RESUMEN
BACKGROUND: Surgical wound classification (SWC) is used for risk stratification of surgical site infection (SSI) and serves as the basis for measuring quality of care. The objective was to examine the accuracy and reliability of SWC. This study was purposed to evaluate the discrepancies in SWC as assessed by three groups: surgeons, an infection control nurse, and histopathologic evaluation. The secondary aim was to compare the risk-stratified SSI rates using the different SWC methods for 30 d postoperatively. METHODS: An analysis was performed of the appendectomies from January 2013 to June 2014 in the Cantonal Hospital of Schaffhausen. SWC was assigned by the operating surgeon at the end of the procedure and retrospectively reviewed by a Swissnoso-trained infection control nurse after reading the operative and pathology report. The level of agreement among the three different SWC assessment groups was determined using kappa statistic. SSI rates were analyzed using a chi-square test. RESULTS: In 246 evaluated cases, the kappa scores for interrater reliability among the SWC assessments across the three groups ranged from 0.05 to 0.2 signifying slight agreement between the groups. SSIs were more frequently associated with trained infection control nurse-assigned SWC than with surgeons based SWC. CONCLUSIONS: Our study demonstrated a considerable discordance in the SWC assessments performed by the three groups. Unfortunately, the currently practiced SWC system suffers from ambiguity in definition and/or implementation of these definitions is not clearly stated. This lack of reliability is problematic and may lead to inappropriate comparisons within and between hospitals and surgeons.
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Apendicectomía , Apendicitis/cirugía , Disparidades en Atención de Salud/estadística & datos numéricos , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infección de la Herida Quirúrgica/prevención & control , Herida Quirúrgica/clasificación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Control de Infecciones/métodos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Cirujanos/estadística & datos numéricos , Herida Quirúrgica/diagnóstico , Herida Quirúrgica/patología , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , SuizaRESUMEN
PURPOSE: Percutaneous tibial nerve stimulation (pTNS) was originally developed to treat urinary incontinence. Recently, some case series have also documented its success in the treatment of fecal incontinence. Nevertheless, the mechanism underlying this effect remains unknown but may be related to changes in rectal capacity. The aim of this study was to investigate the success of pTNS for the treatment of fecal urge incontinence and assess the influence of rectal capacity on treatment efficacy. METHODS: All patients undergoing pTNS for fecal incontinence between July 2009 and March 2014 were enrolled in a prospective, observational study consisting of a therapeutic regimen that lasted 9 months. Therapy success was defined as a reduction in the CCI (Cleveland Clinic incontinence) score of ≥50% and patient-reported success. Furthermore, quality of life (Rockwood's scale) and changes in anorectal physiology were recorded. RESULTS: Fifty-seven patients with fecal urge incontinence were eligible, nine of whom were excluded. The success rate was 72.5%. Incontinence events and urge symptoms were significantly reduced after 3 months and at the end of therapy. The median CCI score decreased from 12 to 4 (P < 0.0001), and the quality of life was significantly improved. However, rectal capacity was not significantly related to treatment success before or after therapy. No adverse events were observed. CONCLUSIONS: These results demonstrate that pTNS can improve the symptoms and quality of life of patients with fecal urge incontinence. However, the study fails to demonstrate a correlation between treatment success and changes in rectal capacity.
