Rectum

1 ESGE recommends cold snare polypectomy (CSP) as the preferred technique for removal of diminutive polyps (size ≤ 5 mm). This technique has high rates of complete resection, adequate tissue sampling for histology, and low complication rates. (High quality evidence, strong recommendation.) 2 ESGE suggests CSP for sessile polyps 6 - 9 mm in size because of its superior safety profile, although evidence comparing efficacy with hot snare polypectomy (HSP) is lacking. (Moderate quality evidence, weak recommendation.) 3 ESGE suggests HSP (with or without submucosal injection) for removal of sessile polyps 10 - 19 mm in size. In most cases deep thermal injury is a potential risk and thus submucosal injection prior to HSP should be considered. (Low quality evidence, strong recommendation.) 4 ESGE recommends HSP for pedunculated polyps. To prevent bleeding in pedunculated colorectal polyps with head ≥ 20 mm or a stalk ≥ 10 mm in diameter, ESGE recommends pretreatment of the stalk with injec...

Based on a "field-effect" theory in colon carcinogenesis, and the expression of the disaccharide tumor marker D galactose-beta-[1-->3]-N-acetyl-D-galactosamine (Gal-GalNAc) in the rectal mucus of patients with cancer and precancer of the colon, Shamsuddin developed a simple, accurate, inexpensive, easy to perform and rapid (< or = 15 min) screening test for colonic cancer and precancerous lesions. In this study we examined 137 rectal mucus samples of randomly selected patients with colorectal malignancy or other colorectal diseases to confirm the sensitivity and specificity of this test in Croatia. Additionally, to test the validity of the "field-effect" theory, that the mucosa away from the obvious cancer will show abnormalities as a result of the generalized effect of the carcinogen throughout the entire field of the target tissue, we also monitored a subset of 53 patients post-operatively. Individuals free of colonic or any other malignancies served as c...

Background/Purpose: The purpose of this study was to review the authors' 25-year experience with redo pullthrough procedures for Hirschsprung's disease including surgical technique and long-term outcome. Methods: From 1974 to now, over 325 patients with Hirschsprung's disease have been treated at C.S. Mott Children's Hospital. This includes 30 patients referred after an unsuccessful pull-through at another hospital and 2 patients with an unsuccessful pull-through from C.S. Mott. All redo pull-throughs (n ϭ 19) were performed in these patients, and their clinical courses are reviewed. Results: Twelve patients required reoperation secondary to a mechanical problem with their first pull-through. The other 7 patients had evidence of residual segments of dilated colon leading to functional failure of their initial operation including 5 patients with documented aganglionic bowel present at the second pull-through. Ten of the patients requiring reoperation initially had an endorectal pull-through (ERPT), 5 had a Duhamel procedure, 3 had a Swenson procedure, and 1 had a Rehbein procedure. Choice of revision was an ERPT in 8 patients in whom an adequate rectal cuff could be developed. Additional redo procedures included a Duhamel in 8 patients and a Swenson in 3 patients. Follow-up ranges from 3 months to 23 years (mean, 13.8 years). There were no deaths in the series, and 1 patient required a third pull-through. All patients who are not neurologically impaired and are over age 3 are continent except one (94%). Stools per day range from 1 to 10 (mean, 3.2). Conclusions: Redo pull-through operations for Hirschsprung's disease appear to be as effective as primary procedures in terms of continence and stooling frequency. Distinct from other series, we found an ERPT to be the procedure of choice if an adequate rectal cuff was present.

BACKGROUND There is still ongoing debate on therapeutic results of traumatic colorectal perforations. The aim of this study was to evaluate and compare the incidence, management, and outcome of patients with traumatic colonic perforations. METHODS From January 1997 to December 2002, 85 surgical patients underwent emergency operation for traumatic colonic perforations. Patients were reevaluated by analyzing the relationship between the overall morbidity and mortality and the surgical treatment options. We took into consideration the time interval between perforation and treatment as well as the nature, the site, and the cause of perforation, patients' age, and additional organ injuries. RESULTS Mean age was 32,1. The most injured segment was transverse segment of the colon. Hartmann's procedure was performed in 3 patients (3.5%); resection, and primary anastomosis in 11 patients (12%); primary repair in 57(67%); primary repair and proximal diverting colostomy in 11(%12) ; col...

Ovarian activity was monitored in 2181 oestrous cycles from 1136 thoroughbred brood mares to accurately determine overall ovulation rate, the relative distribution of ovulations between left and right ovary, whether mare age had an effect on these parameters and whether ovulation pattern in one cycle affected the pattern within the next. Ultrasonic scanning was used in preference to rectal palpation and slaughterhouse material due to its greater accuracy. Mare's ages ranged from 3 to 22 years. The results obtained indicated a similar incidence of ovulation occurring on the right (49.5% of all ovulations) or left ovary (50.5%). Multiple ovulations (MO) occurred in 22.4% of oestrous cycles. Significantly (P < 0.01), more double ovulations (DO) were bilateral (57.2%) than unilateral (42.8%); 20.7% were unilateral right and 22.1% were unilateral left. There were 828 mares grouped into six age groups: A (3-5 years), B (6-8 years), C (9-11 years), D (12-14 years), E (15-18 years), F (18-22 years). The distribution of ovulation between the left and right ovary was not affected by age group, but significant association (P < 0.01) was evident between age and MO. Group A had 15% of cycles resulting in MO compared to 19.4, 24.6, 25.8, 28.6 and 35.1% in groups B-F, respectively. A significant (P < 0.01) association between MO in successive cycles was also demonstrated, with a greater chance (P < 0.05) of successive single ovulations (SO) being on alternate ovaries. There was no significant repeatability of the classification of DO in one cycle compared to the next. We conclude that: (i) the mare is a symmetrical ovulator; (ii) 22.4% of cycles yield MO (ovulation rate 1.23); (iii) this MO incidence increased (P < 0.01) with age; (iv) the exhibition of MO in one cycle was linked to an increased probability (P < 0.01) of a MO occurring at the next one and (v) SO in one ovary was more likely (P < 0.05) to be followed by a SO on the alternate ovary during the next cycle.

