Two different gracilis loops in graciloplasty of congenital fecal incontinence: comparison of the therapeutic effects.

PURPOSE: The aim of this study was to compare the clinical effect of graciloplasty using two different gracilis encircled loops for the treatment of fecal incontinence after anoplasty for imperforate anus. METHODS: From January 2009 to January 2012, 38 patients were treated by graciloplasty. The patients were randomly divided into two groups, one group consisting of 18 cases underwent the "γ-loop" and the other group consisting of 20 cases underwent the "υ-loop." All patients underwent postoperative defecation training and regular follow-up. All patients were evaluated via Wexner score and anal manometry (including anal resting pressure, anal maximal squeeze pressure, duration of anal squeeze, and rectal maximum tolerable volume) before and after graciloplasty. In addition, it was assessed whether the patients had difficulty defecating while squatting after surgery. RESULTS: The surgeries on the 38 patients were accomplished successfully. There were no differences in postoperative complications between the two groups (P > 0.05). The Wexner score and anal manometry parameters of the two groups were gradually improved after operation. The generalized estimating equation results of the Wexner score indicated that the difference of measurement time was statistically significant (P < 0.05) but the difference of measurement group was not statistically significant (P > 0.05). The results of anal manometry parameters using repeated measures ANOVA indicated that differences between different time points were statistically significant (all P < 0.05) but differences between different surgery groups were not statistically significant (all P > 0.05). Regarding the postoperative defecating difficulties while squatting, the probability of occurrence in the "γ-loop" group was significantly higher than that in the "υ-loop" group. The difference between the two groups was statistically significant (P < 0.05). CONCLUSIONS: Graciloplasty with different gracilis loops can improve anal function in patients. However, "υ-loop" can significantly improve difficulties in defecating while squatting.

[Prognostic analysis of 40 cases with rectal gastrointestinal stromal tumor].

OBJECTIVE: To analyze the prognosis of rectal gastrointestinal stromal tumors (GIST). METHODS: Records of 40 patients diagnosed as rectal GIST at the Affiliated Chinese Traditional Medical Hospital of Xinjiang Medical University and the People's Hospital of Tianjin City between June 1979 and June 2010 were reviewed. Clinical features, treatment modalities and outcomes were analyzed. RESULTS: There were 23 males and 17 females with a median age of 54.5 years old (range, 28-81 years old). During the follow-up(median 52.5 months, range 1-300 months), 18 patients developed recurrence including 7 local recurrence, 6 metastasis and 5 local recurrence complicated with metastasis. The overall survival rates at 1, 3 and 5 years were 82.5%, 60.0%, and 42.5% respectively. On univariate analysis, tumor size(P<0.01), Fletcher classification(P<0.01), mitotic index(P<0.01), and post-operative distant metastasis were associated with survival. Multivariate analysis showed that tumor size(P<0.05), mitotic rate (P<0.01), and postoperative distant metastasis(P<0.01) were independent prognostic factors associated with survival. CONCLUSIONS: Surgery is the main treatment for rectal GIST. Tumor size, mitotic rate and metastasis are independent prognostic factors in patients with rectal GIST.

[Diagnosis and treatment of sacrococcygeal teratoma in adults: analysis of 17 cases].

OBJECTIVE: To investigate the diagnosis and treatment of sacrococcygeal teratoma in adults. METHODS: The clinical data of 17 patients with sacrococcygeal teratoma confirmed by pathological examination, 9 males and 8 females, aged 20 - 53, were analyzed retrospectively. RESULT: Correct diagnosis was made pre-operatively in 13 of the 17 patients. Two cases were misdiagnosed as with leiomyoma, and 2 cases as with sacrococcygeal cyst. Pathological examination confirmed the diagnosis of teratoma in all 17 cases. Thirteen patients were followed up for 1 - 5 years post-operatively. Malignant change was seen in 1 case, and 1 patient died 1 year after operation. Two patients suffered a relapse and then fully recovered after re-operation, and the other 15 patients all recovered without relapse. CONCLUSION: Sacrococcygeal teratoma in adults usually has no typical clinical symptom and signs and is often misdiagnosed. The pathologic examination is the base to make a definite diagnosis. Complete excision is necessary to prevent local recurrence and potential malignant transformation. The sacrococcygeal approach or combined abdominal-sacral approach is recommended.

Clinical and molecular analysis of hereditary non-polyposis colorectal cancer in Chinese colorectal cancer patients.

AIM: To analyze the frequency of hereditary non-polyposis colorectal cancer (HNPCC) in Chinese colorectal cancer (CRC) patients, and to discuss the value of microsatellite instability (MSI) and/or immunohistochemistry (IHC) for MSH2/MLH1 protein analysis as pre-screening tests in China. METHODS: The Amsterdam criteria I and II (clinical diagnosis) and/or germline hMLH1/hMSH2 mutations (genetic diagnosis) were used to classify HNPCC families. Genetic tests, including microsatellite instability, immunohistochemistry for MSH2/MLH1 proteins and hMSH2/hMLH1 genes, were performed in each proband. RESULTS: From July 2000 to June 2004, 1988 patients with colorectal cancer were analysed and 114 CRC patients (5.7%) from 48 families were categorized as having HNPCC, including 76 from 26 families diagnosed clinically and 38 from the other 22 families diagnosed genetically. The sensitivity and specificity of high MSI and IHC for predicting mutations were 100% and 54%, and 79% and 77%, respectively. CONCLUSION: The frequency of HNPCC is approximately 10% among all Chinese CRC cases. The MSI and IHC detections for hMSH2/hMLH1 proteins are reliable pre-screening tests for hMLH1/hMSH2 germline mutations in families suspected of having HNPCC.