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1.
Surg Innov ; 20(6): 614-24, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23404204

RESUMO

BACKGROUND: Sacral neuromodulation (SN) is an emerging treatment for constipation. This review evaluates the mechanism of action, techniques, efficacy, and adverse effects of SN in the management of constipation. METHODS: Electronic searches for studies describing the use of SN were performed in PubMed, MEDLINE and Embase. Abstracts were reviewed and full text copies of all relevant articles obtained. RESULTS: Fifty-nine results were obtained on the initial searches. Ten studies discussed the results of SN in patients with constipation. A total of 225 temporary neuromodulations and 125 permanent implants were performed. Bowel diaries showed improvement in assessment criteria in more than 50% of patients on temporary neuromodulation and the results were maintained in approximately 90% of patients who underwent permanent implantation over medium to long-term follow-up. The rate of adverse effects was high, but the majority of them were related to electrode position. Improvements in transit studies and anorectal physiology after neuromodulation were noted in some studies. The recognized limitations included a lack of randomized studies and an inability to perform meta-analysis. CONCLUSION: Sacral neuromodulation may be an effective treatment in selected patients with constipation and should be a part of the management repertoire. Improvement in defecatory frequency with temporary wire placement is a good predictor of subsequent response following permanent implant. Further research into predictive factors for success would improve patient selection.


Assuntos
Constipação Intestinal/terapia , Terapia por Estimulação Elétrica/métodos , Procedimentos Neurocirúrgicos/métodos , Sacro/cirurgia , Raízes Nervosas Espinhais/cirurgia , Constipação Intestinal/cirurgia , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/instrumentação
3.
Colorectal Dis ; 12(10 Online): e190-9, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19895595

RESUMO

AIM: Patients suffering from advanced colorectal cancer can experience unintended weight loss and/or treatment-induced gastrointestinal toxicity. Based on current evidence, the routine use of parenteral nutrition (PN) for patients with colorectal cancer is not recommended. This study evaluates the effect of PN supplementation on body composition, quality of life (QoL), chemotherapy-associated side effects and survival in patients with advanced colorectal cancer. METHOD: Eighty-two patients with advanced colorectal cancer receiving a palliative chemotherapy were prospectively randomized to either oral enteral nutrition supplement (PN-) or oral enteral nutrition supplement plus supplemental PN (PN+). Every 6 weeks body weight, body mass index (BMI), chemotherapy-associated side effects and caloric intake were assessed, haemoglobin and serum albumin were measured. Body composition was assessed by body impedance analysis, and QoL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQC30 questionnaire. RESULTS: No differences were evident at baseline between the groups for age, sex, diagnosis, weight, BMI or QoL. A difference in BMI was observed by week 36, whereas differences of the mean body cell mass could be observed from week 6, albumin dropped significantly in the PN- group in week 36 and QoL showed significant differences from week 18. Chemotherapy-associated side effects were higher in PN-. The survival rate was significantly greater in the PN+ group. CONCLUSION: A supplementation with PN slows weight loss, stabilizes body-composition and improves QoL in patients with advanced colorectal cancer. Furthermore, it can reduce chemotherapy-related side effects.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma/dietoterapia , Neoplasias Colorretais/dietoterapia , Desnutrição/dietoterapia , Cuidados Paliativos , Nutrição Parenteral , Idoso , Análise de Variância , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Composição Corporal , Peso Corporal , Carcinoma/tratamento farmacológico , Carcinoma/fisiopatologia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/fisiopatologia , Ingestão de Energia , Metabolismo Energético , Feminino , Fluoruracila/administração & dosagem , Hemoglobinas/metabolismo , Humanos , Estimativa de Kaplan-Meier , Leucovorina/administração & dosagem , Masculino , Desnutrição/prevenção & controle , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Albumina Sérica/metabolismo , Análise de Sobrevida
4.
Praxis (Bern 1994) ; 96(7): 249-55, 2007 Feb 14.
Artigo em Alemão | MEDLINE | ID: mdl-17361911

RESUMO

HAEMORRHOIDAL DISEASE: Stage orientated treatment of haemorrhoidal disease using conservative and operative measures provides high healing rates with low complication- and recurrence rates. ANAL FISSURE: Muscle relaxing ointments (Nitrates, Ca-channel-blocker) are the treatment of choice for chronic anal fissure. In cases of insufficiency fissurectomy provides high healing rates. ABSCESS AND ANAL FISTULA: Anal fistulae are treated with respect of their involvement of the anal sphincters. Distal fistulae are completely excised reaching high healing rates, proximal fistulae are treated using local flap procedures with healing rates reaching 50 to 80%. ANAL INCONTINENCE: Treatment of anal incontinence is depending on the severity and on the etiology of the disease. The following procedures are used: conservative: improving consistency, physical exercises, electrostimulation Biofeedback-Training surgical: Sphincterreconstruction, Pre-anal Repair, Post-anal Repair, Total Pelvic Floor Repair, Dynamic Graciloplasty, Artificial Anal Sphincter, Sacralnervestimulation, Stoma


