Category: Study

Epidemiology
Referring to the incidence the colon – rectal cancer is listed on the second place for males, (12%) following the bronchial cancer and on the second place for females with 16% following the breast cancer.

Scope of Work
1 – The main objective of this paper is the evaluation of sensitiveness of different examining methods and the comparison among their results.
2 – The post intervention staging according TNM and the comparison with the pre intervention stage is another object of this paper.
3 – The comparison of the tumor stage against histology and the grade of tumor differentiation is the third object of this study.
4 – The final object is the R classification (residual tumor).

Patients and methods
330 patients in the Chirurgical Service of the Hospital University Center Nene Tereza, Tirana, Albania during the period December 2005 April 2009 have been studied.
The data and results from the objective examination, images, fibro colonoscopy and biopsy have been collected. One file for every patient was prepared and completed. The following examination methods were used for our patients:
1.Objective examination
2.Abdominal X-ray, which was realized by the same examiner.
3.Fibro colonoscopy
4.CT-scanner
5.Trans rectal X-ray
6.Pre intervention biopsy
7.Post intervention biopsy
:
These patients were considered at high risk if one or more statements below was true:
1.At age of fifty years old or older.
2.they had a history of adenomatous polyps
3.recent sigmoidoscopic evidence of one or more polyps
4.a positive finding on fecal occult-blood testing
5.history of colorectal cancer in one or more first-degree relatives

378 patients were recovered and treated. 31 of them were excluded from the examination and the study in the case when:
1.history of colorectal cancer in one or more first-degree relatives were noticed
2.colonic biopsy or polypectomy within the previous 14 days was taken
3.barium on a scout film retained
4.colostomy
5.allergy to glucagons
6.known glucagonoma, insulinoma

Only 14 patients didnt agree on the examinations.

The colon was prepared before the endo luminal examinations in the same way for every patient according a hydrate and laxative diet. The material for the biopsy has been taken for laboratory results in the same way for every patient as well. The material has been taken for biopsy results a day after the intervention and has been saved in formalin solution 100%.
Biopsy was taken for the primar tumor in the aboral part of the resectat, distal part from Stapler when it is not used, lateral parts including meso colon and meso rectum.

Based on the collected results and pre intervention examinations the clinical classification of the tumor stages was done. The final staging was done based on the intra intervention data and post intervention biopsy data.

The classification by TNM recommended by U.I.C.C. was used for the post and pre intervention staging.
For the post intervention staging we used also the classifications of the grade of tumor differentiation (G) and by the residual tumor (R). After that, we compared the pre and post intervention stages for every patient and finally a final comparison.

The sensitivity of the pre intervention examination got estimated having compared with each other and with the intra intervention and post intervention results.
The statistical data was found based on:
The average results
Standard deviation
Z Test
Wilcoxon Test for comparing the pre and post intervention data.

Results
The ratio Males/Females was 1.2/1. 160 patients had the blood group 0, 90 of them had the A blood group, other 60 patients had B and 20 of them had AB.

Referring to the tumor localization we came across that it was localized in the Colon in 240 patients and in Rectum in 90 of them. The distribution of the Colon tumor was as following: find

Colon ascendens 40 patients 12%
Hepatic Flexure 20 patients 6%
Transverse Colon 20 patients 6%
Lienal Flexure 20 patients 6%
Descendent Colon 50 patients 15%
Sigma 90 patients 27.5%
Rectum 90 patients 27.5%

Objective examination
In 100 patients with colon tumor or 42% was identified a real material mass during the abdomen palpation.
Out of 100 patients 70 had a stage III tumor and 30 of them Stage IV tumor.

Rectal touch was performed in all patients and resulted positive in 80 out of 90 with Ca. Recti, with a sensitivity of 88%.

Both examinations identified a primary tumor in 180 patients with colon rectal cancer.

Abdominal X-ray: primary tumor was found in 150 patients with colon cancer or 62.5%. Lymphonodus were found in 40 patients out of 110 with I/O or in 36.4%. In 30 patients distant metastasis (hepatic) were found out of 60 patients with I/O or 50% and it was not found by the X-ray in 20 patients with ascid resulted with I/O. In total the sensitivity of the X-ray in detecting the primary tumor was 45%.

