Rehabilitation of fecal incontinence: what is the influence of anal sphincter lesions?

BACKGROUND: The aim of this study was to evaluate the results of rehabilitative treatment of incontinent patients with anal sphincter lesions in order to verify whether these lesions influence the outcome of rehabilitation. METHODS: Between January 2008 and June 2011, 48 patients [36 women, age range 51-77 years; 12 men, age range 57-70 years] affected by fecal incontinence were included in the study. After a preliminary clinical evaluation, including the Fecal Incontinence Severity Index (FISI) score, all patients were studied by means of endoanal ultrasound and anorectal manometry. Two patients groups were identified: Group 1 comprised 27 patients with sphincter lesions and Group 2 had 21 patients without sphincter lesions. All 48 underwent a multimodal rehabilitation program. At the end of the rehabilitation program, all patients were reassessed by means of clinical evaluation and anorectal manometry and their data were analyzed. RESULTS: Although we obtained an overall significantly lower FISI score in all patients after rehabilitation (p < 0.001) when compared with pre-treatment values, our study revealed that patients with sphincter lesions had a significantly worse post-rehabilitative FISI score (p < 0.003) when compared with those patients with intact anal sphincters and that there is a linear relationship between post-rehabilitative FISI scores and severity of sphincter lesions (ρ s 0.69). CONCLUSIONS: These data suggest that rehabilitation may be less effective in patients affected by sphincter defects.

Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma.

BACKGROUND: Low rectal cancers situated less than 5 cm from the anal margin are still usually treated with abdomino-perineal excision (APE). Our aim is to compare the quality of life (QOL) of five-year survivors treated for low or very low rectal cancer with an advanced/complex coloanal procedure with the QOL of patients submitted to a standard APE with a definitive abdominal stoma. METHODS: Sixty-two patients, operated on radically for low or very low rectal cancer, who came for their fifth year follow-up visit and were free from cancer, were studied. Thirty patients (group 1) had an APE with permanent abdominal stoma. Thirty-two patients (group 2) had undergone a radical advanced and complex procedure to avoid the abdominal stoma. The patients received the European Organisation for the Research and Treatment of Cancer (EORTC) QOL-30 generic and the CR38 colorectal cancer QOL questionnaires with the recommendation to return the questionnaire to the hospital. The Mann-Whitney U-test and chi (2) Fisher test were employed for statistical analysis. RESULTS: All questionnaires were returned. Patients without a terminal abdominal stoma had a better score in six categories of the QOL 30 and in two categories of the CR38. No differences were observed in the other variables examined. CONCLUSIONS: After five years, cancer-free patients operated on for low or very low rectal cancer have a better QOL if a definitive terminal abdominal stoma was avoided.

Key factors for best control of the systemic leakage during hyperthermic isolated limb perfusion (HILP) in ECC. A critical synthesis of our experience.

The L-PAM-ILP procedures under true hyperthermal regime (41.5-41.8 degrees C) require both close control of the physical parameters of the treatment (temperatures profiles and time duration, artero-venous pressure, perfusate flow rate) and medical rationale (drug, dosage, fractioning, timing). All the above essential procedures must be supported by rigorous methodology, reliable operation of the medical devices and apparatus and real-time monitoring of the treatment parameters. Real-time monitoring is essential for proper trimming and modulation of the parameters during treatment. This paper delineates the technical improvements that we have implemented for drug leakage monitoring and control in the systemic circulation aimed at improving the therapeutic efficacy and at reducing the occurrence of unexpected complications.

Optimal procedure for thermal delivery in hyperthermic/chemotherapeutic treatments in the isolated perfusion of the the limbs.

Isolated locoregional limbs perfusion treatments of various malignancies have demonstrated synergistic efficacy when hyperthermia was associated with chemotherapy. This paper delineates the criteria, the technical provisions and the specifications that have been improved and implemented at our Institution. It is believed that, following the indications offered in this paper, several, apparently still unsolved problems of treatment planning and implementation will be overcome, offering closely controlled and highly reproducible procedures with a significant progress in the feasibility of reliable comparisons of the results among different research centres and in the reduction of the occurrence of controversial results or unexpected complications.

Treatment of locally advanced hepatocellular carcinoma by hepatic intra-artery chemotherapy: a pilot study.

BACKGROUND: Hepatocarcinoma is one of the most common malignant tumours world-wide with poor prognosis. Treatment of locally advanced hepatocarcinoma is still controversial. Transcatheter arterial (chemo-)embolisation of hepatocarcinoma are widely used methods but some aspects regarding their use and usefulness have not yet been clarified. Systemic remedies have not yet been proven to affect patient survival. AIMS: To determine if intra-arterial chemotherapy with 5-flurouracil and folinic acid in locally advanced hepatocarcinoma is a viable alternative to existing therapies. PATIENTS: Twenty-four inoperable consecutive patients with locally advanced hepatocarcinoma were enrolled. They all underwent intra-arterial chemotherapy via a surgically implanted port-a-cath, and folinic acid (100 mg/m2) and 5-flurouracil (up to 550 mg/m2) were administered with a 1-week or a 2-week schedule. RESULTS: Nineteen patients completed the study: 2 showed a complete positive response, 11 a partial response, 6 stable disease, while 4 showed a disease progression. Median survival time was 19 (range 4-85) months. Child A patients showed a significant longer survival. CONCLUSIONS: Intra-arterial chemotherapy using folinic acid and 5-flurouracil may be useful in the treatment of locally advanced hepatocarcinoma in cirrhotic patients even in the presence of thrombosis. This treatment could be also useful in comparing transarterial chemoembolisation to a curative treatment.

[Biofragmentable anastomosis ring (BAR) in surgery of the digestive system]. / Le anastomosi con l'anello bioframmentabile (BAR) in chirurgia dell'apparato digerente.

Twenty-six patients submitted to surgery using BAR in intestinal anastomosis have been studied. The results were compared with data of the literature concerning this device of anastomosis and about mechanical staplers and manual suture. The following data were taken into consideration: type of operation, type of anastomosis, average time of execution, complications, days of postoperative canalization and feeding, costs of three anastomosis types. Postoperative complications rate were 23% with a postoperative death rate of 7.6%. There was only one intraoperative complication during a colorectal anastomosis. The average time, to package an intestinal anastomosis using BAR, was 69.9 minutes. The average type of postoperative canalization was 3.7 days and average period in hospital was 10.3 days. The costs of manual suture, of mechanical staplers and of BAR are respectively L. 50,000, 1,340,000 and 583,000. BAR complications are similar to the other techniques; this study shows a reduction of operative time, postoperative canalization and period in hospital, with a consequent decreasing of global costs. The execution of intestinal anastomosis using BAR is easier then the other techniques, the learning time is least and the procedure is uniform. The introduction of this technique in the common operative practice together with manual suture and stapler is stressed.

[Umbilical endometriosis: report of a case and review of the literature]. / Endometriosi ombelicale: presentazione di un caso e revisione della letteratura.

The authors present a clinical of umbilical endometriosis in a young woman. This patient never underwent any operation or diagnostic abdominal procedures. The case is very interesting because of problems concerning differential diagnosis with other umbilical and periumbilical diseases and pathogenetic theories. In this study the authors suggest a hypothesis to explain the localization of ectopic endometrium in this site. We review the literature, with some comments on therapeutic options; finally we compare the medical and the surgical approach and we suggest an advisable therapy.