RESUMO
BACKGROUND: Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America. METHODS: A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1-84) months. RESULTS: One hundred and thirty-one patients [119 females, median age of 62.2 (range 19-87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1-84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as "significant". CONCLUSIONS: Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.
Assuntos
Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/terapia , Sacro/inervação , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/estatística & dados numéricos , Eletrodos Implantados , Feminino , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sacro/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
A capillary zone electrophoresis (CZE) method has been developed to separate and quantitate naphazoline (NAPH), dyphenhydramine (DIP) and phenylephrine (PHE) in nasal solutions. Samples were diluted 1:25 in ultrapure water and injected at the anodic end. A central composite design has been used to optimise the experimental conditions for a complete and fast separation of the active ingredients studied. Critical parameters such as voltage, pH and buffer concentration have been studied to evaluate how they affect responses such as resolution and migration times. Separation was performed on a silica capillary with 75 microm I.D. and 70 cm total length at an applied voltage of 17.7 kV with a phosphate run buffer of pH 3.72 and 0.063 mol l(-1). Calibration curves were prepared for NAPH, DIP and PHE. For each analyte, the correlation coefficients were >0.999 (n=15). The RSD% of six replicate injections for each analyte were reasonably good. The method was applied to the quantitation of the three components in a commercial dosage form. The proposed method has the advantage of needing a very simple sample pretreatment and being faster than a typical HPLC chromatographic method.
Assuntos
Difenidramina/análise , Nafazolina/análise , Fenilefrina/análise , Administração Intranasal , Algoritmos , Eletroforese Capilar , Excipientes , Concentração de Íons de Hidrogênio , Indicadores e Reagentes , Soluções Farmacêuticas , Reprodutibilidade dos Testes , Espectrofotometria UltravioletaRESUMO
The use of multivariate spectrophotometric calibration for the simultaneous determination of dexamethasone and two typical excipients (creatinine and propylparaben) in injections is presented. The resolution of the three-component mixture in a matrix of excipients has been accomplished by using partial least-squares (PLS-1). Notwithstanding the elevated degree of spectral overlap, they have been rapidly and simultaneously determined with high accuracy and precision (comparable to the HPLC pharmacopeial method), with no interference, and without resorting to extraction procedures using non-aqueous solvents. A simple and fast method for wavelength selection in the calibration step is used, based on the minimisation of the predicted error sum of squares (PRESS) calculated as a function of a moving spectral window.
Assuntos
Creatinina/análise , Dexametasona/análise , Parabenos/análise , Calibragem , Cromatografia Líquida de Alta Pressão , Indicadores e Reagentes , Análise Multivariada , Reprodutibilidade dos Testes , Espectrofotometria UltravioletaRESUMO
Los autores estudian el caso clinico de una nina recien nacida, pretermino, con eritrodermia ictiosiforme no ampollar entidad de rarisima aparicion en nuestro medio. Se describen las caracteristicas semiologicas con intensa eritrodermia descamativa en grandes laminas, fisuras y compromiso del estado general, efectuando consideraciones histopatologicas, clinicas y terapeuticas
Assuntos
Recém-Nascido , Humanos , IctioseRESUMO
Los autores estudian el caso clinico de una nina recien nacida, pretermino, con eritrodermia ictiosiforme no ampollar entidad de rarisima aparicion en nuestro medio. Se describen las caracteristicas semiologicas con intensa eritrodermia descamativa en grandes laminas, fisuras y compromiso del estado general, efectuando consideraciones histopatologicas, clinicas y terapeuticas