A STUDY ON PRESENTATION AND BEHAVIOR OF COLO-RECTAL CARCINOMA IN JHARKHAND

Introduction: Colo-rectal carcinoma is most frequent neoplasm of Western countries. It is 3rd most common in men and 2nd most common in women. The Aim of this study is to know different presentations and age variations and its method of diagnosis and management. Materials and methods: This is a observational study including 25 patients presented in the Emergency and OPD of RIMS, Ranchi with complaints of bleeding PR, alteration of bowel habits, rectal pain and discharge, incontinence, abdominal pain and distention and loss of weight. Results: Most common age of presentation is 40-50 years, most commonly involving men. Most common presentation is alteration of bowel habits followed by bleeding PR. Diagnosis was mostly made by CECT whole abdomen and colonoscopic /Rectal biopsy. Follow-up was done by CEA levels. Conclusion: There is increased incidence of colo-rectal carcinoma in young patients and there is tendency of late presentation of colo-rectal cancers.

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Clinical Features and Outcome of Sporadic Colorectal Carcinoma in Young Patients: A Cross-Sectional Analysis from a Developing Country

ISRN Oncology ◽

10.1155/2014/461570 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Muhammad Nauman Zahir ◽

Eisha Mahpara Azhar ◽

Sobia Rafiq ◽

Kulsoom Ghias ◽

Munira Shabbir-Moosajee

Keyword(s):

Colorectal Carcinoma ◽

Rectal Carcinoma ◽

Early Onset ◽

Multivariable Analysis ◽

Young Patients ◽

Retrospective Chart Review ◽

Cross Sectional ◽

Female Ratio ◽

Colon Cancers ◽

Rectal Cancers

Background. Early onset colorectal carcinoma (CRC) is rare and has been hypothesized to be a biologically and clinically distinct entity personifying aggressive disease and worse survival. Methods. Data for 131 patients was collected by retrospective chart review. Cox proportional hazard model was used to compute prevalence ratios and 95% confidence intervals. Results. Early onset sporadic CRC accounted for 32% of all CRC treated in the specified time period. The mean age was 33.3±7.9 years and the male to female ratio was 2:1. Colon and rectal cancers accounted for 55% and 45% of patients, respectively. 96% of rectal carcinoma patients received appropriate therapy as opposed to 65% of colon cancers. On multivariable analysis, appropriate reception of therapy (PR 4.99; 95% CI, 1.21–20.6) and signet ring morphology (PR 2.40; 95% CI, 1.33–4.32) were significantly associated with rectal cancers as opposed to colon cancer. Kaplan-Meier analysis revealed a trend towards inferior survival for rectal carcinoma 2 years after diagnosis. Conclusion.A high prevalence of early onset CRC was noted in the study. A trend towards inferior survival was seen in patients with rectal cancer. This finding raises the possibility of rectal carcinoma being an aggressive subset of young CRC.

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TWISTED POUCH SYNDROME - A DIFFICULT TO DIAGNOSE MECHANICAL COMPLICATION OF ILEAL POUCH-ANAL ANASTOMOSIS: OUTCOMES AFTER REDO POUCH PROCEDURES

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.041 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S16-S17

Author(s):

Stefan Holubar ◽

Amy Lightner ◽

Taha Qazi ◽

Erica Savage ◽

Justin Ream ◽

...

Keyword(s):

