Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.923
Filtrar
2.
JAMA Netw Open ; 7(3): e240068, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38427356

RESUMO

This cross-sectional study evaluates use and availability of follow-up anoscopy among persons at highest risk for anal cancer.


Assuntos
Neoplasias do Ânus , Infecções por HIV , Humanos , Proctoscopia/métodos , Citologia , Neoplasias do Ânus/diagnóstico , Infecções por HIV/complicações
3.
Sci Rep ; 14(1): 4672, 2024 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-38409328

RESUMO

Colonoscopy and endoscopic ultrasound play pivotal roles in the assessment of rectal diseases, especially rectal cancer and inflammatory bowel diseases. Optical coherence tomography (OCT) offers a superior depth resolution, which is a critical factor for individualizing the therapeutic concept and evaluating the therapy response. We developed two distinct rectoscope prototypes, which were integrated into a 1300 nm MHz-OCT system constructed at our facility. The rapid rotation of the distal scanning probe at 40,000 revolutions per minute facilitates a 667 Hz OCT frame rate, enabling real-time endoscopic imaging of large areas. The performance of these OCT-rectoscopes was assessed in an ex vivo porcine colon and a post mortem human in-situ colon. The OCT-rectoscope consistently distinguished various layers of the intestinal wall, identified gut-associated lymphatic tissue, and visualized a rectal polyp during the imaging procedure with 3D-reconstruction in real time. Subsequent histological examination confirmed these findings. The body donor was preserved using an ethanol-glycerol-lysoformin-based technique for true-to-life tissue consistency. We could demonstrate that the novel MHZ-OCT-rectoscope effectively discriminates rectal wall layers and crucial tissue characteristics in a post mortem human colon in-situ. This real-time-3D-OCT holds promise as a valuable future diagnostic tool for assessing disease state and therapy response on-site in rectal diseases.


Assuntos
Doenças Retais , Neoplasias Retais , Animais , Suínos , Humanos , Tomografia de Coerência Óptica/métodos , Proctoscopia , Endoscopia Gastrointestinal , Reto
5.
Int J Urol ; 31(2): 139-143, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37847117

RESUMO

OBJECTIVES: Rectal bleeding is a common complication of transrectal ultrasound-guided prostate biopsy (TRPB). Massive rectal bleeding after TRPB can be life threatening. We initiated proctoscopy after TRPB to clarify the incidence of rectal bleeding and evaluated the usefulness of proctoscopy for controlling bleeding after TRPB. MATERIALS: Two hundred and fifty six patients who underwent TRPB were included in the study. TRPB was performed under local anesthesia. Post-biopsy, we performed a proctoscopy to evaluate the degree of rectal bleeding at four levels (G0, no bleeding; G1, traces; G2, venous bleeding requiring hemostasis; and G3, massive venous bleeding or arterial bleeding). Once the bleeding site on the rectal wall was identified, a gauze tampon was placed at the bleeding site and compressed for a few minutes. A second proctoscopy was performed to confirm complete hemostasis, after which the TRPB was terminated. RESULTS: Proctoscopy revealed that the degree of bleeding was G0 in 27 cases, G1 in 104 cases, G2 in 116 cases, and G3 in nine cases. Rectal bleeding that required hemostasis (G2 and G3) was observed in 125 of 256 cases (48.3%). Among the 125 cases, bleeding was stopped by compression in 121 cases; in the remaining four cases, bleeding continued despite compression and was stopped by suturing of the bleeding site. Suturing was performed by urologists, and none of the 256 patients had problematic posterior hemorrhage. CONCLUSIONS: Proctoscopy enables precise and effective pressure hemostasis. Moreover, suturing hemostasis under direct vision can be performed in cases in which pressure hemostasis is difficult. Continued proctoscopy allays urologists' fear of post-TRPB rectal bleeding.


