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Schulte B, Göb M, Singh AP, Lotz S, Draxinger W, Heimke M, Pieper M, Heinze T, Wedel T, Rahlves M, Huber R, Ellrichmann M. High-resolution rectoscopy using MHz optical coherence tomography: a step towards real time 3D endoscopy. Sci Rep 2024; 14:4672. [PMID: 38409328 PMCID: PMC10897148 DOI: 10.1038/s41598-024-55338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
Colonoscopy and endoscopic ultrasound play pivotal roles in the assessment of rectal diseases, especially rectal cancer and inflammatory bowel diseases. Optical coherence tomography (OCT) offers a superior depth resolution, which is a critical factor for individualizing the therapeutic concept and evaluating the therapy response. We developed two distinct rectoscope prototypes, which were integrated into a 1300 nm MHz-OCT system constructed at our facility. The rapid rotation of the distal scanning probe at 40,000 revolutions per minute facilitates a 667 Hz OCT frame rate, enabling real-time endoscopic imaging of large areas. The performance of these OCT-rectoscopes was assessed in an ex vivo porcine colon and a post mortem human in-situ colon. The OCT-rectoscope consistently distinguished various layers of the intestinal wall, identified gut-associated lymphatic tissue, and visualized a rectal polyp during the imaging procedure with 3D-reconstruction in real time. Subsequent histological examination confirmed these findings. The body donor was preserved using an ethanol-glycerol-lysoformin-based technique for true-to-life tissue consistency. We could demonstrate that the novel MHZ-OCT-rectoscope effectively discriminates rectal wall layers and crucial tissue characteristics in a post mortem human colon in-situ. This real-time-3D-OCT holds promise as a valuable future diagnostic tool for assessing disease state and therapy response on-site in rectal diseases.
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Affiliation(s)
- Berenice Schulte
- Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Madita Göb
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | | | - Simon Lotz
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | | | - Marvin Heimke
- Center of Clinical Anatomy, Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Mario Pieper
- Institute of Anatomy, University of Luebeck, Luebeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Tillmann Heinze
- Center of Clinical Anatomy, Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Thilo Wedel
- Center of Clinical Anatomy, Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Maik Rahlves
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Robert Huber
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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2
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Huang X. The "Hands" teaching method for the classification of anorectal abscess. Asian J Surg 2024; 47:1093-1094. [PMID: 37996380 DOI: 10.1016/j.asjsur.2023.10.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Affiliation(s)
- Xing Huang
- The First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Hunan, Changsha, China.
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Varol Fİ, Güngör Ş, Selimoğlu MA, Şamdancı E. Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience. Korean J Gastroenterol 2024; 83:17-22. [PMID: 38268164 DOI: 10.4166/kjg.2023.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024]
Abstract
Background/Aims Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. This study reviewed the 13-year experience of the authors' institution to increase clinicians' awareness of SRUS in the presence of symptoms. This paper reports the endoscopic and histopathological findings in children presenting with hematochezia. Methods The clinical and laboratory findings of 22 patients diagnosed with biopsy-proven SRUS in the authors' clinic between 2007 and 2020 were evaluated retrospectively. Results The mean age at diagnosis was 12.5±2.6 years, and 59.1% of the patients were male. The median time of diagnosis was 24 months. A single ulcer lesion was found by colonoscopy in 18 patients (81.8%), two ulcers in two patients (9%), and more than two ulcers in two patients (9%). The pathology reports of all biopsies taken from the lesions were consistent with a solitary rectal ulcer. In the first stage, the treatment was started with toilet training, a high-fiber diet, and laxatives. In 11 patients (50%) who did not respond to the initial treatment, a 5-ASA enema was added. A glucocorticoid enema was added to treatment in five patients (22%) whose complaints did not regress despite this treatment. Clinical remission was achieved in five of the patients (18.1%). The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04). Conclusions This study is the first large series on Turkish children. An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients.
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Affiliation(s)
- Fatma İlknur Varol
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, İnönü University, Faculty of Medicine, Malatya, Turkey
| | - Şükrü Güngör
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, İnönü University, Faculty of Medicine, Malatya, Turkey
| | - Mukadder Ayşe Selimoğlu
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, İnönü University, Faculty of Medicine, Malatya, Turkey
| | - Emine Şamdancı
- Department of Pathology, Faculty of Medicine, Malatya, Turkey
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Ianieri MM, De Cicco Nardone A, Benvenga G, Greco P, Pafundi PC, Alesi MV, Campolo F, Lodoli C, Abatini C, Attalla El Halabieh M, Pacelli F, Scambia G, Santullo F. Vascular- and nerve-sparing bowel resection for deep endometriosis: A retrospective single-center study. Int J Gynaecol Obstet 2024; 164:277-285. [PMID: 37555349 DOI: 10.1002/ijgo.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Surgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve- and vascular-sparing approach. METHODS A single-center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles-Eccersley-Scott-Symptom [KESS] questionnaire and Gastro-Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery. RESULTS Sixty-one patients were enrolled. No patients had Clavien-Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self-catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity. CONCLUSION Our vascular- and nerve-sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery.
