Purpose: To compare the efficacy of three different rectal cleansing methods for reducing post-procedural infectious complications after transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and Methods: A total of 451 consecutive patients who underwent TRUS-guided prostate biopsy were prospectively included in this study. All patients received targeted antimicrobial prophylaxis and underwent bowel preparation through laxative administration. The patients were divided into three groups on the basis of the method of rectal cleansing immediately before the procedure. Group I patients (n =165) underwent cleansing of the perianal skin using povidone-iodine cotton balls; group II patients (n=116) received an injection of povidone-iodine solution (0. 1 g/mL) into the anal and lower rectal canals; and group III patients (n =170) received direct manual cleansing of the mucosal surface of the anus and lower rectum using povidone-iodine cotton balls. The three groups were compared regarding the incidence of post-procedural infectious complications, re-hospitalization rates, and mean length of hospital stay using one-way ANOVA, the Chi-square test, and multiple logistic regression analysis. Results: Post-procedural infectious complications occurred in %11. 2, %21. 8, and %6. 5 of groups I, II, and III, respectively (P <. 001). The incidence of overall infectious complications was significantly lower in group II (%95 CI: 0. 958– 0. 232, OR = 0. 472, P =. 038) and group III (%95 CI: 0. 555– 0. 129, OR = 0. 267, P <. 001) than in group I. Re-hospitalization rates were %2. 6, %9. 7, and %0. 6 in groups I, II, and III, respectively (P <. 001). The incidence of re-hospitalization was significantly lower in group II (%95 CI: 0. 869– 0. 070, OR = 0. 247, P =. 029) and group III (%95 CI: 0. 421– 0. 007, OR = 0. 055, P =. 005) than in group I. The mean length of hospital stay was significantly longer in group I than in group III (P =. 009). Conclusion: Combined with targeted antimicrobial prophylaxis, direct manual cleansing of the mucosal surface of the anus and lower rectum using povidone-iodine cotton balls was most effective in preventing post-procedural infectious complications among the three different rectal cleansing methods.

BACKGROUND AND OBJECTIVE: Constipation is one of the most common disorders of gastrointestinal tract in children. Anorectal manometry (AM) is a non-invasive procedure to determine its etiology. The aim of this study was to present the findings of this diagnostic procedure and relationship between clinical manifestations and determining the necessity of rectal biopsy.METHODS: This cross-sectional study was performed on 192 children with chronic constipation aged between 6 months to 12 years during 2008-2010 at Amirkola children's hospital. For unresponsive cases to treatment, AM was performed. The association of fecal incontinency (FI) and withholding status, with recto anal inhibitory reflex (RAIR), internal anal sphincter tonicity (IAT) and necessity of rectal biopsy was analyzed.FINDINGS: The mean age of patients was 48.1±27.5 months. RAIR was present in 177 cases (92.2%) and absent in 15 cases (7.8%). The mean IAT was 34.1±19.9 cmH2O. All of the cases with history of FI were RAIR positive (p=0.04) and cases with history of withholding were RAIR positive too (p=0.607). Out of the 6 cases with rectal biopsy, in 4 patients Hirschsprung's Disease (HD) was proved (2.08% of cases) that in these 4 cases, RAIR was not completely present.CONCLUSION: This study shows that although RAIR is present in the majority of severe chronic constipated patients, but HD is not ruled out specially in patients without FI and withholding and AM is beneficial in this specific group, for choosing them for probable rectal biopsy.

Background: Hirschsprung's disease (HD) is the most common cause of colon obstruction in neonates. Lack of calretinin immunohistochemistry (IHC) in colon lamina propria could be associated with aganglionosis. Methods: This cross-sectional retrospective study examined 64 patients suspicious of HD and conducted on collected-demographic data and Hematoxylin/Eosin (H & E) results of the surgical rectal biopsy from the archive of Imam Hossein Hospital, Isfahan, Iran. Calretinin IHC was achieved for all the specimens, and the results of the two methods were compared. The receiver operating characteristic (ROC) chart shows sensitivity changes according to (1-specificity). Moreover, sensitivity, specificity, as well as the positive and negative predictive values (PPV and NPV) of calretinin staining in lamina propria and muscularis mucosa, compared to H & E staining, was calculated in this study. Results: The number of males and females was the same in this study (n=32; 50%). The age of the patients ranged from 1 month to 156 months (13 years). Out of 64 patients, 8 cases were diagnosed with HD, and calretinin staining was negative in 7 patients; moreover, only one case showed weak positive staining. In 56 patients, who were not HD, two patients with negative calretinin staining had a positive H&E staining report. The current study aimed to check the diagnostic value of calretinin IHC in lamina propria of patients suspicious of HD. Compared to H&E staining, which is the routine method in thick wall biopsies, the statistics show that calretinin IHC has a high diagnostic value (P<0. 001), sensitivity of 87%, specificity of 96%, PPV of 77%, and NPV of 98%. Conclusion: In conclusion, calretinin IHC utilized in specimens seems superficial and inadequate; moreover, the association with the high specificity percentage (96%) could help physicians with less invasive biopsy methods, such as endoscopic rectal biopsy.

