Preoperative administration of erythropoietin stimulates tumor recurrence after surgical excision of colon cancer in mice by a vascular endothelial growth factor-independent mechanism.

BACKGROUND: It has been suggested that preoperative administration of erythropoietin (Epo) in patients with gastrointestinal cancer reduces transfusional needs and is also associated with lower morbidity. On the other hand, experimental and clinical studies show that Epo might enhance tumor growth and angiogenesis. Our aim was to ascertain whether preoperative administration of Epo has any effect on tumor recurrence after curative surgery using an experimental model of colon cancer. MATERIALS AND METHODS: We induced tumors by injecting B51LiM colon cancer cells into the cecal wall of Balb/c mice. We randomized the animals into three groups of treatment with (1) recombinant human Epo, (2) recombinant mouse Epo, or (3) vehicle alone, for 12 d until cecectomy. On postoperative day 12, we killed mice and analyzed tumor recurrence. We measured serum levels of vascular endothelial growth factor and determined vascular endothelial growth factor expression and tumor microvessel density by immunohistochemistry. We also investigated the in vitro effect of Epo on B51LiM cell line proliferation. RESULTS: All three groups displayed tumor recurrence, but the final tumor load score and total tumoral weight were higher in the two groups that included Epo. The differences were statistically significant when we compared the recombinant mouse Epo group with the control group. We found no evidence of increased angiogenesis or enhanced cell proliferation as possible mechanisms of Epo-induced recurrence. CONCLUSIONS: Preoperative administration of Epo stimulates tumor recurrence in an animal model of colon cancer. Our results point to the need for further research on the mechanisms of tumor growth enhancement by Epo, to better understand the benefits or disadvantages of Epo treatment.

Menopause and obstetric history as risk factors for fecal incontinence in women.

BACKGROUND: Fecal incontinence is a highly prevalent condition, especially in women. However, few data on prevalence in women attending primary care are available, particularly regarding the presence of risk factors. OBJECTIVE: The aim of this study was to determine characteristics of women with fecal incontinence and to analyze obstetric history and menopause as potential risk factors. DESIGN: Observational study with a cross-sectional design. SETTINGS: Patients in primary care at 10 health care centers in Barcelona, Spain. MAIN OUTCOME MEASURES: Fecal incontinence was defined as loss of flatus or liquid/solid stool occurring at least monthly. Data on the following variables were collected by face-to-face interviews and patient questionnaires: demographic and clinical characteristics, obstetric history, menopause data, fecal incontinence, and quality of life. Univariable and multivariable analyses were performed to study the association of potential risk factors with fecal incontinence. RESULTS: The study included 332 women with a mean age of 60.8 (SD, 17.8) years. The prevalence of fecal incontinence was 12.0% (40/332). Flatus incontinence was reported in 27 patients (67.5%), liquid stool incontinence in 25 (62.5%), and solid stool incontinence in (19) 47.5%. On multivariable analysis, the only independent risk factors for fecal incontinence were an obstetric history of complicated deliveries (instrumentation or podalic presentation; OR, 3.66; 95% CI, 1.54-8.68, P = .003) and menopause (OR, 5.67; 95% CI, 1.35-23.78; P = .018). LIMITATIONS: The cross-sectional design hampered identification of the time at which the impact of menopausal status occurred, and data obtained from patient interviews was subject to recall bias. CONCLUSIONS: Complicated deliveries are risk factors for fecal incontinence in women. Fecal incontinence appears to be more prevalent in menopausal women.

[Prevalence of fecal incontinence and its relationship with bowel habit in patients attended in primary care]. / Prevalencia de incontinencia fecal y su relación con el hábito defecatorio en pacientes atendidos en medicina primaria.

BACKGROUND AND OBJECTIVES: Fecal incontinence is a high prevalence disease in general population. The diagnosis of alterations in bowel habit could be of interest for the management of this clinical disorder. The aim of the study was to study the relationship between fecal incontinence prevalence and alteration of bowel habit in patients of a metropolitan area of Barcelona. PATIENTS AND METHODS: A cross-sectional multicenter study was undertaken by interviewing the population attending 10 primary health centers. The presence of symptoms of fecal incontinence was analyzed and the bowel habit was assessed using the validated Spanish version of Bristol Stool Scale. RESULTS: A total of 518 subjects were studied with a mean age of 60.3 (SD: Standard deviation 17.7) years. The overall prevalence of fecal incontinence was 10.8% (2.7% incontinence to flatus, 3.7% liquid stool and 4.4% solid stool). There was a normal bowel habit in 75.6% in the group of patients without fecal incontinence and in 54.5% in patients with fecal incontinence (p=0.001). CONCLUSION: The prevalence of fecal incontinence in primary care is high. 45% of patients with fecal incontinence exhibited an abnormal bowel habit.

Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice.

BACKGROUND: Recent reports have suggested that anastomotic leakage is associated with greater rates of tumor recurrence and cancer-specific mortality after surgery for colorectal cancer. The impact of postoperative intra-abdominal infection on long-term oncologic results, however, is still controversial, and no direct causal relationship has been found between both processes. Our aim was to investigate the influence of postoperative intraabdominal infection on angiogenesis and tumor growth in an animal model of colon cancer. METHODS: Balb/c mice were randomized immediately after injection of 5x10(6) B51LiM cells into the cecal wall into 2 groups: cecal resection without postoperative infection (group 1), and cecal resection with postoperative intra-abdominal infection (group 2). A total of 18 days after cell injection, cecectomy was performed, and infection was induced in group 2 by intraperitoneal injection of 3x10(8) colony-forming units of Bacteroides fragilis. On postoperative day 12, the mice were killed. RESULTS: Comparing group 1 with group 2, tumor recurrence was more frequent in animals with intraabdominal infection (65% vs 100%, respectively; P=02). VEGF serum levels were greater at the time of sacrifice in the group with infection (11+/-10 vs 30+/-23 pg/mL; P<.05). Tumor angiogenesis was also increased in the postoperative infection group. The mean (+/-standard deviation) microvessel density was 16+/-7 versus 28+/-11 vessels per high-power field (P<.05). CONCLUSION: We concluded that postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after operative excision of a colon cancer in mice.