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Recto/fisiopatología , Nervio Tibial/fisiopatología , Estimulación Eléctrica Transcutánea del Nervio , Canal Anal/fisiopatología , Defecación , Incontinencia Fecal/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estimulación Eléctrica Transcutánea del Nervio/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: Perineal stapled prolapse resection (PSP) has been described as a new surgical treatment for external rectal prolapse in 2008. Short-term and midterm results acknowledged PSP as a safe, fast and simple procedure for high-risk patients. This study aims to assess long-term results after PSP. METHODS: All patients who underwent PSP from 2007 to 2015 were analyzed retrospectively. Data was gathered from medical records and operative reports and by interviews with the general practitioner or the patient. RESULTS: Indication for PSP was provided in 64 cases. One procedure had to be changed to an Altemeier's and another to a laparoscopic rectopexy. The median age was 79.9 years (range 25.9-97.5). Spinal anaesthesia was used in 19 patients. The median operation time was 32.5 min (range 25-51.2). There was no mortality. One patient had to be reoperated. All other complications were minor. The median hospital stay was 6.0 days (range 2-23). Median follow-up of patients alive was 6.0 years (range 0.2-8.4). The 5-year recurrence-free survival rate for primary prolapse was 70.1 % compared to 34.3 % for recurrent prolapses (p = 0.048). Further positive prognostic factors were specimen length over 8 cm and lack of preoperative obstructed defecation syndrome. Faecal incontinence was remedied in 18, and new onset was recorded in 6 patients (significant incontinence rate reduction (p = 0.025)). CONCLUSION: Due to low morbidity and the possibility of spinal anaesthesia, PSP is suitable for frail patients. The recurrence rate for primary prolapse is similar to alternative perineal procedures like Delorme's and Altemeier's, but inferior to the laparoscopic techniques.
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Prolapso Rectal/cirugía , Grapado Quirúrgico , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Perineo/cirugía , Calidad de Vida , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Previous studies showed that perineal stapled prolapse resection for external rectal prolapse improves continence and has short operation times and low complication rates. OBJECTIVE: The aim of this study was to assess the midterm recurrence rates, functional results, and patient satisfaction after perineal stapled prolapse resection. DESIGN: This was a retrospective study. SETTINGS: : The study was performed at a tertiary hospital in Switzerland. PATIENTS: From November 2007 to October 2011, a total of 56 consecutive patients were included in the study. MAIN OUTCOME MEASURES: Recurrence rates, functional results according to the Wexner incontinence scale, and patient satisfaction using a visual analog scale were determined. RESULTS: The median age was 78.5 years (range, 24-94 years), and 2 patients were men. Midterm results were available for 46 (82%) of 56 patients after a median follow-up of 25.5 months (range, 2-47 months). In 10 cases (18%) data collection was not possible. The recurrence rate at 3 years was 19.7% (95% CI 4.2%-32.7%). The Wexner incontinence score improved from a median of 14.5 presurgery to 4.0 points (p < 0.0001) after surgery. Twenty-five patients (54%) stated that their bowel movements were regular postoperatively. On a visual analog scale that measured satisfaction, the median patient score was 9 (range, 0-10), indicating high patient satisfaction. LIMITATIONS: Limitations included the retrospective study design and the lack of clinical examinations to determine recurrence rates. CONCLUSIONS: Perineal stapled prolapse resection is an alternative technique for treating rectal prolapse with a recurrence rate similar to the Altemeier-Mikulicz or Delorme procedures. This technique is a quick and reliable procedure for use in patients with advanced age.
