A Possible Correlation Between Auricular Angiomas and Breast Cancer Through Auricular Acupuncture Diagnosis: An Observational Case-Control Study.

Introduction Auricular acupuncture (AA) can be used for both diagnosis and therapy. Diagnosis done with AA has become more prominent, with inspection by evaluating skin alterations considered the most important step. Literature on AA diagnosis in cancer patients is scarce. Globally, breast cancer (BC) is the most commonly diagnosed cancer in women. Materials and methods Subjects accessing the outpatient Breast Unit Clinic of Padua for BC were evaluated for auricle angiomas, with collected data including a number of angiomas, Romoli's Sectogram sector of identified angiomas, laterality of the auricle with the angioma, age, and laterality of BC. Results Of the 438 subjects evaluated, 129 had BC, and 64 had an identifiable auricle angioma. The odds of an auricular angioma were higher in subjects with BC diagnosis, mainly localized in tumor area II and predominantly ipsilateral to the side affected by BC. Conclusions AA auricle inspection is a simple, quick, and easy diagnostic tool. Screening for the presence and location of auricular angiomas may help health practitioners refer women for BC screening for early diagnosis.

Ultrasound-guided caudal epidural injection to treat symptoms of lumbar spinal stenosis: a retrospective study.

Lumbar spinal stenosis (LSS) occurs when bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, compressing neural and vascular elements in the spinal canal. Compression can cause static back pain, radicular lower extremity pain, or neurogenic claudication. Radiological and clinical findings are needed to diagnose lumbar stenosis. In this framework, caudal epidural steroid injection (ESI) is a standard treatment. The volume injected and needle positioning are the main issues that could compromise the effectiveness of the epidural injection. However, ultrasound-guided caudal epidural injections have become more common in recent years. Since Klocke and colleagues described the ultra-sound-guided caudal block in 2003, it has grown in popularity. Multiple ethnic studies have reported ultrasound-guided caudal injection success rates of 96.9-100%. Color Doppler ultrasonography can also determine if a drug solution reaches the lumbosacral region. We enrolled 42 patients with lumbar spinal stenosis, persistent lumbosciatalgia, and neurogenic claudicatio unresponsive to painkillers who were not surgical candidates. Each patient receives four weekly injections for four weeks. If the patient responds to treatment but still has pain, monthly injections are needed to reach and maintain the benefit. Treatment will be changed if the patient does not respond after 4 caudal injections. Sterile caudal epidural injections are performed with ultrasound guidance and a spinal needle 21G. Triamcinolone 40 mg, levobupivacaine 10 mg, and physiological solution 10 ml are delivered. Each patient received an average of 4 injective treatments (4±2, Means 4, SD 2). Data analysis shows that the treatment reduced pain significantly before and after therapy, which persisted after 3 months. Caudal epidural injection is one of the most common conservative treatments for chronic low back pain with radiculopathy, and lidocaine alone or with steroids is effective. In this framework, the two main literature issues about caudal epidural injection effectiveness on lumbar pain are correct. Therefore, 10 ml is suitable and effective for treating symptoms without side effects. Pain reduction of over 50% from start to finish and three-month follow-up have shown significant results in pain control and disability improvement. Finally, caudal epidural injection for lumbar spinal stenosis symptoms is effective, safe, and provides long-term pain relief.

Probing the Energy-Smeared R Ratio Using Lattice QCD.

We present a first-principles lattice QCD investigation of the R ratio between the e^{+}e^{-} cross section into hadrons and into muons. By using the method of Ref. [1], that allows one to extract smeared spectral densities from Euclidean correlators, we compute the R ratio convoluted with Gaussian smearing kernels of widths of about 600 MeV and central energies from 220 MeV up to 2.5 GeV. Our theoretical results are compared with the corresponding quantities obtained by smearing the KNT19 compilation [2] of R-ratio experimental measurements with the same kernels and, by centering the Gaussians in the region around the ρ-resonance peak, a tension of about 3 standard deviations is observed. From the phenomenological perspective, we have not included yet in our calculation QED and strong isospin-breaking corrections, and this might affect the observed tension. From the methodological perspective, our calculation demonstrates that it is possible to study the R ratio in Gaussian energy bins on the lattice at the level of accuracy required in order to perform precision tests of the standard model.

