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

effect of calendula officinalis in therapy of acetic acid induced ulcerative colitis in dog as an animal model

In patients with ulcerative colitis [UC], the repeated cycle of injury and repair of intestinal mucosa has been reported to increase the risk of colon cancer. So, a safe and efficient therapy is required for the treatment and prophylaxis for the disease. This study aims to investigate the efficacy of Calendula officinalis extract in treatment of experimentally induced ulcerative colitis in dog animal model. During fall 2010, 10 out-bred female German dogs [1-2 years old; weighs of 20-25 kg] were enrolled. Ulcerative colitis was induced with 6% acetic acid as enema and method of treatment was retrograde [via enema] too by C. officinalis. Loose stools, diarrhea, gross bleeding and loss of body weight happened after administration of acetic acid and crypt damage, loss of epithelium, infiltration of inflammatory cells and depletion of goblet cells were noticed histologically. C. officinalis could successfully resolve the damages of UC. Treatment with C. officinalis can broaden the current therapy options for UC

Short-term complications of hemorrhoidectomy in outpatient and inpatient operations in Shiraz, Southern Iran

Today, hospitals and patients are both willing to benefit from outpatient services. Considering limits of supply, it seems that there is a need to run productive management in offering health services to prevent wasting of supplies and facilities. This study compares the complications caused by hemorrhoidectomy in outpatient and inpatient operations. In a cross-sectional study during 1.5 years, 208 patients without any background disease were enrolled. They were randomly allocated into two groups [inpatient and outpatient] and interviewed within two weeks after surgical operations. The data were collected through a questionnaire and physical examination. The complications in the two groups of operating theater of hospital and clinic were then compared regarding sex, occupation, education and etc. One week after the surgical operation, the patients in the hospital operating theater showed significantly a better healing recovery of their wound. Other complications such as pain, hemorrhage, infection, inflammation, involuntary emission of feces and gas indicated no significant difference between the two groups. After 2 weeks, more pain was noticed in patients in the operating theaters of the hospital and in clinics, there was more infection visible. The hemorrhage, inflammation, wound healing, involuntary emission of feces and gas did not indicate a significant difference between the operating theater of hospital and the clinic. There was no significant difference regarding the patients' satisfaction in the two groups. We recommend that for optimized use of supplies and equipments in operating theaters and to lower the cost and shorten queue of patients, grade 2 hemorrhoids are performed in the operating theater of clinics considering sterilization and safety procedures

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

Necrotizing pancreatitis as an unusual cause of severe abdominal pain during pregnancy

Acute pancreatitis is an uncommon cause of abdominal pain during pregnancy that may become severe and rarely progresses to a necrotizing form with a high maternofetal mortality even in young patients[1, 2]. A small number of pregnant women with acute pancreatitis have an associated hyperlipidemia, usually hypertriglyceridemia while in all these cases, pancreatitis is mild in severity and is responsive to conservative medical management[2.3]. We present a case of necrotizing pancreatitis in a 25 years old pregnant woman at 34 weeks of gestation, who presented with acute abdominal pain, nausea and vomiting that required operative management

Comparison of the rhomboid fasciocutaneous transposition flap with primary simple closure in the treatment of uncomplicated pilonidal disease

Pilonidal disease is a common condition that affects younger people in which over half of the affected patients present with a sacrococcygeal abscess. This study was performed to compare the outcome of excision and primary closure with that of rhomboid excision and flap procedure in patients with uncomplicated pilonidal disease. A total of 90 consecutive patients with pilonidal disease were randomly divided into: group 1 who underwent the rhomboid fasciocutaneous transposition flap procedure [n=45] and group 2 who underwent excision and primary closure [n=45]. Length of hospital stay and postoperative complications, which included surgical site infection, seroma and hematoma, as well as the time to resumption of work and early recurrence were compared for all patients. Duration of hospital stay [p<0.001] and time to resumption of work [p<0.001] was less for group 1. During a median follow-up of 12 months, no recurrence was detected in patients in group 1 whereas six patients developed recurrence in group 2 [p=0.013]. Rhomboid fasciocutaneous transposition flap procedure, with its acceptable long-term results and shorter hospital stay, is preferable to simple excision and primary closure in the treatment of uncomplicated pilonidal disease

Surgical management of combined perforated and bleeding duodenal ulcer

Peptic ulcer is one of the most frequent diseases of the alimentary tract, while mortality from perforated peptic ulcer still remains high. We conducted this retrospective study to determine the adverse operative risk factors for perforated hemorrhagic peptic ulcers in Shiraz, southern Iran. 896 patients with peptic ulcer were enrolled. A questionnaire was used to collect the data on age, gender, site of ulcer, presentation, endoscopic findings, type of peptic ulcer complications, method of treatment, surgical procedure, and results of the treatment. Complicated duodenal ulcer was 15% in period I, and 11.5% in period II [P>SD of the age of +/- 0.05]. The mean 11 years. The age of the patients with perforated duodenal the patients was 42.7 8.6 years. Perforation with 12.5 and in hemorrhagic patients 37.4 +/- ulcer was 48 hemorrhagic duodenal ulcer in the first period was 1.2% and in second period, 0.2%. In the second period, simple closure was done in 29 [74%] patients, and in perforated DU cases, conservative management was done in 23 [56%] patients. Although the number of complicated duodenal ulcer cases increased from period I to period II, complications of duodenal ulcer [Kissing disease] significantly decreased

Comparison between two methods of excision and primary closure of pilonidal sinus

Controversy still exists about the best surgical method for the treatment of pilonidal sinus. The aim of this study was to compare two methods of excision and primary closure. One hundred and seventy-three patients with pilonidal sinus, 119 [69%] men and 54 [31%] women, and a mean age of 23.3 +/- 7.5 yrs and divided into two Groups of A [electrocautery] and B [excision] for the removal of pilonidal sinus. Wound complications, hospital stay, times to heal, return to work, patient's comfort and recurrence rate were recorded for the two groups. The postoperative follow-up was 6 months. All patients were able to resume their normal lives and activities 7-9 days after the operation. Wound infection and recurrence rate were significantly [P<0.05] less prevalent in Group A [5% and 3.8%] than in Group B [1% and 0%]. There was no significant difference between two groups in regard to hospital stay, time to heal, time to return to work and patients' comfort after 6 months of follow-up. The use of electrocautery at the base of the wound is not recommended because it may obscure the exact extent of the pilonidal sinus and increase the rate of recurrences

Use of colchicine in reduction or prevention ot talc-induced intra-abdominal adhesion bands

Postoperative peritoneal adhesion bands are one of the most common complications caused by foreign material. To investigate the effect of colchicine on talc-induced peritoneal adhesion bands. Method: Adhesion bands were induced in 30 short hair England Guinea pigs by introduction of talc-saline solution [10 mL, 10%] into the peritoneal cavity. Afterwards, the pigs were randomly divided into two equal groups and colchicine was orally given to the experimental group. Finally, laparotomy was performed and the adhesion bands in both groups were classified using the Nair classification and compared with each other. Only four [23%] out of 15 Guinea pigs of the target group developed substantial adhesions, while the other 11 [75%] pigs developed only insubstantial adhesions [grade 0-1]. On the other hand, the entire control group developed substantial adhesions. Colchicine, at a dosage of 0.02 mg/kg, prevented and reduced formation and severity of adhesion bands [p<0.05]. Therefore, given the safety, low cost and acceptable side effects, colchicine may be a useful agent for prevention or reduction of adhesion band formation. Human studies on this subject are warranted