Efficacy of biofeedback therapy before and after sphincteroplasty for fecal incontinence because of obstetric injury: a randomized controlled trial

Fecal incontinence is a challenging condition in that it exerts various psychosocial impacts on daily life. Different treatment modalities have been suggested for fecal incontinence. The present study aimed to evaluate the efficacy of biofeedback therapy in combination with surgery in the management of fecal incontinence. The present randomized controlled trial was performed on 27 women with a complaint of fecal incontinence because of delivery trauma. The patients underwent sphincteroplasty and levatorplasty via the same method by 2 colorectal surgeons. In Group I, biofeedback therapy was performed 3 months before and 6 months after the surgery; in Group II, biofeedback therapy was applied only 6 months after the surgery; and in Group III, only surgical management was performed. The results revealed a significant difference between the preoperative and postoperative Wexner scores of incontinence in all the 3 groups. Additionally, the difference between the preoperative and postoperative scores was significant only in Group I and Group III, but not in Group II. The reduction in the Wexner score was significantly less in Group III. However, no significant difference was observed between the 3 groups concerning the mean difference of preoperative and postoperative manometry. The present study revealed no significant role for biofeedback therapy alone in the improvement of manometric evaluation. However, the Wexner score, which is an indicator of patient satisfaction, increased with biofeedback therapy following sphincteroplasty. In general, surgical treatment is now reserved for selected patients with fecal incontinence and has recently been developed with biofeedback therapy

Developing a novel risk-scoring system for predicting relapse in patients with ulcerative colitis: a prospective cohort study

Objectives: Ulcerative Colitis [UC] follows a natural clinical course of relapses and remissions. The aim of this study was to construct a risk-scoring formula in order to enable predicting relapses in patients with UC

Methods: From October 2012 to October 2013, 157 patients from Shiraz, southern Iran who were diagnosed with UC and in remission were enrolled. At 3-month intervals, multiple risk factors of hemoglobin, complete blood counts, serum iron and albumin, erythrocyte sedimentation rate, and faecal calprotectin levels, sex, age, cigarette smoking, positive family history of inflammatory bowel diseases, past history of appendectomy, extra-intestinal accompanying diseases, extent of disease at the beginning of study, number of previous relapses, duration of disease and duration of remission before the study were assessed. Univariate and multivariate logistic regression were applied to fit the final model. The new risk-scoring system accuracy was assessed using receiver-operating-characteristics [ROC] curve analysis

Results: Seventy four patients [48.1%] experienced a relapse. Multivariate analysis revealed that relapses could significantly be predicted by the level of fecal calprotectin [OR=8.1], age [OR=9.2], the Seo activity index [OR=52.7], and the number of previous relapses [OR=4.2]. The risk scoring formula was developed using the regression coefficient values of the aforementioned variables

Conclusion: Four predictor variables were significant in the final model and were used in our risk-scoring formula. It is recommended that patients who achieve high scores are diligently observed, treated, and followed up

late-onset psoas abscess formation associated with previous appendectomy: a case report

Psoas abscesses could originate from an adjacent source of infection in the abdominopelvic cavity known as a secondary complication of acute appendicitis. However, it is considered as a very rare event when occurring late after the presentation of appendicitis. Whether it is the source or complication of acute appendicitis following appendectomy remains unclear. A 25-year-old man was admitted to our center with fever and abdominal pain. His past medical history was unremarkable except for having an acute appendicitis and complicated appendectomy 4 years before presenting illness. On admission, the patient was febrile with right lower quadrant abdominal tenderness and moderate leukocytosis. The Abdominopelvic CT-scan revealed a large right psoas muscle than the opposite site, that contained a hypodense mass measuring 6 cm in diameter with extension into right iliacus and internal oblique muscles..The patient underwent subsequent percutaneous abscess drainage under image guide and concurrent broad-spectrum antibiotic therapy

Interposition of ileal J-pouch for rectum reconstruction in dog

Background: The gold standard of the management of rectal cancer in the middle and lower parts is low anterior resection with coloanal anastomosis. About 50% of the patients undergoing this procedure might experience some complications because of the low capacity of the neorectum. The aim of this study was to evaluate ileal J-pouch interposition as a neorectum between the anal canal and the remaining colon in comparison to coloanal anastomosis and transverse coloplasty

Methods: Twelve dogs, weighing 23-27 kg, were divided into three groups. After laparotomy, the volume of the primary rectum was measured so that it could be compared with that of the neorectum at the end of the study. After rectal resection in Group A, the colon was directly anastomosed to the anus. In Group B, a 5-cm longitudinal incision was made 2 cm proximal to the anastomosis and was sutured transversely [coloplasty]. In Group C, a 5-cm ileal J-pouch was interposed between the colon and anus. After 8 weeks, the neorectum was evaluated for volume, radiology, and pathology