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Affiliation(s)
- Manuel Maria Ianieri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | | | | | - Pia Clara Pafundi
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Federica Campolo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Abatini
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Miriam Attalla El Halabieh
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Pacelli
- Catholic University of the Sacred Heart, Rome, Italy
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Anorectal Branch of Chinese Medical Doctor Association, Clinical Guidelines Committee of Anorectal Branch of Chinese Medical Doctor Association, Anorectal Motility Disorders Committee of Colorectal Surgeons Branch of Chinese Medical Doctor Association, Colorectal Branch of China International Exchange and Promotive Association for Medical and Healthcare. [Chinese expert consensus on colonic and anorectal manometry (2023 edition)]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:1095-102. [PMID: 38110269 DOI: 10.3760/cma.j.cn441530-20230922-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Colonic and anorectal manometry includes anorectal manometry and colonic manometry. Anorectal manometry is a common method to evaluate anorectal function, which can objectively reflect the pathological and physiological abnormalities of outlet obstructive constipation and fecal incontinence, as well as the impact of anorectal surgery on continence. Colonic manometry is a new type of colon motility detection method developed in recent years. It can record the peristalsis and contraction of the whole colon through a pressure measuring catheter, which helps physicians further evaluate various colonic diseases. However, various factors such as testing equipment, operating standards, and evaluation parameters are difficult to unify. There is no consensus on the operation and interpretation of colorectal anal pressure measurement. Under the guidance of the Anorectal Branch of Chinese Medical Doctor Association, in collaboration with Clinical Guidelines Committee, Anorectal Branch of Chinese Medical Doctor Association, Anorectal motility disorders Committee , Colorectal Surgeons Branch of Chinese Medical Doctor Association, Colonic Branch of China international exchange and promotive association for medical and healthcare, Tianjin Union Medical Center is leading the organization of domestic experts in this field. Based on searching relevant literature and combining clinical experience at home and abroad, after multiple discussions, the "Chinese expert consensus on colonic and anorectal manometry" has been prepared. This consensus discusses the indications, contraindications, pre examination management and technical procedures, treatment of complications, and interpretation of examination reports for colonic and anorectal manometry , aiming to guide the standardized clinical practice of colonic and anorectal manometry.
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Zhu Y, Yuan L, Chen Y, Wang F, Yao J. The effect of auricular acupressure for postoperative analgesia in anorectal disease: A meta-analysis. Asian J Surg 2023; 46:5989-5990. [PMID: 37723033 DOI: 10.1016/j.asjsur.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Affiliation(s)
- Ying Zhu
- The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, PR China.
| | - Li Yuan
- The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, PR China
| | - Yanlin Chen
- The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, PR China
| | - Feng Wang
- The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, PR China
| | - Jie Yao
- The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, PR China.
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Cooper EA, Cunningham C, Lindsey I. Role of Sacral Nerve Stimulation in Rectoanal Intussusception. Dis Colon Rectum 2023; 66:e1138. [PMID: 37535145 DOI: 10.1097/dcr.0000000000003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Edward A Cooper
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Spampinato S, Rancati T, Waskiewicz JM, Avuzzi B, Garibaldi E, Faiella A, Villa E, Magli A, Cante D, Girelli G, Gatti M, Noris Chiorda B, Rago L, Ferrari P, Piva C, Pavarini M, Valdagni R, Vavassori V, Munoz F, Sanguineti G, Di Muzio N, Kirchheiner K, Fiorino C, Cozzarini C. Patient-reported persistent symptoms after radiotherapy and association with quality of life for prostate cancer survivors. Acta Oncol 2023; 62:1440-1450. [PMID: 37801288 DOI: 10.1080/0284186x.2023.2259597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the persistence of symptoms after radiotherapy (RT) for localised prostate cancer (PCa) and the association with quality of life (QOL). MATERIALS AND METHODS Prospective patient-reported outcome (PRO) from a multi-institutional study on PCa treated with radical RT (2010-2014) was analysed. Data was collected at baseline (BL) and follow-ups (FUPs) up to 5 years. Patients with BL and ≥3 late FUPs (≥6 months) were analysed. PRO was scored by means of the IPSS and ICIQ-SF (urinary), LENT-SOMA (gastrointestinal [GI]), and EORTC-C30 (pain, insomnia, fatigue, and QOL) questionnaires. Symptoms were defined 'persistent' if the median score over FUPs was ≥3 (urinary) or ≥2 (GI, pain, insomnia, and fatigue), and worse than BL. Different thresholds were chosen to have enough events for each symptom. QOL was linearly transformed on a continuous scale (0-100). Linear-mixed models were used to identify significant differences between groups with and without persistent symptoms including age, smoking status, previous abdominal surgery, and diabetes as confounders. Mean QOL differences between groups were evaluated longitudinally over FUPs. RESULTS The analysis included 293 patients. Persistent urinary symptoms ranged from 2% (straining) to 12% (weak stream, and nocturia). Gastrointestinal symptoms ranged from 7% (rectal pain, and incontinence) to 30% (urgency). Proportions of pain, insomnia, and fatigue were 6, 13, and 18%. Significant QOL differences of small-to-medium clinical relevance were found for urinary incontinence, frequency, urgency, and nocturia. Among GI symptoms, rectal pain and incontinence showed small-to-medium differences. Fatigue was associated with the largest differences. CONCLUSIONS The analysis showed that symptoms after RT for PCa occur with different persistence and their association with QOL varies in magnitude. A number of persistent urinary and GI symptoms showed differences in a comparable range. Urinary incontinence and frequency, rectal pain, and faecal incontinence more often had significant associations. Fatigue was also prevalent and associated with largely deteriorated QOL.
