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1.
Georgian Med News ; (311): 115-120, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33814403

RESUMO

The object of the study is to develop optimal reconstructive functional reservoirs for the treatment of children with aganglionosis after total colectomy. Since 1980 till 2020 we have been treating 53 children up to 3 years with aganglionosis after total colectomy using optimal reconstructive surgery technique lying in the formation of a functional intestinal reservoir. Colostomy was performed as the first stage of surgical treatment of all children. Effective ways of restoring the integrity of the intestinal tract after a total colostomy with creating of functionally advantageous circumstances for reservoirs formation were presented as "J" - reservoirs (n=2); ileotransplant with lateral ileo-ileoanastomosis (n=34); ileotransplant with lateral ileo-colonoastomosis (n=7); ileorectal primary anastomosis (n=1) or entero-enteroanastomosis with an invagination valve (n=8) or implantation of an ileocecal valve (n=1). The colostomy was closed after 3-4 months. There were no results in the postoperative period. After 3 months the frequency of defecation often is 10-15 times a day, and after 1 year it changes to 2-4 times a day. All the children survived. The results of functional tests are good. Bowl function is tolerable. The radiographs show a formed rectum with a sufficient reservoir and normal colonization. Restoration of integrity of the intestinal tract with the formation of functionally advantageous reservoir in the form of double ileo-colotransplant and ileo-ileotransplant "side-to-side" is the best option for reconstructive surgery performing in children with agangliosis after total colectomy. Formation of functionally advantageous reservoir prevents impaired water-electrolyte balance, improves normobiosis, improves formation and accumulation of feces, slows down passage through the digestive tract and prevents the development of other metabolic disorders. A modernized surgical approach, which lies in creation of various options for functionally advantageous reservoir in order to eliminate effects of colon absence in children, contributes to facilitating the postoperative period, accelerating rehabilitation, improving social adaptation and patients quality of life.


Assuntos
Doença de Hirschsprung , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Criança , Colectomia , Doença de Hirschsprung/cirurgia , Humanos , Íleo/cirurgia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Reto/cirurgia
2.
Niger Postgrad Med J ; 28(1): 22-26, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33642320

RESUMO

Background: Colorectal cancer (CRC) is the most prevalent gastrointestinal (GI) cancer. With 5% risk of developing CRC in life, it became the third leading cause of cancer death in developed nations. In Nigeria, it is the most common GI cancer. However, there are limited data on CRC in the study area (North-Western part of Nigeria). The aim of this study was to identify the clinical, endoscopic and histological profile of CRC seen on colonoscopy. Methodology: This was a retrospective descriptive study where colonoscopic and histological records of suspected CRC in the study centre between January 2008 to December 2017 were evaluated. Results: Records of 135 patients were reviewed, and males constituted 63.7%. The mean age was 46.61 ± 16.80 years, with 30-39 years as a modal group. Common presentations were diarrhoea (86.7%) and bleeding per rectum (68.9%). Areas affected were rectosigmoid colon (63%), ascending colon (14.1%), descending colon (8.9%), transverse colon (7.4%) and anal canal (6.7%). Histologically, adenocarcinoma was reported in 57.8%, mucinous adenocarcinoma in 8.1% and signet ring cell adenocarcinoma in 3.7%. Tubular and villous adenomas were 3% each. Others were carcinoid tumours (1.5%), metastatic adenocarcinoma, squamous cell carcinoma, basal cell carcinoma, GI stromal tumour, inflammatory myofibroblastic tumour, angiosarcoma and adenoid cyst carcinoma reported in 0.7% each. Conclusion: Majority of the patients with CRC were in their young age. The most common presentations were diarrhoea, weight loss and anaemia. The most common site of affectation was in the left colon, while the most common histological finding was adenocarcinoma.


Assuntos
Colonoscopia , Neoplasias Colorretais , Adulto , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Reto , Estudos Retrospectivos
3.
Diving Hyperb Med ; 51(1): 116-118, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33761553

RESUMO

INTRODUCTION: This report describes the use of hyperbaric oxygen treatment (HBOT) to treat a case of colorectal anastomosis ischaemia following colorectal surgery. CASE REPORT: A 47-year-old man developed post-operative colorectal anastomosis ischaemia with leak after laparoscopic low anterior resection for T3N0 adenocarcinoma of the rectum. The leak with concomitant ischaemia presented 17 days after surgery. HBOT was administrated in 11 sessions over three weeks and the patient followed endoscopically and radiologically for two months. At two months the anastomosis showed both endoscopic and radiological healing; therefore the ileostomy was closed. Anal function was satisfactory with no incontinence or evidence of sepsis. CONCLUSIONS: Intra-operative or late leak with concomitant ischaemia of a colorectal anastomosis is a challenging event in colorectal surgery. HBOT may be beneficial in promoting healing in selected patients. Further studies are needed to evaluate conservative treatments and the role of HBOT.


