Safe distal margin resection in patients with low rectal cancer undergoing neoadjuvant chemoradiation

Background: Colorectal carcinoma is the third most common cause of death in Iran. This study was performed in order to determine the appropriate distal clearance margin [DCM] for resection of rectal cancer in patients who undergo neoadjuvant chemoradiotherapy for sphincter preserving procedure. Materials and Methods: This was a cross-sectional study conducted in Shahid Faghihi Hospital of Shiraz University of Medical Sciences from 2006 to 2011. We included all patients with low rectal cancer who underwent neoadjuvant chemoradiotherapy. The medical charts of patientsand disease characteristics were recorded. The local recurrence, recurrence-free survival and mortality rates were compared between those with DCM >/=2cm and DCM <2cm. Results: Overall, 82 patients with a mean age of 56.7 +/- 16.4 years were included. The DCM was found to be >/=2cm in 45 [54.9%] patients and <2cm in 37 [45.1%]. The two study groups were comparable in terms of age [p=0.573], sex [p=0.505], histopathological tumor grade [p=0.165], and distance of tumor to anal verge [p=0.125]. Patients with DCM >/=2cm had a lower local recurrence rate [35.6% vs. 97.3%; p<0.001], a higher recurrence-free survival rate [88.9% vs. 67.6%; p=0.032] and a lower mortality rate [11.1% vs. 32.4%; p=0.027]. Conclusion: Although some studies have showed that DCM<2cm leads to similar results compared to DCM>/= 2cm, our findings revealed that obtaining a distal clearance margin of 2cm for resection of rectal cancer in patients who have undergone neo-adjuvant chemoradiotherapy is associated with a lower local recurrence rate, higher recurrence-free survival rate and lower mortality rate

Comparison of electrotherapy, rubber band ligation and hemorrhoidectomy in the treatment of hemorrhoids: a clinical and manometric study

Treatment of hemorrhoid disease is one of the most challenging fields in general surgery in which different methods are used to treat this condition. In this study, we compared the manometric and clinical results of three treatment methods for hemorrhoids. A total of 150 patients with symptomatic grades II or III internal hemorrhoids were randomly assigned to three groups. Group A underwent Ferguson hemorrhoidectomy, group B were treated with rubber band ligation [RBL] and group C were treated with direct current electrotherapy. Preoperatively, grade III hemorrhoids had significantly higher mean resting pressure and mean squeezing pressure in comparison to grade II hemorrhoids. After hemorrhoidectomy, patients in group A had a significant decrease in the maximum resting pressure [90.8 to 77.7 mmHg] and maximum squeezing pressure [130.6 to 114.8 mmHg] with a significant raise in the volume of the first sensation. However there was no significant change in manometric indexes after RBL and electrotherapy. Group A patients had more postoperative pain and itching compared to groups B and C. We conclude that electrotherapy is a safe, effective and simple method of treating grades II and III uncomplicated internal hemorrhoids. This procedure is associated with little postoperative pain and complications, and has the least changes in anorectal manometric characteristics. Therefore electrotherapy may be recommended as a treatment of choice for grades II and III uncomplicated internal hemorrhoids

Application of western blotting using native antigen B for serodiagnosis of human cystic echinococcosis

Hydatidosis is one of the most important helminthic diseases causing serious health and economic problems in many countries including Iran. Currently available diagnostic approaches for diagnosis of cystic echinococcosis [CE] are not satisfactory since they have not achieved a reasonable validity in diagnosis of CE. This study aimed to assess the performances of Western blotting [WB], using native antigen B, for serological diagnosis of human hydatidosis. Antigen B was prepared from sheep hydatid cyst fluid. Serum samples obtained from 40 surgically proven cases of hydatidosis along with serum samples from non-hydatidosis patients and samples from healthy persons were tested by immunoblotting, using native antigen B. From 40 sera of hydatidosis patients, 32 cases [80%] detected 8 kDa subunit, 29 cases [72.5%] recognized the 16 kDa component and 29 cases [72.5%] detected 24 kDa subunit of antigen B. The highest sensitivity [80%] was achieved with 8 kDa subunit of antigen B while the other components [16 and 24 kDa] showed a lower sensitivity [72.5%]. Samples from healthy controls and non-hydatidosis patients did not yield any detectable band in the Western blotting assay. Accordingly, specificity of the system was found to be 100%. Considering the use of native antigen B, application of western blotting, based on 8 kDa subunit of antigen B, is highly recommended for the confirmatory diagnosis of hydatidosis

Diagnosis of cystic echinococcosis: ultrasound imaging or countercurrent immunoelectrophoresis?

Cystic echinococcosis is a major zoonotic diseases in the Islamic Republic of Iran. This study was carried out in 3 general hospitals in Shiraz. We examined the records of all 1227 surgical patients with a surgically-proven diagnosis of cystic echinococcosis for the 20-year period 1978-98. The results of countercurrent immunoelectrophoresis were compared with pathology and ultrasound reports to determine whether serological tests could be helpful for diagnosis. Countercurrent immunoelectrophoresis could detect only 62.0% of cases, whereas the pathology and ultrasound results were positive for 96.3% of cases. This study confirms the usefulness of ultrasound and suggests that only in doubtful cases would countercurrent immunoelectrophoresis be useful for diagnosing cystic echinococcosis