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Affiliation(s)
- Sofia Spampinato
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Tiziana Rancati
- Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elisabetta Garibaldi
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Adriana Faiella
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Elisa Villa
- Department of Radiotherapy, Humanitas Gavazzeni, Bergamo, Italy
| | - Alessandro Magli
- Department of Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Domenico Cante
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Giuseppe Girelli
- Department of Radiotherapy, Ospedale degli Infermi, Biella, Italy
| | - Marco Gatti
- Department of Radiotherapy, Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Candiolo, Italy
| | - Barbara Noris Chiorda
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luciana Rago
- Department of Radiotherapy, IRCCS CROB, Rionero in Vulture, Italy
| | - Paolo Ferrari
- Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Cristina Piva
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Maddalena Pavarini
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Valdagni
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Fernando Munoz
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute and Università Vita Salute San Raffaele, Milan, Italy
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Solomon N, Habte T, Alemu S, Sori A. Spontaneous rectosigmoid perforation at the watershed area of the Sudeck point in an apparently healthy toddler boy: a case report. J Med Case Rep 2023; 17:423. [PMID: 37807049 PMCID: PMC10561509 DOI: 10.1186/s13256-023-04157-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Spontaneous colon perforation can be classified into stercoral and idiopathic. Stercoral type is associated with chronic constipation, thus it is rare in infants and children. The idiopathic type is sporadic and could occur at any age. Delay in diagnosing or treating idiopathic colon perforation is associated with high mortality and morbidity rates. There are few studies on rectal perforation related to other etiologies or past the neonatal period, and their effect on disease onset and prognosis are unknown. CASE PRESENTATION We report on a case of 2-year-and-5-month-old Oromo boy who presented with fever, diarrhea, vomiting, and progressive abdominal pain of 5-day duration. The boy underwent an exploratory laparotomy for suspected peritonitis and there was a single perforation of approximately 2.0 cm size in the anterior part of the upper one-third of rectum. The perforated rectum was repaired primarily and sigmoid divided diversion colostomy was carried out. CONCLUSION It is important to be aware of idiopathic colon perforation in children, a rare but dangerous condition with high mortality and morbidity in cases of delayed diagnosis or management. Pediatricians and surgeons should consider colon perforation as a cause in children who present with abdominal distention and a history of diarrhea for more than 5 days.
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Affiliation(s)
- Netsanet Solomon
- Department of Surgery, Faculty of Public Health and Medical Sciences, Health Institute, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Tilahun Habte
- Department of Surgery, Faculty of Public Health and Medical Sciences, Health Institute, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Seifu Alemu
- Department of Surgery, Faculty of Public Health and Medical Sciences, Health Institute, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Ayana Sori
- Department of Surgery, Faculty of Public Health and Medical Sciences, Health Institute, Jimma University, P.O. Box 378, Jimma, Ethiopia
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de Beaufort CMC, Derikx JPM, de Jong JR, Burchell GL, Bosscha SRJ, de Beer SA, van Heurn LWE, Gorter RR. Outcomes after Surgical Treatment for Rectal Atresia in Children: Is There a Preferred Approach? A Systematic Review. Eur J Pediatr Surg 2023; 33:345-353. [PMID: 36516962 PMCID: PMC10564564 DOI: 10.1055/s-0042-1758152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/26/2022] [Indexed: 12/23/2022]
Abstract
Rectal atresia (RA) affects only 1 to 2% of all children with anorectal malformations. No consensus on optimal treatment strategy is yet achieved. Therefore, the aim of this systematic review is to summarize all surgical interventions for RA and outcomes described in the current literature. A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library on January 24, 2022. All studies describing treatment for RA in children (< 18 years) were included. Operation technique and postoperative complications were listed. Only descriptive analysis was anticipated. Quality of the studies was assessed using Johanna Briggs Institute critical appraisal checklist for case reports and series. The search yielded 6,716 studies of which, after duplicate removal, 4,028 were excluded based on title and abstract screening. After full-text assessment, 22 of 90 studies were included, yielding 70 patients. Posterior sagittal anorectoplasty (PSARP) and pull-through were most performed (43/70 and 18/70 patients, respectively). Four patients experienced postoperative complications: anal stenosis (n = 1), anastomotic stenosis (n = 2), and death due to a pulmonary complication (n = 1). In the low-quality literature available, most patients with RA are treated with PSARP or pull-through technique. A low complication rate of both has been described but follow-up was often not mentioned. Larger well-designed studies should be performed to determine optimal treatment strategy for children with RA. This study reflects level of evidence V.
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Affiliation(s)
- Cunera M. C. de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Joep P. M. Derikx
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Justin R. de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - George L. Burchell
- Department of Medical Library, Amsterdam University Medical Center, Vrije Universiteit of Amsterdam, Medical Library, Amsterdam, the Netherlands
| | - Sterre R. J. Bosscha
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sjoerd A. de Beer
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lodewijk W. Ernest van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Ramon R. Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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Suárez Pazos N, Cristóbal Poch L, González Sánchez FJ, Del Castillo Diego J. Proctalgia and obstructive defecation syndrome secondary to internal anal sphincter idiopathic hypertrophy. Cir Esp 2023; 101:643. [PMID: 36257573 DOI: 10.1016/j.cireng.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 08/06/2023]
Affiliation(s)
- Natalia Suárez Pazos
- Unidad Coloproctología, Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.
| | - Lidia Cristóbal Poch
- Unidad Coloproctología, Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | | | - Julio Del Castillo Diego
- Unidad Coloproctología, Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
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12
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He CC, Wang SP, Zhou PR, Li ZJ, Li N, Li MS. Inherited CHEK2 p.H371Y mutation in solitary rectal ulcer syndrome among familial patients: A case report. World J Gastroenterol 2023; 29:4809-4814. [PMID: 37664155 PMCID: PMC10473918 DOI: 10.3748/wjg.v29.i31.4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Solitary rectal ulcer syndrome (SRUS) is a rare rectal disease with unknown etiology. Data on the genetic background in SRUS is lacking. CASE SUMMARY Here, we report the first case of SRUS in a mother-son relationship. Gene sequencing was conducted on the whole family, which revealed an inherited CHEK2 p.H371Y mutation. The experiment preliminarily revealed that the CHEK2 mutation did not affect the expression of CHEK2 protein, but affected the function of CHEK2, resulting in the expression level changes of downstream genes such as CDC25A. CONCLUSION SRUS is a genetic susceptibility disease where CHEK2 p.H371Y mutation may play a crucial role in the development and prognosis of SRUS.