Assuntos
Doenças do Ânus/terapia , Doenças Retais/terapia , Doenças do Ânus/diagnóstico , Doenças do Ânus/etiologia , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Doenças Retais/diagnóstico , Doenças Retais/etiologia
5.
Zentralbl Chir ; 124(9): 784-95, 1999.
Artigo em Alemão | MEDLINE | ID: mdl-10544484

RESUMO

In outlet constipation an exact diagnostic evaluation is always necessary because of the different etiologies, multiple combinations in primary and secondary lesions and the number of therapeutic alternatives. Basic diagnostics start with the very important, structured evaluation of the patient's history, colorectal examination including inspection, palpation, procto-, recto-, sigmoidoscopy and anorectal manometry. Depending on the results of this primary evaluation the following methods are indicated: neurophysiologic evaluation (basic neurological examination, EMG, PNTML), defecography ev. including colon contrast enema and gastrointestinal transit time studies. If the complete problem could not be ruled out till that point, the following examinations might be helpful: dynamic pelvic floor MRI, anorectal endosonography, rectal motility studies, fecoflowmetry, colonoscopy, urological und gynecological examinations.


Assuntos
Constipação Intestinal/etiologia , Obstrução Intestinal/diagnóstico , Diafragma da Pelve/fisiopatologia , Doenças Retais/diagnóstico , Adulto , Doença Crônica , Constipação Intestinal/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Masculino , Doenças Retais/etiologia , Doenças Retais/fisiopatologia
6.
Roum Arch Microbiol Immunol ; 57(3-4): 231-42, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-11845435

RESUMO

Based on the finding that reactive oxygen species (ROS) play important roles in mediating proinflammatory cytokine production (e.g. TNF alpha) and that many plant extracts contain substances with antioxidant properties, we examined the antiinflammatory action of a green barley extract, commercially available as "Natural SOD". The results obtained in this study demonstrate that the antiinflammatory properties of "Natural SOD" due to its micromolecular substances, able to scavenge ROS and to down-regulate TNF alpha production, main inflammation mediators produced by specialised cells from peripheral blood (PB) and synovial fluid (SF) of patients with rheumatoid arthritis (RA). We prepared and tested a purified green barley extract (PE) containing micromolecular substances under 1 kDa, able to inhibit TNF alpha releasing--measured by an bioassay--from LPS stimulated human mononuclear cells (MNC) isolated both from PB and SF of RA patients. Luminol-dependent chemiluminescence has been used to measure the scavenging activity of PE on ROS releasing from activated neutrophils isolated from PB of RA patients. PE, containing high concentrations of substances with antioxidant and antiinflammatory properties, could be a more efficient natural drug for human use than "Natural SOD" in the treatment of RA patients.


Assuntos
Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Artrite Reumatoide/imunologia , Hordeum , Leucócitos Mononucleares/efeitos dos fármacos , Neutrófilos/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Artrite Reumatoide/sangue , Células Cultivadas , Regulação para Baixo , Humanos , Leucócitos Mononucleares/metabolismo , Lipopolissacarídeos , Neutrófilos/metabolismo , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Espécies Reativas de Oxigênio/análise , Líquido Sinovial/citologia , Líquido Sinovial/imunologia , Fator de Necrose Tumoral alfa/análise
7.
Roum Arch Microbiol Immunol ; 55(4): 285-94, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-9558963

RESUMO

A green barley extract commercialized as an antiinflammatory product under the name of "Natural SOD" was fractionated based on the molecular weights principle. Knowing that the TNF alpha cytokine plays an important role in inducing inflammatory phenomena, by the use of two determination methods (ELISA and cytotoxicity), the fractions obtained were analysed for their capacity to modulate TNF alpha production/release by an LPS-activated human monocytes line (THP-1). The results pointed to the existence of 3 groups of substances (fractions 3, 4 and 9) apt to modulate TNF alpha production, fraction 4 being the most active. Of the TNF alpha determination methods, ELISA proved to be more sensitive as it detected not only free TNF alpha identified also by the cytotoxicity test, but also TNF alpha complexed with its soluble receptors. The presence of these substances in Natural SOD, fractions with modulatory action upon TNF alpha production, might partly account for the clinical efficiency of this product in the treatment of inflammatory affections reported in humans.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Hordeum , Monócitos/metabolismo , Superóxido Dismutase/farmacologia , Fator de Necrose Tumoral alfa/biossíntese , Linhagem Celular , Humanos , Lipopolissacarídeos/farmacologia , Extratos Vegetais/farmacologia
8.
Z Kinderchir ; 44(5): 318-20, 1989 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-2588814

