Vaginal distention rodent model for fecal incontinence: a pilot study on the effect on defecation behavior

Objectives: Vaginal balloon inflation simulates the compressive forces on the pelvic floor during the second phase of natural delivery. The foremost use of this animal model of vaginal distention (VD) is to study the mechanisms underlying urinary incontinence. As damage to the pelvic floor during natural birth is a common cause of fecal incontinence, the present paper aimed to investigate the effect of VD on defecation behavior in adult rats. Methods: Vaginal distention was performed in 8 rats for 2 hours, and in 3 rats for 4 hours, and sham inflation was performed in 4 rats. With the use of a latrine box in the rat home-cage and 24/7 video tracking, the defecation behavior was examined. The time spent in and outside the latrine was monitored for two weeks preoperatively and three weeks postoperatively, and a defecation behavior index (DBI; range: 0 [continent] to 1 [incontinent]) was defined. Pelvic floor tissue was collected postmortem and stained with hematoxylin and eosin. Results: Vaginal balloon inflation for 2 hours resulted in fecal incontinence in 29% of the animals (responders) whereas the DBI scores of non-responders (71%) and control animals did not change in the postoperative phase compared with the baseline score. A 4-hour balloon inflation resulted in fecal incontinence in 1 animal and caused a humane endpoint in 2 animals with markedly more tissue damage in the 4-hour responder compared with the 2-hour responders. Conclusions: Vaginal balloon inflation, with an optimum duration between 2 and 4 hours, can be used as a model to study changes in defecation behavior in rats induced by pelvic floor damage. (AU)

Research progress of intestinal intervention in patients with neurogenic bowel dysfunction after spinal cord injury / 中国实用护理杂志

Neurogenic bowel dysfunction is one of the common complications after spinal cord injury. Long-term constipation and fecal incontinence can cause great troubles in the daily life of patients and seriously affect their quality of life. The key to the solution is effective intestinal intervention, including the establishment of defecation patterns, dietary interventions, and drug interventions, enema, electromagnetic stimulation, and enterostomy, etc. At the same time, a personalized bowel management plan is formulated based on the specific conditions of the patient to better manage the bowel and improve the patient′s quality of life.

Translation and cross-cultural adaptation of the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ)

Abstract Objective: To translate and cross-culturally adapt the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) for use in Brazilian Portuguese. The CBBDQ is an 18-item tool covering 10 bladder and 8 bowel symptoms that was developed for use with children of 5 to 12 years of age with bowel and bladder dysfunction (BBD). The instrument has already been validated for use in Dutch and English. Method: In the process of translation and cultural adaptation from English to Portuguese, the CBBDQ was submitted to undergo the required steps as established by the international methodological criteria: forward translation, synthesis, back-translation, expert panel review and pre-testing. Results: Ninety-three parents of children with lower urinary tract dysfunction answered the questionnaire. The mean age of the children was 7.6 ± 2.1 years and 54 were female. Internal consistency was excellent, with a Cronbach's alpha of 0.91 to 0.96. Additionally, reliability was high, with an intraclass correlation coefficient of 0.94 (95%CI: 0.85-0.93; p < 0.0001). Conclusion: The translation and cultural adaptation of the CBBDQ enabled a quantitative evaluation of bladder and bowel symptoms to be performed in Brazilian children. The scores achieved allow the severity of BBD to be evaluated, as well as the patient's progress during treatment. The use of this questionnaire in clinical practice and research will allow more consistent data on BBD to be obtained.

