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 early urethral dilatation in prevention of complications in hypospadias patients after urethroplasty

Hypospadias is a common congenital malformation in boys. One of the common surgical techniques for correction of hypospadias is [Tubularized Incised Plate urethraplasty=TIP]. Meatal stenosis and fistula formation are known post-operative complications. The purpose of our study was to evaluate the effect of early urethral dilatation in prevention of post operative complications. A randomized clinical trial including 60 patients with distal hypospadias who underwent tabularized incised plate urethroplasty with or without dilatation was conducted in Bandar Abbas children hospital in 2011. Patients were divided in two groups. The number of the patients and mean age were not different in two groups. Urethral dilatation was started in first group at two weeks following surgery and continued for six months. The patients of second group were followed without urethral dilatation. All patients were followed for occurance of complications for one year. Chi-Square and t-test were used to compare the groups. In the first group the early fistula, late fistula, stenosis, hematoma, urinary infection, cutaneous necrosis, and wound dehiscence were developed in 16.7%, 6.7%, 10%, 26.7%, 13.3%, 10%, and 20% of the patients, respectively. In the second group these complications were seen in 10%, 6.7%, 3.3%, 13.3%, 6.7%, 3.3%, and 6.7% of the patients, respectively. Statistical analysis of results showed no significant differences between two groups in rate of complications. Early urethral dilatation after urethroplasty has no significant effect on postoperative complications

Comparison of the patient satisfaction from inpatient and outpatient fissurectomy in Motahari clinic and Shahid Faghihi hospital, Shiraz, Iran

Introduction: Satisfaction of the patients is considered as an important index in evaluating the performance of the hospitals and is highly effective in developing and improving the quality of the provided services .so, the present study aims to compare the satisfaction of the patients suffering from anal fissure from inpatient and outpatient treatments

Method: This cross-sectional study was conducted on 212 subjects who were selected through systematic sampling from the patients with anal fissure referring to Motahari clinic and Shahid Faghihi hospital. In order to compare the patient satisfaction in two inpatient and outpatient groups, 21-item questionnaire was designed in order to assess the patient satisfaction. Independent t-test and chi-square test were used to analyze this data

Results: satisfaction of the inpatients was significantly more than that of the outpatients [P<0.001]. The inpatients' waiting time for operation was significantly longer than that of the outpatients [P=0.029]. In comparison to the inpatients, the outpatients were more satisfied with the explanations provided regarding food diets after the operation [P=0.004]. Of course, outpatients had felt more stress during the operation compared to the inpatients [P=0.002]. Concerning the treatment environment, the outpatients were more satisfied than the inpatients [P<0.001]; however, the inpatients were more satisfied with the treatment services [P>0.001], quality, and other services compared to the outpatients [P=0.041]

Conclusion: According to the advantages that mentioned, outpatient operations can be a better choice for small surgeries; of course, health planners should pay more attention to its importance and necessity and provide more equipments and welfare facilities in treatment centers

Anti-endomysial and anti-tissue transglutaminase serological test compared with small bowel biopsy in the diagnosis of celiac disease

Celiac is an autoimmune disease that is characterized by an immune-system-related damage in the intestinal tissue after consumption of gluten. There is not any general agreement for gold standard. The Purpose of this study was the evaluation of specificity and sensitivity of anti-endomysial [EMA] and anti-tissue transglutaminase [TTG] Serological test compared to small-bowel biopsy. In the cross sectional study, we took blood specimen from 1825 patients with gastrointestinal disease. All the samples were tested by TTG and EMA kits using ELISA. The patients were studied in two groups. First, the individuals whom their serologic test was positive but their tissue condition was normal and second, those with positive serologic test with pathologic tissue results that show they have celiac disorder. The mean of EMA and TTG shows that the level of antibodies in group 2 is significantly higher than that of the first group [P <0.001]. There is positive correlation between modified marsh criteria of small-bowel biopsy and the two tests. The Sensitivity of EMA and TTG tests for celiac diagnosis is 92%. The specificity of EMA, TTG tests are 100% and 98.5%, respectively. EMA-IgA serology with cut-off point of more than 66 together with TTG-IgA serology with cut-off point of above 30 can be helpful to distinguish a wide range of patients who need small-bowel biopsy

Comparison of lidocaine-meperidine with lidocaine-meperidine -nitroglycerin for intravenous regional anesthesia