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Procedimientos Quirúrgicos del Sistema Digestivo , Perineo/cirugía , Complicaciones Posoperatorias , Prolapso Rectal , Recto/cirugía , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Femenino , Humanos , Masculino , Satisfacción del Paciente , Perineo/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Recuperación de la Función , Prolapso Rectal/complicaciones , Prolapso Rectal/fisiopatología , Prolapso Rectal/cirugía , Recto/fisiopatología , Estudios Retrospectivos , Prevención Secundaria , Suiza , Resultado del TratamientoRESUMEN
BACKGROUND: Stapled transanal rectal resection with a new, curved, multifire stapler (Transtar procedure) has shown promising short- and midterm results for treating obstructed defecation syndrome. However, few results have been published on long-term outcome. OBJECTIVE: This study aimed to investigate long-term functional results and quality of life after the Transtar procedure. DESIGN: This is a retrospective study. SETTING: This study was conducted at a tertiary hospital in Switzerland. PATIENTS: Seventy consecutive patients (68 female) with obstructed defecation syndrome had a median age of 65 years (range, 20-90). INTERVENTION: The Transtar procedure was performed between January 2007 and March 2010. MAIN OUTCOME MEASURES: Postoperative functional results were evaluated with the Symptom Severity Score, Obstructed Defecation Score, and Cleveland Incontinence Score. Quality of life was evaluated with the Fecal Incontinence Quality of Life Score and the SF-36 Health Survey. Data were divided into 4 groups of 1-, 2-, 3-, and 4-year follow-ups. RESULTS: The functional scores showed significant postoperative improvement throughout the studied period (p = 0.01). The quality-of-life scores showed a tendency for improvement only in the mental components on the SF-36 Health Survey (p = 0.01). Sixteen patients reported postoperative fecal urgency, but this subsided within a few months. Nine patients reported new postoperative episodes of incontinence and required further treatment. LIMITATIONS: This study was limited by its retrospective nature, the selection bias, and a bias by the small number of questionnaires available for some scores. CONCLUSION: The Transtar procedure was successful for long-term treatment of obstructed defecation syndrome. Fecal urgency and incontinence were observed, but typically resolved within months. Therefore, the Transtar procedure appears to be a reasonable approach to treating obstructed defecation syndrome in the long term.
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Estreñimiento/cirugía , Incontinencia Fecal/cirugía , Recto/cirugía , Grapado Quirúrgico/métodos , Adulto , Anciano , Anciano de 80 o más Años , Defecación , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Diseño de Equipo , Femenino , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Sesgo de Selección , Engrapadoras Quirúrgicas , Síndrome , Resultado del TratamientoRESUMEN
Hemorrhoidal disease represents a prevalent benign condition of the lower gastrointestinal tract. As a common and early symptom of hemorrhoids, patients present with painless rectal bleeding during or after defecation. For the treatment of hemorrhoidal disease, a large variety of operative and non-operative therapeutic options exists. In the present article, the authors aim to provide guidance for stage-directed therapy of hemorrhoidal disease based on up-to-date knowledge and the authors' own clinical experience.
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Cirugía Colorrectal/tendencias , Medicina Basada en la Evidencia , Hemorreoidectomía/métodos , Hemorreoidectomía/tendencias , Hemorroides/diagnóstico , Hemorroides/cirugía , HumanosRESUMEN
PURPOSE: Recent studies have reported excellent healing and low recurrence rates for rhomboid flaps for pilonidal sinus disease. The cosmetic outcome has been less investigated and is the focus of this study following Limberg flap reconstruction of recurrent and complex pilonidal disease. METHODS: From August 2006 to December 2007 patients with a recurrent or complex pilonidal sinus were enrolled consecutively. All underwent excision and closure with a Limberg flap. At 3 weeks, morbidity was assessed in the outpatient clinic. Recurrence rate, self-esteem, cosmetic outcome, body image, and patient satisfaction were analyzed prospectively at 1 year. RESULTS: Seventy patients (57 males) with a median age of 24.8 years (range, 14.7-46.5) were operated on. Median follow-up was 1.4 years (range, 1.0-2.8). The mean cosmetic score was reduced to 16.4 (± 4.3) of 24, the mean body image score was good with 17.9 (± 2.6) of 20, and the mean overall satisfaction was high at 7.6 (± 2.3) of 10. Self-esteem remained unchanged after surgery; it was 7.8 (± 2.3) preoperatively and 7.8 (± 2.1) postoperatively (P = .818). After 3 weeks 84.3% of the wounds were completely healed. Complications occurred in 18 patients (25.7%), including superficial infection and partial suture dehiscence. Six (8.6%) needed reoperation, and all belonged to the group with acute infection before flap closure (P < .001). There was no incidence of flap necrosis. The recurrence rate was 1.6% at 1-year follow-up. CONCLUSION: Initial wound closure and low recurrence rates after treatment with Limberg flap in pilonidal sinus disease lead to high patient satisfaction. The cosmetic outcome is acceptable, but an issue for some patients. These results support the use of the Limberg flap in complex pilonidal sinus disease after carefully informing patients about the cosmetic consequences.