Assuntos
Neoplasias Colorretais , Oxigenação Hiperbárica , Anastomose Cirúrgica/efeitos adversos , Humanos , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Oxigênio , Reto/cirurgia
11.
Arq Bras Cir Dig ; 33(4): e1569, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33759959

RESUMO

BACKGROUND: OPN ABCB5. Studies with biomarkers in TMA (tissue microarray) have been showing important results regarding its expression in colon cancer. AIM: Correlate the expression profile of the OPN and ABCB5 biomarkers with the epidemiological and clinicopathological characteristics of the patients, the impact on the progression of the disease and the death. METHOD: A total of 122 CRC patients who underwent surgical resection, immunomarking and their relationship with progression and death events were evaluated. RESULT: The average age was 61.9 (±13.4) years. The cases were distributed in 42 (35.9%) in the ascending/transverse colon, 31 (26.5%) in the sigmoid, 27 in the rectum (23.1%), 17 (14.5%) in the descending colon. Most patients had advanced disease (stages III and IV) in 74 cases (60.9%). There was a predominance of moderately differentiated tumors in 101 samples (82.8%); despite this, the poorly differentiated subtype proved to be an independent risk factor for death in 70%. Metastasis to the liver proved to be an independent risk factor for death in 75% (18/24), as well as patients with primary rectal tumors in 81.5% (22/27). CONCLUSION: The immunohistochemical expression of the OPN and ABCB5 markers was not associated with epidemiological and clinicopathological characteristics. Regarding the progression of disease and death, it was not possible to observe a correspondence relationship with the evaluated markers.


Assuntos
Subfamília B de Transportador de Cassetes de Ligação de ATP , Adenocarcinoma , Neoplasias do Colo , Neoplasias Colorretais , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Adenocarcinoma/genética , Adenocarcinoma/patologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Humanos , Pessoa de Meia-Idade , Prognóstico , Reto
12.
Nat Commun ; 12(1): 1851, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33767170

RESUMO

Radiographic imaging is routinely used to evaluate treatment response in solid tumors. Current imaging response metrics do not reliably predict the underlying biological response. Here, we present a multi-task deep learning approach that allows simultaneous tumor segmentation and response prediction. We design two Siamese subnetworks that are joined at multiple layers, which enables integration of multi-scale feature representations and in-depth comparison of pre-treatment and post-treatment images. The network is trained using 2568 magnetic resonance imaging scans of 321 rectal cancer patients for predicting pathologic complete response after neoadjuvant chemoradiotherapy. In multi-institution validation, the imaging-based model achieves AUC of 0.95 (95% confidence interval: 0.91-0.98) and 0.92 (0.87-0.96) in two independent cohorts of 160 and 141 patients, respectively. When combined with blood-based tumor markers, the integrated model further improves prediction accuracy with AUC 0.97 (0.93-0.99). Our approach to capturing dynamic information in longitudinal images may be broadly used for screening, treatment response evaluation, disease monitoring, and surveillance.


Assuntos
Quimiorradioterapia Adjuvante/métodos , Aprendizado Profundo , Imagem por Ressonância Magnética/métodos , Terapia Neoadjuvante/métodos , Neoplasias Retais/diagnóstico por imagem , Biomarcadores Tumorais/sangue , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Reto/diagnóstico por imagem , Reto/patologia , Resultado do Tratamento
13.
Dtsch Med Wochenschr ; 146(7): 441-445, 2021 04.
Artigo em Alemão | MEDLINE | ID: mdl-33780988

RESUMO

The functional gastrointestinal disorders (FGIDs) have a high prevalence and are associated with high healthcare costs. The diagnosis of these diseases could be difficult and require func-tional tests such as high-resolution manometry (HRM) of the esophagus, anorectal manometry and H2-Breathtests. Due to the COVID-19 Pandemic and the fear of infections there was a marked reduction in the number of performed exams in the last months - nevertheless some exams are necessary, in order to exclude or to diagnose important and dangerous diseases like Achalasia. Goal of this article is to present some new and relevant developments in the field. The HRM of the esophagus is the diagnostic standard for Achalasia, a rare clinical condi-tion associated to dysphagia - new European guidelines suggests a safe strategy in perform-ing the pneumatic dilatation.The intestinal methanogen overgrowth (IMO) is a clinical condition caused by a high production of methane in the small intestine due to overgrowth of Methanobrevibacter smithii, this condition could be in some patients associated with irritable bowel syndrome.


