Introduction of a handmade vacuum-assisted sponge drain for the treatment of anastomotic leakage after low anterior rectal resection

Purpose@#Anastomotic leakage, a known major postoperative complication, potentially leads to readmission, reoperation, and increased mortality rates in patients, such as rectal cancer patients following a low anterior resection (LAR). Currently, vacuum-assisted closure, as featured by B-Braun (B-Braun Medical B.V.), is already being used for the treatment of gastrointestinal leakages and fistulas. The main aim of this study was to introduce a novel method for creating a vacuum-assisted drain for the treatment of anastomotic leakage after LAR. @*Methods@#All 10 patients, who underwent LAR surgery from 2018 to 2019, were diagnosed with anastomotic leakage and had received neoadjuvant chemotherapy prior to surgery. Therefore, patients were treated with a handmade vacuum-assisted drain and were revisited every 5 to 7 days for further evaluations and drain replacement until leakage resolution. Physical features of cavity, time of diagnose, and duration of treatment were analyzed correspondingly. The handmade vacuum-assisted sponge drain was prepared for each patient in each session of follow-up. @*Results@#Eight out of 10 patients experienced complete closure of the defect. The mean delay time from the day of operation to the diagnosis of anastomotic leakage was 61.0±80.4 days while the mean time for leakage closure was 117.6±68.3 days. Eventually, 7 cases underwent ileostomy reversal with no complications during a 3-month follow-up. @*Conclusion@#In this study, we evaluated the healing process of anastomotic leakage after the usage of a handmade vacuum-assisted sponge drain in a case series method. In our trial, we provided an innovative cost-benefit method easily applicable in the operating room.

Down-regulation of ribosomal S6 kinase RPS6KA6 in acute myeloid leukemia patients

Objective: Signaling pathways such as extracellular regulated kinase/mitogen activated protein kinase [ERK/MAPK] have increased activity in leukemia. Ribosomal 6 kinase [RSK4] is a factor downstream of the MAPK/ERK pathway and an important tumor suppressor which inhibits ERK trafficking. Decrease in RSK4 expression has been reported in some malignancies, which leads to an increase in growth and proliferation and eventually poor prognosis. In this study we measured RSK4 expression rate in acute myeloid leukemia [AML]

Materials and Methods: This cross-sectional study was undertaken in 2013-2014 at Ghaem Hospital in Mashhad, Iran, on 40 AML patients and 10 non-AML patients as the control group. The expression rate was measured by real-time polymerase change reaction [PCR] and employing the ??CT method. Data were analyzed using Mann-Whitney and Spearman tests using SPSS [version 11.5]

Results: Expression rate of RSK4 was significantly decreased in the AML group in comparison with the non-AML group [P<0.001]. There was also a significant decrease in RSK4 expression in AML with t[15;17] in comparison to other translocations [P=0.004]

Conclusion: We detected a down-regulation of RSK4 in AML patients. This may lead to an increase in the activity of the ERK/MPAK pathway and exacerbate leukemogenesis or the prognosis of the patients

Role of oxidative stress in modulating unfolded protein response activity in chronic myeloid leukemia cell line

Background: Recently, it has been revealed that tyrosine kinase inhibitors [TKIs] act through inducing both oxidative and endoplasmic reticulum [ER] stress in chronic myeloid leukemia cells. However, ER stress signaling triggers both apoptotic and survival processes within cells. Nevertheless, mechanisms by which TKIs avoid the pro-survival effects are not clear. The aim of this study was to evaluate the potential role of oxidative stress in activity of unfolded protein response [UPR] survival pathway within K562 cell line

Methods: The expression of UPR survival target genes, Xbpl, and Grp94 [glucose requiring protein 94] was studied in single and combined exposure to oxidative and ER stress in K562 cell line by quantitative and qualitative PCR

Results: The expression of UPR-related survival gene Grp94 was hampered by exposing to oxidative stress in cell induced with ER stress

Conclusion: Interaction of oxidative and ER stress may role as a mediator influencing UPR signaling activity