Fallo intestinal en el paciente crítico: reconocimiento, abordaje multidisciplinario y unidades dedicadas / Intestinal failure in critical patients: recognition, multidisciplinary approach and dedicated units / Insuficiência intestinal no paciente crítico: reconhecimento, abordagem multidisciplinar e unidades dedicadas

Resumen: Introducción: en el paciente crítico el intestino es protagonista de la respuesta al estrés. Los síntomas de insuficiencia intestinal en las unidades de cuidados intensivos no son específicos y no se incluyen en escalas de gravedad comúnmente usadas, sin embargo, el 62% de los pacientes críticos presenta síntomas gastrointestinales al menos una vez al día. Demostrándose la relación existente entre la aparición de problemas gastrointestinales y la mortalidad en pacientes críticos. Objetivo: proporcionar el conocimiento teórico necesario sobre el fallo intestinal como entidad exclusiva, su reconocimiento en el paciente grave, clasificación y enfoque multidisciplinario del tratamiento. Métodos: se realizó una revisión cualitativa y sistemática en los idiomas inglés y español de la literatura publicada y actualizada hasta febrero del 2020. Conclusiones: las alteraciones gastrointestinales son frecuentes en el paciente crítico y un determinante en su mortalidad. Reconocer el fallo y disfunción intestinal permite optimizar el tratamiento, reducir la mortalidad e incidencia de complicaciones, las unidades dedicadas con un equipo de experiencia en el manejo del fallo intestinal agudo constituyen un aspecto clave en este sentido.

Summary: Introduction: in critically ill patients, intestine function expresses the response to stress. Symptoms of intestinal failure in intensive care units are not specific and are not included in commonly used severity scales. However, 62% of critically ill patients present gastrointestinal symptoms at least once a day, demonstrating the relationship between the appearance of gastrointestinal problems and mortality in critical patients. Objective: to provide the necessary theoretical knowledge about intestinal failure as an exclusive entity and how to recognize it in critically ill patients, classification and a multidisciplinary approach to treatment of this condition. Methods: a qualitative and systematic review was carried out of the literature published and updated until February 2020 both in English and in Spanish. Conclusions: gastrointestinal disorders are frequent in critically ill patients and constitute a determining factor in their mortality. Recognizing intestinal failure and dysfunction allows the optimization of treatment, reduces mortality and the incidence of complications. The creation of dedicated units with experienced staff in the management of acute intestinal failure is a key aspect in this regard.

Resumo: Introdução: em pacientes críticos, o intestino é o protagonista da resposta ao estresse. Os sintomas de insuficiência intestinal em unidades de terapia intensiva não são específicos e não estão incluídos nas escalas de gravidade comumente usadas; no entanto, 62% dos pacientes criticamente enfermos apresentam sintomas gastrointestinais pelo menos uma vez ao dia, demonstrando a relação entre o aparecimento de problemas gastrointestinais e mortalidade em pacientes críticos. Objetivo: proporcionar o conhecimento teórico necessário sobre a insuficiência intestinal como entidade exclusiva, seu reconhecimento em pacientes críticos, classificação e abordagem multidisciplinar do tratamento. Métodos: foi realizada uma revisão qualitativa e sistemática nos idiomas inglês e espanhol da literatura publicada e atualizada até fevereiro de 2020. Conclusões: as alterações gastrointestinais são frequentes em pacientes críticos e determinam sua mortalidade. O reconhecimento da insuficiência e disfunção intestinal permite otimizar o tratamento, reduzindo a mortalidade e a incidência de complicações; contar com unidades dedicadas e com equipe experiente no manejo da insuficiência intestinal aguda são um aspecto fundamental nesse sentido.

Improvement of neurogenic bowel dysfunction after spinal cord injury using functional magnetic stimulation based on anorectal manometry / 国际生物医学工程杂志

