SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up.

PURPOSE: This study evaluated the long-term (5-year) durability of radiofrequency energy delivery for fecal incontinence. METHODS: This was an extension of the follow-up from our original prospective study in which patients who suffered from fecal incontinence were treated with the SECCA system for radiofrequency energy delivery to the anal canal muscle. The Cleveland Clinic Florida Fecal Incontinence Scale (0-20), fecal incontinence-related quality of life score, and Medical Outcomes Study Short-Form 36 were administered to five years. Differences between baseline and follow-up were analyzed by using paired t-test. RESULTS: A total of 19 patients were treated and followed for five years, including 18 females (aged 57.1 (range, 44-77) years). The mean duration for fecal incontinence was 7.1 (range, 1-21) years. At five-year follow-up, the mean fecal incontinence score had improved from 14.37 to 8.26 (P<0.00025) with 16 patients (84.2 percent) demonstrating>50 percent improvement. All fecal incontinence-related quality of life scores improved, including lifestyle (2.43 to 3.15; P<0.00075), coping (1.73 to 2.6; P<0.00083), depression (2.24 to 3.15; P<0.0002), and embarrassment (1.56 to 2.51; P<0.0003). The social function component of the Short-Form 36 improved from 38.3 to 60 (P<0.05). There was a trend toward improvement in the mental component summary of the Short-Form 36 from 38.1 to 48.14. There were no long-term complications. CONCLUSIONS: Significant and sustained improvements in fecal incontinence symptoms and quality of life are seen at five years after treatment with the SECCA system. This treatment should be considered for patients suffering from fecal incontinence not amenable to surgery and who have failed conservative management.

[First experience in surgical treatment of hemorrhoidal disease using the PPH stapler]. / Experiencia inicial en el tratamiento quirúrgico de la enfermedad hemorroidal con la engrapadora PPH.

BACKGROUND: Haemorrhoidal disease is a frequent entity worldwide. The surgical management is indicated in third or fourth degree internal hemorrhoidal disease. The conventional hemorrhoidectomy has showed good results but the severe postoperative pain is an important complain. Currently diverse surgical alternatives have been described, mainly to avoid the postoperative pain that follows surgical hemorrhoidectomy. One of these new options is the stapled hemorrhoidectomy using the PPH stapler. This procedure may produce less postoperative pain, with a shorter inpatient stay and faster return to work. OBJECTIVE: The aim of this paper is to analyze the results of using the Procedure for Prolapsed Hemorrhoids (PPH) as treatment in Hemorrhoidal Disease. MATERIAL AND METHODS: This is an observational and descriptive study, where 17 patients underwent stapled hemorrhoidectomy with PPH procedure, between March 2000 and August 2003. RESULTS: 52.8% of this patients presented grade three internal hemorrhoids and 47.2% grade four; 52.9% presented mild postoperative pain; 41.2% moderate and 5.9% severe pain. In a short and median follow up, due to the persistence of hemorrhoidal disease symptoms two patients required surgical re-intervention. Two more patients presented incontinency. One patient presented stenosis in the line of staples treated satisfactory with an anal dilatation session. CONCLUSIONS: The use of PPH is a feasible and safe procedure and it could be a surgical alternative in the treatment of hemorrhoidal disease, even before than conventional hemorrhoidectomy.

Experiencia inicial en el tratamiento quirúrgico de la enfermedad hemorroidal con la engrapadora PPH / First experience in surgical treatment of hemorrhoidal disease using the PPH stapler

Background. Haemorrhoidal disease is a frequent entity worldwide. The surgical management is indicated in third or fourth degree internal hemorrhoidal disease. The conventional hemorrhoidectomy has showed good results but the severe postoperative pain is an important complain. Currently diverse surgical alternatives have been described, mainly to avoid the postoperative pain that follows surgical hemorrhoidectomy. One of these new options is the stapled hemorrhoidectomy using the PPH stapler. This procedure may produce less postoperative pain, with a shorter inpatient stay and faster return to work. Objective. The aim of this paper is to analyze the results of using the Procedure for Prolapsed Hemorrhoids (PPH) as treatment in Hemorrhoidal Disease. Material and methods. This is an observational and descriptive study, where 17 patients underwent stapled hemorrhoidectomy with PPH procedure, between march 2000 and august 2003. Results. 52.8% of this patients presented grade three internal hemorrhoids and 47.2% grade four; 52.9% presented mild postoperative pain; 41.2% moderate and 5.9% severe pain. In a short and median follow up, due to the persistence of hemorrhoidal disease symptoms two patients required surgical re-intervention. Two more patients presented incontinency. One patient presented stenosis in the line of staples treated satisfactory with an anal dilatation session. Conclusions. The use of PPH is a feasible and safe procedure and it could be a surgical alternative in the treatment of hemorrhoidal disease, even before than conventional hemorrhoidectomy.

