Iranian Journal of Colorectal Research
Volume:10 Issue: 4, Dec 2022

Currently, neoadjuvant chemoradiation followed by total mesorectal excision through a low anterior- or abdominoperineal resection (APR) is considered the standard treatment approach in the vast majority of patients with locally advanced rectal cancer. Even though LAR allows for anatomic rectal preservation, APR led to significant morbidity and compromised quality of life in rectal cancer patients. Approximately 10-40% of patients achieve clinical complete response (CCR) following neoadjuvant chemoradiation. Meanwhile, the rate of pathologic complete response (PCR) is usually less than CCR rate. Complete response rate may be improved by escalating radiation dose and optimizing (total) neoadjuvant chemotherapy. Therefore, at least one-fifth of patients will have the chance of rectal preservation using the watch-and-wait strategy. In this therapeutic strategy, patients should be followed up by an active surveillance protocol to detect early tumor regrowth and salvage radical surgery and will, therefore, provide comparable oncologic outcomes to those achieved in patients who undergo initial radical surgery. This review aimed to present the largest reports and highlight the most recent evidence and guidelines for watch-and-wait therapeutic strategy in patients with rectal cancer.

Background Colorectal cancer (CRC) is one of the more diffuse reasons for malignancy-associated death worldwide. According to the evidence that CRC is predominantly symptomless as it advances to the highest stages, the administration of screening schemes planned at initial diagnosis is required to lower the prevalence and fatality rate . We aimed to review the literature on different molecular procedures for detection of stool-based biomarkers in CRC. Methods and Evidence Acquisition In the current study we reviewed papers of Google Scholar and PubMed database with no time limitation. Conclusion An integrative framework of all epigenetic and genetic modifications compared to other traditional procedures were studied which represented a more acceptable specificity and sensitivity for the diagnosis, treatment, evaluating drug response and also the clinical outcome of CRC. Differential expression analysis of stool-derived RNAs (sRNAs) and stool DNA (sDNA) testing for ultrasensitive mutations, methylation, and fragmentation patterns can lead to an early-stage diagnosis and a better prognosis for CRC patients in a higher accuracy.

Colorectal carcinoma forms a major cause of cancer-related mortality and morbidity, while having increasing incidence, all over the world. Carcino Embryonic Antigen(CEA) is the established tumour marker for colorectal cancer, with uses in screening, pre treatment staging, post therapeutic monitoring and detecting recurrence. However, CEA is affected by multiple factors including smoking or benign gastrointestinal diseases. Hence the need for investigating alternative tumour markers like Cytokeratin fragment 21-1(CYFRA 21-1). The objective of this Cross Sectional study were to find if the combination of CYFRA 21-1 and CEA is superior to CEA alone as a diagnostic marker in colonic cancer. From June 2016 to December 2019, 69 consecutive patients with a histologically confirmed diagnosis of colonic adenocarcinoma were included in the study. The serum levels of both tumour markers were analysed before starting any definite treatment. Sensitivity and Positive Predictive Values for both tumour markers were calculated. Correlation between tumour markers was tested using Pearson’s correlation. Correlation between TNM stage and tumour marker was tested using Spearman’s Rho test. 41 patients had elevated CEA while 33 patients had elevated CYFRA 21-1. CEA and CYFRA 21-1 mildly positively correlated with each other, with an R value of 0.2598(p value 0.031). Spearman’s correlation with clinical stage of cancer was found to be 0.50834 for CEA(p value < 0.005) and 0.59828 for CYFRA 21-1(p value < 0.005). Sensitivity of CEA 59.42%, while that of CYFRA 21-1 was 47.83%. The combination of both had a sensitivity of 75%.. The combination of CYFRA 21-1 and CEA was found to be more effective in picking up cases of colonic cancer than CEA alone. Both CYFRA 21-1 and CEA correlated well with the stage of disease. A combination of these biomarkers has great potential to evolve as diagnostic aid in colonic cancer.

Inflammatory Bowel Disease (IBD) is a complex multifactorial disease that includes two Crohn's disease and ulcerative colitis (UC). The UC characterized by inflammation, oxidative stress, and increased intestinal epithelial cell apoptosis. The present study aiming to investigate the protective potential of a combination of five safety products: Bromelain (BR), Silibinin (SB), Alpha-lipoic acid (ALA), Inulin (IN) and Sodium butyrate (BU) against UC. Seventy-two male Balb/c mice were divided into 9 groups, and administered for 14 days by a minimum effective dose of BR, SB, ALA, IN, BU or all together (PAC). Mesalazine (MZ) is used to compare the therapeutic effects of the compounds. Colitis was induced by rectal injection of acetic acid (4%) in 12th day. Blood and colon tissue were collected and the expression of inflammatory cytokines, and oxidative stress indices were examined using ELISA methods. The SPSS v.24 was used for data analysis. All the therapeutic groups including BR, IN, BU, ALA, SB separately, partially improved histopathological changes due to colitis, but PAC treatment prior to colitis induction significantly (p<0.001), and more effectively alleviated the extent and intensity of the histological signs of cell damage including inflammation intensity, macroscopic and microscopic colon damage, and improved colitis. A significant decrease in inflammatory cytokines and oxidative stress indices also observed in the group treated with ALA, SB and PAC. This new drug combination (PAC) is more beneficial for the prevention of UC better than MZ that is a usual treatment of UC.