Objective:To explore the effect of functional magnetic stimulation(FMS) on the intestinal function of patients with neurogenic bowel dysfunction (NBD) after spinal cord injury using anorectal manometry technology.Methods:36 NBD patients were divided into FMS group and control group by random number table method. Patients in the control group received conventional treatment, including diet adjustment, abdominal massage, and pelvic floor muscle training. Patients in the FMS group received FMS treatment on the basis of conventional treatment. Using 3D high-resolution anorectal manometry and neurogenic intestinal dysfunction score, the intestinal function of the two groups of patients before and after the treatment were evaluated.Results:After receiving conventional treatment + FMS treatment, the high-pressure belt length, anal systolic pressure, rectal pressure, rectal-anal pressure difference, initial sensory threshold, bowel sensation threshold, maximum tolerance threshold, rectal compliance of the patients in the FMS group received were better than those before the treatment (all P<0.05). After receiving conventional treatment, only the rectal-anal pressure difference, initial sensory threshold and maximum tolerance threshold of the patients in the control group were significantly improved (all P<0.05). The improvement of the FMS group on the length of the high-pressure belt, anal systolic pressure, rectal pressure, and initial sensory threshold was significantly better than those of the control group (all P<0.05). Conclusions:The implementation of FMS therapy on the basis of conventional treatment can better improve the intestinal motility and intestinal sensation of the patients with NBD. The 3D high-resolution anorectal manometry technique can be used to quantitatively evaluate the intestinal function of NBD patients.

Prevalence of Bladder and Bowel Dysfunction in the Outpatient Clinic of Pediatric Urology and Nephrology / Prevalencia de la disfunción de la vejiga y del intestino en la consulta ambulatoria de urología y nefrología pediátrica

Zoom Image Abstract Objective Bladder and bowel dysfunction (BBD) is defined as the presence of functional alterations in both organs. The correct diagnosis and treatment prevent the exposure of patients to multiple antibiotic treatments, invasive procedures and radiological studies. The aim of the present study was to estimate the prevalence of BBD in the outpatient clinic of pediatric urology and nephrology. Methods A prospective cohort composed of 334 patients aged between 5 and 18 years was evaluated. The Pediatric Lower Urinary Tract Symptom Score (PLUTSS) was applied. A score higher than 8 was considered as significant urinary symptomatology. Moreover, the Bristol Stool Scale and the Rome IV Criteria for functional constipation and fecal incontinence were used. Patients with organic pathologies were excluded. The risk factors were evaluated using logistic regression models. Results The median age was 9 years old (interquartile range [IQR]: 6­13). The PLUTSS questionnaire was significant in 16.5% of the kids, constipation was found in 31.9%, and fecal incontinence, in 4%. The prevalence of BBD was of 27.8%. The female gender (odds ratio [OR]: 2.47; p = 0.002) and psychological disorders (OR: 4.637; p = 0.024) were considered risk factors. The evaluation of the PLUTSS questionnaire showed relevance regarding incontinence (OR: 3.059; p = 0.038), enuresis (OR: 8.532; p < 0.001); intermittent flow (OR: 9.211; p = 0.004), frequency (OR: 6.73; p = 0.005), and constipation (OR: 34.46; p < 0.001). Conclusions The prevalence of BBD is of 27.8% in the outpatient clinic. It is important to prevent associated complications and the exposure to multiple antibiotic treatments, as well as invasive and imaging procedures, which also generate high costs to the health system.