Introducción. La enfermedad hemorroidal tiene una prevalencia elevada en nuestro medio. El tratamiento quirúrgico está indicado cuando se presenta enfermedad hemorroidal interna grado III y IV. La hemorroidectomía convencional ha demostrado tener buenos resultados; sin embargo, el dolor postoperatorio es un inconveniente frecuente. Por ello se han propuesto otras alternativas entre las que se encuentra la hemorroidectomía con engrapadora (PPH), que puede ocasionar menor dolor postoperatorio y una recuperación más rápida. Objetivo. El objetivo de este trabajo es analizar los resultados a corto y mediano plazos del uso de la engrapadora PPH en la enfermedad hemorroidal. Material y métodos. Se realizó un estudio descriptivo y observacional de 17 pacientes sometidos a tratamiento quirúrgico con engrapadora PPH entre marzo de 2000 a agosto de 2003. Resultados. De los pacientes, 52.8% presentó hemorroides internas grado III y 47.2% grado IV. Presentaron dolor mínimo postoperatorio, 52.9%; 41.2% moderado y 5.9% dolor intenso. Debido a persistencia sintomática dos pacientes fueron reintervenidos quirúrgicamente. Dos más presentaron incontinencia. Un paciente presentó estenosis en la línea de grapas, tratado satisfactoriamente mediante una sesión de dilatación anal. Conclusiones. El empleo de la engrapadora PPH es un método factible y seguro que puede proponerse como una alternativa de elección antes de la hemorroidectomía convencional.

[Surgical treatment for colonic diverticular disease. Experience in the INCMNSZ]. / Tratamiento quirúrgico para la enfermedad diverticular de colon. Experiencia en el INCMNSZ.

BACKGROUND: Even though most patients with colonic diverticular disease respond to conservative management, some patients persist with symptoms or develop complications that require surgery. The objective of this study was to identify main surgical indications for colonic diverticular disease, and to evaluate the outcomes of surgical treatment. MATERIALS AND METHODS: A retrospective review of patients that underwent a surgical procedure for colonic diverticular disease from 1979 through 2000, was performed. Surgical indications were acute diverticulitis (54%) (group 1), stenosis (19%), fistula (9.54), recurrent diverticulitis (9.5%) and bleeding (8%) (group 2). Results. Seventy-four patients with a mean age of 56 years were studied. Fifty-eight percent were male. Surgical morbidity and mortality rates of acute diverticulitis were 55%, and 15%, respectively. The surgical procedures of this group were proximal stomas (45%), Hartmann's procedures (38%), and resections with primary anastomosis (17%). Second group morbidity and mortality rates were 35 and 5.8%, respectively. Thirty-six patients underwent two or more surgical procedures with statistical significance between first and second groups (61 vs. 28%; p < 0.05). The mortality of two-stage surgeries was lower than derivative procedures (13 vs. 22%; p = 0.009). A high Hinchey's score was the only factor associated with mortality (28.5 vs. 0%; p = 0.042). CONCLUSIONS: Mortality of surgical procedures for colonic diverticular disease is associated with a high Hinchey score. Primary anastomosis is o safe, procedure in some cases.