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Seno Pilonidal/cirugía , Colgajos Quirúrgicos , Adolescente , Adulto , Imagen Corporal , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Satisfacción del Paciente , Estudios Prospectivos , Recurrencia , Autoimagen , Resultado del TratamientoRESUMEN
PURPOSE: Clinical studies have demonstrated that stapled transanal rectal resection with Contour Transtar (Transtar procedure) is a safe and effective treatment for patients with obstructive defecation syndrome. The aim of this study was to determine functional outcome and quality of life after the procedure. METHODS: Female patients with obstructive defecation syndrome were enrolled prospectively for the Transtar procedure. Intussusception and anterior rectocele were confirmed by clinical investigation and by magnetic resonance defecography. Functional outcome was measured by obstructed defecation syndrome score, severity of symptoms score, and Wexner score preoperatively and postoperatively. Quality of life was assessed by the Cleveland Clinic constipation score, the fecal incontinence quality of life scale, and the SF-36v2 health survey. RESULTS: Between January 2007 and November 2008, 52 consecutive patients (median age: 64 years) were included in the study. Before the surgery, 12 patients experienced fecal incontinence. Functional scores improved significantly: 6 weeks after surgery, the obstructed defecation syndrome score decreased from a median of 16 (range, 9-22) to 5 (range, 2-10) and the severity of symptoms score, from 16 (range, 9-21) to 4 (range, 0-9) (each P < .0001). After 6 weeks, 10 patients had fecal incontinence and 12 patients experienced fecal urgency. At 3 months, 6 patients were still incontinent, 3 of whom were treated successfully with sacral neuromodulation. Fecal urgency resolved in all cases after 6 months. Quality of life improved, particularly in the mental components. CONCLUSION: Despite the described postoperative symptoms, most of which can be treated conservatively, the Transtar procedure is an effective treatment for patients with obstructive defecation syndrome and improves quality of life significantly.
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Estreñimiento/cirugía , Intususcepción/cirugía , Calidad de Vida , Recuperación de la Función , Rectocele/cirugía , Recto/cirugía , Grapado Quirúrgico , Estreñimiento/etiología , Estreñimiento/fisiopatología , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Incontinencia Fecal/cirugía , Femenino , Humanos , Intususcepción/complicaciones , Intususcepción/fisiopatología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Estudios Prospectivos , Recto/fisiopatología , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
PURPOSE: Modern sphincter-preserving surgery for ultralow rectal carcinoma has a comparable oncological radicality to abdomino-perineal extirpation (APE). The aim of this study was to assess the long-term morbidity of ultralow anterior resection (ULAR) and its impact on quality of life (QoL) METHODS: The medical records of 142 consecutive patients who underwent surgery for ultralow rectal carcinoma from January 1991 to December 2004 were reviewed retrospectively. The rate of rehospitalisation and rate of non-reversed temporary stomas ("failure" stoma) were analysed. Generic and cancer-specific quality of life questionnaires were used to assess quality of life. RESULTS: There were a total of 82 ULAR and 60 APE. After ULAR, 25 (30.5%) of the patients were readmitted, stenosis and anastomotic leakage being the main reasons. After APE, only 2 (3.3%) of the patients were readmitted (P < 0.001). The rate of patients with a permanent stoma after sphincter-saving surgery was 22.0%. The failure rate was higher for older patients (P = 0.005) and for coloanal pull-through anastomosis (P = 0.001). The exploratory analysis revealed a negative impact of a "failure" stoma on QoL. CONCLUSION: Severe long-term morbidity and high failure rate of stoma reversal have a significantly worse impact on QoL after ULAR; therefore, APE is a valid alternative to ULAR, especially in elder patients with planned coloanal pull-through anastomosis.
