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1.
Colorectal Dis ; 21(11): 1321-1325, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31230404

RESUMO

AIM: Empty pelvis syndrome and radiation-induced bowel injury are two major clinical issues resulting from the pelvic dead space after pelvic exenteration (PE). In order to avoid these complications, different methods of pelvic floor reconstruction have been proposed. We report our experience on the use of breast prosthesis. METHOD: Fifty-three patients who underwent PE and three who underwent palliative surgery with silicone breast prosthesis placement were included. RESULTS: Forty-seven posterior PE, six total PE and three palliative procedures were identified. Sphincter preservation was feasible in 34 patients (62.3%). There were no deaths. Overall morbidity was 37.5%. There were no complications such as sepsis or obstruction related to the prosthesis. Adjuvant radiotherapy was delivered in 16 cases (30.1%) without any side-effects. Reconstruction of intestinal continuity was possible in 12 patients (36.3%) with sphincter preservation and the prosthesis allowed a prompt identification of the rectal stump. CONCLUSION: Breast prosthesis placement is a simple and safe method to minimize complications resulting from empty pelvis syndrome and can be adopted to exclude bowel loops from the radiation field. Reconstruction of intestinal continuity after resection is also simplified.


Assuntos
Implantes de Mama , Exenteração Pélvica/efeitos adversos , Distúrbios do Assoalho Pélvico/prevenção & controle , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/prevenção & controle , Implantação de Prótese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Diafragma da Pelve/cirurgia , Distúrbios do Assoalho Pélvico/etiologia , Pelve/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
2.
G Chir ; 32(10): 404-10, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22018214

RESUMO

Procedure for Prolapse and Hemorrhoids (PPH or Longo procedure), a stapled circumferential anal mucosectomy, has proven to be very popular as it is considered safe and successful. However, a high haemorrhoid recurrence rate is reported, specially due to insufficient mucosal resection. The authors have come up with a technical modification to the mucoprolapsectomy, notably the Single Stapler Parachute Technique (SSPT), in order to obtain more abundant mucosal resection. In this study they will present the results obtained in 80 patients treated for muco-haemorrhoidal prolapse, 40 of whom underwent traditional PPH, while the remaining 40 patients underwent SSPT, both performed in two different specialised centres located in Rome, Italy.


Assuntos
Hemorroidas/cirurgia , Prolapso Retal/cirurgia , Grampeamento Cirúrgico/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Seguimentos , Hemorroidas/complicações , Hemorroidas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso Retal/complicações , Prolapso Retal/patologia , Adulto Jovem
3.
G Chir ; 32(8-9): 357-60, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22018255

RESUMO

Researchers believe that human muscle-derived cells are able to restore leak-point pressure to normal levels by differentiating into new muscle fibres that prevent anal sphincter muscle atrophy. Laboratory data are needed to identify exactly how these cells work to regenerate muscle. The objective of this study is to test whether stem cells can be employed to treat internal anal sphincter (IAS) injuries in humans; to this end, this work will use a two-step process to study: first, the effectiveness of the treatment in a sample of animals with artificial injuries to the IAS and then to verify the results in a population of selected humans affected by pathology.


Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Incontinência Fecal/cirurgia , Transplante de Células-Tronco Mesenquimais , Canal Anal/fisiopatologia , Canal Anal/cirurgia , Animais , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas/efeitos dos fármacos , Dexametasona/farmacologia , Humanos , Hidrocortisona/farmacologia , Modelos Animais , Desenvolvimento Muscular/efeitos dos fármacos , Músculo Esquelético/citologia , Ratos , Ratos Mutantes , Ratos Wistar , Regeneração , Células Satélites de Músculo Esquelético/fisiologia , Imunodeficiência Combinada Severa , Transplante Heterólogo
4.
G Chir ; 30(11-12): 507-9, 2009.
Artigo em Italiano | MEDLINE | ID: mdl-20109382

RESUMO

Rectovaginal fistula (RVF) is an abnormal communication between vagina and anorectum. Most frequent causes are iatrogenic. Often surgery is the therapy of choice. The suggested treatments include trans-anal access or combined trans-anal and vaginal access. We present the case of a woman with complicated iatrogenic fistula treated by a combined trans-anal and vaginal access, interposition of buccal mucosa and opposition of PRP (platelet rich plasma).


