Iranian Journal of Colorectal Research
Year:2013 | Volume:1 | Issue:3|Papers Count:9

Context: Increasing epidemic of colorectal cancer worldwide and the expenses of the current screening and treatment of this potentially fatal condition have raised the interest of in finding a primary prophylactic measure. Aspirin has been administrated for more than 40 years to achieve this.Evidence Acquisitions: In this manuscript, we reviewed the best available evidence on the prophylatic use of aspirin for colorectal cancer prevention.Results: The analysis and large cohort studies revealed that although using ASA would probably decrease the risk of colon cancer, this would not occur before 5-8 years after treatment. ASA usage would increase the risk of major gastrointestinal bleeding.Conclusions: Aspirin has been proposed as a chemopreventive agent in colorectal cancer (CRC) for many years, but there are still debates on the proper candidates, treatment time and cost benefit analysis of this potentially harmful drug. This brief review would try to answer these questions using the currently available evidence.

Background: The extent of lymph node involvement is the most significant prognostic indicator in resected locoregional colorectal cancer.Objectives: This study aimed to investigate the prognostic value of total lymph nodes identified and ratio of lymph nodes in resected colorectal cancer.Patients and Methods: Two hundred seventy five patients with histologically proven resected locoregional invasive colorectal adenocarcinoma from 2003 to 2011 were included. All patients were treated with standard surgical resection for their colorectal cancer. Patients with incomplete data, or unresectable tumors or distant metastases were excluded from the study. All potential prognostic variables were evaluated for their impact on the local control, disease-free, and overall survival rates.Results: Of the 275 patients, 162 were men and 113 were women with a median age of 54 (range 23-84) years. The mean total lymph nodes were significantly higher in colon cancer than rectal cancer (11 versus 7.5, P=0.001). In node positive (stage III) patients, the mean lymph nodes ratio was 0.5 for rectal cancers and 0.37 for colon cancers respectively showing a nonsignificant (P=0.05) trend toward higher lymph nodes ratio in rectal cancer patients. In univariate analysis, the mean total number of lymph node identified was a prognostic factor for 5-year disease free (P=0.04) and overall survival (P=0.02) rates. In node positive patients, lymph nodes ratio was a prognostic factor for 5-year local control (P=0.04), disease free survival (P=0.01), and overall survival (P=0.01) rates. On multivariate analysis, advanced primary tumor stage, rectal primary site and the presence of perineural invasion were independent adverse prognostic factors for overall survival.Conclusions: Total lymph nodes identified and ratio of lymph nodes are associated with oncological outcomes outcomes in patients with colorectal cancer.

Background: Single incision laparoscopic surgery (SILS) is especially developed to achieve better cosmetic results. Using the umbilicus for ports access is widely accepted in this approach.Objectives: The aim of this study was to evaluate our initial experience with a new port access technique applied for laparoscopic appendectomy: Periumbilical Multiport Laparoscopic Appendectomy (PUMLA). Patients and Methods: Between January 2011 and March 2013, a total of 14 appendectomies were performed using a new port access technique. Patients were selected randomly. Thirteen of these cases had acute appendicitis, and one patient had familial Mediterranean fever (FMF). During these operations, three separate curvilinear incisions were created in the periumbilical skin folds and ports were placed in these ways. The five millimeter port was used for a zero degree telescope. The other two were used to manipulate the laparoscopic instruments. The appendectomy was performed intracorporeally in six cases; however, in eight cases, the appendix was taken out via a trocar after dissecting the mesoappendix, then the appendectomy was performed extracorporeally. Reconstruction was not needed to the umbilicus as there was no anatomical distortion.Results: Five patients were female, and nine were male. Age range was 5 to 15 years (mean 9.7 years). Operation time was between 20 and 82 minutes (mean 43 minutes). We did not need to convert to standard laparoscopic appendectomy or place an additional port in any of these patients. The average postoperative hospitalization was 14.1 hours (5-33 h). No complications such as wound infection, trocar site hernia, adhesive small-bowel obstruction, or abscess were observed in the early and late postoperative period. Good cosmetic results were obtained after the separate periumbilical curvilinear incision technique.Conclusions: We found that this new port access technique is feasible, safe, and associated with good cosmetic results.

Background: Anastomotic leakage is claimed to be responsible for about one third of deaths following colon surgeries. Therefore, research on applied materials that may prevent leakage and improve healing requires more attention.Objectives: This study was conducted to determine surgical and histological outcomes of applying human amniotic membrane (HAM) in colonic anastomosis in dogs.Materials and Methods: Eight cross breed male dogs were divided into two equal groups. After anesthesia and exploration, 5cm of left colon was resected, and end to end anastomosis was performed in a single layer. In the treatment group (B), HAM patch measuring 2×3 cm was wrapped around the anastomotic line. Mann-Whitney U test was used to compare the results in the two groups due to small sample size, and normal distribution of data was examined using the Kolmogorov simirnov test (P=0.03).Results: Modified scoring system for surgical wound healing was used to identify the grade of healing in all samples. The healing score was significantly higher in the HAM group (P=0.01).Conclusions: HAM plays a positive role in healing of colonic anastomosis, and would lead to better histological outcomes compared to simple anastomosis in dogs.