Resumen Objetivo El síndrome de disfunción de la vejiga y del intestino (DVI) se define como la presencia de alteraciones funcionales en ambos órganos. El correcto diagnóstico y tratamiento previene la exposición de los pacientes a múltiples manejos antibióticos, procedimientos invasivos y estudios radiológicos. El objetivo de este estudio es estimar la prevalencia de DVI en la consulta ambulatoria de urología y nefrología pediátrica. Métodos Se evaluó una cohorte prospectiva de 334 pacientes de 5 a 18 años. Se aplicó el cuestionario de Puntuación de Síntomas del Tracto Urinario Inferior (Pediatric Lower Urinary Tract Symptom Score, PLUTSS), cuyo resultado mayor a 8 fue considerado significativo. Adicionalmente, se usó la Escala de Heces de Bristol (Bristol Stool Scale) y los Criterios Roma IV (Rome IV Criteria) para estreñimiento e incontinencia fecal. Los factores de riesgo se evaluaron bajo modelos de regresión logística. Resultados La edad mediana fue de 9 años (rango intercuartil [RIC]: 6­13). El cuestionario PLUTSS fue significativo en 16,5% de los niños, y se observó estreñimiento en 31,9%, e incontinencia fecal en 4%. La prevalencia de DVI fue de 27,8%. El sexo femenino (razón de probabilidades [RP]: 2.47; p = 0.002) y desordenes psicológicos (RP: 4.637; p = 0.024) fueron considerados factores de riesgo. La evaluación del cuestionario PLUTSS mostró relevancia en incontinencia (RP: 3.059; p = 0.038), enuresis (RP: 8.532; p < 0.001), flujo intermitente (RP: 9.211; p = 0.004), frecuencia (RP: 6.73; p = 0.005), y estreñimiento (RP: 34.46; p < 0.001). Conclusiones La prevalencia de DVI fue de 27.8% en la consulta ambulatoria. Es importante prevenir complicaciones asociadas y la exposición a múltiples tratamientos antibióticos, procedimientos invasivos e imagenológicos, que adicionalmente generan altos costos al sistema de salud.

Advance in Acupuncture and Moxibustion for Neurogenic Bowel Dysfunction after Spinal Cord Injury (review) / 中国康复理论与实践

Neurogenic bowel dysfunction is one of the common complications after spinal cord injury. This paper reviewed the acupuncture and moxibustion used for neurogenic bowel dysfunction after spinal cord injury, from the aspects of prescription, acupoint selection, evaluation and possible mechanism. The ideas for further researches were discussed.

Aquaporin Over-expression for Constipation in Rats with Spinal Cord Injury / 中国康复理论与实践

Objective:To investigate the relation between aquaporins (AQPs) and fecal water content in rats with spinal cord injury. Methods:A total of 48 female Sprague-Dawley rats were divided into control group (n= 24) and spinal cord injury group (SCI group,n = 24). SCI group underwent transection at T8, while the control group was only subjected to laminectomy. Posterior limb function was assessed by Basso-Beattie-Bresnahan (BBB) score before modeling and on the 1st, 3rd, 7th, 14th and 28th day after SCI. Fecal water content was measured before modeling and on the 3rd, 14th and 28th day after SCI. Colon specimens were collected to detect the expression of AQP1, AQP3 and AQP4 by immunohistochemistry on the 3rd, 14th and 28th day after SCI. Results:The BBB score was significantly lower in SCI group than in the control group (t > 69.230,P< 0.001) after SCI, as well as the fecal water content (t > 5.814,P< 0.001). The expression of AQP1, AQP3, and AQP4 in the colon was higher in SCI group than in the control group (|t|> 5.165,P < 0.01) on the 3rd, 14th, and 28th day after SCI. The expression of AQPs negatively correlated with fecal water content (r = -0791~-0.730,P< 0.001). Conclusion:The expression of AQPs in the colon of rats after SCI was up-regulated, which was correlated with excessive water absorption after SCI.

Study on the clinical application of the intervention program of bowel dysfunction in patients with spinal cord injury / 上海交通大学学报（医学版）

Objective • To verify the effectiveness of the intervention program of bowel dysfunction in patients with spinal cord injury (SCI). Methods • Eighty bowel dysfunction patients with SCI in a rehabilitation hospital in Shanghai from Jan. to Dec. 2018 were included. According to the time of admission, the patients were divided into intervention group and control group, with 40 cases in each group. The patients in the control group received the routine nursing, and the patients in the intervention group were provided with the intervention program constructed by this study. The bowel function indexes of the two groups were compared at the time of admission, 4 weeks after intervention and 1 month after discharge. The quality of life in the two groups was compared at the time of admission and 1 day before discharge. Results • After intervention, the defecation frequency, fecal character score, defecation time, abdominal distention, constipation rate and drug dependence rate of the intervention group were lower than those of the control group (all P<0.05), and their total scores of quality of life and the scores in various fields were higher than those of the control group (all P<0.05). The differences in the quality of life between the two groups of patients after intervention and at the time of admission were statistically significant except for the social field (all P<0.05). Conclusion • The intervention program for bowel dysfunction patients with SCI can effectively lead to the recovery of the bowel function, reduce the incidence of bowel complications, and improve the quality of their life.

Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review / Uroterapia no tratamento de crianças e adolescentes com disfunção vesical e intestinal: revisão sistemática

ABSTRACT Objective: To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. Method: Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. Results: Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. Conclusion: This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.

RESUMO Objetivo: Identificar e descrever os protocolos e desfechos clínicos das intervenções de uroterapia em crianças e adolescentes com disfunção vesical e intestinal. Método: Revisão sistemática realizada em junho de 2018 nas bases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library e PsycInfo. Foram incluídos ensaios clínicos e estudos quase-experimentais dos últimos 10 anos, em crianças e/ou adolescentes com sintoma urinário e intestinal e aplicação de no mínimo um componente de uroterapia. Resultados: 13 ensaios clínicos e 1 estudo quase-experimental foram incluídos, sendo a qualidade metodológica moderada. A heterogeneidade da amostra e de delineamento metodológico dos artigos impediu a realização de meta-análise. A análise descritiva por meio de percentual simples demonstrou redução dos sintomas e melhora dos parâmetros de urofluxometria. Os componentes de uroterapia identificados foram: orientação educacional, ingestão hídrica, redução de cafeína, posicionamento adequado para eliminação, treinamento do assoalho pélvico, micção programada e controle/manejo da constipação. Conclusão: Esta revisão sinaliza resultados positivos em termos de redução de sintomas e melhora nos parâmetros de urofluxometria com aplicação de uroterapia padrão como primeira linha de tratamento nos casos de crianças e adolescentes com disfunção vesical e intestinal. Recomenda-se que estudos futuros tragam contribuições no que tange a frequência, número e tempo para as consultas de uroterapia.

Validation of Portuguese version of the low anterior resection syndrome score / Validação da versão em português do escore da síndrome da ressecção anterior baixa

ABSTRACT Objective: The authors aim to perform a thorough translation with cultural adaptation of the patient reported outcome tool, Low Anterior Resection Syndrome (LARS) Score, to the Portuguese language (LARS-PT) in the Portuguese population with rectal cancer, after proctectomy with anastomosis. Methods: According to the current international recommendations, we designed this study encompassing three main phases: (i) cultural and linguistic validation to European Portuguese; (ii) feasibility and reliability tests of the version obtained in the previous phase; and (iii) validity tests to produce a final version. The questionnaire was completed by 154 patients from six Portuguese Colorectal Cancer Units, and 58 completed it twice. Results: Portuguese version of LARS score showed high construct validity. Regarding the test-retest, the global Intraclass Correlation showed very strong test-retest reliability. Looking at all five items, only items 3 and 5 present a moderate correlation. LARS score was able to discriminate symptoms showing worse quality of life, in patients submitted to preoperative radio and chemotherapy. Conclusions: LARS questionnaire has been properly translated into European Portuguese, demonstrating high construct validity and reliability. This is a precise, reproducible, simple, clear and user-friendly tool for evaluating bowel function in rectal cancer patients after sphincter saving operation.

