ABSTRACT
Direct electrical stimulation of the colon offers a promising approach for the induction of propulsive colonic contractions by using an implantable device. The objective of this study was to assess the feasibility to induce colonic contractions using a commercially available battery-operated stimulator (maximum pulse width of 1 ms and maximum amplitude of 10 V). Three pairs of pacing electrodes were inserted into the cecal seromuscular layer of anesthetized pigs. During a first set of in vivo experiments conducted on six animals, a pacing protocol leading to cecum contractions was determined: stimulation bursts with 1 ms pulse width, 10 V amplitude (7-15 mA), 120 Hz frequency, and 30-s burst duration, repeated every 2-5 min. In a second testing phase, an evaluation of the pacing protocol was performed in four animals (120 stimulation bursts in total). By using the battery-operated stimulator, contractions of the cecum and movement of contents could be induced in 92% of all stimulations. A cecal shortening of about 30% and an average intraluminal pressure increase of 10.0 +/- 6.0 mmHg were observed.
Subject(s)
Colon/physiology , Animals , Cecum/physiology , Electric Power Supplies , Electric Stimulation/methods , Electrodes , Feasibility Studies , Female , Male , SwineABSTRACT
BACKGROUND: Anal condylomata acuminata (ACA) are caused by human papilloma virus (HPV) infection which is transmitted by close physical and sexual contact. The result of surgical treatment of ACA has an overall success rate of 71% to 93%, with a recurrence rate between 4% and 29%. The aim of this study was to assess a possible association between HPV type and ACA recurrence after surgical treatment. METHODS: We performed a retrospective analysis of 140 consecutive patients who underwent surgery for ACA from January 1990 to December 2005 at our tertiary University Hospital. We confirmed ACA by histopathological analysis and determined the HPV typing using the polymerase chain reaction. Patients gave consent for HPV testing and completed a questionnaire. We looked at the association of ACA, HPV typing, and HIV disease. We used chi, the Monte Carlo simulation, and Wilcoxon tests for statistical analysis. RESULTS: Among the 140 patients (123 M/17 F), HPV 6 and 11 were the most frequently encountered viruses (51% and 28%, respectively). Recurrence occurred in 35 (25%) patients. HPV 11 was present in 19 (41%) of these recurrences, which is statistically significant, when compared with other HPVs. There was no significant difference between recurrence rates in the 33 (24%) HIV-positive and the HIV-negative patients. CONCLUSIONS: HPV 11 is associated with higher recurrence rate of ACA. This makes routine clinical HPV typing questionable. Follow-up is required to identify recurrence and to treat it early, especially if HPV 11 has been identified.
Subject(s)
Condylomata Acuminata/epidemiology , Condylomata Acuminata/surgery , Papillomaviridae/classification , Papillomaviridae/genetics , Papillomavirus Infections/epidemiology , Adult , Anal Canal/virology , Condylomata Acuminata/prevention & control , Condylomata Acuminata/virology , Female , Genotype , Hospitals, University , Human papillomavirus 11/classification , Human papillomavirus 11/genetics , Human papillomavirus 11/isolation & purification , Human papillomavirus 6/classification , Human papillomavirus 6/genetics , Human papillomavirus 6/isolation & purification , Humans , Male , Monte Carlo Method , Papillomaviridae/isolation & purification , Papillomavirus Infections/prevention & control , Papillomavirus Infections/surgery , Papillomavirus Infections/virology , Recurrence , Surveys and Questionnaires , Switzerland/epidemiologyABSTRACT
Acute abdominal pain tends not to be treated by surgeons and emergency physicians. However, literature has become clear that analgesics are effective and do not disturb clinical examination, diagnostic process and do not delay surgery. Thus, early treatment of acute abdominal pain is recommended. In the absence of scientific evidence, protocols must be established by each institution and validated by quality process.
Subject(s)
Abdomen, Acute/diagnosis , Abdominal Pain/diagnosis , Analgesics/therapeutic use , Acute Disease , Clinical Protocols , Diagnosis, Differential , Humans , Quality Assurance, Health CareABSTRACT
A colorectal obstruction generally requires an urgent approach, both diagnostically and therapeutically. This context and a poor general condition make surgery hazardous. An auto-expansive stent is an effective therapeutic alternative, more often used to remove such a benign or malignant colorectal obstruction. In the latter presentation, the stent allows for the removal of the obstacle and for the establishment of a precise diagnosis before surgery. In the case of an incurable tumour or where removal is contra-indicated, a stent can represent a palliative treatment. Success in terms of re-establishment of perfusion, is about 85%. The most frequently encountered complication is perforation and is an indication for urgent surgery. Migration and obstruction of the stent are less frequent.
