ABSTRACT
BACKGROUND: Transanal endoscopic microsurgery (TEM) has become the treatment of choice for benign rectal lesions and early rectal cancer (T1). The size classification of rectal polyps is controversial. Some articles define giant rectal lesions as those larger than 5 cm, which present a significantly increased risk of complications. The aim of this study was to evaluate the feasibility of TEM in these lesions. METHODS: An observational descriptive study with prospective data collection evaluating the feasibility of TEM in large rectal adenomas was performed between June 2004 and September 2018. Patients were assigned to one of the three groups according to size: < 5 cm, very large (5-7.9 cm) and ultra-large (≥ 8 cm). Descriptive and comparative analyses between groups were performed. RESULTS: TEM was indicated in 761 patients. Five hundred and seven patients (66.6%) with adenoma in the preoperative biopsy were included in the study. Three hundred and nine out of 507 (60.9%) tumors < 5 cm, 162/507 (32%) very large tumors (5-7.9 cm) and 36/507 (7.1%) ultra-large tumors (≥ 8 cm) were reviewed. Morbidity increased with tumor size: 17.5% in tumors < 5 cm, 26.5% in those 5-7.9 cm, and 36.1% in those > 8 cm. Peritoneal perforation, fragmentation, free margins and stenosis were also more common in very large and ultra-large tumors (p < 0.001). There were no statistical differences between the groups in the definitive pathology (p = 0.38). CONCLUSIONS: TEM in these large tumors is associated with higher rates of morbidity, peritoneal perforation, free margins and stenosis. Although these tumors do not require total mesorectal excision and are eligible for TEM, the surgery must be carried out by experienced surgeons.
Subject(s)
Intestinal Polyps/pathology , Intestinal Polyps/surgery , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Transanal Endoscopic Microsurgery/statistics & numerical data , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Rectum/pathology , Rectum/surgery , Treatment Outcome , Tumor BurdenABSTRACT
The current diagnosis of Parkinson's disease (PD) is based on a subjective assessment by the specialist. The monitoring of the tremor that presents in the hand index fingers in a patient with Parkinson's is one of the most important parameters to diagnose the evolution of the disease in an objective manner. This research analyze the tremor in the hand index fingers of patients with PD with medication and without medication. A sensor based in a triaxial accelerometer was used to acquire the data produced by the acceleration changes of parkinsonian tremor in the case of three activities: postural tremor, action tremor and rest tremor. Acquired data were processed in Matlab; the data were filtered and the spectral power density (PSD) was estimated with the Burg periodogram. It has been verified that the system presented in this article can accurately detect the parkinsonian tremors of the patients evaluated, additionally has been found that with the medication the tremors do not disappear completely, these remained with the same frequencies of PD but with a very small amplitude.
Subject(s)
Parkinson Disease , Tremor , Acceleration , Fingers , HumansABSTRACT
Heterosexual couples of individuals infected by HIV represent a group of high risk of virus infection. We have investigated the presence of fragments of the HIV genome with a new nucleic acid amplification technique (PCR or polymerase chain reaction) in lymphocytes from 33 seronegative couples with anti-HIV antibodies, most of which were heroin addicts. 12 of the 33 couples (36%) had positive PCR for a gag HIV amplimer in the absence of antibodies. 4 of them (12%) also showed reactivity for sequences from an env amplimer. A control group of 7 patients with AIDS and 4 seropositive couples showed reactivity to gag and env in all. It is concluded that silent HIV infection may frequently develop in heterosexual couples of infected individuals.