BACKGROUND. Clinical and pathological staging of prostate cancer has been, and remains, problematic. Since prostate-specific antigen (PSA)-detected tumors are often discerned during ''screening,'' what are their significance? METHODS. We analyzed 67 consecutive patients with stage T1c prostate cancer undergoing radical prostatectomy at our institution from August 1, 1991-September 12, 1995, and who had whole-mount specimen processing. Diagnosis was determined in all cases by transrectal ultrasound-guided biopsy. RESULTS. The mean age of our patients was 63 years, and the mean PSA at time of diagnosis was 8.6 ng/ml (median, 7.2 ng/ml). There was organ-confined cancer in 31/67 (46%) patients; 17/67 (25%) had periprostatic fat infiltration, and of these 5 (7%) had seminal vesicle involvement. Thirty-one of 67 (46%) had positive surgical margins. Twenty-two (33%) had a Gleason sum of ജ7 in the final pathological specimen. Insignificant tumors (dominant tumor volume <0.20 cc) were found in only 4 cases. Smaller tumors were more likely to be found when the PSA was <10 ng/ml. Multifocal disease was found in 64/67 (96%) prostate specimens. CONCLUSIONS. This study adds impetus to the growing realization that nonpalpable prostate cancer, detected because of elevated PSA, is rarely insignificant. Our findings add further emphasis to the fact that patients diagnosed by PSA elevation have, for the most part, significant cancer that should be treated aggressively.

Extraperitoneal rectal gunshot wounds have been managed with a variety of methods from simple diverting colostomy to combinations of rectal repair, proximal diversion, transperitoneal or presacral drainage, and distal bowel irrigation techniques. Treatment methodology is chosen based on anecdotal experience, and there is no clear evidence that any technique is superior to the others. The objective of this study was to compare 3 methods of managing civilian extraperitoneal gunshot wounds. Retrospective analysis of 30 consecutive patients with extraperitoneal rectal gunshot wounds was undertaken. Patients were treated with 1 of these 3 techniques: (1) simple diverting colostomy without rectal repair (group A, 12 patients); (2) diverting colostomy and rectal repair (group B, 12 patients); and (3) diverting colostomy and presacral drainage without repair (group C, 6 patients). Injury, hospital course, and outcome data were compared. The 3 groups were similar in age, injury severity, admission hemodynamics, preoperative and intraoperative time, blood loss, fecal contamination, and associated injuries. The overall incidence of complications was 27% (8/27): 25% (3/12) in group A, 33% (4/12) in group B, and 17% (1/6) in group C (p ‫؍‬ NS). Complications directly associated with the rectal injury were found in 2 cases (7%): 1 group A patient developed a vesicorectal fistula and 1 group B patient developed a rectocutaneous fistula. For 10 patients with both rectal and bladder injuries, the complication rates for groups A, B, and C were 50%, 20%, and 0%, respectively (p ‫؍‬ NS). No patient died. In conclusion, diverting colostomy without rectal repair or drainage appears to be safe for the management of most civilian retroperitoneal rectal gunshot wounds. Additional surgical maneuvers may be required for combined rectal and urinary trauma or other complex rectal injuries. Sound surgical principles, tailored to the individual case, should overrule any unproven dogmas.

Inverse planning optimization using biologically based objectives is becoming part of the intensity modulated optimization process. The performances and efficacy of the biologically based gEUD (generalized Equivalent Uniform Dose) objective implemented in the Photon Optimizer (PO) of Varian Eclipse treatment planning system have been here analyzed. gEUD is associated with the parameter a that accounts for the seriality of a structure, being higher for more serial organs. The PO was used to optimize volumetric modulated arc therapy (VMAT) plans on a virtual homogeneous cylindrical phantom presenting a target and an organ at risk (OAR). The OAR was placed at 4 mm, 1 and 2 cm distance, or cropped at 0, 2 and 4 mm from the target. Homogeneous target dose of 60 Gy in 20 fractions was requested with physical dose-volume objectives, while OAR dose was minimized with the upper gEUD objective. The gEUD specific a parameter was varied from 0.1 to 40 to assess its impact to OAR sparing and target coverage. Actual head and neck and prostate cases, with one parotid and the rectum as test OAR, were also analyzed to translate the results in the more complex clinical environment. Increasing the a parameter value in the gEUD objective, the optimization achieved lower volumes of the OAR which received the highest dose levels. The maximum dose in the OAR was minimized well with a values up to 20, while further increase of a to 40 did not further improve the result. The OAR mean dose was reduced for the OAR located at 1 and 2 cm distance from the target, enforced with increasing a. For cropped OARs, a mean dose reduction was achieved for a values up to 3-5, but mean dose increased for higher a values. The optimal choice of the parameter a depends on the mutual OAR and target position, and seriality of the organ. Today no significant compendium of clinical and biological specific a and gEUD values are available for a wide range of OARs.