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Free Text ◽

Mechanical Complication ◽

Rectal Pain ◽

Bowel Habits ◽

Additional Surgery ◽

Free Text Search ◽

Anal Anastomosis ◽

Redo Pouch

Abstract Background Ileal pouch-anal anastomosis (IPAA) is a technically demanding procedure. Intraoperatively, great care must be taken to assure a straight superior mesenteric axis. Rarely, twisted pouches are inadvertently constructed, resulting in deviations of expected pouch function, i.e. patients readily able to open their bowels on average 7x/24 hours without pain. Twisted pouches may result in symptoms classified as pouch dysfunction. Herein we describe our quaternary pouch referral center experience with twisted pouch syndrome (TPS). Methods We performed a retrospective review of our prospectively maintained pouch registry from 1995 – 2020. Patients were identified using free-text search of redo IPAA operative reports for variations of the term “twist”. We defined twisted pouch syndrome as intraoperative findings of twisting of the pouch as the primary pathology. Data are presented as frequency (proportion) or median (interquartile range). Results Over 25-years, we identified 29 patients with confirmed TPS who underwent a redo pouch procedure by 10 surgeons. Overall, 65% were female, median BMI 21.2 (19.5 – 26) kg/m2. The duration from the index IPAA to the redo procedure was 4 (2 – 8) years; all (100%) were referral cases constructed elsewhere. Original diagnoses included: ulcerative colitis (90%), FAP (10%), lack of interstitial cells of Cajal in 1 patient (10%). All patients presented with symptoms of pouch dysfunction including erratic bowel habits (96%) with urgency/frequency, abdominal/pelvic/rectal pain (92%), and obstructive symptoms (88%). Most had (75%) been treated for chronic pouchitis with antibiotics or biologics, and 46% had undergone 1 or more additional surgery. Prior to redo IPAA procedure patients underwent a thorough workup: 100% pouchoscopy, 96% GGE, 93% underwent EUA, 88% MRI, 73% manometry, and 42% defecography. TPS was diagnosed in 15% by pouchoscopy, in 10% by imaging, and in 75% was diagnosed intra-operatively at re-diversion (20%) or revision/redo IPAA (55%). In terms of surgical intervention, 85% were initially re-diverted. A total of 18 (62%) underwent pouch revision, and 10 (38%) required redo-IPAA. Short-term outcomes: LOS 7.5 (5 – 9) days, any complication 48%, readmission 11%, reoperation 3.4%, zero mortalities. After a median follow-up 50 (28 – 60) months, 2 never had loop ileostomy closure, 1 had pouch excision, and 1 a Kock pouch, yielding an overall pouch survival rate of 86%. Conclusions Twisted pouch syndrome presents with pouch dysfunction manifest by erratic bowel habits, unexplained pain, and obstructive (defecation) symptoms. This syndrome may also mimic chronic pouchitis. Despite a thorough workup which may suggest a mechanical problem, many patient may not be diagnosed until time of redo pouch surgery. Redo surgery for twisted pouch syndrome results in long-term pouch survival for the majority.

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Is colorectal cancer associated with altered bowel habits in young patients?

ANZ Journal of Surgery ◽

10.1111/ans.16532 ◽

2020 ◽

Author(s):

Ashray Rajagopalan ◽

Ellathios Antoniou ◽

Marina Morkos ◽

Ellen Rajagopalan ◽

Asiri Arachchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Young Patients ◽

Bowel Habits

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The Ethical Dilemma of Adolescent Bariatric Surgery

Clinical Scholars Review ◽

10.1891/1939-2095.6.2.124 ◽

2013 ◽

Vol 6 (2) ◽

pp. 124-130

Author(s):

Dorothy Roedel Ferraro

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Ethical Issues ◽

Young Patients ◽

The United States ◽

Adolescent Obesity ◽

Public Health Issue ◽

Sustained Weight Loss ◽

And Behavior ◽

Adolescent Bariatric Surgery

Adolescent obesity and obesity-related conditions have risen at alarming rates in the United States, positioning childhood obesity as a major public health issue. The consequences of adolescent obesity are far-reaching and often include medical, psychosocial, emotional, and economic burdens. Traditional interventions targeted at diet and behavior modification are largely ineffective in reducing adolescent adiposity. Bariatric surgery, therefore, is gaining recognition as a means to significant and sustained weight loss in the teenage population. Given the innovative nature of this intervention and the lack of robust evidence to support its safety and efficacy in this population, few procedures are being performed on pediatric patients. Surgical weight loss in young patients with severe obesity poses a staid ethical burden to all involved. This article addresses the ethical issues of beneficence and nonmaleficence as they apply to adolescent bariatric surgery. Bariatric surgery for the treatment of severe adolescent obesity is an ethical and effective approach when performed discriminately in centers that can provide expert interprofessional support.

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Surgical outcomes, bowel habits and quality of life in young patients after ileoanal anastomosis for ulcerative colitis

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2016.03.002 ◽

2016 ◽

Vol 51 (8) ◽

pp. 1246-1250 ◽

Cited By ~ 16

Author(s):

J. Leslie Knod ◽

Monica Holder ◽

Alexander R. Cortez ◽

Bruno Martinez-Leo ◽

Patricia Kern ◽

...

