CHROMOENDOSCOPY IN THE SCREENING OF COLORECTAL ADENOMAS

S.V.MOUZICA, A.B.VINNITSKAYA

Hospital of modern cancer care, Kiev, UKRAINE

Introduction. Colonoscopy (CS) is the most effective method of screening of colorectal cancer (CRC), which allows not only to examine all parts of the colon, but also biopsy and remove polyps. It is known that screening CS with polypectomy reduces the risk of development of CRC by 50 - 67%, and mortality - by 65%. However, the ratio of the number of adenomas detected by CS to the number of patients, may differ 10 times in different endoscopists, despite the same professional experience. The portion of adenomas missed during screening CS may reach 27%.

The purpose of this study is a comparative evaluation of results of endoscopic screening by the method of standard CS and chromoendoscopy with indigocarmine solution

Materials and methods. The study included 439 asymptomatic patients (with average age of 50.8), who were performed CS with the purpose of screening of CRC and colorectal adenomas with intravenous sedation (propofol). Patients with previously detected carcinoma and / or adenomas of colon and rectum were excluded from the study. The study carried out without chromoendoscopy in 152 patients, further 287 patients were performed staining of all sections of the colon with 0.2% solution of indigocarmine. All polyps identified in both groups were removed with further pathomorphologic examination. The both groups were equivalent by age, sex and percentage of total colonoscopies. To determine the reliability of obtained results, Mann-Whitney test was used.

Results. There was found 3 cases of invasive colonic cancer, which accounted for 0.7% of the total number of participants of the screening. There was diagnosed total of 246 colorectal adenomas with size of 1 to 40 mm. 134 (54.5%) among all the adenomas were located proximal to the splenic flexure. As a result chromocolonoscopy there was found significantly more patients with colorectal adenomas: 36.9% vs. 20.3% (p = 0.005). The ratio of adenomas per patient constituted 0.32 and 0.68 (p = 0.005) in the group of standard CS and chromoendoscopy respectively.

Conclusion. Results of the comparative study have shown great effectiveness of chromocolonoscopy with indigocarmine compared with the standard examination in the screening of colorectal adenomas.

APOPTOSIS MARKERS IN CROHN’S DISEASE

V.V.PAVLENKO, G.A.KATAGANOVA, S.B.ALEXANDROVA

State Medical Academy, Stavropol, RUSSIA

The aim of the study. The study content of apoptosis markers - CD-95 (APO-1/Fas) and CD-95-L in the peripheral blood of patients with Crohn's disease.

Materials and methods. We examined 20 patients with complicated forms of CD (8 men and 12 women) aged between 20-60 years at the exacerbation stage. Stenosing form of CD was found in 7 patients, inflammatory and infiltrative - in 6 patients, penetrating - in 5 patients. The control group included 10 actually healthy individuals. The expression of CD-95 and CD-95-L by T-lymphocytes of peripheral blood was determined by the method of flow cytometry (flow cytometer FACS CALLIBUR). The CD-95 content in the control group constituted 58,45 ± 7,4%, CD-95-L - 9,8 ± 0,9%.

Statistical processing of the obtained results was performed by “Excel”, “Biostat”, “Statistica-6” program packages by using nonparametric criteria Mann-Whitney and paired t- Student criterion.

Results. In patients at the exacerbating stage of CD, the CD-95 content in peripheral blood increased (84,1 ± 4,2%, p <0.05 with control). The level of expression of CD-95-L on T-cells of peripheral blood, on contrary, reduced (5,6 ± 1,6%, p <0.05 with control). In the group of patients with penetrating form of CD there was observed increased ability to express CD-95 (84,96 ± 2,61%, P <0,05 with the control and between groups), whereas in the groups of patients with stenosing and inflammatory-infiltrative forms of CD data the data did not differ (74,26 ± 8,26% and 66,35 ± 10,51%, respectively, P <0.05 with control and P> 0.1 between groups). The content of CD-95-L was reduced in the group with penetrating form of the disease (3,36 ± 1,01%, P <0,05 with the control and between groups). In groups of patients with stenosing and inflammatory-infiltration form of significant differences in the expression, studied apoptosis markers were not observed (16,75 ± 11,53% and 17,3 ± 6,74%, respectively, P <0.05 with control and P> 0 1 between groups).

Conclusion. In the period of exacerbation of CD, content of CD-95 in the peripheral blood increased, and CD-95-L - reduced. The highest indicators of CD-95 and the lowest content of CD-95-L were observed in groups of patients with severe penetrating form of the disease. Defect of apoptosis mechanisms can turn to be a key factor of excess accumulation of T cells in the intestine tissue, and as a result, persistence of the inflammatory process in CD.

Date: 2014-12-28; view: 911