Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome

PURPOSE

Hemorrhoids are the most common benign anorectal diseases. Mucopexy strengthens the anal canal mucosa, which can be performed alone or in combination with Doppler-guided hemorrhoidal artery ligation (DG-HAL). In this study, we compared the postoperative complications between simple mucopexy plus HAL with and without a Doppler guide.

METHODS

This study was performed as a single-blinded randomized clinical trial. Patients referred to a tertiary colorectal referral clinic with grades 3 and 4 hemorrhoids who were candidates for surgical intervention entered the study. Thirty-six patients were randomly divided into 2 groups. Group A including 18 patients underwent mucopexy and DG-HAL and the other 18 patients (group B) underwent standard mucopexy and HAL without a Doppler guide. Postoperative pain score and the duration of oral analgesic consumption were recorded. Additionally, postoperative symptoms and complications were recorded and compared between the 2 methods.

RESULTS

There was no significant difference between the 2 groups in terms of pain score and the duration of postoperative analgesic consumption as well as the incidence of postoperative complications. Besides, the primary grade of hemorrhoids was not significantly associated with recurrence, but there was a significant association between body mass index and Wexner score (WS) with recurrence. The mean WS of patients showed a significant decrease in both groups postoperatively. However, the rate of WS reduction was not remarkably different between the 2 groups.

CONCLUSION

Simple mucopexy with blind HAL (without Doppler guide) might be considered for the treatment of grades 3 and 4 hemorrhoids effectively.

Minimal invasive management of proximal small bowel bleeding: A case report and reviewing the evidences

Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinely visited in emergency departments. Although most of these patients are managed with endoscopic modalities, some of them are managed with surgical interventions. Most of emergency surgical interventions are done via laparotomy. With evolution in minimal invasive surgery, the role of laparoscopic surgeries in emergency settings is on a rise. Case Presentation: In this report we describe a case of lower gastrointestinal bleeding that was presented with melena and during workups no bleeding lesion was detected in colon, stomach or duodenum. Further investigations revealed bleeding of proximal jejunum mass that was resected with the laparoscopic approach which is rarely used in the emergency management of patients with gastrointestinal bleedings. Also, resection and anastomosis of proximal jejunal loop was challenging in this case. Conclusion: This report is intended to describe the feasibility of laparoscopy in proximal small bowel lesion resection in emergency settings as well as the role of computed tomography (CT) angiography in detecting the source of obscure gastrointestinal bleeding.

Prognostic Factors of Recurrence and Survival in Operated Patients with Colorectal Cancer

BACKGROUND: The recurrence of colorectal cancers is considered to be one of the greatest post-surgical complications that is affected by various factors. This study was designed to investigate the prognostic factors that affect the recurrence and survival of patients with colon and rectal cancers. METHODS: A retrospective study was performed on 380 patients with colorectal cancers who underwent surgery were enrolled in the study (152 patients with colon cancer and 228 patients with rectal cancer). Preoperative serum albumin level, type of surgery, tumor size, differentiation grade, proximal, distal and radial, and marginal involvement, the total number of excised lymph nodes, the number of involved lymph nodes, and tumor stage were recorded. Also, the incidences of recurrence and metastasis were recorded during the study. RESULTS: 380 patients with a mean age of 57.11 years were enrolled in the study. 152 patients with an average age of 57.57 years were diagnosed as having colon cancer. Recurrence and metastasis occurred in two patients (1.3%) and five patients (3.3%), respectively. 18 patients (11.8%) died because of colon cancer. 228 patients with a mean age of 56.81 had rectal cancer. Recurrence was seen in 19 patients (8.3%) and metastasis in 33 patients (14.5%). 38 patients (16.7%) died because of rectal cancer. Tumor size and involved lymph nodes were independent prognostic factors for the recurrence and metastases of colon cancer. Only involved lymph nodes were associated with death due to colon cancer. Independent prognostic factors for rectal cancer metastasis include serum albumin level and age. The total number of excised lymph nodes was the only predictor of tumor recurrence and death in rectal cancer. The median survival times of colon and rectal cancers were 90 and 110 months, respectively. CONCLUSION: The size of the tumor and the number of involved lymph nodes were independent prognostic factors for recurrence and metastasis of colon cancer. Also, the number of involved lymph nodes was associated with colon cancer-related deaths. In the case of rectal cancer, serum albumin levels and age predicted metastases. Only the total number of excised lymph nodes had a reverse relationship with recurrence and rectal cancer-related death.