Assuntos
/complicações , Gastroenteropatias/diagnóstico , Archaea/metabolismo , Testes Respiratórios , Acalasia Esofágica/diagnóstico , Esôfago/fisiopatologia , Gastroenteropatias/economia , Gastroenteropatias/epidemiologia , Humanos , Intestino Delgado/microbiologia , Manometria , Metano/biossíntese , Guias de Prática Clínica como Assunto , Reto/fisiopatologia
14.
Nihon Shokakibyo Gakkai Zasshi ; 118(2): 154-160, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33563855

RESUMO

A man in his 70s presented to Kyojinkai Komatsu Hospital with lower left abdominal pain and hematochezia after repeated use of laxatives. Computed tomography (CT) revealed continuous bowel wall thickening from the descending colon to the rectum. The symptoms and CT findings were consistent with ischemic colitis. The patient's condition improved with conservative treatment. However, the patient was reexamined 3 months later because complaints of constipation and voiding difficulty continued. Colonoscopic findings revealed rectal stenosis and reddish edematous mucosa with nodular alterations. Although CT showed that the abnormality in the descending and sigmoid colon had resolved, the wall thickening and annular stricture of the rectum persisted. The prostate was irregularly enlarged, encircling and compressing the rectum. Rectal biopsy results did not reveal malignancy. However, moderately to poorly differentiated adenocarcinoma was detected by prostate biopsy. Consequently, the patient was diagnosed with prostate cancer with rectal involvement. The rectal wall thickening and the symptoms improved following hormone therapy. Thus, concomitant prostate cancer invasion should be considered when CT reveals continuous colon wall thickening up to the rectum in a patient suspected of ischemic colitis.


Assuntos
Adenocarcinoma , Colite Isquêmica , Neoplasias da Próstata , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Colite Isquêmica/diagnóstico por imagem , Colite Isquêmica/etiologia , Humanos , Masculino , Neoplasias da Próstata/complicações , Neoplasias da Próstata/diagnóstico por imagem , Reto/diagnóstico por imagem
15.
BMC Surg ; 21(1): 82, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579251

RESUMO

BACKGROUND: In recent years, natural orifice specimen extraction surgery (NOSES) has become a field of special interest for colorectal surgeons. Some researchers have reported transanal specimen extraction in the laparoscopic anterior rectal resection, including intersphincteric resection (ISR) and rectal eversion-resection. However, these surgical procedures have certain limitations. Based on the proven expertise in laparoscopic surgery, our center has developed a modified technique of transanal specimen extraction. The aim of this study was to investigate the safety and feasibility of a modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection. METHODS: From January 2011 to January 2014, the patients with upper rectal or lower sigmoid colon cancer who had undergone laparoscopic anterior rectal resection with specimen extraction by a modified transanal technique were enrolled in the observation group, and the patients who had undergone laparoscopic anterior rectal resection with specimen extraction via an abdominal incision by the same surgeons during the same period were enrolled in the control group. RESULTS: A total of 36 patients were included in the observation group and 128 patients were included in the control group. There were no significant differences (P > 0.05) between the two groups in terms of the mean operative time [144 ± 10 min vs. 141 ± 11 min], mean intraoperative blood loss [63 ± 6 ml vs. 61 ± 7 ml], and the mean time to anal exhaust [67 ± 7 h vs. 65 ± 8 h]. However, there were significant differences (P < 0.05) between the two groups in terms of the mean postoperative Visual Analogue Scale (VAS) pain scores [3.4 ± 1.1 vs. 4.5 ± 1.2], mean postoperative hospital stay [6.0 ± 1.1 days ± vs. 7.2 ± 1.2 days], and incidence of postoperative complications (4/36 vs. 15/128). Long-term follow-up results showed that there was no significant difference (P > 0.05) between the two groups in terms of the 3- or 5-year overall survival. CONCLUSIONS: The modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection fulfilled the principle of no-neoplasm touch technique, with advantages, such as minimal trauma, rapid recovery, and fewer complications. Long-term follow-up results also showed satisfactory oncological outcomes.