CT-scanner was performed in 270 patients. The number of patients with primary tumor, lymphonodus, distant meta and ascid are listed in the table below:

Colon-rectal
270 patients Primar TumorLymphonodusDistant Meta Ascid
CT-scanner270806020
I/O1601106020
Sensitivity 100%73%100%100%

Fibro-colonoscopy was performed in 330 patients. The examination was done properly in 327 patients where material for the pre intervention biopsy was taken. The examination was not fully performed in 6 patients because the radioscopy didnt go through the intestine lumen in the descendent colon level because of a malign polyp. The irrigography was done which found bipolar tumors in the lienal flexure level.

Trans rectal Echo – was performed in 90 patients with rectal cancer. The primary tumor was found in 80 of them or 88.9%; lymphonodus were found in 10 patients out of 40 who resulted I/O and post intervention ( 50%).

Pre intervention biopsy It was performed in all patients and adenoma carcinoma resulted in 270 patients, Ca. Muchoid in 40 patients and negative in 20 patients when the post intervention biopsy was positive. The histological pre and post intervention diagnosis resulted similar.

Based on the pre intervention examinations results the clinical staging was achieved and the result showed 20 patients with a stage I tumor or 6%; stage II in 60 patients (18%); stage III in 180 patients (55%) and stage IV in 70 patients (21%).

Based on the intra intervention data the post intervention staging was achieved and the results were as in the following table. 30 patients had a stage I tumor (9%), 110 patients stage II tumor (31%), 130 patients stage III tumor (40%) and 60 patients stage IV tumor or 20%.

FIGURE

The classification according the differentiation grade of the tumor was achieved and the results showed 120 cases or 36.4% where the tumor was differentiated properly, in 130 cases or 40% the tumor was fairly differentiated, in 40 cases or 12% it was differentiated not properly and in 40 patients or 12% was not differentiated.
The classification according the residual tumor was also achieved and the results showed that a resection R0 was performed in 250 patients or 76%, R1 in 20 patients or 6% and R2 in other 60 patients or 18%. (FIGURE)

STATISTICAL ANALYSIS
1.The statistical analysis carried out with the Z test showed that the higher sensitivity of the scanner in detection of the lymphonodus and metastasis comparing to the abdominal X-ray has a statistical value (p
2.The statistical comparison through the Wilcoxon test between the pre and post intervention stages shows a discordance between the stage II and II with a statistical value of (p

DISCUSSION
Te colon rectal cancer is one of the most common malign pathologies of the gastro intestinal tract and it is accompanied by a very high mortality. Te survival rate depends on the stage of the tumor. Many authors have shown a high increase of the survival rate with 5 years through a good diagnostic procedure and treatment in the early stages of this pathology.

From the above written data it is obvious the high importance of the early diagnostic revealing of the colon rectal cancer. The various examination methods should tend:
a- To be as more accurate as possible in detecting or excluding of this pathology
b-To perform a real pre intervention staging in order to choose the most proper surgical method.
The patients survival rate according many authors depends on how radical the surgical intervention is and that is expressed by the R classification (residual tumor). This classification helps also to select the most appropriate and correct schemes of the post intervention neo adjuvant therapy (chemo and radio therapy).
In our series we have analyzed the objective examination data, different types of the images and fibro colonoscopy comparing those results with the intra intervention findings.