Needle contact test in auricular acupuncture for shoulder pain and where effective auricular acupoints identified are positioned on the map: A controlled study.

Active Points Test on auricle was renamed Needle Contact Test (or NCT), considered an extremely effective method to select most efficient auricle acupoint for Auricular Acupuncture (or AA) therapy. Our aims were to evaluate NCT efficiency as viable diagnostic option to identify the most appropriate AA acupoints to be selected for SupraSpinatus Tendinopathy (SST) associated shoulder pain treatment and to evaluate which auricle area has greater concentration of NCT positive acupoints in subjects with SST shoulder pain, comparing results with available AA ear maps. 45 subjects with SST diagnosis were enrolled. On 30 subjects in treatment group, NCT was performed on acupoints of the auricle shoulder representation areas (i.e., Scaphoid Fossa), while in 15 subjects of control group, NCT was performed on auricle areas not shoulder associated. Statistically significant lower Numeric Pain Rating Scale scores were seen for study group over time and compared to control. A small sample showed statistically significant increase of SST shoulder maximum abduction range of Movements. NCT identified best SST shoulder pain AA acupoints in Scaphoid Fossa (or SF1 and SF2). In conclusion NCT is a viable tool to efficiently identify the best AA acupoints in SST shoulder pain treatment.

Effect of Low- and High-Frequency Auricular Stimulation with Electro-Acupuncture on Cutaneous Microcirculation: A Cross-Over Study in Healthy Subjects.

Background: The regulation of microcirculation depends on the dynamic interaction of different factors: the autonomic nervous system plays a pivotal role in the blood flow and acupuncture can modulate it, obtaining different results depending on the site, the frequency, and the intensity of the stimulation. Methods: 18 healthy subjects have been enrolled and have undergone two sessions of electroacupuncture stimulations: one session using high frequency and one with low frequency. Microcirculation has been monitored continuously during stimulation using the laser Doppler method. Results: The microcirculatory parameters have shown a significant difference between high and low-frequency stimulation, suggesting that low-frequency stimulation is more effective for obtaining a vasodilator effect. Discussion: Our results show that low-frequency stimulation can increase the cutaneous microcirculatory flux, without significantly modifying blood pressure and heart rate. The auricular stimulation causes an increase in the activity of the vagus nerve, increasing the cholinergic activity without acting on post-junctional muscarinic receptors. Conclusion: Auricular acupuncture has a significant impact on the regulation of microcirculation.

The Medial Surface of the Auricle: Historical and Recent Maps. What Are the Possible Expectations of the "Thumb-Index Technique".

INTRODUCTION: The medial surface of the auricle (MSotA), as compared to the lateral, has been less studied and has limited consensus among schools of auricular acupuncture (AA) due to its small size, greater difficulty in carrying out an adequate physical examination on it, and less precise and limited agreement on its anatomical references as compared to the lateral surface. The thumb-index technique TIT is performed using a guiding finger (taking advantage of the anatomical conformation of the lateral surface) to guide the explorer finger (placed on the MSotA) to project the therapeutic areas and land marks on the MSotA. TIT could be considered useful and effective in AA to make the most of diagnostic and therapeutic MSotA potential. METHODS: An investigation was carried out on the impact of TIT in AA practice through a survey collected from former AA students. RESULTS: TIT showed a high consensus, and is used and appreciated by AA practitioners. Discussion/ Conclusions: To date, in AA, there is no thoroughly shared nomenclature for MSotA. TIT is simple and quick to project on to MSotA the well-coded lateral surface auricular maps from French or Chinese AA schools.

Diaphragm Ultrasound: A Valuable Predictor of the Outcome of Extubation. An Observational Pilot Study in Covid-19 Related ARDS.

