ABSTRACT
BACKGROUND: Low anterior resection for rectal cancer often results in severe bowel dysfunction, specifically low anterior resection syndrome (LARS), with symptoms such as incontinence, urgency, and frequent bowel movements. Percutaneous tibial nerve stimulation (PTNS) resulted in a high rate of success in patients with fecal incontinence. The aim of this study was to evaluate the effectiveness of treatment with PTNS in LARS and to identify predictors of the outcome of the technique. METHODS: The study was conducted from May 2012 to April 2015 at the Alvaro Cunqueiro Hospital, University Hospital Complex of Vigo, Spain. Ten patients with LARS were recruited consecutively. All patients underwent 2 sessions per week (30 min each one) for 6 weeks. Patients were followed for 3 weeks, and those who had a significant clinical improvement were recruited to a second phase of PTNS. Some patients presenting with relapse during follow-up underwent an additional phase of PTNS. Outcome measures included Wexner scores, quality of life scores, and urgency of defecation. RESULTS: Three patients did not complete the treatment due to poor response in the first phase. Incontinence was reduced in the remaining seven of ten patients. The median Wexner score at initial patient evaluation was 14 (IQR 10.75-18.5), which decreased to 10 (IQR 6.5-18) after treatment (p = 0.034). A statistically significant improvement was demonstrated in quality of life scale, lifestyle, depression, and daily defecation urgency (p < 0.05). LARS Score improvement was observed in five patients (50%) with a total resolution of LARS in 2 (20%). CONCLUSIONS: PTNS is an ambulatory treatment that could play an important role in the context of a multimodal treatment approach in patients with LARS. It could be a first-line treatment to identify non-responders to conservative management who need different and more invasive treatments.
Subject(s)
Digestive System Surgical Procedures/adverse effects , Electric Stimulation Therapy/methods , Postoperative Complications , Rectal Diseases/therapy , Rectum/surgery , Tibial Nerve , Aged , Defecation , Female , Humans , Male , Middle Aged , Pilot Projects , Quality of Life , Rectal Diseases/etiology , Rectal Neoplasms/surgery , Rectum/physiopathology , Surveys and Questionnaires , Syndrome , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate by bacteriological analysis the possible relationship between the chronicity of perianal fistulae and the presence of probable permanent infection of the fistulae. MATERIAL AND METHODS: The study included 27 patients, 21 men and 6 women who had undergone surgery for chronic perianal fistulae type II (according to the Parks classification). A total of 27 samples of their fistulous tracts were sent to the microbiology department for the identification of germs. All samples were taken from the theatre and delivered to the laboratory in the same manner. They were then processed under de same conditions in terms of dilutions, inoculation and culture mediums used for the identification of germs in the tracks of the fistulae. RESULTS: A total of 45 were isolated from 21 different species of microorganisms. Most samples (78.26%) had polymicrobic growth. The predominant species were: Escherichia coli (45.45%), Bacteroides fragilis (16.66%), Staphylococcus aureus (12.12%) and Streptococcus viridans (12.12%). No Mycobacteria were found in any specimen. CONCLUSIONS: Anal fistulae can be colonized by poli- or mononormal intestinal or skin microbacterial flora or a combination of both. This report suggests that neither the type or the number of germs its related to the chronicity of cryptoglandular anal fistulae.
Subject(s)
Anal Canal , Intestinal Fistula/microbiology , Bacteria/isolation & purification , Female , Humans , Male , Prospective Studies , Rectal Diseases/microbiologyABSTRACT
We report a case of leiomyosarcoma of the lower segment of the inferior vena cava in a fifty nine year old man who presented with bilateral leg edema on physical exploration. Ultrasonography, computed tomography scan and intravenous urography demonstrated the existence of a retroperitoneal tumour. The tumour and the affected venous fragment were resected. Postoperative radiotherapy was given. The patient was re-operated on three years later because of extra-local recurrence. Two years later the patient is assymptomatic and without radiological evidence of recurrence and/ or metastasis.