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Surgical Outcomes ◽

Ileoanal Anastomosis ◽

Young Patients ◽

Bowel Habits

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An Unusual Case of Maternal Death

Scottish Medical Journal ◽

10.1177/003693308002500311 ◽

1980 ◽

Vol 25 (3) ◽

pp. 241-242 ◽

Cited By ~ 1

Author(s):

R. Watson ◽

J. H. Kennedy

Keyword(s):

Fallopian Tube ◽

Maternal Death ◽

General Condition ◽

Unusual Case ◽

Rectal Biopsy ◽

Premature Labour ◽

Rectal Pain ◽

Poorly Differentiated Adenocarcinoma ◽

Poorly Differentiated ◽

Stillborn Infant

A 21-year-old primigravid patient presented at 16 weeks gestation with rectal pain. She developed peritonitis at 36 weeks gestation. At laparotomy a very inflamed right fallopian tube and ovary was removed together with a healthy looking appendix. Premature labour occurred two days later with delivery of a stillborn infant. Her general condition deteriorated. On rectal biopsy a mucin secreting carcinoma, probably of secondary origin, was found. Shortly before her death a poorly differentiated adenocarcinoma of the breast was diagnosed.

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SURGICAL TREATMENT OPTIONS IN COMPLICATED COLO-RECTAL CANCERS OPERATED IN EMERGENCY

Journal of Surgical Sciences ◽

10.33695/jss.v6i1.263 ◽

2019 ◽

Vol 6 (1) ◽

pp. 9-13

Author(s):

Georgiana Bianca Constantin ◽

D. Firescu ◽

R. Bîrlă ◽

S. Constantinoiu

Keyword(s):

Treatment Options ◽

Right Hemicolectomy ◽

Late Presentation ◽

Screening Programs ◽

The Poor ◽

Rectal Cancers ◽

Curative Intention ◽

Surgical Operations ◽

Clinical Emergency ◽

Hartmann Operation

Globally, the colo-rectal cancer is the 4th in frequency of all neoplasia and in Romania is the 2nd, with a yearly tendency of increasing the number of new cases. The poor symptomatology in the inchoate stages and also the deficiency of effective screening programs lead to frequently late presentation of patients, with tumors in complicated stages, when the surgical operations, very often can no longer have a curative intention. We will present the results of a retrospective study during 10 years (2007-2016) that included 431 patients with complicated colo-rectal cancers, admitted and operated in the 2nd Surgery Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galati, Romania. In 133 cases (30,9%), most of them occlusive, it was practiced in emergency a left iliac anus, leaving the tumor in its place. The Hartmann operation was practiced in 97 cases (22,5%). Anytime it was possible, we practiced operations with radical intentions, like: right hemicolectomy, in 46 cases (10,7%), left hemicolectomy, in 13 cases (3%), segmentary colectomy with anastomosis, in 30 cases (6,9%). Regarding the surgical operations in emergency, many of them don’t have a radical intention, taking into account the local invasion of the tumors and the metastasis. In these situations, a first surgical gesture is required, as an intervention that is meant to save the patient’s life, solving only the complication.

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Radiation Therapy for Local-Regional Recurrences of Rectal Carcinoma following Primary Surgery

Tumori Journal ◽

10.1177/030089169708300508 ◽

1997 ◽

Vol 83 (5) ◽

pp. 818-821

Author(s):

Mattia F. Osti ◽

Alessio Bonanni ◽

Alfredo Zurlo ◽

Riccardo Maurizi Enrici ◽

Carissimo Biagini

Keyword(s):

Radiation Therapy ◽

Rectal Carcinoma ◽

Residual Disease ◽

Combined Treatment ◽

Poor Quality ◽

Primary Surgery ◽

Survival After Relapse ◽

Rectal Cancers ◽

Treatment Tolerance

Aims and background Several studies have emphasized the role of radiation therapy for patients with pelvic recurrences of rectal carcinoma following primary surgery. The occurrence of local-regional relapse usually means a poor prognosis and often a poor quality of life, so that different authors consider the prognosis of patients relapsing after surgery worse than those with primary inoperable tumors or those with residual disease after resection. Methods Between January 1988 and January 1995, 43 patients with local recurrence of rectal carcinoma were treated at our Institution. Twenty-three had previously been operated by abdominoperineal resection and 20 by anterior resection. Thirteen cases also received adjuvant chemotherapy. All patients underwent irradiation with a 6-15 MeV linear accelerator; 8 (19%) received a total dose of up to 45 Gy on the pelvis and 35 (81%) higher than 45 Gy. Eighteen cases (42%) underwent 3-6 courses of chemotherapy with 5-fluorouracil and folates during radiation. Results Treatment tolerance was satisfactory. All cases underwent restaging at 45 days from completion of treatment. Sixteen cases (37%) showed a radiologic response >50%. Median overall survival after relapse was 18.8 months. There were no statistical significant differences in survival between patients treated exclusively with radiation and those treated with chemo-radiothera-py (17 vs 22 months). The results of patients who received doses higher than 45 Gy were statically better (P < 0.05) than those irradiated up to 45 Gy. A slight increase in survival was demonstrated in cases submitted to radical surgery after combined treatment (25 months). Twenty-seven cases (63%) obtained pain control after radiation therapy (median pain remission, 11 months). Conclusions Our results seem to encourage radiation therapists, surgeons and oncologists to have a more curative attitude in the treatment of selected patients with local-regional recurrences of rectal cancers by using multi-modality therapy.