Background: Whole body hyperthermia induced by radiative systems has been used in therapy of malignant diseases for more than ten years. Von Ardenne and co-workers have developed the 'systemiche Krebs-Mehrschritt-Therapic' (sKMT), a combined regime including whole body hyperthermia of 42°C, induced hyperglycaemia and relative hyperoxaemia with additional application of chemotherapy. This concept has been employed in a phase I/II clinical study for patients with metastatic colorectal carcinoma at the Virchow-Klinikum since January 1997. Methods: The sKMT concept was performed eleven times under intravenous general anaesthesia, avoiding volatile anaesthetics. Core temperatures of up to 42°C were reached stepwise by warming with infrared-A-radiation (IRATHERM 2000®). During the whole procedure blood glucose levels of 380-450 mg/dl were maintained as well as PaO 2 levels above 200 mmHg. Extensive invasive monitoring was performed in all patients including measurements with the REF-Ox-Pulmonary artery catheter with continuous measuring of mixed venous saturation (Baxter Explorer®) and invasive monitoring of arterial blood pressure. Data for calculation of hemodynamic and gas exchange parameters were collected four times, at temperatures of 37°C, 40°C, 41.8-42°C and 39°C, during measurements FiO 2 was 1.0 at all times. Fluids were given in order to keep central-venous and Wedge pressure within normal range during the whole procedure. Statistics were performed using the Wilcoxon Test. Results: Statistically significant differences were found between heart rate, cardiac index and systemic vascular resistance comparing data at 37°C and 42°C. Heart rate and cardiac index increased to a maximum at 42°C (P < 0.0001) whereas systemic vascular resistance had its minimum at 42°C (P < 0.0001). Mean arterial pressure dropped with increasing temperature, differences were not significant. Calculation of stroke volume index and ventricular volumes showed only a slight decrease in endsystolic volumes with increasing temperature, the resulting differences in right ventricular ejection fraction were marginally significant (P = 0.038) comparing 42°C to baseline. Right ventricular stroke work index as well as mean pulmonary arterial pressure increased at 42°C (P = 0.0115 and P = 0.0037), pulmonary vascular resistance only dropped little compared to systemic vascular resistance, left ventricular stroke work index even dropped with increasing temperature, though showing no significant difference. Values for mixed venous oxygen saturation did not vary during therapy, pulmonary right-left shunt showed a temperature associated increase (P = 0.0323) to a maximum at 42°C. Conclusion: Under the procedure of sKMT cardiac function in patients, who do not have any pre-existing cardiac impairment, can be maintained almost unchanged, ie with normal right and left ventricular pressure, despite an increase in right ventricular stroke work Acknowledegment: Supported by Deutsche Krebshilfe.

To assess the degree of upgrading and increase in clinical risk category of transperineal template biopsy (TTB) compared with transrectal ultrasonography-guided prostate biopsy (TRUSB). Upgrading of TRUSB Gleason grade and sum after radical prostatectomy (RP) is well recognised. TTB may offer a more thorough mapping of the prostate than TRUSB, as well as a more accurate assessment of the tumour. In this retrospective cohort study of prospectively collected data, we compare the initial TRUSB and TTB Gleason grade and sum with the final assessment at RP. Following Ethics Committee approval, 431 laparoscopic and robotic RP specimens of two urologists, fellowship-trained in minimally invasive RP, were examined in the private sector between April 2009 and October 2013. Final RP Gleason grade and sum were compared with the initial prostate biopsy. All pathological assessments were performed by a dedicated uropathology unit, experienced in prostate pathology. Upgrading was defined either a...

Purpose This study aims to review the short-term recurrence and complications of Doppler-guided hemorrhoidal artery ligation (DG-HAL) with mucopexy. Methods Approval was obtained for a retrospective chart review of patients who underwent DG-HAL from January 2007 to June 2009. A treatment failure was recorded if internal hemorrhoids were noted at follow up or symptoms persisted. All recurrences were assessed for predictive factors. Results The procedures were performed by four surgeons. Ninety-six patients were included. The average age was 63.5 years (21-81 years). The mean follow up was 15 months (3-35 months). Of the patients, 93 (96.8%) reported bleeding pre-operatively. Mucopexy accompanied DG-HAL in 87 (90.6%). Postoperative complications occurred in nine (9%) patients. Residual hemorrhoids were evident in 20 (21%) patients, 13 of whom required further management for symptomatic disease, five with DG-HAL. Fifty percent (10/20) and 70% (9/13) of the recurrences necessitating further treatment transpired during the first 20 procedures of each surgeon. All 13 symptomatic recurrences demonstrated large, circumferential internal hemorrhoids. Conclusions DG-HAL is a simple procedure with a low complication rate. Recurrences are more frequent during the learning curve. Patients with large, circumferential internal hemorrhoids should be counseled about a possible higher rate of recurrence. DG-HAL can be effectively repeated for recurrences.