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Affiliation(s)
- Cheng-Cheng He
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Shan-Ping Wang
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Pei-Rong Zhou
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Zhi-Jun Li
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Na Li
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Ming-Song Li
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
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Wu K, Little RD, Long A, Khera A, Kamm MA, Basnayake C. Clinical features and outcomes of adult idiopathic megarectum. Eur J Gastroenterol Hepatol 2023; 35:550-552. [PMID: 36966769 DOI: 10.1097/meg.0000000000002545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Idiopathic megarectum is characterized by abnormal, pronounced rectal dilatation in the absence of identifiable organic pathology. Idiopathic megarectum is uncommon and under-recognized. This study aims to describe the clinical features and management of idiopathic megarectum. METHODS A retrospective review was undertaken on patients diagnosed with idiopathic megarectum with or without idiopathic megacolon over a 14-year period until 2021. Patients were identified from the hospital's International Classification of Diseases codes, and pre-existing clinic patient databases. Patient demographics, disease characteristics, healthcare utilization and treatment history data were collected. RESULTS Eight patients with idiopathic megarectum were identified; half of the patients were female, with the median age of symptom onset being 14 years (interquartile range [IQR] 9-24). The median rectal diameter measured was 11.5 cm (IQR 9.4-12.1). The most common presenting symptom was constipation, bloating and faecal incontinence. All patients required prior sustained periods of regular phosphate enemas and 88% were using ongoing oral aperients. Concomitant anxiety and or depression were found in 63% of patients and 25% were diagnosed with an intellectual disability. Healthcare utilization was high with a median of three emergency department presentations or ward admissions related to idiopathic megarectum per patient over the follow-up period; 38% of patients required surgical intervention during the period of follow-up. CONCLUSION Idiopathic megarectum is uncommon and associated with significant physical and psychiatric morbidity and high healthcare utilization.
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Affiliation(s)
- Kyle Wu
- St Vincent's Hospital Melbourne, Melbourne, Australia
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14
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Pinto MYP, Wee C, Jarmin M. Management of rectal foreign body: a rare complication with colonic intussusception. ANZ J Surg 2023; 93:766-767. [PMID: 36039814 DOI: 10.1111/ans.18008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Cecilia Wee
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Martin Jarmin
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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15
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Cantay H, Turker UA. Prevalence of perianal diseases and associated factors in primigravida women: A hospital-based cross-sectional study. Saudi Med J 2022; 43:1142-1148. [PMID: 36261207 PMCID: PMC9994506 DOI: 10.15537/smj.2022.43.10.20220198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To define the incidence of anorectal diseases in primigravida women as well as in the first month after delivery and the factors affecting the development of anorectal diseases. METHODS The sample size was determined as 328 primigravida women. Research data were collected from pregnant women who applied to Gynecology and Obstetrics Polyclinic, Kars Harakani State Hospital Gynecology and General Surgery Polyclinic, Kafkas University, Kars, Turkey, between November 2020 and August 2021.The pregnant women were examined and surveyed 4 times; in the second and third trimesters, on the day after delivery, and in the first month after delivery. Chi-square test was used in the analysis of the data determined by counting. Variables which were statistically significant (p<0.05) in the Chi-square test were included in the backward logistic regression analysis. RESULTS Perianal disease was observed in 103 (38.6%) of the pregnant women. The incidence of perianal disease was found to be 4.917 times (confidence interval [CI]: [2.134-11.327]) higher in those with perianal disease compared with those without, 2.936 times (CI:[1.584-5.439]) higher in those who did not consume fiber-rich foods compared with those who did, 9.512 times (CI: [4.583-19.742]) higher in those with constipation compared with those without, and 23.721 times (CI: [5.363-104.915]) higher in those whose pushing stage duration was above average compared with that in those whose pushing stage duration was below average. CONCLUSION In primigravida pregnants, the risk of perianal disease increases in those who have perianal disease before pregnancy, those who do not consume fibrous food, those who have constipation, and those who have a long pushing period.
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Affiliation(s)
- Hasan Cantay
- From the Department of General Surgery (Cantay), Faculty of Medicine, Kafkas University, and from the Obstetrics and Gynecology Clinic (Turker), Kars Harakani Public Hospital, Kars, Turkey.
| | - Ulku Ayse Turker
- From the Department of General Surgery (Cantay), Faculty of Medicine, Kafkas University, and from the Obstetrics and Gynecology Clinic (Turker), Kars Harakani Public Hospital, Kars, Turkey.
