihiko; Sasaki, Fumio (Aichi Cancer Center, Nagoya (Japan). Hospital)


    Twenty one patients undergoing surgical treatment for rectal carcinoma were examined by means of the first prototype model of MR endoscope (designed and provided by Yokokawa Medical Co. and Olympus Opt. Co., Tokyo, Japan) for the staging before surgery. The same patients also underwent the staging with endoscopic ultrasonography (EUS) before surgery. As a surface coil at the tip of antenna probe was accurately positioned on the cancerous lesion using non-magnetic fiberscope, all lesions were detected by MR endoscopy. The whole rectal wall was apparent as 3 or 5 layers on images obtained with 3D fast SPGR method of MR endoscopy. The diagnostic accuracies in detection of rectal wall infiltration by MR endoscopy were 100% (2/2) in the cases in which cancerous invasion was detected in the submucosa by MR endoscopy, 50% (3/6) in those of the muscularis propria, 83% (10/2) in those of perirectal fat, 100% (1/1) in those of the adjacent organs and 76% (16/21) in all cases. The diagnostic accuracies in detection of rectal wall infiltration by EUS were 100% (3/3) in the cases in which the cancerous invasion was detected in the submucosa by EUS, 57% (4/7) in those of the muscularis propria, 90% (9/10) in those of perirectal fat, 100% (1/1) in those of the adjacent organs and 81% (17/21) in all cases. The sensitivity of MR endoscopy in detection of lymph node infiltration was 85.7%; specificity, 61.5%; and accuracy, 70%. EUS showed the same sensitivity, specificity and accuracy. These findings suggest that MR endoscopy may be as accurate as EUS in the preoperative staging of rectal carcinoma. In comparison with EUS, MR endoscopy has multiplanar capabilities and wide scanning area. But, MR endoscopy needs MRI apparatus and MR imaging cannot be acquired in real time. The improvement of MR endoscope is desired. (author).

  18. Rectal artesunates, their utilization, and parental perception in the management of malaria in children from Abeokuta, southwestern Nigeria.

    Sam-Wobo, Sammy Olufemi; Agbeyangi, Oludare Alani; Ekpo, Uwemedimo Friday; Akinloye, Oluseyi Adeboye; Mafiana, Chiedu F; Adeleke, Monsuru Adebayo


    Utilization, efficacy, perception, and acceptability of rectal artesunates for treatment of malaria were assessed in 264 children below 5 years attending two tertiary health facilities in Abeokuta, Nigeria. The children systematically selected were 136 from State Hospital Ijaye and 128 from Federal Medical Centre (FMC), Idi-Aba. Body weights and vital statistics of the children were measured; and blood samples were collected before and 24 h after administration of the rectal artesunates (Plasmotrim-50/200 mg Artesunate) to evaluate the efficacy of the suppository. The first dose of rectal artesunate suppository was administered at a dose of 5-10 mg/kg of body weight per rectum. Giemsa thin and thick films were employed to determine parasite species, malaria parasite count/μL (MPC/μL), and percentage of parasitized red blood cells (PPRBCs). Data were analyzed using SPSS version 16.0. Plasmodium falciparum was the malaria parasite identified by blood examination, with a pretreatment prevalence of 98.9%. Male children had higher infection rate (55%) than females (45%), and infection among age groups and weight groups varied. Chi-square analysis revealed a significant difference between weight and malaria parasite count (p0.05) among the sexes. Chi-square analysis of pre- and post-treatment revealed a significant difference between MPC/μL and PPRBC at p<0.05. This confirmed the efficacy of rectal artesunate in reducing the parasite density (parasitaemia) within 24 h of treatment. On acceptability, 99.60% of parents accepted to use the suppository. However, 87.1% of parents preferred its usage, as it is easy to administer with no adverse effects when administered on their children. If health officials increase more public knowledge on the use of rectal artesunates, the high mortality now experienced in children under 5 years due to malaria disease would be greatly reduced.

  19. Iatrogenic Rectal Injury During Radical Prostatectomy: Is Colostomy Inevitable End?

    Ramazan Topaktas


    Full Text Available Aim: Radical prostatectomy (RP is the gold standard treatment method for localized prostate cancer, because of its high oncological success. Iatrogenic rectal injury (IRI during RP is rarely seen, but it may causes serious complications because of the close anatomic relationship between the prostate and rectum. Aim is to present our series about management of IRI without colostomy. Material and Method: Between June 1999 and June 2013, radical retropubic prostatectomy (RRP was performed to 372 patients by a single surgeon. 10 cases (%2,6 were complicated by a rectal injury during RRP. Instant rectal closure was performed in 3 layers without a diverting colostomy, at the time of surgery. Omental vascular flap was placed between rectum and vesicourethral anastomosis. Results: The clinical stages of IRI cases were T1c, T2a and T2c in 2, 3 and 5 patients, respectively. Their preoperative Gleason scores were 6, 7 and 8 in 3, 5 and 2 patient, respectively. None of the 10 had undergone previous prostatic or rectal surgery, or received preoperative radiotherapy or hormonal therapy. Discussion: Instant diagnosis and rectal wall closures by three layers are essential for successful repair. Our technique seems as a safe, minimal invasive and highly effective option for the management of IRI.

  20. Association of anorectal malformation with anal and rectal duplication

    Karla A. Santos-Jasso


    We present three cases of rectal duplications with anorectal malforma- tion with recto-perineal fistula and colonic duplication. Two of them with delayed diagnosis and bowel obstruction, treated with laparotomy, colostomy and side-to-side anastomosis of the proximal colonic duplica- tion; in the third case the diagnosis of the colonic and rectal duplication was made during a colostomy opening. For definitive correction, the three patients underwent abdomino-perineal approach and side-to-side anastomosis of the rectal duplication, placement of the rectum within the muscle complex, and later on colostomy closure. In a fourth patient with anorectal malformation and colostomy after birth, the perineal electro-stimulation showed two muscle complexes. A posterior sagittal approach in both showed two separate blind rectal pouches; an end- to-side anastomosis of the dilated rectum was made, and the muscle complex with stronger contraction was used for the anoplasty. The posterior sagittal approach is the best surgical option to preserve the muscle complex, with a better prognosis for rectal continence.

  1. Recent advances in robotic surgery for rectal cancer.

    Ishihara, Soichiro; Otani, Kensuke; Yasuda, Koji; Nishikawa, Takeshi; Tanaka, Junichiro; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Kazama, Shinsuke; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki


    Robotic technology, which has recently been introduced to the field of surgery, is expected to be useful, particularly in treating rectal cancer where precise manipulation is necessary in the confined pelvic cavity. Robotic surgery overcomes the technical drawbacks inherent to laparoscopic surgery for rectal cancer through the use of multi-articulated flexible tools, three-dimensional stable camera platforms, tremor filtering and motion scaling functions, and greater ergonomic and intuitive device manipulation. Assessments of the feasibility and safety of robotic surgery for rectal cancer have reported similar operation times, blood loss during surgery, rates of postoperative morbidity, and circumferential resection margin involvement when compared with laparoscopic surgery. Furthermore, rates of conversion to open surgery are reportedly lower with increased urinary and male sexual functions in the early postoperative period compared with laparoscopic surgery, demonstrating the technical advantages of robotic surgery for rectal cancer. However, long-term outcomes and the cost-effectiveness of robotic surgery for rectal cancer have not been fully evaluated yet; therefore, large-scale clinical studies are required to evaluate the efficacy of this new technology.

  2. Patterns of metastasis in colon and rectal cancer.

    Riihimäki, Matias; Hemminki, Akseli; Sundquist, Jan; Hemminki, Kari


    Investigating epidemiology of metastatic colon and rectal cancer is challenging, because cancer registries seldom record metastatic sites. We used a population based approach to assess metastatic spread in colon and rectal cancers. 49,096 patients with colorectal cancer were identified from the nationwide Swedish Cancer Registry. Metastatic sites were identified from the National Patient Register and Cause of Death Register. Rectal cancer more frequently metastasized into thoracic organs (OR = 2.4) and the nervous system (1.5) and less frequently within the peritoneum (0.3). Mucinous and signet ring adenocarcinomas more frequently metastasized within the peritoneum compared with generic adenocarcinoma (3.8 [colon]/3.2 [rectum]), and less frequently into the liver (0.5/0.6). Lung metastases occurred frequently together with nervous system metastases, whereas peritoneal metastases were often listed with ovarian and pleural metastases. Thoracic metastases are almost as common as liver metastases in rectal cancer patients with a low stage at diagnosis. In colorectal cancer patients with solitary metastases the survival differed between 5 and 19 months depending on T or N stage. Metastatic patterns differ notably between colon and rectal cancers. This knowledge should help clinicians to identify patients in need for extra surveillance and gives insight to further studies on the mechanisms of metastasis.

  3. Patient surveillance after curative-intent surgery for rectal cancer.

    Johnson, Frank E; Longo, Walter E; Ode, Kenichi; Shariff, Umar S; Papettas, Trifonas; McGarry, Alaine E; Gammon, Steven R; Lee, Paul A; Audisio, Riccardo A; Grossmann, Erik M; Virgo, Katherine S


    The follow-up of patients with rectal cancer after potentially curative resection has significant financial and clinical implications for patients and society. The ideal regimen for monitoring patients is unknown. We evaluated the self-reported practice patterns of a large, diverse group of experts. There is little information available describing the actual practice of clinicians who perform potentially curative surgery on rectal cancer patients and follow them after recovery. The 1795 members of the American Society of Colon and Rectal Surgeons were asked, via a detailed questionnaire, how often they request 14 discrete follow-up modalities in their patients treated for cure with TNM stage I, II, or III rectal cancer over the first five post-treatment years. 566/1782 (32%) responded and 347 of the respondents (61%) provided evaluable data. Members of the American Society of Colon and Rectal Surgeons typically follow their own patients postoperatively rather than sending them back to their referral source. Office visit and serum CEA level are the most frequently requested items for each of the first five postoperative years. Endoscopy and imaging tests are also used regularly. Considerable variation exists among these highly experienced, highly credentialed experts. The surveillance strategies reported here rely most heavily on relatively simple and inexpensive tests. Endoscopy is employed frequently; imaging tests are employed less often. The observed variation in the intensity of postoperative monitoring is of concern.

  4. Intersphincteric Resection for Low Rectal Cancer – Case Report

    Russu Cristian


    Full Text Available Introduction: Surgical treatment for low rectal cancer represents a challenge: to perform a radical resection and to preserve the sphincter’s function. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome. Case presentation: We report a case of a 73 years old woman admitted in April 2014 in surgery, for low rectal cancer. The diagnostic was established by colonoscopy and malignancy confirmed by biopsy. Complete imaging was done using computed tomography and magnetic resonance to establish the exact stage of the disease. The interdisciplinary individualized treatment began with radiotherapy (total dose of 50 Gy, administered in 25 fractions followed by surgery after eight weeks. We performed intersphincteric rectal resection by a modified Schiessel technique. There were no postoperative complications and the oncologic and functional results were very good at one year follow up. Conclusions: Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results.

  5. Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis

    CHEN Kai-yun; XIANG Guo-an; WANG Han-ning; XIAO Fang-lian


    Background Rectal carcinoma patients are often accompanied by hepatic metastasis. The aim of this study was to evaluate the therapeutic efficacy of simultaneous laparoscopic excision for rectal carcinoma with synchronous hepatic metastasis.Methods A total of 41 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients underwent laparoscopic surgery and 18 patients underwent traditional open surgery to simultaneously remove the rectal tumor and hepatic metastasis lesions. All patients received postoperative adjuvant chemotherapy. All the patients were followed up from 36 to 72 months (mean 45.3 months).Results All the operations were performed successfully and no patient was turned to open surgery in laparoscopic group. The mean blood loss, the mean postoperative hospital stay, the mean blood transfusion and the mean intestinal functional recovery time showed a significant difference between the two groups (P<0.05). The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the laparoscopic group, without significant difference compared with the open group (77.8%, 38.9% and 0) (P>0.05).Conclusions Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis is safe and effective with similar survival achieved by the traditional open abdominal surgery.

  6. [Current MRI staging of rectal cancer].

    Wietek, B M; Kratt, T


    Colorectal carcinoma is the second most prevalent cause for cancer, and has very variable outcomes. Advancements in surgery, the change from adjuvant to neo-adjuvant radio-chemo-therapies as well as in clinical diagnostics have improved the prognosis for patients in a multi-modal therapy concept. An accurate primary staging including a reliable prediction of the circumferential resection margin (CRM) has established MR Imaging (MRI) beside intraluminal endoscopic ultrasound (EUS). MRI facilitates the selection of patients likely to benefit from a preoperative therapy, especially in cases of unfavorable factors. Currently the relationship of the tumor to the mesorectal fascia has become a more important prognostic factor than the T-staging, particularly for surgical therapy. In addition further prognostic factors like the depth of infiltration into the perirectal fat and the extramural venous infiltration (EMVI) have important impact on therapy and prognosis. High resolution MRI has proved useful in clarifying the relationship between the tumor and the mesorectal fascia, which represents the CRM at the total mesorectal excision (TME) especially in the upper and middle third. Preoperative evaluation of the other prognostic factors as well as the nodal status is still difficult. It is used increasingly not only for primary staging but also progressively for the monitoring of neoadjuvant therapy. The addition of diffusion weighted imaging (DWI) is an interesting option for the improvement of response evaluation. The following overview provides an introduction of MRI diagnosis as well as its importance for the evaluation of the clinically relevant prognostic factors leading to an improvement of therapy and prognosis of patients with rectal carcinoma. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Digital photography

    Windsor, J S; Rodway, G W; Middleton, P M; McCarthy, S


    The emergence of a new generation of "point-and-shoot" digital cameras offers doctors a compact, portable and user-friendly solution to the recording of highly detailed digital photographs and video images...

  8. Digital Tectonics

    Christiansen, Karl; Borup, Ruben; Søndergaard, Asbjørn;


    Digital Tectonics treats the architectonical possibilities in digital generation of form and production. The publication is the first volume of a series, in which aspects of the strategic focus areas of the Aarhus School of Architecture will be disseminated.......Digital Tectonics treats the architectonical possibilities in digital generation of form and production. The publication is the first volume of a series, in which aspects of the strategic focus areas of the Aarhus School of Architecture will be disseminated....

  9. Digital squares

    Forchhammer, Søren; Kim, Chul E


    Digital squares are defined and their geometric properties characterized. A linear time algorithm is presented that considers a convex digital region and determines whether or not it is a digital square. The algorithm also determines the range of the values of the parameter set of its preimages....... The analysis involves transforming the boundary of a digital region into parameter space of slope and y-intercept...

  10. Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

    Draaisma, W.A.; Nieuwenhuis, D.H.; Janssen, L.W.M.; Broeders, I.A.M.J.

    Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort

  11. Comparison between core temperatures measured telemetrically using the CorTemp® ingestible temperature sensor and rectal temperature in healthy Labrador retrievers.

    Osinchuk, Stephanie; Taylor, Susan M; Shmon, Cindy L; Pharr, John; Campbell, John


    This study evaluated the CorTemp(®) ingestible telemetric core body temperature sensor in dogs, to establish the relationship between rectal temperature and telemetrically measured core body temperature at rest and during exercise, and to examine the effect of sensor location in the gastrointestinal (GI) tract on measured core temperature. CorTemp(®) sensors were administered orally to fasted Labrador retriever dogs and radiographs were taken to document sensor location. Core and rectal temperatures were monitored throughout the day in 6 resting dogs and during a 10-minute strenuous retrieving exercise in 6 dogs. Time required for the sensor to leave the stomach (120 to 610 min) was variable. Measured core temperature was consistently higher than rectal temperature across all GI locations but temperature differences based on GI location were not significant (P = 0.5218). Resting dogs had a core temperature that was on average 0.4°C above their rectal temperature with 95% limits of agreement (LoA) between 1.2°C and -0.5°C. Core temperature in exercising dogs was on average 0.3°C higher than their concurrent rectal temperature, with LoA of +1.6°C and -1.1°C.

