Efficacy of infliximab combined with surgery in the treatment of perianal fistulizing Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of infliximab combined with surgery in the treatment of perianal fistulizing Crohn disease (CD).</p><p><b>METHODS</b>Clinical data of 15 patients with perianal fistulizing CD receiving infliximab combined with surgery in the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2010 to June 2011 were analyzed retrospectively. One week after operation, all the patients received infliximab infusion thrice at weeks 0, 2, and 6. Crohn disease activity index (CDAI), perianal Crohn disease activity index (PDAI), body mass index (BMI), routine blood test and endoscopy were evaluated at week 0, 14. Adverse reactions and healing time were recorded.</p><p><b>RESULTS</b>At week 14, the response rate was 100% with 86.7% (13/15) complete responders. One patient had local improvement and one developed recurrent fistula. The mean healing time was 32.5 (20-45) d. Anorectal stenosis in 4 patients was significantly improved. At week 14, CDAI decreased to 114.0±90.3 from 230.5±97.5 after IFX treatment. PCDAI decreased to 2.8±3.2 from 9.9±3.4, and BMI increased to (21.5±3.0)kg/m(2) from (19.1±3.1)kg/m(2). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet and neutrophil were significantly decreased from baseline (all P<0.01). Intestinal mucosa healed completely in one patient. There were no serious adverse events except hypokalemia in one patient and severe infusion reaction in another.</p><p><b>CONCLUSION</b>Infliximab combined with surgery is effective and safe for perianal fistulizing CD.</p>

Diagnosis on the preoperative staging of rectal cancer by magnetic resonance imaging with water-bag in rectum / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) with water-bag in rectum in prediction of pathological staging of rectal cancer.</p><p><b>METHODS</b>Clinical data of 19 patients with rectal carcinoma assessed by MRI with water-bag in rectum for tumour (T) and mesorectal nodal (N) staging were analyzed retrospectively. Preoperative MRI assessment was compared with postoperative histopathological findings.</p><p><b>RESULTS</b>The tumors were correctly staged by MRI in 15 patients, understaged in 2 and overstaged in 2. The accuracy of T stage was 78.9% (15/19). Mesorectal node were correctly staged in 11 patients, overstaged in 2 and understaged in 6. The accuracy of node staging was 57.9% (11/19), sensitivity was 3/9, and specificity was 80%(8/10).</p><p><b>CONCLUSION</b>Preoperative MRI with water-bag in rectum can not provide correct predictive data on mesorectal node stage, but has certain value in the T staging of rectal carcinoma.</p>

Application of magnetic resonance imaging in the diagnosis of complex anal fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of magnetic resonance imaging (MRI) in the diagnosis of complex anal fistula.</p><p><b>METHODS</b>The preoperative digital examination and MRI with the phased-array coil were implemented for 28 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results.</p><p><b>RESULTS</b>Twenty-five patients were diagnosed as complex anal fistula, 1 presacral cyst and 2 chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI,while the patients with presacral cyst and perianal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients were suffered from trans-sphincteric fistula, 10 intersphincteric, 5 supra- sphincteric and 7 extra-sphincteric. The diagnosis rates of the internal opening with digital examination and MRI were 48% and 84%, the rates of the primary tract were 76% and 100%, and the rates of the secondary extensions were 57.9% and 94.7% respectively. The differences in detection of internal opening, primary tract and secondary extensions between MRI and digital examination were significant (P<0.01).</p><p><b>CONCLUSION</b>MRI with the phased-array coil can correctly orient the internal opening and direction of the complex anal fistula, and find the relationship between anorectal sphincters and the complex fistula.</p>

Study the value of screening hereditary nonpolyposis colorectal cancer kindreds by detecting the expression of hMLH1/hMSH2 with tissue microarray / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the value of screening hereditary nonpolyposis colorectal cancer (HNPCC) kindreds by detecting the expressions of hMLH1/hMSH2 with tissue microarray.</p><p><b>METHODS</b>A tissue microarray with 22 colorectal cancers from HNPCC families and 15 sporadic colorectal cancers was established, and the expressions of hMLH1/hMSH2 were detected by immunohistochemistry (IHC).</p><p><b>RESULTS</b>The expressions of hMLH1 or hMSH2 were negative in 15 of 22 HNPCC and 1 of 15 sporadic colorectal cancers in routine IHC. The expressions of hMLH1 or hMSH2 were negative in 17 of 22 HNPCC and 2 of 15 sporadic colorectal cancers in tissue microarray. The examination of hMSH2 expression yielded same results between routine IHC and tissue microarray. There were no difference on the hMLH1 expressions between routine IHC and tissue microarray.</p><p><b>CONCLUSION</b>Tissue microarray is a high-throughput way to detect the expressions of hMLH1/hMSH2 and is applicable to screen HNPCC kindreds.</p>

Detection of microsatellite instability in colorectal cancer by fluorescence multiplex polymerase chain reaction and its clinical value / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To detect microsatellite instability(MSI) in colorectal cancer by fluorescence multiplex polymerase chain reaction(FM-PCR) and explore its clinical value.</p><p><b>METHODS</b>MSI of 110 colorectal cancer patients undergone surgical resection in our department from 2004 to 2005 were examined by FM-PCR, and the pathological characteristics were compared between MSI and microsatellite stable (MSS) colorectal cancer patients.</p><p><b>RESULTS</b>Among 110 cases, the male were 66 and the female were 44. Mean age was 60.8 (26-94) yrs. All 5 microsatellite markers were amplified. Out of them, 10 cases (8.1%) were MSI-H, 13 cases (11.8%) were MSI-L and 87 cases (79.1%) were MSS. Instability of BAT-26 was found in 9 cases (8.2%), BAT-25 was in 11 cases (10.0%), D2S123 was in 11 cases (10.0%), D5S346 was in 6 cases (8.2%) and D17S250 was in 8 cases (7.3%). Age between MSI and MSS colorectal cancer patients was significant and other pathological characteristics were not significant.</p><p><b>CONCLUSIONS</b>FM-PCR is a clinically stable method for MSI detection in colorectal cancer patients. There are no significant differences between MSI and MSS pathological characteristics of colorectal cancer patients.</p>