A rare case of repeated anastomotic recurrence due to tumor implantation after curative surgery for sigmoid colon cancer

<p>Abstract</p> <p>Background</p> <p>Anastomotic recurrence is often experienced at colocolic or colorectal anastomoses. Tumor cell implantation has been reported as the mechanism of anastomotic recurrence. However, anastomotic recurrence occurring repeatedly after curative surgery is rare. We herein report a rare case of repeated anastomotic recurrence after curative surgery for sigmoid colon cancer.</p> <p>Case presentation</p> <p>A 51-year-old man underwent radical surgery for sigmoid colon cancer. However, anastomotic recurrence developed three times during three years and six months after the initial operation in spite of irrigation with 5% povidone-iodine before anastomosis. The serum carcinoembryonic antigen (CEA) level had been within normal limits after sigmoidectomy. Finally, the patient underwent abdominoperineal resection. The clinico-pathological findings revealed that possible tumor cell implantation caused these anastomotic recurrences. The patients survived without recurrence during the follow-up period of seven years and nine months.</p> <p>Conclusion</p> <p>We experienced a rare case of repeated anastomotic recurrence due to possible tumor implantation after curative surgery for sigmoid colon cancer; however the prognosis was ultimately very good. CEA monitoring was insensitive for detection of anastomotic recurrence in this case.</p

Updated meta-analysis of randomized controlled trials comparing conventional excisional haemorrhoidectomy with LigaSure for haemorrhoids

Background:\ud To compare the surgical outcome of haemorrhoidectomy performed using LigaSure bipolar diathermy with conventional haemorrhoidectomy.\ud \ud Methods:\ud Only randomized and alternate allocated studies were included from the major electronic databases using the search terms "ligasure" and "haemorrhoids" Duration of operation, blood loss during operation, postoperative pain score, wound healing, in-hospital stay, time to return to normal activities and complications were assessed.\ud \ud Results:\ud The 11 trials contained a total of 1,046 patients; the largest study was based on 273 patients and two earlier studies were based on 34 patients. No significant gender mismatch between the groups was reported in any of the studies. The patients’ ages were similar between groups in the studies, as was disease severity. All 11 studies reported a shorter duration of the operation when using LigaSure compared to the conventional technique (p<0.001). The postoperative pain score (p=0.001) and blood loss during operation (p=0.001) were significantly reduced. After LigaSure haemorrhoidectomy wound healing (p=0.004) and the return to normal activities (p=0.001) were significantly faster than after conventional haemorrhoidectomy. However, the overall incidence of complications reported was not significantly different (p=0.056).\ud \ud Conclusions:\ud LigaSure is an effective instrument for haemorrhoidectomy which results in less blood loss, quicker wound healing and earlier return to work.\u

Functional outcome after perineal stapled prolapse resection for external rectal prolapse

<p>Abstract</p> <p>Background</p> <p>A new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up.</p> <p>Methods</p> <p>From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour^®Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores.</p> <p>Results</p> <p>32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (<it>P </it>< 0.0001). No new incidence of constipation was reported.</p> <p>Conclusions</p> <p>The PSP is an elegant, fast and safe procedure, with good functional results.</p> <p>Trial registration</p> <p>ISRCTN68491191</p

Adaptation of the urban codes : a story of placemaking in Jerusalem

The tension between stability and adaptability, and the pursuit for mechanisms that allow cities to face internal and external pressures, is a fundamental question for contemporary urban planners. To understand this tension and to develop a complexity-based perspective for planning action that deals with this tension, we describe the city as a complex assemblage employing adaptive mechanisms in front of rapid change. We argue how processes of coding, decoding and recoding continuously take place in the urban setting and are part of such adaptive mechanisms, in particular where community's informal codes diverge from formal practices. In this context, we examine 'placemaking' as an urban mechanism whose function is not only to allow different local voices to express themselves, but also to assist in updating and adapting the 'urban DNA' to the city constituents and their diversity. The placemaking project that took place in Jerusalem over the period 2016-2018 is analysed in this framework. We show how Jerusalem municipality is experimenting with new ways of working with very diverse populations via wide-scale community-led methodologies viewed as part of the city capacity to learn and adapt within a changing environment. We turn to epigenetics, a biological field researching micro- and macro-evolutionary mechanisms, to provide us with a theoretical descriptive model that can help represent the impact of such a wide project in both short-term and long-term recoding at the level of urban rules and regulations. This allows us to identify relevant operational mechanisms yielding novelty in approach to the co-existence between formal urban codes and local communities' strong sub-codes