Morbilidad y mortalidad de la reconexión colorrectal posterior al procedimiento de Hartmann / Morbi-mortality of Hartmann's reversal procedure

Introducción: el procedimiento de Hartmann es una alternativa de tratamiento para cirugías colorrectales de emergencia, sin embargo, su reconexión es difícil y propensa a complicaciones. Se ha propuesto que un periodo de tiempo mayor entre el procedimiento inicial y la reconexión puede disminuir las complicaciones. El objetivo de esta investigación es determinar la morbilidad y mortalidad de la reconexión posHartmann, y analizar la presencia de factores de riesgo para complicaciones. Material y métodos: se analizaron retrospectivamente 48 pacientes cuyas edades oscilaron entre 57 ± 16 años, de los cuales 19 (40 %) eran mayores de 65 años y 21 (44 %) tenían enfermedades crónicas concomitantes. Se buscaron factores de morbilidad y mortalidad con prueba U de Mann- Whitney y prueba exacta de Fisher. Resultados: la indicación más frecuente del procedimiento fue la diverticulitis aguda (42 %). El periodo entre el procedimiento de Hartmann y la reconexión fue de ocho meses, con un rango de 1 a 46 meses. La duración aproximada de la cirugía de reconexión fue de 267 minutos (rango de 120 a 540). Se presentaron complicaciones en 29 pacientes (60 %), incluyendo fístulas de la anastomosis en seis (12 %) y muerte en cuatro (8 %). No se asociaron mayores complicaciones o más tiempo quirúrgico, con un intervalo de tiempo menor entre el procedimiento de Hartmann y la reconexión. Conclusiones: la reconexión posHartmann es un procedimiento con alta morbilidad y mortalidad, sin que se asocie al intervalo de tiempo entre el procedimiento y la reconexión.

BACKGROUND: Hartmann's operation is an alternative for emergency colorectal surgeries, but its reversal may be difficult and prone to complications. A longer interval for its reversal has been recommended to decrease complications. METHODS: In order to determine rates of morbi-mortality and to ascertain the association between the time interval for its reversal and presence of complications, we undertook a retrospective analysis of 48 patients with a mean age of 57 +/- 16 years. Nineteen patients (40%) were >65 years, and 21 (44%) had one or more underlying chronic disease. Perioperative factors associated with morbi-mortality were determined by means of the Mann-Whitney U test and Fisher exact test. RESULTS: Acute diverticulitis was the most frequent indication (42%). Mean interval between Hartmann's operation and its reversal was 8 months (range: 1 to 46 months). Mean duration of the reversal operation was 267 min (range: 120 to 540 min). There were complications in 29 patients (60%) including anastomotic leaks in 6 (12%) and operative deaths in 4 (8%). A shorter interval between Hartmann's operation and its reversal was not associated with more complications or longer surgical time. CONCLUSIONS: Hartmann's reversal operation has high rates of morbidity and mortality that are not influenced by the time interval from the original operation.

[Single-layer colonic anastomoses using polyglyconate (Maxon) vs. two-layer anastomoses using chromic catgut and silk. Experimental study]. / Anastomosis colónicas en una sola capa continua con poligliconato (maxon) vs. anastomosis en dos capas con catgut cró6mico y seda. Estudio experimental.

BACKGROUND: The safety of an intestinal anastomosis is usually measured by its complication rate, especially the incidence of anastomotic leakage. A wide variety of methods have been described to reestablish intestinal continuity including single-layer continuous or two-layer interrupted anastomosis. OBJECTIVES: To evaluate if the single-layer continuous anastomosis using polygluconate is safer and reliable than two-layer interrupted anastomosis with chromic catgut and silk. MATERIAL AND METHODS: A prospective, experimental, randomized and comparative analysis was conducted in 20 dogs. They were divided in two groups; group 1 underwent two-layer interrupted anastomosis and group 2 underwent sigle-layer continuous technique. Anastomoses were timed. Both groups were under observation. Anastomotic leakage, and other complications were evaluated. The animals were sacrified and the anastomosis was taken out together with 10 cm of colon on both sides of the anastomosis. Breaking strength, histologic evaluation and hydroxyproline determination were performed. RESULTS: Ten two-layer anastomosis and ten single-layer anastomosis were performed. A median of 25 minutes (range: 20-30 minutes) was required to construct the anastomoses in group 1 versus 20 minutes (range: 12-25 minutes) in group 2. All animals survived and no leakage was observed. Wound infection ocurred in four dogs (20%). Median breaking strength was 230 mm Hg in group 1 and 210 mm Hg in group 2. Hydroxyproline concentration was 8.94 mg/g in group 1 (range: 5.33-16.71) and 9.94 mg/g in group 2 (range: 2.96-21.87). There was no difference among groups about the inflammatory response evaluated by pathology. There was no statistical significance in any variable evaluated. CONCLUIONS: This study demonstrates that a single-layer continuous is similar in terms of safety to the two-layer technique, but because of its facility to perform, the single-layer technique could be superior.

