Role of Covering Ileostomy in Causation of Anastomotic Strictures in Low Anterior Resections for Rectum Carcinoma

Background Colorectal resection anastomosis is the commonest cause of rectal strictures. Anastomotic site ischemia, incomplete doughnuts from stapled anastomosis and pelvic infection, are some of the risk factors that play a role in the development of postoperative rectal strictures. However, the role of diverting stoma in the development of rectal strictures has not been studied extensively. Objectives To study the difference in the occurrence of anastomotic strictures (AS) in patients submitted to low anterior resection (LAR) with covering ileostomy (CI), and to LAR without CI for carcinoma rectum. Methods This was a prospective, comparative case control study carried out at a tertiary care referral center. Low anterior resection with covering ileostomy was performed in patients with rectum carcinoma in the study group, while LAR without covering ileostomy was performed in the control group. The study group had 29 patients, while the control group had 33 patients with rectum carcinoma. Results During the mean follow-up period of 9.1months, 8 (28%) patients in the study group and 2 (6%) patients in the control group developed AS (p =0.019). Out of these 8 patients with AS in the study group, 50% had Grade-I AS, 25% had Grade-II AS, while 25% of the patients had Grade-III (severe) AS. However, both patients who developed AS in the control group had a mild type (Grade I) of AS. Conclusion Covering ileostomy increases the chances of AS formation after LAR for rectum carcinoma. Also, the SKIMS Clinical Grading of Rectal Strictures is a simple and handy tool available for every surgeon to grade, classify and monitor the postoperative rectal strictures.

Tumor Therapy with Amanita phalloides: Benefits and Limitation

Background: Classical tumor treatments can fail: surgeries, radiation and chemotherapy not always elongate the life span. Less destructive treatments are possible nowadays. To find and analyse the efficiency of alternate treatments, long term case reports are essential. Aim: To determine long term analyses of Amanita treatment in patients with different tumor types. Methods: Patients are treated with Amanita alone, as long as the tumor growth of cells can be retarded. Other anti tumor therapies are applied in addition, when the retardation of the tumor growth is not sufficiently manageable with Amanita alone. The treatments with Amanita are supported by application of Terebinthina laricina in intervals to eliminate Borrelia. Results: The state of a patient with a thyroid-carcinoma and a rectum-carcinoma can be stabilized for ten years with Amanita alone, until her age of 90 years. The patient cannot further tolerate uptake of Amanita. Thyroid cells start to grow, rectum-carcinoma cells grow slower. The disease state of a patient with prostate-carcinoma can be stabilized with Amanita alone for six years. Other therapies are applied from then on in intervals in addition for further six years. No chemotherapy or radiation is applied. The patient died at the age of 84 with metastases. A patient with B-cell chronic lymphatic leukemia is treated with Amanita as sole antitumor therapy for eleven years. After that period, no further antitumor treatment is necessary, the patient lives now with high but stable leukocyte count for two years after the end of the Amanita therapy. Conclusions: Amanita can inhibit tumor growth of different tumor types for a long period of time, elongation of the life span is possible. A synergistic effect of anti-Borrelia treatment is observed. Occasionally the tumor growth of cells stops without further anti tumor therapy, and no correlation with the origin can be identified.