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Canal Anal/cirugía , Complicaciones Posoperatorias/cirugía , Neoplasias del Recto/cirugía , Estomas Quirúrgicos , Anciano , Canal Anal/patología , Anastomosis Quirúrgica , Constricción Patológica/etiología , Constricción Patológica/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Hospitalización , Humanos , Masculino , Calidad de Vida , Procedimientos de Cirugía Plástica , Neoplasias del Recto/complicaciones , Estudios Retrospectivos , Encuestas y Cuestionarios , Insuficiencia del TratamientoRESUMEN
BACKGROUND: A new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up. METHODS: From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour Transtar stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores. RESULTS: 32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (P < 0.0001). No new incidence of constipation was reported. CONCLUSIONS: The PSP is an elegant, fast and safe procedure, with good functional results. TRIAL REGISTRATION: ISRCTN68491191.
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Perineo/cirugía , Prolapso Rectal/cirugía , Grapado Quirúrgico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suturas , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: The aim of this study was to evaluate the sustainability of sacral neuromodulation (SNM) success in patients with fecal incontinence (FI) and/or constipation. METHODS: This is a retrospective analysis of a prospective database of patients who received SNM therapy for FI and/or constipation between 2006 and 2015. Success rates, complications and reintervention rates were assessed after up to 10 years of follow-up. RESULTS: Electrodes for test stimulation were implanted in 101 patients, of whom 79 (78.2%) received permanent stimulation. The mean follow-up was 4.4 ± 3.0 years. At the end of follow-up, 57 patients (72.2%) were still receiving SNM. The 5-year success rate for FI and isolated constipation was 88.2% (95% confidence interval [CI], 80.1-97.0%) and 31.2% (95% CI, 10.2-95.5%), respectively (P ï¼ 0.001). In patients with FI, involuntary evacuations per week decreased ï¼ 50% in 76.1% of patients (95% CI, 67.6-86.2%) after 5 years. A lead position at S3 was associated with an improved outcome (P = 0.04). Battery exchange was necessary in 23 patients (29.1%), with a median battery life of 6.2 years. Reinterventions due to complications were necessary in 24 patients (30.4%). For these patients, the 5-year success rate was 89.0% (95% CI, 75.3-100.0%) compared to 78.4% (95% CI, 67.2-91.4%) for patients without reintervention. CONCLUSIONS: SNM offers an effective sustainable treatment for FI. For constipation, lasting success of SNM is limited and is thus not recommended. Reinterventions are necessary but do not impede treatment success.
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Estreñimiento/cirugía , Incontinencia Fecal/cirugía , Recto/cirugía , Grapado Quirúrgico/métodos , Femenino , Humanos , MasculinoRESUMEN
PURPOSE: A perineal approach to treating rectal prolapse is ideal for frail patients. Recently, internal rectal redundancy has been successfully treated with transanal resection using the Contour Transtar stapler. This technique has been modified to the perineal stapled prolapse resection. The surgical technique and the preliminary results of the new procedure for external rectal prolapse are presented. METHODS: Patients not suited for transabdominal treatment were included prospectively for perineal stapled prolapse resection in two colorectal centers. Feasibility, complications, and reinterventions were assessed. RESULTS: In 14 of 15 patients, perineal stapled prolapse resection was performed without complications in a median operating time of 33 (range, 22-52) minutes. One procedure was changed to an Altemeier because of a staple line disruption. Two patients required reintervention as a result of postoperative hemorrhage. No other severe complications occurred. At follow-up, all patients were well and showed no early recurrence of prolapse. CONCLUSIONS: Perineal stapled prolapse resection is a new surgical procedure for external rectal prolapse, which is easy and quick to perform. Functional results and long-term recurrence rate must be investigated further.
