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Laterally spreading tumors of the colon and rectum. What is their real importance?
GASTROENTEROLOGY Vol. 118, No.4
A1526 SSAT ABSTRACTS
6890
6893
MAGNIFICATION OF IMAGES IN VIDEOCOLONOSCOPY. ANALYSIS OF THE DEGREE OF ATYPIA BY AGE BAND OF NEOPLASIC LESIONS OF THE COLON AND RECTUM. Artur Adolfo Parada, Hj Perez, Ceo Santos, Pb Poletti, Ms Horruna, Tf Sechi, S. Dagostim, Ys Tung, F. Sesti, Mgp Cortes, L. Ziviani, Hosp 9 de Julho, Sao Paulo, Brazil.
HIGH PLASMA LEVELS OF ARGININE AND LIVER ARGINASE IN KUPFFER·CELL·DEPLETED RATS AFTER PARTIAL HEPA· TECTOMY. Hubert A. Prins, Catharina Meijer, Paul Am Leeuwen, Free Univ Hosp, Amsterdam, Netherlands.
OBJECTIVE: To analyze the degree of atypia by age range of the neoplasias of the colon and rectum via magnified image. MATERIAL AND METHODS: In the period of June 1998 to June 1999,535 neoplasic lesions of the colon and rectum were diagnosed with the aid of image magnification (Fujinon EC- 410 CM) and chromoscopy (indigo carmin at 0,4%). We grouped the lesions by age band and analyzed them by degree of histopathological atypia. The subjects were 48,9% female and 51,1% male. RESULTS: Of the 535 lesions, 154 (28,7%) were hyperplastic and 381 (71,2%) neoplasic. Of the latter, 319 (59,6%) were adenomas, 37 (6,9%) serrated adenomas, and 25 (4,7%) were adenocarcinomas. CONCLUSION: Starting age 40, we did not observe any increase in the degree of atypia when the age range increased.
6891 LATERALLY SPREADING TUMORS OF THE COLON AND REC· TUM. WHAT IS THEIR REAL IMPORTANCE? Artur Adolfo Parada, Ceo Santos, Hj Perez, Pb Poletti, Ms Homma, Tf Secchi, S. Dagostim, Ys Tung, F. Sesti, Mgp Cortes, L. Ziviani, Hosp 9 de Julho, Sao Paulo, Brazil. OBJECTIVE: Lesions macroscopically classified as LST exhibit a behavior that is distinct from other elevated, superficial, or depressed lesions of the colon and rectum. The objective of this research is to study these lesions and gain an understanding of their origin and development. MATERIAL AND METHODS: In the period of June 1991 to June 1999, we diagnosed the presence of LST lesions in 57 patients with a total of 62 lesions, found mostly in female patients (67,7%). The ages ranged from 33 to 81, averaging 60,9 years. The lesions were most frequently located in the ascendant colon (32,3%), cecum (24,7%), and rectum (21,0%). Histological study demonstrated that 46,77% of these lesions were adenomas, 41,16% adenocarcinomas, generally restricted to mucosal and 8,09% were hyperplastic lesions. CONCLUSION: Lesions whose macroscopic appearance is compatible with LST occur more frequently in female patients (67,7%) and in the right colon (57%). 91,93% of these neoplasic with a high incidence of adenocarcinomas (45,16%). However these remain restricted to the for long periods of time and susceptible to endoscopic resection mucosa in more than 90% of cases.
