• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6251-6255
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• 2012

Radiation proctitis and radiation cystitis are major complications for patients with cervical carcinoma following radiotherapy. In the present study, we aimed to determine the potential risk factors for the development of radiation proctitis and radiation cystitis after irradiation. A total of 1,518 patients with cervical carcinoma received external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDRICB) in our hospital. The incidences of radiation proctitis and radiation cystitis were recorded and associations with different factors (age, time period, tumor stage) were analyzed with ${\chi}^2$ (chi-squared) and Fisher exact tests. We found that 161 and 94 patients with cervical carcinoma were diagnosed with radiation proctitis and radiation cystitis, respectively, following radiotherapy. The prevalence of Grade I-II radiation proctitis or radiation cystitis was significantly lower than that of Grade III (radiation proctitis: 3.82% vs. 6.76%, P < 0.05; radiation cystitis: 2.31% vs. 3.87%, P < 0.05) and was significantly enhanced in patients with late stage (IIIb) tumor progression compared to those in early stage (Ib, IIa) (P < 0.05). Moreover, the incidence of radiation proctitis and cystitis was not correlated with age or, time period following radiation, for each patient (P > 0.05). These observations indicate that a late stage of tumor progression is a potential risk factor for the incidence of radiation proctitis and cystitis in cervical carcinoma patients receiving radiotherapy.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.5589-5594
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• 2015

Cystitis and proctitis are defined as inflammation of bladder and rectum respectively. Haemorrhagic cystitis is the most severe clinical manifestation of radiation and chemical cystitis. Radiation proctitis and cystitis are major complications following radiotherapy. Prevention of radiation-induced haemorrhagic cystitis has been investigated using various oral agents with minimal benefit. Bladder irrigation remains the most frequently adopted modality followed by intra-vesical instillation of alum or formalin. In intractable cases, surgical intervention is required in the form of diversion ureterostomy or cystectomy. Proctitis is more common in even low dose ranges but is self-limiting and improves on treatment interruption. However, treatment of radiation proctitis is broadly non-invasive or invasive. Non-invasive treatment consists of non-steroid anti-inflammatory drugs (NSAIDs), anti-oxidants, sucralfate, short chain fatty acids and hyperbaric oxygen. Invasive treatment consists of ablative procedures like formalin application, endoscopic YAG laser coagulation or argon plasma coagulation and surgery as a last resort.

• Radiation Oncology Journal
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• 제19권3호
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• pp.265-274
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• 2001

목적 : 방사선 직장염은 골반부위에 방사선치료를 받는 환자에서 나타나는 급성부작용 중의 하나이다. 이러한 방사선 직장염은 병리학적으로 염증성 대장질환과 유사한 소견을 보인다. 따라서 염증성 대장질환의 유발인자로서 최근 활발하게 연구되고 있는 nitric oxide (NO)의 과다생성이 방사선 직장염을 유발하는 주요 원인일 수도 있다. 이를 검증하기 위하여 본 연구자들은 적절한 방사선 직장염 동물모델을 확립하고 이 모델에서 NO의 과다생성과 직장점막의 손상 정도의 상호 관련성을 연구하였다. 대상 및 방법 : 암컷 백서(Wistar)의 직장에 $10\~30\;Gy$의 다양한 선량의 방사선을 조사하였다. 방사선조사 후 5일 및 10일째에 직장조직을 얻어 점막의 형태학적 변화를 육안적으로 및 조직학적으로 관찰하였다. 방사선에 의한 손상에 대한 NO의 과다 생성이 미치는 영향을 평가하기 위하여 iNOS의 발현과 nitrite 측정을 시행하였고 iNOS의 억제제 및 기질을 경구투여한 후 점막 손상의 변화를 형태학적 및 생화학적으로 관찰하였다. 결과 : 육안적으로나 조직학적으로 17.5 Gy 이상의 선량에서는 직장 점막에 명백한 손상이 발생하였으나 15 Gy 이하에서는 일부 검체에서만 경미한 정도의 변화를 나타냈다. 20 Gy 이상의 방사선을 조사한 후에는 검체 대부분에서 등급 4의 조직학적 변화를 보였기 때문에 임상에서 흔히 경험하는 방사선 직장염을 재현할 수 있는 가장 적절한 일회 방사선조사량으로 17.5 Gy를 선택하였다. 직장 점막의 조직학적 손상정도가 방사선량 및 iNOS의 과발현과 유의한 상관관계를 보였다. 그러나 iNOS의 기질 및 억제제의 경구투여시 iNOS 발현양상, NO 생성 뫼 조직 손상 정도의 차이는 없었다. 결론 : 임상에 적용할 수 있는 방사선 직장염 연구를 위한 동물모델로서 적절한 일회 방사선조사량은 17.5 Gy임을 확인하였다. 또한 덜 연구결과는 NO의 과다생성이 방사선에 의한 염증 및 손상 정도와는 연관성을 가지나 직접적인 원인이 아님을 시사하고 있다.

