Micturitional dysfunction after anterior resection for rectal cancer. Rehabilitative treatment.

A clinical study was made of 21 patients (13 men and eight women) who had undergone anterior resection of the rectum for cancer at the National Tumour Institute of Milan between April 1984 and April 1985. After surgery, 13 patients (including three men with benign prostatic hypertrophy) showed voiding dysfunctions (hesitancy, dysuria, and weak stream) and bladder areflexia. Two of them also had positive Lapides' tests. An early rehabilitative treatment was started after surgery and the entire group was thoroughly reexamined one year later. Only the two patients with positive Lapides' tests still had bladder areflexia with residual urine greater than 100 ml. One of them also had a urinary tract infection. None of them showed decreased renal function.

Sacral chordoma and rehabilitative treatment of urinary disorders.

Sacral chordoma is one of the rarest tumors of the central nervous system (less than 1% of the entire group). Mictional disorders are among the most frequent symptoms and are caused by the extrinsic compression brought to bear on the cauda equina and by surgical demolition of the sacrum. Seven patients who had undergone sacral resection for chordoma, starting from S2, were followed for at least one year. It was observed that mictional disorders were often early symptoms signalling the presence of chordoma. Several patients were affected by a complete bladder denervation (infrasacral lesion) after surgery. Early rehabilitative treatment given after surgery for one year restored normal bladder functions in all the patients whose bladder denervation seemed to be not total (negative Lapides' test). Even when a complete infrasacral lesion of the bladder has been ascertained, early rehabilitative treatment may well prevent serious renal damage.

Biofeedback conditioning for fecal incontinence.

Twenty-one subjects suffering daily from fecal incontinence were treated with biofeedback training as a rehabilitative trial. Fifteen of these patients had incontinence following surgical interventions; the other six had senile incontinence. A device was employed to record the pressure existing at the level of the anal canal and to stimulate the rectal ampulla to control the performance of the external anal sphincter and the sensibility of the rectum. Of the 31 treated patients, eighteen (86%) presented good results with satisfactory recovery of anal incontinence, and three subjects (14%) showed unsatisfactory results (more than one episode of incontinence monthly). Although both groups of patients showed improvement in external anal sphincter contraction, the sensibility of the rectum to endoluminal distention improved more in good responders. The employment of biofeedback training to obtain improvement of the threshold of rectal sensibility (minimal volume of endoluminal distention to produce the sensation of imminent defecation and external anal sphincter contraction) has proved useful in the rehabilitation of incontinent patients.

Biofeedback training to obtain continence in permanent colostomy. Experience of two centers.

Biofeedback training is proposed as rehabilitative training for patients with permanent colostomies to help them achieve fecal continence. The results of a preliminary study of 18 patients are reported.

Bladder and urethral dysfunction after radical abdominal hysterectomy: rehabilitative treatment.

We studied bladder and urethral function prospectively in 64 patients before and after Wertheim's radical hysterectomy. Immediately after surgery, neurogenic bladder dysfunction of various degrees was found in 70% of all patients who presented difficulty of voiding, with high residual urine and/or stress incontinence. All the patients have received an early rehabilitative treatment with kinesitherapy and/or pharmacological therapy after the bladder catheter removal and the urodynamics' results. We have obtained a satisfactory functional recovery of the bladder activity in 91% of the symptomatic patients.

Bladder urethral dysfunction after abdominoperineal resection of the rectum for ano-rectal cancer.

We prospectively studied bladder and urethral function in 44 patients before and after abdominoperineal resection of the rectum for ano-rectal cancer. The patients were investigated with the following examinations: combined cystometry and electromyography, urethral pressure profile measurement, urecholine denervation test, urine culture, urethrogram and residual urine measurement after voiding. Urodynamic results after surgery demonstrated the partial or total denervation of the detrusor muscle with bladder areflexia in the 54% of the cases, the decrease in the urethral pressure profile in the 48% of the cases, and the absence of detrusor sphincter dyssynergia in all cases. Urethrogram results showed a high incidence of bladder dislocation into the presacral space (36%). Urine cultures were frequently positive in 52% of the patients. Most patients (52%) had difficulty in voiding with high residual urine and/or stress incontinence (4.5%). All the patients received an early rehabilitative treatment with kinesitherapy and/or pharmacologic therapy after bladder catheter removal and after urodynamic results. The patients with neurogenic bladder with residual urine volume had satisfactory functional recovery of the activity.