Introduction & Objective: Hirschsprung's disease (HD) is a motor disease caused by defects in the migration of nerve cells during the development of the gastrointestinal tract, which causes functional obstruction. The present study investigates the hypothesis that the absence of nerve trunk hypertrophy in a biopsy specimen is associated with a longer segment of aganglionosis. Materials & Methods: Demographic characteristics of patients such as age, sex, type of surgery, length of the involved part during surgery were recorded and then patients' pathological specimens were recorded in terms of diameter and number of nerve trunks and then the relationship between nerve trunk diameter in ganglion-free segment and intestine without the ganglion was examined. Chi-square test and Fisher's exact test were used for analytical data. Results: Twenty five children with Hirschsprung's disease were examined according to gender and age, boys were the most frequent and the majority of patients were infants. As expected, the most affected site was the rectosigmoid. Out of 25 patients, 6 patients had a nerve trunk less than 40 micrometers, of which only 2 patients had involvement of the entire colon. No correlation was found between nerve trunk diameter and age, sex, and length of the involved intestine. Conclusions: The hypothesis that the lack of hypertrophy of the nerve trunk could be associated with more severe intestinal involvement and a more proximal transition zone was not confirmed. The results can be said that in HD, hypertrophy of the nerve trunk is seen in the pathology specimen in the aganglionic segment.

Background: The purpose of this study was to determine the degree of alignment of prostate carcinoma in a rectal biopsy with radical prostatectomy in patients with prostate carcinoma to determine which biopsy samples are consistent with surgical specimens. Methods: In this cross-sectional study, out of 122 patients with prostate cancer who had undergone radical prostatectomy surgery in Sina hospital of Tabriz 65 patients with clinical records and pathological reports of needle biopsy, and radical prostatectomy biopsy specimens were available. The required information was recorded in questionnaire made for this study, and then the pathologic report and Gleason score and lymph-vascular involvement of the specimens were determined separately and finally the Trans rectal pathology report of the biopsy was compared with the histopathology report of radical prostatectomy in each patient. Results: The most common Gleason score and radical prostatectomy score were 6 (41. 5%) and 6(40%), respectively. The lowest frequency of Gleason score, radical of the prostatectomy, and Trans rectal biopsy score were 10 (3. 1%), 8(4. 6%)%), and 4(4. 6%), respectively. Generally, 24. 6% of the prostatectomy samples were similarly scored, while 63. 1% reported Trans rectal biopsy specimens and 12. 3% reported low Trans rectal biopsy. By grouping the samples into histopathology levels this association was 41. 5% identical in terms of scores and 49. 2% in excess and 9. 2% in lower reporting. The most common histopathology degree was rarely (49%) in Trans rectal biopsy and moderate in 40% in radical prostatectomy about 43% of badly differentiated cancers in the surgical specimens remained at the same level and the highest reporting rates were in the group with a good degree of distinction (66%). The highest correlation between rectal biopsy samples and radical prostatectomy samples was at the 6th grade and lowest compliance rate was in 4th and 8th grades. Conclusion: The highest degree of alignment was in the bad differentiation group, which indicates the high predictive power of biopsy specimens at this degree of differentiation. The present study suggests that the size of the smaller prostate and the high pre-surgical PSA may be predictive of increasing the Gleason score after radical prostatectomy.

Background and Aim: Fine Needle Aspiration Biopsy is an effective diagnostic method in the field of medical pathologies. Easiness, accuracy, validity and usefulness of this method have been verified frequently. This method is useful not only for soft tisse or even intraosseous lesions, but also recurrence of tumors (metastasis), resistence to treatment, verification of malignancy, differentiation between malignancy and benignment and determination of organisms causes infection. Unfortunately the use of this method is not common in dental pathology. So this study intendes to show the diagnostic value of FNA specially for intraosseous lesions causing jaw radiolucency.Methods and Materials: This investigation consisted of 80 patients who were referred to Taleghani General Hospital who were then referred to the pathology or surgery departments at Shahid Beheshti dental school.Cases consist of 29 females (36.25) % and 51 males (63.75%). Sampletaking was conducted using a 10 cc, gauge 19 syringe.Results: Results show 90% sensitivity and 75% specificity for jaw radiolucent lesions in FNA method. Correlation between FNA and jaw radiolucencies was significant (P<0.001) and it's power was at equal accepctable level according to cramer's V (phi - cramer's =0.623). Based on FNA cytology power, lesions with positive predictive value of 78.30 had a microscopic view compatible to the findings of other similar studies.Conclusion: FNA can be used as a reliable method for rapid, early and in expensive diagnosis, resulting in an on time, and appropriate treatment plan.