Tratamiento quirúrgico para la enfermedad diverticular de colon: Experiencia en el INCMNSZ / Surgical treatment for colonic diverticular disease: Experience in the INCMNSZ

Background. Even though most patients with colonic diverticular disease respond to conservative management, some patients persist with symptoms or develop complications that require surgery. The objective of this study was to identify main surgical indications for colonic diverticular disease, and to evaluate the outcomes of surgical treatment. Materials and methods. A retrospective review of patients that underwent a surgical procedure for colonic diverticular disease from 1979 through 2000, was performed. Surgical indications were acute diverticulitis (54%) (group 1), stenosis (19%), fistula (9.5%), recurrent diverticulitis (9.5%) and bleeding (8%) (group 2). Results. Seventy-four patients with a mean age of 56 years were studied. Fifty-eight percent were male. Surgical morbidity and mortality rates of acute diverticulitis were 55%, and 15%, respectively. The surgical procedures of this group were proximal stomas (45%), Hartmann's procedures (38%) and resections with primary anastomosis (17%). Second group morbidity and mortality rates were 35 and 5.8%, respectively. Thirty-six patients underwent two or more surgical procedures with statistical significance between first and second groups (61 vs. 28%; p < 0.05). The mortality of two-stage surgeries was lower than derivative procedures (13 vs. 22%; p = 0.009). A high Hinchey's score was the only factor associated with mortality (28.5 vs. 0%; p = 0.042). Conclusions. Mortality of surgical procedures for colonic diverticular disease is associated with a high Hinchey score. Primary anastomosis is a safe procedure in some cases.

Antecedentes. Aunque la mayoría de pacientes con enfermedad diverticular de colon responde al manejo conservador, algunos persisten con síntomas o presentan complicaciones que requieren cirugía. El objetivo de esta revisión fue identificar las indicaciones quirúrgicas para la enfermedad diverticular de colon y evaluar los resultados en el manejo quirúrgico de la misma. Material y métodos. Se realizó una revisión retrospectiva de pacientes sometidos a cirugía por enfermedad diverticular de colon de 1979 al 2000. Las indicaciones de cirugía fueron diverticulitis aguda (54%) (grupo 1), estenosis (19%), fístula (9.5%), diverticulitis recurrente (9.5%) y hemorragia (8%) (grupo 2). Resultados. Se estudiaron un total de 74 pacientes con una edad promedio de 56 años. Cincuenta y ocho por ciento fueron del sexo masculino. La morbilidad de los pacientes operados por diverticulitis aguda fue de 55% y la mortalidad de 15%. El tipo de cirugías en este grupo fueron estomas derivativos (45%), procedimientos de Hartmann (38%) y resecciones con anastomosis primaria (17%). La morbilidad y la mortalidad de las cirugías del segundo grupo fueron de 35 y 5.8%, respectivamente. Treinta y seis pacientes tuvieron dos o más operaciones, con diferencia significativa al comparar el grupo 1 con el grupo 2 (61 vs. 28%; p < 0.05). La mortalidad de los pacientes que tuvieron un procedimiento resectivo fue menor que cuando se desfuncionalizó (13 vs. 22%; p - 0.009). El único factor asociado con mortalidad fue un Hinchey elevado (28.5 vs. 0%; p - 0.042). Conclusiones. La mortalidad de la cirugía para complicaciones de la enfermedad diverticular de colon se asocia a un grado de Hinchey elevado. La resección con anastomosis primaria es un procedimiento seguro en casos seleccionados.

Anastomosis colónicas en una sola capa continua con poligliconato (maxon) vs. anastomosis en dos capas con catgut crómico y seda: Estudio experimental / Single layer colonic anastomoses using maxon vs. two layer anastomoses using chromic catgut and silk: structured abstract