Frequency of FLT3 ITD and FLT3 TKD mutations in multiple myeloma patients [a case control study]

Background and Aims: multiple myeloma is a malignant proliferation of plasma cells derived from a single clone. The tumor, its products and the host response lead to organ damages. Some factors that are responsible in its pathogenesis are recognized. As FMS like Tyrosine Kinase 3 receptor [FLT3] mutation has been proved as a determining factor in leukemic patients; the goal of this study was to find association of FLT3 internal tandem duplication [ITD] and FLT3 tyrosine kinase domain [TKD] mutations with multiple myeloma

Materials and Methods: this case-control study was conducted on 60 paraffinembedded bone marrow biopsies [30 multiple myeloma and 30 normal bone marrow specimens] in the pathology departments of Ghaem and Imam Reza hospitals in Mashhad. After sections preparation, DNA was extracted and two PCR reactions were set up for detection of FLT3/ ITD and FLT3/TKD mutations

Results: the Mean age of samples was 64+/-10 years. No FLT3 mutations were detected in multiple myeloma patients

Conclusion: our findings showed that occurrence of FLT3 mutations seem unusual in multiple myeloma

Platelet volume indices in patients with varicocele / 대한생식의학회지

OBJECTIVE: This study sought to evaluate platelet volume indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR]) in varicocele patients, and compare it with platelet volume parameters in healthy controls. METHODS: This cross-sectional study involved 2 groups: group 1 included 51 varicocele subjects and group 2 consisted of 50 healthy control subjects of similar ages. Peripheral venous blood samples were collected with ethylenediaminetetraacetic acid-K2 anticoagulant between 8:30 AM and 10 AM following an overnight fast. Platelet volume parameters (MPV, PDW, and P-LCR) were measured in both groups within 2 hours of sampling. RESULTS: The mean PDW, MPV, and P-LCR were 13.9+/-2.5%, 10.1+/-1.3 fL, and 27.3+/-7.8% in varicocele patients, respectively, and were 12.6+/-2.4%, 9.3+/-1.1 fL, and 21.9+/-6.4% in the control group, respectively. The mean PDW, MPV, and P-LCR were significantly higher in the varicocele group than the control group. CONCLUSION: The results of the present study suggest that vascular components may play an important role in the pathophysiology of varicocele; therefore, there is a great need for prospective studies to confirm this relationship.

Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

Delorme's Procedure: An Effective Treatment for a Full-Thickness Rectal Prolapse in Young Patients

PURPOSE: Delorme's procedure is infrequently applied in young adults because of its assumed higher recurrence rate. The aim of this prospective study was to assess the efficacy of the Delorme's technique in younger adults. METHODS: Fifty-two consecutive patients were entered in our study. We followed patients for at least 30 months. Their complaints and clinical exam results were noted. RESULTS: Our study included 52 patients (mean age, 38.44 years; standard deviation, 13.7 years). Of the included patients, 41 (78.8%) were younger than 50 years of age, and 11 (21.1%) were older than 50 years of age. No postoperative mortalities or major complications were noted. Minor complications were seen in 5 patients (9.6%) after surgery. The mean hospital stay was 2.5 days. In the younger group (age 50 years), fecal incontinence was improved in 20% (1 out of 5 with previous incontinence) of the patients, and recurrence was seen in 18.2% (2 patients). In 50% of the patients with a previous recurrence (3 out of 6 patients) following Delorme's procedure as a secondary procedure, recurrence was observed. CONCLUSION: Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases.