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16
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Association of Coloproctology of Great Britain and Ireland Annual Meeting, 4-6 July 2022, Edinburgh. Colorectal Dis 2022; 24 Suppl 2:3-93. [PMID: 36065629 DOI: 10.1111/codi.16259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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17
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Pathela P, Qasmieh S, Gandhi M, Rozen E, Okochi H, Goldstein H, Herold BC, Jamison K, Schillinger JA, Nash D. Brief Report: Use of Remnant Specimens to Assess Use of HIV PrEP Among Populations With Risk of HIV Infection: A Novel Approach. J Acquir Immune Defic Syndr 2022; 90:382-387. [PMID: 35357337 PMCID: PMC9246871 DOI: 10.1097/qai.0000000000002992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV-uninfected persons being evaluated for sexually transmitted infections (STIs) may be good HIV pre-exposure prophylaxis (PrEP) candidates. We measured PrEP use in a sentinel STI patient population. DESIGN Cross-sectional study, New York City Sexual Health Clinics (January 2019-June 2019). METHODS Remnant serum samples from 644 HIV-uninfected men who have sex with men (MSM) and 97 women diagnosed with chlamydia, gonorrhea, and/or early syphilis were assayed for tenofovir and emtricitabine levels using a validated liquid chromatography-mass spectrometry assay. Using paired test results and medical records, we assessed (1) prevalence and (2) correlates of PrEP use on the day of STI diagnosis (adjusted prevalence ratios [aPRs]). RESULTS PrEP use among 741 patients was 32.7% [95% confidence interval (CI): 29.3 to 36.0]; 37.3% for MSM and 2.1% for women. PrEP use was high among White MSM (46.8%) and lowest among women. Among MSM with rectal chlamydia/gonorrhea or early syphilis, PrEP use was associated with age [aPR = 1.7 (95% CI: 1.2 to 2.4) for ages 25-34 years and aPR = 2.0 (1.4 to 2.9) for ages 35-44 years, vs. 15 to 24 years]; number of recent sex partners [aPR = 1.4 (1.0 to 2.0) for 3-5 partners, aPR = 2.1 (1.5 to 3.0) for 6-10 partners, aPR = 2.2 (1.6 to 3.1) for >10 partners, vs. ≤2 partners]; having sex/needle-sharing partners with HIV [aPR = 1.4 (1.1-1.7)]; and inconsistent condom use [aPR = 3.3 (1.8-6.1)]. Race/ethnicity, past-year STI diagnosis, and postexposure prophylaxis use were not associated. CONCLUSIONS One in 3 people with newly diagnosed STIs had detectable serum PrEP, and PrEP use was exceedingly rare among women. Routinely collected remnant samples can be used to measure PrEP use in populations at high risk of HIV acquisition.
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Affiliation(s)
- Preeti Pathela
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Saba Qasmieh
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
| | - Monica Gandhi
- University of California San Francisco Center for AIDS Research, San Francisco, CA
| | - Elliot Rozen
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Hideaki Okochi
- University of California San Francisco Center for AIDS Research, San Francisco, CA
| | | | | | - Kelly Jamison
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Julia A. Schillinger
- New York City Department of Health and Mental Hygiene, Queens, NY
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Denis Nash
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
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18
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Fritz S, Killguss H, Schaudt A, Sommer CM, Richter GM, Belle S, Reissfelder C, Loff S, Köninger J. Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature. Langenbecks Arch Surg 2022; 407:2499-2508. [PMID: 35654873 DOI: 10.1007/s00423-022-02571-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retained rectal foreign bodies (RFBs) are uncommon clinical findings. Although the management of RFBs is rarely reported in the literature, clinicians regularly face this issue. To date, there is no standardized management of RFBs. The aim of the present study was to evaluate our own data and subsequently develop a treatment algorithm. METHODS All consecutive patients who presented between January 2006 and December 2019 with rectally inserted RFBs at the emergency department of the Klinikum Stuttgart, Germany, were retrospectively identified. Clinicopathologic features, management, complications, and outcomes were assessed. Based on this experience, a treatment algorithm was developed. RESULTS A total of 69 presentations with rectally inserted RFBs were documented in 57 patients. In 23/69 cases (33.3%), the RFB was removed transanally by the emergency physician either digitally (n = 14) or with the help of a rigid rectoscope (n = 8) or a colonoscope (n = 1). In 46/69 cases (66.7%), the RFB was removed in the operation theater under general anesthesia with muscle relaxation. Among these, 11/46 patients (23.9%) underwent abdominal surgery, either for manual extraction of the RFB (n = 9) or to exclude a bowel perforation (n = 2). Surgical complications occurred in 3/11 patients. One patient with rectal perforation developed pelvic sepsis and underwent abdominoperineal extirpation in the further clinical course. CONCLUSION The management of RFBs can be challenging and includes a wide range of options from removal without further intervention to abdominoperineal extirpation in cases of pelvic sepsis. Whenever possible, RFBs should obligatorily be managed in specialized colorectal centers following a clear treatment algorithm.
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Affiliation(s)
- Stefan Fritz
- Department of General, Visceral, Thoracic, and Transplantation Surgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Deutsches End- und Dickdarmzentrum, Mannheim, Germany.