Assuntos
Plasma Rico em Plaquetas , Lesões por Radiação/terapia , Fístula Retovaginal/terapia , Idoso , Braquiterapia/efeitos adversos , Carcinoma Endometrioide/radioterapia , Carcinoma Endometrioide/cirurgia , Terapia Combinada , Neoplasias do Endométrio/radioterapia , Neoplasias do Endométrio/cirurgia , Feminino , Géis , Humanos , Histerectomia , Doença Iatrogênica , Mucosa Bucal/transplante , Lesões por Radiação/etiologia , Lesões por Radiação/cirurgia , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Técnicas de Sutura , Transplante Heterotópico , Cicatrização/efeitos dos fármacos
5.
Scand J Rheumatol ; 30(2): 77-81, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11324793

RESUMO

OBJECTIVE: to evaluate gastro-intestinal (GI) permeability in patients with limited systemic sclerosis (LSS) at baseline and after oral acetylsalicylic acid (ASA). METHODS: 13 patients with LSS and 10 controls were studied. Baseline GI permeability was assessed with orally administered sucrose, mannitol, and lactulose. Gastric lesions and Helicobacter status were investigated by endoscopy. In 5 patients and 6 controls (with normal baseline permeability) the GI permeability response was assessed after oral ASA. RESULTS: compared with controls, gastric (p<0.05) and intestinal (p<0.02) permeability was higher in LSS patients, at baseline. After oral ASA gastric permeability (sucrose) increased in both groups (controls: 186%, LSS: 265%), whereas the lactulose/mannitol ratio raised significantly only in LSS (+31% and +148%; p<0.05 vs controls). CONCLUSIONS: baseline permeability is altered in LSS; the exaggerated response of the small intestine to ASA may represent a genetically determined or a disease-related dysfunction of the mucosal barrier.


Assuntos
Sistema Digestório/metabolismo , Esclerodermia Localizada/metabolismo , Adulto , Aspirina , Sistema Digestório/efeitos dos fármacos , Endoscopia Gastrointestinal , Feminino , Mucosa Gástrica/enzimologia , Humanos , Pessoa de Meia-Idade , Permeabilidade/efeitos dos fármacos , Esclerodermia Localizada/diagnóstico , Sacarose/urina , Urease/análise
6.
Eur J Gastroenterol Hepatol ; 12(5): 529-33, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10833096

RESUMO

BACKGROUND: Portal hypertensive gastropathy (PHG) is frequently found among patients with hepatic cirrhosis and at present the only way to detect and follow PHG is via endoscopy. OBJECTIVE: To assess gastric and intestinal permeability and investigate its relationship to endoscopic findings and indices of portal hypertension and hepatic function. DESIGN AND METHODS: Thirty-one non-diabetic patients with hepatic cirrhosis and PHG (PHG+) were studied and compared with 17 cirrhotic patients without PHG (PHG-). All patients underwent endoscopy for the assessment of PHG and Helicobacter pylori status, ultrasound determination of the diameters of spleen and portal vein, and, subsequently, an oral load of sucrose, lactulose, and mannitol. Sugar concentrations were determined in 6-h urine specimens and expressed as a percentage of the orally administered dose or as lactulose/mannitol ratio. RESULTS: The urinary sucrose excretion was significantly elevated in patients with PHG compared to those without (PHG+, 0.20% +/- 0.03; PHG-, 0.07% +/- 0.01; P< 0.001). No difference was found for the small intestinal probes lactulose and mannitol. Gastric sucrose permeability correlated positively with the endoscopic lesion score (P < 0.001), but not with other parameters of portal hypertension or hepatic function. H. pylori status did not influence gastric permeability. The sensitivity of this test reached 100% for PHG scores > 2. CONCLUSIONS: Gastric permeability to sucrose is increased in patients with PHG, independently of the presence of H. pylori. Sucrose permeability may be useful for the follow-up of patients with PHG.


Assuntos
Mucosa Gástrica/metabolismo , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Gastropatias/etiologia , Sacarose/urina , Feminino , Mucosa Gástrica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Permeabilidade , Valor Preditivo dos Testes , Estatísticas não Paramétricas , Gastropatias/patologia , Sacarose/administração & dosagem
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