Asunto(s)
Laparoscopía/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Recto/cirugía , Cirugía Asistida por Video/métodos , Canal Anal , Disección/instrumentación , Disección/métodos , Humanos , Laparoscopía/instrumentación , Cirugía Endoscópica por Orificios Naturales/instrumentación , Posicionamiento del Paciente , Técnicas de Sutura , Cirugía Asistida por Video/instrumentaciónAsunto(s)
Síndromes Compartimentales/prevención & control , Laparoscopía/métodos , Síndromes de Compresión Nerviosa/prevención & control , Posicionamiento del Paciente/métodos , Traumatismos de los Nervios Periféricos , Rabdomiólisis/prevención & control , Plexo Braquial/lesiones , Nervio Femoral/lesiones , Humanos , Enfermedad Iatrogénica , Laparoscopía/efectos adversos , Pierna/inervación , Nervio Peroneo/lesiones , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Nervio Ciático/lesiones , Nervio Cubital/lesionesAsunto(s)
Canal Anal/cirugía , Anastomosis Quirúrgica/métodos , Colon/cirugía , Laparoscopía , Neoplasias del Recto/cirugía , Recto/cirugía , Disección , Femenino , Humanos , Masculino , Arteria Mesentérica Inferior/cirugía , Venas Mesentéricas/cirugía , Obesidad/complicaciones , Factores Sexuales , Posición Supina , Instrumentos QuirúrgicosRESUMEN
PURPOSE: This study was designed to estimate the prevalence of anal sphincter injury after forceps delivery in a large population of females managed by trained obstetricians in a French hospital and to identify factors predictive for anal sphincter injury. METHODS: We performed a prospective study of healthy females older than 18 years with no history of anal incontinence, anorectal abnormalities, or anorectal surgery after their first vaginal delivery. All females were interviewed using a standardized questionnaire concerning intestinal transit and continence status. Physical examination and endoanal ultrasonography were performed after delivery. RESULTS: Between November 1999 and November 2000, 93 females were included in the study after their first forceps delivery. Eleven patients (11.8 percent) had a partial defect involving the external sphincter, visible on ultrasonography. One patient (1.1 percent) had a partial defect of external sphincter with complete defect of internal sphincter (sequelae of primary repair of a third-degree perineal tear). Seventeen patients (18.2 percent) had flatus incontinence, and four patients (4.3 percent) had liquid stool incontinence. A high daily number of stools was significantly associated with sphincter defect visible on ultrasonography (P=0.02). The development of anal incontinence was not related to sphincter defect on ultrasonography. There was a strong association between perineal tear and sphincter defect visible on ultrasonography (odds ratio, 4.5 (range, 1.2-16.7)). CONCLUSIONS: Anal sphincter injury after forceps delivery was identified in <13 percent of our large population of healthy females. Our study does not confirm previous observations that anal sphincter injury is common after forceps delivery; previously published studies may have overestimated the prevalence of this condition. The only factor with significant predictive value for anal sphincter injury was perineal tear. Anal endosonography should be recommended after obstetric perineal tear.
Asunto(s)
Canal Anal/diagnóstico por imagen , Canal Anal/lesiones , Extracción Obstétrica/efectos adversos , Forceps Obstétrico/efectos adversos , Perineo/lesiones , Adulto , Femenino , Francia/epidemiología , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Factores de Riesgo , UltrasonografíaRESUMEN
BACKGROUND: Crohn's disease (CD) is characterised by inflammation, muscle layer overgrowth, and collagenous fibrosis of the intestinal tract, with no effective therapy against collagen accumulation. AIMS: We quantified production of collagen in resection specimens from normal and CD patients and investigated the effect of regenerating agents (RGTAs) on collagen production. RGTAs are chemically substituted dextrans engineered to mimic the growth factor protecting effects of heparan sulphates. RGTAs have been shown to enhance tissue repair in various in vivo models and to modulate in vitro collagen phenotype differentially according to their structure. PATIENTS: We studied intestinal biopsies from two groups of CD patients: treated with glucocorticoids (CD-GC group: 10 patients) or not treated (CD group: seven patients), and from seven control patients. METHODS: After 24 hours of ex vivo incubation with (3H) proline, collagen I, III, and V were extracted by pepsin and quantitatively separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Biosynthesis of each collagen type was quantified on radiolabelled isolated collagen. RESULTS: Total intestinal collagen production in CD patients compared with controls was increased up to 3.5-fold overall (p<0.001). In particular, collagen III biosynthesis was enhanced by 6.2-fold (p<0.001) in CD patients. In the CD-GC group, collagen production abnormalities were less marked. RGTAs added to the incubation medium in the CD group decreased total collagen production by 50% and decreased collagen III synthesis by 76%. CONCLUSION: This finding offers a rationale for using RGTAs in the treatment of intestinal fibrosis in CD, thus opening up a potential new therapeutic field for this family of drugs.