6892 ANORECTAL PULL·THROUGH AND VECTOR VOLUME MA· NOMETRY· COMPARISON OF STATION AND CONTINUOUS PULL·THROUGH TECHNIQUE. Alexander P. Pietsch, Robert Obermaier, Frank Makowiec, Ulrich T. Hopt, Univ of Rostock, Dept of Surg, Rostock, Germany. Background:Despite of discussions about intra- and interindividual reproducibility, anorectal manometry has gained wide acceptance as diagnostic standard to assess objectively the anorectal sphincter system. However, a general accepted and optimal method for anorectal manometry does not exist. Methods:Following a standardized protocol, using the continuous and station pull-through technique with 8-channel water perfused catheters (radially arranged open side holes), the anorectal manometry was performed in 94 patients (53,8 :!: 17,6 y., 48 females; rectal neoplasm: n=50, ileal pouch anal anastomosis: n= 13, perianal fistula: n=8, hemorrhoids: n=5, fecal incontinence: n=4; others: n= 14). Measured parameters were: mean resting pressure (MRP), mean squeeze pressure (MSP) in the high pressure zone, maximum resting pressure (MaxRP) and maximum squeeze pressure (MaxSP), sphincter length (SL), the resulting resting (RVV) and squeeze vector volumes (SVV) of the anal sphincter. Results:Mean and maximum resting pressure and resulting vector volumes obtained by station pull-through technique (MRP 43,8 :!: 16,2 rrunHg, MaxRP 65,5 :!: 21,7 mmHg; station RVV 21,1 :!: 16,6 cm3*rrunHg) were significantly (p
Introduction: The remnant liver after partial hepatectomy releases arginase into the plasma, which is a reliable indicator of hepatocellular damage. The liver has by far the highest arginase content of the body, converting arginine into ornithine and urea in the final step of the urea cycle. Little information is available on how the release of arginase after partial hepatectomy affects arginine plasma levels. We hypothesized that Kupffer-cells after partial hepatectomy may prevent further hepatocellular damage, contributing to lower arginase release. The aim of the study was to evaluate the role of Kupffer cells in plasma arginase activity and arginine plasma levels after partial hepatectomy. Material & Methods: WagIRij rats (n=72, 250-275g) were randomly assigned to have I ml liposome-encapsulated dichlorornethylene diphosphonate in order to eliminate Kupffer cells (DMDP,n=24), I ml encapsulated-phosphate buffer (PBS,n=24) or I ml NaCl 0.9% (NaCI,n=24) intravenously. Forty-eight hours later, all rats had a two-third liver resection. Rats were killed at 0, 24, 48 and 96 hours after partial hepatectomy. Results: Arginase plasma activity was higher in the DMDP-treated group compared to the controls NaCI and PBS (both p< 0.01, p< 0.05, p< 0.01 and p< 0.01 for 0,24,48 and 96 hours after partial hepatectomy). The release of the hepatocellular enzyme arginase mimicked quite well the transaminases ASAT and ALAT. Arginine plasma levels increased, but were lower in the DMDP treated group compared to NaCI and PBS (both p< 0.05, 24 hours after partial hepatectomy). Conclusion: The study showed that Kupffer-cell depletion results in a higher release of arginase from the remnant liver, indicating a hepatocellular protective function of Kupffer cells. Despite this arginase release, arginine plasma levels were increased after partial hepatectomy. The increase of arginine plasma levels could be explained by the reduction a two-third hepatectomy consequently have on the total arginase content, despite the higher plasma arginase activity, released from the remnant liver after partial hepatectomy.
6894 THE SPECTRUM OF PATHOLOGIC FINDINGS IN RESECTIONS FOR COMPLICATED PANCREATITIS: CAN HISTOLOGY HELP PREDICT PERSISTENT PAIN? Dm Proca, Dl Hibbert, Be Ellison, Wj Schirmer, Ws Melvin, WI Frankel. Background & Aims: Indications for major pancreatic resections (MPR) have been expanded to include complicated pancreatitis (CP). We evaluated pathologic and clinical findings in patients who had MPR for CP, assessed outcome, and determined if disease etiology, operative procedure, and/or histologic findings were associated with recurrent post-operative pain. Methods: Patient charts and slides were reviewed from 44 patients who underwent MPR for CP, including 18 Whipple procedures, 4 Beger resections, 21 distal/subtotal pancreatectomies, and I total pancreatectomy, performed between 1989-1999. H&E slides were reviewed by 2 pathologists and were scored (normal) to 3 (severe) for chronic inflammation, perineural inflammation, and fibrosis. Ductal metaplasia and atypia were noted. Results: The etiology for disease included 14-alcohol, 5-hereditary, 3-idiopathic, 3-pancreas divisum, I-stricture, 2-trauma, I-SLE, and 15unknown. Ages ranged from 22-76 years, with 20 men and 24 women. Perioperative mortality and morbidity were 0% and 7%, respectively. Metaplastic changes were present in 14 cases, ductal atypia was seen in 9, but no malignancies were found. Persistent pain was present in 25 of the 44 patients. Conclusions: MPR for CP can be performed with very low perioperative mortality and morbidity and an acceptable success rate (19/44 pain-free). Patients who underwent Whipple or Beger procedures and those with alcoholic pancreatitis were most likely to have persistent pain. Chronic inflammation, perineural inflammation, and fibrosis did not significantly differ between patients with and without pain suggesting that these histologic findings cannot help predict pain.
°
Comparison of Disease Etiology. Operative Procedure, and Histologic Scores in Patients with and without Persistent Pain
Etiology Alcohol
Pain NoPain
71% (10/14) 29% (4/14)
Other
50% (15/30) 50% (15/30)
Procedure Whipple / Sub/otal/ Beger Distal
65% (15/23) 35% (8/23)
45% (9/20) 55% (10/20)
Histology (mean ± stdev) Perineura I Fibrosis
Chronic lnflam
Int/am
1.1±0.5
0.6±0.9
1.8±0.9
1.2±0.4
08±1.0
2.2±0.8
Values forEtiology andProcedure represent % ofpatients wffh or wfthout pain.