1-Pre intervention examination
a-Objective examination— Our data shows a high sensitivity in the primary tumor determination, both palation and rectal touch. The sensitivity is higher when they are getting analyzed together. This shows despite the computerized medicine era, the traditional methods are still important and of high significance. The throughout and careful examination of the patients who are in doubt of the existence of the colon rectal cancer is a necessary condition.
If our data was compared to those of other authors a high sensitivity of our series of data is visible. We are of the opinion that this is because of the advanced stages in that our patients present themselves for examination and for that reason the probability of the primary tumor detection during the objective examination is higher.
b-Abdominal X-ray The X-ray is a simple examining method, with a lower cost and not risky for the patients.
c-In our series of results it is obvious a high sensitivity regarding the colon tumors, and there is no sensitivity in finding the rectum tumors. If we make a comparison of our data with those of other authors it is distinctive a high sensitivity in our data regarding the colon tumors but the sensitivity against the rectum tumors is very low. This shows that X-ray is necessary to be performed in all patients that are in doubt of a colon rectal cancer, but its results should be taken with reserves into consideration. The higher sensitivity in our data like for the objective examination, we think, appears because of the advanced stages of the tumor in our series.
d-Trans rectal X-ray The above mentioned data shows the necessity of the trans rectal X-ray in the patients with Ca recti. It is necessary especially in the pre intervention staging and the evaluation of the possibility for a radical treatment.
e-CT-scanner The scanner sensitivity is the highest from all other examinations undertaken in this study. It helps not only in the determination of the primary tumor but also in the right evaluation of all components that serve for the pre intervention staging of the colon rectal cancer. In our series the CT scanner has classified some of the patients resulted in post intervention stage II in the stage III. This is explained by the fact that CT scanner has interpreted a part of the lymphonodus as metastasis that in the post intervention resulted reactive.
f-Fibro colonoscopy – Fibro colonoscopy is a procedure that often is accepted with difficulty by the patients. It is very sensitive and its reliability is getting increased in a impressive way compared to our previous studies.
This increase of the reliability is affected by the improvement of the colonoscopies examination comparing to the previous studies. This is because of more capable examiners and also of a better preparation of the colon. Colonoscopy should be achieved not only in the patients where a primary tumor has been detected with other methods, but in all patients where there is a clinical uncertainty of the presence of the colorectal cancer, and for the post intervention follow up, as well. The advantages of the colonoscopy against the scanner stay in the possibility that the colonoscopy gives for a histological confirmation of the diagnosis, whereas the scanner has the advantage of a large possibility for a more precise pre intervention examination. A combined evaluation of the colonoscopy, biopsy and scanner data allows a more precise pre intervention determination of the colon rectal tumor stage.
g-Pre intervention biopsy the pre intervention biopsy has been achieved on all patients with colonoscopy. False negativity identified is because the biopsy was not taken in the right area, because of the small portions of the biopsy or a superficial treatment with fewer cuts by the anatomist and pathologist. The improvement of these three steps would lead to a decrease of the false negativity. False negativity shows that not always we should totally rely on the biopsy results, but a complex judge and discussion should lead to the decision for a surgical intervention taking into consideration all the available elements we have.

2-Pre intervention staging Our series data shows different sensitivity of the used examination methods depending on the tumor stage and also on its localization. The scanner and fibro colonoscopy stay on the first place. When the abdominal X-ray and Trans rectal data and those of the objective examination have been analyzed together the sensitivity is high. This high sensitivity of the last two elements (abdominal X-ray and Objective examination) is result of the advanced stages of the tumor of the presented patients; in the cases of patients with stage I and II tumor the sensitivity is lower. To get a very correct pre intervention staging is necessary and important to use the received data from all examinations.
3-The comparison of the pre and post intervention stage. In our series data it is clear a variance between stages II and II, for stages I and IV there is a good correlation of the results. This variation as above mentioned, we think comes from the wrong interpretation of the lymphonodus from the CT scanner which result reactive in the final biopsy.
4-The tumor stage and differentiation grade. It is clear from our data that the higher differentiation grades tumors are presented in advanced stages. The reasons that influence these results is impossible to get identified by our data, but those shows a low level of the medical culture of the population, for the lack of the revealing policies and strategies in that direction, for the low level of the primary health care as well.
5-R classification (Residual tumor). R classification has been used in the last 10 years. It allows judging of the radical stage of the intervention prognosis of the disease and the need for a neo adjuvant therapy. In our data even in the advanced stages the radical interventions are the most used techniques, what shows the competence and ability of our surgeons who are capable of using the most advanced surgical techniques. This classification serves not only for what above mentioned but is also a test for the professional education (background) of every surgeon.

