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The effect of changing cloud cover on climate, based on cloud-aerosol interactions, is one of the major unknowns for climate forcing and climate sensitivity. It has two components: (1) the impact of aerosols on clouds and climate due to in situ interactions (i.e., rapid response) and (2) the effect of aerosols on the cloud feedback that arises as climate changes-climate feedback response. We examine both effects utilizing the NASA Goddard Institute for Space Studies ModelE2 to assess the indirect effect, with both mass-based and microphysical aerosol schemes, in transient twentieth century simulations. We separate the rapid response and climate feedback effects by making simulations with a coupled version of the model as well as one with no sea surface temperature or sea ice response ("atmosphere-only" simulations). We show that the indirect effect of aerosols on temperature is altered by the climate feedbacks following the ocean response, and this change differs depending upon which aerosol model is employed. Overall, the effective radiative forcing (ERF) for the "direct effect" of aerosol-radiation interaction (ERFari) ranges between -0.2 and -0.6 W m-2 for atmosphere-only experiments, while the total effective radiative forcing, including[C0]the indirect effect (ERFari+aci) varies between about -0.4 and -1.1 W m-2 for atmosphere-only simulations; both ranges are in agreement with those given in Intergovernmental Panel on Climate Change (2013). Including the full feedback of the climate system lowers these ranges to -0.2 to -0.5 W m-2 for ERFari and -0.3 to -0.74 W m-2 for ERFari+aci. With both aerosol schemes, the climate change feedbacks have reduced the global average indirect radiative effect of atmospheric aerosols relative to what the emission changes would have produced, at least partially due to its effect on tropical upper tropospheric clouds.
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BACKGROUND AND AIMS: While in the past, thoracotomy represented the traditional surgical approach for the treatment of epiphrenic diverticula, actually mini-invasive approach seems to be the preferred treatment as many series have been published in the recent years. This article describes the authors' experience with the laparoscopic approach for performing diverticulectomy, myotomy, and Nissen-Rossetti fundoplication. MATERIAL AND METHODS: From 1994 to 2010, 21 patients (10 men and 11 women), mean age 58.5 years (range 45-74 years), with symptomatic epiphrenic diverticulum underwent laparoscopic diverticulectomy, myotomy and Nissen-Rossetti fundoplication. RESULTS: The mean operative time was 135 min (range = 105-190 min). Mean hospital stay was 14.2 days (range = 7-25 days). In 5 patients (23.8%), a partial suture staple line leak was observed. Conservative treatment achieved leak resolution in all the cases. One patient (4.8%) died of a myocardial infarction in the postoperative period. After a mean clinical follow-up period of 78 months (range = 6-192 months), excellent or good outcome was referred with no dysphagia in 16 patients (80%) and only mild occasional dysphagia in 4 patients (20%). CONCLUSIONS: Surgical treatment of epiphrenic diverticula remains a challenging procedure also by mini-invasive approach, with major morbidity and mortality rates. For this reason, indications must be restricted only to selected and symptomatic patients in specialized centers.
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Divertículo Esofágico/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Fundoplicatura/métodos , Laparoscopia/métodos , Idoso , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Grampeamento Cirúrgico , Toracotomia , Resultado do TratamentoRESUMO
Although there is evidence that liquids have flowed on the surface at Titan's equator in the past, to date, liquids have only been confirmed on the surface at polar latitudes, and the vast expanses of dunes that dominate Titan's equatorial regions require a predominantly arid climate. We report the detection by Cassini's Imaging Science Subsystem of a large low-latitude cloud system early in Titan's northern spring and extensive surface changes (spanning more than 500,000 square kilometers) in the wake of this storm. The changes are most consistent with widespread methane rainfall reaching the surface, which suggests that the dry channels observed at Titan's low latitudes are carved by seasonal precipitation.