Evaluation of the results of three different methods of postmastectomy lymphedema treatment.

The aim of this study was to evaluate the following methods of postmastectomy lymphedema treatment: pneumatic massage with uniform pressure, pneumatic massage with differentiated pressure, and manual lymphatic massage. The study concerned three groups of 20 mastectomized patients with secondary early developed arm lymphedema. The measurement of circumference on seven points of both arms, the self-scoring mood questionnaire, and the visual analogue scale (VAS) were evaluated before, at the end, and 3 months after the treatment. We observed a permanent edema reduction, which was statistically significant, with uniform pressure pneumatic massage and with manual lymphatic massage, but not with differentiated pneumatic massage. The VAS and the self-scoring mood questionnaire made from measuring the subjective ratings of the patients confirmed the objective evaluations.

Report on 42 cases of postirradiation lesions of the brachial plexus and their treatment.

Here we report 42 cases of postirradiation lesions of the brachial nerve plexus in patients treated with radiotherapy after radical mastectomy. These lesions usually appeared at least 1 year after treatment, and motorial disturbances always developed, even if initially they may have been absent. A comparison of the case material indicates that a reduction in the dose administered to the supraclavicular region and exclusion of the axillary region from the treatment resulted in a significant reduction in the incidence of these lesions. In fact, in a group of 490 patients treated by the old radiotherapy method at the Istituto Nazionale Tumori of Milan (i.e., administration of 6000 rad to the brachial nerve plexus), 16 cases of lesions at this plexus were observed. In a group of 200 patients treated instead with a new method (i.e., administration of 4900 rad to the brachial nerve plexus and exclusion of the axillary region), no nerve lesions were observed, with significance levels, according to Fisher's test, less than 0.9%. Since radiolesions at the brachial nerve plexus have a very bad prognosis with regard to functioning of the limb and physiotherapy is of little help, this new therapeutic method is very useful, and it is not accompanied by an increase in the number of local recurrences as compared to the old method.

[Physical rehabilitation in mastectomized women]. / La riabilitazione fisica nelle donne mastectomizzate

The paper highlights the importance of rehabilitation programmes for women subjected to radical mastectomy. Within the Milan National Tumour Institute, the activity promoted by the antalgic and Rehabilitation Department concerning some 700 patients per annum takes in 3 phases: information; prevention; treatment of the disease. After thorough psychological and medical observation of the patient, all available treatment methods are deployed on conditions which present in the form of hypomobility of the homolateral extremity, lymphangitis, lymphoedema and possibly neurological damage to the brachial plexus. The results of this rehabilitation programme have meant a notable reduction in the forms and have led to rapid return to society.

[Presentation of 25 cases of post-irradiation lesions of the brachial plexus and their treatment]. / Presentazione di 25 casi di lesioni postirradiatorie del plesso brachiale e loro trattamento

A study was carried out on a series of 25 patients who were operated on for breast cancer and who submitted to postoperative radiotherapy, in which lesions of the brachial nervous plexus from ionizing radiations were obtained. In almost all the cases, 24 out of 25, various symptoms such as paresthesiae, pain, and motorial disturbances, were observed even one year after the completion of the treatment. Motorial troubles, which in 13 cases were not detected at the moment of the diagnosis of the other lesions, always occurred later. Etiopathogenesis and diagnosis of these lesions have been considered, as well as the possibility of lowering the incidence of such troubles. The conclusion can be drawn that useful results can be obtained, to a certain extent, only if therapeutic treatment is performed early: in most cases, however, the lesions showed a progressive evolution.

[Rehabilitation of patients with colostomy]. / La riabilitazione dei colostomizzati

The psychological and physical problems associated with colostomy are discussed. Techniques with colostomy are discussed. Techniques designed to prevent faecal incontinence and permit intestinal performance in accordance with desired rhythms are indicated. Application of such methods at the Colostomy Rehabilitation Centre, Milan Tumour Institute, has been attended by success on both the physical and the social plance. The importance of forming trained staffs and patient associations for the exchange of experience and assistance in an extra-hospital milieu is stressed.