Assuntos
Proctoscopia , Próstata , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/cirurgia , Próstata/patologia , Proctoscopia/efeitos adversos , Reto , Biópsia/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia
6.
J Low Genit Tract Dis ; 28(1): 101-106, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38117565

RESUMO

OBJECTIVES: To evaluate high-risk human papillomavirus testing (hrHPV) as an alternative for anal cytology in screening for high-grade anal neoplasia (AIN2-3) among males with HIV. To identify predictive risk factors for AIN2-3 and develop a clinical tool to triage males with HIV for high-resolution anoscopy (HRA) without cytology. DESIGN: Retrospective cohort study of 199 adult cisgender men and transgender women with HIV referred to an anal neoplasia clinic in the Southeastern United States between January 2018 and March 2021. METHODS: Each subject underwent cytology, hrHPV, and HRA. Clinical and sociodemographic risk factors were collected for each subject. Significant risk factors for AIN2-3 were identified using logistic regression, and a triage tool incorporating these factors was developed. Screening test characteristics were calculated for cytology with and without adjunct hrHPV, hrHPV alone, and the triage tool. RESULTS: In multivariate analysis, significant predictors of AIN2-3 were hrHPV positivity (odds ratio [OR] = 11.98, CI = 5.58-25.69) and low CD4 count (OR = 2.70, CI = 1.20-6.11). There was no significant difference in positive or negative predictive values among the tool, stand-alone hrHPV, and anal cytology with adjunct hrHPV. Sensitivity and specificity were not significantly different for stand-alone or adjunctive hrHPV testing. Compared with cytology, stand-alone hrHPV and the novel triage tool reduced unnecessary HRA referrals by 65% and 30%, respectively. CONCLUSIONS: Stand-alone hrHPV would have missed 11 of 74 AIN2-3 and generated 74 fewer unnecessary HRAs than current cytology-based screening patterns, which led to 115 unnecessary HRAs in our cohort. We propose triaging those with low CD4 count, hrHPV positivity, and/or smoking history for HRA.


Assuntos
Neoplasias do Ânus , Infecções por HIV , Infecções por Papillomavirus , Pessoas Transgênero , Neoplasias do Colo do Útero , Adulto , Masculino , Humanos , Feminino , Triagem , Proctoscopia , Estudos Retrospectivos , Neoplasias do Ânus/diagnóstico , Infecções por HIV/diagnóstico , Infecções por Papillomavirus/diagnóstico , Papillomaviridae , Neoplasias do Colo do Útero/diagnóstico
7.
Sci Rep ; 13(1): 22099, 2023 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-38092835

RESUMO

To present rectal endoscopic findings and toxicity after definitive moderately hypofractionated, intensity-modulated radiotherapy (IMRT) for prostate cancer. We retrospectively reviewed patients who underwent IMRT for prostate cancer and underwent post-radiotherapy endoscopies between 2008 and 2018. Endoscopic findings were reviewed and graded using Vienna Rectoscopy Score (VRS). We have analyzed the association between endoscopic findings and rectal bleeding, and investigated risk factors for rectal bleeding. Total 162 patients met the inclusion criteria of this study. There was a trend of VRS worsening during the initial 3 years after radiotherapy followed by recovery. Rectal bleeding was highest at 1 year after radiotherapy and improved thereafter. The 5-year cumulative incidence of grade ≥ 2 rectal bleeding was 14.8%. In the multivariable Cox regression analysis, cardiovascular disease (hazard ratio [HR] 2.732, P = 0.037), rectal wall V65 (HR 1.158, P = 0.027), and VRS ≥ 3 in first post-radiotherapy endoscopy (HR 2.573, P = 0.031) were significant risk factors for rectal bleeding. After IMRT for prostate cancer, VRS and rectal bleeding worsened over 1-3 years after radiotherapy and recovered. Cardiovascular disease, rectal wall V65, and VRS ≥ 3 in first post-radiotherapy endoscopy were significant risk factors for rectal bleeding.


Assuntos
Doenças Cardiovasculares , Neoplasias da Próstata , Lesões por Radiação , Radioterapia de Intensidade Modulada , Masculino , Humanos , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Doenças Cardiovasculares/etiologia , Lesões por Radiação/etiologia , Reto , Proctoscopia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/complicações , Neoplasias da Próstata/etiologia
8.
J Surg Res ; 290: 45-51, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37182438