Introduction: Because both early and delayed weaning are associated with increased mortality, longer stay in the ICU and higher economic costs, performing extubation once the patient can cope with the respiratory load is completely recommended. Ultrasound Sonography (US) is an available bedside tool that allows a rapid assessment and visualization of the different structures involved in spontaneous breath. M-mode ultrasonography can be useful for the assessment of diaphragm kinetics, providing valuable information about diaphragm disfunction. Aim of the Study: The aim of this study is to find a correlation between the value of the acceleration of the diaphragm detected with the US M-mode and the outcome of the weaning. Materials and Methods: We have enrolled 19 patients admitted in our ICU. Each patient underwent the trial with the ultrasound M-mode to assess the acceleration of the diaphragm during the contraction. We have analyzed the results relating them to the outcome of the weaning. Results: While 11 of our patients have had a successful weaning, 8 have failed it, and we can see that the outcome is associated to the values of acceleration. Discussion: Our study has demonstrated that an assessment of the diaphragm function using US could represent a usable and effective technique as the acceleration is related to the force generated by the diaphragm contraction. Conclusions: In conclusion, the acceleration could be a useful parameter to consider when it comes to the prediction of the outcome of the weaning process.

Analytical Characterization of 3-MeO-PCP and 3-MMC in Seized Products and Biosamples: The Role of LC-HRAM-Orbitrap-MS and Solid Deposition GC-FTIR.

Among the phencyclidine (PCP) and synthetic cathinone analogs present on the street market, 3-methoxyphencyclidine (3-MeO-PCP) is one of the most popular dissociative hallucinogen drugs, while 3-methylmethcathinone (3-MMC) is a commonly encountered psychostimulant. Numerous 3-MeO-PCP- and 3-MMC-related intoxication cases have been reported worldwide. Identification of the positional isomers of MeO-PCP and MMC families are particularly challenging for clinical and forensic laboratories; this is mostly due to their difficult chromatographic separation (particularly when using liquid chromatography-LC) and similar mass spectrometric behaviors. 3-MeO-PCP and 3-MMC were identified in two powders, detained by two subjects and seized by the police, by different analytical techniques, including liquid chromatography-high-resolution accurate-mass Orbitrap mass spectrometry (LC-HRAM-Orbitrap-MS), and solid deposition gas chromatography-Fourier transform infrared spectroscopy (sd-GC-FTIR). LC-HRAM-Orbitrap-MS allowed us to assign the elemental formulae C18H27NO (MeO-PCP) and C11H15NO (MMC) through accurate mass measurement of the two MH+ ions, and the comparison of experimental and calculated MH+ isotopic patterns. However, MH+ collision-induced product ions spectra were not conclusive in discriminating between the positional isomers [(3-MeO-PCP vs. 4-MeO-PCP) and (3-MMC vs. 4-MMC and 2-MMC)]. Likewise, sd-GC-FTIR easily allowed us to differentiate between the MeO-PCP and MMC positional isomers unambiguously, confirming the presence of 3-MeO-PCP and 3-MMC, due to the high-quality match factor of the experimental FTIR spectra against the target FTIR spectra of MeO-PCP and MMC isomers in a dedicated library. 3-MeO-PCP (in contrast to 3-MMC) was also detected in blood and urine samples of both subjects and analyzed in the context of routine forensic casework by LC-HRAM-Orbitrap-MS following a simple deproteinization step. In addition, this untargeted approach allowed us to detect dozens of phase I and phase II 3-MeO-PCP metabolites in all biological specimens. Analysis of the extracted samples by sd-GC-FTIR revealed the presence of 3-MeO-PCP, thus confirming the intake of such specific methoxy-PCP isomer in both cases. These results highlight the effectiveness of LC-HRAM-Orbitrap-MS and sd-GC-FTIR data in attaining full structural characterization of the psychoactive drugs, even in absence of reference standards, in both non-biological and biological specimens.

Review of computed tomographic colonography from a surgeon's perspective.