Results: All the samples were alive until the end of the study. The healing of the anastomotic lines was acceptable [pathologically] in all. The mean volume expansion was 20.9% in Group A, 21.7% in Group B, and 118.2% in Group C, with the latter being significantly higher than that of the other groups [P=0.03]. Colon J-pouch and coloplasty after proctectomy in some situations have not been performable. This study evaluated the performance of ileal J-pouch interposition

Conclusion: This study showed that ileal J-pouch interposition might produce an acceptable reservoir function and that it seems feasible and safe in selected cases

Expression status of UBE2Q2 in colorectal primary tumors and cell lines

Background: Activation of the ubiquitin-proteasome pathway in various malignancies, including colorectal cancer, is established. This pathway mediates the degradation of damaged proteins and regulates growth and stress response. The novel human gene, UBE2Q2, with a putative ubiquitin-conjugating enzyme activity, is reported to be overexpressed in some malignancies. We sought to investigate the expression levels of the UBE2Q2 gene in colorectal cell lines as well as in cancerous and normal tissues from patients with colorectal cancer

Methods: Levels of UBE2Q2 mRNA in cell lines were assessed by Real-Time PCR. Western blotting was employed to investigate the levels of the UBE2Q2 protein in 8 colorectal cell lines and 43 colorectal tumor samples

Results: Expression of UBE2Q2 was observed at the level of both mRNA and protein in colorectal cell lines, HT29/219, LS180, SW742, Caco2, HTC116, SW48, SW480, and SW1116. Increased levels of UBE2Q2 immunoreactivity was observed in the 65.11% [28 out of 43] of the colorectal carcinoma tissues when compared with their corresponding normal tissues. Difference between the mean intensities of UBE2Q2 bands from cancerous and normal tissues was statistically significant at P<0.001 [paired t test]

Conclusion: We showed the expression pattern of the novel human gene, UBE2Q2, in 8 colorectal cell lines. Overexpression of UBE2Q2 in the majority of the colorectal carcinoma samples denotes that it may have implications for the pathogenesis of colorectal cancer

Late results of endorectal flap in management of high type perianal fistula

Fistula-in-ano is a problematic perianal disease for physicians and patients because of its occasional difficulty in management. Due to the different types of fistulas seen in patients, careful approach is necessary to correctly choose from among the various surgical techniques. One surgical method for complex fistula is the endorectal advancement flap which has been frequently performed because of its low complication rate. This study enrolled 40 [33 males, 7 females] patients who suffered from high type fistula [greater than 30%-50% involvement of the external sphincter] as noted on digital rectal examination and endoanalsonography. Patients were seen at Shahid Faghihi Hospital, affiliated with Shiraz University of Medical Sciences, between 2007 and 2011. All enrolled patients received similar preoperational preparation. We used the jackknife operative position and determined the internal orifice of the fistula by inserting a probe, with injection of methylene blue or oxygen peroxide. Endorectal advancement flap included the mucosa, submucosa and thin portion of the muscle that completely covered the sutured internal orifice area. The external orifice was opened to adjust the external border of the external sphincter to allow for effective drainage. All enrolled patients were followed for 36 months, which was noticeable statistically when compared with other study findings of high type fistula. The location of the external orifice, age, sex and bowel habits were not related to recurrence rate. Endorectal advancement flap in selected patients who suffer from high type fistula seems to have beneficial effects with a low recurrence rate. Therefore, management of complex high type fistulas remains a challenging topic.

healing effect of teucrium polium in acetic acid-induced ulcerative colitis in the dog as an animal model

Inflammatory bowel diseases [IBD], which include ulcer-ative colitis [UC] and Crohn's disease [CD], are debilitating and chronic disorders with unpredictable courses and complicated treatment measures. Therefore, an efficient treatment protocol seems necessary as therapeutic prophylaxis for these disorders. This study aims to determine the healing effect of Teucrium polium [T. polium] in acetic acid-induced UC in an experimental dog model. From September to December 2010, eight male [20-25 kg] crossbred dogs were used for induction of UC by 6% acetic acid, tran-srectally. After one week, three biopsies [10, 20 and 30 cm proximal to the anal verge] were taken from the colon of each animal for histological studies. In the presence of UC, 400 mg/kg/day of T. polium extract was administered orally and transrectally [via enema] for 30 days in six of the dogs. The remaining two dogs were used as controls and did not receive T. polium. Multiple biopsies were taken 7, 14, and 30 days after discontinuation of T. polium in the same manner as before treatment. After administration of acetic acid, we noted the presence of multiple ulcers, diffuse inflammation, PMN infiltration in the lamina propria, glandular destruction and goblet cell depletion. Treatment with T. polium restored the colonic architecture with an increased number of healthy cells and a reduction in inflammatory cells. Damage of the surface epithelial cells and mucosal layer of the lumen were reversed, which lead to faster ulcer healing. T. polium may be a treatment choice for UC and can broaden the current therapy options for UC

