Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up.

BACKGROUND: To assess whether sacral nerve stimulation (SNS) is an effective treatment for severe fecal incontinence (FI) after radiotherapy (RT)/chemoRT (CRT) in combination with pelvic surgery. METHODS: A multicenter study was conducted on patients with FI that developed after multimodal therapy for pelvic tumors and was refractory to non-operative management, who were treated with SNS between November 2009 and November 2012. Data were prospectively collected and retrospectively analyzed. Cleveland Clinic FI score (CCFIS), FI episodes per week, FI Quality of Life (FIQoL), anorectal manometry and pudendal nerve terminal motor latency were evaluated before and after SNS. RESULTS: Eleven patients (seven females, mean age 67.3 ± 4.8 years) were evaluated in the study period. Multimodal treatments included surgery and CRT (four rectal, two cervical and one prostate cancers), surgery and RT (one cervical and two endometrial cancers) and CRT (one anal cancer). The mean radiation dose was 5.3 Gy, and mean interval between the end of RT and onset of FI was 43.7 ± 23 months. Before SNS, the mean CCFIS and the mean number of FI episodes per week were 15.7 ± 2.8 and 12.3 ± 4.2, respectively. At 12-month follow-up, mean CCFIS improved to 3.6 ± 1.8 (p = 0.003) and the mean number of FI episodes decreased to 2.0 ± 1.9 per week (p = 0.003). These results persisted at 24-month follow-up. Significant improvement was also observed for each of the four domains of FIQoL at 12- and 24-month follow-up. Anorectal manometry values did not change significantly at follow-up. CONCLUSIONS: SNS is feasible and may be an effective therapeutic option for FI after multimodal treatment of pelvic malignancies.

Numerical model for RF capacitive regional deep hyperthermia in pelvic tumors.

A numerical model based on Finite Element Method (FEM) for the prediction of power density distribution and temperature during RF-capacitive hyperthermia treatment has been presented in the paper and the results are discussed. In particular the models are related to the treatment of pelvic tumors where it is more difficult to localize and focus heat in deep regions. The geometrical and physical model of the patient is reconstructed with a segmentation procedure by means of dedicated software. The geometrical meshed model has been used as input for the solution of coupled electromagnetic and thermal problems. A deep analysis of different configurations derived from specific scientific literature of the last years has been presented in the paper and discussed. The results obtained by FEM analyses have demonstrated the suitability of this method for the prediction of power and temperature distribution during RF capacitive hyperthermia and that the calculation procedure is an efficient mean to evaluate the efficacy of the heating system.

[Clinical study of the treatment of endometriosis with promoting blood circulation and stasis removing method].

The treatment of endometriosis by blood circulation promoting and stasis removing method is based on the experience carried in the "Ji Yin Gang Mu" and the fact that this disease belongs to the category of pelvic stagnant blood. The study group consisted of 53 women with endometriosis. They were manifested as dysmenorrhea, menoxenia, ovarian chocolate cysts and enlarged uterus. The control group consisted of ten women with normal regular menstrual cycle. This article deals with the method of using the hemodynamic index of uterus arterial blood flow. After treatment the blood flow amount of uterus arteries of 53 cases (study group) obviously decreased and their uterus arterial blood flow speed reduced markedly as compared with pretreatment status, (P < 0.001 and P < 0.01) respectively, while pre-treatment group was significantly higher than that of control group (P < 0.001). After medical treatment for 3.5 months, symptoms such as dysmenorrhea and menstrual disorder basically disappeared. 22 ovarian chocloate cysts became smaller and 16 disappeared. The pregnancy rate was 45%. The data of this study suggest that the mechanism of treatment of promoting blood circulation to remove stasis might be closely related to the regulation of physico-chemical characteristics of blood and the adjustment of the function of hemodynamics.

[Clinical results of radiofrequency capacitive hyperthermia in deep-seated tumors].

The advantages of deep radiofrequency (RF) capacitive heating are its applicability to various anatomical sites and negligible systemic effects. The disadvantages are on the other hand, that its primary usefulness is limited to patients with thin subcutaneous fat and with large or hypovascular tumors. Clinical benefits of RF hyperthermia combined with radiotherapy are strongly suggested for deep-seated tumors. Intratumor low density areas on post-treatment CT and histopathological examinations are considered important parameters to assess the tumor response to thermoradiotherapy.