Objective: Successful results after one-stage trans-anal pull-through (OSTAPT) operation for Hirschsprung's disease (HD) depend on accurate identification of the aganglionic segment in intraoperative frozen section (FS). Misinterpretation of the findings of the rectal biopsy is an anxietyevoking pitfall for the surgeon. This study aims to describe our experiences in comparing results of FS and permanent Section (PS) rectal biopsies in children with HD who were candidates for OSTAPT in a single-step operation.Methods: Subjects under the age of 14 years, admitted from March 2000 to July 2008 in a university-affiliated children’s hospital for open rectal biopsy to diagnose HD were included in the study. All biopsies were taken 2-3 cm above the dentate line.210 specimens of full-thickness rectal biopsy were obtained for both frozen section and permanent biopsy from all patients, examined by two well experienced pediatric pathologists for ascertaining the presence of ganglion cells, and the results were compared. Analysis was performed by SPSS Software version 11.5.Findings: Two-hundred one infants and children underwent FS rectal biopsy to exclude HD.Positive results were seen in 63.8% of the specimens examined as PS and in 58.3% of FS samples.93.9% of positive results in FS studies were confirmed by PS studies.6.1% of FS reports were false positive and 21.7% were false negative (P<0.001). The sensitivity of FS was 85.8% and specificity 90.2%. Positive predictive value (PPV) was 93.9% and negative predictive value (NPV) was 78.3% in FS studies (P<0.001). The accuracy of FS was 80.4%.Conclusion: Although FS of the rectal biopsy is useful in defining the aganglionic segment during operation, according to this study, it cannot be used as the sole base for performing primary pullthrough operation before the results of the permanent section are on hand.

Introduction: Infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS-Bx) have been observed to be increasing. This research aimed to assess the incidence of infection in patients who underwent TRUS-Bx and identify the associated risk factors.Methods: This prospective cross-sectional study included 439 patients who underwent TRUS-Bx. The frequency of infection and its related risk factors were assessed using a checklist based on various variables. The patients' data were recorded according to the study's inclusion and exclusion criteria.Results: The average age of the patients was 64.6±8.7 years old   —infection after TRUS-Bx was observed in 2.1% of patients (n=9). Lower Age (P-value=0.005) and benign prostatic hyperplasia (BPH) (P-value=0.047) showed a significant association with an increased risk of infection after TRUS-Bx in univariate analysis. However, in multivariate analysis, age was the only factor significantly associated with infectious complications, indicating a decreased risk of infection in older patients (P-value=0.009). We did not find a significant association between infection after prostate biopsy and previous prostate biopsy or surgery, urethral catheterization, prostate cancer or prostatitis pathology report, diabetes mellitus, and serum creatinine level.Conclusions: According to this study, infection after prostate biopsy occurs in 2.1 % of cases, and younger patients are more at risk.

BACKGROUND AND OBJECTIVE: Hirsch sprung s disease (H.D) is the most common cause of lower gastrointestinal tract obstruction in newborns. Diagnosis of H.D was established by a full-thickness rectal biopsy, then it was replaced by rectal suction biopsy, that is easier and has less complications. This study was done to compare the sub mucosa and muscular coat of rectal wall for ganglion cells. METHODS: In this descriptive, analytical and cross-sectional study, data were obtained from 239 pathological reports in archive of Shahid Beheshti hospital, department of pathology from 1991 to 2001. Serial sections (up to 60 sections) were tested microscopically.FINDINGS: Sixty-one from 239 specimens were diagnosed as H.D (19.3%) and in 172 cases ganglion cells were present in both muscular and sub mucosal layers (54.43%). Sensitivity of sub mucosa for presence of ganglion cells was 96.6% and correlation between sub mucosal and muscular layers for absence of ganglion cell was 100% (p<0.05). CONCLUSION: The results showed a good correlation between advantages of serial sections of muscular and sub mucosal layers for presence of ganglion cells. Probability of coincident presence of ganglion cells in both layers was confirmed.