Shiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Caution in Use of Synthetic Mesh in Repairing the Incisional Hernia004544410.17795/acr-13171ENAhmadIzadpanahColorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran0000-0003-2029-0829Journal Article19700101Background Pouchitis is a non-specific inflammation of the ileal reservoir and the most frequent complication that patients experience in long periods. Diagnosis should be made based on the clinical, endoscopic, and histological aspects. Prediction of pouchitis is an important issue for the physician. Objectives The study was aimed to identify the predictive factors of pouchitis as well as their importance. Patients and Methods In the present study, two classification techniques entitled decision trees method and logistic regression analysis were used to help the physician in prediction of pouchitis in ulcerative colitis (UC) patients. These patients are submitted to a specific surgery. The ability of these two methods in prediction is achieved by comparison of the accuracy of the correct predictions (the minimum error rate) and the interpretability and simplification of the results for clinical experts. Results The accuracy rate in prediction is 0.6 for logistic regression method and 0.45 for decision tree algorithm. In addition, the mean squared error is lower for logistic regression (0.41 versus 0.48). However, the area under the ROC is more for decision tree than logistic regression (0.52 and 0.45 respectively). Conclusions The results are not in favor of none of these two methods. However, the simplicity of decision tree for clinical experts and theoretical assumptions of logistic regression method make the choice clear. But more sample size may be needed to choose the best model with more confident.https://colorectalresearch.sums.ac.ir/article_45444_301d489442501472469a6070e7fc354c.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Oral Psyllium Herbal Laxative, Clinical Trial in a Difficult Group004544510.17795/acr-14314ENJohnF. MayberryDepartment of Gastroenterology, University Hospitals of Leicester NHS Trust, Leicester, UK0000-0002-4117-8740Journal Article19700101Background Pouchitis is a non-specific inflammation of the ileal reservoir and the most frequent complication that patients experience in long periods. Diagnosis should be made based on the clinical, endoscopic, and histological aspects. Prediction of pouchitis is an important issue for the physician. Objectives The study was aimed to identify the predictive factors of pouchitis as well as their importance. Patients and Methods In the present study, two classification techniques entitled decision trees method and logistic regression analysis were used to help the physician in prediction of pouchitis in ulcerative colitis (UC) patients. These patients are submitted to a specific surgery. The ability of these two methods in prediction is achieved by comparison of the accuracy of the correct predictions (the minimum error rate) and the interpretability and simplification of the results for clinical experts. Results The accuracy rate in prediction is 0.6 for logistic regression method and 0.45 for decision tree algorithm. In addition, the mean squared error is lower for logistic regression (0.41 versus 0.48). However, the area under the ROC is more for decision tree than logistic regression (0.52 and 0.45 respectively). Conclusions The results are not in favor of none of these two methods. However, the simplicity of decision tree for clinical experts and theoretical assumptions of logistic regression method make the choice clear. But more sample size may be needed to choose the best model with more confident.https://colorectalresearch.sums.ac.ir/article_45445_ddb4450f34274513c1373aea6935a00e.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Minimally Invasive Treatments of Hemorrhoidal Disease454544610.17795/acr-12966ENAhmadIzadpanahColorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran0000-0003-2029-0829Journal Article19700101Context Minimally invasive procedures are used for treatment of nonresponsive hemorrhoids to conservative therapy. These OPD (Out-Patient Department) procedures are effective to eradicate the hemorrhoid symptoms with minimal postoperative pain and complications. Evidence Acquisition In this review, PubMed, and MEDLINE were searched with a time limitation (2002- 2012). Recent articles in English journals were reviewed to evaluate and compare these minimally invasive procedures including Rubber band ligation (RBL), Infrared coagulation (IRC), Direct current Electrotherapy (DCE), and Sclerotherapy. Results Upon the articles, 881 were treated with RBL, 454 with IRC, 1203 with DCE, and 2372 with sclerotherapy. Postoperative pain, which is a common complication of hemorrhoidectomy, was 3-25% in RBL, 2.13-4.3% in DCE, and 1.8-7% in sclerotherapy. Pain was mild to moderate and rarely needed analgesic. Postoperative rectal bleeding was seen in 1.26-32.4% of patients treated with RBL. Recurrence of preoperative symptoms was 1.9-39% for RBL, 6.9-21% for sclerotherapy, and 2.9-3% for DCE. Postoperative complications were minor in all procedures and for sclerotherapy it was seen in 6.9-21% of patients. Success rate was 69.4-96.4% in RBL, 80% in IRC, 89.3-99.7% in sclerotherapy, and 98.2% in DCE. Patients’ satisfaction was 98% for DCE versus 99% for RBL and IRC. Operation time for each tag of hemorrhoid was 4.5-10 minutes for DCE, regarding different amplitudes of currency and degrees of hemorrhoid, and 13 minutes for sclerotherapy and not reported for other methods. Conclusions Minimally invasive procedures are used depending on surgeon’s experience and preference. These modalities are comparable from different aspects. The cost of treatment and availability of equipment may affect the choice of modality. All of these techniques could be used in patients resulting in maximum success rate and minimum complications.https://colorectalresearch.sums.ac.ir/article_45446_8a27e48cdc93812e4dcfda0753a29f41.