New research has addressed many of the early concerns of computed tomographic colonography (CTC) and these studies are now beginning to shape clinical practices. A review of the literature demonstrates that the sensitivity of CTC in screening for large polyps (>/= 1cm) or cancers in the large intestine is as high as that of conventional optical colonoscopy, however, the sensitivity decreases with the diameter of the polyp. Despite this, CTC is well tolerated, more acceptable to patients than optical colonoscopy and therefore may improve colorectal cancer screening compliance. This review not only describes the diagnostic accuracy and sensitivity of CTC, and the evolving role of CTC as a primary colon cancer screening option, but also the recent studies that have demonstrated the additional value of CTC utilization for practicing clinicians.

3,5,11 needles: looking for the perfect number of needles--a randomized and controlled study.

Acupuncture has been successfully used in myofascial pain syndromes. However, the number of needles used, i.e. the "dose" of acupuncture stimulation, to obtain the best antinociceptive efficacy, is still a matter of debate. The question was addressed comparing the clinical efficacy of 3 different therapeutic schemes, mainly characterized by different numbers of needles used on 90 patients affected by a painful cervical myofascial syndrome. Patients were divided into 3 groups; the first group of 30 patients was treated with 11 needles, the second group of 30 patients was treated with 5 needles and the third group of 30 patients was treated with 3 needles. Each group underwent eight cycles of somatic acupuncture. In each session and in each group, all needles were stimulated until the pain tolerance threshold was reached; "pain tolerance is the amount of pain a person can handle without breaking down, either physically or emotionally". Pain intensity was evaluated before therapy, immediately after, and at 1 and 3 months follow-up by means of both the Mc Gill Pain Questionnaire and the Visual Analogue Scale (VAS). Pain and the repercussion of pain on the patient's quality of life (DOPE- Descriptors Of Pain Effects) were also measured using a test we developed, administered at each session. In all groups, needles were inserted superficially, except for the two most painful trigger points that were deeply inserted. All groups, independently from the number of needles used, obtained a good and significant therapeutic effect without clinically relevant differences among groups. For this pathology and patients of this kind, the number of needles, 3 or 5 or 11, seems not to be an important variable in determining the therapeutic effect.

Diabetes mellitus and colorectal cancer prognosis: a meta-analysis.

BACKGROUND: Diabetes mellitus is associated with an increased incidence of colorectal cancer, but the impact of diabetes mellitus on colorectal cancer prognosis is not clear. OBJECTIVE: We conducted a meta-analysis of observational studies to examine the association between preexisting diabetes mellitus and colorectal cancer all-cause mortality, cancer-specific mortality, and recurrence. DATA SOURCES: Medline and Embase were searched through August 22, 2012. STUDY SELECTION: We included studies reporting all-cause mortality, cancer-specific mortality, disease-free survival, or recurrence in patients who have colorectal cancer according to diabetic status. INTERVENTION: Meta-analyses were performed by the use of random-effects models. MAIN OUTCOME MEASURES: The primary outcomes measured were all-cause mortality, cancer-specific mortality, and disease-free survival. RESULTS: Twenty-six articles met our inclusion criteria. Patients with colorectal cancer who had diabetes mellitus had a 17% increased risk of all-cause mortality (relative risk, 1.17; 95% CI, 1.09-1.25) and a 12% increased risk of cancer-specific mortality (relative risk, 1.12; 95% CI, 1.01-1.24) in comparison with those who did not have diabetes mellitus. Those with diabetes mellitus also had poorer disease-free survival (relative risk, 1.54; 95% CI, 1.08-2.18) compared with their nondiabetic counterparts. In subgroup analyses, diabetes mellitus was associated with all-cause mortality in both rectal (relative risk, 1.24; 95% CI, 1.07-1.29) and colon cancer patients (relative risk, 1.17; 95% CI, 1.07-1.29). Sensitivity analyses including only patients with nonmetastatic disease identified stronger associations between diabetes mellitus and both all-cause (relative risk, 1.32; 95% CI, 1.21-1.44) and cancer-specific (relative risk, 1.27; 95% CI, 1.06-1.52) mortality. LIMITATIONS: Some studies had short follow-up or did not report mean or median follow-up. The included studies were heterogeneous in study population, diabetes mellitus diagnostic criteria, and outcome ascertainment. CONCLUSION: Patients with colorectal cancer who have diabetes mellitus are at greater risk for all-cause and cancer-specific mortality and have worse disease-free survival than those who do not have diabetes mellitus. Studies are warranted to determine whether the proper treatment could attenuate the excess mortality among patients with colorectal cancer who have diabetes mellitus.

