ABSTRACT
AIM: Management of faecal incontinence (FI) remains challenging because no definitive optimal treatment for this condition has yet been determined. Regenerative medicine could be an attractive therapeutic alternative for treating FI. Here, we aimed to determine the safety and feasibility of autologous expanded mesenchymal stem cells derived from adipose tissue (AdMSCs) in the treatment of patients diagnosed with structural FI. METHOD: This was a randomized, multicentre, triple-blinded, placebo-controlled pilot study conducted at four sites in Spain with 16 adults with FI and a sphincter defect. Autologous AdMSCs were obtained from patients from surgically excised adipose tissue. These patients were intralesionally infused with a single dose of 4 × 107 AdMSCs or a placebo while under anaesthesia. We assessed the safety and feasibility of the treatment as the cumulative incidence of adverse events and the treatment efficacy using the Cleveland Clinic Faecal Incontinence Score, Faecal Incontinence Quality of Life score and Starck criteria to classify sphincter defects and anorectal physiology outcomes. RESULTS: Adipose tissue extraction, cell isolation and intralesional infusion procedures were successful in all the patients. There was only one adverse event connected to adipose tissue extraction (a haematoma), and none was associated with the injection procedure. There were no significant differences in any of the assessed clinical, manometric or ultrasonographic parameters. CONCLUSION: This study indicates that this infusion procedure in the anal sphincter is feasible and safe. However, it failed to demonstrate efficacy to treat patients with structural FI.
Subject(s)
Fecal Incontinence , Mesenchymal Stem Cells , Anal Canal , Double-Blind Method , Fecal Incontinence/therapy , Humans , Pilot Projects , Quality of LifeABSTRACT
Colonic fistulas in an open wound are always a challenge for colorectal surgeons, and this report provides a technique for the appropriate management of these cases. We communicate the use of a negative pressure dressing therapy as part of the palliative care for a patient following the development of an enterocutaneous fistula. The use of this therapy allowed us to keep the patient clean and comfortable during the last few days of his life.
Subject(s)
Colonic Diseases/therapy , Intestinal Fistula/therapy , Negative-Pressure Wound Therapy , Surgical Wound Dehiscence/surgery , Aortic Aneurysm/surgery , Biliary Fistula/surgery , Blood Vessel Prosthesis Implantation , Fatal Outcome , Humans , Male , Middle Aged , Palliative Care , Postoperative Complications/surgeryABSTRACT
Los adenomas hepatocelulares son tumores muy infrecuentes, benignos y se describen como lesiones solitarias. Se han asociado al uso de anabolizantes, anticonceptivos orales y a las enfermedades causadas por la acumulación de glucosa.La adenomatosis hepática se considera una entidad distinta del adenoma hepatocelular, caracterizada por la presencia de lesiones múltiples y por no tener relación con los factores hormonales y metabólicos antes descritos. El propósito de nuestro trabajo es describir el caso de un varón de 25 años, sin historia previa de uso de anabolizantes, que ingresa en el hospital por presentar un dolor abdominal agudo debido a la rotura espontánea de un adenoma hepático. El paciente requirió cirugía urgente, y se realizó una hepatectomía derecha y una resección de otro nódulo presente en el segmento II. El examen histológico (mostró 5 nódulos) posibilitó el diagnóstico de adenomatosis hepática. Revisamos la bibliografía para documentarnos sobre los casos de varones (11 casos descritos) con adenomatosis hepática, su presentación clínica y su tratamiento (AU)