  12. Digital Citizenship

    Isman, Aytekin; Canan Gungoren, Ozlem


    Era in which we live is known and referred as digital age.In this age technology is rapidly changed and developed. In light of these technological advances in 21st century, schools have the responsibility of training "digital citizen" as well as a good citizen. Digital citizens must have extensive skills, knowledge, Internet and …

  13. Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention

    Sheng-Xiang Rao; Meng-Su Zeng; Jian-Ming Xu; Xin-Yu Qin; Cai-Zhong Chen; Ren-Chen Li; Ying-Yong Hou


    AIM: To determine the accuracy of high-resolution magnetic resonance imaging (MRI) using phased-array coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.METHODS: In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging (in-plane resolution, 0.66 × 0.56)with phased-array coil were performed for T-staging and measurement of distance between the tumor and the mesorectal fascia. The assessment of MRI was compared with postoperative histopathologic findings. Sensitivity,specificity, accuracy, positive predictive value, and negative predictive value were evaluated.RESULTS: The overall magnetic resonance accuracy was 85.1% for T staging and 88% for predicting mesorectal fascia involvement. Magnetic resonance sensitivity, specificity, accuracy, positive predictive value,and negative predictive value was 70%, 97.9%, 89.6%,93.3% and 88.5% for ≤ T2 tumors, 90.5%, 76%,85.1%, 86.4% and 82.6% for T3 tumors, 100%, 95.2%,95.5%, 62.5% and 100% for T4 tumors, and 80%,90.4%, 88%, 70.6% and 94% for predicting mesorectal fascia involvement, respectively.CONCLUSION: High-resolution MRI enables accurate preoperative assessment for T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.

  14. Rectal suppository insertion: the reliability of the evidence as a basis for nursing practice.

    Bradshaw, Ann; Price, Lynda


    This paper considers the correct method for inserting a rectal suppository, both as a medication and also to achieve bowel evacuation. The aim is to find out whether the correct method is blunt end or pointed end foremost. It follows from a question raised by a third year student nurse. In the classroom, she had been taught that the correct method for the administration of a suppository for systemic absorption was to insert it blunt end foremost into the rectum. However, if the suppository was to be used for evacuant purposes, it should be given pointed end foremost. In clinical practice, however, she was told the suppository should always be inserted pointed end foremost in all cases, whatever the purpose. This article seeks to clarify the dilemma by examining the sources of evidence underpinning different methods for inserting a rectal suppository. Hence, the literature on the insertion of rectal suppositories was gathered as systematically as possible from medical journals and textbooks, nursing journals and textbooks and manufacturers' information to patients. Having gathered the literature, this was examined, appraised and critically analysed for rigour, coherence and reliability. The review of the literature appears to show that evidence adduced for inserting the suppository blunt end foremost derives from one study published in the Lancet in 1991, which challenged 'commonsense'. There did not appear to be other, more recent research. On the other hand, manufacturers' information to patients states generally that the suppository should be inserted pointed end foremost. This has direct relevance for the administration of suppositories and also raises questions as to how research may become integrated into healthcare practice without adequate justification. An article published in the Lancet in 1991 has had a fundamental effect on nursing practice, but has not been subject to scrutiny. The advice given in this Lancet article differs from that currently given by

  15. Comparison between two perineal procedures for treatment of rectal prolaps

    Ahmed Mohamed Abozid, Nabila Mohamed A. Shams, , Yahia Hassan


    Full Text Available The optimal surgical procedures for the management of rectal prolapse is still under debate so comparison between two operations were done in our series. Eighteen patients with complete rectal prolaps were treated surgically through the perineum they were divided into two groups. First group were treated by recto-segmoidectomy and levatroplasty to fortify the pelvic floor, the second group were treated by rectopexy using prolene mesh and levetroplasty to fortify the pelvic floor, the mesh was inserted between the rectum and sacrum and fixed through perineal incision. The recurrence rate !""#$$!%$ &significant difference in hospital stay among both groups. Also there were no other cases of postoperative complications such as anastomotic leak or stricture, affection of the bladder dysfunction in both groups. Aim of work The aim of this work was to compare the short-term outcome of two different perineal operative procedures in patients with full thickness rectal prolaps.

  16. Treatment of advanced rectal cancer after renal transplantation

    Hai-Yi Liu; Xiao-Bo Liang; Yao-Ping Li; Yi Feng; Dong-Bo Liu; Wen-Da Wang


    Renal transplantation is a standard procedure for end-stage renal disease today. Due to immunosuppressive drugs and increasing survival time after renal trans-plantation, patients with transplanted kidneys carry an increased risk of developing malignant tumors. In this case report, 3 patients with advanced rectal can-cer after renal transplantation for renal failure were treated with anterior resection or abdominoperineal resection plus total mesorectal excision, followed by adjuvant chemotherapy. One patient eventually died of metastasized cancer 31 mo after therapy, although his organ grafts functioned well until his death. The other 2 patients were well during the 8 and 21 mo follow-up periods after rectal resection. We therefore strongly argue that patients with advanced rectal cancer should receive standard oncology treatment, including opera-tion and adjuvant treatment after renal transplantation. Colorectal cancer screening in such patients appears justified.

  17. Rectal bleeding and its management after irradiation for cervix cancer

    Chun, Mi Son; Kang, Seung Hee; Kil, Hoon Jong; Oh, Young Taek; Sohn, Jeong Hye; Ryu, Hee Suk; Lee, Kwang Jae [School of Medicine, Ajou University, Suwon (Korea, Republic of); Jung, Hye Young [College of Medicine, Yonsei University, Seoul (Korea, Republic of)


    Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. The study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gy x 7, or 5 Gy x 6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12 {approx} 86 months). The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding: an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor ({rho} > 0.0432). The

  18. Modern management of rectal cancer: A 2006 update

    Glen C Balch; Alex De Meo; Jose G Guillem


    The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and NO), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Information concerning the depth of tumor penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection.Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1NOM0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended.In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases,preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered,including: (1) total mesorectal excision (TME); (2)autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin;(5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7)postoperative quality

  19. Changes in NAD/ADP-ribose metabolism in rectal cancer

    L. Yalcintepe


    Full Text Available The extent of ADP-ribosylation in rectal cancer was compared to that of the corresponding normal rectal tissue. Twenty rectal tissue fragments were collected during surgery from patients diagnosed as having rectal cancer on the basis of pathology results. The levels of ADP-ribosylation in rectum cancer tissue samples (95.9 ± 22.1 nmol/ml was significantly higher than in normal tissues (11.4 ± 4 nmol/ml. The level of NAD+ glycohydrolase and ADP-ribosyl cyclase activities in rectal cancer and normal tissue samples were measured. Cancer tissues had significantly higher NAD+ glycohydrolase and ADP-ribosyl cyclase activities than the control tissues (43.3 ± 9.1 vs 29.2 ± 5.2 and 6.2 ± 1.6 vs 1.6 ± 0.4 nmol mg-1 min-1. Approximately 75% of the NAD+ concentration was consumed as substrate in rectal cancer, with changes in NAD+/ADP-ribose metabolism being observed. When [14C]-ADP-ribosylated tissue samples were subjected to SDS-PAGE, autoradiographic analysis revealed that several proteins were ADP-ribosylated in rectum tissue. Notably, the radiolabeling of a 113-kDa protein was remarkably greater than that in control tissues. Poly(ADP-ribosylation of the 113-kDa protein in rectum cancer tissues might be enhanced with its proliferative activity, and poly(ADP-ribosylation of the same protein in rectum cancer patients might be an indicator of tumor diagnosis.

  20. Endoscopic ultrasound for the characterization and staging of rectal cancer. Current state of the method. Technological advances and perspectives.

    Gersak, Mariana M; Badea, Radu; Graur, Florin; Hajja, Nadim Al; Furcea, Luminita; Dudea, Sorin M


    Endoscopic ultrasound is the most accurate type of examination for the assessment of rectal tumors. Over the years, the method has advanced from gray-scale examination to intravenous contrast media administration and to different types of elastography. The multimodal approach of tumors (transrectal, transvaginal) is adapted to each case. 3D ultrasound is useful for spatial representation and precise measurement of tumor formations, using CT/MR image reconstruction; color elastography is useful for tumor characterization and staging; endoscopic ultrasound using intravenous contrast agents can help study the amount of contrast agent targeted at the level of the tumor formations and contrast wash-in/wash-out time, based on the curves displayed on the device. The transvaginal approach often allows better visualization of the tumor than the transrectal approach. Performing the procedure with the rectal ampulla distended with contrast agent may be seen as an optimization of the examination methodology. All these aspects are additional methods for gray-scale endoscopic ultrasound, capable of increasing diagnostic accuracy. This paper aims at reviewing the progress of transrectal and transvaginal ultrasound, generically called endoscopic ultrasound, for rectal tumor diagnosis and staging, with emphasis on the current state of the method and its development trends.

  1. Digital preservation

    Deegan, Marilyn


    Digital preservation is an issue of huge importance to the library and information profession right now. With the widescale adoption of the internet and the rise of the world wide web, the world has been overwhelmed by digital information. Digital data is being produced on a massive scale by individuals and institutions: some of it is born, lives and dies only in digital form, and it is the potential death of this data, with its impact on the preservation of culture, that is the concern of this book. So how can information professionals try to remedy this? Digital preservation is a complex iss

  2. Digital subtraktion

    Mussmann, Bo Redder


    Digital subtraktion er en metode til at fjerne uønskede oplysninger i et røntgenbillede. Subtraktionsteknikken bruges primært i forbindelse med angiografi hvor man kun er interesseret i at se selve karret. Derfor er digital subtraktion i daglig tale synonymt med DSA eller DVI – hhv. Digital...... Subtraction Angiography eller Digital Vascular Imaging. Benævnelserne er to røntgenfirmaers navn for den samme teknik. Digital subtraktion kræver speciel software, samt at apparaturet kan eksponere i serier....

  3. Perioperative Colonic Evaluation in Patients with Rectal Cancer; MR Colonography Versus Standard Care

    Achiam, Michael Patrick; Løgager, Vibeke; Lund Rasmussen, Vera;


    was to prospectively evaluate the completion rate of preoperative colonic evaluation and the quality of perioperative colonic evaluation using magnetic resonance colonography (MRC) in patients with rectal cancer. MATERIALS AND METHODS: Patients diagnosed with rectal cancer were randomized to either group A: standard...... is a valuable tool and is recommended as part of the standard preoperative evaluation for patients with rectal cancer....

  4. Rectal diaphragm in a patient with imperforate anus and rectoprostatic fistula

    Thakur Ashokanand


    Full Text Available The association of rectal diaphragm in an imperforate anus has not been reported until now. A 1-year-old male presented with right transverse colostomy for high anorectal malformation. The patient had imperforate anus and a recto-prostatic fistula with rectal diaphragm. We managed the case by an ano-rectal pull through with excision of the diaphragm.

  5. Rectal cancer : developments in multidisciplinary treatment, quality control and European collaboration

    Gijn, Willem van


    In the last two decades, treatment of rectal cancer has considerably improved in Europe. Although this applies to most solid malignancies, improvements in the diagnosis and treatment of rectal cancer surpass virtually all others. In the early 1990s, outcome after rectal cancer treatment was poor,

  6. The prognostic value of lymph node ratio in a national cohort of rectal cancer patients

    Lykke, J; Jess, P; Roikjaer, O


    OBJECTIVE: To analyze the prognostic implications of the lymph node ratio (LNR) in curative resected rectal cancer. SUMMARY BACKGROUND DATA: It has been proposed that the LNR has a high prognostic impact in colorectal cancer, but the lymph node ratio has not been evaluated exclusively for rectal ...... that the introduction of LNR should be considered for rectal cancer in a revised TNM classification....

  7. Variability of marker-based rectal dose evaluation in HDR cervical brachytherapy.

    Wang, Zhou; Jaggernauth, Wainwright; Malhotra, Harish K; Podgorsak, Matthew B


    In film-based intracavitary brachytherapy for cervical cancer, position of the rectal markers may not accurately represent the anterior rectal wall. This study was aimed at analyzing the variability of rectal dose estimation as a result of interfractional variation of marker placement. A cohort of five patients treated with multiple-fraction tandem and ovoid high-dose-rate (HDR) brachytherapy was studied. The cervical os point and the orientation of the applicators were matched among all fractional plans for each patient. Rectal points obtained from all fractions were then input into each clinical treated plan. New fractional rectal doses were obtained and a new cumulative rectal dose for each patient was calculated. The maximum interfractional variation of distances between rectal dose points and the closest source positions was 1.1 cm. The corresponding maximum variability of fractional rectal dose was 65.5%. The percentage difference in cumulative rectal dose estimation for each patient was 5.4%, 19.6%, 34.6%, 23.4%, and 13.9%, respectively. In conclusion, care should be taken when using rectal markers as reference points for estimating rectal dose in HDR cervical brachytherapy. The best estimate of true rectal dose for each fraction should be determined by the most anterior point among all fractions.

  8. Correction of rectal sacculation through lateral resection in dogs with perineal hernia - technique description

    P.C. Moraes


    Full Text Available The occurrence of perineal hernias in dogs during routine clinical surgery is frequent. The coexistence of rectal diseases that go undiagnosed or are not correctly treated can cause recurrence and postoperative complications. The objective of this report is to describe a surgical technique for treatment of rectal sacculation through lateral resection in dogs with perineal hernia, whereby restoring the rectal integrity.

  9. Rectal cancer survival in the Nordic countries and Scotland

    Folkesson, Joakim; Engholm, Gerda; Ehrnrooth, Eva


    The aim of this study was to present detailed population-based survival estimates for patients with a rectal adenocarcinoma, using cancer register data supplemented with clinical data. Based on cancer register data, differences in rectal cancer survival have been reported between countries in Eur...... and detailed data in order to understand international survival differences, and cautions comparisons between large national samples and those of smaller areas........ Age standardized 5-year relative survival and multiplicative regression models for the relative excess mortality were calculated. 3888 patients were included in the survival study. Men in Denmark, Finland and Iceland had lower 5-year relative survival and poorer stage distribution compared to Norway...

  10. Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier’s procedure)

    Sipahi, Mesut; Arslan, Ergin; Börekçi, Hasan; Aytekin, Faruk Önder; Külah, Bahadır; Banlı, Oktay


    Perineal procedures have higher recurrence and lower mortality rates than abdominal alternatives for the treatment of rectal prolapse. Presence of incarceration and strangulation also influences treatment choice. Perineal rectosigmoidectomy is one of the treatment options in patients with incarceration and strangulation, with low mortality and acceptable recurrence rates. This operation can be performed especially to avoid general anesthesia in old patients with co-morbidities. We aimed to present perineal rectosigmoidectomy and diverting loop colostomy in a patient with neurological disability due to spinal trauma and incarcerated rectal prolapse. PMID:27528816

  11. Medical image of the week: pulmonary metastases of rectal cancer

    Insel M


    Full Text Available A 51-year-old woman with known rectal cancer currently receiving systemic chemotherapy presented with 2 weeks of worsening dyspnea on exertion. The day prior to admission she developed persistent inspiratory and expiratory wheeze. CT scan demonstrated right main stem endobronchial mass and a heterogeneous mass comprising the entire left hemithorax (Figure 1. Flexible bronchoscopy demonstrated a fungating mass at the carina extending down both main stems (Figure 2. The mass was snared and removed with cryotherapy and pathology was consistent with metastatic rectal adenocarcinoma.

  12. Digital Natives or Digital Tribes?

    Watson, Ian Robert


    This research builds upon the discourse surrounding digital natives. A literature review into the digital native phenomena was undertaken and found that researchers are beginning to identify the digital native as not one cohesive group but of individuals influenced by other factors. Primary research by means of questionnaire survey of technologies…

  13. Magnetic Resonance Imaging (MRI) with retrograde intralumen contrast enhancement of the rectum in diagnostics of rectovaginal fistulas after combination therapy of rectal cancer. Experience of application

    Usova, A.; Frolova, I.; Afanasev, S.; Tarasova, A.; Molchanov, S.


    Experiment of use of MRI in diagnostics of rectovaginal fistulas after combination therapy of rectal cancer is shown on clinical examples. We used retrograde contrasting of a rectum with 150ml ultrasonic gel to make MRI more informative in case of low diagnostic efficiency of ultrasound, colonoscopy and gynecological examination.

  14. Comparison of histopathology, cultivation of tissues and rectal contents, and interferon-gamma and serum antibody responses for the diagnosis of bovine paratuberculosis

    Huda, A.; Jensen, H.E.


    , hepatic and supramammary). Histopathological examination and bacterial culture of tissues each revealed that six of the 16 cattle were infected, whereas repeated culture of rectal contents revealed only five infected animals. Except for the hepatic lymph node of a single animal, culture-positive tissues...