Immunolocalization of DCAMKL-1, a putative intestinal stem cell marker, in normal colonic tissue.

Doublecortin and CaM kinase-like-1 (DCAMKL-1) is a microtubule-associated protein kinase which has been recently proposed as a gastrointestinal stem cell marker. The aim of our study was to characterize DCAMKL-1 expression in normal human colon by immunohistochemistry. DCAMKL-1 immunostaining was performed on histologically normal colorectal biopsies from 14 patients. Immunoreactivity was found in over 60% of colonic crypts and was represented by strong cytoplasmic staining, anti-luminal in distribution, and was reminiscent of cytoplasmic orientation of neuroendocrine cells. The highest number (48.5%) of DCAMKL-1 positive cells was found in the first 4 cells from the crypt base. Seventy percent of DCAMKL-1 positive cells were located in the lower third of the crypt, 26% in the middle third and 4% in the upper third. Therefore, in normal colonic mucosa, expression of DCAMKL-1 is not confined to the stem cell compartment. When we compared DCAMKL-1 immunostaining with that of the leucine-rich-repeat-containing G-protein-coupled receptor 5 (Lgr5), an intestinal stem cell marker, and chromogranin-A (CgA), an enteroendocrine cell marker, we found that DCAMKL-1 positive cells co-stained with Lgr5 only at the crypt base, but co-stained with CgA throughout the crypt. Our findings suggest that DCAMKL-1 marks a subset of colorectal stem cells, as well as a subset of enteroendocrine cells.

DCLK1 immunoreactivity in colorectal neoplasia.

INTRODUCTION: Microtubule-associated doublecortin and CaM kinase-like-1 (DCLK1) is a novel candidate marker for intestinal stem cells. The aim of our study was to assess DCLK1 immunoreactivity in colorectal carcinogenesis and its correlation with prognosis. METHODS: DCLK1 immunostaining was performed in colorectal tissue from 71 patients, including 18 adenomatous polyps, 40 primary adenocarcinomas, and 14 metastatic lesions. Each case was evaluated by a combined scoring method based on the intensity of staining (score 0-3) and the percentage of tissue staining positive (score 0-3). Immunoexpression for DCLK1 was considered as positive when the combined score was 2-6 and negative with a score of 0-1. RESULTS: Overall, 14/18 (78%) of polyps, 30/40 (75%) of primary adenocarcinomas, and 7/14 (50%) of distant metastases were positive for DCLK1. In adenomatous polyps and primary cancer there was no association between DCLK1 staining score and tumor pathology. However, after curative colorectal cancer resection, patients whose tumor had a high (≥5) combined staining score had increased cancer-specific mortality compared to patients with low (0-4) staining score (hazard ratio 5.89; 95% confidence interval: 1.22-28.47; P = 0.027). CONCLUSION: We found that DCLK1 is frequently expressed in colorectal neoplasia and may be associated with poor prognosis. Further studies are necessary to validate the use of DCLK1 as a prognostic marker.

Somatic acupuncture versus ear acupuncture in migraine therapy: a randomized, controlled, blind study.

This study compares the clinical effectiveness of somatic and ear acupuncture for treatment of migraine without aura. 35 patients were divided into 2 groups, one receiving somatic and the other ear acupuncture. Both groups were treated once a week for 8 weeks and needles were stimulated manually. The severity of pain was evaluated with the Migraine Index and the visual analogue of Scott-Huskisson; other 2 tests were used to monitor the pain threshold and Zung's Self-rating Depression Scale was applied to assess variations in patients' mood. These tests were performed before the beginning and at the end of treatment and, for the follow up, after 1, 3 and 6 months from the end of therapy. On the basis of the migraine index, pain at the end of therapy was significantly lower than before the treatment, being residual pain 54.83% and 63.43%, respectively for somatic and ear acupuncture. Apparently, the 2 treatments were equally effective, as no significant difference could be assessed. On the contrary, a significant difference between the 2 groups was clear during the follow up: in fact, after 6 months residual pain was 16.80% and 48.83% for somatic and ear acupuncture, respectively (p=0.038). These results were confirmed by the Visual Analogue Scale (VAS) test and by the evaluation of pain threshold. It is noteworthy that also Zung's depression test showed a significant decrease of score was present in both groups, at all the times investigated with no difference between the two treatments. These results, though preliminary, are quite promising in supporting the effectiveness of ear acupuncture for treatment of migraine without aura.

