فهرست مطالب ali sobhanian

Ghost ileostomy is a newly invented method that is used in patients with low anterior resection and colorectal anastomosis. Ghost ileostomy can be used instead of a converting stoma. A converting stoma (CS) is critical after low rectal resection procedures due to its role in preventing anastomosis leakage, especially in patients who are at higher risk, but its complications are non-negligible. The authors approached a study of Ghost ileostomy to identify its probable post-operation morbidity and mortality. The purpose of this study was to assess the prevalence of some post-operation morbidity such as anastomosis bleeding or hematoma, prolonged ileus, pulmonary embolism, intra-abdominal abscess, wound site infection, and other complications.

26 patients with low anterior resection and colorectal anastomosis due to colon cancer without any risk factor between 2013 and 2014 were selected. Checking of anastomosis leakage after 10-14 days post-operation was analyzed to assess the prevalence of anastomosis leakage and compare post-operation morbidity and mortality.

The mean age of cases was 55 years (40 to 65). 16 (61.5%) were male and 10 (38.5%) females. The average BMI is 23.7 and all of the patients are in the normal range. The authors’ mortality rate was negative. 2 patients (0.076%) suffered from prolonged ileus and one patient (0.038%) had a wound site infection. Other postoperation morbidities such as anastomosis bleeding or hematoma, pulmonary embolism, intra-abdominal abscess were negative. The authors had no stoma-related morbidity and also no anastomosis morbidity.

Anastomosis leakage is the most common complication in colorectal surgeries. Diverting stoma can decrease complications of anastomosis leakage but there is no evidence of its preventing role. By using ghost ileostomy, the authors can manage selective loop ileostomy and the complications will be reduced. The most reliable way for anastomosis leakage diagnosis is the surgeon’s suspicion. Converting stoma that is used for preventing anastomosis leakage, has significant complications of its own. As the anastomosis leakage does not have a high prevalence, the authors can use ghost ileostomy to reduce the complications and improve the quality of life.

Anastomosis leakage is a pivotal post colorectal surgery, threatening patient survival. Unspecific clinical presentations prolong the diagnostic process, potentially reducing the effectiveness of interventions. This situation has highlighted the need for a biomarker that enables early prediction of anastomosis leakage (AL). Previous studies suggest the potential utility of serum levels of white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT) as biomarkers for early detection of AL. Consequently, the present study was conducted with the aim of investigating the potential correlation of these markers with the occurrence of AL.

Patients who were referred to the hospitals of Tehran University of Medical Sciences from November 2018 to January 2020 were evaluated for inclusion in the study. After obtaining informed consents, 277 cases were enrolled in the study. Serum levels of WBC, CRP, and PCT were measured preoperatively and up to five days postoperation. A statistical correlation analysis was conducted using SPSS software (version 24).

Among the 277 cases, 14 exhibited AL. The highest sensitivity and specificity for AL were observed for CRP on the second and third post-operative days. PCT, however, showed higher utility on the fourth post-operative day with 57% sensitivity, 56% specificity (p-value = 0.001 for the second day and 0.002 on the third day), and a negative predictive value of 96%. These values changed to 36%, 64%, and 95% respectively on the fifth postoperative day, which remains within the acceptable range (p-value = 0.018).

Both CRP and PCT have potential utility as diagnostic biomarkers for the presence of AL and can significantly accelerate the diagnosis period. For the highest sensitivity and specificity, CRP should be used on the second and third post-operative days. The optimal utility for PCT, however, is on the fourth post-operative day.

 Ripening is the process of preparing the cervix for induction of labor and is crucial to identify a low-complication, low-cost, and safe method of inducing labor before spontaneous labor begins. Therefore, this study aimed to demonstrate the impact of the evening primrose capsule on inducing labor, as well as to compare its effect to that of misoprostol.

 This prospective clinical trial study was performed on 200 low-risk pregnant women candidate for delivery in an academic hospital in Tehran from 2018 to 2020. Patients were randomly divided into two groups to receive 25 µg misoprostol vaginally or 500 mg evening primrose vaginal capsule to induce labor and repeated every three hours until reaching the bishop score > 4 in case of no effective up to three doses. The total drug dose, as well as maternal and neonatal outcomes evaluated and compared between groups.

 Although misoprostol was significantly more effective than evening primrose in increasing cervical bishop score in the inactive phase of labor, the active phase and delivery time were not different between the groups. Also, there was no significant difference between the two groups in the cesarean section rate. Maternal complications, including uterine hyperstimulation, headache, or gastrointestinal complications in the group receiving misoprostol were significantly higher in misoprostol group, but fetal complications, including Apgar score, pH, hospitalization, and meconium excretion, were not significantly different between the two groups.

 Evening primrose capsules are safe and can be used to induce labor because of the lower risk of hyperstimulation of the uterus and the higher tolerance. There should be more research done to see if this medicine can be used alone or in conjunction with misoprostol or mechanical dilators or if it can be administered at home rather than in the hospital.