  15. The rectal cancer microRNAome - microRNA expression in rectal cancer and matched normal mucosa

    Gaedcke, Jochen; Grade, Marian; Camps, Jordi


    PURPOSE: miRNAs play a prominent role in a variety of physiologic and pathologic biologic processes, including cancer. For rectal cancers, only limited data are available on miRNA expression profiles, whereas the underlying genomic and transcriptomic aberrations have been firmly established. We...... therefore, aimed to comprehensively map the miRNA expression patterns of this disease. EXPERIMENTAL DESIGN: Tumor biopsies and corresponding matched mucosa samples were prospectively collected from 57 patients with locally advanced rectal cancers. Total RNA was extracted, and tumor and mucosa mi......RNA expression profiles were subsequently established for all patients. The expression of selected miRNAs was validated using semi-quantitative real-time PCR. RESULTS: Forty-nine miRNAs were significantly differentially expressed (log(2)-fold difference >0.5 and P cancer and normal rectal...

  16. Application of digital random-dot stereogram in the physical examination of pilot recruitment%数字化随机点立体图在招飞体检中的应用

    曹利群; 刘静; 高原; 胡晓东; 王静; 彭秀军


    Objective To find out the practicability of the digital random-dot stereogram (RDS) in the primary physical examination for naval air-force recruiting. Methods The stereo-acuity of 861 cases which with normal visual acuity was measured by digital RDS in the primary examination for naval air-force recruiting. Titmus test and heterophoria dimensionality measurement were taken for those who were with significant abnormal stereovision (stereo-acuity≥800"). The time limit for each subject is 1.5 min. Results One subject (0.12% of total) failed in recognizing the large visual field stereo-blindness screening plate. As to the stereo-acuity values for correctly recognizing the screening plate, 4 subjects (0.46%) were at 800", 7 (0.81%) were at 400", 4 (0.46%) were at 200", 9 (1.05%) were at 100", 76 (8.83%) were at 60" and 760 (88.27%) were less than 40". Among the 5 subjects whose stereo-acuity ≥ 800", 4 were diagnosis as exotropia. Conclusions The digital RDS could accurately and promptly measure the quantitative values of stereo-acuity dispense with any monocular cues. It shows effective applied value in the physical examination for pilots recruiting.%目的 探讨数字化随机点立体图在我国招飞体检中的实用价值.方法 应用数字化随机点立体图对861例视力及眼位正常的招飞体检受试者进行立体视锐度检查,对于立体视觉显著异常(立体视锐度≥800")者进一步进行Titmus立体镜检查及隐斜度数测定.结果 立体盲筛查图未通过者1例,占受检者总数的0.12%;立体视锐度800"者为4例,占0.46%;立体视锐度400"为7例,占0.81%;立体视锐度200"为4例,占0.46%,立体视锐度100"为9例,占1.05%;立体视锐度60"为76例,占8.83%;立体视锐度≤40"为760例,占88.27%.立体视锐度≥800"的5例中,4例为显性外斜视.结论 数字化随机点立体图没有任何单眼线索,能精准地进行立体视锐度定量测定,使用快捷简便,具有可操作性,在招飞体检工作中有重要实用价值.

  17. Rare Presentation of Gastroesophageal Carcinoma with Rectal Metastasis: A Case Report.

    Makker, Jasbir; Karki, Niraj; Sapkota, Binita; Niazi, Masooma; Remy, Prospere


    BACKGROUND Gastroesophageal cancers, previously considered rare, are rapidly increasing worldwide. We present here a unique case of gastroesophageal carcinoma with metastasis to the rectum. CASE REPORT A 60-year-old female patient presented with constipation, bloating, and weight loss of 4-month duration. She had undergone sleeve gastrectomy 6 years before. Endoscopies performed revealed a friable-looking mucosa in the lower esophagus and a polypoid rectal mass. Histopathological examination from both the esophageal and rectal lesions revealed poorly differentiated adenocarcinoma cells. Immunohistochemistry stain from both specimens was positive for CK7 supporting the gastric site primary with metastasis to the rectum. Further evaluation also revealed metastasis to bone and malignant pleural effusion. Chemotherapy with palliative intent was initiated. CONCLUSIONS Colorectal metastasis is commonly seen from cancers of the breast, stomach, melanoma, kidney, prostate, and ovaries. However, colorectal metastasis from gastroesophageal cancer has never been reported in the medical literature. Diagnosis relies on histopathologic examination and immunohistochemical staining of the tumor. Treatment depends on the tumor stage. Tumors with widespread metastatic disease are candidates for palliative chemotherapy.

  18. The Quality-of-Life Effects of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

    Herman, Joseph M., E-mail: [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Narang, Amol K. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Griffith, Kent A. [Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Zalupski, Mark M. [Department of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Reese, Jennifer B. [Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Gearhart, Susan L. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Azad, Nolifer S. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Chan, June; Olsen, Leah [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Efron, Jonathan E. [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Lawrence, Theodore S.; Ben-Josef, Edgar [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)


    Purpose: Existing studies that examine the effect of neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer on patient quality of life (QOL) are limited. Our goals were to prospectively explore acute changes in patient-reported QOL endpoints during and after treatment and to establish a distribution of scores that could be used for comparison as new treatment modalities emerge. Methods and Materials: Fifty patients with locally advanced rectal cancer were prospectively enrolled at 2 institutions. Validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) and colorectal cancer-specific (EORTC QLQ-CR38 and EORTC QLQ-CR 29) QOL questionnaires were administered to patients 1 month before they began CRT, at week 4 of CRT, and 1 month after they had finished CRT. The questionnaires included multiple symptom scales, functional domains, and a composite global QOL score. Additionally, a toxicity scale was completed by providers 1 month before the beginning of CRT, weekly during treatment, and 1 month after the end of CRT. Results: Global QOL showed a statistically significant and borderline clinically significant decrease during CRT (-9.50, P=.0024) but returned to baseline 1 month after the end of treatment (-0.33, P=.9205). Symptoms during treatment were mostly gastrointestinal (nausea/vomiting +9.94, P<.0001; and diarrhea +16.67, P=.0022), urinary (dysuria +13.33, P<.0001; and frequency +11.82, P=.0006) or fatigue (+16.22, P<.0001). These symptoms returned to baseline after therapy. However, sexual enjoyment (P=.0236) and sexual function (P=.0047) remained persistently diminished after therapy. Conclusions: Rectal cancer patients undergoing neoadjuvant CRT may experience a reduction in global QOL along with significant gastrointestinal and genitourinary symptoms during treatment. Moreover, provider-rated toxicity scales may not fully capture this decrease in patient-reported QOL. Although most symptoms are transient

  19. Smooth muscle enfoldment internal sphincter construction after intersphincteric resection for rectal cancer.

    Heiying Jin

    Full Text Available To assess smooth muscle enfoldment and internal sphincter construction (SMESC for improvement of continence after intersphincteric resection (ISR for rectal cancer.Twenty-four Bama miniature pigs were randomly divided into a conventional ISR group and experimental SMESC group, with 12 pigs in each group. The proximal sigmoid colon was anastomosed directly to the anus in the ISR group. In the SMESC group, internal sphincter construction was performed. At 12 weeks before and after surgery, rectal resting pressure and anal canal length were assessed. Three-dimensional ultrasound was used to determine the thickness of the internal sphincter. After the animals were sacrificed, the rectum and anus were resected and pathological examinations were performed to evaluate the differences in sphincter thickness and muscle fibers.All 24 animals in the SMESC group and the ISR group survived the surgery. Twelve weeks post-surgery, the rectal resting pressure, length of the anal high-pressure zone and the postoperative internal sphincter thickness for the ISR group were significantly lower than for the SMESC group. There was a thickened area (about 2 cm above the anastomotic stoma among animals from the SMESC group; in addition, the smooth muscles were significantly enlarged and enfolded when compared to the ISR group.This animal model study shows that the SMESC procedure achieved acceptable reconstruction of the internal anal neo-sphincter (IAN/S, without increasing surgical risk. However, the findings in this experimental animal model must be confirmed by clinical trials to determine the safety and efficacy of this procedure in clinical practice.

  20. CT colonography with rectal iodine tagging: Feasibility and comparison with oral tagging in a colorectal cancer screening population

    Neri, Emanuele, E-mail: [Diagnostic and Interventional Radiology – Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Italy); Mantarro, Annalisa; Faggioni, Lorenzo; Scalise, Paola; Bemi, Pietro; Pancrazi, Francesca [Diagnostic and Interventional Radiology – Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Italy); D’Ippolito, Giuseppe [Federal University of São Paulo – Sena Madureira 1500 – Vila Mariana, UNIFESP, São Paulo, SP (Brazil); Bartolozzi, Carlo [Diagnostic and Interventional Radiology – Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Italy)


    Highlights: • In the group receiving rectal tagging, mean per-polyp sensitivity, specificity were 96.1% and 95.3%; while in the group receiving oral tagging, mean per-polyp sensitivity, specificity were 89.4% and 95.8%. The difference between the two groups was not statistically significant (p = 0.549). • Rectal tagging can be an effective alternative to oral tagging. • Rectal tagging allowed greater patient acceptance and lower overall examination time. - Abstract: Purpose: To evaluate feasibility, diagnostic performance, patient acceptance, and overall examination time of CT colonography (CTC) performed through rectal administration of iodinated contrast material. Materials and methods: Six-hundred asymptomatic subjects (male:female = 270:330; mean 63 years) undergoing CTC for colorectal cancer screening on an individual basis were consecutively enrolled in the study. Out of them, 503 patients (group 1) underwent CTC with rectal tagging, of which 55 had a total of 77 colonic lesions. The remaining 97 patients (group 2) were randomly selected to receive CTC with oral tagging of which 15 had a total of 20 colonic lesions. CTC findings were compared with optical colonoscopy, and per-segment image quality was visually assessed using a semi-quantitative score (1 = poor, 2 = adequate, 3 = excellent). In 70/600 patients (11.7%), CTC was performed twice with both types of tagging over a 5-year follow-up cancer screening program. In this subgroup, patient acceptance was rated via phone interview two weeks after CTC using a semi-quantitative scale (1 = poor, 2 = fair, 3 = average, 4 = good, 5 = excellent). Results: Mean per-polyp sensitivity, specificity, positive and negative predictive values of CTC with rectal vs oral tagging were 96.1% (CI{sub 95%} 85.4 ÷ 99.3%) vs 89.4% (CI{sub 95%} 65.4 ÷ 98.1%), 95.3% (CI{sub 95%} 90.7 ÷ 97.8%) vs 95.8% (CI{sub 95%} 87.6 ÷ 98.9%), 86.0% (CI{sub 95%} 73.6 ÷ 93.3) vs 85.0% (CI{sub 95%} 61.1 ÷ 96.0%), and 98.8% (CI{sub 95

  1. Late Laparoscopic Management of Traumatic Rectal Injury Without Protective Colostomy

    Travassos, Daisy V.; Chrzan, Rafal; van der Zee, David


    The gold standard of treatment in the case of fecal peritonitis in association with traumatic rectal perforation is closure of the perforation in combination with a diverting colostomy. In this paper, we report the successful laparoscopic management of such a trauma without colostomy 24 hours after

  2. Value of intraoperative radiotherapy in locally advanced rectal cancer

    Ferenschild, Floris T. J.; Vermaas, Maarten; Nuyttens, Joost J. M. E.; Graveland, Wilfried J.; Marinelli, Andreas W. K. S.; van der Sijp, Joost R.; Wiggers, Theo; Verhoef, Cornelis; Eggermont, Alexander M. M.; de Wilt, Johannes H. W.


    PURPOSE: This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer. METHODS: Between 1987 and 2002, 123 patients with initial unresectable an

  3. Priapism secondary to penile metastasis of rectal cancer

    Ji Chan Park; Wook Hyun Lee; Min Kyu Kang; Suk Young Park


    Metastatic penile carcinoma is rare and usually originates from genitourinary tumors. The presenting symptoms or signs have been described as nonspecific except for priapism. Rectal adenocarcinoma is a very unusual source of metastatic penile carcinoma. We report a case of metastatic penile carcinoma that originated from the rectum. Symptomatic improvement occurred with palliative radiotherapy.

  4. Anastomotic leakage after anterior resection for rectal cancer: risk factors

    Bertelsen, C A; Andreasen, A H; Jørgensen, Torben;


    OBJECTIVE: The study aimed to identify risk factors for clinical anastomotic leakage (AL) after anterior resection for rectal cancer in a consecutive national cohort. METHOD: All patients with an initial first diagnosis of colorectal adenocarcinoma were prospectively registered in a national...

  5. Whither papillon? Future directions for contact radiotherapy in rectal cancer

    Lindegaard, J; Gerard, J P; Sun Myint, A;


    Although contact radiotherapy was developed 70 years ago, and is highly effective with cure rates of over 90% for early rectal cancer, there are few centres that offer this treatment today. One reason is the lack of replacement of ageing contact X-ray machines, many of which are now over 30 years...

  6. Prototype of a rectal wall ultrasound image analysis system

    Xiao, Di; Ng, Wan S.; Abeyratne, Udantha R.; Tsang, Charles B.


    This paper presents a software system prototype for rectal wall ultrasound image processing, image display and 3D reconstruction and visualization of the rectal wall structure, which is aimed to help surgeons cope with large quantities of rectal wall ultrasound images. On the core image processing algorithm part, a novel multigradient field active contour model proposed by authors is used to complete the multi-layer boundary detection of the rectal wall. A novel unifying active contour model, which combines region information, gradient information and contour's internal constraint, is developed for tumor boundary detection. The region statistical information is described accurately by Gaussian Mixture Model, whose parameter solution is computed by Expectation-Maximization algorithm. The whole system is set up on Java platform. Java JAI technology is used for 2D image display, Java3D technology is employed for 3D reconstruction and visualization. The system prototype is currently composed of three main modules: image processing, image display and 3D visualization.

  7. Three-dimensional Conformal Radiation Therapy Techniques for Rectal Cancer

    J.J.M.E. Nuyttens (Joost)


    markdownabstract__Abstract__ The third most common malignancy in the Netherlands is colorectal cancer. Rectal cancer affects every year around 2000 new patients. The highest incidence is found at an age above 70 years, and in men (sex ratio: 1.48). In Europe, the treatment of preference for locally

  8. Lifetime costs of colon and rectal cancer management in Canada.

    Maroun, Jean; Ng, Edward; Berthelot, Jean-Marie; Le Petit, Christel; Dahrouge, Simone; Flanagan, William M; Walker, Hugh; Evans, William K


    Colorectal cancer is the second leading cause of cancer-related mortality among Canadians. We derived the direct health care costs associated with the lifetime management of an estimated 16,856 patients with a diagnosis of colon and rectal cancer in Canada in 2000. Information on diagnostic approaches, treatment algorithms, follow-up and care at disease progression was obtained from various databases and was integrated into Statistics Canada's Population Health Model (POHEM) to estimate lifetime costs. The average lifetime cost (in Canadian dollars) of managing patients with colorectal cancer ranged from $20,319 per case for TNM stage I colon cancer to $39,182 per case for stage III rectal cancer. The total lifetime treatment cost for the cohort of patients in 2000 was estimated to be over $333 million for colon and $187 million for rectal cancer. Hospitalization represented 65% and 61% of the lifetime costs of colon and rectal cancer respectively. Disease costing models can be important policy- relevant tools to assist in resource allocation. Our results highlight the importance of performing preoperative tests and staging in an ambulatory care setting, where possible, to achieve optimal cost efficiencies. Similarly, terminal care might be delivered more efficiently in the home environment or in palliative care units.

  9. Genomic evaluation of rectal temperature in Holstein cattle

    Heat stress negatively impacts the production, fertility, and health of dairy cattle. Rectal temperature (RT) has unfavorable genetic correlations with production, longevity, economic merit, and somatic cell score in Holstein cows. The objectives of the current study were to perform a genome-wide as...

  10. The result of implementation of multidisciplinary teams in rectal cancer

    Wille-Jørgensen, Peer; Sparre, Peter; Glenthøj, Anders


    , postoperative mortality, local recurrence, distant recurrence and over-all and disease-free survival. Results:  811 patients were diagnosed with primary rectal cancer in Hvidovre and Bispebjerg Hospitals 1.5.2001-31.8.2006. The frequency of preoperative MRI scans increased in the MDT cohort and perioperative...