RESUMO

INTRODUCTION: Rigid proctosigmoidoscopy (RP) and flexible sigmoidoscopy (FS) are two modalities commonly used for intraoperative evaluation of colorectal anastomoses. This study seeks to determine whether there is an association between the endoscopic modality used to evaluate colorectal anastomoses and the rate of anastomotic leak (AL), organ space infection, and overall infectious complication. METHODS: The 2012-2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing colorectal anastomoses. Anastomotic evaluation method (RP versus FS) was identified by Current Procedural Terminologycoding and used for group classification. Outcomes measured included AL, organ space infections, and overall infection. Multivariable logistic regression analysis for predicting AL was performed. RESULTS: We identified 7100 patients who underwent a colorectal anastomosis with intraoperative endoscopic evaluation. RP was utilized in 3397 (47.8%) and FS in 3703 (52.2%) patients. RP was used more commonly in diverticulitis (44.5% versus 36.2%, P < 0.01), while FS was used more frequently in malignancy (47.5% versus 36.7%, P < 0.01). Anastomotic evaluation with FS was associated with lower rates of organ space infection (3.8% versus 4.8%, P = 0.025) and AL (2.9% versus 3.8%, P = 0.028) compared to RP. On multivariate logistic regression modeling, anastomotic evaluation with RP was associated with a higher risk of AL (odds ratio 1.403, 95% CI 1.028-1.916, P = 0.033) compared to FS. CONCLUSIONS: Compared to FS, rigid proctosigmoidoscopic evaluation of a colorectal anastomosis was associated with an increased rate of AL and organ space infection.


Assuntos
Neoplasias Colorretais , Proctoscopia , Humanos , Proctoscopia/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Reto/cirurgia , Reto/patologia , Neoplasias Colorretais/cirurgia , Estudos Retrospectivos
11.
Tech Coloproctol ; 26(3): 175-180, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34905132

RESUMO

BACKGROUND: Local excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment. Transanal minimally invasive surgery (TAMIS) is the most recent alternative developed for local excision. In this study we evaluate the results after implementing TAMIS as the routine procedure for local excision of rectal neoplasms. METHODS: All patients who underwent TAMIS from January 2016 to January 2020 at St. Olav's University Hospital were included, and clinical, pathological and oncological data were prospectively registered. The primary endpoint was local recurrence, and the secondary endpoint was complications. RESULTS: There were 76 patients (42 men, mean age was 69 years [range 26-88 years]), The mean tumour level was 82 mm (range 20-140 mm) from the anal verge measured on rigid proctoscopy, and mean tumour size was 32 mm (range 8-73 mm). Three patients experienced complications needing intervention (Clavien-Dindo > 3A). Seventeen patients had rectal adenocarcinoma, 9 of whom underwent R0 completion total mesorectal excision (cTME). Fifty-five patients had an adenoma, 3 of whom developed recurrence (5.4%) within 12 months. All recurrences were treated successfully with a new TAMIS procedure. In addition, TAMIS was used in treatment of 2 patients with a neuroendocrine tumour, 1 patient with a haemangioma and 1 patient with a solitary rectal ulcer. CONCLUSIONS: TAMIS surgery is associated with a low risk of complications and a low recurrence rate in rectal neoplasms. In cases of adenocarcinoma, R0 cTME surgery is feasible in the sub-group with high risk T1 and T2 tumours.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias Retais , Cirurgia Endoscópica Transanal , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Proctoscopia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/métodos
13.
Sex Health ; 18(6): 515-516, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34838154

RESUMO

Anal examination and proctoscopy are important skills needed to facilitate the diagnoses of STIs and cancer. Clinician (25 doctors/15 nurses) confidence was higher for anal examination versus proctoscopy (median Likert scores 4/5 vs 5/5, P≤0.05) and higher in doctors compared with nurses (median Likert scores 5/5 vs 4/5, P<0.008, 4/5 vs 2/5, P<0.005), and related to years of experience (5/5 vs 4/5, P<0.001, 3/5 vs 5/5, P=0.007). Barriers included lack of opportunities for training, concerns about patient reluctance, and lack of available equipment. We need to be innovative when up-skilling the specialist sexual health workforce using online training and optimising opportunities for clinical assessment of MSM.


Assuntos
Infecções por HIV , Saúde Sexual , Minorias Sexuais e de Gênero , Homossexualidade Masculina , Humanos , Masculino , Projetos Piloto , Proctoscopia , Comportamento Sexual
14.
Sci Rep ; 11(1): 21857, 2021 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-34750473

