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Key Clinical Message: Vaginal cuff dehiscence post‐hysterectomy is rare yet significant. Early recognition and prompt surgical intervention are crucial to prevent complications like bowel infarction. Consider second‐look laparotomy in cases of uncertain bowel viability. Vaginal cuff dehiscence (VCD) is a rare but potentially life‐threatening complication following a hysterectomy characterized by the separation of the vaginal vault. This condition, which may result in vaginal evisceration (VE), presents a significant risk of pelvic contents, particularly the small bowel, protruding into the vagina. Early diagnosis and prompt surgical intervention are paramount to prevent severe complications, including bowel infarction, obstruction, and peritonitis. Although VCD and VE are rare, they require urgent surgical management to avoid adverse outcomes. We reported a case of small bowel evisceration in a woman with a history of total abdominal hysterectomy 6 months ago. VCD and VE are very rare but life‐threatening complications of hysterectomy. Discussing the symptoms with patients who have multiple risk factors is crucial to avoid severe sequels following hysterectomy. Based on our experience, performing a second‐look laparotomy is a reliable approach to ensure the viability of the intestinal loop. However, it will likely increase the risk of infection. [ABSTRACT FROM AUTHOR]

Objective: This study was performed with the aim to evaluate the results of the treatment of vaginal fistulas caused by pelvic malignancy and to present a new surgical technique. In this retrospective study, patients with vaginal fistula who have been treated in Ghaem and Omid Hospitals of Mashhad University of Medical Sciences from 2004 to 2020 were studied. The inclusion criteria were the patients whose fistulas were caused by malignant neoplasia with pelvic organ origin. The patients with fistulas caused by other causes were excluded from the study. Patients' information was collected from the electronic records and the hospital archives and also the information recorded by the surgeon. Results: Out of 26 patients with vaginal fistula caused by pelvic malignancies, 18 cases had enterovaginal fistula. Cancer of cervix (11 cases) was the most prevalent cancer. Time interval between the incidence of fistula and the onset of the disease was 43.5 months. About 16 patients had a history of radiotherapy before the onset of the fistula, and 23 cases had undergone surgery before the onset of fistula. About 11 patients were treated with resection, 8 patients with ostomy, and 5 with fistulized loop bypass. Discussion and conclusion: In cases of extensive pelvic involvement with a tumor, it is recommended to use intestinal bypass in fistula site with the technique provided in this article, since it controls the symptoms of the patient and has limited complications. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of malnutrition in hospitalized patients is reported to be high. In particular, patients with esophageal cancer are prone to malnutrition, due to preoperative digestive system dysfunctions and short-term non-oral feeding postoperatively. Selection of an appropriate method for feeding in the postoperative period is important in these patients. Materials and Methods: In this randomized clinical trial, 40 patients with esophageal cancer who had undergone esophagectomy between September 2008 and October 2009 were randomly assigned into either enteral feeding or parenteral feeding groups, with the same calorie intake in each group. The level of serum total protein, albumin, prealbumin, transferrin, C3, C4 and hs-C-reactive protein (hs-CRP), as well as the rate of surgical complications, restoration of bowel movements and cost was assessed in each group. Results: Our results showed that there was no significant difference between the groups in terms of serum albumin, prealbumin or transferrin. However, C3 and C4 levels were significantly higher in the enteral feeding group compared with the parenteral group, while hs-CRP level was significantly lower in the enteral feeding group. Bowel movements were restored sooner and costs of treatment were lower in the enteral group. Postoperative complications did not differ significantly between the groups. There was one death in the parenteral group 10 days after surgery due to myocardial infarction. Conclusion: The results of our study showed that enteral feeding can be used effectively in the first days after surgery, with few early complications and similar nutritional outcomes compared with the parenteral method. Enteral feeding was associated with reduced inflammation and was associated with an improvement in immunological responses, quicker return of bowel movements, and reduced costs in comparison with parenteral feeding. [ABSTRACT FROM AUTHOR]

Objective: Pectus excavatum (PE) and pectus carinatum (PC) are two common chest deformities. We investigated the prevalence of chest wall deformities including PE and PC in Iranian population. Methods: 25587 children and adolescents aged 7-14 years consisting of 13586 (53.1%) males and 12001 (46.9%) females were studied using cluster-stratified sampling method. Screening was clinical and based on descriptive findings. Suspected subjects with chest wall deformity were referred to the expert surgeon to confirm the diagnosis. Findings: The prevalence of chest deformities in our population was 204 (1.03%). The mean age of subjects was 10.2±3.0 years. Of these subjects 124 (0.49%) [74 (54%) males and 50 (42%) females)] had PE and 80 (0.31%) [58 (72.5%) males and 22 (17.5%) females)] had PC. Conclusion: The prevalence of PE seems to be very high in Iran. Special attention must be paid to diagnose and treat this problem in our population. [ABSTRACT FROM AUTHOR]