  11. Sexual function in females after radiotherapy for rectal cancer

    Bruheim, Kjersti; Tveit, Kjell Magne; Guren, Marianne G. (The Cancer Centre, Oslo Univ. Hospital, Ullevaal, Oslo (Norway)), E-mail:; Fossaa, Sophie D. (Faculty of Medicine, Univ. of Oslo, Oslo (Norway)); Skovlund, Eva (School of Pharmacy, Univ. of Oslo, Oslo (Norway)); Balteskard, Lise (Dept. of Oncology, Univ. Hospital of Northern Norway, Tromsoe (Norway)); Carlsen, Erik (Dept. of Clinical Cancer Research, Oslo Univ. Hospital, The Norwegian Radium Hospital, Oslo (Norway))


    Background. Knowledge about female sexual problems after pre- or postoperative (chemo-)radiotherapy and radical resection of rectal cancer is limited. The aim of this study was to compare self-rated sexual functioning in women treated with or without radiotherapy (RT+ vs. RT?), at least two years after surgery for rectal cancer. Methods and materials. Female patients diagnosed from 1993 to 2003 were identified from a national database, the Norwegian Rectal Cancer Registry. Eligible patients were without recurrence or metastases at the time of the study. The Sexual function and Vaginal Changes Questionnaire (SVQ) was used to measure sexual functioning. Results. Questionnaires were returned from 172 of 332 invited and eligible women (52%). The mean age was 65 years (range 42-79) and the time since surgery for rectal cancer was 4.5 years (range 2.6-12.4). Sexual interest was not significantly impaired in RT+ (n=62) compared to RT? (n=110) women. RT+ women reported more vaginal problems in terms of vaginal dryness (50% vs. 24%), dyspareunia (35% vs. 11%) and reduced vaginal dimension (35% vs. 6%) compared with RT? patients; however, they did not have significantly more worries about their sex life. Conclusion. An increased risk of dyspareunia and vaginal dryness was observed in women following surgery combined with (chemo-)radiotherapy compared with women treated with surgery alone. Further research is required to determine the effect of adjuvant therapy on female sexual function

  12. Single-Access Laparoscopic Rectal Surgery Is Technically Feasible

    Siripong Sirikurnpiboon


    Full Text Available Introduction. Single-access laparoscopic surgery (SALS has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments. Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications. Settings and Design. Prospective study. Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5 cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules. Statistical Analysis Used. Mean, minimum–maximum. Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.

  13. Rectal angiolipoma: A case report and review of literature

    Sabite Kacar; Sedef Kuran; Tulay Temucin; Bulent Odemis; Nilufer Karadeniz; Nurgul Sasmaz


    Angiolipoma is a rare vascular variant of the benign lipomatous tumors and is generally seen in subcutaneous tissues. We report a 70-year-old female with abdominal distension not related to rectal small polypoid mass with peduncule described as angiolipoma by histologically,and review the literature.

  14. Solitary rectal ulcer syndrome in children: A literature review

    Seyed Mohsen Dehghani; Abdorrasoul Malekpour; Mahmood Haghighat


    Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding,copious mucus discharge,feeling of incomplete defecation,and rarely rectal prolapse.SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings.The current treatments are suboptimal,and despite correct diagnosis,outcomes can be unsatisfactory.Some treatment protocols for SRUS include conservative management such as family reassurance,regulation of toilet habits,avoidance of straining,encouragement of a high-fiber diet,topical treatments with salicylate,sulfasalazine,steroids and sucralfate,and surgery.In children,SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases,however,it is being reported more than in the past.This condition in children is benign; however,morbidity is an important problem as reflected by persistence of symptoms,especially rectal bleeding.In this review,we discuss current diagnosis and treatment for SRUS.

  15. Multicenter evaluation of rectal cancer reimaging post neoadjuvant (MERRION) therapy.

    Hanly, Ann M


    The aim of this study was to evaluate the utility of reimaging rectal cancer post-CRT (chemoradiotherapy) with magnetic resonance (MR) imaging of the pelvis for local staging and computed tomography of thorax, abdomen, and pelvis (CT TAP) to identify distant metastases.

  16. Patient factors may predict anastomotic complications after rectal cancer surgery

    Dana M. Hayden


    Conclusion: Our study identifies preoperative anemia as possible risk factor for anastomotic leak and neoadjuvant chemoradiation may lead to increased risk of complications overall. Further prospective studies will help to elucidate these findings as well as identify amenable factors that may decrease risk of anastomotic complications after rectal cancer surgery.

  17. Posterior sagittal rectopexy in the treatment of recurrent rectal ...

    Conservative management was successful in four cases. Eighteen were treated with ... Constipation improved in seven out of 12 patients, who had history of .... prolapse after previous intervention. ... infection, suture erosion into the rectal wall, pain during defecation ... effective and can improve functional outcome without.

  18. Rectal absorption of morphine from controlled release suppositories

    Moolenaar, Frits; Meyler, Pim; Frijlink, Erik; Jauw, Tjoe Hang; Visser, Jan; Proost, Johannes


    The absorption profiles and bioavailability of morphine in human volunteers (n = 13) were described after oral administration of MS Contin tablets and rectal administration of a newly developed controlled release suppository. By manipulating the viscosity of fatty suppository base an entirely

  19. Surgeon-related factors and outcome in rectal cancer.

    Porter, G A; Soskolne, C L; Yakimets, W W; Newman, S C


    OBJECTIVE: To determine whether surgical subspecialty training in colorectal surgery or frequency of rectal cancer resection by the surgeon are independent prognostic factors for local recurrence (LR) and survival. SUMMARY BACKGROUND DATA: Variation in patient outcome in rectal cancer has been shown among centers and among individual surgeons. However, the prognostic importance of surgeon-related factors is largely unknown. METHODS: All patients undergoing potentially curative low anterior resection or abdominoperineal resection for primary adenocarcinoma of the rectum between 1983 and 1990 at the five Edmonton general hospitals were reviewed in a historic-prospective study design. Preoperative, intraoperative, pathologic, adjuvant therapy, and outcome variables were obtained. Outcomes of interest included LR and disease-specific survival (DSS). To determine survival rates and to control both confounding and interaction, multivariate analysis was performed using Cox proportional hazards regression. RESULTS: The study included 683 patients involving 52 surgeons, with > 5-year follow-up obtained on 663 (97%) patients. There were five colorectal-trained surgeons who performed 109 (16%) of the operations. Independent of surgeon training, 323 operations (47%) were done by surgeons performing < 21 rectal cancer resections over the study period. Multivariate analysis showed that the risk of LR was increased in patients of both noncolorectal trained surgeons (hazard ratio (HR) = 2.5, p = 0.001) and those of surgeons performing < 21 resections (HR = 1.8, p < 0.001). Stage (p < 0.001), use of adjuvant therapy (p = 0.002), rectal perforation or tumor spill (p < 0.001), and vascular/neural invasion (p = 0.002) also were significant prognostic factors for LR. Similarly, decreased disease-specific survival was found to be independently associated with noncolorectal-trained surgeons (HR = 1.5, p = 0.03) and surgeons performing < 21 resections (HR = 1.4, p = 0.005). Stage (p < 0

  20. Yield of yearly routine physical examination in HIV-1 infected patients is limited: A retrospective cohort study in the Netherlands.

    van Amsterdam, Marleen A; van Assen, Sander; Sprenger, Herman G; Wilting, Kasper R; Stienstra, Ymkje; Bierman, Wouter F W


    Routine physical examinations might be of value in HIV-infected patients, but the yield is unknown. We determined the diagnoses that would have been missed without performing annual routine physical examinations in HIV-infected patients with stable disease. Data were collected from the medical records of 299 HIV-1-infected patients with CD4 count >350 cells/mm3 if not using combination antiretroviral therapy (cART), or CD4 count >100 cells/mm3 and undetectable viral load if using cART. We defined the diagnoses that would have been missed without performing routine physical examinations on annual check-ups in 2010. Exclusion criteria were hepatitis B/C co-infection, start/ switch of cART physical examination even if not routinely scheduled. For 24 patients (8.0%) the routine physical examination led to the finding of a new diagnosis: six-all men who have sex with men (MSM)-had a concurrent sexually transmitted infection, eight had hypertension, and ten others had a large variety of diagnoses. A total atrioventricular block with bradycardia was the most clinically relevant finding. Annual physical examinations of HIV-infected patients with stable disease brought few new diagnoses that would have been missed without performing a routine examination. Our results suggest that standard assessments could be restricted to six-monthly measuring blood pressure in all patients and annually performing anogenital and digital rectal examination on MSM.

  1. Association between polycyclic aromatic hydrocarbons and human rectal tumor or liver cancer

    Guohong Jiang; Limin Lun; Liyuan Cong


    Objective: The aim of this study was to investigate the effect of polycyclic aromatic hydrocarbons (PAHs) in rectal carcinoma and hepatocarcinoma genesis. Methods: The PAHs in the human rectal cancer and liver cancer tissues, the adjacent tissues and homologous tissues without rectal cancer or liver cancer were extracted by ultrasonic wave. The extracts were then cleaned up and enriched by solid phase extraction, analyzed by high performance liquid chromatography (HPLC) with fluorescence spectroscopy. Results: Four kinds of PAHs were detected in human rectal and hepatic tissues. The contents of pyrene, 2-methylanthracene and benzo (a) pyrene in both rectal cancer tissues and adjacent homologous tissues were higher than rectal tissues without rectal cancer, the differences were statistically significant (P 0.05). The differences of the content of each PAHs between rectal cancer and adjacent tissue were not significant (P > 0.05). The contents of the four PAHs in the three kinds of liver tis-sues were not statistically significant (P > 0.05). Conclusion: PAHs are found in human rectal tissues or hepatic tissues. The contents of PAHs in human rectal tissue may have an effect on the occurrence of human rectal cancer while the contents of PAHs in human hepatic tissues may have not ones.

  2. A digital filter for an analog-digital converter with delta-sigma modulation

    Beliavskaia, T. G.; Levchuk, Iu. P.; Strigina, E. V.


    Various methods of implementing the digital versions of analog-digital converters are examined, with attention given to homogeneous, triangular, and low-frequency digital filters. A comparison of the implementations proposed here makes it possible to optimize the structure of an analog-digital converter with respect to the hardware costs depending on the required accuracy.

  3. Digital printing

    Sobotka, Werner K.


    Digital printing is described as a tool to replace conventional printing machines completely. Still this goal was not reached until now with any of the digital printing technologies to be described in the paper. Productivity and costs are still the main parameters and are not really solved until now. Quality in digital printing is no problem anymore. Definition of digital printing is to transfer digital datas directly on the paper surface. This step can be carried out directly or with the use of an intermediate image carrier. Keywords in digital printing are: computer- to-press; erasable image carrier; image carrier with memory. Digital printing is also the logical development of the new digital area as it is pointed out in Nicholas Negropotes book 'Being Digital' and also the answer to networking and Internet technologies. Creating images text and color in one country and publishing the datas in another country or continent is the main advantage. Printing on demand another big advantage and last but not least personalization the last big advantage. Costs and being able to coop with this new world of prepress technology is the biggest disadvantage. Therefore the very optimistic growth rates for the next few years are really nonexistent. The development of complete new markets is too slow and the replacing of old markets is too small.

  4. Digital displacements

    Pors, Anja Svejgaard


    In recent years digital reforms are being introduced in the municipal landscape of Denmark. The reforms address the interaction between citizen and local authority. The aim is, that by 2015 at least 80 per cent of all correspondence between citizens and public authority will be transmitted through...... digital interface. However, the transformation of citizen services from traditional face-to-face interaction to digital self-service gives rise to new practices; some citizens need support to be able to manage self-service through digital tools. A mixture of support and teaching, named co...

  5. Rectal premedication in pediatric anesthesia: midazolam versus ketamine

    Moshirian N


    Full Text Available Background: Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The rectal route is one of the most commonly accepted means of drug administration. The aim of our study was to investigate and compare the efficacy of rectally administered midazolam versus that of ketamine as a premedication in pediatric patients.Methods: We performed a prospective randomized double-blinded clinical trial in 64 children, 1 to 10 years of age, randomly allocated into two groups. The midazolam group received 0.5 mg/kg rectal midazolam and the ketamine group received 5 mg/kg rectal ketamine. The preoperative sedation scores were evaluated on a three-point scale. The anxiolysis and mask acceptance scores were evaluated separately on a four-point scale, with ease of parental separation, based on the presence or lack of crying, evaluated on a two-point scale. Results: Neither medication showed acceptable sedation (>75%, with no significant difference in sedation score between the two groups (P=0.725. Anxiolysis and mask acceptance using either midazolam or ketamine were acceptable, with  midazolam performing significantly better than ketamine (P=0.00 and P=0.042, respectively. Ease of parental separation was seen in both groups without significant difference (P=0.288 and no major adverse effects, such as apnea, occurred in either group.Conclusions: Rectal midazolam is more effective than ketamine in anxiolysis and mask acceptance. Although they both can ease separation anxiety in children before surgery, we found neither drug to be acceptable for sedation.

  6. Epidemiological characteristics of Candida species colonizing oral and rectal sites of Jordanian infants

    Aqel Kamal F


    Full Text Available Abstract Background There is evidence that Candida colonization contributes to increasing invasion of candidiasis in hospitalized neonates. Few studies investigated the epidemiology and risk factors of Candida colonization among hospitalized and non-hospitalized infants. This prospective study investigated the major epidemiological characteristics of Candida species colonizing oral and rectal sites of Jordanian infants. Methods Infants aged one year or less who were examined at the pediatrics outpatient clinic or hospitalized at the Jordan University Hospital, Amman, Jordan, were included in this study. Culture swabs were collected from oral and rectal sites and inoculated on Sabouraud dextrose agar. All Candida isolates were confirmed by the Remel RapID yeast plus system, and further investigated for specific virulence factors and antifungal susceptibility MIC using E-test. Genotyping of C. albicans isolates was determined using random amplified polymorphic DNA (RAPD analysis method. Results A total of 61/492 (12.4% infants were colonized with Candida species by either their oral/rectal sites or both. Rectal colonization was significantly more detected than oral colonization (64.6% verses 35.4%, particularly among hospitalized infants aged more than one month. The pattern and rates of colonization were as follows: C. albicans was the commonest species isolated from both sites and accounted for 67.1% of all isolates, followed by C.kefyr (11.4%, each C. tropicalis and C. glabrata (8.9% and C. parapsilosis (3.8%. A various rates of Candida isolates proved to secrete putative virulence factors in vitro; asparatyl proteinase, phospholipase and hemolysin. C. albicans were associated significantly (P Candida species. All Candida isolates were susceptible to amphotericin B and caspofungin, whereas 97% of Candida species isolates were susceptible to fluconazole using E-test. The genetic similarity of 53 C. albicans isolates as demonstrated by dendrogram

  7. Digital Audio Collections

    Jason Tenter


    Full Text Available

    This paper is about the possibility of libraries creating digital music or audio collections based on the current state of the digital music industry, and in comparison with the difficulties librarians have found in adding e-books to collections. In comparing the e-book and digital music markets, factors such as digital rights management (DRM and the differences in both markets’ relationships with customers are examined. This juxtaposition suggests that where e-books have been difficult to include in library collections because publishers want to maintain control over their content, music publishers have had to resign some of the control over their products because of file-sharing, and so may work with libraries to develop these collections in a more constructive way than e-book venders. At the end of the paper, some models are suggested for developing these collections.