Pulsatility index in aortic coarctation: a possible way to evaluate factors affecting stenting outcome

The pulsatility index [PI] shows continuous blood flow to the end organs and is a significant factor believed to decrease in aortic coarctation. Correction of this factor is of great importance in the treatment ofstenotic lesions of the aorta. However, there are minimal data regarding the trend of changes in the PI after stent implantation. Furthermore, the association between the PI and other echocardiographic indices in patients undergoing stent implantation is unclear. This study was designed to evaluate changes in the PI following stenting and its correlation with other echocardiographic indices. Twenty-three patients with a diagnosis of aortic coarctation consecutively underwent two-dimensional and Doppler echocardiographic imaging modalities twice [before and after stenting]. The patients were divided into two groups based on the percentage of increase in the PI after stenting [ 50%]. The relation between the post-stenting PI and the baseline echocardiographic indices was assessed. The PI was increased from 0.89 [SD = 0.30] to 1.75 [SD = 0.51] after stenting [p value < 0.001]. Baseline diastolic/systolic velocity [D/S velocity] ratio of the abdominal aorta [p value = 0.013], mean velocity [p value = 0.033], and peak gradient of the descending aorta [p value = 0.033] were significantly higher in the patients with >/= 50% increase in the PI after stenting. Our findings showed that elevation in the PI after stenting was a predictable criterion in patients with aortic coarctation: it was predicted by some baseline clinical and echocardiographic indices. Baseline D/S ratio velocity of the abdominal aorta, mean velocity and peak gradient of the descending aorta, and baseline systolic blood pressure were the statistically significant indices to predict >/= 50% increase in the PI in our patients

Impact of morphine dependency on secondary intention wound healing in rat

Wound healing has always been among important and crucial subjects in medicine. Morphine dependency has also been a social and health problem in the Middle East. This study was aimed to investigate the effects of morphine dependency on pro-inflammatory and fibroblast cell recruitment, as well as reepithelialization and the revascularization processes involved in secondary intention wound healing in rats. A full-thickness wound [2×2 cm in diameters] was created on the dorsum of two groups of rats, a control group and a second group consisted of morphine dependent rats. During the first 14 days of post wounding the wound was excised consecutively at priorly planned days with peripheral margins of normal skin. The specimens were evaluated by two pathologists, who were blind to the study design, and the cellular population, re-epithelialization and revascularization were reported by them. Histological examination of the wound tissue showed evidence of increased population of fibroblasts and a plateau or decreased recruitment of macrophage and neutrophile cells. In the dependent group re-epithelialization was observed to be enhanced significantly in comparison to the control group while having an inhibitory effect on revascularization. The present study demonstrates that morphine dependency enhances re-epithelialization as well as tissue recruitment of fibroblasts; thereby probably enhancing secondary intention wound healing

Management of treadmill hand injuries using soft tissue distraction

In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a ; metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age. In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients. In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed. A total of 8 patients [3 girls and 5 boys] following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just l patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers. Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients

Soft tissue distraction using pentagonal frame for long-standing traumatic flexion deformity of interphalangeal joints / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Interphalangeal joint contracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction with no collateral ligament transection or volar plate removal in comparison with traditional operation of contracture release and partial ligament transection and volar plate removal.</p><p><b>METHODS</b>In this prospective study, a total of 40 patients in two equal groups (A and B) were studied. Patients suffering from chronic flexion contracture of abrasive traumatic nature were included. Group A were treated by soft tissue distraction using pentagonal frame technique and in Group B the contracture release was followed by finger splinting.</p><p><b>RESULTS</b>Analyzed data revealed a significant difference between the two groups for range of motion in the proximal interphalangeal joints (P less than 0.05), while it was not meaningful in the distal interphalangeal joints (P larger than 0.05). There was not a significant difference in the degrees of flexion contracture between groups (P larger than 0.05). Regression analysis showed that using pentagonal frame technique significantly increased the mean improvement in range of motion of proximal interphalangeal joints (P less than 0.001), while the higher the preoperative flexion contracture was observed in proximal interphalangeal joints, the lower improvement was achieved in range of motion of proximal interphalangeal joints after intervention (P less than 0.001).</p><p><b>CONCLUSION</b>Soft tissue distraction using pentagonal frame technique with gradual and continuous collateral ligament and surrounding joint tissues distraction combined with skin Z-plasty significantly improves the range of motion in patients with chronic traumatic flexion deformity of proximal and/or distal interphalangeal joints.</p>

Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a widespread chronic health condition which is significantly more prevalent in women. We conducted a gender difference analysis by comparing findings of men and women to determine whether any significant differences exist or not. METHODS: This single-center study was conducted in Tehran, Iran during 2009-2010. IBS was diagnosed on the basis of Rome III criteria. A simple "10 point" objective questionnaire was used. RESULTS: A total number of 144 IBS patients including 44 (30.6%) males and 100 (69.4%) females with the mean age of 37.50 +/- 11.50 years, were assessed. The only differently observed symptom was nausea which was significantly more prevalent in females (49% vs 18.2%, P < 0.001). The commonest subtype of IBS in male patients was diarrhea predominant IBS (38.6%); while, constipation predominant IBS was the most frequent type among females (38%). Moreover, the frequency of loose, mushy or watery stools within the last 3 months was significantly higher among males (2.11 +/- 1.67 vs 1.37 +/- 1.50, P = 0.009). CONCLUSIONS: We report that gender is important in IBS. Although qualitative comparison of different subtypes of IBS between male and female failed to meet the statistically significant level, the answers to the corresponding questions of ROME III IBS module suggest the higher prevalence of bowel movements and looser stool in males. Moreover, nausea was reported more often by females.

Role of the Lewis and ABO Blood Group Antigens in Helicobacter pylori Infection

Background: Helicobacter pylori infection is a major risk factor for chronic gastritis and gastric cancer. Some findings show increased frequencies of these diseases in individuals with type O blood and in secretors (expressing Leb antigen), but other studies have not found any relationship between blood groups and this infection. Given that H. pylori infection and gastric cancer are common in Iran, the assessment of the pathogenesis of this infection in relation to these blood groups could be valuable. Methods: In a cross-sectional study, we determined the ABO and Lewis blood groups of participants using the tube method and evaluated the level of anti-H. pylori immunoglobulin G using an enzyme-linked immunosorbent assay. This study included 171 Iranian blood donors from Mashhad, Iran, during 2010. The significance of the differences in the frequencies of the Lewis and ABO phenotypes between individuals infected with and without H. Pylori infection were tested using the chi-square test. A P-value < 0.05 was considered significant. Results: H. pylori infection was found in 76.6% of the study subjects (n = 131). The most common ABO blood group was O (33.9%), and the most common Lewis blood group was Le(a-b+) (54.7%). The frequencies of the ABO, Lewis, and secretion phenotypes were not significantly different between the infected and uninfected subjects. Conclusion: We did not find any significant relationship between the Lewis, ABO, and secretion phenotypes and H. pylori infection.

[Treatment of upper limb deformities using soft tissue distraction: an introduction to pentagonal frame]

Soft tissue distraction is an increasingly accepted treatment method in hand surgery which can be applied as a method of contracture release from elbow to proximal phalangeal joints. Common methods have been shown that contracture release alone is not enough and leads to recurrence after a while. Currently, joint and soft tissue distraction and holding them in a proper position in which physiotherapy can be done is the most accepted method. Herein we present a technique named "pentagonal frame" for soft tissue distraction which can help us in reaching the desired outcome. As a result of novelty of this technique and lack of enough data regarding its outcome, we would like to report its treatment results in this article. In this case series study, we report 33 patients that presented with soft tissue contracture in their hands. In this method, a thin 1-1.5 mm Kirschner wire was passed horizontally at the proximal head of the distal phalanx and bent like a frame around the finger, forming a pentagonal shape for anchorage and allowing limb traction without damage to pulp and soft tissues. Two forms of traction were performed: static [with a wire exerting pressure] or dynamic [using a rubber band to adjust the tension]. The wire or rubber band may be temporarily freed to commence active and passive physiotherapy. We maintained the frame for 3-6 weeks which played the role of night splint within final weeks. SPSS V.16 was used for data analysis. In this study, 33 patients [23 male, 10 female] with a mean age of 20.91 years [SD=13.05] were evaluated. The patients underwent surgery for a mean of 3 times. After the surgery and removing the frame, patients were followed up every 6 months for a maximum of 5 years. The difference between flexion contracture in PIP, before and after the surgery was statistically significant [65.15 +/- 37.44 vs. 7 +/- 4.74, p<0.001]. Except for one case of pin infection that was treated using antibiotic administration and its removal, no other major complications were encountered during the follow-up period [3-5 years]. The pentagonal frame with its effective traction on soft tissues and ligaments and additional physiotherapy may be used as an effective treatment for soft tissue adhesions. Moreover, it provides traction to the fingers and even the hand without complications on distal phalanx and joints and allows concurrent physiotherapy