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Malignant Neoplasms of the Anal Canal454544710.17795/acr-11985ENShapourOmidvariDepartment of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR IranSayedHasanSamiraRazzaghiStudent Research Committee, Resident of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR IranHamidNasrolahiDepartment of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR IranAhmadMosalaeiShiraz Institute for Cancer Research, Shiraz University of Medical Sciences, Shiraz, IR IranNiloofarAhmadlooDepartment of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR IranMansourAnsariDepartment of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR IranJournal Article19700101Background Malignant neoplasms of the anal canal are rare, accounting for approximately 4% of all colorectal malignancies. Objectives The present study aimed to report the clinicopathological characteristics and treatment outcomes of 41 cases with malignant neoplasms of the anal canal. Patients and Methods Between 1999 and 2012, 41 consecutive patients were diagnosed with primary malignant neoplasm of the anal canal, who were treated and followed up at Namazi hospital. Only primary malignant tumors arising from the anal canal were included. Patients with secondary anal canal involvement from rectal or perianal skin cancers and metastatic tumors were excluded. Results There were 22 women and 19 men, aged 33 to 83 years, with a median age of 57 years at diagnosis. Sixteen patients (39%) had localized disease, 21 (51%) had regional disease, and 4 (10%) had metastatic disease at diagnosis. Squamous cell carcinoma (61%) was the most frequent histologic subtype, followed by adenocarcinoma (27%), malignant melanoma (10%), and gastrointestinal stromal tumor (2%). After a median follow-up of 51 (11-169) months for surviving patients, 22 patients were alive and without disease, three were alive with disease, and 19 patients died due to the disease. Histological subtype (P = 001), and stage of disease (P = 0.002) were prognostic factors for overall survival. The 5-year local control, disease-free, and overall survival rates for all patients were 63.9%, 53%, and 59.4% respectively. Conclusions This study indicated that squamous cell carcinoma, adenocarcinoma, and malignant melanoma are the most frequent malignant neoplasms in the anal canal. Histological subtype and disease stage are the most important prognostic factors for overall survival in this region.https://colorectalresearch.sums.ac.ir/article_45447_742bdc77d883a29bf47c962fb0712c3e.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Evaluation of the Growth Parameters in Children with Chronic Functional Constipation584544810.17795/acr-11979ENSeyed MohsenDehghaniHamdollahKaramifarDepartment of Pediatric Endocrinology, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR IranMohammad HadiImaniehElhamMohebbiGastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR IranAbdorrasoulMalekpourGastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR IranMahmoodHaghighatGastroenterohepatology Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR IranJournal Article19700101Background Chronic functional constipation is an epidemic problem in children affects the children's growth. Objectives The aim of this study was to evaluate the growth parameters in children with chronic functional constipation and compare them with healthy individuals. Patients and Methods One hundred children with chronic functional constipation (defined as Rome III criteria) referred to Pediatric Gastroenterology Clinic enrolled in this study. Control group consisted of 100 children who referred for well-child visits, without constipation. Weight, height, body mass index (BMI) and z-score weight, z-score height and z-score BMI were calculated for each patient and control group. Results Both case and control groups consisted of the same age (P = 0.725) and gender (P = 0.777) individuals. The BMI (P < 0.0001) and BMI z-scores (P < 0.0001) of constipated children were significantly higher than the control group. Also, weight (P = 0.004) and weight z-scores (P < 0.0001) were significantly higher in the study group. There was no significant difference in height between the two groups (P = 0.1), but constipated children had higher height z-scores than control group (P = 0.027). The rate of obesity (define as BMI z-score > 2) in children with chronic constipation was 40% that was significantly higher than the normal control group (11%) (P < 0.0001). Conclusions We found a higher obesity rate and also higher BMI and weight z-scores in children with functional constipation compared with healthy control group. The reasons for the association between obesity and constipation are not clear and many factors including diet, activity level, or hormonal influences, are involved that require additional studies.https://colorectalresearch.sums.ac.ir/article_45448_4980de326b2df3475ab8083c27679a02.