  8. The surged faradic stimulation to the pelvic floor muscles as an adjunct to the medical management in children with rectal prolapse

    Jhanwar Atul


    Full Text Available Abstract Background To assess the role of the surged faradic stimulation to the pelvic floor muscles as an adjunct to the conservative management in the children of idiopathic rectal prolapse Methods Study design: Prospective Setting: Pediatric Surgery Department, Pt BD Sharma, Post Graduate Institute of Medical Sciences, Rohtak Subjects: 47 consecutive children with idiopathic rectal prolapse attending the Pediatric Surgery out patient department from July 2005 to June 2006 Methodology: The information pertaining to duration and the extent of rectal prolapse, predisposing or associated medical conditions, results of local clinical examination were noted. Surged faradic stimulation using modified intraluminal rectal probe, was given on the alternate days. The conventional conservative medical management was also continued. The extent of relief and the number of the sittings of faradic stimulation required were noted at various stages of follow-ups Statistical Methods: Mean values between those completely cured and others; poor responders and others were compared with t-test and proportions were compared with Chi square test. The p-value Results The mean number of sittings in the completely cured group (n = 28(64% was (12.4 ± 7.8 and was comparable with very poor responder (n = 6(13%. There was higher percentage of relief (76% at the first follow up (at 15 days in completely cured Vs other (37% and also the poor responders showed (20% Vs other (68% and was statistically significant. Conclusion With use of faradic stimulation, even the long-standing rectal prolapse can be fully cured. The follow up visit at 2 weeks is very important to gauge the likely success of this modality in treatment of the patients with rectal prolapse. Those showing poor response at this stage may require alternative treatment or take a long time to get cured

  9. Nanocytology of rectal colonocytes to assess risk of colon cancer based on field cancerization.

    Damania, Dhwanil; Roy, Hemant K; Subramanian, Hariharan; Weinberg, David S; Rex, Douglas K; Goldberg, Michael J; Muldoon, Joseph; Cherkezyan, Lusik; Zhu, Yuanjia; Bianchi, Laura K; Shah, Dhiren; Pradhan, Prabhakar; Borkar, Monica; Lynch, Henry; Backman, Vadim


    Developing a minimally invasive and cost-effective prescreening strategy for colon cancer is critical because of the impossibility of conducting colonoscopy on the entire at-risk population. The concept of field carcinogenesis, in which normal-appearing tissue away from a tumor has molecular and, consequently, nano-architectural abnormalities, offers one attractive approach to identify high-risk patients. In this study, we investigated whether the novel imaging technique partial wave spectroscopic (PWS) microscopy could risk-stratify patients harboring precancerous lesions of the colon, using an optically measured biomarker (L(d)) obtained from microscopically normal but nanoscopically altered cells. Rectal epithelial cells were examined from 146 patients, including 72 control patients, 14 patients with diminutive adenomas, 20 patients with nondiminutive/nonadvanced adenomas, 15 patients with advanced adenomas/high-grade dysplasia, 12 patients with genetic mutation leading to Lynch syndrome, and 13 patients with cancer. We found that the L(d) obtained from rectal colonocytes was well correlated with colon tumorigenicity in our patient cohort and in an independent validation set of 39 additional patients. Therefore, our findings suggest that PWS-measured L(d) is an accurate marker of field carcinogenesis. This approach provides a potential prescreening strategy for risk stratification before colonoscopy.

  10. The role of autofluorescence colonoscopy in diagnosis and management of solitary rectal ulcer syndrome

    Latos, W.; Kawczyk-Krupka, A.; Ledwon, A.; Kosciarz-Grzesiok, A.; Misiak, A.; Sieron-Stoltny, K.; Sieron, A.


    Solitary rectal ulcer syndrome (SRUS) is a chronic disease of the rectum. Although SRUS is a benign condition there are studies which suggest that chronic ischaemia which occurs in the SRUS may lead to "transitional mucosa" that is similar to that adjacent to colorectal carcinomas and adenomas and may lead to colorectal dysplasia and carcinoma development. The exclusion of primary or metastatic malignancy is the most important aim in the differential diagnosis of SRUS. In our study we assess the possibilities of autofluorescence colonoscopy (AFC) in diagnosis and management of SRUS. We performed white light colonoscopy first. The tissue samples were taken for pathological examination. When SRUS was histopathologically confirmed AFC was performed by means of Xillix OncoLIFE. During AFC numerical colour value (NCV) of autofluorescence of SRUS lesions was noted. During 1946 colonoscopies eight persons were diagnosed as having solitary rectal ulcer syndrome. We did not observe autofluorescence increase in case of polipoid and flat ulcer lesions (NCV 0,39-0,67; mean 0,525) and little increase of autofluorescence in case of erythema lesion (NCV- 0,94). SRUS is a rare disorder of the rectum but it causes differential diagnosis problems. The most common reason for incorrect diagnosis are inadequate tissue specimens. AFC allows to reveal subtle areas within the lesions of more intense autofluorescence and localizes the potential cancer-transformating dysplasia. In this way the most representative area with highest risk of pre- or cancerous changes, for biopsy specimen is indicated.

  11. Usefulness of per-rectal portal scintigraphy with Tc-99m pertechnetate for galactosemia in infants

    Shiomi, Susumu; Sasaki, Nobumitsu; Ikeoka, Naoko; Kuroki, Tetsuo; Okano, Yoshiyuki; Kawabe, Joji; Ochi, Hironobu [Osaka City Univ. (Japan). Medical School


    Galactosemia discovered by newborn screening is rarely caused by enzyme deficiency. It has recently been reported that among patients without enzyme deficiency portosystemic shunting may be a cause of galactosemia in some patients. We did per-rectal portal scintigraphy in patients with such galactosemia detected during screening of newborns to examine the usefulness of this method for the diagnosis of portosystemic shunts via the inferior mesenteric vein. The subjects were eight neonates with galactosemia without enzyme deficiency detected during screening. A solution containing technetium-99m pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were recorded sequentially. The per-rectal portal shunt index was determined by calculating the ratio for counts of the liver to counts for the heart integrated for 24 seconds immediately after the appearance of the liver time-activity curve. A portosystemic shunt was detected in both of the patients with a shunt index of 30% or more, but not in the six patients with a shunt index less than 30%. The blood galactose levels of these six patients later entered the reference range. This method is noninvasive and there is little exposure to the radionuclide. It seemed to be useful for the diagnosis of portosystemic shunt in newborns with galactosemia without enzyme deficiency. (author)

  12. Microwave prostatic hyperthermia: Interest of urethral and rectal applicators combination -- Theoretical study and animal experimental results

    Despretz, D.; Camart, J.C.; Michel, C.; Fabre, J.J. [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France); Prevost, B. [Centre Oscar Lambret, Lille (France); Sozanski, J.P. [INSERM, Lille (France); Chive, M. [Univ. des Sciences et Technologies de Lille, Villeneuve D`Ascq (France)]|[INSERM, Lille (France)


    Microwave thermotherapy systems used for benign prostatic hyperplasia treatment generally operate with urethral or rectal applicator to deliver the microwave energy in the prostate. This technique does not allow an efficient heating of all the gland particularly in the case of large adenoma or when the treatment is limited to only one heating session. A solution to this problem is given by using simultaneously the rectal and urethral applicators. A complete 915-MHz microwave thermotherapy system is presented with two applicators which can operate independently or simultaneously to deliver the microwave energy in the prostate. Electromagnetic and thermal modeling have been developed for the applicator antenna optimization, to calculate the specific absorption rate (SAR) and the thermal pattern in the prostate for each applicator alone and when they operate together in phase. Different canine experiments have been performed to prove the interest of using the two applicators simultaneously as compared when they operate alone. Histological examination cuts of the prostate gland after heating have been carried out.

  13. Rectal prolapse in a child: an unusual presentation of Clostridium difficile-associated pseudomembranous colitis.

    Huang, Shu-Ching; Yang, Yao-Jong; Lee, Chung-Ta


    Pseudomembranous colitis after short-course antibiotics is rare in children. We report a 14-month-old girl who presented with rectal prolapse complicated with Clostridium difficile-associated pseudomembranous colitis after a 4-day course of oral cefuroxime for treatment of acute otitis media. Abdominal sonogram showed a pelvic mass, and computed tomography revealed thickened wall of the rectum. Sigmoidoscopy demonstrated discrete yellowish plaques adherent to an edematous mucosa. Stool cultures for C difficile were positive and C difficile toxins A and B were detected in her stool. Histological examination of colonic biopsy showed superficial erosion of the mucosa and the adherent pseudomembranes. She achieved a full recovery after discontinuing cefuroxime. Our case implied that C difficile infection should be considered in children presenting with rectal prolapse, especially when they are taking or have recently received antibiotic therapy. Supportive therapy and discontinuation of antibiotics are generally sufficient for patients with C difficile-associated pseudomembranous colitis who present with mild diarrheal illness.

  14. [Role of neoadjuvant radiotherapy for rectal cancer : Is MRI-based selection a future model?].

    Kulu, Y; Hackert, T; Debus, J; Weber, M-A; Büchler, M W; Ulrich, A


    Following the introduction of total mesorectal excision (TME) in the curative treatment of rectal cancer, the role of neoadjuvant therapy has evolved. By improving the surgical technique the local recurrence rate could be reduced by TME surgery alone to below 8 %. Even if local control was further improved by additional preoperative irradiation this did not lead to a general survival benefit. Guidelines advocate that all patients in UICC stage II and III should be pretreated; however, the stage-based indications for neoadjuvant therapy have limitations. This is mainly attributable to the facts that patients with T3 tumors comprise a very heterogeneous prognostic group and preoperative lymph node diagnostics lack accuracy. In contrast, in recent years the circumferential resection margin (CRM) has become an important prognostic parameter. Patients with tumors that are very close to or infiltrate the pelvic fascia (positive CRM) have a higher rate of local recurrence and poorer survival. With high-resolution pelvic magnetic resonance imaging (MRI) examination in patients with rectal cancer, the preoperative CRM can be determined with a high sensitivity and specificity. Improved T staging and better prediction of the resection margins by pelvic MRI potentially facilitate the selection of patients for study-based treatment strategies omitting neoadjuvant radiotherapy.

  15. Tumor phosphatidylinositol-3-kinase signaling and development of metastatic disease in locally advanced rectal cancer.

    Anne Hansen Ree

    Full Text Available BACKGROUND: Recognizing EGFR as key orchestrator of the metastatic process in colorectal cancer, but also the substantial heterogeneity of responses to anti-EGFR therapy, we examined the pattern of composite tumor kinase activities governed by EGFR-mediated signaling that might be implicated in development of metastatic disease. PATIENTS AND METHODS: Point mutations in KRAS, BRAF, and PIK3CA and ERBB2 amplification were determined in primary tumors from 63 patients with locally advanced rectal cancer scheduled for radical treatment. Using peptide arrays with tyrosine kinase substrates, ex vivo phosphopeptide profiles were generated from the same baseline tumor samples and correlated to metastasis-free survival. RESULTS: Unsupervised clustering analysis of the resulting phosphorylation of 102 array substrates defined two tumor classes, both consisting of cases with and without KRAS/BRAF mutations. The smaller cluster group of patients, with tumors generating high ex vivo phosphorylation of phosphatidylinositol-3-kinase-related substrates, had a particularly aggressive disease course, with almost a half of patients developing metastatic disease within one year of follow-up. CONCLUSION: High phosphatidylinositol-3-kinase-mediated signaling activity of the primary tumor, rather than KRAS/BRAF mutation status, was identified as a hallmark of poor metastasis-free survival in patients with locally advanced rectal cancer undergoing radical treatment of the pelvic cavity.

  16. Metastasis of Rectal Adenocarcinoma to the Pancreas. Two Case Reports and a Review of the Literature

    Jeannine Bachmann


    Full Text Available Context The vast majority of pancreatic tumors are of pancreatic origin. Nonetheless, a variety of extrapancreatic tumors can involve the pancreas and may manifest with different clinicopathological characteristics. Case report We report on two patients with a history of rectal cancer who were referred to our department with a pancreatic mass: one patient 2 years after a low anterior resection (TNM stage: pT3 pN0 pM0, the other patient 2.5 years after an abdominoperineal resection (TNM stage: pT3 pN1 pM0. In the first case, computed tomography showed a cystic mass in the pancreas but fine-needle biopsy followed by cytopathological analysis revealed only necrotic tissue. In the other patient, magnetic resonance tomography showed a hypodense structure in the pancreatic body/tail. Suspecting pancreatic tumors, distal pancreatectomies were carried out. Subsequent histological examination revealed metastases of rectal cancer in both cases. Conclusion In patients with a history of a malignant tumor, a newly diagnosed mass in the pancreas - although rare - should raise the suspicion of metastatic disease. Surgical resection may be an option for a curative approach which can be offered to otherwise healthy patients if there is no evidence of other metastases.

  17. Comparing histopathological and magnetic resonance imaging based mesorectal fascia status in patients with rectal carcinoma.

    Hassan, Usman; Khan, Rizwanullah; Mehmood, Muhammad Tariq


    To compare mesorectal fascia status on histopathological findings with MRI based radiological mesorectal fascia status in patients with rectal carcinoma taking histopathology finding as gold standard. Analytical study. Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2011 to April 2012. Biopsy proven cases of rectal adenocarcinoma undergoing abdominoperineal resection were included in this study. Microscopic examination of slides was done to determine mesorectal fascia status as involved or otherwise without knowing the results of mesorectal fascia status on MRI. Mesorectal fascia status of MRI was determined by a radiologist who was not aware of the histopathological assessment of mesorectal fascia. Mean and standard deviation was calculated for age. Frequency and percentage were calculated for gender and mesorectal fascia status. 2 x 2 table was generated to calculate sensitivity, specificity, positive predictive value and negative predictive values and diagnostic accuracy of MRI for mesorectal fascia involvement taking histopathology as gold standard. The sensitivity of MRI to detect mesorectal fascia involvement was 23.07% and specificity was 70.5%. Positive predictive value of MRI was 10% and negative predictive value was 54.54%. Diagnostic accuracy of MRI for mesorectal fascia involvement was calculated as 50%. MRI findings regarding mesorectal fascia status as involved or otherwise are not helpful when compared with histopathological findings which is the gold standard.

  18. Digital Libraries

    Papy, Fabrice


    Of vital interest to all librarians and information specialists, this book presents all aspects of the effects of digitization of today's and tomorrow's libraries. From social to technical issues, Digital Libraries includes chapters on the growth of the role of librarian, the reader experience, cataloging, search engines, OPAC, law, ergonomic studies, and the future of libraries.

  19. Digital Audiobooks:

    Have, Iben; Pedersen, Birgitte Stougaard

    Audiobooks are rapidly gaining popularity with widely accessible digital downloading and streaming services. The paper is framing how the digital audiobook expands and changes the target groups for book publications and how it as an everyday activity is creating new reading experiences, places...

  20. Effect of rectal enemas on rectal dosimetric parameters during high-dose-rate vaginal cuff brachytherapy. A prospective trial

    Sabater, Sebastia; Andres, Ignacio; Sevillano, Marimar; Berenguer, Roberto; Aguayo, Manuel; Villas, Maria Victoria [Complejo Hospitalario Universitario de Albacete (CHUA), Department of Radiation Oncology, Albacete (Spain); Gascon, Marina; Arenas, Meritxell [Hospital Universitari Sant Joan, Department of Radiation Oncology, Reus (Spain); Rovirosa, Angeles; Camacho-Lopez, Cristina [University of Barcelona, IDIBAPS, Gynecological Cancer Unit, Radiation Oncology Department, ICMHO, Hospital Clinic, Barcelona (Spain)


    To evaluate the effects of rectal enemas on rectal doses during postoperative high-dose-rate (HDR) vaginal cuff brachytherapy (VCB). This prospective trial included 59 patients. Two rectal cleansing enemas were self-administered before the second fraction, and fraction 1 was considered the basal status. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Statistical analyses used paired and unpaired t-tests. Despite a significant 15 % reduction in mean rectal volume (44.07 vs. 52.15 cc, p = 0.0018), 35.6 % of patients had larger rectums after rectal enemas. No significant rectal enema-related DVH differences were observed compared to the basal data. Although not statistically significant, rectal cleansing-associated increases in mean rectal DVH values were observed: D{sub 0.1} {sub cc}: 6.6 vs. 7.21 Gy; D{sub 1} {sub cc}: 5.35 vs. 5.52 Gy; D{sub 2} {sub cc}: 4.67 vs. 4.72 Gy, before and after rectal cleaning, respectively (where D{sub x} {sub cc} is the dose to the most exposed x cm {sup 3}). No differences were observed in DVH parameters according to rectal volume increase or decrease after the enema. Patients whose rectal volume increased also had significantly larger DVH parameters, except for D{sub 5} {sub %}, D{sub 25} {sub %}, and D{sub 50} {sub %}. In contrast, in patients whose rectal volume decreased, significance was only seen for D{sub 25} {sub %} and D{sub 50} {sub %} (D{sub x} {sub %} dose covering x % of the volume). In the latter patients, nonsignificant reductions in D{sub 2} {sub cc}, D{sub 5} {sub cc} and V{sub 5} {sub Gy} (volume receiving at least 5 Gy) were observed. The current rectal enemas protocol was ineffective in significantly modifying rectal DVH parameters for HDR-VCB. (orig.) [German] Beurteilung der Auswirkungen von rektalen Dosen waehrend postoperativer High-Dose-Rate-(HDR-)Brachytherapie an der Scheidenmanschette (''vaginal cuff brachytherapy'', VCB). An

  1. Interobserver variation in rectal and bladder doses in orthogonal film-based treatment planning of cancer of the uterine cervix

    Raghukumar P


    Full Text Available Orthogonal film-based treatment planning is the most commonly adopted standard practice of treatment planning for cancer of the uterine cervix using high dose rate brachytherapy (HDR. This study aims at examining the variation in rectal and bladder doses when the same set of orthogonal films was given to different observers. Five physicists were given 35 pairs of orthogonal films obtained from patients who had undergone HDR brachytherapy. They were given the same instructions and asked to plan the case assuming the tumor was centrally placed, using the treatment-planning system, PLATO BPS V13.2. A statistically significant difference was observed in the average rectal (F = 3.407, P = 0.01 and bladder (F = 3.284, P = 0.013 doses and the volumes enclosed by the 100% isodose curve ( P < 0.01 obtained by each observer. These variations may be attributed to the differences in the reconstruction of applicators, the selection of source positions in ovoids and the intrauterine (IU tube, and the differences in the selection of points especially for the rectum, from lateral radiographs. These variations in planning seen within a department can be avoided if a particular source pattern is followed in the intrauterine tube, unless a specific situation demands a change. Variations in the selection of rectal points can be ruled out if the posterior vaginal surface is clearly seen.