Background. The safety of an intestinal anastomosis is usually measured by its complication rate, especially the incidence of anastomotic leakage. A wide variety of methods have been described to reestablish intestinal continuity including single-layer continuous or two-layer interrupted anastomosis. Objectives. To evaluate if the single-layer continuous anastomosis using polygluconate is safer and reliable than two-layer interrupted anastomosis with chromic catgut and silk. Material and methods. A prospective, experimental, randomized and comparative analysis was conducted in 20 dogs. They were divided in two groups; group 1 underwent two-layer interrupted anastomosis and group 2 underwent sigle-layer continuous technique. Anastomoses were timed. Both groups were under observation. Anastomotic leakage, and other complications were evaluated. The animals were sacrified and the anastomosis was taken out together with 10 cm of colon on both sides of the anastomosis. Breaking strength, histologic evaluation and hydroxyproline determination were performed. Results. Ten two-layer anastomosis and ten single-layer anastomosis were performed. A median of 25 minutes (range: 20-30 minutes) was required to construct the anastomoses in group 1 versus 20 minutes (range: 12-25 minutes) in group 2. All animals survived and no leakage was observed. Wound infection ocurred in four dogs (20%). Median breaking strength was 230 mm Hg in group 1 and 210 mm Hg in group 2. Hydroxyproline concentration was 8.94 mg/g in group 1 (range: 5.33-16.71) and 9.94 mg/g in group 2 (range: 2.96-21.87). There was no difference among groups about the inflammatory response evaluated by pathology. There was no statistical significance in any variable evaluated. Conclusions. This study demonstrates that a single-layer continuous is similar in terms of safety to the two-layer technique, but because of its facility to perform, the single-layer technique could be superior.

Antecedentes. Una de las preocupaciones más importantes en cirugía colorrectal es la presencia de dehiscencia o fístula de la anastomosis. Múltiples técnicas han sido descritas para realizar anastomosis, entre las que se incluyen las anastomosis en una sola capa o en dos capas. Objetivos. Evaluar si la anastomosis colonica en una capa con poligliconato es más segura y efectiva que la anastomosis colonica en dos capas con catgut crómico y seda. Material y métodos. Se llevó a cabo un estudio prospectivo, experimental, aleatorio y comparativo en 20 perros. Se dividieron a los animales en dos grupos; grupo 1: anastomosis en dos capas y grupo 2: anastomosis en una sola capa. Se evaluó el tiempo de duración de la anastomosis. Todos los animales se mantuvieron en observación evaluando datos de complicaciones como fístulas colocutáneas o dehiscencia de la anastomosis. En el día diez del postoperatorio se sacrificaron. Se resecó el segmento de la anastomosis abarcando 10 cm proximales y 10 cm distales. Se midió la presión de ruptura, se realizó análisis histopatológico y se determinó la cantidad de hidroxiprolina de la línea de la anastomosis. Resultados. Se incluyeron diez perros en el grupo 1 y diez perros en el grupo 2. La mediana del tiempo de duración de la anastomosis en el grupo 1 fue de 25 minutos (rango: 20-30 minutos) y en el grupo 2 de 20 minutos (rango: 12-25 minutos) (p = NS). No se presentaron datos de fístula, dehiscencia o estenosis de la anastomosis. Cuatro perros presentaron infección en la herida. La presión de ruptura del grupo 1 fue de 230 mm Hg (115-360) y del grupo 2 fue de 210 mm Hg (100-300). La concentración de hidroxiprolina en el grupo 1 fue de 8.94 mg/gramo (rango: 5.33-16.71), y en el grupo 2 fue de 9.94 mg/gramo (rango: 2.96-21.87). No se encontró diferencia significativa en las variables analizadas. Se comparó el grado de reacción inflamatoria en ambos grupos, no hubo diferencia estadística. Conclusiones. Los dos procedimientos son seguros y confiables de realizar, aunque por su mayor facilidad, estos datos apoyan la utilización del método de una sola capa.

[Morbi-mortality of Hartmann's reversal procedure]. / Morbilidad y mortalidad de la reconexión colorrectal posterior al procedimiento de Hartmann.

BACKGROUND: Hartmann's operation is an alternative for emergency colorectal surgeries, but its reversal may be difficult and prone to complications. A longer interval for its reversal has been recommended to decrease complications. METHODS: In order to determine rates of morbi-mortality and to ascertain the association between the time interval for its reversal and presence of complications, we undertook a retrospective analysis of 48 patients with a mean age of 57 +/- 16 years. Nineteen patients (40%) were >65 years, and 21 (44%) had one or more underlying chronic disease. Perioperative factors associated with morbi-mortality were determined by means of the Mann-Whitney U test and Fisher exact test. RESULTS: Acute diverticulitis was the most frequent indication (42%). Mean interval between Hartmann's operation and its reversal was 8 months (range: 1 to 46 months). Mean duration of the reversal operation was 267 min (range: 120 to 540 min). There were complications in 29 patients (60%) including anastomotic leaks in 6 (12%) and operative deaths in 4 (8%). A shorter interval between Hartmann's operation and its reversal was not associated with more complications or longer surgical time. CONCLUSIONS: Hartmann's reversal operation has high rates of morbidity and mortality that are not influenced by the time interval from the original operation.