Conclusions
-All the examining methods used in this study show sensitivity in the detection of the colon rectal cancer.
-Fibro colonoscopy, biopsy and scanner are the most convincing and secure procedures with a high sensitivity.
-The received results from all examining methods are necessary for a most accurate pre intervention staging.
-The variation between pre and post intervention stages was distinctive for the stages II and III.
-The pre intervention staging classifies a part of the tumors of stage II into the stage III.
-Despite the differentiation grade of tumors, they are present more in the stages III, IV showing not appropriate medicine.
-The R classification allows to judge on the radicalism of the intervention, disease prognosis, need for a neo adjuvant therapy and serves as a test for the level of the surgical techniques.

References:
Harry Bleiberg, Phillipe Rougier, Nancy Kemeny, Hansjochen Wilke Colorectal cancer: A clinical guide to therapy
Understanding colon cancer – A. Richard Adrouny
Moller T.: Rontgennormal befunde, 2 Aufl. Thieme, Stutgart, 1996
Elezi B.; Mediteraneal Week of Surgery
Goldberg S.M.,Gordon P.H., Nivatuongs S.: Essential of anorectal surgery., J.B Lippincott Co., Philadelphia.
Dionigi R.; Chirurgia, seconda edizione
Sabiston D.C.; Textbook of Surgery Xl/Ed. WB. Saunders Co., Philadelphia, 1991.
Waldman D., K. Ruckauer: Endoscopisch Therapeutische Eingrifle im colorectalen Bereich, Chirurg, 1999

Study in New Zealand; spread your wings and fly
What is one of the major differences between the human race and the animal species that co-exist on this planet Earth? A human can best be deciphered from the animals on the basis of education and learning .We have been a lot fortunate to acquire the very foundation of learning and education, the ones that have been deprived have still not seen growth. Education plays a very important role in life; its only through education we are considered to be civilized and worthy enough to be a part of the every growing economy and the world. This world would have never seen development without the very presence of teaching; our morals and lessons that were imparted to us today have brought us where we stand. Education is a building block and a ladder to growth and success, without it all we would have witnessed is failure.

Undoubtedly India has mastered in providing education to millions yet there is a big chunk for students that aspire to study abroad. One of the vibrant nations that is best known to offer excellent education is New Zealand. This place is not only popular across the globe for the enigmatic beauty it possesses but also for the high standard and quality education it offers to the aspiring students. It is known to possess a perfect framework for delivering exceptional education and learning, thus Study in New Zealand and secure your future.

Merits of studying in New Zealand

Study in British based education system with world class highly valued qualifications
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Get to study in the Universities that are in the top 500 worldwide ranking
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New Zealand is a great place to study due to scenic beauty and a modern dynamic culture
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The people all over the world are keen to know their fate and fortune by dint of astrology and palmistry. The science of astrology has remained popular among the people because of its truthfulness. The hand reading has been very popular during last decade since many intellectual people started entering in the field of palm reading. This science is divided into two parts such as: chirognomy and chiromancy. The chirognomy tells as for the science of shapes and sizes of the palm while chiromancy is related to the lines on the hand. The major lines are life line, head line, fate line, marriage line, travel line and health line etc.
The marriage line on the palm tells all about the love and marital life. It is a small line that moves on the mount of Mercury just below the little finger. This should be clean, straight and without any breaks, chains and island etc. to have a happy and successful conjugal life. The palm reader should take the heart line and mount of Venus in to consideration so as to get perfect prediction about marital happiness. The streak of the heart should also be strong and long as well as clean to have reciprocal love and affection between the husband and wife.
The mount of Venus on the palm is also highly imperative while calculating marriage streak on the palm. The mount of Venus needs to be well developed on the hand to have romantic nature in order to enliven conjugal life. This mount on the hand has also responsibility to have good sexual life.
Some of the descriptions about marriage line are given below.
1.When the line of marriage is long, clean and without any breaks it ensures a good marital life.
2.If the marriage line has an island on the middle of the streak then there will be unhappiness in conjugal life and ill health of the partner also indicated.
3.When the marital streak on palm touches the streak of the heart it is a sure indication of death of the life partner.
4.If the marriage line crossed the streak of the heart and moves towards the mount of Venus then there will be separation between husband and wife.
5.When the marital streak is bifurcated on the mount of Mercury then there will be continuous conjugal dispute and unhappiness.
6.If the marriage line takes a detour towards the little finger on the mount of mercury then there will be no marriage in the life.
7.When streak of the marriage touches the mount of Sun then the person will tie the knot with a person who is highly reputed and wealthy.
The palmist should be extremely careful while considering marriage line since it is a very sensitive subject to everyone. It is advisable to have a numerological study of both partner as well as astrological study of the charts of both the partner in order to come to conclusion as to the prediction of conjugal life. The palmist also should have a palm reading of both partners to prognosticate with accuracy.