Serum Antigen and Antibody Detection in Echinococcosis: Application in Serodiagnosis of Human Hydatidosis

Diagnosis of hydatidosis is based on immunodiagnostic methods along with radiological and ultrasound examinations. The objectives of the present study were to develop a specific and simple antigen-based ELISA method for diagnosis of hydatidosis and compare it with antibody detection method. The subjects in this study included 89 patients in the following groups: surgically confirmed hydatidosis patients (35 cases), control with other parasitic diseases (29 cases), and healthy controls (25 cases). Hyperimmune serum was raised against hydatid cyst fluid in rabbits. Anti-hydatid cyst IgG was purified by affinity chromatography using protein A column and labeled with horseradish peroxidase. Collected sera were assessed for hydatid cyst antigens and antibody by ELISA. Circulating hydatid antigen was found in 9 out of 35 patients with surgically confirmed hydatidosis. A sensitivity of 25.7% and a specificity of 98.0% were calculated for the antigen detection assay. Antibody detection by indirect ELISA, using antigen B, showed that 94.2% of patients (33 cases) have anti-hydatid cyst antibodies in their serum while cross reaction was noted in a few of non-hydatidosis patients. A sensitivity of 94.2% and specificity of 81.6% were found for the antibody detection assay. Findings of this study indicated that antibody detection assay is a sensitive approach for diagnosis of hydatid cyst while antigen detection assay might be a useful approach for assessment of the efficacy of treatment especially after removal of the cyst.

Ruptured Meckel's mesodiverticulum and Meckel's diverticulum following blunt abdominal trauma

To present a case of simultaneous rupture of Meckel's diverticulum and mesodiverticulum with abdominal pain following a blunt trauma to the abdomen, sustained during an automobile accident. Following a head-on automobile collision a 36-year-old man was referred to the emergency room with abdominal pain, guarding and rigidity and was taken to the operating theater with a preoperative impression of peritonitis due to rupture of a hollow viscus. Upon abdominal exploration, ruptured Meckel's diverticulum [from the base] and ileum with active bleeding from mesodiverticulum was found. The ileum was repaired in two layers: a segmental bowel resection including Meckel's diverticulum and the gastrointestinal tube anastomosed without any tension. The patient has a normal postoperative course. This case shows that a blunt abdominal trauma can tear the mesodiverticulum and rupture the Meckel's diverticular base simultaneously, resulting in hemoperitoneum and chemical peritonitis. Diagnosis and management of this type of injury are basically the same as those of acute surgical abdomen following trauma

In vitro protoscolicidal effects of hypertonic glucose on protoscolices of hydatid cyst

To evaluate the protoscolicidal effects of various concentrations of hypertonic glucose, live protoscolices of sheep were exposed to 10%, 15%, 25% and 50% glucose solutions. Cetrimide (0.5%), silver nitrate (0.5%) and hypertonic saline (20%) were used as positive controls, while physiological saline was used as a negative control. After 1, 2 and 5 min, the protoscolicidal effects were determined by 1% eosin. A 25% glucose solution had no significant protoscolicidal effect. However, a 50% glucose solution revealed higher protoscolicidal effect than 0.5% silver nitrate but weaker effect than 0.5% cetrimide; the effect was comparable with that of 20% hypertonic saline. The results showed that hypertonic glucose solution is highly effective in killing protoscolices of Echinococcus granulosus in vitro.

Assessment of electrotherapy in treatment of hemorrhoids in Southern Iran

In this study, we have developed an electrotherapy device in order to improve the outcome and decrease the number of referrals and duration of treatment of internal hemorrhoid. We treated 2015 hemorrhoids among 931 patients [382 males and 549 females]; 319 hemorrhoids were grade 1, 1158 grade 2 and 538 grade 3, from May 1995 to October 2002, at Nemazee and Faghihee Hospitals in Shiraz University of Medical Sciences, Shiraz, Iran. All patients were referred due to fresh rectal bleeding or reducible prolapsed hemorrhoid with no response to medical treatment. After introduction of anesthesia, 27-30 mAmp direct current was applied to each hemorrhoid with durations of 4.5 minutes for grade 1, 5.5 minutes for grade 2 and 7 minutes for grade 3. Our results showed that 97.1% of patients responded well to the treatment and 27 patients returned with fresh rectal bleeding or prolapsed hemorrhoid in 2 weeks to 2 months postoperatively. Ninety-six% of the patients were discharged on the same operating day. After 24 hours postoperation, 92% of the patients had no any pain and no need any analgesic. Among those patients who had not responded to the treatment; 24 cases underwent electrotherapy for a 2nd time and 3 patients were treated excising their prolapsed hemorrhoids. No other complications were detected. Postoperative pain was mild and tolerable and 93.2% of patients returned to normal activity after 2 days. Electrotherapy with the above mentioned method is considered safe and effective without any major complications and with acceptable patient's satisfaction. This method can be used for treatment of grades 1, 2 and 3 hemorrhoids