Persistent sciatic artery presenting as blue toe: diagnostic dilemma

A persistent sciatic artery [PSA] results from lack of regression of the fetal arterial blood supply of the leg and is often combined with an abnormally developed superficial femoral artery. Here in we would like to present a 63 year old woman presenting for the first time with blue toe and on further evaluation diagnosis of PSA was made. Our case illustrates that a complete physical examination and comprehensive evaluation of the peripheral arterial system of the lower limb including possible persistence of sciatic artery is essential in patients presenting as blue toe before embarking on a surgical or other type of interventional procedure

Peripheral Blood Lymphocyte Subset Counts in Pre-menopausal Women with Iron-Deficiency Anaemia

Background: Iron-deficiency anaemia (IDA) is a major worldwide public health problem. Children and women of reproductive age are especially vulnerable to IDA, and it has been reported that these patients are more prone to infection. This study was done to evaluate alteration of lymphocyte subgroups in IDA. Methods: In this prospective study, we investigated lymphocyte subsets in pre-menopausal women with iron-deficiency anaemia; 50 normal subjects and 50 IDA (hypochromic microcytic) cases were enrolled. Experimental and control anticoagulated blood samples were evaluated using flow cytometry to determine the absolute and relative numbers of various lymphocyte subgroups. Finally, the results of the patient and control groups were compared. Results: Mean (SD) absolute counts of lymphocytes, CD3+ cells, CD3+/CD4+ subsets (T helper) and CD3+/CD8+ subsets (T cytotoxic) in the patient group were 2.08 (0.65) x 109/L, 1.53 (0.53) x 109/L, 0.87 (0.28) x 109/L, and 0.51 (0.24) x 109/L, respectively. The results showed significant differences between case and control groups in mean absolute counts of lymphocytes (P = 0.014), T lymphocytes (P = 0.009), helper T cells (P = 0.004), and cytotoxic T cells (P = 0.043). Conclusion: This study showed that absolute counts of peripheral blood T lymphocytes as a marker of cell-mediated immunity may be decreased in pre-menopausal women with iron-deficiency anaemia, and that these patients may be more prone to infection.

Extensive subcutaneous emphysema due to colonic perforation following colonoscopy

During colonoscopy, subcutaneous emphysema may occur as a result of colonic perforation into retroperitoneal area. In this report, a 54-year-old woman with sigmoid colon perforation following colonoscopy is described. Subcutaneous emphysema was the first manifestation of the perforation in this case. Initially, the patient received supportive, non-surgical treatment, but due to development of acute abdominal signs and symptoms in later stages, the patient underwent surgical treatment

[Association between the level of HbA1c and serum lipids profile in type 2 diabetic patients]

Impaired lipid metabolism in diabetic patients is implicated in cardiovascular complications. The aim of this study was to evaluate the effect of glycemic control on the lipid profile of type 2 diabetic patients. This study was performed at Emam Reza Hospital, Mashhad, Iran, in 2006. A total of 357 adults with type 2 diabetes [144 males and 213 females] were evaluated. This study was approved by the local committee of medical Ethics. in the standard condition, the sera analysed for fasting blood glucose [FBG] by glucose oxidase method, and for total cholesterol, triglyceride, high density lipoprotein cholesterol [HDL-C] and low density lipoprotein cholesterol [LDL-C] by enzymatic methods, and for HbA1c by chromatography method. The data analyzed by [SPSS, version 11.5], Pearson's correlation test, t test and one- way analysis of variance. P values