RESUMO

Prevention of postoperative anastomotic leakage in rectal surgery is still required. This study investigated the feasibility of endoscopic hand suturing (EHS) on rectal anastomosis ex vivo. By using isolated porcine colon, we prepared ten anastomoses 6-10 cm from the virtual anus. Then, we sutured anastomoses intraluminally by EHS, which involved a continuous suturing method in 5 cases and a nodule suturing method with extra corporeal ligation in 5 cases. Completeness of suturing, number of stitches, procedure time and presence of stenosis were investigated. Furthermore, the degree of stenosis was compared between the two suturing methods. In all cases, EHS were successfully completed. The median number of stitches and procedure time was 8 and 5.8 min, respectively. Stenosis was created in all continuous suturing cases whereas none was seen in nodule suturing cases. The shortening rate was significantly greater in the continuous suturing method than in the nodule suturing method. Intraluminal reinforcement of rectal anastomosis by EHS using nodule suturing with extra corporeal ligation is feasible without stenosis, which may be helpful as a countermeasure against possible postoperative anastomotic leakage in rectal surgery.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Modelos Anatômicos , Reto/cirurgia , Técnicas de Sutura , Anastomose Cirúrgica/instrumentação , Animais , Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Estudos de Viabilidade , Humanos , Técnicas In Vitro , Modelos Animais , Proctoscopia/instrumentação , Proctoscopia/métodos , Sus scrofa , Técnicas de Sutura/instrumentação
18.
Colomb Med (Cali) ; 52(2): e4124776, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34188328

RESUMO

Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.


El trauma de recto es poco frecuente, pero generalmente se asocia a lesiones de órganos adyacentes en la región pélvica y abdominal. Estudios recientes han cambiado los paradigmas del manejo tradicional derivados del trauma militar, mostrando mejores resultados en la morbilidad y mortalidad. Sin embargo, las técnicas de control de daños en el trauma rectal aún son controvertidas. El objetivo de este articulo es proponer el algoritmo de manejo del paciente con trauma rectal e inestabilidad hemodinámica, según los principios de la cirugía de control de daños. Se propone que las lesiones del recto en su porción intraperitoneal sean manejadas de la misma manera que las lesiones del colon. Mientras que el manejo de las lesiones extraperitoneales del recto dependerá del compromiso de la circunferencia rectal. Si es mayor del 25% se recomienda realizar una colostomía. Si es menor, se propone optar por el manejo conservador o el reparo primario. Saber que hacer o que no hacer en el trauma de recto marca la diferencia.


Assuntos
Algoritmos , Colostomia , Consenso , Reto/lesões , Ferimentos Penetrantes/cirurgia , Colômbia , Colo/lesões , Tratamento Conservador , Exame Retal Digital , Humanos , Proctoscopia , Tomografia Computadorizada por Raios X/métodos , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/terapia
20.
Lancet Gastroenterol Hepatol ; 6(4): 327-334, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33714370

RESUMO

Anal squamous cell carcinoma is the most common type of anal cancer and is largely associated with anal human papillomavirus infection. The incidence of anal squamous cell carcinoma is increasing, and although still uncommon in the general population, a high incidence has been noted in specific population groups (eg, patients with HIV, men who have sex with men [MSM], recipients of solid organ transplants, women with genital neoplasia, and patients with systemic lupus erythematosus or inflammatory bowel disease). The higher incidence among individuals who are HIV-positive makes anal squamous cell carcinoma one of the most common non-AIDS-defining cancers among HIV-positive individuals. Anal cancer screening in high-risk groups aims to detect high-grade squamous intraepithelial lesions, which are considered anal precancerous lesions, and for which identification can provide an opportunity for prevention. A blind anal cytology is normally the first screening method, and for patients with abnormal results, this approach can be followed by an examination of the anal canal and perianal area under magnification, along with staining-a technique known as high-resolution anoscopy. Digital anorectal examination can enable early anal cancer detection. Several societies are in favour of screening for HIV-positive MSM and recipients of transplants. There are no current recommendations for screening of anal precancerous lesions via endoscopy, but in high-risk groups, a careful observation of the squamocolumnar junction should be attempted. Several treatments can be used to treat high-grade squamous intraepithelial lesions, including argon plasma coagulation or radiofrequency ablation, which are largely limited by high recurrence rates. Gastroenterologists need to be aware of anal squamous cell carcinoma and anal precancerous lesions, given that patients at high risk are frequently encountered in the gastroenterology department. We summarise simple procedures that can help in early anal squamous cell carcinoma detection.


Assuntos
Neoplasias do Ânus/prevenção & controle , Carcinoma de Células Escamosas/prevenção & controle , Lesões Pré-Cancerosas/prevenção & controle , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Humanos , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/terapia , Proctoscopia , Melhoria de Qualidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...