OBSTETRIC INJURY OF THE RECTUM WITH INTACT ANAL SPHINCTER - TWO CASE REPORTS

Background

Injury of the rectum with intact anal sphincter is an extremely rare but very serious complication of vaginal delivery. It is also called a "buttonhole" tear.

Case

We present two cases of "buttonhole" tear/injury.

Results

In one case, the injury was recognized at the time of delivery and adequately treated. In the other case the injury was not diagnosed on time and the patient was treated for complications on the 6th postpartal day.

Conclusion

The consequences for the wellbeing of young mothers with perineal injury can be serious and affect social and sexual aspects of their lives. Adequate surgical treatment and postoperative care assure optimal results and prevent long term complications such as fistulas or fecal incontinence.

Cytokeratin 20 positive cells in blood of colorectal cancer patients as an unfavorable prognostic marker

OBJECTIVES

Cytokeratin 20 (CK20) is one of the most investigated markers for the detection of circulating colorectal cancer (CRC) cells by reverse transcription polymerase chain reaction (RT-PCR). The aim of this study was to evaluate prognostic value of RT-PCR detection of circulating CRC cells using CK20 as a marker, and to compare the value of preoperative and postoperative blood sample analysis for that purpose.

METHODS

Ribonucleic acid (RNA) was isolated from mononuclear cell fraction of blood samples taken from 95 CRC patients before and after tumor resection and from 23 healthy volunteers and assayed by real-time RT-PCR for CK20 expression.

RESULTS

In patients positive for CK20 postoperatively both progression-free survival (PFS) and overall survival were significantly shorter than in patients negative for CK20 postoperatively, while the difference between patients positive and negative for CK20 preoperatively was not statistically significant in terms of neither PFS nor overall survival.

CONCLUSION

Our results have shown prognostic value of circulating cancer cells detected in postoperative blood samples from CRC patients using CK20 as marker for RT-PCR, which has potential implications for treatment of these patients. In clinical practice, CK20 expression profile could be a factor in weighting treatment options in CRC patients. In cases where multiple treatment options are possible, patients with positive postoperative CK20 expression could be candidates to receive more aggressive treatment.

SMAD7 variant rs4939827 is associated with colorectal cancer risk in Croatian population

BACKGROUND

Twenty common genetic variants have been associated with risk of developing colorectal cancer (CRC) in genome wide association studies to date. Since large differences between populations exist, generalisability of findings to any specific population needs to be confirmed.

AIM

The aim of this study was to perform an association study between risk variants: rs10795668, rs16892766, rs3802842 and rs4939827 and CRC risk in Croatian population.

METHODS

An association study was performed on 320 colorectal cancer cases and 594 controls recruited in Croatia. We genotyped four variants previously associated with CRC: rs10795668, rs16892766, rs3802842 and rs4939827.

RESULTS

SMAD7 variant rs4939827 (18q21.1) was significantly associated with CRC risk in Croatian population. C allele was associated with a decreased risk, odds ratio (OR): 0.70 (95% CI: 0.57-0.85, P=3.5E-04). Compared to TT homozygotes, risk was reduced by 34% in heterozygotes (OR=0.66, 95% CI: 0.47-0.92) and by 52% in CC homozygotes (OR=0.48, 95% CI: 0.33-0.72).

CONCLUSION

Our results show association of rs4939827 with colorectal cancer risk in Croatian population. The higher strength of the association in comparison to other studies suggests population-specific environmental or genetic factors may be modifying the association. More studies are needed to further describe role of rs4939827 in CRC. Likely reason for failure of replication for other 3 loci is inadequate study power.

Common variation near CDKN1A, POLD3 and SHROOM2 influences colorectal cancer risk

We performed a meta-analysis of five genome-wide association studies to identify common variants influencing colorectal cancer (CRC) risk comprising 8,682 cases and 9,649 controls. Replication analysis was performed in case-control sets totaling 21,096 cases and 19,555 controls. We identified three new CRC risk loci at 6p21 (rs1321311, near CDKN1A; P = 1.14 × 10(-10)), 11q13.4 (rs3824999, intronic to POLD3; P = 3.65 × 10(-10)) and Xp22.2 (rs5934683, near SHROOM2; P = 7.30 × 10(-10)) This brings the number of independent loci associated with CRC risk to 20 and provides further insight into the genetic architecture of inherited susceptibility to CRC.

Identification and characterization of potential autochthonous starter cultures from a Croatian "brand" product "Slavonski kulen"

The microbial population of a traditional Croatian fermented sausage "Slavonski kulen" was isolated, identified and subjected to technological and functional characterization in order to select potential autochthonous functional starter cultures. Dominant microflora were lactic acid bacteria (LAB), followed by staphylococci. Identification of isolated lactobacilli showed domination of Leuconostoc mesenteroides and Lactobacillus acidophilus while Staphylococcus xylosus and Staphylococcus warneri outnumbered the staphylococcal microbiota. Most of the isolated LAB and Staphylococcus species displayed good growth in the presence of 5% of NaCl and at 12, 18 and 22°C. All LAB and most of the staphylococci possess proteolytic activity and only Staphylococcus xylosus had lipolytic activity. All lactobacilli and staphylococci isolates produced significant concentrations of lactic acid (as determined by HPLC) and showed antimicrobial activity against pathogenic test microorganisms. Dominant LAB and Staphylococcus species displayed growth in the presence of 1% bile. Most of the staphylococci and all of lactobacilli showed sensitivity to all antibiotics tested.

Structural Brain Abnormalities in Homicidal Patient: Forensic Case Report

Background:

Studies have revealed that areas associated with violent behaviour are located in the prefrontal cortex, medial temporal regions and limbic regions. Key regions commonly found to be impaired in population of violent homicide offenders include prefrontal cortex, temporal gyrus, amygdala-hippocampal complex, and anterior cingulate cortex. Recent findings have confirmed link between large arachnoid cysts and psychotic symptoms. There is no scientific data in literature on the case of homicidal forensic patient with large arachnoidal cyst and lesion of frontal and temporal brain regions.

Clinical presentation:

We present the first forensic clinical case of male homicidal patient, age 29, with arachnoidal cyst (Galassi III) occupying large portion of the right brain hemisphere. The patient is presented with acute psychotic behavior after he killed his father and was escorted to our department for psychiatric evaluation. The patient was catatonic upon admission to the hospital and completely non-cooperative (mute). After interviewing patient's family members we have collected data regarding visible changes in his behaviour in the last two years accompanied with frequent attacks of headache. MRI study revealed large arachnoid cyst in the right brain hemisphere compressing right frontal and temporal cortex with lesions in frontal and temporal cortex and lesion of the white brain matter in insular region of both hemispheres. The patient was ordered antipsychotic therapy (clozapin) and schedulled for further psychiatric observation.

Conclusion:

This clinical case represents highly probable link between structural brain changes and homicidal forensic patient. We have shown multiple structural brain abnormalities supporting neuroscientific hypothesis that impulsive homicide offenders lack the prefrontal “inhibitory” machinery.