A1526 SSAT ABSTRACTS
6890
6893
MAGNIFICATION OF IMAGES IN VIDEOCOLONOSCOPY. ANALYSIS OF THE DEGREE OF ATYPIA BY AGE BAND OF NEOPLASIC LESIONS OF THE COLON AND RECTUM. Artur Adolfo Parada, Hj Perez, Ceo Santos, Pb Poletti, Ms Horruna, Tf Sechi, S. Dagostim, Ys Tung, F. Sesti, Mgp Cortes, L. Ziviani, Hosp 9 de Julho, Sao Paulo, Brazil.
HIGH PLASMA LEVELS OF ARGININE AND LIVER ARGINASE IN KUPFFER·CELL·DEPLETED RATS AFTER PARTIAL HEPA· TECTOMY. Hubert A. Prins, Catharina Meijer, Paul Am Leeuwen, Free Univ Hosp, Amsterdam, Netherlands.
OBJECTIVE: To analyze the degree of atypia by age range of the neoplasias of the colon and rectum via magnified image. MATERIAL AND METHODS: In the period of June 1998 to June 1999,535 neoplasic lesions of the colon and rectum were diagnosed with the aid of image magnification (Fujinon EC- 410 CM) and chromoscopy (indigo carmin at 0,4%). We grouped the lesions by age band and analyzed them by degree of histopathological atypia. The subjects were 48,9% female and 51,1% male. RESULTS: Of the 535 lesions, 154 (28,7%) were hyperplastic and 381 (71,2%) neoplasic. Of the latter, 319 (59,6%) were adenomas, 37 (6,9%) serrated adenomas, and 25 (4,7%) were adenocarcinomas. CONCLUSION: Starting age 40, we did not observe any increase in the degree of atypia when the age range increased.
6891 LATERALLY SPREADING TUMORS OF THE COLON AND REC· TUM. WHAT IS THEIR REAL IMPORTANCE? Artur Adolfo Parada, Ceo Santos, Hj Perez, Pb Poletti, Ms Homma, Tf Secchi, S. Dagostim, Ys Tung, F. Sesti, Mgp Cortes, L. Ziviani, Hosp 9 de Julho, Sao Paulo, Brazil. OBJECTIVE: Lesions macroscopically classified as LST exhibit a behavior that is distinct from other elevated, superficial, or depressed lesions of the colon and rectum. The objective of this research is to study these lesions and gain an understanding of their origin and development. MATERIAL AND METHODS: In the period of June 1991 to June 1999, we diagnosed the presence of LST lesions in 57 patients with a total of 62 lesions, found mostly in female patients (67,7%). The ages ranged from 33 to 81, averaging 60,9 years. The lesions were most frequently located in the ascendant colon (32,3%), cecum (24,7%), and rectum (21,0%). Histological study demonstrated that 46,77% of these lesions were adenomas, 41,16% adenocarcinomas, generally restricted to mucosal and 8,09% were hyperplastic lesions. CONCLUSION: Lesions whose macroscopic appearance is compatible with LST occur more frequently in female patients (67,7%) and in the right colon (57%). 91,93% of these neoplasic with a high incidence of adenocarcinomas (45,16%). However these remain restricted to the for long periods of time and susceptible to endoscopic resection mucosa in more than 90% of cases.