Background: Intravenous regional anesthesia [IVRA] is a easy and reliable method for extremity injuries. To improve block quality, decrease tourniquet pain and postoperative analgesia different drugs has been used as an adjuvant in IVRA. In this study, we evaluated the effect of nitroglycerin [NTG] in quality improvement when added to lidocaine and Meperidine as an adjuvant in IVRA

Material and Methods: Fifthly patient with upper extremity injury under IVRA were randomly and blindly to two groups. Under identical condition, control group received total dose of 200 mg lidocaine and 20 mg Meperidine diluted with saline [40cc] and study group received 200 mg lidocaine and 20 mg Meperidine plus 200?g Nitroglycerine. Onset time, anesthesia quality, tourniquet pain and analgesic use were assessed during surgery. After tourniquet deflation, the time to first analgesic requirement and side effect were noted

Results: The sensory block onset time were shortened in study groups [3.7 +/- 1.1 vs 5.1 +/- 1.3] [P=0.004].Intraoperative pain score and quality of analgesic were not different between two groups and fentanyl requirement was similar. The onset of postoperative pain were similar in study and control groups.[78.79 [61.28-92.23] vs 52.28 [35.07-73.448]].[P=0.29]

Conclusion: Addition of Nitroglycerine to lidocaine and Meperidine in intravenous regional anesthesia shortens onset times of sensory block but is not improved the quality of intraoperative analgesia and postoperative pain in patients undergoing hand surgery

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

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

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 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

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

Wind sock deformity in rectal atresia

Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age

effect of silver nitrate, chloroformic garlic extract, and normal saline in induction of sclerosing cholangitis in rabbits

To evaluate the effects of 0.5% silver nitrate, 20% chloroformic garlic extract, and 0.9% normal saline in induction of sclerosing cholangitis in the bile ducts of rabbits. During a-6-months period from April to September 2006 in Shiraz University Laboratory Animal Research Center, we selected 3 equal groups of rabbits. We injected 0.5% silver nitrate, 20% chloroformic garlic extract, and 0.9% normal saline into the bile ducts of each group. The animals were euthanized, and autopsied after 4 months and the liver and bile ducts were removed and studied histopathologically. Cholangiography was undertaken to evaluate the presence and extent of any sclerosing cholangitis. Animals showed sclerosing cholangitis in silver nitrate group [7 [58%]], one [8%] in chloroformic garlic extract group and one [7%] in normal saline group. The difference between silver nitrate and chloroformic garlic extract groups were statistically significant and similar results were noticed between chloroformic garlic extract and normal saline groups. Twenty percent of chloroformic garlic extract had fewer complications such as sclerosing cholangitis, compared to other materials

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

effect of season and Ramadan fasting on the onset of acute cholecystitis

To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acute cholecystitis. A cross-sectional study was conducted in Faghihi and Namazee Hospitals between September 1999 to August 2004. All files of patients with definite diagnosis of gallstone induced acute cholecystitis were reviewed for age, gender, date and method of treatment in relation to seasons and Ramadan fasting month. For comparison, we used Shaaban months [prior months] and Shavval months [following months]. Eight hundred and sixty-four files [32.7% male and 62.8% were female] with definite diagnosis of acute cholecystitis were reviewed. Mean age was 56.3 +/- 16.18 years. The frequency of acute cholecystitis was higher in summer in comparison with other seasons. The difference in the frequency of acute cholecystitis in Ramadan in comparison with Shaaban and Shavval months was not considerable. Acute cholecystitis displays seasonal characteristics; however, this seasonal variability would be influenced by other unknown environmental and genetic factors. Ramadan fasting may not precipitate the onset of acute cholecystitis

effect of adolescents' participation on drinking water consumption habits in the rural area of Rostam Abad

Water - related diseases are among the most important public health problems in developing countries and providing the people with safe water is a key factor in health promotion. Thus, the present study was conducted to investigate the effect of adolescents' participation on drinking water habits of Rostam Abad village in Bouin Zahra in 2004. This research is a quasi - experimental study with 36 adolescent cases who covered 102 families. At first, training sessions were held for the adolescents and then each of them took charge of a few families [average 3 families] for education and control. Ultimately, the percentage of rural families who used healthy water [chlorinated or boiled] before and after adolescents' participation was compared. To compare the mean consumption of safe water pre and post intervention t - test was used. The results showed that none of the rural families consumed healthy water before intervention. However, 68.8% of the families used healthy water after intervention. Paired t-test showed a significant difference between mean consumption of safe water pre and post intervention [P=0.001]. Adolescent participation affects the index of providing and consumption of healthy water in rural areas. Thus, it is suggested that this approach be applied as a practical means to increase the healthy water consumption in rural areas

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