Factors affecting quality of life for patients with rectal cancer undergoing radiotherapy

Rectal cancer is a significant health problem for patient and results in bowel and sexual function problems. Quality of life is an important outcome measure that has to be considered when deciding treatment strategy for rectal cancer. It has become an integral part of the modern assessment of cancer treatment. This study has been conducted to assess the factors affecting quality of life for patients with rectal cancer undergoing radiotherapy. A descriptive exploratory study was conducted at the surgical outpatient's clinics and Radiotherapy and Nuclear Medicine Department in Ain Shams University Hospitals. A purposive sample of 50 adult patients from both sexes with rectal cancer undergoing radiotherapy were recruited for the conduction of this study, from the above mentioned setting. [1] Patients' interview questionnaire sheet were used to assess factors affecting quality of life [pre treatment course, during radiotherapy and pre surgery], [2] Quality of Life Scale that was used to assess the impact of rectal cancer on the quality of life dimension [physical, psychological, social and spiritual] for the patients during and after radiotherapy and [3] A self-report 5 day diary to identify patients' complications during radiotherapy sessions. The prominent factors affecting on quality of life were patients' age and education, disease stage, side-effects, physical condition and nature of the surgery. There were statistically significant differences between the side-effects during and after radiotherapy, added to the improvement in physical and psychological domains of quality of life post radiotherapy by one month later. There were many factors affecting on quality of life for patients with rectal cancer undergoing radiotherapy [pre treatment course, during radiotherapy and pre surgery]. In addition strong positive correlation was found regarding to these factors and quality of life domains. Further studies are needed to focus on other factors affecting on quality of life for patients with rectal cancer undergoing chemotherapy

Effect of length of oesophageal stump on postoperative gastro-oesophageal function after resection of lower oesophageal carcinoma

Oesophageal carcinoma is not uncommon. One common goal of curative and palliative resection of oesophageal carcinoma is to achieve good functional outcome. During the last decade, Ivor Lewis operation with intrathoracic oesophagogastric anastomosis has been rising as the operation of choice for lower oesophageal carcinoma. It is wdl known that no oesophageal substitute is able to function as proper as the original organ, the peristalsis of which is essential to propel food into the gastric reservoir. Many authors think that the greater the length of the remaining oesophageal stump the better the postoperative functional outcome. The aim of this work was to evaluate the functional outcome after Ivor Lewis oesophagectomy and gastric pull-up for oesophageal cancer and to correlate the results with the length of the preserved oesophageal stump. Twenty patients [15 males, mean age 60 ys] were studied at the sixth postoperative month by questionnaire, stationary manometry and upper GI endoscopy. The commonest postoperative unpleasant complaints were early postprandial sensation of fullness [70%], diarrhea [40%] and gastrooesophageal reflux disease [GORD] [40%]. GORD was more profound in the left lateral position. According to the actual site of the oesophago-gastric anastomosis away from the central incisors as seen during endoscopy, patients were classified into 2 groups: High anastomosis group [A] with anastomosis lying less than 25cm from the central incisors [i.e. the anatomical length of the oesophageal stump < 10 cm] and low anastomosis group [B] with anastomosis lying at or below 25cm from the central incisors [ie. the anatomical length of the oesophageal stump >/= 10 cm]. It has been found that in low anastomosis group, there was a significant difference between the anatomical length of oesophageal stump and the functional length [as measured by manometry]. Patients in low anastomosis group had significantly better postoperative oesophageal body functions as revealed by better mean peristaltic pressure amplitudes [37 mmHg in group B versus 20.1 mmHg in group A, P < 0.05], better duration of contractions [2.11 sec. in group B versus 1.62 sec. in group A, P < 0.05] and better propagation velocity of the muscular contractions [2.7 mm/sec, in group B versus 2.01 mm/sec, in group A, P < 0.05]. This was reflected clinically by significant increase in body weight and significantly higher proportion of patients regaining their normal preoperative body weight in the low anastomosis group. It has been concluded that, provided oncological rules are not breached, Ivor Lewis operation with low intrathoracic anastomosis gives better functional outcome than high anastomosis in patients with lower oesophageal carcinoma

Differences between colorectal cancer in Egypt and the Western prototype

This study aimed to review patients with colorectal cancer presented to a general surgery unit with special interest in coloproctology in Ain-Shams University concentrating on the differences between the pattern of the disease in Egypt and western countries. The study is a six-year retrospective review of one hundred and fifty-five patients with colorectal cancer. The results showed that 38% of the tumors occurred in patients less than 40 years and only 15% of patients were above 60 years of age. 3% of the tumors were Dukes A and 58% were Dukes C. 6% of the tumors were irresectable, 36% of the resections were palliative and 29% of curative operations entailed massive resection of nearby organ or tissue. Synchronous adenomas were present in 5.2% of patients and bilharziasis in 3.2%. At a mean follow up of 52 months, 58% of curative resection patients had recurrence, 38% died of their disease or secondary to its treatment and 42% were alive and disease free

Acute large bowel obstruction: Is it mechanical or functional

The value of urgent contrast large bowel enema in the diagnosis and its impact on management of patients with acute large bowel obstruction has been tested. Twenty two patients were the subject of this study. Urgent contrast enema has been done in 13 patients. Correlation between clinical and radiological diagnosis revealed that differentiation between mechanical obstruction and pseudo obstruction can be difficult depending on clinical picture and plain X ray films. The clinical and plain radiological diagnosis was wrong in 22.5% of patients. On the other hand urgent contrast enema had a 100% accuracy. The importance of this investigation is to avoid unnesecessary operations in pseudo obstruction patients who are generally a high surgical risk