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Metano , Saturno , Atmosfera , Meio Ambiente Extraterreno , AstronaveRESUMO
BACKGROUND: Preoperative chemoradiotherapy (CRT) improves the survival of patients with oesophageal cancer when compared with surgery alone. METHODS: We conducted a phase II, multicenter trial of FOLFOX-4 and cetuximab in patients with locally advanced oesophageal cancer (LAEC) followed by daily radiotherapy (180 cGy fractions to 5040 cGy) with concurrent weekly cetuximab. Cytokines levels potentially related to cetuximab efficacy were assessed using multiplex-bead assays and enzyme-linked immunosorbent assay at baseline, at week 8 and at week 17. Primary end point was complete pathological response rate (pCR). RESULTS: In all, 41 patients were enroled. Among 30 patients who underwent surgery, a pCR was observed in 8 patients corresponding to a rate of 27%. The most frequent grade 3/4 toxicity was skin (30%) and neutropenia (30%). The 36-month survival rates were 85 and 52% in patients with pathological CR or PR vs 38 and 33% in patients with SD or PD. CONCLUSIONS: Incorporating cetuximab into a preoperative regimen for LAEC is feasible; no correlation between cytokines changes and patient outcome was observed. Positron emission tomography/computed tomography study even if influenced by the small number of patients appears to be able to predict patients outcome both as early and late metabolic response.
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Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Esofágicas/terapia , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Biomarcadores Tumorais/sangue , Cetuximab , Terapia Combinada , Citocinas/sangue , Neoplasias Esofágicas/sangue , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Esofagectomia , Feminino , Fluoruracila/administração & dosagem , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Compostos Organoplatínicos/administração & dosagem , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Radioterapia AdjuvanteRESUMO
PURPOSE: The aims of this study were to evaluate several clinical and instrumental parameters in a large number of patients with constipation and incontinence as well as in healthy controls and discuss their potential implications in the functional aspects of these disorders. METHODS: Eighty-four constipated and 38 incontinent patients and 45 healthy controls were submitted to a protocol based on proctologic examination, clinico-physiatric assessment, and instrumental evaluation. RESULTS: Constipated and incontinent patients had significantly worse lumbar lordosis as well as lower rate in the presence of perineal defense reflex than controls. Constipated but not incontinent patients had a lower rate of puborectalis relaxation than controls. Furthermore, worse pubococcygeal tests and a higher rate of muscle synergies presence, either agonist or antagonist, were observed in both constipated and incontinent patients compared to controls. CONCLUSIONS: This study has demonstrated strong correlations between physiatric disorders and the symptoms of constipation and incontinence. Further studies designed to demonstrate a causal relationship between these parameters and the success of a specific treatment of the physiatric disorders on the proctology symptoms are warranted.
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Constipação Intestinal/diagnóstico , Defecação , Técnicas de Diagnóstico do Sistema Digestório , Incontinência Fecal/diagnóstico , Músculo Esquelético/fisiopatologia , Inquéritos e Questionários , Adulto , Idoso , Estudos de Casos e Controles , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/reabilitação , Defecografia , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Incontinência Fecal/reabilitação , Feminino , Humanos , Lordose/complicações , Vértebras Lombares , Masculino , Manometria , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Seleção de Pacientes , Diafragma da Pelve/fisiopatologia , Medicina Física e Reabilitação , Valor Preditivo dos Testes , Reflexo Anormal , Fatores de Risco , Ultrassonografia , Adulto JovemRESUMO
This study aims to evaluate by the use of 24-hour combined multichannel intraluminal impedance and pH monitoring (MII-pH) the efficacy of the Nissen fundoplication in controlling both acid and nonacid gastroesophageal reflux (GER) in patients that underwent Heller myotomy for achalasia. It has been demonstrated that fundoplication prevents the pathologic acid GER after Heller myotomy, but no objective data exists on the efficacy of this antireflux surgery in controlling all types of reflux events. The study population consisted of 20 patients that underwent laparoscopic Heller myotomy and Nissen fundoplication for achalasia. All patients were investigated with manometry and MII-pH. MII-pH showed no evidence of postoperative pathologic GER. The overall number of GER episodes was normal in both the upright and recumbent position. This reduction was obtained because of the postoperative control of both the acid and nonacid reflux episodes. The Nissen fundoplication adequately controls both acid and nonacid GER after extended Heller myotomy. Further controls with MII-pH are warranted to check at a longer follow-up for the efficacy of this antireflux procedure in achalasic patients.
