[Fecal incontinence: role of anal sphincter rehabilitation]. / Incontinenza fecale: ruolo della riabilitazione.

Fecal incontinence is a highly disabling symptom which causes the patient to gradually abandon all forms of social, family and working relationships. Rehabilitation was adopted initially in cases of surgical failure and considered as being only palliative. In our study we tested an original rehabilitation protocol for faecal incontinence which embraces 3 methods--physio-kinesitherapy, electrostimulation and biofeedback--in what we have called "anal sphincter functional rehabilitation". The study was conducted in 196 patients (61 M, 135 F) mean age 42.9 (range: 11-86), with faecal incontinence of varying aetiology. The 3 methods were carried out simultaneously in 3 one-hour sessions a week. The protocol envisaged 15 consecutive sessions at the end of which a first assessment was made of the results achieved. Therapeutic success was achieved in 93.4% of cases. The results obtained with our protocol do not differ from those reported by other Authors and we can therefore state that functional rehabilitation of the anal sphincter is to be viewed not merely as a valid alternative to surgery, but as the therapy of choice for fecal incontinence.

[Constipation. Proposal for a new classification and therapy]. / Outlet obstruction defecation. Proposta di un nuovo inquadramento e terapia.

The Authors propose a new classification for constipation according to which 84 patients were selected (63 females, 21 males) for a functional rehabilitation programme. Patients were subjected to a diagnostic protocol involving the performance of a number of instrumental tests. Degree and symptomatology of constipation were established by taking the clinical history of the patient. The rehabilitation protocol involved the simultaneous performance of physiokinesitherapy, electrostimulation and biofeedback of the pelvic floor. Patients underwent 3 weekly sessions, each lasting 60 minutes, over a series of 15 consecutive sessions, followed by a series of 6 consecutive sessions every three months. One-year results showed that 77 patients (92%) reported achieving regular intestinal activity with at least one evacuation a day and at intervals of no more than 3 days, and with a modification of faecal consistency and discontinuation of laxatives and/or cathartics. The other 7 patients (8%) continued using laxatives at a minimal dosage but had an improved evacuation rate and faecal consistency. The results show that many patients with constipations can undergo rehabilitation procedures with encouraging and remarkable therapeutic success.

[Pathophysiological and clinical trials of the abdominal compartment syndrome]. / Fisiopatologia e clinica della sindrome compartimentale addominale.

The abdominal compartment syndrome (ACS) is defined a situation of high degrade abdominal hypertension (IAH) with clinicals signs of multiorganic dysfunction. It's observed like in the intensive care, in particular surgycals and postraumatics, there is ever a bigger frequence of complications presented by criticals patients. The various trials remark a changeable incidence, but the common factor is characterized by a particular severity of scores. All the possibles mechanicals, haemorragicals, infiammatories, and postraumatics causes act, but don't enable the stability among abdominal content, abdominal compliance and parietal tension. The initial triad of effects is constitued by the elevation of diaphragm and the visceral and vascular compression; after this triad provoke a pathophysiologic system that, through various levels, bring to a respiratory, renal and cardiocirculatory dysfunction and to a parietal, hepatic and intestinal ischemia with consequent bacterical translation: sepsis and MOF. The Burch's classification (1996) report four levels of gravity by the slight (< 15 mmHg) to the heavyest (> 35 mmHg): the firsts two levels are of intensivistic competence and for the detention are used conservatives metodics and pharmacological approach; instead in the lasts two levels it's necessary to foresee a surgycal treatment of laparotomy, washing and drainage with following temporary paret's closure. The mortality is now very elevated (29-62%) especially when it's already established a multiorganical dysfunction; therefore it's necessary forward its appearance through the monitorization of abdominal pression (IAP) with the measurement of vescical pression in alls criticals patients at the aim to treat immediately the firsts signs of IAH.

[Emergency surgery for colorectal cancer: our experience]. / Le neoplasie del grosso intestino in urgenza: nostra esperienza.

Colorectal cancers have an extremely negative prognosis in the elderly, with a high percentage of clinical presentations requiring emergency surgery and high perioperative mortality rates. The clinical manifestations of this type of cancer set in a cutely in 20% of cases due to the sudden onset of one of the basic complications. The authors report on their experience with 79 patients undergoing emergency surgery for colorectal cancer. The choice of operation was made on the basis of the patient's general condition, as estimated by his or her ASA score, and the presence of associated diseases.