  2. Digital chest radiography

    Debess, Jeanne Elisabeth; Johnsen, Karen Kirstine; Thomsen, Henrik


    Background: Chest radiography is one of the most common examinations in radiology departments. In 2013 approximately 80,000 chest x-rays were performed on women in the fertile age. Even low dose for the examinationCorrect collimation Purpose: Quality improvement of basic radiography focusing...... collimations depending on side of radiograph. Results from dose reduction will be presented on the congress Conclusion: Correct positioning and collimation of digital chest radiographs can reduce the radiation dose significant to the patients and by that improve the quality of basic radiography....... on collimation and dose reduction in digital chest radiography Methods and Materials A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from one hundred fifty self-reliant female patients between 15 and 55 years...

  3. Examining the use of color-infrared digital aerial photography to map common non-native invasive plants on two Southern Indiana U.S. Fish & Wildlife Service National Wildlife Refuges

    US Fish and Wildlife Service, Department of the Interior — OBJECTIVES: The overall objective was to determine if CIR digital aerial photography could be used to efficiently map and analyze common invasive plant distribution...

  4. The Importance of Preoperative Staging of Rectal Cancer Using Multiparametric MRI. A Systematic Review

    Bauer, Ferdinand


    A correct preoperative stadialization of rectal carcinoma has a direct influence upon its therapeutic strategy, resulting in a significant improvement of the survival rate and life quality after the treatment. The therapeutic strategy refers to the option of undergoing or not preoperative radiochemotherapy before the total mesorectal excision (TME). The technical advances in the magnetic resonance domain makes possible the multiparametric examinations (mp MRI) with medical equipments (3T models are common) good enough to obtain images having an excellent quality, which allow a correct diagnosis of the local tumour spread. These multiparametric examinations include T2 multiplan sequences and T1 sequences, which offer valuable morphological information due to the high resolution of anatomic structures and DWI functional sequences, with a decisive role in tracing residual tumours after post-surgery radiochemotherapy. The functional examination using DWI is the only highly accurate non-invasive diagnostic method which can differentiate the fibrosis from vital tumoral remnants. The dynamic contrast-enhanced examination (DCE) combined with DWI and volumetry can give supplementary information as to the complete and incomplete response to RCT, and is efficient in detecting a local recurrence after TME. Also, MRI is the only diagnostic method which has the necessary accuracy to assess the meso-rectal fascia, which represents the circumferential resection margin (CRM) in the case of TME. With the help of MRI we can measure with a precision similar to histology the minimal distance to the mesorectal fascia, essential in planning the surgical treatment, and more important than the T stadialization. This allows the selection of patients with an unfavourable prognosis factor who would benefit from radiotherapy or from RCT. The evaluation of other prognostic factors as the condition of nodes, their number and primary site, and the extramural venous invasion (EMVI) have an

  5. Balloon-Occluded Antegrade Transvenous Sclerotherapy to Treat Rectal Varices: A Direct Puncture Approach to the Superior Rectal Vein Through the Greater Sciatic Foramen Under CT Fluoroscopy Guidance

    Ono, Yasuyuki, E-mail:; Kariya, Shuji, E-mail:; Nakatani, Miyuki, E-mail:; Yoshida, Rie, E-mail:; Kono, Yumiko, E-mail:; Kan, Naoki, E-mail:; Ueno, Yutaka, E-mail:; Komemushi, Atsushi, E-mail:; Tanigawa, Noboru, E-mail: [Kansai Medical University, Department of Radiology (Japan)


    Rectal varices occur in 44.5 % of patients with ectopic varices caused by portal hypertension, and 48.6 % of these patients are untreated and followed by observation. However, bleeding occurs in 38 % and shock leading to death in 5 % of such patients. Two patients, an 80-year-old woman undergoing treatment for primary biliary cirrhosis (Child-Pugh class A) and a 63-year-old man with class C hepatic cirrhosis (Child-Pugh class A), in whom balloon-occluded antegrade transvenous sclerotherapy was performed to treat rectal varices are reported. A catheter was inserted by directly puncturing the rectal vein percutaneously through the greater sciatic foramen under computed tomographic fluoroscopy guidance. In both cases, the rectal varices were successfully treated without any significant complications, with no bleeding from rectal varices after embolization.

  6. Digital Leadership

    Zupancic, Tadeja; Verbeke, Johan; Achten, Henri


    . With this paper we intend to initiate a discussion in the eCAADe community to reflect and develop ideas in order to develop digital leadership skills amongst the membership. This paper introduces some important aspects, which may be valuable to look into when developing digital leadership skills.......Leadership is an important quality in organisations. Leadership is needed to introduce change and innovation. In our opinion, in architectural and design practices, the role of leadership has not yet been sufficiently studied, especially when it comes to the role of digital tools and media...

  7. Digital holography

    Picart, Pascal


    This book presents a substantial description of the principles and applications of digital holography.The first part of the book deals with mathematical basics and the linear filtering theory necessary to approach the topic. The next part describes the fundamentals of diffraction theory and exhaustively details the numerical computation of diffracted fields using FFT algorithms. A thorough presentation of the principles of holography and digital holography, including digital color holography, is proposed in the third part.A special section is devoted to the algorithms and method

  8. Digital electronics

    Morris, John


    An essential companion to John C Morris's 'Analogue Electronics', this clear and accessible text is designed for electronics students, teachers and enthusiasts who already have a basic understanding of electronics, and who wish to develop their knowledge of digital techniques and applications. Employing a discovery-based approach, the author covers fundamental theory before going on to develop an appreciation of logic networks, integrated circuit applications and analogue-digital conversion. A section on digital fault finding and useful ic data sheets completes th


    Nielsen, Kurt Gammelgaard; Petersen, Lise


    In accordance with The Danish eGOVERNMENT strategy 2011-2015 digital assessment and exam should be implemented at all Danish universities by the end of 2013. University of Southern Denmark (SDU) decided to start the implementation in May 2010.By the exam term of January 2013, the implementation proved successful, and close to completion. The majority of assessments at all of the 5 faculties and 5 campuses were digital, and students had handed in a total of 17.021 digital assessments.On the ba...

  10. Digital Leadership

    Zupancic, Tadeja; Verbeke, Johan; Achten, Henri


    Leadership is an important quality in organisations. Leadership is needed to introduce change and innovation. In our opinion, in architectural and design practices, the role of leadership has not yet been sufficiently studied, especially when it comes to the role of digital tools and media....... With this paper we intend to initiate a discussion in the eCAADe community to reflect and develop ideas in order to develop digital leadership skills amongst the membership. This paper introduces some important aspects, which may be valuable to look into when developing digital leadership skills....

  11. Digital Insights

    Knudsen, Gry Høngsmark

    and practices with digital media, when they meet and interpret advertising. Through studies of advertising response on YouTube and experiments with consumers’ response to digitally manipulated images, the dissertation shows how digital media practices facilitate polysemic and socially embedded advertising......, by incorporating media as both channel, frame, and apparatus for advertising response, the dissertation brings into attention that more aspects than the text-reader relationship influence ad response. Finally, the dissertation proposes the assemblage approach for exploring big data in consumer culture research...

  12. Rectal cancer survival in the Nordic countries and Scotland

    Folkesson, J.; Engholm, G.; Ehrnrooth, E.


    The aim of this study was to present detailed population-based survival estimates four patients with a rectal adenocarcinoma, using cancer register data supplemented with clinical data. Based oil cancer register data. differences in rectal cancer survival have been reported between countries ill ...... for high quality and detailed data in order to understand international survival differences, and cautions comparisons between large national samples and those of smaller areas. (C) 2009 UICC Udgivelsesdato: 2009/11/15...... included. Age standardized 5-year relative survival and multiplicative regression models for the relative excess mortality were calculated. 3888 patients were included in the survival study. Men in Denmark, Finland and Iceland hall lower 5-year relative survival and poorer stage distribution compared...

  13. The influence of hormone therapies on colon and rectal cancer

    Mørch, Lina Steinrud; Lidegaard, Øjvind; Keiding, Niels;


    followed 1995-2009. Information on HT exposures was from the National Prescription Register and updated daily, while information on colon (n = 8377) and rectal cancers (n = 4742) were from the National Cancer Registry. Potential confounders were obtained from other national registers. Poisson regression...... analyses with 5-year age bands included hormone exposures as time-dependent covariates. Use of estrogen-only therapy and combined therapy were associated with decreased risks of colon cancer (adjusted incidence rate ratio 0.77, 95 % confidence interval 0.68-0.86 and 0.88, 0.80-0.96) and rectal cancer (0......Exogenous sex hormones seem to play a role in colorectal carcinogenesis. Little is known about the influence of different types or durations of postmenopausal hormone therapy (HT) on colorectal cancer risk. A nationwide cohort of women 50-79 years old without previous cancer (n = 1,006,219) were...

  14. Management of stage Ⅳ rectal cancer:Palliative options

    Sean M Ronnekleiv-Kelly; Gregory D Kennedy


    Approximately 30% of patients with rectal cancer present with metastatic disease.Many of these patients have symptoms of bleeding or obstruction.Several treatment options are available to deal with the various complications that may afflict these patients.Endorectal stenting,laser ablation,and operative resection are a few of the options available to the patient with a malignant large bowel obstruction.A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity.In this review,we describe various options for palliation of symptoms in patients with metastatic rectal cancer.Additionally,we briefly discuss treatment for asymptomatic patients with metastatic disease.

  15. Treatment tactics in patient with rectal cancer complicating ulcerative colitis

    Yu. A. Barsukov


    Full Text Available A successful treatment of a young patient with a 15-year anamnesis of ulcerative colitis, who has been diagnosed with rectal cancer, is presented in this case report. A non-standard surgical intervention has been performed following all principles of oncologic surgery. A subtotal colectomy has been performed with ultra-low anterior resection of rectum. Ascendoanal anastomosis has been performed forming the neo-rectum. There were no complications in postoperative period. Considering disease stage (T3N1M0 adjuvant XELOX was administered for 6 months along with 2 cycles of prophylactic treatment with 5-aminosalycilic acid. During 2-years follow-up there are no signs of rectal cancer and ulcerative colitis progression. After pelvic electrostimulation defecation frequency decreased to 3–4 times per day, a patient has complete social rehabilitation.

  16. Personalized surgery for rectal tumours: the patient's opinion counts.

    Audisio, R A; Filiberti, A; Geraghty, J G; Andreoni, B


    In recent times there have been many important changes in the surgical management of rectal cancer. The general thrust of these changes has been towards a less invasive approach with preservation of intestinal continuity and avoidance of the psychological sequelae of a stoma. It is also becoming increasingly apparent that profound sexual and autonomic dysfunction can be associated with abdominoperineal resection. This paper highlights these issues and the conflict between performing an adequate oncological procedure and reducing the incidence of postoperative psychological morbidity. It outlines the great changes there have been in surgical technique and their relevance to psychological problems after surgery for rectal cancer. The need for auditing psychological morbidity when assessing the outcome of surgical series is emphasised, as is the importance of involving the patient in the medical decision making.

  17. SU-D-BRA-04: Fractal Dimension Analysis of Edge-Detected Rectal Cancer CTs for Outcome Prediction

    Zhong, H; Wang, J; Hu, W; Shen, L; Wan, J; Zhou, Z; Zhang, Z [Fudan University Shanghai Cancer Center, Shanghai (China)


    Purpose: To extract the fractal dimension features from edge-detected rectal cancer CTs, and to examine the predictability of fractal dimensions to outcomes of primary rectal cancer patients. Methods: Ninety-seven rectal cancer patients treated with neo-adjuvant chemoradiation were enrolled in this study. CT images were obtained before chemoradiotherapy. The primary lesions of the rectal cancer were delineated by experienced radiation oncologists. These images were extracted and filtered by six different Laplacian of Gaussian (LoG) filters with different filter values (0.5–3.0: from fine to coarse) to achieve primary lesions in different anatomical scales. Edges of the original images were found at zero-crossings of the filtered images. Three different fractal dimensions (box-counting dimension, Minkowski dimension, mass dimension) were calculated upon the image slice with the largest cross-section of the primary lesion. The significance of these fractal dimensions in survival, recurrence and metastasis were examined by Student’s t-test. Results: For a follow-up time of two years, 18 of 97 patients had experienced recurrence, 24 had metastasis, and 18 were dead. Minkowski dimensions under large filter values (2.0, 2.5, 3.0) were significantly larger (p=0.014, 0.006, 0.015) in patients with recurrence than those without. For metastasis, only box-counting dimensions under a single filter value (2.5) showed differences (p=0.016) between patients with and without. For overall survival, box-counting dimensions (filter values = 0.5, 1.0, 1.5), Minkowski dimensions (filter values = 0.5, 1.5, 2.0, 2,5) and mass dimensions (filter values = 1.5, 2.0) were all significant (p<0.05). Conclusion: It is feasible to extract shape information by edge detection and fractal dimensions analysis in neo-adjuvant rectal cancer patients. This information can be used to prognosis prediction.




    Introduction. Convulsion is a dangerous occurrence in pediatric disease that requires immediately intervention. It is one of the common causes of referring children to emergency room and must be controlled as soon as possible for prevention of systemic complications and the brain damages. We compared the effect of intravenous (IV) versus rectal diazepam in control of convulsion in c...

  19. Female urogenital dysfunction following total mesorectal excision for rectal cancer

    Raja Ashraf


    Full Text Available Abstract Background The effect of Total Mesorectal Excision (TME on sexual function in the male is well documented. However, there is little literature in female patients. The aim of this study was to review the pelvic autonomic nervous anatomy in the female and to perform a retrospective audit of urinary and sexual function in women following surgery for rectal cancer where TME had been performed. Urogenital dysfunction was assessed through interview and questionnaire. Method Twenty-three questionnaires, eighteen returned, were sent to women with a mean age 65.5 yrs (range 34–86. All had undergone total mesorectal excision for rectal cancer between 1998–2001. Mean follow-up was 18.8 months (range 3–35. Results Preoperatively 5/18 (28% were sexually active, 3/18 (17% of patients described urinary frequency and nocturia and 7/18 (39% described symptoms of stress incontinence prior to surgery. Postoperatively all sexually active patients remained active although all described some discomfort with penetration. Two of the patients sexually active described reduced libido secondary to the stoma. Postoperative urinary symptoms developed with 59% reporting the development of nocturia, 18% developed stress incontinence and one patient required a permanent catheter. Of those with symptoms, 80% persisted longer than three months from surgery. Symptoms were predominant in those patients with low rectal cancers, particularly those undergoing abdomino-perineal excision and in those who had previously undergone abdominal hysterectomy. Conclusion The treatment of rectal cancer involves surgery to the pelvic floor. Despite nerve preservation this is associated with the development of worsening nocturia and stress incontinence. This is most marked in those patients who had previously undergone a hysterectomy. Further studies are warranted to assess the interaction with previous gynaecological surgery.

  20. Robotic anterior resection of rectal cancer: technique and early outcome

    DU Xiao-hui; SHEN Di; LI Rong; LI Song-yan; NING Ning; ZHAO Yun-shan; ZOU Zhen-yu


    Background The Da Vinci system is a newly developed device for colorectal surgery.With advanced stereoscopic vision,lack of tremor,and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools.Since conventional laparoscopic total mesorectal excision is a challenging procedure,we have sought to assess the utility of the Da Vinci robotic system in anterior resections for rectal cancer.Methods Between November 2010 and December 2011,a total of 22 patients affected by rectal cancer were operated on with robotic technique,using the Da Vinci robot.Data regarding the outcome and pathology reports were prospectively collected in a dedicated database.Results There were no conversions to open surgery and no postoperative mortality of any patient.Mean operative time was (220±46) minutes (range,152-286 minutes).The median number of lymph nodes harvested was (14.6±6.5) (range,8-32),and the circumferential margin was negative in all cases.The distal margin was (2.6±1.2) cm (range,1.0-5.5 cm).The mean length of hospital stay was (7.8+2.6) days (range,7.0-13.0 days).Macroscopic grading of the specimen was complete in 19 cases and neady complete in three patients.Conclusions Robotic anterior resection for rectal surgery is safe and feasible in experienced hands.Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures.This technique may facilitate minimally invasive radical rectal surgery.