Background: Colon carcinoma growth depends on many factors such as, different organisms, and immune cells, which induce and produce inflammatory cytokines. Umbelliprenin is a naturally prenylated coumarin with anti-inflammatory activities. Its ability to induce cancer cell death has shown variation on different cancer cell lines.Objectives: 7-Prenyloxycoumarins, including umbelliprenin have been widely investigated because of their pharmacological activities. This paper shows the effect of umbelliprenin on colon cancer cell lines.Material and Methods: In the present study, invasive SW48 and noninvasive SW1116 were treated with umbelliprenin (6.25, 12.5, 25, 50, 100, and 200 mM), and the cytotoxicity was determined using a methyl thiazolelydiphenyl-tetrazolium bromide (MTT) assay.Results: Umbelliprenin had significant cytotoxic activity against SW48 cells at all study concentrations (except for 6.25 mM), with IC50 values of 117, 77, and 69 mM after 24, 48, and 72 h, respectively. However, it was cytotoxic against SW1116 only at higher concentrations of 100 and 200 mM (34% and 64% cell death). At lower concentrations, umbelliprenin showed a significant proliferative effect on this noninvasive cancer cell line. Our data were validated by eye and microscopic images.Conclusions: We found a moderate cytotoxic activity of umbelliprenin against invasive SW48 cells, and both cytotoxic and proliferative effects on noninvasive SW1116 cells. Therefore, using umbelliprenin as an anti-inflammatory or cytotoxic compound for patients with colon cancer should be used with care.

Introduction: Mucosa associated lymphoid tissue (MALT) lymphoma most commonly involves the stomach and its treatment is surgery, antibiotic therapy or radiotherapy. Rectal MALT is not only so rare, but also the treatment is not clear as gastric MALT.Case Presentation: Our patient was a 66 year old man presenting with 5-6 months abdominal pain and anemia. In colonoscopy, a rectal ulcer was found and biopsy revealed MALT lymphoma. Physical examination and staging evaluations had normal results. Radiotherapy was started for him but he did not tolerate radiotherapy and instead received chemotherapy. After 38 months of follow up, he was fine.Conclusions: The incidence of rectal MALT is rare, and treatment is not so clear. The results on H. pylori eradication, radiotherapy and chemotherapy are more controversial.

Dear Editor: We read with great interest the article by Taghavi et al. (1) presenting data on epidemiological factors of inflammatory bowel disease (IBD) in the southern region of Iran. The study included a great number of patients and the data was analyzed retrospectively. First of all, the article demonstrated an overall increase in the incidence rates of both Ulcerative Colitis (UC) and Crohn’s Disease (CD). The study raises several important issues about the presentation of IBD epidemiology and provided some interesting data. First, Taghavi et al. mentioned the female predominance in both UC and CD. In our study, we found male predominance in UC (2) with a rate of 1.4:1 and this finding was compatible with the results of a multicenter IBD epidemiologic survey from Turkey (3). In the mentioned study, male to female ratio was 1.3:1 in both UC and CD groups (3). Secondly, in Taghavi et al. study the mean age was 34.68±1.44 years (range: 8-79 years) in UC patients and 32.97±1.34 years (range: 9–80 years) in CD patients.

Dear Editor: We read with interest the article published by Ghahramani, et al. (1). The research has been well planned and blinded. The results are impressive. However, there is a discrepancy between the outcome measures of the study and the outcome measured mentioned in the title. It would be better if constipation as an outcome is also included in the title because constipation alone without haemorrhoids and fissures is also a cause of concern in pregnancy. Further, I found that the results of the study are more reliable with respect of beneficial effects on constipation than haemorrhoids.

Dear Editor: Taghavi et al. (1) reported in their retrospective analytical study, about multiple epidemiological factors of inflammatory bowel disease (IBD) in South region of Iran. They reported an increasing number of IBD patients with no significant change in lag time between the onset and diagnosis of IBD. In addition, they found a correlation between the type of disease and positive family history, and reported the age range of 20-29 years as the peak of age distribution of IBD and without any second peak at the age of 60 years. The authors’ two further interesting observations are focusing on the dominance of left-sided colitis and the incredible frequent use of infliximab (57%) in Crohn’s disease (CD). The prevalence and incidence of IBD seems to be stable in the high-incidence areas like North America or Northern Europe; however, an increasing number of cases is recorded in Southern and Eastern Europe and Asia.