RESUMO Objetivo: Os autores pretendem fazer uma tradução minuciosa e culturalmente adaptada para a língua portuguesa do escore da Síndrome de Ressecção Anterior Baixa (Low Anterior Resection Syndrome [LARS]), um instrumento de desfecho relatado pelo paciente, na população portuguesa com câncer retal após proctectomia com anastomose. Métodos: De acordo com as recomendações internacionais atuais, o estudo foi projetado abrangendo três fases principais: (i) validação cultural e linguística para o português europeu; (ii) testes de viabilidade e confiabilidade da versão obtida na fase anterior; e (iii) testes de validade para produzir a versão final. O questionário foi preenchido por 154 pacientes de seis unidades portuguesas de câncer colorretal e 58 pacientes completaram duas vezes. Resultados: A versão em português do escore LARS mostrou alta validade de construto. A correlação intra-classe global apresentou confiabilidade muito forte no teste-reteste. Considerando-se todos os cinco itens, apenas os itens 3 e 5 apresentam uma correlação moderada. O escore LARS foi capaz de discriminar sintomas com pior qualidade de vida em pacientes submetidos a radio- e quimioterapia pré-operatória. Conclusões: O questionário LARS foi traduzido corretamente para o português europeu, demonstrando alta validade de construto e confiabilidade. Trata-se de uma ferramenta precisa, reproduzível, simples, clara e fácil de usar para avaliar a função intestinal em pacientes com câncer retal após operações poupando o esfíncter.

Gastrointestinal Motility after Spinal Cord Injury in Rats: An X-ray Study / 中国康复理论与实践

Objective To study the dynamic changes of the intestinal function of neurogenic bowel dysfunction rats caused by spi-nal cord injury using X-ray radiography. Methods Twenty-four female Sprague-Dawley rats were divided into control group (n=12) and spinal cord injury group (n=12). The T10spinal cord injury model was established using aneurysm clip (70 grams calibration force) for 60 seconds. The control group exposed the dura only. X-ray Barium was used to observe the dynamic changes of in-testinal function, and HE staining was used to observe the pathology of the colon before and four weeks after modeling. Results Compared with the control group, gastric emptying and intestinal transit function significantly reduced in the spinal cord injury group (P<0.05). Conclusion The spinal cord injury model can be successfully duplicated with aneurysm clip in rats; neurogenic bowel dysfunction occurs after spinal cord injury, gastric emptying and intestinal transit function are weakened.

Progress in Evaluation of Neurogenic Bowel Dysfunction after Spinal Cord Injury(review) / 中国康复理论与实践

Neurogenic bowel dysfunction is one of the most common complications of spinal cord injury.It can cause abdominal distension,constipation,fecal incontinence,difficult defecation,prolonged defecation and other symptoms.At present, neurogenic bowel dysfunction is mainly evaluated through general condition,physical examination,experimental exami-nation,professional scales and intestinal microbiota,etc.

Research progress of neurogenic bowel dysfunction in spinal cord injury / 上海交通大学学报（医学版）

Spinal cord injury has the characteristics of high incidence, high disability, high cost and younger age. It imposes a huge burden on patients and society. Neurogenic bowel dysfunction is one of the serious complications of spinal cord injury. It often manifests as constipation and fecal incontinence, which severely limit the social activities of patients and reduce the quality of life. It is a major problem for clinicians to solve. In recent years, the concern for neurogenic bowel dysfunction after spinal cord injury has been increasing. This article reviewed its epidemiology, classification, pathophysiological, diagnosis and treatment.

Clinical Study of Hyperbaric Oxygen with Needles Retained After BO's Abdominal Acupuncture for Neurogenic Bowel Dysfunction After Spinal Cord Injury / 上海针灸杂志

Objective To observe the therapeutic efficacy of hyperbaric oxygen with needles retained after BO's abdominal acupuncture in treating neurogenic bowel dysfunction after spinal cord injury. Method Ninety patients diagnosed with neurogenic bowel dysfunction after spinal cord injury were randomized into hyperbaric oxygen with needles retained group, hyperbaric oxygen followed by acupuncture group, and acupuncture followed by hyperbaric oxygen group, 30 cases each. The clinical efficacies of the three groups were observed. Result The three treatment protocols were all effective in treating neurogenic bowel dysfunction due to spinal cord injury, but the hyperbaric oxygen with needles retained group was superior to the other two groups(P<0.05), and the hyperbaric oxygen followed by acupuncture group was better than the acupuncture followed by hyperbaric oxygen group(P<0.05). Conclusion Hyperbaric oxygen with needles retained can effectively treat neurogenic bowel dysfunction due to spinal cord injury, and generally enhance the quality of life of spinal cord injury patients.