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A Review on Breast Cancer Care in Africa

Breast Care ◽

10.1159/000443156 ◽

2015 ◽

Vol 10 (6) ◽

pp. 364-370 ◽

Cited By ~ 16

Author(s):

Eva J. Kantelhardt ◽

Gizaw Muluken ◽

Getachew Sefonias ◽

Ayele Wondimu ◽

Hans Christoph Gebert ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Young Patients ◽

Case Series ◽

Cancer Control ◽

Late Presentation ◽

Geographic Region ◽

Systematic Search ◽

Middle Income ◽

African Patients

Background: The global incidence of breast cancer (BC) is rising, especially in low- and middle-income countries. The purpose of this review is to summarize existing publications on BC care in Africa. Patients and Methods: A systematic search in MEDLINE and smaller databases was carried out to identify African studies on BC treatment, and an additional PubMed search was performed for relevant topics on BC care. Results: A total of 219 publications, mainly from North and West Africa, were found by systematic search. We also selected articles on BC epidemiology, risk factors, clinical presentation, and cancer control in Africa. Conclusions: Publications on BC treatment are mostly from hospital case series. Evidence on treatment from prospective randomized trials that address the specific characteristics of African patients is lacking. The epidemiologic data shows rising incidences in Africa. The prevalence of risk factors is changing by age group, geographic region, and over time. The clinical picture of BC differs from that of Western countries due to the high proportion of young patients (on account of the African population with a high proportion of young people) and late presentation. Global collaborative efforts are needed to address the rising need for improved BC care in Africa.

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Juvenile Huntington’s disease: two case reports and a review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-020-02494-7 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Sigita Lesinskienė ◽

Darja Rojaka ◽

Rūta Praninskienė ◽

Aušra Morkūnienė ◽

Aušra Matulevičienė ◽

...

Keyword(s):

Huntington's Disease ◽

Huntington’S Disease ◽

Psychiatric Symptoms ◽

Case Reports ◽

Genetic Disorders ◽

Young Patients ◽

University Hospital ◽

Important Message ◽

Juvenile Huntington’S Disease ◽

And Behavior

Abstract Background Huntington’s disease is a rare, autosomal dominant neurodegenerative disease characterized by motor, cognitive, and psychiatric symptoms. Usually, the disease symptoms first appear around the age of 40, but in 5–10% of cases, they manifest before the age of 21. This is then referred to as juvenile Huntington’s disease. According to the small number of cases reported in the literature, the course of juvenile Huntington’s disease significantly differs from adult onset and shows significant interpatient variability, making every case unique. Case presentation Our study aims to highlight the complexity and diversity of rare juvenile Huntington’s disease. We report cases of two Caucasian patients with chronic tics referred to the Huntington’s Disease Competence Center of Vilnius University Hospital Santaros Klinikos with suspicion of juvenile Huntington’s disease due to the appearance of chronic motor tics, and behavior problems. The diagnosis of juvenile Huntington’s disease was confirmed on both clinical and genetic grounds. In both cases described, the patients developed symptoms in all three main groups: motor, cognitive, and psychiatric. However, the first patient was experiencing more severe psychiatric symptoms; in the second case, motor symptoms (rigidity, tremor) were more prominent. In both cases, apathy was one of the first symptoms and affected patients’ motivation to participate in treatment actively. These two case descriptions serve as an important message for clinicians seeing patients with chronic tics and gradually worsening mood and behavior, indicating the need to investigate them for rare genetic disorders. Conclusions Description of these two clinical cases of juvenile Huntington’s disease provides insight into how differently it manifests and progresses in young patients and the difficulties the patients and their families face. There were different but painful ways for families to accept the diagnosis. Because the disease inevitably affects the patient’s closest ones, it is crucial to also provide adequate psychological and social support to all the family members. Establishment of multidisciplinary specialist centers for Huntington’s disease, as demonstrated by our experience, not only allows timely diagnosis and treatment plans but also ensures thorough disease management and care for patients and systematic support for their families.

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