Background Colorectal cancer is one of the leading causes of cancer-associated morbidity and mortality worldwide. The local anti-tumour immune response is particularly important for patients with stage II where the tumour-draining lymph nodes have not yet succumbed to tumour spread. The lymph nodes allow for the expansion and release of B cell compartments such as primary follicles and germinal centres. A variation in this anti-tumour immune response may influence the observed clinical heterogeneity in stage II patients. Aim The aim of this study was to explore tumour-draining lymph node histomorphological changes and tumour pathological risk factors including the immunomodulatory microRNA-21 (miR-21) in a small cohort of stage II CRC. Methods A total of 23 stage II colorectal cancer patients were included. Tumour and normal mucosa samples were analysed for miR-21 expression levels and B-cell compartments were quantified from Haematoxylin and Eosin slides of lymph nodes. These measures were compared to clinicopathological risk factors such as perforation, bowel obstruction, T4 stage and high-grade. Results We observed greater Follicle density in patients with a lower tumour T stage and higher germinal centre density in patients with higher pre-operative carcinoembryonic antigen levels. Trends were also detected between tumours with deficiency in mismatch repair proteins, lymphatic invasion and both the density and size of B-cell compartments. Lastly, elevated tumour miR-21 was associated with decreased Follicle and germinal centre size. Conclusion Variation in B-cell compartments of tumour-draining lymph nodes is associated with clinicopathological risk factors in stage II CRC patients.

Backgrounds Grade I and II haemorrhoids are commonly managed in colorectal practice. Management often involves rubber band ligation. The haemorrhoid energy therapy (HET) device (Medtronic, Minneapolis, MN, USA) has been developed as an alternative to rubber band ligation (RBL). This study is the first to prospectively evaluate the device versus RBL in the management of grade I and II haemorrhoids. Methods A single blind, randomized controlled trial was conducted in the colorectal outpatient department. Patients with symptomatic haemorrhoids suitable for banding were prospectively recruited and randomized. Primary outcome was post procedural pain at 1 h as recorded on a 10‐point Likert scale. Secondary outcomes were efficacy in reduction of haemorrhoidal symptom score at 12 weeks, daily average and maximum pain scores for 14 days and complications arising from the intervention. Results Thirty patients were randomized (14 HET, 16 RBL). There was no significant difference between the two group's pre‐intervention symptom score and haemorrhoidal grade. The mean pain scores at 1 h in the HET group were 1.5 ± 068 (95% confidence interval), and in the RBL group 4.64 ± 1.74 (95% confidence interval) (P < 0.05). Average (0.7 versus 2.95, P < 0.05) and maximum (1.25 versus 4.4, P < 0.05) pain were lower in the HET group on day one post procedure. At 12 weeks there was no significant difference in the reduction of haemorrhoid symptom scores between the groups (HET 2.27, RBL 1.5 (P > 0.2)). Conclusion HET causes less pain then RBL, and is at least as effective in treating the symptoms associated with grade I and II haemorrhoids in the outpatient setting.

Background: Colorectal cancer is one of the leading causes of cancer-associated morbidity and mortality worldwide. The local anti-tumour immune response is particularly important for patients with stage II where the tumour-draining lymph nodes have not yet succumbed to tumour spread. The lymph nodes allow for the expansion and release of B cell compartments such as primary follicles and germinal centres. A variation in this anti-tumour immune response may influence the observed clinical heterogeneity in stage II patients. Aim:The aim of this study was to explore tumour-draining lymph node histomorphological changes and tumour pathological risk factors including the immunomodulatory microRNA-21 (miR-21) in a small cohort of stage II CRC.Methods: A total of 23 stage II colorectal cancer patients were included. Tumour and normal mucosa samples were analysed for miR-21 expression levels and B-cell compartments were quantified from Haematoxylin and Eosin slides of lymph nodes. These measures were compared to clinicopathological risk factors such as perforation, bowel obstruction, T4 stage and high-grade. Results:We observed greater follicle density in patients with a lower tumour T stage and higher germinal centre density in patients with higher pre-operative carcinoembryonic antigen levels. Trends were also detected between tumours with deficiency in mismatch repair proteins, lymphatic invasion and both the density and size of B-cell compartments. Lastly, elevated tumour miR-21 was associated with decreased follicle and germinal centre size. Conclusion:Variation in B-cell compartments of tumour-draining lymph nodes is associated with clinicopathological risk factors in stage II CRC patients. What does this paper add to the literature?This study demonstrates the variability of tumour draining lymph node morphological features in stage II CRC patients. This provides new scope for biomarker discovery in stage II CRC patients which is a research priority for this patient group.

INTRODUC TI ON BackgroundExternal rectal prolapse (ERP) is defined as a protrusion of all layers of the rectal wall through the anal canal [1]. Factors that may contribute to the development of rectal prolapse include pelvic floor dysfunction, chronic straining, a deep pouch of Douglas and multiparity [1,2]. The condition is estimated to affect 0.5% of the population, with older, multiparous women predominantly affected [3,4].Men account for 10% of the rectal prolapses seen and treated [5][6][7].Rectal prolapse in men is much higher in countries such as Egypt, where it commonly affects younger patients, but the exact mechanism for this is not well known [8][9][10].Surgical management of ERP can be broadly divided into abdominal and perineal approaches [11]. Most of the published literature on rectal prolapse focuses on women, with little guidance on the management of rectal prolapse in men [12]. The perineal approach is often reserved for clinically comorbid and frail patients