Diagnosis and Surgical Treatment of Adhesive Intestinal Obstruction after Spinal Cord Injury: 35 Cases Report / 中国康复理论与实践

@#Objective To analyze the clinical characteristics of spinal cord injury patients with postoperative adhesive intestinal obstruction, and summarize the clinical experience of diagnosis and treatment. Methods 35 spinal cord injury patients with postoperative adhesive intestinal obstruction in our department from August 2008 to August 2013 were reviewed. Results All of them had a history of abdominal surgery for various reasons, 22 cases received sigmoid colon pouch procedure and 13 cases received cholecystectomy. 25 cases suffered T10-L1 spinal cord injury, 10 cases suffered cervical spinal cord injury; 26 cases (74.3%) received non-operative treatment and recovered, 9 cases (25.7%) were transferred to surgery. Conclusion There is no typical clinical symptom and sign in spinal cord injury patients with adhesive intestinal obstruction after abdominal surgery, so early diagnosis is difficult, and the imaging examination is necessary. When non-operation treatment is not effective to these patients, surgical treatment should be timely carried out.

Diagnosis and Surgical Treatment of Adhesive Intestinal Obstruction after Spinal Cord Injury:35 Cases Report / 中国康复理论与实践

Objective To analyze the clinical characteristics of spinal cord injury patients with postoperative adhesive intestinal obstruc-tion, and summarize the clinical experience of diagnosis and treatment. Methods 35 spinal cord injury patients with postoperative adhesive intestinal obstruction in our department from August 2008 to August 2013 were reviewed. Results All of them had a history of abdominal surgery for various reasons, 22 cases received sigmoid colon pouch procedure and 13 cases received cholecystectomy. 25 cases suffered T10-L1 spinal cord injury, 10 cases suffered cervical spinal cord injury;26 cases (74.3%) received non-operative treatment and recovered, 9 cases (25.7%) were transferred to surgery. Conclusion There is no typical clinical symptom and sign in spinal cord injury patients with adhe-sive intestinal obstruction after abdominal surgery, so early diagnosis is difficult, and the imaging examination is necessary. When non-opera-tion treatment is not effective to these patients, surgical treatment should be timely carried out.

Functional results after treatment for rectal cancer / Resultados funcionais após tratamento de câncer retal

INTRODUCTION: With improving survival of rectal cancer, functional outcome has become increasingly important. Following sphincter-preserving resection many patients suffer from severe bowel dysfunction with an impact on quality of life (QoL) - referred to as low anterior resection syndrome (LARS). STUDY OBJECTIVE: To provide an overview of the current knowledge of LARS regarding symptomatology, occurrence, risk factors, pathophysiology, evaluation instruments and treatment options. RESULTS: LARS is characterized by urgency, frequent bowel movements, emptying difficulties and incontinence, and occurs in up to 50-75% of patients on a long-term basis. Known risk factors are low anastomosis, use of radiotherapy, direct nerve injury and straight anastomosis. The pathophysiology seems to be multifactorial, with elements of anatomical, sensory and motility dysfunction. Use of validated instruments for evaluation of LARS is essential. Currently, there is a lack of evidence for treatment of LARS. Yet, transanal irrigation and sacral nerve stimulation are promising. CONCLUSION: LARS is a common problem following sphincter-preserving resection. All patients should be informed about the risk of LARS before surgery, and routinely be screened for LARS postoperatively. Patients with severe LARS should be offered treatment in order to improve QoL. Future focus should be on the possibilities of non-resectional treatment in order to prevent LARS. (AU)

