A simple tool to evaluate common disorders: validation of a "proctological symptom scale".

Purpose: Proctological symptomatology is of little complexity and therefore appears particularly suitable for comparative evaluation by visual scales. We devised a "proctological symptom scale" (PSS) with separate scales for four cardinal proctological symptoms: pain, itching/irritation, discharge/moisture, and bleeding. The objective of this study was to evaluate the PSS among proctological patients and non-proctological controls.

A prospective multi-institutional study assessing clinical outcome with the NiTi compression anastomosis ring (Biodynamix ColonRingTM) in elective colorectal anastomoses.

Background/aims: This 3-institution study assessed the short-term clinical outcome and safety profile of the NiTi Biodynamix ColonRingTM compression anastomosis in elective colorectal resection.

Methodology: A prospective, open-label, non-randomized trial was conducted at 3 separate institutions between October 2008 to October 2009 in patients undergoing elective colorectal resection with the Biodynamix ColonRingTM compression anastomosis ring, assessing technical factors in its operative use, immediate and short-term clinical outcome parameters (length of hospital stay, time to first passage of flatus and stool and to oral intake) and peri-operative complications including anastomotic failure or stenosis and wound infection.

Results: Forty patients (22 females, mean age 65.

The effect of neoadjuvant Imatinib therapy on outcome and survival after rectal gastrointestinal stromal tumour.

Aim: The study aimed to characterize the pathological and clinical response of rectal gastrointestinal stromal tumours (GISTs) to neoadjuvant Imatinib.

Method: The medical records of patients with rectal GISTs who were diagnosed and treated in five medical centres in Israel between January 2002 and January 2009 were retrospectively examined. Twelve patients who fulfilled the inclusion criteria of nonmetastatic rectal GIST for which preoperative neoadjuvant treatment with Imatinib was considered were suitable for enrollment.

A prospective, randomized, controlled, multicenter study of a real-time, intraoperative probe for positive margin detection in breast-conserving surgery.

Background: This randomized, double-arm trial was designed to study the benefit of a novel device (MarginProbe, Dune Medical Devices, Caesarea, Israel) in intraoperative margin assessment for breast-conserving surgery (BCS) and the associated reduction in reoperations.

Methods: In the device group, the probe was applied to the lumpectomy specimen and additional tissue was excised according to device readings. Study arms were compared by reoperation rates and by correct surgical reaction confirmed by histology.

End-to-end compression anastomosis of the rectum: a pig model.

Background: Generations of investigators have attempted to achieve compression bowel anastomosis by a sutureless device, providing temporary support to the tissue and facilitating the natural healing process. The biocompatibility of nickel-titanium alloy has made it attractive for use in medical implants and devices, and several studies have described the creation of a side-to-side compression anastomosis in colon surgery with a nickel-titanium clip. We evaluated the feasibility and safety of a newly designed gun for applying a nickel-titanium compression anastomosis ring (CAR) to create an end-to-end colorectal anastomosis in a porcine model.

Simple clinical examination predicts complexity of perianal fistula.

Objective: To investigate the diagnostic value of the distance between external opening of perianal fistula and anal verge and to evaluate its relation to the type of fistula. Preoperative identification of complex fistulae is important for proper planning of treatment.

Patients And Methods: One hundred and fifteen consecutive patients operated for perianal fistula were studied prospectively.

Predominance of younger age, advanced stage, poorly-differentiated and mucinous histology in Israeli Arab patients with colorectal cancer.

Background: Colorectal cancer (CRC) incidence in the Israeli population is higher in the Jewish population than among Arabs.

Materials And Methods: To determine the differences in demographic, clinical, histopathological and molecular characteristics of CRC between these two ethnic groups, 125 Arab patients treated at 3 community hospitals over a 20-year period were compared to a group of 208 consecutive Jewish patients. The mutator (replication error-positive [RER]) phenotype was detected by immunohistochemical evaluation of hMLH1 and hMSH2 protein expression in tumor tissue.

Splenic and mesenteric emboli in a patient with protruding aortic arch atheroma.

Protruding atheromas in the thoracic aorta are an important cause of embolic disease. Transesophageal echocardiography (TEE) is the modality of choice for diagnosis of these lesions. We present a patient with splenic infarction in whom TEE revealed a large mobile atheroma in the aortic arch.

Duodenal necrosis as the presenting manifestation of polyarteritis nodosa.

Polyarteritis nodosa involves necrotising vasculitis of small and medium-sized arteries. Multiple organ systems are involved. A non-specific and slow course of disease is common.

Ergotamine-induced anorectal strictures: report of five cases.

Purpose: Ergotamine tartrate suppositories are used for treatment of migraine headache attacks. Chronic abuse may lead to severe anorectal complications such as ulceration, stricture, and rectovaginal fistula. These complications are rare, and only sporadic reports may be found.

Sutureless closed hemorrhoidectomy: a new technique.

Objective: To compare a new technique of radical hemorrhoidectomy using an electrothermal device originally devised to seal vessels in abdominal operations, with the conventional open Milligan-Morgan procedure performed with diathermy.

Summary Background Data: Hemorrhoidectomy is one of the most commonly performed anorectal operations. Two well-established methods, the "open" Milligan-Morgan excision and the "closed" Ferguson technique, both carry risks of postoperative bleeding, urinary retention, and late anal stenosis.

Complications of Milligan-Morgan hemorrhoidectomy.

Based on a retrospective review of a personal experience with 500 modified Milligan-Morgan hemorrhoidectomies, technical suggestions for avoiding early and late complications are presented. The problems of early and delayed bleeding, anal verge and mucosal stenosis, pain and prolonged healing due to persistent anal ulcer are discussed

Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer.

Purpose: It is possible that implantation of viable malignant cells is one of the mechanisms of anastomotic recurrence in rectosigmoid cancer. The viability of shed intraluminal cells was previously established and malignant cells were retrieved on circular staplers in unwashed rectal stumps. The aim of this study is to evaluate the effectiveness of a defined and uniform washout protocol in eradication of intraluminal malignant cells during anterior resection.

Surgical treatment of leiomyosarcoma of the distal duodenum.

Malignant tumors of the small intestine are rare. An uncommon finding of leiomyosarcoma located in the fourth part of the duodenum was diagnosed by gastrointestinal contrast studies, CT and angiography. Although malignant lesions of the small bowel are usually diagnosed late and thus are far advanced, curative resection was possible in our case.

Abdominal stoma fashioned by a used circular stapler.

A method of application of a used circular stapler in abdominal stoma formation is described. The procedure is rapid, simple, carries less tissue trauma than the conventional methods and does not involve any additional cost. It allows for a precise circular aperture in the abdominal wall which may be optimally adjusted to the bowel diameter.