Topical microbicides to stop sexually transmitted diseases, such as herpes simplex virus type 2 (HSV-2), are urgently needed. The emerging field of nanotechnology offers novel suitable tools for addressing this challenge. Our objective was to study, in vitro and in vivo, antiherpetic effect and antiviral mechanisms of several polyanionic carbosilane dendrimers with anti-HIV-1 activity to establish new potential microbicide candidates against sexually transmitted diseases. Plaque reduction assay on Vero cells proved that G2-S16, G1-S4, and G3-S16 are the dendrimers with the highest inhibitory response against HSV-2 infection. We also demonstrated that our dendrimers inhibit viral infection at the first steps of HSV-2 lifecycle: binding/entry-mediated events. G1-S4 and G3-S16 bind directly on the HSV-2, inactivating it, whereas G2-S16 adheres to host cell-surface proteins. Molecular modeling showed that G1-S4 binds better at binding sites on gB surface than G2-S16. Significantly better binding properties of G1-S4 than G2-S16 were found in an important position for affecting transition of gB trimer from G1-S4 prefusion to final postfusion state and in several positions where G1-S4 could interfere with gB/gH-gL interaction. We demonstrated that these polyanionic carbosilan dendrimers have a synergistic activity with acyclovir and tenofovir against HSV-2, in vitro. Topical vaginal or rectal administration of G1-S4 or G2-S16 prevents HSV-2 transmission in BALB/c mice in values close to 100%. This research represents the first demonstration that transmission of HSV-2 can be blocked by vaginal/rectal application of G1-S4 or G2-S16, providing a step forward to prevent HSV-2 transmission in humans.

Organ preservation strategies are under investigation for patients with locally advanced rectal cancer (LARC) who achieve a complete pathologic response in the primary tumor (ypT0) after neoadjuvant chemoradiation therapy (CRT). This study explored the value of this approach for cN+ patients. Data were retrieved from our institutional prospective rectal cancer database. Tumors with mesorectal lymph nodes larger than 5 mm shown on endorectal ultrasonography, pelvic magnetic resonance imaging, or both were staged as cN+. The study population comprised 226 patients (142 men and 84 women; median age, 64 years) with LARC who underwent CRT followed by surgery including total mesorectal excision (TME) (n = 179) and full-thickness local excision (LE) (n = 47) between 1996 and 2013. At staging, 123 patients (54.4 %) were cN+. In 65 cases (28.7 %), ypCR was observed. Metastatic mesorectal lymph nodes (ypN+) were detected in 41.6 % of the cN+ patients and in 2.8 % of the cN0 patients (P &lt; 0...

Introduction: In this study we aimed to determine whether high-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches. We also attempted to identify the best approach for visualizing these structures. Methods: Normal anatomy of the pudendal nerve was evaluated in 3 cadavers and 20 healthy volunteers proximally at the level of the ischial spine and distally with low-frequency (2-5-MHZ) and high-frequency (12-7-MHZ and 17-5-MHZ) transducers. Two musculoskeletal radiologists performed the examinations and evaluations. Volunteers were placed in 3 different positions, which allowed different approaches (posterior, medial, and anterior transperineal). A 0-3 scale was used to assess nerve visibility. Results: Visualization of the pudendal nerve at the ischial spine was best when using a medial approach (P < 0.004); the terminal branches were seen best with the anterior approach (P < 0.002). Conclusion: High-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches.

Serum samples from 26 monozygotic twin pairs concordant or discordant with regard to inflammatory bowel disease, and rectal biopsies from 42 twins of the same subject group, were examined for IgG subclasses. They were all compared with normal controls. Almost all affected twins were in clinical remission. Paired immunofluorescence staining of the rectal mucosa showed that those with ulcerative colitis had a significantly higher (p<0.01) proportion of IgGI producing mucosal immunocytes than normal controls (78.1% v 55.9%). Conversely, the IgG2 cell fraction was significantly reduced (15.9% v 34.6%). Healthy twins from ulcerative colitis pairs tended to show a raised proportion of IgGl cells and the IgG2 cell fraction was significantly reduced (p<005). In discordant ulcerative colitis twin pairs, no difference appeared in the cellular IgG subclass pattern between healthy and affected twins. Furthermore, the proportion of IgGl in these healthy and diseased twins showed good correlation (T=0.867). The results in rectal mucosa of twins with Crohn's disease were widely scattered and affected

The importance of chronic immune activation in progression to AIDS has been inferred by correlative studies in HIV-infected individuals and in nonhuman primate models of SIV infection. Using the SIV mac251 macaque model, we directly address the impact of immune activation by ...

is an Instructor in the (MI) is a topic o f much controversy and speculation. Investigators have shown that decreasing heart rates in the presence of an acute MI produces increased disparity between refractory periods. The refractory periods of adjacent myocardial cells are so radically Unbergraduafe School of Nursing at the University of Pennsylvania in Philadelphia. different that the cell with the less prolonged absolute refractory period is capable of being electrically stimulated ahead of its neighboring cells, and is thus able to electrically stimulate adjacent cells in a non-systematic manner. This sporadic electrical stimulation is often what occurs secondary to extreme sinus bradycardia and leads to the development of ventricular fibrillation. a fatal arrhythmia (Kent, Smith, Redwood and Epstein. 1973). Much disputation pervades the issue of whether rectal stimulation of the vagus nerve reflexly causes changes in cardiac rhythm and decreases in cardiac rate in the patient with an acute MI. Much disputation pervades the issue of whether rectal stimulation o f the vagus nerve reflexly causes changes in cardiac rhythm and decreases in cardiac rate in the patient with an acute MI. It is believed by some investigators (Kerzner. Wolf, Kosowsky, and Lown. 1973) that stimulation of the vagus nerve slows the rate of firing of the sinus node, the natural pacemaker of the heart. s3 that other kinds of paccmaker cells are abnormally forced to iniiiate the electrical impulse. This kind of ectopic or abnormal response pattern predisposes the heart to ventricular fibrillation via the mechanism of increased disparity between refractory periods described above. Recent studies on vagus nerve stimulation (David and Fletcher, 1969; Goldstein. Karsh. Orlando. Norman. Franham. Redwood and Epstein.