Microniosomes for concurrent doxorubicin and iron oxide nanoparticles loading; preparation, characterization and cytotoxicity studies

The current work deals with developing a suitable drug delivery system of doxorubicin (DOX) for intraperitoneal chemotherapy using niosomes through formulating non-ionic surfactants consisting of Brij™ 52, span™ 60 and Solulan™ C24. Entrapping the magnetite nanoparticles in the hydrophilic parts of niosomes was accompanied with high-efficient DOX loading by the current novel remote-loading method. Cytotoxicity of the prepared formulations was evaluated in vitro against A549 and PC-12 cell lines using the colorimetric WST-1 assay test. The obtained results revealed that, the cytotoxicity of DOX increased up to 22% especially on A549 cells by the current delivery system.

Pulling Seton: Combination of mechanisms

BACKGROUND

Seton-based techniques are among popular methods for treating high type anal fistula. These techniques are categorized to cutting and noncutting regarding their mechanism of action. In this report we are about to describe a new technique, which is a combination of both mechanisms; we call it Pulling Seton.

MATERIALS AND METHODS

In this technique after determining internal and external orifice of fistula, fistulectomy is done from both ends to the level of external sphincteric muscle. Finally, a remnant of fistula, which remains beneath external sphincteric muscle is excised, and Seton is passed instead of it and tied externally. After the wound heals, patient is asked to pull down the Seton for 3-4 min, 4 times a day. We prospectively enrolled 201 patients with high type anal fistula in this study.

RESULTS

Seton gradually passes through external sphincteric muscle till it is displaced outwards or removed by a surgeon via a small incision. 94% of patients treated by this method accomplished their treatment completely without recurrence. None of the patients developed permanent fecal or gas incontinence. Only 5% of patients developed with recurrence of fistula. Since Seton traction is not permanent in this technique, Seton cuts external sphincter slowly, and minimal rate of incontinence is reported.

CONCLUSION

Pulling Seton seems to be an efficient way in treating high type anal fistula with minimal rate of recurrence and complications such as incontinence and authors suggest further randomized studies to compare its efficacy with other Seton-based techniques.

Incidence of hepatocellular carcinoma in southeast iran

BACKGROUND AND AIMS

Hepatocellular carcinoma (HCC) is a well-known consequence of chronic liver disease (CLD). The aim of this study was to extract the HCC incidence rate in the province of Kerman, located in southern part of Iran, and compare the data with other parts of the country.

MATERIALS AND METHODS

All medical records related to HCC were collected through hospitals or outpatient services in public or private centers. The records of all oncology, radiotherapy, and pathology centers in Kerman province were actively searched between 1999 and 2006. The annual incidence of HCC around the country was calculated, using the national cancer registry database provided by the Health Ministry of IR Iran from 2005 to 2006. Using Stata version 8, the crude and age-sex-standardized annual incidence rates were computed.

RESULTS

The crude annual incidence rates of HCC per 100,000 persons in Kerman and Iran were 0.522 (95% CI = 0.238- 0.88) and 0.199 (95% CI = 0.167-0.234), respectively. When adjusting for age and sex, the annual incidence rates of HCC in Kerman and Iran were 0.7 (95% CI = 0.4-1.1) and 0.2 (95% CI = 0.2-0.3) per 100,000 persons, respectively (P<0.01).The mean age of patients in Kerman was around 5.5 years younger than other parts of Iran (56.17 ± 18.32 years versus 61.68 ± 14.62 years; P=0.004).