Asunto(s)
Colágeno/biosíntesis , Enfermedad de Crohn/metabolismo , Dextranos/farmacología , Mucosa Intestinal/metabolismo , Oligosacáridos/farmacología , Adulto , Anciano , Colágeno/análisis , Colágeno Tipo III/biosíntesis , Enfermedad de Crohn/tratamiento farmacológico , Técnicas de Cultivo , Dextranos/química , Femenino , Glucocorticoides/uso terapéutico , Humanos , Intestinos/efectos de los fármacos , Masculino , Persona de Mediana Edad , Oligosacáridos/químicaRESUMEN
BACKGROUND: Laparoscopic colorectal resection may induce bladder and sexual dysfunction secondary to injury to the autonomic nervous system. The aim of this study was to evaluate urinary and sexual function in male patients after laparoscopic colorectal resection for diverticular disease. METHODS: From January 1997 to March 2002, we performed a retrospective analysis of urinary and sexual function in 56 consecutive male patients who had undergone laparoscopic colorectal resection for diverticular disease. Preoperative and 6-month postoperative assessment was carried out using data collected via standardized postal questionnaires. RESULTS: Three patients were excluded (one had a prior prostatectomy, one had Peyronie's disease, and one was treated with neuroleptics). Fifty-three patients with a mean age of 54 A+/- 2 years were included in the study. There were no conversions. The morbidity rate was 9.4%. Mean follow-up was 27 A+/- 2 months. There was no significant difference in preoperative and postoperative urinary function. Fifty-one patients (96%) were sexually active preoperatively and were still sexually active postoperatively. Compared with the preoperative period, postoperative impairment of libido, erection, ejaculation, and orgasm were not significant. Every patient was able to achieve ejaculation after the intervention, and no retrograde ejaculations were reported. One patient was unable to have an erection after the intervention. CONCLUSION: Laparoscopic colorectal resection for diverticular disease does not significantly impair urinary and sexual function.
Asunto(s)
Diverticulosis del Colon/cirugía , Laparoscopía/efectos adversos , Enfermedades del Recto/cirugía , Disfunciones Sexuales Fisiológicas/etiología , Trastornos Urinarios/etiología , Divertículo/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Disfunciones Sexuales Fisiológicas/epidemiología , Trastornos Urinarios/epidemiologíaAsunto(s)
Colectomía , Colon Sigmoide/cirugía , Laparoscopía , Prolapso Rectal/cirugía , Femenino , Humanos , Factores SexualesRESUMEN
BACKGROUND: Some operated on cancer patients require specialized complementary chemotherapy. Often, this takes place in another institution, where the patient consults the medical oncologist before hospitalization. The aim of this study was to analyze the potential benefit of a videoconference consultation within this framework. METHODS: Sixteen operated on cancer patients hospitalized in the Surgical Unit received a teleconsultation in the presence of their surgeon and with the chemotherapist at some distance. During this period, the modalities of chemotherapy proposed, the duration of the teleconsultation, the economy of transport, and so on were noted. Twenty-four hours later each patient filled in a questionnaire aimed at, one, evaluating the quality of the image on an visual analogue scale (VAS) and the potential inconvenience involved; and two, evaluating the index of patient satisfaction on VAS. Furthermore, the last 12 patients filled in a questionnaire adapted to each of them, according to the information they had received. Each correct answer was noted 1, and each incorrect answer was noted 0. A memorization percentage was deduced. RESULTS: The average age of the 16 patients was 63.4 years (range 46 to 78). The average duration of the teleconsultation was 27 minutes (12 to 40). The index of image satisfaction was 61.3%. As for the last 12 patients, 9.8 questions (7 to 12) enabled the calculation at 24 hours of the percentage of data retained by the patient (memorization index) based on the modalities and consequences of the chemotherapy. The percentage of correct answers was 80.5%. Fourteen of the 16 patients considered that teleconsultation had its advantages. Two patients would have preferred a classic consultation. The global satisfaction index was 79.9%. The average cost of functioning per patient was 187.76 FF A saving in transport of 509.92 FF was recorded per patient. CONCLUSIONS: In the context of this original study, teleconsultation neither altered the doctor-patient relationship nor the quality of the message transmitted. Furthermore, it encourages closer links between complementary teams working at a distance and multidisciplinarity in cancerology.