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Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Fundoplicatura , Refluxo Gastroesofágico/prevenção & controle , Adolescente , Adulto , Idoso , Impedância Elétrica , Acalasia Esofágica/complicações , Acalasia Esofágica/fisiopatologia , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Humanos , Laparoscopia , Masculino , Manometria , Pessoa de Meia-Idade , Adulto JovemRESUMO
The aim of this study is to evaluate if esophageal dysmotility can influence the outcome of laparoscopic total fundoplication for gatro-esophageal reflux disease (GERD). The advent of laparoscopic fundoplication has greatly reduced the morbidity of antireflux surgery and by now, it should be considered the surgical treatment of choice for GERD. Some authors assert that total versus partial fundoplication should improve the rate of postoperative dysphagia or gas bloat syndrome, particularly in patients with esophageal dysmotility. From September 1992 to December 2005, 420 consecutive patients 171 male and 249 female, mean age 42.8 years (range 12-80) underwent laparoscopic Nissen-Rossetti fundoplication. At manometric evaluation, we divided patients into two groups: group A (163/420; 38.8%) with impaired esophageal peristalsis (peristaltic waves with a pressure < 30 mmHg), and group B (257/420; 61.2%) without impaired peristalsis. We followed up clinically 406 out of 420 (96.7%) patients, 156/163 patients (95.7%) in group A and 250/257 patients (97.3%) in group B. An excellent outcome was observed in 143/156 (91.7%) group A patients and in 234/250 (93.6%) group B patients (P = NS). Both groups showed significant improvement in clinical symptom score with no statistically significant difference between patients with normal and impaired peristalsis. Thus, preoperative defective esophageal peristalsis is not a contraindication to total laparoscopic fundoplication.
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Esôfago/fisiopatologia , Fundoplicatura , Laparoscopia , Avaliação de Resultados em Cuidados de Saúde , Peristaltismo/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Monitoramento do pH Esofágico , Esofagite/cirurgia , Esôfago/cirurgia , Feminino , Seguimentos , Refluxo Gastroesofágico/cirurgia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
AIM: To determine the impact of total fundoplication on the spontaneous esophageal clearance, known as secondary peristalsis. BACKGROUND: Although there is general agreement that total fundoplication is not an obstacle to bolus swallowing (primary peristalsis), whether it is an obstacle to spontaneous esophageal clearance (secondary peristalsis) is still not clear. Based on 24-hour monitoring, multichannel intraluminal impedance was used to calculate the time of spontaneous bolus clearance (BCT). METHODS: Mean BCT was prospectively calculated in 15 consecutive patients before and after total fundoplication. BCT was calculated in seconds including all the gastroesophageal reflux episodes, whereas bolus swallows (solid meals and liquid swallows) were excluded from the analysis. RESULTS: BCT was extrapolated from 1,057 episodes in the 623 h of study. Overall, BCT did not change after surgery (13.6 +/- 4 vs. 15.2 +/- 10 s; p = nonsignificant) and in the upright (12.2 +/- 3 vs. 16.5 +/- 7 s; p = nonsignificant) and recumbent position (22.9 +/- 9 vs. 23.0 +/- 9 s; p = nonsignificant). CONCLUSIONS: In this study total fundoplication did not affect the BCT by combined 24-hour ph monitoring and multichannel intraluminal impedance.
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Monitoramento do pH Esofágico , Esôfago/fisiopatologia , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Peristaltismo , Adulto , Deglutição , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Período Pós-Operatório , Cuidados Pré-Operatórios , Estudos Prospectivos , Resultado do TratamentoAssuntos
Diafragma/ultraestrutura , Hérnia Hiatal/etiologia , Adulto , Biópsia , Tecido Conjuntivo/ultraestrutura , Diafragma/anormalidades , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Músculo Esquelético/ultraestrutura , RecidivaRESUMO
BACKGROUND: No studies have specifically reported on the use of a diagnostic tool based on physiatric assessment of constipated or incontinent patients METHODS: Sixty-seven constipated and 37 incontinent patients were submitted to a standard protocol based on proctologic examination, clinico-physiatric assessment (puborectalis contraction, pubococcygeal test, perineal defence reflex, muscular synergies, postural examination) and instrumental evaluation (anorectal manometry, anal US and dynamic defaecography). Patients were offered pelvic floor rehabilitation (thoraco-abdominoperineal muscle coordination training, biofeedback, electrical stimulation and volumetric rehabilitation). RESULTS: After rehabilitation treatment, decreases of Wexner constipation score (p=0.0001) and Pescatori incontinence score (p=0.0001) were observed. CONCLUSION: This diagnostic protocol might improve the selection of patients with defaecatory disorders amenable for rehabilitation treatment.