Pseudomembranous colitis is an undesirable complication of C difficle infection. C difficle, although a part of normal gut flora, can become a nuisance and cause varying degrees of colitis, given the opportunity of a conducive host environment. Pseudomembranous colitis is managed medically with metronidazole or vancomycin, but can progress to toxic megacolon in upto 3% of cases. This dire complication may necessitate surgical management and is associated with a high mortality rate. Our case is a 15 year old, otherwise healthy patient who presented with perforative peritonitis with septic shock and diagnosed with dual colonic perforations on exploratory laparotomy. Pathological analysis of the specimen suggested presence of pseudomembranous throughout the resected segment of the colon. We suggest considering PMC as a differential diagnosis in a complicated toxic megacolon, regardless of the age of the patient, duration of antibiotic therapy and underlying diagnosis, particularly when there is an obscure history and diagnostic uncertainty.

Introduction

 Inverse acne (IA) is a chronic inflammatory skin disease that is more common in women, especially during puberty and menopause. It is believed that the first link of the pathogenetic mechanism is hyperkeratinization of the follicular cavity, followed by follicular occlusion, followed by expansion and rupture, and the presence of bacterial agents in the focus leads to the development of a local inflammatory reaction. Many concomitant diseases and triggers have been identified, including bacterial flora, which can significantly complicate the course of IA, lead to the chronization of the disease and a poor response to therapy. Early diagnosis of IA leads to the timely appointment of treatment. The diagnosis of IA is based on clinical features, and depending on the stage of severity according to Hurley, it is very important to choose the appropriate treatment. 

Case presentation

The authors present a clinical case of IA complicated by actinomycosis and viral hepatitis C.

Conclusion

 Actinomycosis is currently a rare diagnosis, especially in developed countries. In clinical practice, the diagnosis of actinomycosis can be difficult due to the nonspecific clinical and pathological features of the pathogen, its inherent difficulties in in vitro cultivation and complex histological characteristics. However, given the growing number of immunocompromised patients worldwide (for example, HIV-infected or hepatitis C patients) and numerous reports of infection with actinomycetes in these conditions, actinomycosis should be considered as a possible opportunistic infection.

INTRODUCTION 

Recto urethral fistula is relatively rare condition with worldwide incidence rates of less than 3%, and have a wide range of clinical presentations. Treatment involves surgical correction with various techniques described in literature. Here we look at a case series of complex recto urethral fistulae and their management involving local tissue flaps.

CASE PRESENTATION

Three patients with complex recto urethral fistulae underwent surgical repair with a pedicled gracilis muscle flap. All patients underwent a pelvic magnetic resonance scan and a flexible antegrade and retrograde cystoscopy prior to their repair. For two patients, the gracilis muscle flap was harvested from the left thigh and the right thigh for the third patient.

Trauma and radiation are the two most common causes of recto urethral fistulae. Most of these patients have a poor quality of life and require surgical repair with some form tissue interposition. The failure of a prior RUF repair results in worsening of the patient’s quality of life and makes the subsequent surgery more challenging. Diversion of both the urine and faeces as the initial treatment results in better outcomes of the final repair, and hence should always be included in the management protocol of this rare entity.

Bezoars are non-dissolved hard masses of undigested or partially digested food or foreign material that are trapped in the gastrointestinal tract. Bezoars are broadly classified into four groups, viz; phytobezoars, trichobezoar, lactobezoars, and pharmacobezoars. One of the common sub-types of phytobezoars is amlookobezoar (diospyrobezoar).

To describe the clinical profile and treatment outcome of a series of patients of amlookobezoar presenting with small bowel obstruction.

This prospective observational case-series study includes five patients of both sexes presenting with small bowel obstruction (SBO) caused due to amlookobezoar. All patients were evaluated with respect to detailed history, physical examination and radiological assessment to confirm the diagnosis. Radiological assessment included X-ray abdomen, USG and CECT abdomen.

We had total of five cases of SBO caused due to amlookobezoars. The age of these patients ranged from 8-years to 22-years with male-female ratio of 4:1. All the 5 patients in this series presented with the features of SBO in the autumn months. None of our patients had any other significant predisposing factor for bezoar formation except that all of these patients had taken significant amount of amlooks (persimmon fruit) 3-10days earlier. Four patients eventually required the exploratory laparotomy. All the four patients had soft to firm bezoars stuck up in distal or mid-ileum. Fortunately in all these 4 patients, we were able to manually breakdown the amlookobezoars and milk them down beyond the ileocaecal level without the need for any enterotomy, gut resection or creation of stoma. In all of the 4 operated patients, the postoperative period was almost uneventful.

Though uncommon, but amlookobezoars should be considered as differential diagnosis in a case of small bowel obstruction. Amlookobezoars commonly affects young adolescent males in the autumn months and often needs a laparotomy with fragmentation and milking down of amlookobezoars.