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  • ISSN: 2373-9487
    Volume 5, Issue 3
    Review Article
    Esther Cha, EceUnal, and John H. Marks*
    The evolution of minimally invasive laparoscopic technology in the field of surgery has revolutionized how surgeons pursue surgical treatment options in colorectal cancer. With several major randomized controlled trials to date, laparoscopic colectomies have shown to be equal, if not superior, to open colectomies in regards to oncologic outcome and complications. The introduction of robotic technology in 2000 with the da Vinci S Surgical System, da Vinci Si in 2009 and its latest alteration da Vinci Xi (Intuitive Surgical, Sunnyvale, CA, USA) in 2014 have expanded minimally invasive surgical options. Robotic surgery is a natural evolution of minimally invasive surgery. This paper reviews the contribution and impact of robotic surgery and reflects on future considerations of robotics in colorectal cancer therapy.
    Nikolaos Margetis* and Theodoros Mariolis-Sapsakos
    Colorectal cancer (CRC) is the third most common cancer worldwide, whose mortality remains high, despite the huge amount of knowledge accumulated and the development of preventive strategies. Recent advances have demonstrated that small, non-coding RNA molecules (microRNAs), which inhibit or abrogate the translation of their mRNA-targets, are critical regulators across the full spectrum of stages of colorectal tumorigenesis process. The prototypical microRNA is let-7, with highly conserved sequence through species. Let-7 is found in ten mature isoforms, characterized by remarkable redundancy and abundance in colorectal epithelium. Let-7 is widely considered a tumor-suppressor, with scarce reports implying a concurrent oncogenic activity as well. K-ras oncogene, one of the most crucial genetic alterations in colorectal tumorigenesis, is a major target of let-7. The intact let-7 complementary sites (LCSs) in the 3' UTR of mRNA of K-ras are indispensable for the complete action of let-7 upon K-ras expression. LCS6 is viewed as the most important of these LCSs, and a SNP variant (T to G) inside this locus exerts more prognostic and predictive role in CRC, when combined with K-ras status and let-7 levels. Mature let-7 is down regulated in colorectal cancer tissue compared with its paired normal mucosa; nonetheless it is gradually up regulated through the successive stages of colorectal tumorigenesis process, playing a central role in all the accomplishment of all these intermediate stages. Its high levels are considered a favorable prognostic and predictive biomarker, whereas its low levels may confer to early diagnosis of colorectal cancer. As let-7 collaborates with other miRNAs, regulates crucial oncogenes (as K-ras and c-myc) and tumor-suppressing pathways (as Wnt/APC and p53) and is regulated by a plethora of its effectors, it might serve as an in vivo manipulator of patients suffering from colorectal cancer in the future.
    Marc A. Ward* and Michael B. Ujiki
    Gastric adenocarcinoma is one of the most common causes of cancer-related deaths worldwide. Minimally invasive surgery used in the treatment of gastric cancer has shown to offer similar oncologic outcomes to standard open operations with decreased morbidity and better quality of life. A number of minimally invasive surgery techniques have been developed to surgically treat both early and locally advanced gastric cancer. These techniques include both endoscopic and laparoscopic resection methods, the use of which is highly dependent on the oncologic stage of the tumor. This manuscript is designed to review the most recent evidence surrounding minimally invasive surgical therapies in the treatment of gastric cancer.
    Case Report
    Manouchehr Aghajanzadeh*, Amine Shafaroudi, and Rassol Hassanzadeh
    A Zenker's diverticulum is the rarest type of gastrointestinal diverticulum and is located immediately above the upper esophageal sphincter and typically presents in the elderly population with dysphagia regurgitation, halitosis, and malnutrition. Here we report cases of large Zenker's diverticula with malnourished secondary to dysphagia, regurgitation, hoarseness, or halitosis, profound weight loss, anemia, cough and aspiration pneumonia. She underwent an open resection of the Zenker's diverticulum and myotomy and discharged with good condition.
    Research Article
    Monjur Ahmed*
    Objective: To find out the incidence of antibiotic use in mild acute pancreatitis using BISAP (Bedside Index of Severity in Acute Pancreatitis) score and to compare the rate of antibiotic usage between an academic tertiary care institution(ATCI)and its community hospital division (CHD).
    Materials and methods: Retrospective data was analyzed using electronic medical records from the ATCI and the CHD in Philadelphia, Pennsylvania. Patients aged >18 years irrespective of race and sex with documented mild acute pancreatitis (BISAP 0 to 3) admitted between June, 2011 to June, 2013 were included in the study. Patients with biliary obstruction, cholangitis or other source of comorbid infection for which antibiotics could reasonably be administered were excluded from the study.
    Data analysis was done by Microsoft excel software and Z score calculator.
    Results: 468 available charts were reviewed, 288 patients (179 from ATCI and 109 from CHD) met the study inclusion criteria. Mean age was 51.7 years, 43.5% were male and 56.5% were female. In total, 32.3% of patients with the diagnosis of mild acute pancreatitis irrespective of etiology received antibiotics. At ATCI, 46 out of 179 (probability =0.257) [1] patients received antibiotics while at CHD, 47 out of 109 (probability = 0.431) patients received antibiotics. There was a significant difference on antibiotic usage (z = -3.0, p <0.05) between the hospital sites.
    Conclusion: About one third of patients with mild acute pancreatitis received antibiotics. There was an increasing trend towards antibiotic use with increasing BISAP score. There was a significant difference in antibiotic usage between an academic tertiary care institution and a community hospital, with patients at the community hospital being more likely to receive antibiotics for mild acute pancreatitis.
    Krishnasamy Narayanasamy DM*, Kirankumar B, and Rajendran Karthick
    This study aims to evaluate the epidemiology and risk factors of Gallstone disease (GSD) in South India population. Medical records of 124 patients diagnosed with GSD between October 2012 to May 2015 were reviewed retrospectively. Mean age of the GSD patients was 44.56 ± 14.9 years. Patients with gallstones were higher in women than in men. The male-to-female ratio of GSD patients was 1:1.4. Ninety Nine (80%) patients with gallstones underwent cholecystectomy. In our analysis, none of the risk factors (Diabetes mellitus, Coronary Artery Disease, Multiparity, Cholecystitis, Cholecystectomy, Non-veg diet) on occurrence of gallstones has been statistically significant. This study shows that increasing age and female gender are higher chance of gallstone formation compared to the others. Even though variations in risk factors for GSD, our study did not find any unique and different risk factor among the population of South India as compared to the other countries.
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