Video-assisted anal fistula treatment for complex anal fistula: a long-term follow-up study.

AIM: This prospective study aimed to evaluate the safety and efficacy of video-assisted anal fistula treatment (VAAFT) in complex fistula-in-ano (FIA). METHOD: Consecutive patients presenting with complex FIA were recruited between November 2012 and November 2018. The primary outcome was healing of the fistula. RESULTS: Seventy-two patients were included, 39 (54%) of whom were men, with a mean age of 46 (±11) years. The mean follow-up was 32 (±18) months. Complete healing was achieved in 64 (89%) patients. When persistent and recurrent cases were considered together, the failure rate was 21% and the success rate 79%. When patients failed, they were offered VAAFT again, after which there was an in increase in the healing rate, which overall (primary and secondary) was 86%. There was no statistically significant deterioration in continence. Eight (11%) patients experienced postoperative complications which required no additional surgical intervention. CONCLUSION: VAAFT represents a promising, sphincter-saving technique for the treatment of complex FIA. It has proved efficacious, with 79% of patients achieving complete healing after its primary application. After a second use, this reached 86%. The main advantage of VAAFT compared with other sphincter-saving techniques is working under direct vision. VAAFT has a good safety profile with 11% of patients experiencing minor complications, and there is no effect on continence.

Stapled transanal rectal resection for the treatment of rectocele associated with obstructed defecation syndrome: a large series of 262 consecutive patients.

BACKGROUND: This study aims to investigate functional results and recurrence rate after stapled transanal rectal resection (STARR) for rectocele associated with obstructive defection syndrome (ODS). METHODS: A study was conducted on patients with ODS symptoms associated with symptomatic rectocele ≥ 3 cm on dynamic defecography who had STARR at our institution between 01/2007 and 12/2015. Data were prospectively collected and analyzed. ODS was evaluated using the Wexner constipation score. Primary outcomes were functional results, determined by the improvement in 6-month postoperative Wexner constipation score, and 1-year recurrence. Secondary outcomes were operative time, time to return to work, pain intensity measured using the visual analogue scale (VAS), patient satisfaction, and overall postoperative morbidity and mortality at 30 days. RESULTS: Two-hundred-sixty-two consecutive female patients [median age 54 years (range 20-78)] were enrolled in the study. The median duration of follow-up was 79 months (range 30-138). Sixty (23%) patients experienced postoperative complications, but only 9 patients required reinterventions for surgical hemostasis (n = 7), fecal diversion for anastomotic leakage (n = 1), and recto-vaginal fistula repair (n = 1). Only 1 intraoperative complication (stapler misfire) was reported, and there were no deaths. There was a statistically significant (p < 0.001) reduction in the median (range) Wexner constipation score from 19 (14-24) preoperatively to 9 (5-15) 6 months postoperatively. Only 10 (4%) patients experienced recurrence and only 3 of them required additional reintervention. Patient satisfaction at 1 year was excellent in 86%, good in 13%, and poor in 1% of patients. CONCLUSIONS: STARR is a safe, effective, and minimally invasive technique for the treatment of rectocele associated with ODS.

[Signet-ring cell carcinoma of the Vater's ampulla: report of a clinical case]. / Carcinoma a cellule ad anello con castone dell'ampolla di vater: osservazione di un caso clinico.

We report the case of a sixty-six year-old man admitted at our hospital with a suspected malignant tumor of the ampulla of Vater. The patient underwent a Pylorus-preserving pancreatico-duodenectomy. Histology showed a signet-ring cell carcinoma of the ampulla of Vater. This case is the 13th report in the literature of a signet-ring cell carcinoma of the ampulla of Vater.

[Cerebellar metastasis from pancreatic adenocarcinoma: report of a clinical case]. / Metastasi cerebellare da adenocarcinoma del pancreas descrizione di un caso clinico.

We describe a case of a metacronous cerebellar metastasis from pancreatic adenocarcinoma occurred in a 67 years old male. Central nervous system metastases from pancreatic carcinoma are mostly autoptic findings. To our knowledge, this is the first case reported in literature of cerebellar metastasis from pancreatic cancer; furthermore, this case calls attention on vomit presentation that could be erroneously attributed to an abdominal relapse. Due to the increasing frequency of central nervous system metastases observed in recent years in other types of cancer, some authors speculate that this event could represent a consequence of the prolonged natural history as the result of improved survival.

Helicobacter pylori and prurigo nodularis.

BACKGROUND/AIMS: Numerous data have suggested that there may be a relationship between Helicobacter pylori (H. pylori) infection and extragastric diseases, including dermatological pathologies. We studied some cases of Hide's Prurigo Nodularis (NP), a very itchy skin disease of unknown origin, in order to asses whether there is a pathogenic correlation between PN and H. pylori infection. METHODOLOGY: Prurigo Nodularis had been diagnosed clinically and histologically in 42 outpatients (27 females and 15 males with mean age of 62 +/- 5 years). All patients were screened for H. pylori infection by esophagogastroduodenoscopy, histologic examination and specific immuno-enzymatic determination. Specific pharmacological treatment was administered to all patients with H. pylori infection. RESULTS: H. pylori colonization was observed in 40/42 patients examined and 32/40 patients presented some immunologic alterations. After the pharmacological treatment, endoscopy and rapid urease test confirmed eradication of H. pylori in 39/40 cases; itching was greatly reduced in the latter and microscopic examination of repeated skin biopsies revealed an improved histologic picture in patients affected by PN associated with H. pylori infection. CONCLUSIONS: The concomitant presence of skin disease, H. pylori infection and immune disorders infers that there may be a pathogenic connection between bacterial infection and the inflammatory alteration of PN. We believe that the pharmacologic treatment induced remission of the skin lesions by direct control of H. pylori chronic infection; in fact, H. pylori may have triggered or enhanced the vasculitis which, in turn, may have enhanced the clinical signs and inflammatory histologic component of PN.

New pedagogy for maternity nursing education.

Baccalaureate nursing faculty sought new ways to teach maternity nursing to expose health care practices that affect, define, and limit women's experiences of reproductive health care. By blending science, story, and spirituality within a feminist philosophy, the faculty created an atmosphere of chaos that transformed the classroom and clinical experiences of students. The students' awakened engagement with maternity nursing practice was evidenced by their connection to woman-centered care issues, and passing rates on the National Council Licensing Examination remained between 97-100%, indicating adequate learning of standard core content.

Story as text for undergraduate curriculum.

A baccalaureate maternity nursing course was transformed from a behaviorist, content-driven curriculum to one of critical dialogue centering upon ethics of care. The inclusion of required readings from a collection of short stories, Birth Stories by Jane Dwinell, RN (1992), served as the primary catalyst in changing faculty and student's curricular experiences. How the class transformed from lecture/discussion format to dialogue is presented around Freire's writings on the dialogic class and Doll's postmodern curriculum perspectives. Student reactions and clinical implications are described. Recommendations for future applications of story in the dialogic classroom is explored.