Background: Fas (Apo-1/CD95) and its specific ligand (FasL) are key elements in apoptosis. They have been studied in different malignancies but there are few published studies about the soluble forms of these markers (i.e. sFas/sFasL) in gastric cancer. We have compared the serum levels of sFas/sFasL in gastric adenocarcinoma patients and cases with pre-neoplastic lesions as potential markers for early diagnosis, and investigated their relation with clinicopathological characteristics. Methods: Fifty-nine newly-diagnosed cases of gastric adenocarcinoma who had undergone gastrectomy, along with 62 endoscopically- and histologically-confirmed non-cancer individuals were enrolled in this study. sFas/sFasL serum levels were detected by Enzyme Linked Immunosurbent Assay. Results: Mean serum sFas level was significantly higher in gastric cancer patients than in control group (305.97 ± 63.71 (pg/ml) vs. 92.98 ± 4.95 (pg/ml), P < 0.001); while the mean serum level of sFasL was lower in patients with gastric adenocarcinoma (0.138 ± 0.04 (pg/ml) vs. 0.150 ± 0.02 (pg/ml), P < 0.001). Mean serum levels of sFas/sFasL were significantly different in both intestinal/diffuse and cardiac/non-cardiac subtypes when compared to the control group (P < 0.001). There was an increase in the serum level of sFas from the first steps of pre-neoplastic lesions to gastric adenocarcinoma (P < 0.001). Patients who had no lymph node involvement (N0) showed significantly higher serum levels of sFas compared to others (P = 0.044). Conclusions: Production of sFas may play a critical role in the carcinogenesis of intestinal-type gastric cancer. sFas serum level may serve as a non-invasive tool for early diagnosis of gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Dendritic Cells (DC) are potent antigen presenting cells with the ability to prime naïve T cells and convert them to cytotoxic T-lymphocytes (CTL). We evaluated the capability of autologous DCs transfected with total tumor and normal RNA to induce cytotoxic CTL as the preliminary step to design a DC-based vaccine in the esophageal squamous cell carcinoma (ESCC). Methods: Monocytes-derived DCs were electroporated with either total tumor RNA or normal RNA. T cells were then primed with tumor RNA transfected DCs and lytic effects of the generated CTL were measured with Cytotoxicity assay and IFN-γ Release Elispot assay. Results: Cytotoxicity was induced against DCs loaded with tumoral RNA (%24.8 ± 5.2 SEM) while in normal RNAloaded DCs, it was minimal (%6.1 ± 2.4 SEM) and significantly lower (p < 0.05). INF-γ secretion was more than 2-folds higher in tumoral RNA-loaded DCs when compared with normal RNA-loaded DCs (p < 0.05). Conclusion: Electroporating DCs with tumor RNA generated tumor antigen presenting cells which in turn enhanced cytotoxic effects of the T cells against ESCC. This may be a useful autologous ex vivo screening tool for confirming the lytic effects of primed T cells on tumors and evaluate probable further adverse effects on noncancerous tissues. These data provide crucial preliminary information to establish a total tumor RNA-pulsed DC vaccine therapy of ESCC. [ABSTRACT FROM AUTHOR]

Sharing the role of immune suppression, interleukin-10 (IL-10), transforming growth factor β (TGF-β), and vascular endothelial growth factor (VEGF) are critical genes in several aspects of tumorigenesis. To elucidate the role of these cytokines in esophageal squamous cell carcinoma (ESCC), their relative mRNA expression in tumoral tissue compared with corresponding tumor-free tissue was evaluated. A total of 49 patients with histologically confirmed ESCC were included in the study prior to any therapeutic interventions. Quantitative analysis of the mRNA expression was performed by real-time reverse transcription-polymerase chain reaction and the clinicopathologic associations were assessed. The mRNA of IL-10, VEGF, and TGF-β was frequently overexpressed in 53.2%, 44.9%, and 37.5% of ESCC patients, respectively. TGF-β was significantly co-expressed with IL-10 and with VEGF. Although VEGF was not independently associated with increased tumor size ( p = 0.065), concomitant overexpression of VEGF with TGF-β was significantly correlated with increased size of the tumor ( p < 0.05). Overexpression of IL-10, TGF-β, and VEGF plays an important role in ESCC and consequently leads to the frequent event of immune evasion in ESCC. TGF-β is concomitantly overexpressed with IL-10 and with VEGF in ESCC. A stimulatory signal from TGF-β to VEGF is necessary for VEGF to promote tumor progression. [ABSTRACT FROM AUTHOR]

The postgastrectomy recurrence rate is as high as 30-65%, with 5-year overall survival rates of <20%. Local recurrence is very common which occurs in 38-45% of cases. The most common sites of locoregional recurrence are the gastric remnant at the anastomosis, the gastric bed, and the regional nodes. The recurrence may occur as early and late events after gastrectomy. Most recurrences are early, within three years of surgery. Numerous studies reported the late recurrences, but most of them having a survival time of less than ten years. This report elucidates a case of recurrent gastric cancer after 24 years postoperatively. [ABSTRACT FROM AUTHOR]

Background: Dendritic cells (DC) are potent antigen presenting cells with the ability to prime naïve T cells and convert them to cytotoxic T-lymphocytes (CTL). We evaluated the capability of autologous DCs transfected with total tumor and normal RNA to induce cytotoxic CTL as the preliminary step to design a DC-based vaccine in the esophageal squamous cell carcinoma (ESCC).Methods: Monocytes-derived DCs were electroporated with either total tumor RNA or normal RNA. T cells were then primed with tumor RNA transfected DCs and lytic effects of the generated CTL were measured with Cytotoxicity assay and IFN-gamma Release Elispot assay.Results: Cytotoxicity was induced against DCs loaded with tumoral RNA (%24.8 +/- 5.2 SEM) while in normal RNA-loaded DCs, it was minimal (%6.1 +/- 2.4 SEM) and significantly lower (p < 0.05). INF-gamma secretion was more than 2-folds higher in tumoral RNA-loaded DCs when compared with normal RNA-loaded DCs (p < 0.05).Conclusion: Electroporating DCs with tumor RNA generated tumor antigen presenting cells which in turn enhanced cytotoxic effects of the T cells against ESCC. This may be a useful autologous ex vivo screening tool for confirming the lytic effects of primed T cells on tumors and evaluate probable further adverse effects on noncancerous tissues. These data provide crucial preliminary information to establish a total tumor RNA-pulsed DC vaccine therapy of ESCC. [ABSTRACT FROM AUTHOR]