Neck pain treatment with acupuncture: does the number of needles matter?

OBJECTIVES: Acupuncture has been successfully used in myofascial pain syndromes. However, the number of needles used, that is, the dose of acupuncture stimulation, to obtain the best antinociceptive efficacy is still a matter of debate. The question was addressed comparing the clinical efficacy of two different therapeutic schemes, characterized by a different number of needles used on 36 patients between 29-60 years of age with by a painful cervical myofascial syndrome. METHODS: Patients were divided into two groups; the first group of 18 patients were treated with 5 needles and the second group of 18 patients were treated with 11 needles, the time of needle stimulation was the same in both groups: 100 seconds. Each group underwent six cycles of somatic acupuncture. Pain intensity was evaluated before, immediately after and 1 and 3 months after the treatment by means of both the Mc Gill Pain Questionnaire and the Visual Analogue Scale (VAS). In both groups, the needles were fixed superficially excluding the two most painful trigger points where they were deeply inserted. RESULTS: Both groups, independently from the number of needles used, obtained a good therapeutic effect without clinically relevant differences. CONCLUSIONS: For this pathology, the number of needles, 5 or 11, seems not to be an important variable in determining the therapeutic effect when the time of stimulation is the same in the two groups.

Long-term oncologic results and complications after preoperative chemoradiotherapy for rectal cancer: a single-institution experience after a median follow-up of 95 months.

BACKGROUND: This study sought to evaluate the long-term outcome and complications, and occurrence of second malignancy after preoperative chemoradiotherapy (pCRT) for rectal cancer. METHODS: One hundred twenty-three consecutive patients (78 men, 45 women) with locally advanced mid-low rectal cancer underwent pCRT between 1994 and 2002. Patients were followed up by one surgeon with a standard protocol, and data were prospectively recorded in a dedicated database. No patient was lost to follow-up. Complications were defined as late if they occurred >6 months after surgery. Overall and disease-free survival were calculated by the Kaplan-Meier method. RESULTS: Of 123 patients, 111 underwent an R0 procedure. The rate of pathologic complete response was 16% (n = 20 patients). At a median follow-up of 95 (range, 56-160) months, 50 late complications occurred in 41 patients, 21 of whom required surgery. In seven cases, the complications were clearly CRT related and were significantly associated with the total dose of radiation delivered (P < .05). The estimated 5- and 10-year overall survival was 76% and 67%, respectively. The estimated 5- and 10-year disease-free survival was 83% and 82%, respectively. In 18 of 19 patients who experienced recurrence (local, n = 3; distant, n = 16), it occurred within 48 months from surgery. The most frequent site of metastasis as first site of recurrence was the lung (9 of 19). The most frequent second primary malignancy was lung cancer (3 of 8). CONCLUSIONS: Despite satisfactory oncological outcome, late morbidity after pCRT is relevant and related to the radiotherapy dose used. Most recurrences and second malignancies were located in the lung.

Role of magnified ileoscopy in the diagnosis of cases of coeliac disease with predominant abdominal symptoms.

