[Sacral nerve stimulation for the treatment of severe fecal incontinence: long-term quality of life and functional outcomes].

BACKGROUND: The aim is to determine whether good functional and quality of life results of sacral nerve stimulation (SNS) in patients with severe fecal incontinence are maintained in the long-term. MATERIAL AND METHODS: Consecutive cohort of patients with severe fecal incontinence not responding to conservative (drugs and/or biofeedback) or surgical (sphincteroplasty) treatment, undergoing SNS between 2002 and 2013. Patients with a definitive implant were individually assessed in consultation throughout the follow-up, until January 2016. Defeca-tory function was assessed by Wexner score and stool diary, and perceived quality of life by FIQL and EQ-5D question-naires. RESULTS: Acute percutaneous nerve evaluation (PNE) was performed on 93 patients; a temporary electrode was implanted in 91 (79.1% women, mean age 62.5 years), obtaining a good functional response in 64. A permanent implant was per-formed in 61 patients, with a mean follow-up of 78.1 months (SD: 35.4; range 1-161); at the end of the study 42 patients remained in follow-up. A significant decrease was observed in the number of days per week with an incontinent episode, from 4.98 (SD 2.1) to 1.25 (SD 1.7), and in Wexner score from 16.88 (SD 2.74) to 6.95 (SD 3.54). Specific FIQL and generic EQ-5D questionnaires showed a significant improvement in quality of life. CONCLUSION: Long-term functional and quality of life outcomes of SNS for the treatment of severe faecal incontinence is maintained, with individual follow-ups that reach 10 years.

Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis.

BACKGROUND: We evaluated the role of helical computed tomographic (HCT) cholangiography in the study of the biliary tract, especially in the detection of choledocholithiasis, and compared it with direct cholangiography. METHODS: One hundred one patients with biliary lithiasic pathology undergoing direct cholangiography to rule out choledocholithiasis were included in this study. HCT was performed before and after slow infusion of cholangiographic contrast. Three-dimensional reconstructions and axial images were reviewed by two independent observers. Ultrasonography also was performed on all patients. RESULTS: The success rate of HCT cholangiography was 99%, with only a slight reaction to the contrast. The density values were significantly higher in the distal region of the tract and showed a significant correlation with serum bilirubin levels. Anatomic evaluation of the biliary tract with CT was similar to that with direct cholangiography. Anatomic variants were found on 23 studies. Twenty-two patients had choledocholithiasis, and 21 cases were detected with HCT cholangiography. The sensitivity of this technique (95.5%) was greater than that with unenhanced CT (60%) and ultrasonography (27.3%). Maximum intensity projection reconstructions were the most valuable for detecting choledocholithiasis. CONCLUSION: HCT cholangiography is a reliable technique that is similar to direct cholangiography in visualizing biliary anatomy, anatomic variants, and choledocholithiasis.

[Paroxysmal unilateral hyperhidrosis]. / Hiperhidrosis unilateral paroxística.

We report the case of a 35-year-old woman with paroxysmal unilateral hyperhidrosis which developed after thoractotomy for Barret's esophagus (benign esophageal stenosis). Hyperhidrosis was on the right side of the face and in the metameric areas corresponding to the right spinal roots C2, C3 and C4. Paroxysms of sweating lasting from 15 to 30 min occurred several times daily, either spontaneously or related with acid food ingestion. The symptoms have been present for the last 10 years. Paroxysmal unilateral hyperhidrosis is a rare disorder of the autonomic nervous system. It has been reported in association with peripheral nerve, spinal cord and cerebral lesions, and in some cases the etiology is unknown.