| | - Hansjörg Killguss
- Department of General, Visceral, Thoracic, and Transplantation Surgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - André Schaudt
- Department of General, Visceral, Thoracic, and Transplantation Surgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
| | - Götz M Richter
- Department of Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
| | - Sebastian Belle
- Department of Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffan Loff
- Department of Pediatric Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Jörg Köninger
- Department of General, Visceral, Thoracic, and Transplantation Surgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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19
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Fogle SE, Donahue CA, Beresneva O, Kuhnen AH, Kleiman DA, Breen EM, Schoetz DJ, Roberts PL, Marcello PW, Saraidaridis JT. Horseshoe Fistulae in the Age of LIFT. J Gastrointest Surg 2022; 26:1077-1083. [PMID: 35064458 DOI: 10.1007/s11605-021-05233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Horseshoe fistula is a challenging benign anorectal condition to treat. The aim of this study was to assess the utilization and success of different definitive fistula repair techniques in the treatment of horseshoe fistula. METHODS This was a retrospective case series which included all patients who were treated for horseshoe fistula from 2006 to 2019 at a single, tertiary care center and whom had at least one follow-up visit. Patients were excluded if < 18 years of age or carried a diagnosis of Crohn's disease. Patients were assessed for fistula recurrence and incontinence. RESULTS Sixty-eight patients were identified. On average, they were 47 years old, 63% male, and 18% current smokers. Seventy-nine percent required seton during their treatment course. Of the 8 first attempts at fistula repair, the types of repair included flap (15%), LIFT (35%), fistulotomy (31%), plug (12%), and fistulotomy and immediate reconstruction (1%). Recurrence for these procedures was as follows: flap 30%, LIFT 21%, fistulotomy 14%, plug 88%, and fistulotomy and immediate reconstruction 0%. Twelve patients who recurred underwent 17 additional procedures to attempt to cure their fistula. Overall, of those who underwent any attempt at definitive repair, 82% of patients were cured of their fistula, 12% had a chronic seton, and 6% had a chronic fistula. Thirteen percent of those who were cured had incontinence. The mean follow-up time was 1.1 years. Patients required a median of 3 procedures (range 1-11). CONCLUSION Horseshoe fistula remains a complex anorectal condition. Successful repair can be performed in > 80% of patients. However, repair can often require multiple surgical procedures.
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Affiliation(s)
- Sydney E Fogle
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Colleen A Donahue
- Division of Colon and Rectal Surgery, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC, 29405, USA
| | - Olga Beresneva
- Division of Colon and Rectal Surgery, Boston Medical Center, 830 Harrison Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Angela H Kuhnen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - David A Kleiman
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Elizabeth M Breen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - David J Schoetz
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Patricia L Roberts
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Peter W Marcello
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Julia T Saraidaridis
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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20
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Bradshaw E. Colorectal nursing and low anterior resection syndrome. Br J Nurs 2022; 31:194-198. [PMID: 35220732 DOI: 10.12968/bjon.2022.31.4.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ellie Bradshaw
- Colorectal and Biofeedback Nurse Specialist, Princess Grace Hospital, London
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21
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Zhou J, Ho V, Javadi B. New Internet of Medical Things for Home-Based Treatment of Anorectal Disorders. Sensors (Basel) 2022; 22:s22020625. [PMID: 35062585 PMCID: PMC8780207 DOI: 10.3390/s22020625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022]
Abstract
Home-based healthcare provides a viable and cost-effective method of delivery for resource- and labour-intensive therapies, such as rehabilitation therapies, including anorectal biofeedback. However, existing systems for home anorectal biofeedback are not able to monitor patient compliance or assess the quality of exercises performed, and as a result have yet to see wide spread clinical adoption. In this paper, we propose a new Internet of Medical Things (IoMT) system to provide home-based biofeedback therapy, facilitating remote monitoring by the physician. We discuss our user-centric design process and the proposed architecture, including a new sensing probe, mobile app, and cloud-based web application. A case study involving biofeedback training exercises was performed. Data from the IoMT was compared against the clinical standard, high-definition anorectal manometry. We demonstrated the feasibility of our proposed IoMT in providing anorectal pressure profiles equivalent to clinical manometry and its application for home-based anorectal biofeedback therapy.
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Affiliation(s)
- Jerry Zhou
- Translational Gastroenterology Laboratory, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (J.Z.); (V.H.)
| | - Vincent Ho
- Translational Gastroenterology Laboratory, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (J.Z.); (V.H.)
- Department of Gastroenterology, Campbelltown Hospital, Campbelltown, NSW 2560, Australia
| | - Bahman Javadi
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Correspondence: ; Tel.: +61-2-9685-9181
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Balytskyy VV. PAIN SYNDROME IN PATIENTS AFTER COMBINED OPERATIONS FOR COMBINED ANO RECTAL DISEASES USING MODERN SURGICAL TECHNOLOGIES. Wiad Lek 2022; 75:2238-2243. [PMID: 36378702 DOI: 10.36740/wlek202209211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To compare the pain in patients with combined pathology of the anal canal and rectum after combined operations using modern high-frequency electrosurgical and radio-surgical devices and a conventional metal scalpel. PATIENTS AND METHODS Materials and methods: The results of treatment of 635 patients with combined pathology of the anal canal and rectum using high-frequency electrosurgery and radio-wave surgery, which were divided into 4 study groups, as well as 112 patients using a metal surgical scalpel were analyzed. RESULTS Results: Assessing the pain syndrome on the first day of the postoperative period, it was found that it was most pronounced in control group patients, where the need for anal¬gesia 2 % promedol solution was 4±1 ml and in the first, third and fourth study groups patients needed for analgesia 2±1 ml of 2 % promedol solution when using "Surgitron" radio-wave surgery device, "EFA" and "KLS Martin" high-frequency electrosurgical devices respectively. When using device "ERBE ICC 200", the need for a 2 % promedol solution for analgesia was 3±1 ml. CONCLUSION Conclusions: Using of radio-wave surgery device and high-frequency electrosurgery devices is much better compared to the use of a surgical metal scalpel because they cause much less pain due to the formation of a thin layer of coagulation necrosis, promoting the formation of a delicate elastic scar and preventing formation of scar anal strictures.