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Perineo/cirugía , Prolapso Rectal/cirugía , Grapado Quirúrgico/métodos , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Prolapso Rectal/etiología , Prolapso Rectal/patología , Recurrencia , Engrapadoras Quirúrgicas , Resultado del TratamientoRESUMEN
PURPOSE: The clinical and morphologic outcome of patients with obstructed defecation syndrome after stapled transanal rectal resection was prospectively evaluated. METHODS: Twenty-four consecutive patients (22 women; median age, 61 (range, 36-74) years) who suffered from obstructed defecation syndrome and with rectal redundancy on magnetic resonance defecography were enrolled in the study. Constipation was assessed by using the Cleveland Constipation Score. Morphologic changes were determined by using closed-configuration magnetic resonance defecography before and after stapled transanal rectal resection. RESULTS: After a median follow-up of 18 (range, 6-36) months, Cleveland Constipation Score significantly decreased from 11 (range, 1-23) preoperatively to 5 (range, 1-15) postoperatively (P = 0.02). In 15 of 20 patients, preexisting intussusception was no longer visible in the magnetic resonance defecography. Anterior rectoceles were significantly reduced in depth, from 30 mm to 23 mm (P = 0.01), whereas the number of detectable rectoceles did not significantly change. Complications occurred in 6 of the 24 patients; however, only two were severe (1 bleeding and 1 persisting pain requiring reintervention). CONCLUSIONS: Clinical improvement of obstructed defecation syndrome after stapled transanal rectal resection correlates well with morphologic correction of the rectal redundancy, whereas correction of intussusception seems to be of particular importance in patients with obstructed defecation syndrome.
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Canal Anal/cirugía , Obstrucción Intestinal/patología , Obstrucción Intestinal/cirugía , Enfermedades del Recto/patología , Enfermedades del Recto/cirugía , Grapado Quirúrgico , Adulto , Anciano , Defecación , Defecografía , Femenino , Estudios de Seguimiento , Humanos , Obstrucción Intestinal/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedades del Recto/fisiopatología , Síndrome , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of our study was to compare intraindividually two rectal enema compositions in MR defecography. MATERIALS AND METHODS: Twenty patients underwent MR defecography twice on a 0.5-T open-configuration system in the sitting position. During the first imaging session, MR defecography was performed with a rectal enema consisting of potato starch mixed with gadolinium (PS group). During the second session, the enema consisted of ultrasound gel mixed with gadolinium (US group). The imaging protocol consisted of midsagittal T1-weighted gradient-recalled echo MR images obtained at rest, at maximal sphincter contraction, at straining, and during defecation. All images were analyzed quantitatively by measuring the contrast-to-noise ratio (CNR) and reviewed by three independent observers with regard to the visibility of pelvic floor abnormalities and the extent of those abnormalities. RESULTS: The CNR values in the PS group (mean +/- SD, 167.49 +/- 44.4) were significantly higher than those obtained in the US group (150.2 +/- 37.8) (p < 0.05). The visibility scores for anterior rectoceles and intussusceptions were higher in the PS group than in the US group (mean visibility scores: PS group, 2.8 +/- 0.42 and 2.6 +/- 0.56, respectively; US group, 2.3 +/- 0.77 and 2.2 +/- 0.74, respectively). The size and the number of incompletely emptying anterior rectoceles were higher in the PS group. CONCLUSION: Ultrasound gel and potato starch provide good contrast and depiction of relevant pelvic floor abnormalities. However, the visibility of pelvic floor abnormalities and extent of those abnormalities depend on the composition of the rectal enema. In particular, the size and degree of anterior rectocele evacuation and intussusception size are often underestimated when ultrasound gel is used for rectal enema.
