Randomized clinical trial of short or long interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer

BACKGROUND

The optimal timing of surgery following preoperative chemoradiotherapy (CRT) is controversial. This trial aimed to compare pathological complete response (pCR) rates obtained after an interval of 8 weeks or less versus more than 8 weeks.

METHODS

Patients with locally advanced rectal adenocarcinoma situated within 12 cm of the anal verge (T3-4 or N+ disease) were randomized to undergo total mesorectal excision (TME) within 8 weeks (classical interval, CI group) or after 8 weeks (long interval, LI group) following CRT.

RESULTS

Among the 327 included patients (CI 160, LI 167), the pCR rate was significantly higher in the LI group than in the CI group (10·0 versus 18·6 per cent; P = 0·027). The highest pCR rate (29 per cent) was observed between 10 and 11 weeks. There was statistically significant disease regression in the LI group, with better stage (P = 0·004) and T category (P = 0·001) than in the CI group. There was no significant difference in surgical quality (rates of tumour-positive margins, TME quality, anastomotic leakage and intraoperative perforation) between the groups. The overall morbidity rate was 22·5 per cent in the CI group and 19·8 per cent in the LI group (P = 0·307). Regression analysis including sex, age, clinical stage, tumour location, tumour differentiation, TME quality, concomitant chemotherapy and interval to surgery revealed no statistically significant predictors of pCR.

CONCLUSION

Disease regression and pCR rate are increased with an interval between CRT and surgery exceeding 8 weeks. Registration number: NCT03287843 (http://www.clinicaltrials.gov).

A Retrospective Study on Mucocele of the Appendix Presented with Acute Abdomen or Acute Appendicitis

Objective

We reported the demographic, clinical, radiologic, preoperative and postoperative characteristics and outcomes on patients of appendix mucocele that presented with or operated for acute appendicitis or acute abdomen.

Methods

A retrospective study. Patients who were presented or operated for acute appendicitis or acute abdomen and had an operative histopathological diagnosis as appendix mucocele (simple mucocele, mucinous cystadenoma, mucinous cystadenocarcinoma) were included. Demographic, clinical, radiologic, preoperative and postoperative data of eligible cases were evaluated.

Results

From January 2003 to February 2010, a total of 2120 patients with the pre-operative diagnosis of acute appendicitis were treated in our center, and nine (0.42%) patients were diagnosed to have mucocele of the appendix. Seven patients (78%) were female. Average age of the patients was 59.5 (range=25-74). Major complaint was right lower quadrant pain in eight (89%) patients. In preoperative ultrasonographic examination of the patients, appendiceal cystic masses (mucocele) were diagnosed in four (44.5%) patients. In histopathologic examination, the number of patients diagnosed to have simple mucocele was two (22%), mucinous cystadenoma was four (45%), and mucinous cystadenocarcinoma was three (33%). No postoperative morbidity or mortality was noted.

Conclusion

Appendix mucocele is a rare disease and it is usually diagnosed histopathologicaly in appendectomy specimens. When a cystic mass in appendix is seen during operation, appendiceal mucocele should be kept in mind to avoid iatrogenic perforation causing pseudomyxoma peritonei and possible concomitant malignancies should be searched.

Rectus Sheath Haematoma: A Rare Cause of Abdominal Pain

Objective

Rectus sheath haematoma (RSH) is a rare entity described as accumulation of blood within the rectus muscle. Patients can present with varying symptoms and signs, mimicking acute abdominal conditions. Failure to diagnose can result in unnecessary diagnostic procedures and surgical interventions.

Methods

We presented a series of 14 cases of RSH presenting to two emergency departments (ED) within a period of 3 years. Their demographic characteristics, medical history, presenting signs, symptoms and treatment were analyzed.

Results

Fourteen cases were diagnosed RSH. Seven cases were on warfarin treatment. Three RSH cases were diagnosed by ultrasonography (USG) only while the remainders had additional computed tomography (CT). Two cases had surgery due to haemoperitoneum, and the rest were treated conservatively with bed rest, analgesics and reversal of anticoagulation therapy. All patients were discharged from hospitals.

Conclusions

RSH is an important entity which must be considered in patients with known risk factors presenting to ED with abdominal pain. In elderly patients with a history of cough, anticoagulant use with palpable mass on abdominal wall, RSH must be considered as a possible diagnosis for unexplained abdominal pain. USG, together with CT in selected cases, should be performed to reveal this rare disease entity.

Stenting of vertebral artery origin with the buddy wire technique in tortuous subclavian artery. A case report

Tortuous vasculature is a common reason for failure to stabilize a guiding catheter in an appropriate position and is associated with a higher incidence of vascular complications. In such a case, the guiding catheter often buckles into the aorta during an attempt to place the balloon or stent. In this report, we used the buddy wire technique to support the guiding catheter, and we passed through the vertebral artery origin stenosis with the help of a microcatheter-microguidewire combination which enabled stent deployment. We kept the buddy wire through the guiding catheter throughout the procedure and the 6F guiding catheter allowed passages of both buddy wire and stent system.

Diagnosis in childhood abdominal Burkitt's lymphoma

BACKGROUND

The role of surgery has changed substantially over the years in abdominal Burkitt's lymphoma. Laparotomy without total excision of the tumor does not have a positive effect on survival, might cause complications, and delays initiation of chemotherapy. Here we present our diagnostic management of patients with abdominal Burkitt's lymphoma.

MATERIALS AND METHODS

The diagnostic methods of abdominal Burkitt's lymphoma cases treated between January 1999 and December 2009 were evaluated retrospectively.

RESULTS

Of the 48 abdominal Burkitt's lymphoma patients, 13 also had extra-abdominal site involvement. Diagnosis was made with ultrasound-guided tru-cut needle biopsy of the abdominal mass (n = 11), fluid cytology (n = 7), extra-abdominal site biopsy (n = 4), bone marrow aspiration (n = 2), gastroscopy (n = 1), and laparotomy (n = 23). In patients diagnosed with laparotomy, chemotherapy was started in 4-22 days (median 7) compared with patients diagnosed with other diagnostic interventions in 2-4 days (median 2) (P < .001).

CONCLUSION

Although the most frequently used technique is laparotomy and open biopsy in our series, other methods provided quicker initiation of chemotherapy and less surgical morbidity. Especially in patients with high stages, cytological evaluation and tru-cut needle biopsy with radiological guidance is a better alternative of laparotomy.

Effects of N-acetylcysteine treatment on oxidative stress in acetic acid-induced experimental colitis in rats

We assessed the possible protective effects of N-acetylcysteine (NAC) against toxic damage in the rat colon. Two doses of NAC (20 mg/kg and 100 mg/kg) given for 2 days and 7 days after acetic acid administration (to induce colitis) were tested. NAC was dissolved in saline and administered locally (intracolonic), systemically (intraperitoneal) or in a combination (intracolonic and intraperitoneal). Several parameters, including macroscopic and histopathological scores and myeloperoxidase, glutathione and nitric oxide concentrations were measured using standard assay procedures. Treatment with 100 mg/kg NAC for 7 days significantly decreased tissue myeloperoxidase, glutathione and nitric oxide concentrations. The 20 mg/kg dose had no protective effects. The data indicate that NAC substantially reduced the degree of colonic injury, probably by regulating free radical production and inhibiting inflammation. It may, therefore, have a role in the treatment of inflammatory bowel disease.