The Synchronous Occurrence of Neuroendocrine Tumor and Gastrointestinal Stromal Tumor (GIST) at Gastric Site

Gastrointestinal stromal tumors (GIST) are the most frequent sarcomas in the gastrointestinal tract. They affect all segments of the digestive tract. The incidental occurrence of GIST and other primary tumors has not been well described in literature. We describe a case of a 73 year old patient who underwent surgery for gastric GIST with an incidental pathologic diagnosis of a gastric neuroendocrine tumor. The occasional finding of this association underlines the importance of a carefully pathological diagnosis for its identification. In literature there is no evidence of concomitant neuroendocrine tumor and gastrointestinal stromal tumor (GIST) at gastric site

Evaluation of toxicity, nephroprotective and hepatoprotective activities of Argan oil on CCl4-induced nephrotoxicity and hepatotoxicity in Wistar rats

In traditional therapy, Argania spinosa L. seeds oil used as a nephroprotective and hepatoprotective agent. The present work aims to investigate the acute toxicity of unroasted Argan oil, and studied the nephroprotective and the hepatoprotective activity of both oils Roasted (Roil) and unroasted Argan oil (UnRoil) on CCl4-induced liver and kidney damages in Wistar rats. Animals were divided into five equal groups; Control and CCl4 groups are received only distilled water (10 mL/Kg/day). Control positive group received 50 mg/Kg/day of Silymarin. Roil and UnRoil groups treated with 2 mL/Kg/day of Roil and UnRoil. One week after each pretreatment, the rats are injected intraperitoneally with 1 mL/kg/week of CCl4. The treatment has lasted for 15 days. The body weight, urinary volume, water, and food intake were measured at the end of the treatment. Then, the animals are sacrificed; the blood and the liver samples were collected for determining the liver weight ratio and biochemical parameters. UnRoil did not show any sign of toxicity up to 5 mL/Kg. In Roil and UnRoil groups the water intake, ALT, AST, total and direct bilirubin, triglycerides, LDL, plasmatic creatinine, urea, uric acid, and MDA levels are reduced significantly as compared with the CCl4 group. However, body weight,liver weight ratio, food intake, urine urea, urinary creatinine, hepatic glycogen, and GSH levels showed a significant increase compared to the CCl4 group. Roil and UnRoil showed important nephroprotective and hepatoprotective effects against CCl4. Although, the roasting process does not influence the ability of Argan seed oils towards these activities.Keywords

Risk factors of acute renal failure in patients with protective ileostomy after rectal cancer surgery

Abstract Background Despite the potential benefits of protective ileostomy in rectal surgery, diverting loop ileostomy construction is not free of specific medical consequences implying unplanned hospital readmissions. The most common reason for readmission in these patients is a dehydration with a prevalence of acute renal failure (ARF) of 20%. The objective of this study was to establish the predictive factors of ARF in patients with protective ileostomy after surgery for rectal cancer from a bicentric study. Methods we conducted a bicentric retrospective cohort study to identify the risk factor of ARF. This study was carried out on 277 patients operated for rectal cancer with necessity of a protective ileostomy during the study period. ARF was measured at any endpoint between ileostomy creation and reversal. Multiple logistic regressions were performed to identify independent risk factors. Results A total of 277 patients were included, and 18% (n = 50) were readmitted for ARF. In multivariate logistic regression, increased age (OR 1.02, p = 0.01), Psychiatric diseases (OR 4.33, p = 0.014), Angiotensin II receptor blockers (OR 5.15, p < 0.001) and the ASA score ≥ 3 (OR 9.5, p < 0.001) were significantly associated with ARF. Conclusion Acute renal failure is a prevalent and significant event in the postoperative course of ileostomy patients. Patients at risk should be risk stratified before discharge and targeted for intensive preventive measures

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)