Zoology is the aspect of science that deals with the study of the animals’ evolution, habitat and behavior. Many students wonder why they need to study zoology. It is a branch of science that does not have anything to do with people so they are left wondering why they have to learn it.

1. The first answer to the question, why is zoology important to us is for humans to have an appreciation for nature. Our nature is not just composed of the humans but of plants and animals as well. Everything in our environment is connected in a complex cycle. If you have a better understanding of how animals would behave and interact with us then you would appreciate nature better. You would feel nature should not be taken for granted.

2. The second answer to the question, why is zoology important to us is for people to have a better understanding of the animals. Some animals are usually misunderstood by people like sharks and snakes. These creatures are thought of as human killers, and this is mainly because we don’t understand why they behave that way. In this branch of science you would be able to learn their natural behavior as well as their habitats so you would completely understand why they would behave in a defensive manner when they seem threatened. Studying zoology would help people achieve clarity over the common myths we have on different wild animals

3. The third answer to the question, why is zoology important to us is to understand the urgency of preserving the animals. Studying this subject would help people know the real facts about animals. One of the negative facts is the dwindling numbers of some species of animals. It makes people realize that there is a need for nature to be always balanced. We need animals to maintain the balance in our environment and for humans to survive as well. This branch of science would help us learn the needs that animals lack and we can respond by thinking of solutions we can give to the endangered species of animals.

4. The fourth answer to the question, why is zoology important to us is for people to learn the importance of the role of humans as caretakers of animals. Modern progress is needed for a country to grow in terms of its economy however it should not force us to compromise our rainforests and oceans. It reminds us that modernization should not just be equated with tall buildings and skyscrapers. People should realize that our modern lives should include the lives of the animals that live with us. They should not be contained in zoos but in their natural habitats as well. We will learn that every living creature on earth has the right to own a habitat and as their caretaker, we need to fight for them to have permanent habitats.

Many tuition free universities are found abroad which allow students to opportunity to enjoy free study in Europe. If you apply directly to these schools, even being an international student and a non-European student, you do not have to pay tuition. . One example of a tuition free college is the Jonkoping International Business School. Based in Northern Scandinavia, the Jonkoping International Business School is an urban university that offers degrees in informatics, finance, business administration, commercial law, and political science studies. Bachelors, masters, and doctoral degrees are offered, and most of the classes are in English. The school is relatively small, with a total enrollment of about 2000 students, of which 25% are international students.
Just like the Jonkoping International Business School, many other tuition free colleges have strong English support due to the . Not all of these institutions focus on business though. There is a wide range of degrees and programs provided around the world, including computer science, IT, and engineering degrees. Another great school is the Royal Institute of Technology in Stockholm, Sweden or the University of Stockholm. These world-class institutions have international programs where the language of instruction is in English. Finland, Norway and even certain schools in Scotland also have a tuition free scheme that benefits those looking to study abroad for free or virtually free (meaning the cost of tuition is either waived or negligible).
There are high quality programs even medical school where one can take advantage of free study in europe. In order to participate in a free study abroad program, be aware that a list of prerequisites awaits you. First things being first, any prospective student needs to contact the embassy of his or her host country to acquire a student visa. Secondly, make sure to check with the university regarding any entry exams or grade requirements. All in all, the dream of attending college shouldn’t be hindered with tuition, and in the case of the many tuition free universities around the world, it doesn’t have to be. Learning more about these colleges offers you amazing opportunities few know about.