Asunto(s)
Neoplasias/tratamiento farmacológico , Planificación de Atención al Paciente , Calidad de la Atención de Salud , Consulta Remota , Anciano , Quimioterapia Adyuvante , Análisis Costo-Beneficio , Humanos , Relaciones Interprofesionales , Persona de Mediana Edad , Neoplasias/cirugía , Paris , Planificación de Atención al Paciente/economía , Satisfacción del Paciente , Relaciones Médico-Paciente , Consulta Remota/economíaRESUMEN
Surgical treatments of rectal prolapse still await a final arrangement. The aim of this work is to present Authors' experience with 12 female patients who underwent laparoscopic rectopexy. The patients, aged between 67 and 84 years, were suffering of a different degree of incontinence classified according to the Browing and Parks scale. Pneumoperitoneum was induced through the Veres needle end 5 trocars were placed. The technique used was the modified Orr-Loygue. One no death was observed and only two not serious intraoperative complications were registered, in both conversion to laparotomy was not necessary. Functional result as for incontinence has been really good (disappeared in 11 cases and improved in one). Whereas regarding the constipation, no improvement was observed in those in who in it was preexisting the operation, not appearing nevertheless, as on the contrary reported by other Authors, in those in whom it wasn't present before surgical treatment. The patients, all in follow-up (range between 10 and 36 months, average 25.08), still now experienced no relapse. In conclusion, on the base of Authors' experience, laparoscopic rectopexy is considered free of particular risks and excellent in the results even if, due to the slight number of series, any definitive judgement can be expressed.
Asunto(s)
Laparoscopía/métodos , Prolapso Rectal/cirugía , Recto/cirugía , Anciano , Anciano de 80 o más Años , Incontinencia Fecal/prevención & control , Femenino , Humanos , Persona de Mediana Edad , Neumoperitoneo Artificial , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Prolapso Rectal/diagnósticoRESUMEN
The advent of transrectal ultrasonography has contributed to improving therapeutic management of cancer of the rectum. The 7.5 MHz transrectal probe evidences five tissue layers in the rectal wall. The 10-12.5 MHz probe can visualize seven layers. Transrectal ultrasonography can also be used to explore the perirectal environment and detect possible nodes. Echographically, the tumor is seen as an hypoechogenic mass invading the rectal wall outwardly, disorganizing the wall structures. Parietal recurrence is seen as a hypoechogenic heterogeneous thickening. Ultrasonographic surveillance can be proposed for operable patients with a high risk of recurrence. Cautious interpretation is required due to the known limitations of transrectal ultrasonography. Truly invaded nodes may not be seen due to their small size (less than 2-3 mm) or their localization far from the probe (false negatives). Transrectal ultrasonography provides important information for therapeutic decision making in terms of surgical access and/or indications for possible adjuvant therapy. Transanal resection may also be ruled out if there are perirectal nodes. Patients may also be selected for preoperative radiotherapy, possibly associated with chemotherapy.