• 한국임상수의학회지
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• 제33권2호
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• pp.142-144
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• 2016

We report a case of Escherichia coli septicemia in a 6-year-old male bottlenose dolphin (Tursiops truncatus). Gross lesions included turbid reddish yellow ascites, fibrous adhesions of rectum and peritoneum, multifocal mucosal ulcers of rectum, and systemic petechiae. Multifocal necrosis with bacterial colonies was observed histologically in mucosal membrane of rectum and anus, and also in caudal mesenteric lymph node, inguinal lymph node, tracheobronchial lymph node, tonsil, spleen, liver, and lung. E. coli was isolated in pure culture from multiple organs including blood, spleen, mesenteric lymph node, liver, lung, and ascites. The E. coli was serotype O25. This case was diagnosed as a septicemia caused by E. coli serotype O25 associated with proctitis.

• 한국임상수의학회지
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• 제39권2호
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• pp.75-80
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• 2022

An 11-year-old male Rex rabbit (Oryctolagus cuniculus) had a rectal prolapse induced by a polypoid mass. The mass was highly vascularized with a cauliflower-like appearance. Anorectal papilloma was suspected, and fine needle aspiration cytology showed eosinophilic inflammation. After surgical removal of the polyp, postoperative care was given, such as systemic antibiotics and analgesics. In the re-examination, the rabbit was resolved, and there were no complications. Histopathological examination of the removed polyp indicated chronic eosinophilic proctitis to be the cause of the inflammatory condition of the protruding rectal polyp.

• Clinical Endoscopy
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• 제55권1호
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• pp.22-32
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• 2022

Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.631-638
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• 2016

Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.

• 대한수의학회지
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• 제14권1호
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• pp.45-48
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• 1974

Four water monitors at Zoological Garden, Chang Gyeong Won, Seoul, died within a week after signs of anorexia, lethargy, and discharge from eyes, nasal and oral cavities. The autopsy findings of the four animals were similar. As a main lesion, the liver was congested and diffuse necrosis was observed. The terminal portions of the rectum were studded with numerous small ulcers causing rectal stenosis. Histopathologically, massive hepatic necrosis preceded by fatty changes were evident. The rectal lesions manifested coagulative necrosis and thrombosis in the mucosa and submucosa.

• Radiation Oncology Journal
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• 제31권2호
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• pp.81-87
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• 2013

Purpose: To describe chronic rectal mucosal damage after pelvic radiotherapy (RT) for cervical cancer and correlate these findings with clinical symptoms and radiation dose. Materials and Methods: Thirty-two patients who underwent pelvic RT were diagnosed with radiation-induced proctitis based on endoscopy findings. The median follow-up period was 35 months after external beam radiotherapy (EBRT) and intracavitary radiotherapy (ICR). The Vienna Rectoscopy Score (VRS) was used to describe the endoscopic findings and compared to the European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) morbidity score and the dosimetric parameters of RT (the ratio of rectal dose calculated at the rectal point [RP] to the prescribed dose, biologically effective dose [BED] at the RP in the ICR and EBRT plans, ${\alpha}/{\beta}$ = 3). Results: Rectal symptoms were noted in 28 patients (rectal bleeding in 21 patients, bowel habit changes in 6, mucosal stools in 1), and 4 patients had no symptoms. Endoscopic findings included telangiectasia in 18 patients, congested mucosa in 20, ulceration in 5, and stricture in 1. The RP ratio, $BED_{ICR}$, $BED_{ICR+EBRT}$ was significantly associated with the VRS (RP ratio, median 76.5%; $BED_{ICR}$, median 37.1 $Gy_3$; $BED_{ICR+EBRT}$, median 102.5 $Gy_3$; p < 0.001). The VRS was significantly associated with the EORTC/RTOG score (p = 0.038). Conclusion: The most prevalent endoscopic findings of RT-induced proctitis were telangiectasia and congested mucosa. The VRS was significantly associated with the EORTC/RTOG score and RP radiation dose.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4711-4715
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• 2013

Aim: The aim of this study was to evaluate acute adverse events and efficacy of three-dimensional intensitymodulated radiotherapy (IMRT) combined with endocrine therapy for intermediate and advanced prostate cancer. Methods: Sixty-seven patients were treated with three-dimensional IMRT combined with maximum androgen blockade. The correlation between radiation-induced rectal injury and clinical factors was further analyzed. Results: After treatment, 21 patients had complete remission (CR), 37 had partial remission (PR), and nine had stable disease (SD), with an overall response rate of 86.5%. The follow-up period ranged from 12.5 to 99.6 months. Thirty-nine patients had a follow-up time of ${\geq}$ five years. In this group, three-year and five-year overall survival rates were 89% and 89.5%, respectively; three-year and five-year progression-free survival rates were 72% and 63%. In univariate analyses, gross tumor volume was found to be prognostic for survival ($X^2$ = 5.70, P = 0.037). Rates of leucopenia and anemia were 91.1% and 89.5%, respectively. Two patients developed acute liver injury, and a majority of patients developed acute radiation proctitis and cystitis, mainly grade 1/2. Tumor volume before treatment was the only prognostic factor influencing the severity of acute radiation proctitis (P < 0.05). Conclusions: IMRT combined with endocrine therapy demonstrated promising efficacy and was well tolerated in patients with intermediate and advanced prostate cancer.