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Constipação Intestinal/diagnóstico , Constipação Intestinal/reabilitação , Incontinência Fecal/diagnóstico , Incontinência Fecal/reabilitação , Diafragma da Pelve/fisiopatologia , Modalidades de Fisioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biorretroalimentação Psicológica , Criança , Constipação Intestinal/fisiopatologia , Terapia por Estimulação Elétrica , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Resultado do TratamentoRESUMO
AIM: To demonstrate that age does not influence the choice of treatment for gastroesophageal reflux disease (GERD). We hypothesized that the outcome of total fundoplication in patients > 65 years is similar to that of patients aged < or = 65 years. METHODS: Four hundred and twenty consecutive patients underwent total laparoscopic fundoplication for GERD. Three hundred and fifty-five patients were younger than 65 years (group Y), and 65 patients were 65 years or older (group E). The following elements were considered: presence, duration, and severity of GERD symptoms; presence of a hiatal hernia; manometric evaluation, 24 h pH-monitoring data, duration of operation; incidence of complications; and length of hospital stay. RESULTS: Elderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in comparison with younger patients. A mild intensity of heartburn often leads physicians to underestimate the severity of erosive esophagitis. The duration of the operation was similar between the two groups. The incidence of intraoperative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 92.9% young patients and 91.9% elderly patients. CONCLUSION: Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.
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Fundoplicatura/estatística & dados numéricos , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/cirurgia , Complicações Intraoperatórias/epidemiologia , Laparoscopia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos ProspectivosRESUMO
AIM: The total fundoplication achieves most effective long-term control of gastro-esophageal reflux disease (GERD). However, the different types of total fundoplication lead to heterogeneous outcomes. In 1972, we standardized a personally modified Nissen-Rossetti which includes the routine use of intraoperative manometry and endoscopy to calibrate and check the wrap. This paper aims to describe the technical details and the outcomes of this procedure adopted since 35 years without modifications as a unique procedure to treat all patients with GERD. METHODS: The study population consisted of all patients affected by GERD who underwent laparoscopic Nissen-Rossetti fundoplication by a single surgeon with one year minimum of follow-up. Technical details of the procedure and data from clinical and instrumental follow-up are described. RESULTS: Clinical follow-up (median 83 months; range 1-13 years) was achieved in 96% of the patients. Ninety-two percent of the patients were satisfied of the procedure and would undergo the same operation. At 12 months, lower esophageal sphincter pressure increased to 27+/-5 mmHg (P<0.05), 24-h monitoring became negative in 91.6% of the patients (P<0.05). DeMeester score was 4.1+/-0.7 (P <0.05). CONCLUSIONS: The laparoscopic Nissen-Rossetti fundoplication with the routine use of the intraoperative manometry and endoscopy, adopted as a unique procedure to treat all the patients with GERD, achieved long-term patient satisfaction in the great majority of the cases. Meticulous preoperative investigation together with a correct surgical technique are needed in securing these results.
