Adenocarcinoma below ileoanal anastomosis for ulcerative colitis: report of a case and review of the literature.

BACKGROUND: Restorative proctocolectomy with hand-sewn ileoanal anastomosis and mucosectomy is warranted in patients with dysplasia and/or cancer on ulcerative colitis to prevent subsequent neoplastic changes in the retained mucosa. However, complete excision of the colonic mucosa cannot be obtained reliably. We report a case of anal canal adenocarcinoma after handsewn anastomosis with mucosectomy. METHODS: A 47-year-old patient, previously submitted to ileorectal anastomosis for colonic cancer on ulcerative colitis, underwent completion proctectomy and handsewn ileoanal anastomosis with mucosectomy for recurrent anastomotic cancer. Two years later, we submitted the patient to pouch removal with permanent ileostomy for a mucinous adenocarcinoma of the anal canal (T2N2Mx) found at follow-up pouch endoscopy. CONCLUSIONS: Only four cases of adenocarcinoma after handsewn anastomosis have been reported in the literature. This new case we report confirms that the risk of malignancy after ileoanal anastomosis with mucosectomy, although small, is real, despite the surgeon taking care with this particular step of the procedure. Careful surveillance is needed in patients with surgical treatment for long-term ulcerative colitis or dysplasia.

Diffusive transfer of water and glucose across the chorionic plate of the isolated human term placenta.

This study investigated systematically the diffusive transfer of water and glucose across the chorionic plate of the human placenta. Isolated sections of human term placentae were perfused at the fetal side (open loop) with modified Ringer's solution (n=31). An artificial amniotic compartment was created on top of the chorionic plate. 3H- and 14C-labelled tracer pairs were added (donor side) to the fetal perfusion fluid or to the 'amniotic' fluid. Transfer fractions (TF, ratio of acceptor side to donor side radioactivity) were calculated as percentages. TF of water and L-glucose from perfusion fluid into the 'amniotic' fluid were 3.9+/-0.5 per cent (mean+/-SEM) and 1.2+/-0.3 per cent after 60 min and significantly different (n=6). In each sample of the following experiments the transfer fraction of the D-hexose was larger than that of the L-isomer. At 60 min, the TF were 1.6+/-0.2 and 1.1+/-0.2 per cent (D-glucose/L-glucose; fetal to amniotic compartment, n=8), from amniotic compartment to fetal perfusate 0.6+/-0.1 and 0.4+/-0.1 per cent (D-glucose/L-glucose, n=11), and 0.8+/-0.1 and 0.6+/-0.1 per cent (3-O-methyl-D-glucose/L-glucose, n=6). The difference between the latter TF lost its significance after cytochalasin B (0.1-0.2 mmol/l) had been added to the amniotic compartment. It is concluded that a limited diffusive pathway across the chorionic plate of the human placenta exists and that the transfer of D-glucose depends in part on facilitated diffusion.