With increasing use of low anterior resection, the length of rectum removed below the tumor is often less than the recommended 2 to 5 cm. It is important to know if this decreases the chance of cure. Between 1963 and 1975, 334 patients sur-vived radical restorative operations for single rectal adenocarcinoma. The length of rectum below the tumor measured on fixed pinned-out pathologic specimens was 2 cm or less in 55 patients (group 1), 2 to 5 cm in 177 (group 2), and 5 cm or more in 102 (group 3). The Dukes' classification, histologic grade, and extent of local spread of the tumors were similar in the three groups. Overall crude 5-year survival rates for groups 1, 2, and 3 were 69.1%, 68.4%, and 69.6%, respectively. Corresponding cancer-specific death rates were 25.5%, 23.2%, and 21.6%. These rates were also similar in matching pathologic subgroups of the three main groups. Of 23 observed or suspected local recurrences, there were four recurrences in group 1 (7.3%), 11 in group 2 (6.2%), and eight in group 3 (7.8%). These results suggest that a margin less than 2 cm below a rectal carcinoma does not affect survival or local recurrence adversely.

Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organ...

Purpose Only a few patients with anorectal malformations (ARM) have satisfactory bowel functions. Studies of ARM have reported psychosocial problems in up to 73% of patients. The aim of the current study was to document the psychosocial needs of patients with ARM. Methods Between June 2004 and September 2005, 44 patients with ARM were treated; the sample included 30 patients (23 males and 7 females) aged 4-17. To focus on potential psychosocial strain, a comprehensive grading system with a sophisticated perspective of continence, associated malformations, number of surgical interventions and postoperative complications was introduced. For psychosocial screening, the following instruments were used: German ''Basis-Dokumentation'' (BADO), Impact on Family Scale (IFS), the Strengths and Difficulties Questionnaire (SDQ). All families assessed their own psychosocial needs. An extensive psychosocial programme was provided. Results Twenty-three patients were suffering severe burden according to the comprehensive grading system. Nearly half of the families reported increased financial stress, and one-third reported emotional or hyperactivity problems of the child. More than 70% confirmed psychosocial need. Conclusions Paediatric surgeons should promote psychosocial support for all patients who suffer severe forms of ARM or its numerous associated malformations as well as for patients undergoing numerous surgical interventions or having many postoperative complications.

Summary  One hundred and forty four patients underwent colonoscopy to detect the cause of rectal bleeding. This was successful in either identifying the lesion or excluding the presume of lesions up to the cecum in 88.88% patients. The source of bleeding was diagnosed in 106 (73.61%) patients. Predominant lesions were nonspecific colitis and ulcers (62.26%), polyps (17.92%), cancer (8.49%), rectal varices (3.77%) and tuberculosis (1.88%). The remainder had other colonie conditions such as radiation colitis, ischemic colitis, vascular malformation, diverti-culosis, right sided ulcerative colitis and pseudopancreatic cyst communicating with the descending colon. The majority (94.33%) of these lesions involved the Heft colon. Thus colonoscopic examination was useful in localizing the cause of rectal bleeding and the predominant lesions were differed from those reported in the western hemisphere.

Previous studies on commensal Escherichia coli from healthy children in the Bolivian Chaco have shown remarkable resistance rates to the old antibiotics since the early 1990s, and the emergence of resistance to newer drugs (fluoroquinolones and expanded-spectrum cephalosporins) in the 2000s. Here we report the results of a new survey conducted in 2011 in the same setting. Rectal swabs were obtained from 482 healthy children (aged 6-72 months) from three urban areas of the Bolivian Chaco. Screening for antibiotic-resistant E. coli was performed by a direct plating method, as in the previous studies. The bla CTX-M genes were investigated by PCR/sequencing, and CTX-Mproducing isolates were subjected to genotyping and detection of several plasmid-mediated quinolone resistance mechanisms. Results showed high rates of resistance to nalidixic acid (76%), ciprofloxacin (44%) and expanded-spectrum cephalosporins (12.4%), demonstrating a relentless increase of resistance to those drugs over the past two decades. CTX-M-type extended-spectrum beta-lactamases were found to be widespread (12%, 97% of extended-spectrum beta-lactamase producers). Compared with the previous studies, CTX-M-producing E. coli underwent a dramatic dissemination (120-fold increase since early 2000s) and a radical change of dominant CTX-M groups (CTX-M-1 and CTX-M-9 groups versus CTX-M-2 group). Most CTX-M producers were not susceptible to quinolones (91%), and 55% carried plasmid-mediated quinolone resistance genes (different combinations of aac(6¢)-Ib-cr, qnrB and qepA). This study shows the rapid and remarkable increasing trend for resistance to fluoroquinolones and expanded-spectrum cephalosporins in one of the poorest regions of Latin America, and underscores the need for urgent control strategies aimed at preserving the efficacy of those drugs in similar settings.