[Morbi-mortality related to ileostomy and colostomy closure]. / Morbimortalidad asociada al cierre de ileostomía y colostomía en asa.

INTRODUCTION: The main goal of gastrointestinal stomas is to divert the faecal stream from technically difficult anastomoses or intestinal obstruction. Current tendency is to avoid definitive stomas, temporary loop stomas are commonly used to protect high risk anastomosis or sections of the distal bowel. The aim of this study was to determine and compare the morbi-mortality after loop stomas closure. METHODS: Retrolective, observational and comparative study was conducted. The files of patients submitted to loop ileostomy or colostomy closure from 1981 to 2001 were reviewed. Statistical analysis was performed by the Fisher's exact test and the Mann-Whitney U test. RESULTS: From a total of 107 procedures included, 73% were ileostomy closures and 27% colostomy closures. The mean age was 46 years (14-88). Protection of anastomoses was the most common indication in both stoma groups. The colostomy group had a larger interval days between stoma creation and closure than the ileostomy group (172.3 days vs. 125.6 days p = 0.008). Stoma closure was performed by hand sewn sutures in 81.3% patients and by stapled technique in 19.7% patients. The mean operative time for stoma closure was higher for colostomy group than for ileostomy (108.1 min vs. 88.3 min, p = 0.04). Colostomy group patients required a midline abdominal incisions more often than ileostomy group (21.4 vs. 2.5% p = 0.04). Morbidity rates were 7.6% for the ileostomy group and 10.3% for the colostomy group. Colostomy closure required a longer length of stay. There was no mortality. CONCLUSION: The results of this study showed that stoma closure was a well tolerated procedure with low morbidity and no mortality rates. The result suggest that ileostomy closure is a simpler procedure.

Anorectal melanoma: report of three cases with extended follow-up.

Primary anorectal melanoma is rare. There is controversy regarding the best surgical treatment because of its poor prognosis. Three cases with extended follow-up are reported in this article. A 53-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. The patient died with distant metastases 8 months later. An 80-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent a transanal local excision. She remains alive 4 years later but with locally recurrent disease. A 78-year-old man with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. He died with local and metastatic disease 25 months later. Recent trends favor local excision when technically feasible, although some patients may require an abdominoperineal resection of the rectum, especially for larger tumors.

Extended two-year results of radio-frequency energy delivery for the treatment of fecal incontinence (the Secca procedure).

PURPOSE: This study evaluated the durability and long-term safety of radio-frequency energy delivery for fecal incontinence (Secca procedure). METHODS: This was an extended follow-up of a prospective study in which patients with fecal incontinence of various causes underwent radio-frequency energy delivery to the anal canal muscle. The Cleveland Clinic Florida Fecal Incontinence Scale (0-20), fecal incontinence-related quality-of-life score, and Medical Outcomes Study Short Form 36 were administered at baseline and at 1, 2, 3, 6, 12, and 24 months after the procedure. Differences between baseline and follow-up were analyzed with the Wilcoxon signed-rank test. RESULTS: Ten females (aged 55.9 +/- 9.2 (range, 44-74) years) were treated. At two-year follow-up, the mean Cleveland Clinic Florida Fecal Incontinence Scale score was improved from 13.8 to 7.3 (P = 0.002), with eight patients having scores of < or =10. All fecal incontinence-related quality-of-life score parameters were improved, including lifestyle (from 2.3 to 3.3; P = 0.002), coping (from 1.7 to 2.7; P = 0.002), depression (from 2.4 to 3.4; P = 0.004), and embarrassment (from 1.5 to 2.4; P = 0.008). There was no decrement in effect noted in any parameter between 12 and 24 months (P > 0.2). The social function component of the Short Form 36 improved from 50 to 82.5 (P = 0.04), whereas there was an improvement trend for the mental component summary of the Short Form 36 from 38.3 to 48.1 (P = 0.11). Protective pad use was eliminated in four of the seven baseline users. There were no long-term complications, such as stricture, pain, or constipation. CONCLUSIONS: A significant improvement in symptoms of fecal incontinence and quality of life persists two years after radio-frequency delivery to the anal canal, which demonstrates durability of this intervention.