Assuntos
Laparoscopia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/patologia , Reto/patologia , Estudos Retrospectivos , Neoplasias do Colo Sigmoide/patologia , Cirurgia Endoscópica Transanal
16.
Medicine (Baltimore) ; 100(6): e24626, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578575

RESUMO

RATIONALE: Abdominal ectopic pregnancy is a very rare form of ectopic pregnancy, yet is associated with higher morbidity due to atypical clinical presentation and misdiagnosis. In this report, we present a case of abdominal ectopic pregnancy with placenta invading to the rectal wall. PATIENT CONCERNS: A 32-year-old woman was admitted to our hospital with an increasing serum ß-hCG level after diagnostic laparoscopy for ectopic pregnancy in the provincial hospital. During the laparoscopy, no gestational sac was found. She was discharged and scheduled for a follow-up visit to assess the level of ß-hCG. One week later, her serum ß-hCG level increased from 7000 IU/l to 12000 IU/l. Transvaginal Doppler ultrasound and abdominal computed tomography (CT) angiography demonstrated a right adnexal mass adherent to the rectal wall. DIAGNOSIS: A rectal ectopic pregnancy is suspected. INTERVENTIONS: Laparoscopic surgery was successfully performed in our hospital to remove the products of conception. OUTCOMES: Histologic examination confirmed the diagnosis of a rectal ectopic pregnancy. The patient had an uneventful recovery and was discharged the next few days. LESSONS: This case report reveals that an abdominal pregnancy is remarkably difficult to diagnose and manage. The gynecologists need to be aware of the possibility of gestational sac between the uterus and the rectum. To make early diagnosis of abdominal pregnancy, they need to combine clinical findings, imaging techniques (ultrasound, CT, MRI) and serial human chorionic gonadotropin measurements. Laparoscopic management should be considered in early abdominal pregnancy. A multidisciplinary team of gynecologists and gastrointestinal surgeons is required to deal with rectal ectopic pregnancy.


Assuntos
Gravidez Abdominal/diagnóstico , Reto , Adulto , Gonadotropina Coriônica Humana Subunidade beta/sangue , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Gravidez Abdominal/sangue , Gravidez Abdominal/diagnóstico por imagem , Gravidez Abdominal/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia Pré-Natal
17.
Yonsei Med J ; 62(3): 187-199, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33635008

RESUMO

The primary goal of surgery for rectal cancer is to achieve an oncologically safe resection, i.e., a radical resection with a sufficient safe margin. Total mesorectal excision has been introduced for radical surgery of rectal cancer and has yielded greatly improved oncologic outcomes in terms of local recurrence and cancer-specific survival. Along with oncologic outcomes, functional outcomes, such as voiding and sexual function, have also been emphasized in patients undergoing rectal cancer surgery to improve quality of life. Intraoperative nerve damage or combined excision is the primary reason for sexual and urinary dysfunction. In the past, these forms of damage could be attributed to the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerve. With the adoption of minimally invasive surgery, visualization of nerve structure and meticulous dissection for the mesorectum are now possible. As the leading hospital employing this technique, we have adopted minimally invasive platforms (laparoscopy, robot-assisted surgery) in the field of rectal cancer surgery and standardized this technique globally. Here, we review a standardized technique for rectal cancer surgery based on our experience at Severance Hospital, suggest some practical technical tips, and discuss a couple of debatable issues in this field.


Assuntos
Vias Autônomas/anatomia & histologia , Fáscia/anatomia & histologia , Fáscia/inervação , Hospitais , Pelve/anatomia & histologia , Pelve/inervação , Reto/cirurgia , Pontos de Referência Anatômicos , Humanos
18.
Khirurgiia (Mosk) ; (2): 48-52, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570354

RESUMO

OBJECTIVE: To improve treatment outcomes in patients with anorectal malformations via research of morphological criteria and differentiated approach to surgical correction. MATERIAL AND METHODS: There were 37 children with various types of anorectal malformations for the period 2000-2019. We analyzed morphological features of atretic rectum wall, fistula, anastomosis with adjacent organs and skin of the perineum. RESULTS: Morphological research of anorectal malformations made it possible to differentiate treatment strategy and explain the causes of unsatisfactory results after perineal and abdominal-perineal proctoplasty. Incidence and severity of complications, as well as early disability were reduced that significantly improved postoperative quality of life. CONCLUSION: According to the morphological criteria, deeper mobilization of atretic rectum within at least 2.5-3 cm of the rectal «cone¼ with intact muscular wall is necessary. This approach was valuable to ensure adequate closure function of the rectum, prevent anal incontinence and restore normal appearance of the perineum. These achievements contributed to decrease in the incidence of admissions, redo surgeries and improvement of social adaptation in children.