This study investigated immunohistochemical properties of cholinergic neurons in the anterior pelvic ganglion (APG) of juvenile male pigs (n=7). Cholinergic neurons were identified using antibodies against choline acetyltransferase (ChAT) and vesicular acetylcholine transporter (VAChT). Immunoblotting was applied to verify the specificity of ChAT-immunostaining. Western blotting performed on APG tissue homogenates detected single immunoreactive protein with a molecular weight matching that of ChAT (71.6 kDa). It was found that many APG neurons expressed immunoreactivity to ChAT or VAChT (40% and 39% of the neurons, respectively). The analysis of adjacent sections from the ganglion revealed complete colocalization of ChAT and VAChT in these nerve cells. Furthermore, virtually all the ChAT-positive neurons were tyrosine hydroxylase (TH)-negative (non-adrenergic) but many of them displayed immunoreactivity to nitric oxide synthase (NOS), vasoactive intestinal polypeptide (VIP), neurope...

The urinary bladder in healthy dogs has dogmatically been considered free of bacteria. This study used culture independent techniques to characterize the healthy canine urinary microbiota. Urine samples collected by antepubic cystocentesis from dogs without urinary infection were used for DNA extraction. Genital tract and rectal samples were collected simultaneously from the same dogs. The V4 hypervariable region of the 16S rRNA bacterial gene was amplified and compared against Greengenes database for OTU assignment and relative abundance for urine, genital, and rectal samples. After excluding 4 dogs with cultivable bacteria, samples from 10 male (M; 1 intact) and 10 female (F) spayed dogs remained. All samples provided adequate genetic material for analysis. Four taxa (Pseudomonas sp., Acinetobacter sp., Sphingobium sp. and Bradyrhizobiaceae) dominated the urinary microbiota in all dogs of both sexes. These taxa were also detected in the genital swabs of both sexes, while the recta...

Objective: To report a case of hematometra following laparoscopic resection of rectovaginal endometriosis extending to the cervix. Design: Case report. Setting: University hospital. Patient(s): A 31-year-old woman with endometriosis and infertility. Intervention(s): Combined laparoscopic and vaginal surgery. Result(s): The cervix had retracted into the vaginal scar after surgery, preventing the escape of menstrual blood. The hematometra was drained, and the cervix was repositioned into the vagina with use of a combined vaginal and laparoscopic approach. Conclusion(s): Retraction of the cervix into the cul-de-sac can occur as a complication of excision of rectovaginal nodules that extend onto the posterior surface of the cervix. Excision of the posterior cervix should avoid deep excision of the posterior lip and should be limited only to the ectocervical margin to avoid such complications.

OBJECTIVE To assess whether extended time intervals (8-12, 13-20 and &gt;20 weeks) between the end of neoadjuvant chemoradiotherapy and surgery affect overall survival, disease-free survival. MATERIALS AND METHODS Retrospective study in 120 patients with rectal adenocarcinoma without evidence of metastasis (T1-4/N0-2/M0) at the time of diagnosis that underwent surgery with curative intent after neoadjuvant chemoradiotherapy with capecitabine and obtained R0 or R1 resection between January 2010 to December 2014 at the National Cancer Institute of Peru. Dates were evaluated by Kaplan-Meier method, log- rank test and Cox regression analysis. RESULTS Of the 120 patients, 70 were women (58%). The median age was 63(26-85) years. All received neoadjuvant chemoradiotherapy. No significant difference was found between the association of the median radial (0.6, 0.7 and 0.8 cm; p=0.826) and distal edge (3.0, 3.5 and 4.0 cm; p=0.606) with time interval groups and similarly the mean resected (18...

Our aims were to determine the normal limits of subepithelial basement membrane (SEBM) thickness in order to more accurately diagnose collagenous colitis in the population from southern Turkey and to investigate into links between SEBM thickness and age, and sex. The study included 100 patients (mean age 50.0+/-13.3 years; male, 34; female, 66) with miscellaneous gastrointestinal symptoms, and normal colonic mucosal appearance in colonoscopic evaluation. Biopsies were taken from five different regions of the colon. SEBM was measured with a calibrated eyepiece on specimens prepared with specific stains for collagen. Intensity of inflammatory cells was graded semiquantitatively. Differences in SEBM thickness among the different colon regions, and relationships between SEBM thickness and age, sex, and density of inflammatory cells were statistically evaluated. The cecum and rectum showed the largest amounts of infiltrate. None of the specimens showed histologic findings of collagenous ...