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Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Anal ultrasound is helpful in assessing organic anorectal lesions, but its role in functional disease is still questionable. The purpose of the present study is to assess anal-vaginal-dynamic perineal ultrasonographic findings in patients with obstructed defecation (OD) and healthy controls. MATERIALS AND METHODS: Ninety-two consecutive patients (77 women; mean age 51 years; range 21-71) with symptoms of OD were retrospectively evaluated. All patients underwent digital exploration, endoanal and endovaginal ultrasound (US) with rotating probe. Forty-one patients underwent dynamic perineal US with linear probe. Anal manometry and defaecography were performed in 73 and 43 patients, respectively. Ultrasonographic findings of 92 patients with symptoms of OD were compared to 22 healthy controls. Anismus was defined on US when the difference in millimetres between the distance of the inner edge of the puborectalis muscle posteriorly and the probe at rest and on straining was less then 5 mm. Sensitivity and specificity were calculated by assuming defaecography as the gold standard for intussusception and rectocele and proctoscopy for rectal internal mucosal prolapse. Since no gold standard for the diagnosis of anismus was available in the literature, the agreement between anal US and all other diagnostic procedures was evaluated. RESULTS: The incidence of anismus resulted significantly higher (P < 0.05) in OD patients than healthy controls on anal (48 vs 22%), vaginal (44 vs 21%), and dynamic perineal US (53 vs 22%). A significantly higher incidence of rectal internal mucosal prolapse was observed in OD patients when compared to healthy controls on both anal (61.9 vs 13.6%, P < 0.0001) and dynamic perineal US (51.2 vs.9% P = 0.001). For the diagnosis of rectal internal mucosal prolapse, anal US had a 100% sensitivity and specificity. For diagnosis of rectal intussusception, anal US had an 83.3% sensitivity and 100% specificity and perineal US had a 66.6% sensitivity and 100% specificity. In the diagnosis of anismus, anal ultrasonography resulted in agreement with perineal and vaginal US, manometry, defaecography, and digital exam (P < 0.05). Other lesions detected by US in patients with OD include solitary rectal ulcer, rectocele and enterocele. Damage of internal and/or external sphincter was diagnosed at anal US in 19/92 (20%) patients, all continent and with normal manometric values. CONCLUSION: Anal, vaginal and dynamic perineal ultrasonography can diagnose or confirm many of the abnormalities seen in patients with OD. The value of the information obtained by this non-invasive test and its role in the diagnostic algorithm of OD is yet to be defined.
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Canal Anal/diagnóstico por imagem , Constipação Intestinal/diagnóstico por imagem , Defecação , Endossonografia/métodos , Intussuscepção/diagnóstico por imagem , Doenças Retais/diagnóstico por imagem , Prolapso Retal/diagnóstico por imagem , Vagina/diagnóstico por imagem , Adulto , Idoso , Canal Anal/fisiopatologia , Constipação Intestinal/fisiopatologia , Defecografia , Feminino , Humanos , Hipertrofia , Intussuscepção/fisiopatologia , Masculino , Manometria , Pessoa de Meia-Idade , Relaxamento Muscular , Valor Preditivo dos Testes , Pressão , Doenças Retais/fisiopatologia , Prolapso Retal/fisiopatologia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Laparoscopic fundoplication for gastroesophageal reflux disease (GERD) and hiatal hernia has been validated worldwide in the past decade. However, hiatal hernia recurrence still represents the most frequent long-term complication after primary repair. Different techniques for hiatal closure have been recommended, but the problem remains unsolved. The authors theorized that ultrastructural alterations may be implicated in hiatal hernia. Thus, this study was undertaken to investigate the presence of these alterations in patients with or without hiatal hernia. METHODS: Samples from Laimer-Bertelli connective membrane and muscular crura at the esophageal hiatus were collected from 19 patients with GERD and hiatal hernia (HH group), and from 7 patients without hiatal hernia enrolled as the control group (NHH group). Specimens were processed and analyzed by transmission electron microscopy. RESULTS: Muscle and connective samples from the NHH group did not present any ultrastructural alteration that could be detected by transmission electron microscopy. Similarly, connective samples from the HH group showed no ultrastructural alterations. In contrast, all muscle samples from the HH group exhibited sarcolemmal alterations, subsarcolemmal vacuolar degeneration, extended disruption of sarcotubular complexes, increased intermyofibrillar spaces, and sarcomere splitting. CONCLUSION: The evidence of ultrastructural alterations in all the patients in the HH group raises the suspicion that the long-term outcomes of antireflux surgery depend not only on the surgical technique, but also on the underlying muscular diaphragmatic illness.