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Affiliation(s)
- Vitaliy V Balytskyy
- VINNYTSIA NATIONAL M.I. PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE; PUBLIC NON-PROFIT ENTERPRISE "KHMELNYTSKYI REGIONAL HOSPITAL", UNDER KHMELNYTSKYI REGIONAL COUNCIL, KHMELNYTSKYI, UKRAINE
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Abstract
Low anterior resection syndrome (LARS) is a collection of symptoms that can occur as a result of a low anterior resection for bowel cancer. Transanal irrigation (TAI) can be used to manage these symptoms. This article describes a retrospective audit of 15 patients who were using TAI to manage symptoms of LARS. The aim of the audit was to ascertain whether the use of TAI improved outcomes for these patients. The data suggest that TAI has reduced both the frequency of bowel movements and episodes of faecal incontinence. Those patients using higher volumes of water seem to have experienced more benefit than those patients using lower volumes of water. These findings are consistent with current literature around TAI for LARS and suggest research into optimum volume of water would be beneficial.
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Affiliation(s)
- Rebecca Embleton
- Bowel Dysfunction Specialist Nurse, Durham Bowel Dysfunction Service, County Durham and Darlington NHS Foundation Trust
| | - Michelle Henderson
- Academic Clinical Nurse Specialist, Durham Bowel Dysfunction Service, County Durham and Darlington NHS Foundation Trust
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Balytskyy V, Zakharash M, Kuryk O. THE RESULTS OF SURGICAL TRATMENT OF COMBINED ANO RECTAL DISEASES USING RADIO-FREQUENCY AND HIGH-FREQUENCY ELECTROSURGICAL DEVICES. Georgian Med News 2021:13-19. [PMID: 34628371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The combined pathology of the anal canal and rectum is a very important problem today, due to its progressive growth, especially in industrialized countries over the past two or three decades. The aim of the study was to conduct a comparative assessment of using high-frequency electrosurgical devices and also radio-frequency device for treatment of combined anal саnal and rectal pathology. The results of treatment of 635 patients with combined anal canal and rectal diseases have been analyzed. Using high-frequency electrosurgical device "ERBE ICC 200" (ERBE Elektromedizin GmbH, Germany) have been operated on 169 (26,6%) patients, high-frequency electrosurgical device "EFA" (Russia) - 114 (17,9%) patients, high-frequency electrosurgical device "KLS Martin" (KLS Martin Group, Germany)- 107 (16,9%) patients and radio-frequency device "Surgitron" (Ellman International, USA) - 245 (38,6%) patients. After operations for assessment the effectiveness of using the above technologies all patients in each group were underwent to morphological investigations of anal canal and rectal tissues to study the depth of coagulation necrosis. In case of using of the high-frequency electrosurgical device "ERBE ICC 200" the incision of tissues occurred with formation of coagulation necrosis layer, which thickness was 0,113-0,457mm, in case of using high-frequency electrosurgical device "EFA" a layer of coagulation necrosis formed with thickness 0,074-0,434mm, in case of using high-frequency electrosurgical device"KLS Martin" forms a thin layer of coagulation necrosis in the thickness along the edge of the cut 0,053-0,333 mm and using of radio-frequency device "Surgitron" was accompanied with the formation on the cut edge of a thin coagulation necrosis layer with depth 0,037-0,297mm. Application of these modern radio-frequency and high-frequency technologies, due to the minimal and slight influence on tissues, contributes to reducing the operations duration, intensity of the postoperative pain, improving the terms of patients rehabilitation.
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Affiliation(s)
- V Balytskyy
- 1Vinnytsia National M.I. Pyrogov Memorial Medical University; 2Khmel`nyts`kyi regional hospital, Khmel`nyts`kyi; Ukraine
| | - M Zakharash
- 3Bogomolets National Medical University, Kyiv, Ukraine
| | - O Kuryk
- 3Bogomolets National Medical University, Kyiv, Ukraine
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Puppo A, Olearo E, Gattolin A, Rimonda R, Novelli A, Ceccaroni M. Intraoperative Ultrasound for Bowel Deep Infiltrating Endometriosis: A Preliminary Report. J Ultrasound Med 2021; 40:1417-1425. [PMID: 32991006 DOI: 10.1002/jum.15511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 06/11/2023]
Abstract
The decision to perform either conservative surgery or segmental bowel resection for bowel deep infiltrating endometriosis (DIE) is made intraoperatively, after a preoperative assessment, based on the nodule's features. We introduce a technique to evaluate DIE bowel nodules using laparoscopic intraoperative ultrasound (US) during laparoscopic radical treatment of 9 cases of DIE invading the bowel. Once the bowel lesion was isolated, an intraoperative 12-4-MHz US transducer was placed on the surface of the nodules to study their US features and to gain measurements. Deep infiltrating endometriosis nodules appear at intraoperative US as hypoechoic elliptical lesions with a clear definition of margins and the depth of infiltration of the rectal wall.
