Evaluation of diagnostic accuracy of 3-D endoanal ultrasound in perianal fistula in comparison with intraoperative findings / Avaliação da precisão diagnóstica da USE 3D endoanal em casos de fistula perianal, em comparação com os achados cirúrgicos

ABSTRACT Objective: Perianal fistula is a common and debilitating disease. The definite treatment is surgery, identifying of primary and secondary tract, internal opening of fistula has important role in planning of surgical techniques. This study's goal was to determine the diagnostic accuracy of 3-D ultrasound in perianal fistula in comparison with intraoperative findings. Materials and methods: This study is a cross-sectional study. Adult patients (18-85 years old) with anal fistula have been selected. 3-D EUS was done for all patients by gastroenterologist. Then surgery was done. Check lists filled by endoscopist and surgeon was studied and data analysis was done. Results: The study examined 76 patients, in according to results for kappa coefficient there was a perfect agreement between 3-D ultrasound results and surgery in internal opening that was 96% (p < 0.001) and concordance was 0.974. In extension tract the agreement was 0.973 and concordance was 0.987 (p < 0.001). Conclusion: There was perfect agreement between 3-D ultrasound and surgical findings in internal opening, primary tract and trunk expansion. 3-D ultrasound shows a high diagnostic accuracy when compared with surgery to assessment of perianal fistula before surgery.

RESUMO Objetivo: A fistula perianal é doença comum e debilitante. O tratamento definitivo é cirúrgico. A identificação dos tratos primário e secundário e de abertura interna da fístula desempenha papel importante no planejamento das técnicas cirúrgicas. O objetivo do presente estudo foi determinar a precisão diagnóstica da USE 3D em casos de fístula perianal, em comparação com os achados cirúrgicos. Materiais e métodos: Este é um estudo transversal. Foram selecionados pacientes adultos (18-85 anos) com fístula anal. Todos os pacientes foram examinados por USE 3D realizada por um gastroenterologista. Em seguida, procedeu-se à cirurgia. O endoscopista e o cirurgião estudaram as listas de verificação, com análise dos dados. Resultados: Nesse estudo foram examinados 76 pacientes. De acordo com os resultados para o coeficiente kappa, foi observada perfeita concordância entre os resultados da USE 3D e cirurgia para IO, de 96% (p < 0,001), com concordância de 0,974. Na extensão do trato a concordância foi 0,973 e concordância de 0,987 (p < 0,001). Conclusão: Foi observada concordância perfeita entre USE 3D e os achados cirúrgicos em abertura interna, trato primário e expansão do tronco. USE 3D demonstra elevada precisão diagnóstica, quando comparada com a cirurgia, para avaliação da fístula perianal antes da operação.

Determining the degree of adherence to treatment in inflammatory bowel disease patients.

AIM: Since the inflammatory bowel disease (IBD) is a disorder which requires continuous drug intake to induce and maintain the remission phase, finding the barriers for low adherent group, may improve the disease phase and quality of life in those patients. BACKGROUND: IBD is defined as a chronic immune disorder with unpredictable flares. The common treatment of these diseases can be effective for inducing and maintaining remission courses. Therefore the use of long-term medication therapy is the crucial key to prevent surgery and complications in patients with IBD. METHODS: Morisky Medication Adherence Scales (MMAS) is used for detecting level of adherence to the medicines for 137 patients with IBD. Demographic and clinical data are recorded for all patients and quality of life has been evaluated by Short-Form 36 questionnaire in 55 patients. RESULTS: Demographic and clinical features showed no correlation with the degree of adherence. The MMAS-8 score in the low adherent group significantly different than that in the medium and high adherer group. No relation was found statistically between level of adherence and mental or physical sates (p value=0.17, 1.2) and total quality of life (p value=0.22) in patients with IBD. CONCLUSION: Designing smart reminder and the physician's explain about adverse effects and beneficial of medicines may be effective to confront with forgetfulness and feeling comfort with treatment. Improve a strategy in order to regular measurement of adherence to medication, provides enough information about stop taking medication.

A mucinous cystadenoma in rectal cuff of a patient with familial adenomatous polyposis.

INTRODUCTION: Familial adenomatous polyposis (FAP) may be associated with some extracolonic manifestations which in this vein, it is known as Gardner's syndrome. To our knowledge, so far, there is no report of mucinous cystadenoma in association with FAP. CASE PRESENTATION: We report a 31-year-old woman with FAP who underwent total proctocolectomy with ileal pouch-anal anastomosis 5 years earlier. During endoscopic surveillance, she was found to have a submucosal lesion in rectal cuff. RESULTS: Endoscopic ultrasound (EUS) revealed a round submucosal anechoic lesion measuring about 3 cm originating from the second layer of the rectal cuff. Surgical resection was performed and a cystic tumor was removed. Histologic examination was consistent with mucinous cystadenoma. CONCLUSION: FAP can be associated with mucinous cystadenoma.