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Diafragma/ultraestrutura , Hérnia Hiatal/patologia , Adulto , Junção Esofagogástrica/ultraestrutura , Feminino , Refluxo Gastroesofágico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valores de ReferênciaRESUMO
The study aims to evaluate, at medium- and long-term follow-up, the efficacy of Nissen-Rossetti fundoplication to control both gastro-oesophageal and pharyngeal reflux, detected with the use of 24-hour pH-multi-channel intra-luminal impedance. Of the 1000 patients who underwent Nissen-Rossetti fundoplication in our Division since 1972, the laparoscopic approach was adopted in 428 consecutive patients with gastro-oesophageal reflux disease. The study population consisted of patients from this group with one-year follow-up. Thirty-one patients had undergone pre-operative evaluation with pH-multi-channel intra-luminal impedance and were classified on the basis of clinical assessment into gastro-oesophageal, or pharyngeal reflux disease group. Pre-operative data are reported. Comparison between gastro-oesophageal reflux and pharyngeal reflux are extrapolated from pH-multi-channel intra-luminal impedance. No conversion to open surgery and no mortality occurred. A major complication occurred in 4 patients (1.1%) and led to a re-intervention in 3. An excellent outcome was reported in 92.9% of the patients at mean follow-up of 83.2 +/- 7 months. Instrumental outcomes are discussed. In conclusion, Nissen-Rossetti fundoplication provides excellent protection from gastro-oesophgeal and pharyngeal reflux. The use of pH-multi-channel intra-luminal impedance is suitable in patients candidate to anti-reflux surgery to detect non-acid reflux.
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Fundoplicatura/instrumentação , Refluxo Gastroesofágico/fisiopatologia , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Faringe/fisiopatologia , Cuidados Pós-Operatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Duodenoscopia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-IdadeAssuntos
Carcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Laparoscopia , Cuidados Paliativos/métodos , Idoso , Carcinoma/tratamento farmacológico , Carcinoma/radioterapia , Quimioterapia Adjuvante , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante , Estudos RetrospectivosRESUMO
PURPOSE: Pneumatic balloon dilation has been shown to be effective in the management of chronic anal fissure, but its effect on the anal sphincter has not been fully investigated. The aim of this study was to evaluate prospectively the clinical, anatomic, and functional pattern in a group of patients treated by pneumatic balloon dilation. METHODS: A series of 33 consecutive patients suffering from chronic anal fissure underwent pneumatic balloon dilation. Anal manometry and ultrasonography were performed prior to and 6 to 12 months after the treatment. Manometry was accomplished by means of an endoanal 40-mm balloon inflated with a pressure of 1.4 atmospheres that was left in situ for six minutes under local anesthesia. All patients were interviewed daily for three days after surgery and then clinically evaluated between the third and fifth postoperative weeks. Most patients were interviewed after 25.7 +/- 8.4 months (mean +/- standard deviation). Anal incontinence was evaluated by means of a validated score of 1 to 6. RESULTS: The chronic anal fissure healed between the third and fifth weeks in 31 patients (94 percent), who became asymptomatic 2.5 +/- 1.4 days after pneumatic balloon dilation. None of them reported anal pain two years after the treatment (n = 20). The first post-pneumatic balloon dilation defecation was painless in 27 cases (82 percent). Two multiparous females (6 percent of the patients) complained of minor transient anal incontinence (score, 3). Chronic anal fissure recurred in one case (3 percent) after treatment. At manometry, the preoperative anal resting pressure decreased from 91 +/- 11.2 to 70.5 +/- 5.6 and to 78 +/- 5.7 mmHg, 6 and 12 months after pneumatic balloon dilation, respectively (P < 0.0001). Anal ultrasonography did not show any significant sphincter defect. CONCLUSIONS: Pneumatic balloon dilation seems to be an effective, safe, easy procedure that decreases anal resting pressure without endosonographically detectable significant sphincter damage.
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Cateterismo/métodos , Fissura Anal/terapia , Adulto , Canal Anal/patologia , Doença Crônica , Endossonografia , Incontinência Fecal , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Paridade , Estudos Prospectivos , Resultado do TratamentoRESUMO
Images acquired of Saturn's rings and small moons by the Cassini Imaging Science Subsystem (ISS) during the first 9 months of Cassini operations at Saturn have produced many new findings. These include new saturnian moons; refined orbits of new and previously known moons; narrow diffuse rings in the F-ring region and embedded in gaps within the main rings; exceptionally fine-scale ring structure in moderate- to high-optical depth regions; new estimates for the masses of ring-region moons, as well as ring particle properties in the Cassini division, derived from the analysis of linear density waves; ring particle albedos in select ring regions; and never-before-seen phenomena within the rings.