Anorectal Gastrointestinal Stromal Tumour: A Case Treated with Radical Surgery.

Gastrointestinal Stromal Tumour involving rectum and anal canal is an extremely rare entity. This is a case report of a 47 years lady presented with fresh rectal bleed associated with rectal pain and foul smelling rectal mucus discharge. On rectal examination, she had a firm mass palpable about 1.5 cm from anal verge. Considering the size of the tumour and its close proximity with cervix and involvement of levator muscles, extralevator abdominal perineal excision of rectum was undertaken with good recovery after surgery. It was followed by imatinib therapy.

[Prevention and management of anterior resection syndrome].

Because of the improvement of surgical technique and the widely use of multimodality therapy, more patients with rectal cancer undergo sphincter-preserving surgery. However, it has been reported that up to 90% of such patients will suffer from bowel dysfunction, ranging from increased bowel frequency to faecal incontinence or evacuatory dysfunction. This wide spectrum of symptoms after resection of the rectum has been termed anterior resection syndrome (ARS). This disordered bowel function has a substantial negative effect on quality of life, however, the causal mechanisms have not been clarified. The present review discusses the clinical manifestation, underlying mechanisms, as well as prevention and treatment strategies.

[Sacral nerve stimulation treatment in functional anorectal pain].

OBJECTIVE: To evaluate the treatment outcomes of sacral nerve stimulation(SNS) for functional anorectal pain(FAP). METHODS: A total of 32 patients of FAP received SNS treatment through S3 from March 2011 to December 2011. Visual analogue scale(VAS), anal pressure measure, and health survey(SF-36) before and after treatment were used to evaluate the outcomes. RESULTS: After treatment, VAS score was significantly decreased, rectal anal reflex threshold volume elevated, and anal maximum contraction pressure (AMCP) and anal rest pressure significantly decreased compared with those before treatment(all P<0.01). Except for general health, the remaining dimension score of the SF-36 increased significantly after treatment, and the differences were statistically significant(P<0.05 or P<0.01). After SNS treatment, 19 cases were cured, 12 improved, 1 was refractory. The total effective rate was 96.9% during 3 months after treatment. CONCLUSION: SNS is a safe and effective alternative for FAP and can alleviate the pain symptom and improve the quality of life.

Analysis of biomechanical parameters extracted from anorectal manometry of fecally-continent and incontinent patients / Análise de parâmetros biomecânicos extraídos da manometria anorretal de pacientes continentes e com incontinência fecal / Análisis de parámetros biomecánicos extraídos de la manometría recto-anal de pacientes con continencia e incontinencia fecal

OBJECTIVE: to evaluate the average resulting area from the Pressure x Time curves resulting from the manometric anorectal exam and compare it with the support capacity of voluntary squeeze. Materials and METHODS: the data set was represented by data from 11 exams from continent patients and eight exams from patients with grade III fecal incontinence. The manometric curves were delineated, and the areas and support capacity of voluntary squeeze calculated, by means of the R computer language and the algorithm developed. RESULTS: the resulting averages for support capacity of voluntary squeeze in continent patients and patients with grade III fecal incontinence were 33.07 seconds and 30.76 seconds (p>0.05) and the averages for area were 2362.04 mmHg x second and 947.92 mmHg x second (p<0.05), respectively. CONCLUSION: the average resulting area is able to differentiate continent patients from incontinent and is shown to be a possible parameter in the analysis of biomechanical behavior related to the mechanisms of anorectal continence.

OBJETIVO: avaliar a área média resultante, proveniente das curvas pressão versus tempo, pertencentes ao exame manometria anorretal e confrontá-la com a capacidade de sustentação. MATERIAIS E MÉTODOS: a casuística foi representada por dados de 11 exames de pacientes continentes e oito exames de pacientes com incontinência fecal grau III. Por meio da linguagem computacional R e do algoritmo desenvolvido foram delineadas as curvas manométricas e calculadas as áreas e capacidades de sustentação. RESULTADOS: as médias resultantes da capacidade de sustentação de pacientes continentes e com incontinência fecal grau III foram 33,07 segundos e 30,76 segundos (p>0,05) e as da área, 2362,04 mmHg x segundo e 947,92 mmHg x segundo (p<0,05), respectivamente. CONCLUSÃO: a área média resultante foi capaz de diferenciar os pacientes continentes dos incontinentes e demonstra ser um possível parâmetro na análise do comportamento biomecânico, relacionado aos mecanismos de continência anorretal.

OBJETIVO: evaluar el área media resultante proveniente de las curvas Presión versus Tiempo pertenecientes al examen manometría rectal y afrontarla con la capacidad de sustentación. Materiales y MÉTODOS: la casuística fue representada por datos de 11 exámenes de pacientes moderados y ocho exámenes de pacientes con incontinencia fecal grado III. Por medio del lenguaje computacional R y del algoritmo desarrollado fueron delineadas las curvas manométricas y calculadas las áreas y capacidades de sustentación. RESULTADOS: los medios resultantes de la capacidad de sustentación de pacientes moderados y con incontinencia fecal grado III fueron 33,07 segundos y 30,76 segundos (p>0,05) y las de la área, 2362,04 mmHg x según y 947,92 mmHg x según (p<0,05), respectivamente. CONCLUSIÓN: el área media resultante fue capaz de diferenciar los pacientes continentes de los incontinentes y demuestra ser un posible parámetro en el análisis del comportamiento biomecánico relacionado a los mecanismos de continencia rectal.

Acute pandysautonomia: mass spectrometric and histopathological studies of the sympathetic nervous system during long term L-threo-3,4-dihydroxyphenylserine treatment.

Stable isotope labelled L-threo-3,4-dihydroxyphenylserine (L-DOPS) infusion tests and histopathological studies of the rectal autonomic nerves were performed in a patient with acute pandysautonomia. A pronounced increase in blood pressure occurred and stable isotope labelled noradrenaline appeared in the plasma during L-DOPS infusion in the acute stage, but decreased during the next three years. Noradrenergic nerve fibres in the rectal mucosa showed no recovery, and so clinical improvement had occurred without apparent significant regeneration of the peripheral autonomic nerves.