Background and aims: Defecating proctography has been traditionally used to assess patients with evacuatory dysfunction. More recently, dynamic transperineal ultrasound has been described, defining the interaction between the infralevator viscera and the pelvic floor at rest and during straining. This study compared qualitative diagnosis and quantitative measurement obtained by defecography and dynamic transperineal ultrasonography in patients with evacuatory difficulty. Patients and methods: Thirty-three women were examined using both techniques with both examiners blinded to the results of the other method. Quantitative measurement was made of rectocele depth, anorectal angle (at rest and during maximal straining) and anorectal junction position at rest and movement during straining. Results: There was good agreement for the diagnoses of rectocele, rectoanal intususseption, and rectal prolapse. Dynamic transperineal ultrasound was more likely than defecography to make multiple diagnoses or to diagnose an enterocele when a rectocele was present. There was no difference noted between the two techniques for the measurement of anorectal angle at rest, anorectal junction position at rest, or anorectal junction movement during straining. The mean anorectal angle during straining was 123.3±4.3°as measured by defecography and 116.4±3.3°as measured by dynamic transperineal ultrasound, nearly reaching statistical significance. Conclusion: Dynamic transperineal ultrasound is a simple and accurate technique for assessment of the pelvic floor and soft-tissues in patients with evacuatory dysfunction.

The piebald lethal mouse with a deletion of endothelin-B receptor gene (EDNRB) is a model for Hirschsprung's disease (HD), whereas the SOX10 gene is vital for the development of intestinal neural crest-derived cells. Recently, we created a SOX10 transgenic mouse with intestinal neural crestderived cells visible with enhanced green fluorescent protein (VENUS), that is, SOX10-VENUS + / EDNRB sl/sl to investigate intestinal innervation in HD. Methods: SOX10-VENUS + /EDNRB sl/sl (n = 30) were compared with wild-type littermates as controls (EDNRB s/s , n = 30). Mice were killed on days 3, 7, or 12 of age. The entire colorectum was excised, fixed with 4% paraformaldehyde, and examined using fluorescence microscopy alone without staining. Results: In normoganglionic colorectum from controls, a grid network of nerve fibers/glial cells was visualized that connected smoothly with extrinsic nerve fibers running along the colorectal wall. In aganglionic colorectum from SOX10-VENUS + /EDNRB sl/sl mice, there was no grid network and more extrinsic nerve fibers than controls that invaded the colon wall becoming elongated with branching fibers. Normoganglionic colon from controls and SOX10-VENUS + /EDNRB sl/sl mice appeared the same. Innervation patterns did not change over time. Conclusion: This is the first time for abnormal enteric innervation in aganglionic colon in a model for HD to be visualized without staining.

TO THE EDITOR: Patients with celiac disease (CD) may develop complications or health problems that increase morbidity and mortality (1). The reported prevalence of adult CD has varied in the United States and European countries, ranging from 1:250 to 1:1500 (2). The disease became a significant health issue from the introduction and spread of the gluten-containing grains during the European Neolithic age. Why is CD so prevalent in modern populations, despite millennia of selection against celiacs? Genetic adventages are not defined (3). I read with interest the letter by James regarding the sex ratio in offspring of celiac women (4). In a nationwide historical cohort study from Denmark (5), the proportion of male sex was significantly lower than an expected value. I speculate that the low male sex ratio in offspring may be an important advantage for celiacs. The diffusion of agricultural practices and stable settlements were connected with periodic crop failure, wars, and famine. During World War II Dicke, a Dutch general pediatrician, observed considerable variations in the well-being of celiac patients. The shortage of bread and porridge caused the symptoms and signs of sprue to disappear. The patients relapsed after Swedish planes dropped bread into the Netherlands (2). Throughout thousands of years in agricultural communities celiac women, adapted to malnutrition on a gluten diet, may have improved in periods of grain shortage and also, probably, in preharvest (6). Contrary to other members of the population, their well-being, libido, and fertility increased. Women with CD gave birth mostly to female children, who had a lower risk of mortality in infancy than males and were not directly involved in battles in adulthood. To my knowledge, of large reports on pregnancy outcomes in celiac women only the study of Norgard et al. (5) supplied data on sex of offspring. The relation between pattern of clinical manifestation of the disease and sex ratio in offspring is unexplored.

THE so-called 'pyogenic streptococci' possess a dominant serologically active carbohydrate that forms the basis of the Lancefield serogrouping system. The β-haemolytic pathogenic streptococci of animals belong to Lancefield group B (Streptococcus agalactiae) and Lancefield group C (Streptococcus dysgalactiae, Streptococcus dysgalactiae equisimilis, Streptococcus equi equi and Streptococcus equi zooepidemicus) (Timoney 1993). Unless controlled, S agalactiae is the most prevalent mastitis pathogen in dairy cows (Radostits and others 1997). Infections of the mammary gland of camels with S agalactiae are common and have been reported from the United

The functional role of the different classes of visceral afferents that innervate the large intestine is poorly understood. Recent evidence suggests that low-threshold, wide-dynamic-range rectal afferents play an important role in the detection and transmission of visceral pain induced by noxious colorectal distension in mice. However, it is not clear which classes of spinal afferents are activated during naturally occurring colonic motor patterns or during intense contractions of the gut smooth muscle. We developed an in vitro colorectum preparation to test how the major classes of rectal afferents are activated during spontaneous colonic migrating motor complex (CMMC) or pharmacologically induced contraction. During CMMCs, circular muscle contractions increased firing in low-threshold, wide-dynamic-range muscular afferents and muscular-mucosal afferents, which generated a mean firing rate of 1.53 ± 0.23 Hz ( n = 8) under isotonic conditions and 2.52 ± 0.36 Hz ( n = 17) under isome...