  1. The effect of hysterectomy on ano-rectal physiology.

    Kelly, J L


    Hysterectomy is associated with severe constipation in a subgroup of patients, and an adverse effect on colonic motility has been described in the literature. The onset of irritable bowel syndrome and urinary bladder dysfunction has also been reported after hysterectomy. In this prospective study, we investigated the effect of simple hysterectomy on ano-rectal physiology and bowel function. Thirty consecutive patients were assessed before and 16 weeks after operation. An abdominal hysterectomy was performed in 16 patients, and a vaginal procedure was performed in 14. The parameters measured included the mean resting, and maximal forced voluntary contraction anal pressures, the recto-anal inhibitory reflex, and rectal sensation to distension. In 8 patients, the terminal motor latency of the pudendal nerve was assessed bilaterally. Pre-operatively, 8 patients were constipated. This improved following hysterectomy in 4, worsened in 2, and was unchanged in 2. Symptomatology did not correlate with changes in manometry. Although, the mean resting pressure was reduced after hysterectomy (57 mmHg-53 mmHg, P = 0.0541), the maximal forced voluntary contraction pressure was significantly decreased (115 mmHg-105 mmHg, P = 0.029). This effect was more pronounced in those with five or more previous vaginal deliveries (P = 0.0244, n = 9). There was no significant change in the number of patients with an intact ano-rectal inhibitory reflex after hysterectomy. There was no change in rectal sensation to distension, and the right and left pudendal nerve terminal motor latencies were unaltered at follow-up. Our results demonstrate that hysterectomy causes a decrease in the maximal forced voluntary contraction and pressure, and this appears to be due to a large decrease in a small group of patients with previous multiple vaginal deliveries.

  2. The immunohistochemical demonstration of Helicobacter pylori in rectal ectopia.

    Corrigan, Mark Anthony


    The finding of heterotopic gastric mucosa in the rectum is rare, with less than 40 reported cases in the literature. A condition of unknown etiology, several hypotheses exist including infectious and congenital. We report a case of ectopic gastric tissue in the rectum of a 47-year-old female, and her subsequent clinical course. Furthermore for the first time, we present immunohistologic evidence of the presence of Helicobacter pylori in rectal ectopic gastric tissue.

  3. Transcriptomic Profiles Differentiate Normal Rectal Epithelium and Adenocarcinoma


    Adenocarcinoma is a histologic diagnosis based on subjective findings. Transcriptional profiles have been used to differentiate normal tissue from disease and could provide a means of identifying malignancy. The goal of this study was to generate and test transcriptomic profiles that differentiate normal from adenocarcinomatous rectum. Comparisons were made between cDNA microarrays derived from normal epithelium and rectal adenocarcinoma. Results were filtered according to standard deviation ...

  4. SEOM Clinical Guideline of localized rectal cancer (2016).

    González-Flores, E; Losa, F; Pericay, C; Polo, E; Roselló, S; Safont, M J; Vera, R; Aparicio, J; Cano, M T; Fernández-Martos, C


    Localized rectal adenocarcinoma is a heterogeneous disease and current treatment recommendations are based on a preoperative multidisciplinary evaluation. High-resolution magnetic resonance imaging and endoscopic ultrasound are complementary to do a locoregional accurate staging. Surgery remains the mainstay of treatment and preoperative therapies with chemoradiation (CRT) or short-course radiation (SCRT) must be considered in more locally advanced cases. Novel strategies with induction chemotherapy alone or preceding or after CRT (SCRT) and surgery are in development.

  5. Robotic Surgery for Rectal Cancer: An Update in 2015

    Kwak, Jung Myun; Kim, Seon Hahn


    During the last decade, robotic surgery for rectal cancer has rapidly gained acceptance among colorectal surgeons worldwide, with well-established safety and feasibility. The lower conversion rate and better surgical specimen quality of robotic compared with laparoscopic surgery potentially improves survival. Earlier recovery of voiding and sexual function after robotic total mesorectal excision is another favorable outcome. Long-term survival data are sparse with no evidence that robotic sur...

  6. Post hemorrhoidectomy pain control: rectal Diclofenac versus Acetaminophen

    Rahimi M


    Full Text Available "nBackground: Anal surgeries are prevalent, but they didn't perform as outpatient surgeries because of concerns about postoperative pain. The aim of the present study was to compare the effects of rectal acetaminophen and diclofenac on postoperative analgesia after anal surgeries in adult patients. "nMethods: In a randomized, double-blinded, placebo-controlled study 60 ASA class I or II scheduled for haemorrhoidectomy, anal fissure or fistula repair, were randomized (with block randomization method to receive either a single dose of 650 mg rectal acetaminophen (n=20, 100 mg rectal diclofenac (n=20 or placebo suppositories (n=20 after the operation. The severity of pain, time to first request of analgesic agent after administration of suppositories and complications were compared between three groups. Pain scores were evaluated in patients by Visual Analogue Scale (VAS in 0 (after complete consciousness in recovery, 2, 4, 12 and 24 hours after surgery. The period between administration of the suppositories and the patients' first request to receive analgesic was compared between groups. "nResults: Pain scores were lower significantly in rectal diclofenac than the other groups. The period between administration of the suppositories and the patients' first request to receive analgesic in diclofenac group was 219±73 minutes, was significantly longer compared with placebo (153±47 minutes and acetaminophen (178±64 minutes groups. No complications were reported. "nConclusions: Diclofenac suppository is more effective than acetaminophen suppository in post hemorrhoidectomy pain management.




    Full Text Available Introduction. Convulsion is a dangerous occurrence in pediatric disease that requires immediately intervention. It is one of the common causes of referring children to emergency room and must be controlled as soon as possible for prevention of systemic complications and the brain damages. We compared the effect of intravenous (IV versus rectal diazepam in control of convulsion in children.
    Methods. Study group included eighty patients with seizure (from 3 months to 12 years old. Forty patients received rectal diazepam and other ones received diazepam intravenously.
    Results. The convulsion was controlled with rectal diazepam in less than 5 minutes (N diazepam less than 2 minutes and this method was not difficult even for parents.
    Discussion. Control of convulsion less than one minute has no relation to the route of diazepam administration. The important factors for control of seizure are dose of diazepam and the prompt use of it after seizure.

  8. GLUT-1 expression and response to chemoradiotherapy in rectal cancer.

    Brophy, Sarah


    Preoperative chemoradiotherapy is used in locally advanced rectal cancer to reduce local recurrence and improve operability, however a proportion of tumors do not undergo significant regression. Identification of predictive markers of response to chemoradiotherapy would improve patient selection and may allow response modification by targeting of specific pathways. The aim of this study was to determine whether expression of glucose transporter-1 (GLUT-1) and p53 in pretreatment rectal cancer biopsies was predictive of tumor response to chemoradiotherapy. Immunohistochemical staining for GLUT-1 and p53 was performed on 69 pretreatment biopsies and compared to tumor response in the resected specimen as determined by the tumor regression grade (TRG) scoring system. GLUT-1 expression was significantly associated with reduced response to chemoradiotherapy and increasing GLUT expression correlated with poorer response (p=0.02). GLUT-1 negative tumors had a 70% probability of good response (TRG3\\/4) compared to a 31% probability of good response in GLUT-1 positive tumors. GLUT-1 may be a useful predictive marker of response to chemoradiotherapy in rectal cancer.

  9. Rectal swabs for analysis of the intestinal microbiota.

    Budding, Andries E; Grasman, Matthijs E; Eck, Anat; Bogaards, Johannes A; Vandenbroucke-Grauls, Christina M J E; van Bodegraven, Adriaan A; Savelkoul, Paul H M


    The composition of the gut microbiota is associated with various disease states, most notably inflammatory bowel disease, obesity and malnutrition. This underlines that analysis of intestinal microbiota is potentially an interesting target for clinical diagnostics. Currently, the most commonly used sample types are feces and mucosal biopsy specimens. Because sampling method, storage and processing of samples impact microbiota analysis, each sample type has its own limitations. An ideal sample type for use in routine diagnostics should be easy to obtain in a standardized fashion without perturbation of the microbiota. Rectal swabs may satisfy these criteria, but little is known about microbiota analysis on these sample types. In this study we investigated the characteristics and applicability of rectal swabs for gut microbiota profiling in a clinical routine setting in patients presenting with various gastro-intestinal disorders. We found that rectal swabs appeared to be a convenient means of sampling the human gut microbiota. Swabs can be performed on demand, whenever a patient presents; swab-derived microbiota profiles are reproducible, whether they are gathered at home by patients or by medical professionals in an outpatient setting and may be ideally suited for clinical diagnostics and large-scale studies.


    Fernando Bray BERALDO


    Full Text Available BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19% participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001. None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy, and duration of surgery.ConclusionThis study identified an incidence of 19% of moderate to severe urinary dysfuction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.

  11. Locally advanced rectal cancer: the importance of a multidisciplinary approach.

    Berardi, Rossana; Maccaroni, Elena; Onofri, Azzurra; Morgese, Francesca; Torniai, Mariangela; Tiberi, Michela; Ferrini, Consuelo; Cascinu, Stefano


    Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens.

  12. GLUT-1 expression and response to chemoradiotherapy in rectal cancer.

    Brophy, Sarah; Sheehan, Katherine M; McNamara, Deborah A; Deasy, Joseph; Bouchier-Hayes, David J; Kay, Elaine W


    Preoperative chemoradiotherapy is used in locally advanced rectal cancer to reduce local recurrence and improve operability, however a proportion of tumors do not undergo significant regression. Identification of predictive markers of response to chemoradiotherapy would improve patient selection and may allow response modification by targeting of specific pathways. The aim of this study was to determine whether expression of glucose transporter-1 (GLUT-1) and p53 in pretreatment rectal cancer biopsies was predictive of tumor response to chemoradiotherapy. Immunohistochemical staining for GLUT-1 and p53 was performed on 69 pretreatment biopsies and compared to tumor response in the resected specimen as determined by the tumor regression grade (TRG) scoring system. GLUT-1 expression was significantly associated with reduced response to chemoradiotherapy and increasing GLUT expression correlated with poorer response (p=0.02). GLUT-1 negative tumors had a 70% probability of good response (TRG3/4) compared to a 31% probability of good response in GLUT-1 positive tumors. GLUT-1 may be a useful predictive marker of response to chemoradiotherapy in rectal cancer.

  13. Critical appraisal of laparoscopic vs open rectal cancer surgery

    Winson Jianhong Tan; Min Hoe Chew; Angela Renayanti Dharmawan; Manraj Singh; Sanchalika Acharyya; Carol Tien Tau Loi; Choong Leong Tang


    AIM:To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection(LRR) and the impact of conversion in patients with rectal cancer.METHODS:An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection.Patients were compared in three groups:Open surgery(OP),laparoscopic surgery,and converted laparoscopic surgery.Short-term outcomes,long-term outcomes,and survival analysis were compared.RESULTS:Among 633 patients studied,200 patients had successful laparoscopic resections with a conversion rate of 11.1%(25 out of 225).Factors predictive of survival on univariate analysis include the laparoscopic approach(P = 0.016),together with factors such as age,ASA status,stage of disease,tumor grade,presence of perineural invasion and vascular emboli,circumferential resection margin < 2 mm,and postoperative adjuvant chemotherapy.The survival benefit of laparoscopic surgery was no longer significant on multivariateanalysis(P = 0.148).Neither 5-year overall survival(70.5% vs 61.8%,P = 0.217) nor 5-year cancer free survival(64.3% vs 66.6%,P = 0.854) were significantly different between the laparoscopic group and the converted group.CONCLUSION:LRR has equivalent long-term oncologic out c ome s w he n c ompare d t o OP.Laparos c opic conversion does not confer a worse prognosis.

  14. Rectal swabs for analysis of the intestinal microbiota.

    Andries E Budding

    Full Text Available The composition of the gut microbiota is associated with various disease states, most notably inflammatory bowel disease, obesity and malnutrition. This underlines that analysis of intestinal microbiota is potentially an interesting target for clinical diagnostics. Currently, the most commonly used sample types are feces and mucosal biopsy specimens. Because sampling method, storage and processing of samples impact microbiota analysis, each sample type has its own limitations. An ideal sample type for use in routine diagnostics should be easy to obtain in a standardized fashion without perturbation of the microbiota. Rectal swabs may satisfy these criteria, but little is known about microbiota analysis on these sample types. In this study we investigated the characteristics and applicability of rectal swabs for gut microbiota profiling in a clinical routine setting in patients presenting with various gastro-intestinal disorders. We found that rectal swabs appeared to be a convenient means of sampling the human gut microbiota. Swabs can be performed on demand, whenever a patient presents; swab-derived microbiota profiles are reproducible, whether they are gathered at home by patients or by medical professionals in an outpatient setting and may be ideally suited for clinical diagnostics and large-scale studies.

  15. Diclofenac rectal suppository: an effective modality for perineal pain.

    Naz, Shabnam; Memon, Naila Yousuf; Sattar, Asma; Baloch, Rafia


    To determine the frequency of perineal pain after childbirth after a single dose of diclofenac rectal suppository. This cross-sectional study was conducted at Shaikh Zayed Women Hospital, Larkana, Pakistan, from April to September 2014, and comprised patients who were admitted to the labour room for normal vaginal delivery. A single dose of rectal diclofenac suppository of 100mg was given to the patients delivered vaginally or by second-stage emergency Caesarean section. Post-partum pain was noted after 12 and 24 hours of the administration of analgesia. SPSS 16 was used for data analysis. Of the 169 subjects, 63(37.28%) were aged 20 years or less, 85(50.3%) between 21 and 30 years, and 21(12.43%) between 31 and 40 years. Frequency of perineal pain was predominantly mild in 95(56%) patients, moderate in 60(35.5%) and severe in 14(8.28%). The use of non-steroidal anti-inflammatory rectal suppositories was found to be a simple and highly effective modality of reducing the perineal pain.

  16. An isolated vaginal metastasis from rectal cancer

    Ai Sadatomo


    Conclusion: We should keep the vagina within the field of view of pelvic MRI, which is one of the preoperative diagnostic tools for colorectal cancer. If female patients show gynecological symptoms, gynecological examination should be recommended. Isolated vaginal metastases are an indication for surgical resection, and adjuvant chemotherapy is also recommended.

  17. Clinical application of multimodality imaging in radiotherapy treatment planning for rectal cancer.

    Wang, Yan Yang; Zhe, Hong


    Radiotherapy plays an important role in the treatment of rectal cancer. Three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are mainstay techniques of radiotherapy for rectal cancer. However, the success of these techniques is heavily reliant on accurate target delineation and treatment planning. Computed tomography simulation is a cornerstone of rectal cancer radiotherapy, but there are limitations, such as poor soft-tissue contrast between pelvic structures and partial volume effects. Magnetic resonance imaging and positron emission tomography (PET) can overcome these limitations and provide additional information for rectal cancer treatment planning. PET can also reduce the interobserver variation in the definition of rectal tumor volume. However, there is a long way to go before these image modalities are routinely used in the clinical setting. This review summarizes the most promising studies on clinical applications of multimodality imaging in target delineation and treatment planning for rectal cancer radiotherapy.

  18. Digital fabrication


    The Winter 2012 (vol. 14 no. 3) issue of the Nexus Network Journal features seven original papers dedicated to the theme “Digital Fabrication”. Digital fabrication is changing architecture in fundamental ways in every phase, from concept to artifact. Projects growing out of research in digital fabrication are dependent on software that is entirely surface-oriented in its underlying mathematics. Decisions made during design, prototyping, fabrication and assembly rely on codes, scripts, parameters, operating systems and software, creating the need for teams with multidisciplinary expertise and different skills, from IT to architecture, design, material engineering, and mathematics, among others The papers grew out of a Lisbon symposium hosted by the ISCTE-Instituto Universitario de Lisboa entitled “Digital Fabrication – A State of the Art”. The issue is completed with four other research papers which address different mathematical instruments applied to architecture, including geometric tracing system...