OBJECTIVE: Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeliac patients. The aim of this work was to assess whether magnified ileoscopy and the corresponding biopsy could be used when diagnosing coeliac disease (CD). This would be of clinical value in coeliac patients who show predominant abdominal symptoms and who undergo colonoscopy with ileoscopy as first clinical examination. MATERIAL AND METHODS: All patients underwent conventional and magnified ileoscopy, along with histological examination of macroscopic mucosal abnormalities, if present. Patients whose ileoscopy with biopsy suggested CD underwent a blood test for quantitative determination of anti-transglutaminase antibodies and upper gastrointestinal endoscopy with corresponding duodenal biopsy. RESULTS: Out of 143 patients enrolled, 21 had a TI mucosal lesion, and 10 of these showed villous atrophy at ileoscopy only after magnification. Six showed a count of intra-epithelial lymphocytes (IELs) >25/100 enterocytes and upper intestinal lesions, confirming the diagnosis of CD. Finally, of four patients diagnosed with Crohn's disease, TI mucosal aftoid lesions were seen in two only in magnified view. CONCLUSIONS: Magnified ileoscopy reliably recognizes the presence of mucosal villous subtotal or total atrophy at TI. This finding, even if not specific to CD, can address the diagnosis of CD. Magnification in the course of ileoscopy could also be useful in the diagnosis of Crohn's disease.

Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation.

PURPOSE: Obstructed defecation may be treated by stapled transanal rectal resection, but different complications and recurrence rates have been reported. The present study was designed to evaluate stapled transanal rectal resection results, outcome predictive factors, and nature of complications. METHODS: Clinical and functional data of 123 patients were retrospectively analyzed. All patients had symptoms of obstructed defecation before surgery and had rectocele and/or intussusception. Of them, 85 were operated on by the authors and 38 were referred after stapled transanal rectal resection had been performed elsewhere. RESULTS: At a median follow-up of 17 (range, 3-44) months, 65 percent of the patients operated on by the authors had subjective improvement. Recurrent rectocele was present in 29 percent and recurrent intussusception was present in 28 percent of patients. At univariate analysis, results were worse in those with preoperative digitation (P<0.01), puborectalis dyssynergia (P<0.05), enterocele (P<0.05), larger size rectocele (P<0.05), lower bowel frequency (P<0.05), and sense of incomplete evacuation (P<0.05). Bleeding was the most common perioperative complication occurring in 12 percent of cases. Reoperations were needed in 16 patients (19 percent): 9 for recurrent disease. In the 38 patients referred after stapled transanal rectal resection, the most common problems were perineal pain (53 percent), constipation with recurrent rectocele and/or intussusception (50 percent), and incontinence (28 percent). Of these patients, 14 (37 percent) underwent reoperations: 7 for recurrence. Three patients presented with a rectovaginal fistula. One other patient died for necrotizing pelvic fasciitis. CONCLUSIONS: Stapled transanal rectal resection achieved acceptable results at the cost of a high reoperation rate. Patients with puborectalis dyssynergia and lower bowel frequency may do worse because surgery does not address the causes of their constipation. Patients with large rectoceles, enteroceles, digitation, and a sense of incomplete evacuation may have more advanced pelvic floor disease for which stapled transanal rectal resection, which simply removes redundant tissue, may not be adequate. This, together with the complications observed in patients referred after stapled transanal rectal resection, suggests that this procedure should be performed by colorectal surgeons and in carefully selected patients.

The role of the intensity of low frequency electroacupuncture stimulation on the modulation of capsaicin-induced edema in the rat paw. A blind controlled study.

Experimental animal and clinical human data suggest that electroacupuncture (EAP) reduces the release of substance P from sensitive neurons, both at medullar level and in the periphery. Aim of our study is to verify the effect of different intensities of stimulation on edema induced by subcutaneous administration of capsaicin. The study was performed on 72 male Sprague-Dawley rats divided into 4 experimental groups according to the intensity of electrostimulation (5, 10, 50, 70 mA) and a control group. A constant current electrical stimulator delivering positive and negative biphasic wave (duration of one pulse wave complex: 500 microsec; pulse repetition rate: 5/sec) has been used for the stimulation. The lowest intensity of stimulation (5 mA) was effective in the prevention of neurogenic edema. Conversely, higher stimulation intensities, namely 10 and 50 mA, were not effective in reducing edema. Stimulation at 70 mA caused a worsening of edema, probably due to an increased release of substance P in the paw.