The Vienna Rectoscopy Score (VRS; from 0, absence of rectal mucosal changes, to 5) assessed 1 year after radiotherapy is a surrogate end-point of late rectal toxicity. The aim of this study was to investigate the association between treatment-related factors and 1-year VRS. We performed a retrospective analysis of prospectively collected data. Patients with prostate adenocarcinoma treated with definitive or postoperative radiotherapy (RT) underwent endoscopy 1 year after RT. Relationships between VRS of 2 or more and treatment parameters were investigated by univariate and multivariate logistic analyses. One hundred and ninety-five patients (mean age=69 years; range=43-81 years) were considered eligible for the study. At univariate analysis, patients treated with hypofractionation plus radiosurgery boost (p&lt;0.001) and an equivalent dose in 2 Gy per fraction (EQD2) (α/β=3) ≥75 Gy (p&lt;0.001) was associated with a significantly higher incidence of VRS ≥2 after 1 year of follow-up....

In this study, conducted at five slaughterhouses, individual pigs were sampled and followed up from stunning to cooling down of the carcasses. In this way, Salmonella prevalence and possible risk points were described. At the lairage area, pens were sampled using overshoes. At stunning and bleeding, pigs were individually identified and subsequently swabs were taken of the oral cavity and the carcass after polishing, splitting and forced chilling. Additionally, duodenum, ileum, rectum and mesenteric lymph nodes were extracted and samples were taken of the scalding water. All samples were submitted to Salmonella isolation and Salmonella isolates were serotyped and genotyped by pulsed-field gel electrophoresis (PFGE). Of all samples taken (n = 1953), 14.1% were Salmonella positive. The prevalence of S. in the lairage area varied widely (from 0 to 100%) between the slaughterhouses. Of the sampled pigs (n = 226), 48.2% were positive in at least one sample. Statistical analysis revealed that the contamination of the lairage area was related to a higher amount of positive carcasses after polishing. Furthermore, the contamination of the carcasses after splitting and forced chilling was related to the contamination level of the carcass after polishing. A relation between the outer (carcass) contamination and the inner (gut content and lymph nodes) contamination of a pig could not be established. The predominant serotypes were S. Typhimurium (58.7%) and S. Derby (17.4%). Genotyping revealed 46 different PFGE profiles among the 276 Salmonella isolates. The same genotype at the lairage area as in the oral cavity of the pigs was found in 95%. The results indicate that the lairage area is a primary source of Salmonella in slaughter pigs and that carcass contamination originates from the environment rather than from the pig (inner contamination) itself. It further shows that slaughterhouses vary in their capability of dealing with Salmonella positive pigs. A slaughterhouse specific approach is needed, however, general guidelines should be provided to decrease the contamination level of the lairage area and the slaughter environment.

Background: Group B streptococcus (GBS) has been implicated in adverse pregnancy outcomes. GBS recto-vaginal colonization rates significantly vary among different communities and geographic locations. Limited data is available on the prevalence and effects of GBS recto-vaginal colonization among pregnant mothers in developing countries like Ethiopia. Objective: To assess the prevalence of GBS recto-vaginal colonization among near term pregnant mothers and the antimicrobial susceptibility pattern of the isolates. Methods: A cross sectional descriptive study was conducted on pregnant mothers at gestational age of 35-37 weeks attending Ante Natal Clinics at Ghandi Memorial (GMH) and Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa. Samples from lower genital tract and rectum were collected and cultured for GBS on CHROM agar Strep B. Results: Twenty two of the 300 pregnant mothers (7.2%) studied were found to have positive GBS recto-vaginal culture. Twelve isolates (55%) were sensitive to penicillin while 20 (91%) were sensitive to ampicilline. All isolates except one were sensitive to Erythromycin. Conclusion: The study showed recto-vaginal GBS colonization among near term pregnant mothers is reasonably high in our community calling for the need to screen mothers near term and provide appropriate antimicrobial prophylaxis to prevent potential adverse maternal and neonatal outcome.

Practical application of sex-selected spermatozoa in the horse industry would be greatly improved by the ability to develop simplified methods for shipping, storing, and inseminating sex-selected spermatozoa. Acceptable pregnancy rates have been achieved using fresh sex-sorted stallion sperm, however many stallion owners are reluctant to send their stallions to the sorter location for collection during the breeding season. Furthermore, the technology would be more applicable if the hysteroscopic insemination technique was not necessary for adequate pregnancy rates. Hysteroscopic insemination requires expensive equipment and specially trained personnel. In the present study, stallion sperm were sex-sorted after being stored at either 5 • C or 15 • C for 18 h. Twenty million sex-sorted sperm were then inseminated using one of two insemination techniques: the hysteroscopic method or the rectally guided, deep-uterine technique. Results were determined based on 16-day pregnancy status. A first-cycle pregnancy rate of 72% (18/25) was achieved when sperm were shipped at 15 • C, sex-sorted, and then inseminated using the hysteroscopic method. With these results, it can be concluded that stallions are not necessary at the sorter location to achieve acceptable fertility with sex-sorted sperm. There was a tendency for more mares to become pregnant when sperm were shipped at 15 • C prior to sorting, when compared to shipment at 5 • C. Similarly, there was a tendency for more mares to become pregnant when hysteroscopic insemination was utilized,

The median V100 and D90 to the prostate target were 96% and 166 Gy, respectively. In 91% of cases a D90 of 140 Gy was achieved. In these patients, the V100 and D90 values did not have a significant influence on PSA relapse-free survival outcomes. The median maximum ...