INTRODUÇÃO: Com o aumento da sobrevida após câncer retal, o resultado funcional se tornou cada vez mais importante. Após ressecção com preservação do esfíncter, muitos pacientes sofrem de disfunção intestinal com um impacto sobre a qualidade de vida (QdV) - denominada síndrome da ressecção anterior baixa (LARS). OBJETIVO DO ESTUDO: Fornecer uma visão geral do conhecimento atual da LARS com relação à sintomatologia, à ocorrência, aos fatores de risco, à fisiopatologia, aos instrumentos de avaliação e às opções de tratamento. RESULTADOS: A LARS é caracterizada por movimentos intestinais repentinos e frequentes, dificuldades de esvaziamento e incontinência e ocorre em até 50-75% dos pacientes em longo prazo. Os fatores de risco conhecidos são anastomose baixa, radioterapia, lesão direta do nervo e anastomose direta. A fisiopatologia parece multifatorial, com elementos de disfunção anatômica, sensorial e da motilidade. O uso de instrumentos validados para avaliação da LARS é essencial. Atualmente, não há comprovações de tratamento da LARS. Ainda hoje, a irrigação transanal e a estimulação do nervo sacral são comprometidas. CONCLUSÃO: A LARS é um problema comum após ressecção com preservação do esfíncter. Todos os pacientes devem ser informados sobre o risco de LARS antes da cirurgia, e o rastreamento da LARS deve ser rotineiro após a cirurgia. Pacientes com LARS severa devem receber tratamento para melhorar a QdV. O foco futuro deve ser nas possibilidades de tratamento sem ressecção a fim de evitar a LARS. (AU)

Substance P in Neurogenic Bowel Dysfunction after Spinal Cord Injury in Rats / 中国康复理论与实践

@#Objective To investigate the relationship between neurogenic bowel dysfunction (NBD) and substance P in rats suffering from spinal cord injury (SCI). Methods 60 male Sprague-Dawley rats, weighted (220±40) g, were randomly divided into three groups: sham group (n=20), normal group (n=20) and model group (n=20) and then were subdivided into subgroups of 24 h, 1 week, 3 weeks, and 5 weeks respectively after SCI. SCI model was established at thoracic 10 segment of rat with NYU impactor device. The colon tissue of the rats was resected and stored. Substance P in serum and tissue was measured by ELISA. The tissue was examined by real-time RT-PCR and Western blotting to analyze the expression of substance P. Results The colon intestinal transmission function decreased and delineated at minimum value at 3 weeks in the model group. There was statistical significance with respect to the content of substance P in serum and tissue between the sham group and model group at 3 weeks. The expression of substance P in the sham group was (3.12±0.51) times of the model group (P<0.05). Conclusion Substance P may take part in NBD after SCI in rats.

Substance P in Neurogenic Bowel Dysfunction after Spinal Cord Injury in Rats / 中国康复理论与实践

Objective To investigate the relationship between neurogenic bowel dysfunction (NBD) and substance P in rats suffering from spinal cord injury (SCI). Methods 60 male Sprague-Dawley rats, weighted (220±40) g, were randomly divided into three groups:sham group (n=20), normal group (n=20) and model group (n=20) and then were subdivided into subgroups of 24 h, 1 week, 3 weeks, and 5 weeks respectively after SCI. SCI model was established at thoracic 10 segment of rat with NYU impactor device. The colon tissue of the rats was resected and stored. Substance P in serum and tissue was measured by ELISA. The tissue was examined by real-time RT-PCR and Western blotting to analyze the expression of substance P. Results The colon intestinal transmission function decreased and delineated at minimum value at 3 weeks in the model group. There was statistical significance with respect to the content of substance P in serum and tis-sue between the sham group and model group at 3 weeks. The expression of substance P in the sham group was (3.12 ± 0.51) times of the model group (P<0.05). Conclusion Substance P may take part in NBD after SCI in rats.