  19. Digital Humanities

    Brügger, Niels


    the humanities for decades, starting with research fields such as humanities computing or computational linguistics in the 1950s, and later new media studies and internet studies. The historical development of digital humanities has been characterized by a focus on three successive, but co-existing types......Digital humanities is an umbrella term for theories, methodologies, and practices related to humanities scholarship that use the digital computer as an integrated and essential part of its research and teaching activities. The computer can be used for establishing, finding, collecting......, and preserving material to study, as an object of study in its own right, as an analytical tool, or for collaborating, and for disseminating results. The term "digital humanities" was coined around 2001, and gained currency within academia in the following years. However, computers had been used within...

  20. Digital Snaps

    Sandbye, Mette; Larsen, Jonas

    The New Face of Snapshot Photography / Jonas Larsen and Mette Sandbye -- pt. I. IMAGES ON WEB 2.0 AND THE CAMERA PHONE -- ch. 1. Overlooking, Rarely Looking and Not Looking / Martin Lister -- ch. 2. The (Im)mobile Life of Digital Photographs: The Case of Tourist Photography / Jonas Larsen -- ch. 3....... Distance as the New Punctum / Mikko Villi -- pt. II. FAMILY ALBUMS IN TRANSITION -- ch. 4. How Digital Technologies Do Family Snaps, Only Better / Gillian Rose -- ch. 5. Friendship Photography: Memory, Mobility and Social Networking / Joanne Garde-Hansen -- ch. 6. Play, Process and Materiality in Japanese...... Purikura Photography / Mette Sandbye -- ch. 7. 'Buying an Instrument Does Not Necessarily Make You a Musician': Studio Photography and the Digital Revolution / Sigrid Lien -- pt. III. NEW PUBLIC FORMS -- ch. 8 Paparazzi Photography, Seriality and the Digital Photo Archive / Anne Jerslev and Mette Mortensen...

  1. Digital infrared thermography of the scrotum, semen quality, serum testosterone levels in Nellore bulls (Bos taurus indicus and their correlation with climatic factors

    Felipe Rydygier de Ruediger


    Full Text Available The objective was to study the relationship of climatic conditions with the temperature of the scrotum surface and sperm quality through digital infrared thermography in Nellore bulls, raised extensively. In six bulls held with scrotal thermography Flir E40® cameras, blood samples for serum testosterone and semen collection were taken by electroejaculation every 10 days, with six replications. Climatic factors: ambient temperature, relative humidity, dry globe temperature and temperature of the wet globe were recorded using a globe thermometer (InstruTemp®, ITWTG-2000. Thermal images of the scrotum were analyzed with the Flir Tools® software for the temperatures of scrotal surface, the right and left sides of the scrotum lap thirds: dorsal, middle and ventral testicles; and tails of the epididymis. The semen data and thermograms were submitted to ANOVA and Tukey’s test at 5%. Pearson correlation was used for the surface temperatures of the scrotum, rectal temperature, quantitative and qualitative characteristics of semen and climatic factors. There was a positive correlation (P<0.05 for sperm motility x scrotal temperatures; sperm concentration x scrotal temperatures; climatic factors x rectal temperature. There was a negative correlation (P<0.05 between ambient temperature x sperm concentration. It was concluded that the temperature of the scrotum surface and climatic factors, temperature and humidity, influence the quality of semen. Thermography is recommended as a supplementary examination for reproductive evaluation of bulls.

  2. Digital Steganography

    KOCIÁNOVÁ, Helena


    Digital steganography is a technique for hiding data mostly into multimedia files (images, audio, video). With the development of information technology this technique has found its use in the field of copyright protection and secret data transfer, could be even applied in places where is limited possibility of using cryptography (e. g. by law). This thesis gives insight into digital steganography and contains an application using this technique.

  3. Digital watermark

    Jasna Maver


    The huge amount of multimedia contents available on the World-Wide-Web is beginning to raise the question of their protection. Digital watermarking is a technique which can serve various purposes, including intellectual property protection, authentication and integrity verification, as well as visible or invisible content labelling of multimedia content. Due to the diversity of digital watermarking applicability, there are many different techniques, which can be categorised according to diffe...

  4. Digital Library Education: Global Trends and Issues

    Shem, Magaji


    The paper examines trends and issues in digital education programmes globally, drawing examples of developmental growth of Library Information Science (LIS), schools and digital education courses in North America, Britain, and Southern Asia, the slow growth of LIS schools and digital education in Nigeria and some countries in Africa and India. The…

  5. A new instrument for rectal suction biopsy in the diagnosis of Hirschsprung′s disease: Triple rectal suction biopsy

    Barlas Meral


    Full Text Available A new instrument for suction rectal biopsy in infants suspected of having Hirschsprung′s disease is described that can be completely dismantled, physically cleaned, lubricated, and heat sterilised. Triple rectal suction biopsy instrument with the patent application, which involves (0.5 cm diameter suction of mucosa and sub-mucosa and provides taking three different biopsies within a 2 cm distant from each other with a single shot, instead of only one or taking a full layer biopsy under general anesthesia for the diagnosis of Hirschsprung disease. As a preliminary study, in the 36 and 12 biopsy materials taken from the rabbits and children, respectively, it was found that mucosa and sub-mucosa were sufficient and in all of the cross sections, parasympathetic nerve fibers, and ganglion cells were existed. A successful biopsy was usually achieved and no complications occurred.

  6. Health-Related Quality of Life after surgery for primary advanced rectal cancer and recurrent rectal cancer

    Thaysen, Henriette Vind; Jess, Per; Laurberg, Søren


    Aim: A review of the literature was undertaken to provide an overview of Health-related quality of life (HRQoL) after surgery for primary advanced or recurrent rectal cancer and to outline proposals for future HRQoL studies in this area. Method: A systematic literature search was undertaken. Only...... studies concerning surgery for primary advanced or recurrent rectal cancer and describing methods used for measuring HRQoL were considered. Results Seven studies were identified including two prospective longitudinal, three cross-sectional and two based on qualitative data. Global quality of life...... cancer. Larger prospective longitudinal studies are needed to improve information on the effects of this extensive surgery on quality of life....

  7. Quantification of organ motion during chemoradiotherapy of rectal cancer using cone-beam computed tomography.

    Chong, Irene


    There has been no previously published data related to the quantification of rectal motion using cone-beam computed tomography (CBCT) during standard conformal long-course chemoradiotherapy. The purpose of the present study was to quantify the interfractional changes in rectal movement and dimensions and rectal and bladder volume using CBCT and to quantify the bony anatomy displacements to calculate the margins required to account for systematic (Σ) and random (σ) setup errors.

  8. Solitary rectal ulcer syndrome presenting as polypoid mass lesions in a young girl

    Saadah, Omar I; Al-Hubayshi, Maram S; Ghanem, Ahmad T


    Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding, intermittent mucosal prolapse, and passage of mucus per rectum. Colonoscopy revealed multiple polypoid mass lesions with histopathological features of SRUS. The polypoid variant of SRUS is very rare in children and may be confused with rectal malignant or inflammatory conditions.

  9. Digital audiovisual archives

    Stockinger, Peter


    Today, huge quantities of digital audiovisual resources are already available - everywhere and at any time - through Web portals, online archives and libraries, and video blogs. One central question with respect to this huge amount of audiovisual data is how they can be used in specific (social, pedagogical, etc.) contexts and what are their potential interest for target groups (communities, professionals, students, researchers, etc.).This book examines the question of the (creative) exploitation of digital audiovisual archives from a theoretical, methodological, technical and practical

  10. Correlation of chromosomal instability, telomere length and telomere maintenance in microsatellite stable rectal cancer: a molecular subclass of rectal cancer.

    Lisa A Boardman

    Full Text Available INTRODUCTION: Colorectal cancer (CRC tumor DNA is characterized by chromosomal damage termed chromosomal instability (CIN and excessively shortened telomeres. Up to 80% of CRC is microsatellite stable (MSS and is historically considered to be chromosomally unstable (CIN+. However, tumor phenotyping depicts some MSS CRC with little or no genetic changes, thus being chromosomally stable (CIN-. MSS CIN- tumors have not been assessed for telomere attrition. EXPERIMENTAL DESIGN: MSS rectal cancers from patients ≤50 years old with Stage II (B2 or higher or Stage III disease were assessed for CIN, telomere length and telomere maintenance mechanism (telomerase activation [TA]; alternative lengthening of telomeres [ALT]. Relative telomere length was measured by qPCR in somatic epithelial and cancer DNA. TA was measured with the TRAPeze assay, and tumors were evaluated for the presence of C-circles indicative of ALT. p53 mutation status was assessed in all available samples. DNA copy number changes were evaluated with Spectral Genomics aCGH. RESULTS: Tumors were classified as chromosomally stable (CIN- and chromosomally instable (CIN+ by degree of DNA copy number changes. CIN- tumors (35%; n=6 had fewer copy number changes (<17% of their clones with DNA copy number changes than CIN+ tumors (65%; n=13 which had high levels of copy number changes in 20% to 49% of clones. Telomere lengths were longer in CIN- compared to CIN+ tumors (p=0.0066 and in those in which telomerase was not activated (p=0.004. Tumors exhibiting activation of telomerase had shorter tumor telomeres (p=0.0040; and tended to be CIN+ (p=0.0949. CONCLUSIONS: MSS rectal cancer appears to represent a heterogeneous group of tumors that may be categorized both on the basis of CIN status and telomere maintenance mechanism. MSS CIN- rectal cancers appear to have longer telomeres than those of MSS CIN+ rectal cancers and to utilize ALT rather than activation of telomerase.

  11. Massive rectal bleeding from acquired jejunal diverticula


    Abstract Small bowel diverticulosis is an uncommon and often asymptomatic condition that is sporadically observed during radiographic examination or laparotomy. Although it is frequently seen in duodenum, jejunal and ileal locations are very rare. The majority of patients with jejunal diverticula have no symptoms. However, they can present with a number of acute and emergent complications with a high rate of mortality. Bleeding from jejunal diverticula occurs in less than 3% - 8% of patients ...

  12. [Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results].

    Carditello, Antonio; Milone, Antonino; Stilo, Francesco; Mollo, Francesco; Basile, Maurizio


    In recent years the number of patients with partial or total rectal prolapse has increased. Numerous techniques and surgical approaches have been described for its treatment. In this study we examine the main ones and stress the advantages of the transanal-perineal resection technique according to Altemeier and modified by Prasad, which we have used to treat the condition in the last 15 years. From 1988 to 2002, 269 patients with "haemorrhoidal prolapse" were referred to our department; 146 were females (54%), and the mean age was 58 years. Clinical examination and proctosigmoidoscopy revealed the presence of total rectal prolapse in 41 patients (15%, 32 F, 9 M), complicated in 4 cases by moderate incontinence and associated in 3 cases with post-haemorrhoidectomy stenosis. These 41 patients underwent transanal resection according to Altemeier. Thirty-four of them (83%) were operated on under local anaesthesia with sedation, 5 patients (12%) under peridural anaesthesia and 2 patients (5%) under narcosis. The mean hospital stay was 5 days and depended on the time of the first spontaneous evacuation. Check-ups were performed after 7 days, 1 months and every 3 months for 1 year. There was no postoperative mortality, and only 1 case of postoperative haemorrhage, which did not require reoperation, in a patient with a previous myocardial infarct who spontaneously continued to take salicylates up to 24 h before surgery. Thirty-three patients (80%) had their first postoperative evacuation within 48 h of surgery after taking sorbitol orally in the evening, 6 patients (15%) within 72 h, and 2 patients (5%) on postoperative day 4. No evacuative enemas were performed. We observed clinical healing in all patients 1 month after the operation, and regular, spontaneous evacuations without the use of oral laxatives. Stool or gas incontinence were never observed or reported. During the follow-up, only in 2% of cases did we observe partial recurrence of the prolapse. The choice

  13. Management of the Life Cycle of Digital Library Materials

    Marilyn Deegan


    Full Text Available This paper does not deal in any detail with digital preservation, rather it examines the development of digital content and digital libraries in the broader content of digital developments and library developments. Implicit throughout this is the need to create or acquire digital content for long-term access, which means that preservation needs must be foregrounded at all stages of the digital lifecycle.

  14. Clinical and therapeutic considerations of rectal lymphoma: A case report and literature review

    Yilmaz Bilsel; Emre Balik; Sumer Yamaner; Dursun Bugra


    Primary rectal lymphoma is a rare presentation of gastrointestinal lymphomas. Its clinical presentation is indistinguishable from that of rectal carcinoma. Although surgical resection is often technically feasible, optimal therapy for colorectal lymphoma has not yet been identified.We report a case of primary rectal lymphoma (nonHodgkin's large cell lymphoma of type B) with high-grade features that disappeared completely after chemoradiotherapy. This case underlines that primary treatment with systemic chemotherapy and involved-field radiotherapy can be successful for rectal lymphoma, with surgery reserved for complications and chemotherapy failures.

  15. Complex rectal polyps: other treatment modalities required when offering a transanal endoscopic microsurgery service.

    Joyce, Myles R


    Complex rectal polyps may present a clinical challenge. The study aim was to assess different treatment modalities required in the management of patients referred for transanal endoscopic microsurgery.

  16. Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding — A case report

    Sanne Jensen Dich


    Conclusion: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities.

  17. Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study

    Frederiksen, B L; Osler, M; Harling, Henrik


    among colon cancer patients. The social gradient found in rectal cancer patients was significantly different from the lack of association found among colon cancer patients. There are socioeconomic inequalities in the risk of being diagnosed with distant metastasis of a rectal, but not a colonic, cancer....... A reduction in the risk of being diagnosed with distant metastasis was seen in elderly rectal cancer patients with high income, living in owner-occupied housing and living with a partner. Among younger rectal cancer patients, a reduced risk was seen in those having long education. No social gradient was found...

  18. An Unusual Case of Appendiceal Adenocarcinoma Presenting with Rectal Bleeding and Haematuria

    John A. Murphy


    Full Text Available Adenocarcinoma of the appendix is rare, usually being diagnosed intraoperatively when performing appendicectomy or at subsequent histological examination. Here we report a case with acute abdominal pain, rectal bleeding with haematuria being the presenting symptoms. Subsequent computerised tomography demonstrated a complex mass involving the ileum, right colon, sigmoid colon and bladder with inflammatory bowel disease being the most likely cause. At laparotomy a right hemicolectomy, sigmoid colectomy and partial cystectomy was performed with pathological specimens confirming an appendiceal adenocarcinoma as the primary source of the abdominal mass fistulating into adjacent structures. We conclude that although appendiceal tumours are rare – usually diagnosed at appendicectomy, they should be considered in the diagnosis of complex abdominal masses involving small bowel, large bowel and adjacent pelvic structures.

  19. Estimating underreported N2 disease in rectal cancer patients with low lymph node counts.

    Huebner, Marianne; Therneau, Terry; Larson, David


    The variability in the number of lymph nodes examined needs to be taken into account for adequate staging. The definition of nodal staging was refined by quantifying the likelihood of N2 disease when the patient had fewer than four positive LN. In a retrospective study a total of 548 patients with node positive rectal cancer and curative surgery between 1990 and 2006 were identified. The misclassification of pN staging was estimated with a Bayesian computation. The prognostic value of the calculated probability, lymph node ratio (LNR), and nodal stage was assessed with Cox proportional hazard regression. A probability of understaging of 40% or more indicated worse prognosis of cancer-specific survival (CSS) with hazard ratio 2.6 (95%CI: 1.8-3.9, P clinical decision making. Copyright © 2011 Wiley Periodicals, Inc.


    S. Das


    Full Text Available Two hundred seventy two rectal swabs were examined from diarrhoeic and nondiarrhoeic pet dogs and cats. Out of 240 samples from dogs, 131 (54.58% and out of 32 samples from cats, 15 (46.87% were positive for E. coli by cultural characteristic, gram staining, motility,biochemical reactions and sugar fermentation tests. Out of 146 total positive isolates, only 12 isolates were pathogenic. Out of 12 pathogenic isolates of E. coli 6 isolates were O group non- typable and rest 6 E. coli strains were O25, O86a, O44 and O1 from dogs and O36 and O8 from cats. Out of 12 isolates 9 were sensitive to ceftriaxone, 8 were sensitive to ciprofloxacin and gentamicin, 4 were sensitive to amikacin, neomycin and norfloxacin, 2 were to Co-trimoxazole and 1 was sensitive to lomefloxacin. None of the isolate was sensitive to amoxyclav & cephotaxime.