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Pathology of Colorectal Polyps, A Study from South of Iran664544910.17795/acr-12555ENBitaGeramizadehMarziehKeshtkar-JahromiDepartment of Pathology, Shiraz University of Medical Sciences, Shiraz, IR IranJournal Article19700101Background : In western countries with high prevalence of colorectal cancers, colonic polyps are usually adenomatous. There are few studies from Iran regarding to the predominant type of polyps in colorectal area. Objectives We conducted this retrospective study to evaluate the predominant colorectal polyps in our center as the largest referral center of the South region of Iran. Material and Methods We retrospectively analyzed pathology reports of colonoscopies during five years (2005 - 2011). Histologic reports and demographic findings were recorded and compared with published studies in the literatures of other countries from different geographic regions of the world. Results During these years, 990 patients with colorectal polyps were refered to the center. The most common types of polyps were adenomatous (603), followed by hyperplastic (300), juvenile (80), inflammatory (5) and Peutz-Jeghers (2). The most common site of polyp was rectosigmoid. Discussion The type and distribution of colorectal polyps in Iran is very similar to western countries.https://colorectalresearch.sums.ac.ir/article_45449_8b26fbdbf0fbd0636bc3b2d02b6293b7.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Comparative Study of Staging Rubber Band Ligation (RBL) and Hemorrhoidectomy in Treatment of Forth Degree Hemorrhoids664545010.17795/acr-12267ENMahmoudAghaeiHadiHadaviDepartment of Surgery, Kerman University of Medical Sciences, Kerman, IR IranMehrdadVahedianDepartment of Surgery, Kerman University of Medical Sciences, Kerman, IR IranBahramPoorseyediDepartment of Surgery, Kerman University of Medical Sciences, Kerman, IR IranHamidZeynaliDepartment of Surgery, Kerman University of Medical Sciences, Kerman, IR IranMohammad RezaLashkari ZadehDepartment of Surgery, Kerman University of Medical Sciences, Kerman, IR IranJournal Article19700101Background Rubber band ligation is one of the most worldwide used treatments of hemorrhoids because of its effectiveness and low complication rate. Hemorrhoidectomy is the procedure of choice for treatment of grade four hemorrhoids, which is a painful method for a relatively benign disease. There are a few studies available analyzing the effectiveness of RBL as an initial treatment for grade four symptomatic internal hemorrhoids. Objectives This study aimed to analyze the efficacy of the staging rubber band ligation in the treatment of grade four hemorrhoids and compare it to hemorrhoidectomy. Patients and Methods A prospective randomized clinical trial was performed on all patients diagnosed with grade four symptomatic internal hemorrhoids from August 2011 to March 2013. Sixty four patients with grade four hemorrhoids were divided into two groups and underwent hemorrhoidectomy (H group) and rubber band ligation (R group).These patients were compared for any complications and recurrence in a six month period. Results Pain existed in 100% of the H group and 67.7% of the R group in the first visit one week postoperation (P < 0.05). There was a statistically significant difference between the two groups regarding the days off work. Patients’ satisfaction and recurrence were similar in the both groups after a period of six months. Conclusions This study showed that staging rubber band ligation is effective for treating grade four hemorrhoids. Few complications and low recurrence rates were noted, which enable us to recommend this modality as the procedure of choice for the management of selected patients with grade four symptomatic hemorrhoids.https://colorectalresearch.sums.ac.ir/article_45450_2e67a97bffd10b3c5851dab8a5c81ae7.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901A Pilot study on Prediction of Pouchitis in Ulcerative Colitis Patients by Decision Tree Method Versus Logistic Regression Analysis674545110.17795/acr-12649ENSaeedehPourahmadDepartment of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR IranAli RezaSafarpourAlimohammadBananzadehColorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR IranSalarRahimikazerooniColorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR IranZahraZabangirfardColorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR IranJournal Article19700101Background Pouchitis is a non-specific inflammation of the ileal reservoir and the most frequent complication that patients experience in long periods. Diagnosis should be made based on the clinical, endoscopic, and histological aspects. Prediction of pouchitis is an important issue for the physician. Objectives The study was aimed to identify the predictive factors of pouchitis as well as their importance. Patients and Methods In the present study, two classification techniques entitled decision trees method and logistic regression analysis were used to help the physician in prediction of pouchitis in ulcerative colitis (UC) patients. These patients are submitted to a specific surgery. The ability of these two methods in prediction is achieved by comparison of the accuracy of the correct predictions (the minimum error rate) and the interpretability and simplification of the results for clinical experts. Results The accuracy rate in prediction is 0.6 for logistic regression method and 0.45 for decision tree algorithm. In addition, the mean squared error is lower for logistic regression (0.41 versus 0.48). However, the area under the ROC is more for decision tree than logistic regression (0.52 and 0.45 respectively). Conclusions The results are not in favor of none of these two methods. However, the simplicity of decision tree for clinical experts and theoretical assumptions of logistic regression method make the choice clear. But more sample size may be needed to choose the best model with more confident.https://colorectalresearch.sums.ac.ir/article_45451_47b21e54f2d15941ccc50648b4ebbcb5.