[Digital videoproctoscopy: a new diagnostic test in proctology]. / Nuova metodica diagnost ca in proctologia. La videoproctoscopia digitale.

The proctological examination is usually simple, it can be done even without specific preparation. It is completed by proctoscopy, enabling the surgeon to confirm a clinical suspicion and make a differential diagnosis. Proctoscopy, however, may present a number of difficulties: the embarrassing position (both in the Sims and in the genupectural position; the operator is very close to the perineum of the patient); it is not possible to provide visual evidence of the pathology; there are no data archives; no comparison of two examinations can be made after a certain period of time (e.g. to test the validity of the therapy adopted). For these reasons patients are often invited to undergo a video-colonoscopy, which also presents limitations such as low patient compliance, difficult medium- and short-term repetition; ineffective discrimination of anal canal diseases, and, last but not least, the cost, which is substantially higher than that of anoscopy. The Author presents the results of experimentation with digital Videoproctoscopye (Proctomedia s.r.l., Rome, Italy), performed with the aid of a bar on which is situated a separate-head digital camera, a solid light source with an optical fibre guide, and an insufflation channel. The top of the bar can be attached with a bayonet coupling to a disposable rigid proctoscope. The tool is connected to a high-resolution LCD monitor and to a high-definition digital tape with an ethernet card, allowing the surgeon to record images on an SD card. Three hundred and seventy-six digital videoproctoscopies were carried out, enabling the author to make a correct diagnosis of the anal, perianal and rectal pathologies.

[Fecal incontinence: role of anal sphincter rehabilitation]. / Incontinenza fecale: ruolo della riabilitazione.

Fecal incontinence is a highly disabling symptom which causes the patient to gradually abandon all forms of social, family and working relationships. Rehabilitation was adopted initially in cases of surgical failure and considered as being only palliative. In our study we tested an original rehabilitation protocol for faecal incontinence which embraces 3 methods--physio-kinesitherapy, electrostimulation and biofeedback--in what we have called "anal sphincter functional rehabilitation". The study was conducted in 196 patients (61 M, 135 F) mean age 42.9 (range: 11-86), with faecal incontinence of varying aetiology. The 3 methods were carried out simultaneously in 3 one-hour sessions a week. The protocol envisaged 15 consecutive sessions at the end of which a first assessment was made of the results achieved. Therapeutic success was achieved in 93.4% of cases. The results obtained with our protocol do not differ from those reported by other Authors and we can therefore state that functional rehabilitation of the anal sphincter is to be viewed not merely as a valid alternative to surgery, but as the therapy of choice for fecal incontinence.

[Constipation. Proposal for a new classification and therapy]. / Outlet obstruction defecation. Proposta di un nuovo inquadramento e terapia.

The Authors propose a new classification for constipation according to which 84 patients were selected (63 females, 21 males) for a functional rehabilitation programme. Patients were subjected to a diagnostic protocol involving the performance of a number of instrumental tests. Degree and symptomatology of constipation were established by taking the clinical history of the patient. The rehabilitation protocol involved the simultaneous performance of physiokinesitherapy, electrostimulation and biofeedback of the pelvic floor. Patients underwent 3 weekly sessions, each lasting 60 minutes, over a series of 15 consecutive sessions, followed by a series of 6 consecutive sessions every three months. One-year results showed that 77 patients (92%) reported achieving regular intestinal activity with at least one evacuation a day and at intervals of no more than 3 days, and with a modification of faecal consistency and discontinuation of laxatives and/or cathartics. The other 7 patients (8%) continued using laxatives at a minimal dosage but had an improved evacuation rate and faecal consistency. The results show that many patients with constipations can undergo rehabilitation procedures with encouraging and remarkable therapeutic success.

Nonspecific chronic proctitis: clinical evaluation and morphological aspects

A proctite inespecifica foi encontrada, no mais das vezes, na presenca de outras patologias do canal anal. Seus aspectos clinicos e morfologicos foram investigados para identificar a afeccao adequadamente. Os sinais clinicos sao inespecificos e constituem de secrecao mucosa, sangramento retal e tenesmo e foram frequentemente observados, inclusive apos o tratamento cirurgico de afeccoes benignas do canal anal. O estudo acabou por definir a "proctite cronica inespecifica" como doenca inflamatoria do canal anal. O uso de topicos ou de medicamentos anti-inflamatorios nesses pacientes nao modifica os aspectos endoscopicos e histopatologicos, mas controla a sintomatologia.