Rigid rectosigmoidoscopy: still a well-tolerated diagnostic tool.

BACKGROUND: Although rigid rectosigmoidoscopy has been gradually replaced by the use of flexible rectosigmoidoscopy in recent years, it remains an effective, economic and widely available diagnostic tool. The aim of this study was to determine the type and magnitude of symptoms during rigid rectosigmodoscopy. METHODS: Prospective evaluation of patients who underwent diagnostic rigid rectosigmoidoscopy. The main complaints were recorded, and their magnitude quantified using a visual analogue scale. RESULTS: A total of 134 patients (mean age = 48 years) were examined. The prone jackknife position was used in 54% of them and left lateral decubitus in 46%. A complete (full length) examination was achieved in 68%. There were no complications. Sixty percent of patients referred complaints: pain (33%), discomfort by rectal preparation (13%), uncomfortable defecation desire (8%), and discomfort by the position (4%). Median values determined by visual analogue scale for pain, discomfort by rectal preparation, uncomfortable positioning and overall discomfort were graded as 3.3, 3.3, 2.1 and 2, respectively. There was an association between higher magnitude of pain and overall discomfort with female gender, left lateral decubitus position, and full-length exploration (p < 0.05). CONCLUSION: A high percentage of patients have symptoms during rigid rectosigmoidoscopy but the study is usually well tolerated due the low magnitude of pain and discomfort and remains a very cost-effective study.

Effect of ulcerative colitis in the bursting strength of colonic anastomoses in rats.

Inflammatory bowel disease may have a deleterious effect on bowel healing, but its role is difficult to demonstrate in clinical practice because of the association of multiple factors. An experiment was conducted in rats. They were divided into two groups: group I, a model of acetic acid induced colitis, and group II, the control group. Both groups underwent a rectal resection and primary anastomosis. On postoperative day 7, the bursting strength of the anastomosis was evaluated. There were 44 rats in group I and 38 in group II. In 91% of group I rats there were histopathological changes compatible with inflammatory bowel disease (IBD). Mean bursting pressure was significantly reduced in rats with acetic-acid induced IBD (142.18 +/- 18.22 mm Hg in group I, and 208.85 +/- 14.8 mm Hg in group II; p < .05). These results suggest the deleterious effect of IBD on bowel healing.

Código de ética en el contexto del proyecto de Reforma Institucional. Caso: Ministerio de Asuntos Campesinos, Indígenas y Agropecuarios / sss

Plantea que el gobierno ha establecido la Unidad Técnica de lucha Contra la Corrupción con la intención de promover el buen gobierno y devolver la confianza de los ciudadanos en sus instituciones, a través del reforzamiento de la ética tanto en la función pública como en la sociedad para lo cual diseña un plan que permita concienciar sobre los valores que deben convivir en la sociedad. para lograr ese objetivo es necesario contar con Códigos de Ética en las instituciones públicas que permita actuar de acuerdo a los valores y principios establecidos y que sirva de parámetro para la evaluación del comportamiento ético de los funcionarios...es necesario establecer las reformas que se han llevado a cabo en el país para hacer frente al problema de corrupción y lograr una función pública transparente

Alteraciones inmunologicas en mononucleosis infecciosa por virus de Epstein Barr, causante de manifestaciones neurologicas en una Mujer de 23 anos / Immunologic changes in infections mononucleosis by Epstein Barr Virus Causing Neurological manifestations in a 23 years old woman

Se estudio un caso de mononucleosis infecciosa (MI) desde el punto de vista clinico e inmunologico en una mujer de 23 anos con antecedentes de prostitucion, quien presento manifestaciones neurologicas como papiledema bilateral, cuadro meningeo, signo de Babinski y Clonus bilateral. Estas manifestaciones fueron asociadas con infeccion por el virus de Epstein Barr (VEB) diagnosticado por el hallazgo de titulos crecientes de anticuerpos acompanados por alteraciones en la respuesta inmune. Es el primer caso de este tipo de asociacion que se informa en la literatura local