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Mesenteric Vein Thrombosis Complicating Pneumatosis Intestinalis, A Case Report724545210.17795/acr-14446ENKamranBagheri LankaraniHealth Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR IranJournal Article19700101Introduction Pneumatosis intestinalis is usually considered as a benign condition. Here we report the association of this condition with mesenteric vein thrombosis leading to gangrenous bowel which, to our best knowledge, is the first reported association. Case Presentation The patient was a 71-year old Iranian smoker man, who was diagnosed with pneumatosis intestinalis for 11 months and then developed the abdominal pain which was confirmed to be due to the mesenteric vein thrombosis complicated by bowel gangrene. Discussion Although pneumatosis intestinalis is not usually threatening in adults, its new onset in the abdomen of these patients should prompt the complications such as mesenteric vein thrombosis.https://colorectalresearch.sums.ac.ir/article_45452_bb26791d2ef3e513aea27945be4205b3.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran: A review of 740 patients in Fars province, Southern Iran.704545310.17795/acr-14321ENJohnF.MayberryDepartment of Gastroenterology, University Hospitals of Leicester, Leicester, UK0000-0002-4117-8740Journal Article19700101Background Pouchitis is a non-specific inflammation of the ileal reservoir and the most frequent complication that patients experience in long periods. Diagnosis should be made based on the clinical, endoscopic, and histological aspects. Prediction of pouchitis is an important issue for the physician. Objectives The study was aimed to identify the predictive factors of pouchitis as well as their importance. Patients and Methods In the present study, two classification techniques entitled decision trees method and logistic regression analysis were used to help the physician in prediction of pouchitis in ulcerative colitis (UC) patients. These patients are submitted to a specific surgery. The ability of these two methods in prediction is achieved by comparison of the accuracy of the correct predictions (the minimum error rate) and the interpretability and simplification of the results for clinical experts. Results The accuracy rate in prediction is 0.6 for logistic regression method and 0.45 for decision tree algorithm. In addition, the mean squared error is lower for logistic regression (0.41 versus 0.48). However, the area under the ROC is more for decision tree than logistic regression (0.52 and 0.45 respectively). Conclusions The results are not in favor of none of these two methods. However, the simplicity of decision tree for clinical experts and theoretical assumptions of logistic regression method make the choice clear. But more sample size may be needed to choose the best model with more confident.https://colorectalresearch.sums.ac.ir/article_45453_6330cc1cd3d6965b996fae7ae15f3e61.pdfShiraz University of Medical SciencesIranian Journal of Colorectal Research2783-24301220130901Caution in Usage of Synthetic Mesh in Repair of Incisional Hernia.704545410.17795/acr-14444ENSeyedVahid HosseiniJournal Article19700101Introduction In spite of the advances in prenatal and neonatal medicine, giant omphalocele (GO) has remained as a challenge for pediatric surgeons. Although different techniques have been introduced for treating GO, the ideal treatment would be a primary closure without compromising the respiratory system or multiorgan failure. However, reaching this goal is challenging due to the high degree of visceroabdominal disproportion. This present study described the results of primary or secondary closure of five GO cases using the “bilateral mesh graft” technique. Case presentation Five consecutive GO patients were treated in our department. Two patients underwent a primary closure, while three other patients underwent a secondary closure using the “bilateral mesh graft” technique. When two mesh grafts were bilaterally fixed to the rectus abdominis muscles, the abdominal wall was reconstructed in the midline. All 5 patients were closely monitored for potential complications and a follow-up was also performed for each patient after they were discharged. Discussion The “bilateral mesh graft” technique was performed on the pediatric patients with a median age of 2.5 months (range 3 days to 6 months). The median diameter of the abdominal wall defect was 9 cm (range 7-10 cm). Moreover, the median was increased in bladder pressure after closure was 6.4 cm H2O (range 3-10 cm H2O). One of the patients who underwent secondary closure was diagnosed with a congenital heart condition and died postoperatively due to heart failure and respiratory insufficiency. The median hospital staying duration of the four surviving cases was 4.5 days with minimal complications. During the follow-up appointments, all four surviving patients exhibited normal weight gain and a soft abdomen with no infections or erosions detected at the site of surgery. The “bilateral mesh graft” technique yielded good clinical outcomes in both the primary and secondary closure cases. However, prior to surgery, particularly in the primary closure cases, the patients must be evaluated for respiratory function and additional congenital anomalies, such as heart conditions, in order to minimize potential complications. Nevertheless, further research is still needed in order to determine the long-term effects of the functional aspects on the abdominal wall muscles and viscera.https://colorectalresearch.sums.ac.ir/article_45454_583d86c0b55494883d8bb9fbc7989dec.pdf