Chemoradiation for anal squamous cell carcinoma: case report.

INTRODUCTION: Anal squamous cell carcinoma is rare and seems to be associated with chronic inflammatory conditions, infections and immunosuppression. Their incidence has been arising since the last 25 years. Compared to adenocarcinoma of the rectum and squamous cell cancer of the anal canal, squamous cell carcinoma is a distinct entity with a different etiology, pathogenesis, prognosis and requires a different therapeutic approach. Even if surgery remains the main therapeutic option, recent advances have made chemoradiation a valuable therapeutic addition. This case discuss the efficacy of chemoradiation wich can prevent complications and can improve the quality of life. CASE REPORT: A 63-year-old woman presented with history of bloody stool for the last past month. The colonoscopy showed a 2 cm circular lesion on the posterior wall of the anal canal. Biopsy was positive for squamous cell carcinoma and afterwards the patient underwent chemoradiation. At 1 year of follow-up the patient is disease free, with a good sphincter control and had no late complications. CONCLUSION: Since the first studies in 1974, chemoradiation seems to be a good option for most patients with squamous cell carcinoma avoiding surgery.

Evaluation of the gastro-oesophageal junction: defining the incompetent cardio-oeosophageal angle non-invasively with ultrasound and computerized tomography.

This study aimed to demonstrate the presence of gastro-oesophageal reflux disease (GORD) non-invasively using ultrasound (US) and computerized tomography (CT). Intra-abdominal oesophageal length (IAOL) and cardio-oesophageal angle (COA) were measured by US in 25 patients with known reflux and in 25 healthy subjects (control group). CT images of 42 patients with reflux disease and 44 controls were reviewed retrospectively, and IAOL and COA were measured on curved multiplanar format images. Using a cut-off value for IAOL of 20.5 mm, the sensitivity to detect GORD with US was 96% and the specificity was 80% and, with CT, the sensitivity was 95% and the specificity was 78%. A cut-off value of 138.5° for COA yielded sensitivity and specificity values for GORD detection of 76% and 72% with US and 83% and 80% with CT, respectively. In conclusion, with equivocal diagnostic findings, IAOL and COA are useful parameters that can be determined non-invasively by US or CT and may aid diagnosis and treatment choices for patients with suspected GORD.

The effect of neostigmine on postoperative ileus and the healing of colon anastomoses.

OBJECTIVES: The aim of this study was to assess the effects of neostigmine on the postoperative ileus and the healing of colon anastomoses. BACKGROUND: Anastomotic leaks and postoperative ileus are among the most important complications in colorectal surgery. Nutritional status of the patient is one of the most important factors of the anastomoses healing. METHODS: Forty Wistar-albino rats were randomly assigned to (1) colon anastomoses + protein-enriched diet + 1 microg neostigmine, (2) colon anastomoses + protein-enriched diet, (3) colon anastomoses + 30 % dextrose + 1 microg neostigmine, (4) colon anastomoses + 30% dextrose. Body weights, quantities of the consumed products and feces weight change were measured at the first and second 48 hours postoperatively. All rats were sacrificed on the 5th postoperative day. Then, the healing of anastomosis was evaluated by measuring of body weights, burst pressure and hydroxyproline level. RESULTS: There were significant differences between the groups 1 and 2 (p < 0.001), and the groups 3 and 4 regarding the preoperative and postoperative mean weight (p < 0.001). The group 2 did not show any weight loss, whereas the group 1 demonstrated a significant weight gain (p < 0.001). The group 4 showed a significant weight reduction compared to the preoperative period, while the group 3 exhibited a significantly lower weight loss compared to the group 4 (p < 0.001). There were significant differences regarding the burst pressure and hydroxyproline level values of groups with and without neostigmine administration (p < 0.001). CONCLUSION: Starting the early intake of nutrition with neostigmine in the postoperative period reduced the postoperative ileus and increased the healing of colon anastomoses (Tab. 4, Fig. 5, Ref. 27).

Nodule or pseudonodule? Differentiation in Hashimoto's thyroiditis with sonoelastography.

Fine needle aspiration biopsy (FNAB) is the gold standard for the diagnosis of lymphoma in Hashimoto's thyroiditis and is able to differentiate between benign, inflammatory or malignant nodules, classifying them as either true nodules or pseudonodules. This technique is, however, invasive. The present study aimed to differentiate pseudonodules from true nodules by sonoelastography, a non-invasive technique, in 54 patients with Hashimoto's thyroiditis. The accuracy of sonoelastography to differentiate between true or pseudonodules was compared with the gold standard FNAB and with grey scale ultrasonography. The nodules were categorized into three groups: non-demarcated hypoechogenic, demarcated hyperecho genic, and demarcated hypoechogenic. Sono elastography findings were concordant with the cytopathological results and demonstrated that sono elastography was able to detect true thyroid nodules often misdiagnosed by conventional grey scale ultrasonography. Sonoelastography was found to have increased sensitivity for true nodule diagnosis compared with conventional grey scale ultrasonography and may eliminate unnecessary FNABs being carried out.

Sirolimus for rescue of steroid and anti-thymocyte globulin-resistant recurrent acute rejection after liver transplantation: report of one case.

Sirolimus (SRL) not only displays prophylactic activity, it also reverses acute rejection (AR) in humans with ongoing refractory renal allograft rejection and chronic liver allograft rejection. The present case of a human liver allograft recipient documents the utility of SRL therapy for a patient experiencing ongoing resistant recurrent AR just after orthotopic liver transplantation (OLT) and liver dysfunction that had not abated after treatment with corticosteroids and antilymphocyte globulin. SRL was added to the mycophenolate mofetil/steroid regimen to treat the ongoing rejection. The patient was rescued with SRL, not experiencing AR again. To date the patient has exhibited no significant side effects after more than 6 months of SRL therapy and his clinical and general condition have been good; he is completely involved in daily life. SRL is a new and safe immunosuppressive agent for rescue in patients with early OLT and recurrent AR.

Primary epiploic appendagitis: the role of computed tomography in diagnosis.

Primary epiploic appendagitis is a rare entity that occurs due to torsion and inflammation of the epiploic appendages. Clinically, this entity may be mistaken for acute abdomen with resultant unnecessary surgery. In contrast to acute surgical abdomen, epiploic appendagitis usually does not require surgical treatment; most of the patients resolve with conservative management. Diagnosis can be achieved with imaging modalities of which computed tomography is the gold standard procedure. Herein, a patient who presented with acute abdomen like clinical picture, with the computed tomography demonstration of primary epiploic appendagitis, is presented.