CONCLUSIONS

In general, the incidence of HCC is not very high in Iran; however, the higher incidence of HCC in Kerman and also the lower age of onset mandates further research to detect HCC's risk factors in this part of country.

Prevalence of Iron Deficiency Anemia among Iranian Pregnant Women; a Systematic Review and Meta-analysis

INTRODUCTION

Anemia, particularly Iron Deficiency Anemia (IDA), is the most common hematological disorder during pregnancy with considerable complications in both mothers and fetuses. The estimation of anemia prevalence is an important step for health policy makers. Despite being considered a hot topic in epidemiological studies in Iran for the last twenty years, lack of a comprehensive overview on the findings encouraged the authors to carry out this study.

MATERIALS AND METHODS

All published papers in main national and international databases were systematically searched for some specific keywords to find the related studies between the years 1993 and 2007. All published studies which had reported the prevalence of anemia were included in the study except studies on refugees, patients undergoing hemodialysis, patients with thalassemia or cancer or other selective sub-populations. Two trained reviewers independently assessed the inclusion/exclusion criteria and the quality of the selected papers, summarized them and eventually analyzed the data.

RESULTS

Ten eligible papers including 11,037 participants were entered into the analysis. The maximum and minimum reported prevalence rates of anemia during pregnancy were 4.3% and 21.5%, respectively. The overall estimate of anemia prevalence in Iranian pregnant women was 13.6 (95% CI: 8.3 - 18.9). Excluding the only out-layer from the meta-analysis, the overall estimated prevalence was 12.4% (95% CI: 9.6% - 17.9%).

CONCLUSION

The prevalence of anemia in Iranian women during pregnancy is considerably lower than that of most EMRO countries or the one reported by WHO for Iran (> 40%) which had been performed on a small group 16 years ago. The lower prevalence rate of anemia in pregnant women versus the regional rates could be due to the improvements of the national health system and prenatal programs in recent years.

Epidemiology and heterogeneity of hypertension in Iran: a systematic review

There are many descriptive studies on hypertension in Iran, mostly assessing the prevalence of the disease and its associations with various risk factors. In order to gain a better insight into the epidemiology of hypertension in Iran and its heterogeneity around the country, we systematically reviewed all available studies and analyzed their findings using meta-analysis methods. All published papers in Iranian and international journals, final reports of research projects, papers presented in relevant congresses, and also all dissertations of medical students were reviewed using standard keywords. Studies published during 1996 - 2004, which met the eligibility criteria were entered into meta-analysis. We found 38 studies, of which 29 were eligible with a total sample size of 93,661 subjects. Also, we accessed the results of a very large national survey, which reported the prevalence of hypertension in 27 provinces. Our estimation for the overall prevalence of hypertension in 30 - 55 and >55-year-old population were around 23% and 50%, respectively. The prevalence in men was 1.3% less than that in women (P<0.0001). The mean diastolic blood pressure in men was 0.62 mmHg less than that in women while the mean systolic blood pressure was 0.67 mmHg greater.We found a sharp increase in the prevalence of hypertension by age, and also greater risk in females. It seems that the overall prevalence of hypertension in Iran is considerable. Iranian health system should pay more attention to control and treatment of hypertension in general population.

Presence of lead in opium

Opium addiction is a common form of addiction in Middle East countries such as Iran. Recently several reports suggested some kinds of pathologic findings such as abdominal pain, nephropathy, and anemia in opium addict patients. Such pathologic findings suggest lead poisoning in the patients. In this study, the concentration of lead in 10 opium samples was evaluated. The mean concentration of lead in the opium samples was 1.88 ppm. This may explain some of the pathologic findings found in addict patients. The authors would suggest further investigations to evaluate the lead concentration in opium addicts' sera and also routine screening for lead poisoning in opium addict patients.