6892 ANORECTAL PULL·THROUGH AND VECTOR VOLUME MA· NOMETRY· COMPARISON OF STATION AND CONTINUOUS PULL·THROUGH TECHNIQUE. Alexander P. Pietsch, Robert Obermaier, Frank Makowiec, Ulrich T. Hopt, Univ of Rostock, Dept of Surg, Rostock, Germany. Background:Despite of discussions about intra- and interindividual reproducibility, anorectal manometry has gained wide acceptance as diagnostic standard to assess objectively the anorectal sphincter system. However, a general accepted and optimal method for anorectal manometry does not exist. Methods:Following a standardized protocol, using the continuous and station pull-through technique with 8-channel water perfused catheters (radially arranged open side holes), the anorectal manometry was performed in 94 patients (53,8 :!: 17,6 y., 48 females; rectal neoplasm: n=50, ileal pouch anal anastomosis: n= 13, perianal fistula: n=8, hemorrhoids: n=5, fecal incontinence: n=4; others: n= 14). Measured parameters were: mean resting pressure (MRP), mean squeeze pressure (MSP) in the high pressure zone, maximum resting pressure (MaxRP) and maximum squeeze pressure (MaxSP), sphincter length (SL), the resulting resting (RVV) and squeeze vector volumes (SVV) of the anal sphincter. Results:Mean and maximum resting pressure and resulting vector volumes obtained by station pull-through technique (MRP 43,8 :!: 16,2 rrunHg, MaxRP 65,5 :!: 21,7 mmHg; station RVV 21,1 :!: 16,6 cm3*rrunHg) were significantly (p
Introduction: The remnant liver after partial hepatectomy releases arginase into the plasma, which is a reliable indicator of hepatocellular damage. The liver has by far the highest arginase content of the body, converting arginine into ornithine and urea in the final step of the urea cycle. Little information is available on how the release of arginase after partial hepatectomy affects arginine plasma levels. We hypothesized that Kupffer-cells after partial hepatectomy may prevent further hepatocellular damage, contributing to lower arginase release. The aim of the study was to evaluate the role of Kupffer cells in plasma arginase activity and arginine plasma levels after partial hepatectomy. Material & Methods: WagIRij rats (n=72, 250-275g) were randomly assigned to have I ml liposome-encapsulated dichlorornethylene diphosphonate in order to eliminate Kupffer cells (DMDP,n=24), I ml encapsulated-phosphate buffer (PBS,n=24) or I ml NaCl 0.9% (NaCI,n=24) intravenously. Forty-eight hours later, all rats had a two-third liver resection. Rats were killed at 0, 24, 48 and 96 hours after partial hepatectomy. Results: Arginase plasma activity was higher in the DMDP-treated group compared to the controls NaCI and PBS (both p< 0.01, p< 0.05, p< 0.01 and p< 0.01 for 0,24,48 and 96 hours after partial hepatectomy). The release of the hepatocellular enzyme arginase mimicked quite well the transaminases ASAT and ALAT. Arginine plasma levels increased, but were lower in the DMDP treated group compared to NaCI and PBS (both p< 0.05, 24 hours after partial hepatectomy). Conclusion: The study showed that Kupffer-cell depletion results in a higher release of arginase from the remnant liver, indicating a hepatocellular protective function of Kupffer cells. Despite this arginase release, arginine plasma levels were increased after partial hepatectomy. The increase of arginine plasma levels could be explained by the reduction a two-third hepatectomy consequently have on the total arginase content, despite the higher plasma arginase activity, released from the remnant liver after partial hepatectomy.
6894 THE SPECTRUM OF PATHOLOGIC FINDINGS IN RESECTIONS FOR COMPLICATED PANCREATITIS: CAN HISTOLOGY HELP PREDICT PERSISTENT PAIN? Dm Proca, Dl Hibbert, Be Ellison, Wj Schirmer, Ws Melvin, WI Frankel. Background & Aims: Indications for major pancreatic resections (MPR) have been expanded to include complicated pancreatitis (CP). We evaluated pathologic and clinical findings in patients who had MPR for CP, assessed outcome, and determined if disease etiology, operative procedure, and/or histologic findings were associated with recurrent post-operative pain. Methods: Patient charts and slides were reviewed from 44 patients who underwent MPR for CP, including 18 Whipple procedures, 4 Beger resections, 21 distal/subtotal pancreatectomies, and I total pancreatectomy, performed between 1989-1999. H&E slides were reviewed by 2 pathologists and were scored (normal) to 3 (severe) for chronic inflammation, perineural inflammation, and fibrosis. Ductal metaplasia and atypia were noted. Results: The etiology for disease included 14-alcohol, 5-hereditary, 3-idiopathic, 3-pancreas divisum, I-stricture, 2-trauma, I-SLE, and 15unknown. Ages ranged from 22-76 years, with 20 men and 24 women. Perioperative mortality and morbidity were 0% and 7%, respectively. Metaplastic changes were present in 14 cases, ductal atypia was seen in 9, but no malignancies were found. Persistent pain was present in 25 of the 44 patients. Conclusions: MPR for CP can be performed with very low perioperative mortality and morbidity and an acceptable success rate (19/44 pain-free). Patients who underwent Whipple or Beger procedures and those with alcoholic pancreatitis were most likely to have persistent pain. Chronic inflammation, perineural inflammation, and fibrosis did not significantly differ between patients with and without pain suggesting that these histologic findings cannot help predict pain.
°
Comparison of Disease Etiology. Operative Procedure, and Histologic Scores in Patients with and without Persistent Pain
Etiology Alcohol
Pain NoPain
71% (10/14) 29% (4/14)
Other
50% (15/30) 50% (15/30)
Procedure Whipple / Sub/otal/ Beger Distal
65% (15/23) 35% (8/23)
45% (9/20) 55% (10/20)
Histology (mean ± stdev) Perineura I Fibrosis
Chronic lnflam
Int/am
1.1±0.5
0.6±0.9
1.8±0.9
1.2±0.4
08±1.0
2.2±0.8
Values forEtiology andProcedure represent % ofpatients wffh or wfthout pain.