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Medios de Contraste/administración & dosificación , Defecografía/métodos , Enema/métodos , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Pelvis/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
AIM: The aim of this official guideline published by the German Society of Gynecology and Obstetrics (DGGG) and coordinated with the German Society of Urology (DGU) and the German Society of Reproductive Medicine (DGRM) is to provide consensus-based recommendations, obtained by evaluating the relevant literature, on counseling and fertility preservation for prepubertal girls and boys as well as patients of reproductive age. Statements and recommendations for girls and women are presented below. Statements or recommendations for boys and men are not the focus of this guideline. METHODS: This S2k guideline was developed at the suggestion of the guideline commission of the DGGG, DGU and DGRM and represents the structured consensus of representative members from various professional associations (n = 40). RECOMMENDATIONS: The guideline provides recommendations on counseling and fertility preservation for women and girls which take account of the patient's personal circumstances, the planned oncologic therapy and the individual risk profile as well as the preferred approach for selected tumor entities.
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HYPOTHESIS: Permanent sacral nerve stimulation (SNS) is a promising emerging treatment for fecal incontinence. However, there is little data on morbidity and quality of life (QOL) during long-term stimulation. DESIGN: Prospective trial to assess morbidity and QOL in patients treated with SNS. Median follow-up was 13 months (range, 1-42 months). SETTING: University hospital providing primary, secondary, and tertiary care. PATIENTS: Between December 2001 and July 2005, SNS was tested in 44 patients (30 women), with a median age of 65 years (range, 15-88 years). INTERVENTIONS: Percutaneous nerve evaluation and permanent insertion of an implantable pulse generator. MAIN OUTCOME MEASURES: Morbidity, stool diary, and Wexner Score for fecal incontinence; Hanley Score for urinary incontinence; and Gastrointestinal Quality of Life Index, the 36-item short form health survey, and the Royal London Hospital questionnaire for QOL. RESULTS: A permanent stimulator was implanted in 37 patients (84%). Eight patients (22%) experienced complications that required surgical intervention. (A successful restimulation was possible for 5 of those patients.) Adverse effects of SNS were remedied in 5 patients by reprogramming the stimulator. Wexner Scores decreased from a median of 16 points preoperatively (range, 6-20), to a median of 5 points postoperatively (range, 0-13; P<.001). The median number of involuntary stool losses and for urge defecations also decreased significantly. Significant improvement in QOL was found in both generic and incontinence-specific questionnaires (P<.05). The success rate of SNS was 77% (34 of 44 patients) and 92% (34 of 37) in patients with permanent implantation. CONCLUSIONS: The minimally invasive technique of SNS is safe and effective. Most adverse effects can be easily remedied. Our data demonstrate that SNS significantly improves patients' QOL, including their physical and psychological well-being.
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Incontinencia Fecal/cirugía , Prótesis e Implantes , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Morbilidad , Periodo Posoperatorio , Resultado del TratamientoRESUMEN
Spontaneous ruptures of hepatocellular carcinoma (HCC) are rare. Nevertheless they may lead to difficult decisions in the emergency situation. The acute therapies include conservative treatment, transarterial embolization and surgery. Curative treatment of HCC can be achieved by liver resection solely. The decision-making depends on prognostic patient's factors, such as hepatic viral infection status, Child-Pugh grade, liver cirrhosis and number of tumors. In this case transarterial embolization was preferable as a bridging therapy prior to further diagnostics and therapy, to lower the perioperative morbidity and mortality. The therapy of these cases needs an interdisciplinary approach to choose the best possible procedure in each case.
RESUMEN
Cytomegalovirus infections are widely distributed with a seroprevalence of up to 100%. The majority of the cases take a silent course or deal with unspecific clinical symptoms. Complications in immunocompetent patients are rare but may affect the liver and lead up to an acute organ failure. In this case report, we describe a 35-year-old immunocompetent female with an acute cytomegalovirus infection presenting as acute hepatitis with ongoing upper right abdominal pain after cholecystectomy. Upper right abdominal pain is a common symptom with a wide range of differential diagnoses. If common reasons can be excluded, we want to sensitize for cytomegalovirus infection as a minor differential diagnosis even in immunocompetent patients.