RESUMO

Ten children of six to sixteen years with anal incontinence following anal atresia were treated with a conservative intensive continence training programme for a period of 6 to 18 months. The continence efficiency distinctly improved by an optic and acoustic biofeedback conditioning, transcutaneous electrostimulation of the pelvic muscles, by physical examinations and a sensibility training, as well as by contraction exercises. Not only the partial continence ability with low atresia but also the incontinence with high anal atresia could be improved to a level of continence, especially short-time continence. The essential success is based on an improvement of the strength and duration of the muscle contraction, of the sensible perception and of the nerval coordination of the pelvic muscles. After two weeks of therapy, 90% of the possible maximum increase had already been achieved. Thus, an evaluation of the training success was possible. This continence training programme proved an ideal supplement to surgical therapy. Even if other methods of therapy are exhausted, continence training is indicated for the improvement of anal sphincter function.


Assuntos
Anus Imperfurado/cirurgia , Incontinência Fecal/reabilitação , Complicações Pós-Operatórias/reabilitação , Treinamento no Uso de Banheiro , Adolescente , Biorretroalimentação Psicológica , Criança , Terapia Combinada , Seguimentos , Humanos , Modalidades de Fisioterapia
9.
Artigo em Alemão | MEDLINE | ID: mdl-2577679

RESUMO

Eleven children with anal incontinence following a pull-through operation for anorectal agenesis (4 low, 7 high anomalies) were treated with a conservative continence training program (optic/acoustic biofeedback, transcutaneous electrical stimulation, physical therapy, contraction exercises and sensibility training). All patients with one exception showed subjective and objective improvement of continence. Sphincter contraction increased by 80% in high and by 40% in low anomalies. For a short time electrostimulation provided an improvement of up to 20% in sphincter pressure. One additional success was improved coordination. Beside surgical therapy and other methods continence training is always indicated.


Assuntos
Anus Imperfurado/reabilitação , Biorretroalimentação Psicológica/métodos , Incontinência Fecal/reabilitação , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino
10.
Transplantation ; 36(5): 486-90, 1983 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-6356512

RESUMO

Three solutions, hyperosmolar citrate, modified Collins' C2, and Sacks' II solutions were compared as media for cold storage preservation (arterial infusion and subsequent cold storage in the same medium at 0-4 C) of the rat pancreas with a view to preservation of endocrine function. Pancreatic isotransplantation was performed following cold ischemic intervals of 0, 24, 30, and 36 hr, into streptozotocin-induced diabetic recipients. Results were assessed by normoglycemic survival and insulin response, together with K values following i.v. glucose tolerance tests at 3 months postoperatively; 24-hr preservation was achieved with equal success using modified Collins' C2 solution or hyperosmolar citrate-but not with Sacks' II solution. Preservation for 30 hr was consistently successful using modified Collins C2 solution only, but the period could not be extended with success to 36 hr. Hypoglycemia and hyperinsulinemia occurred 24 hr postoperatively in the majority of animals receiving grafts stored in Sacks' II solution, but to a much lesser extent using modified Collins' C2 and hyperosmolar citrate. This was also temporarily seen in grafts stored for 36 hr in modified Collins C2 solution. At 3 months postoperatively after 30 hr cold ischemia, i.v. glucose tolerance tests showed the hyperosmolar citrate cold-stored grafts had lower K values and significantly reduced insulin responses compared with grafts stored in modified Collins' C2 solution. The modified Collins' C2 solution proved to be the most effective of the three solutions tested.


Assuntos
Ilhotas Pancreáticas/fisiologia , Transplante de Pâncreas , Preservação de Tecido/métodos , Animais , Crioprotetores/farmacologia , Avaliação Pré-Clínica de Medicamentos , Congelamento , Isquemia/fisiopatologia , Masculino , Pâncreas/irrigação sanguínea , Pâncreas/efeitos dos fármacos , Ratos , Ratos Endogâmicos , Fatores de Tempo , Transplante Isogênico
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