RESUMEN
AIM: To assess the effectiveness of transanal irrigation (TAI) compared with posterior tibial nerve stimulation (PTNS) in severe and chronic low anterior resection syndrome (LARS). METHOD: A two-group parallel, open-label randomized controlled trial carried out in a single university hospital. The study population included patients with a LARS scale score of more than 29 points who had undergone rectal surgery more than 1 year previously. These were randomly allocated, with a central randomization system, following a 1:1 sequence to TAI or PTNS. The main study outcome was to achieve a reduction of at least one LARS grade in at least 50% of the patients, for each intervention. RESULTS: A total of 27 patients (TAI = 13, PTNS = 14) were randomized. Both groups were similar with regard to confounding factors. Four patients were excluded because of intercurrent disease or early dropout, leaving 23 (TAI, n = 10; PTNS, n = 13) for analysis. Eight out of 10 and 4 out of 13 patients were downgraded with TAI and PTNS, respectively. The median LARS score decreased from 35 [interquartile range (IQR) 32-39] to 12 (IQR 12-26) (P = 0.021) for the TAI group and from 35 (IQR 34-37) to 30 (IQR 25-33) (P = 0.045) for the PTNS group. The Vaizey score fell from 15 (IQR 11-18) to 6 (IQR 4-7) (P = 0.037) and from 14 (IQR 13-17) to 9 (IQR 7-10) (P = 0.007) with TAI and PTNS, respectively, with 80% and 38% of patients, respectively, showing decreases of more than 50%. Improvement in quality of life was observed in both groups. CONCLUSION: Both treatments improved the LARS score in this study but this was only significant in the TAI group.
Asunto(s)
Neoplasias del Recto , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Complicaciones Posoperatorias , Calidad de Vida , Síndrome , Nervio Tibial , Resultado del TratamientoRESUMEN
A 45 year old man with personal history of B-Lactamic antibiotics allergy and one episode of hemochezia was admitted to hospital because of abdominal pain in the lower right quadrant and nausea, and diagnosed of acute appendicitis. At laparotomy he was found to have histological evidence of transmural eosinophilic enteritis in the terminal ileon and ascitis. After an intestinal resection a full evaluation was performed.
Asunto(s)
Abdomen Agudo/etiología , Enteritis/complicaciones , Eosinofilia/complicaciones , Enteritis/patología , Eosinofilia/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We present a case of focal hepatic steatosis, presenting with longstanding and poorly defined discomfort. The exploratory methods could not exclude the presence of a tumor mass in the liver; for this reason the patient was submitted to surgery, which allowed the histological diagnosis. We call attention to the existence of this lesion and the convenience of using all the available diagnostic methods to obtain the diagnosis in order to avoid the risks of an unnecessary major surgical procedure.
Asunto(s)
Hígado Graso/patología , Adulto , Humanos , MasculinoRESUMEN
The authors present two cases of hepatic echinococcus cyst with destruction of the biliary confluent. The severity of this exceptional lesion requires uncommon treatment. Experience with treatment of biliary fistulas when there is a residual cystic cavity, provides arguments for and against primary suture of these fistulas. In these cases, the required treatment consists in reconstruction of the hepatic biliary ducts destroyed (right, left and common) by using the pericystic envelope itself as a plastic neoformative element. The result has demonstrated its efficacy after many years of use, as we have indicated in this article. "Echinococcus granulosus" itself is only rarely a problem in the host, but a hepatic echinococcus cyst does not only pose a spatial problem, except insofar as it often involves the biliary tree. In the cases reported here, the hepatic echinococcus cyst causes biliary problems in over 60% of the cases (1). These biliary problems were as follows: Compression of the common bile duct by the cys; More often, compression of the intrahepatic bile ducts causes the cyst to open inside the biliary duct and to fissure, leading to a biliocystic fistula.
Asunto(s)
Colestasis Intrahepática/etiología , Equinococosis Hepática/complicaciones , Conducto Hepático Común , Adulto , Anciano , Enfermedades de los Conductos Biliares/etiología , Enfermedades de los Conductos Biliares/cirugía , Colecistectomía , Colestasis Intrahepática/cirugía , Equinococosis Hepática/cirugía , Femenino , Humanos , Técnicas de SuturaAsunto(s)
Eritrocitos/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Neoplasias del Yeyuno/diagnóstico por imagen , Leiomioma/diagnóstico por imagen , Adulto , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Neoplasias del Yeyuno/complicaciones , Neoplasias del Yeyuno/patología , Leiomioma/complicaciones , Leiomioma/patología , Cintigrafía , TecnecioRESUMEN
A new technique has been described for the surgical management of Hydatid cyst of the liver. The cystpericystectomy is the treatment of choice, but if used alone it may be dangerous because of the high risk of hemorrhage.