Assuntos
Malformações Anorretais , Incontinência Fecal , Procedimentos Cirúrgicos Reconstrutivos , Canal Anal/anormalidades , Canal Anal/cirurgia , Malformações Anorretais/patologia , Malformações Anorretais/cirurgia , Criança , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Incontinência Fecal/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reto/anormalidades , Reto/cirurgia
19.
Br J Radiol ; 94(1120): 20201221, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33591799

RESUMO

OBJECTIVE: The goal of this study was to investigate whether neoadjuvant chemoradiotherapy (NCRT) plus total mesorectal excision (TME) would improve the outcome of patients with MRI-defined high-risk rectal cancer compared with TME plus adjuvant chemotherapy (ACT) or TME alone. METHODS: We retrospectively enrolled 362 patients with MRI-defined high-risk rectal cancer who were treated with NCRT plus TME, TME plus ACT, or TME alone between January 2008 and August 2018. Cases with a high-risk tumor stage, positive extramural venous invasion, or mesorectal fascia involvement on baseline MRI were considered cases of high-risk rectal cancer. We matched patients treated with NCRT plus TME to patients treated with TME plus ACT and to those treated with TME alone. Kaplan-Meier curves were used to compare local recurrence (LR), disease-free survival (DFS), and overall survival (OS) rates. RESULTS: The cumulative 3 year LR rate in the matched NCRT plus TME group was more favorable than in the TME plus ACT group (0% vs 5.1%; p = 0.037; n = 98) and in the TME alone group (0% vs 11.5%; p = 0.016; n = 61). Patients who received NCRT plus TME demonstrated better cumulative 3 year DFS rates than patients treated with TME plus ACT (85.7% vs 65.3%; p = 0.009) or with TME alone (86.9% vs 68.9%; p = 0.046). No difference in OS was observed among the groups. CONCLUSION: NCRT may improve DFS and LR rates in patients with MRI-defined high-risk rectal cancer when compared with TME plus ACT or TME alone. ADVANCES IN KNOWLEDGE: This study illustrated the specific benefit of NCRT on the outcome measures of MRI-defined high-risk rectal cancer compared with TME plus ACT or TME alone, which was not clearly clarified in previous studies enrolling all patients with Stage II/III rectal cancer.


Assuntos
Quimiorradioterapia/métodos , Imagem por Ressonância Magnética/métodos , Terapia Neoadjuvante/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/cirurgia , Reto/diagnóstico por imagem , Reto/cirurgia , Estudos Retrospectivos , Risco , Resultado do Tratamento
20.
Gan To Kagaku Ryoho ; 48(2): 239-241, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597368

RESUMO

BACKGROUND: Preoperative chemoradiotherapy(CRT)followed by total mesorectal excision(TME)is used for locally advanced rectal cancer, but it can induce postoperative anorectal function. The primary objective of this study is to confirm the efficacy and safety of preoperative CRT and TME without irradiation to the internal and external sphincter muscles. SUBJECTS AND METHODS: Patients were eligible for this study if they met the following inclusion criteria: histologically proven rectal cancer, clinical T3T4N0-2 disease, and a distance between anal margin of tumor and the rental line is more than 2 cm. Twelve patients who underwent preoperative CRT and TME between 2013 and 2017 were enrolled. The primary endpoint was completion rate of sphincter-preserving surgery. RESULTS: All patients completed preoperative CRT without Grade 3 or higher adverse effect. Sphincter-preserving surgery was performed in all cases. The 5-year disease-free survival rate was 46.7%, and the local recurrence-free survival rate was 75%, and the overall survival rate was 90.9%. CONCLUSION: It is suggested that preoperative CRT and TME without irradiation to the internal and external sphincter muscles is effective and safe therapy for locally advanced rectal cancer.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Quimiorradioterapia , Humanos , Neoplasias Retais/cirurgia , Reto , Resultado do Tratamento
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