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Affiliation(s)
- Andrea Puppo
- Department of Obstetrics and Gynecology, Regina Montis Regalis Hospital, Mondovi, Italy
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Elena Olearo
- Department of Obstetrics and Gynecology, Regina Montis Regalis Hospital, Mondovi, Italy
| | - Andrea Gattolin
- Department of General Surgery, Regina Montis Regalis Hospital, Mondovi, Italy
| | - Roberto Rimonda
- Department of General Surgery, Regina Montis Regalis Hospital, Mondovi, Italy
| | - Antonia Novelli
- Department of Obstetrics and Gynecology, Regina Montis Regalis Hospital, Mondovi, Italy
- Division of Gynecology Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
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Chen SC, Futaba K, Leung WW, Wong C, Mak T, Ng S, Gregersen H. Fecobionics assessment of the effect of position on defecatory efficacy in normal subjects. Tech Coloproctol 2021; 25:559-568. [PMID: 33779850 DOI: 10.1007/s10151-021-02439-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Defecation is a complex process and up to 25% of the population suffer from symptoms of defecatory dysfunction. For functional testing, diagnostics, and therapy of anorectal disorders, it is important to know the optimal defecation position. is The aim of this study was to evaluate defecation pressure patterns in side lying, seated and squatting defecation positions in normal subjects using a simulated stool device called Fecobionics. METHODS The Fecobionics expulsion parameters were assessed in an interventional study design conducted from May 29 to December 9 2019. Subjects were invited to participate in the study through advertisement at The Chinese University of Hong Kong. The Fecobionics device consisted of a core containing pressure sensors at the front (caudal end) and rear (cranial end) and a polyester-urethane bag spanning most of the core length which also contained sensors. The Fecobionics bag was distended to 50 ml in the rectum of normal subjects (no present and past symptoms of defecatory disorders, no prior abdominal surgery, medication or chronic diseases). Studies were done in side lying (left lateral recumbent position), seated (hip flexed 90°) and squatting position (hip flexed 25°). Pressure endpoints including the rear-front pressure diagram and defecation indices were compared between positions. RESULTS Twelve subjects (6 females/6 males, mean age 26.3 ± 2.6 [19.0-48.0] years) were included and underwent the planned procedures. The resting anal pressure for side lying and seated positions were 33.1 ± 4.1 cmH2O and 37.1 ± 4.0 cmH2O (p > 0.3). The anal squeeze pressure for side lying and seated positions were 98.4 ± 6.9 cmH2O and 142.3 ± 16.4 cmH2O (p < 0.05). The expulsion duration for the side lying, seated and squatting positions were 108.9 ± 8.3 s, 15.0 ± 2.1 s and 16.1 ± 2.9 s, respectively (p < 0.01 between lying and the two other positions). The maximum evacuation pressure for seated and squatting were 130.1 ± 12.4 cmH2O and 134.0 ± 11.1 cmH2O (p > 0.5). Rear-front pressure diagrams and distensibility indices demonstrated distinct differences in pressure patterns between the side lying position group and the other positions. CONCLUSIONS The delay in expelling the Fecobionics device in the lying position was associated with dyssynergic pressure patterns on the device. Quantitative differences were not found between the seated and squatting position. Trial Registration http://www.clinicaltrials.gov Identifier: NCT03317938.
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Affiliation(s)
- S-C Chen
- GIOME, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F, Clinical Sciences Building, Shatin, Hong Kong, China
| | - K Futaba
- GIOME, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F, Clinical Sciences Building, Shatin, Hong Kong, China
| | - W W Leung
- GIOME, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F, Clinical Sciences Building, Shatin, Hong Kong, China
| | - C Wong
- GIOME, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F, Clinical Sciences Building, Shatin, Hong Kong, China
| | - T Mak
- GIOME, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F, Clinical Sciences Building, Shatin, Hong Kong, China
| | - S Ng
- GIOME, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F, Clinical Sciences Building, Shatin, Hong Kong, China
| | - H Gregersen
- GIOME, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F, Clinical Sciences Building, Shatin, Hong Kong, China.
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Plakhotnyi RО, Кerechanyn ІV, Fedoniuk LY, Kovalchuk NV, Dehtiariova OV, Singh G. COMPERATIVE STRUCTURE OF MUCOSA COAT OF THE PIG`S AND THE HUMAN`S RECTUM. Wiad Lek 2021; 74:1718-1723. [PMID: 34459777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim: To determine whether the pig could be used as biomodel for study and reconstruction of rectal pathology for development the new approaches for prevention and treatment of rectal diseases. PATIENTS AND METHODS Materials and methods: For the research the rectum of 8 vietnamese pot-bellied pigs were used. Via macro- and microscopy the structure of mucosa coat of the pig`s and human`s rectum was compared. RESULTS Results: Mucosa coat`s peculiarities of pig`s and human`s rectum in comparative aspect are described in this article. With the help of traditional methods, known as macroscopy the structure of the pig`s rectal mucosa was study and compared wih macrostructure of human`s rectum. The microstucture of pig`s rectal mucosa was study due to histological method too. The macro- and microscopy demonstrated that structure of pig`s and human`s rectal mucosa are similar and includes same structural components. CONCLUSION Conclusions: Thus, the research proved that pigs can be used as biomodels in biomedical research for creating various new methods and applications in approaching the prevention and treatment of rectal pathology in humans.
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Affiliation(s)
- Roman О Plakhotnyi
- PRIVATE HIGHER EDUCATIONAL ESTABLISHMENT «KYIV MEDICAL UNIVERSITY», KYIV, UKRAINE
| | - Іryna V Кerechanyn
- PRIVATE HIGHER EDUCATIONAL ESTABLISHMENT «KYIV MEDICAL UNIVERSITY», KYIV, UKRAINE
| | | | - Nataliia V Kovalchuk
- PRIVATE HIGHER EDUCATIONAL ESTABLISHMENT «KYIV MEDICAL UNIVERSITY», KYIV, UKRAINE
| | | | - Gagandeep Singh
- PRIVATE HIGHER EDUCATIONAL ESTABLISHMENT «KYIV MEDICAL UNIVERSITY», KYIV, UKRAINE
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ACPGBI Legacy Working Group. Legacy of COVID-19 - the opportunity to enhance surgical services for patients with colorectal disease. Colorectal Dis 2020; 22:1219-28. [PMID: 32857886 DOI: 10.1111/codi.15341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
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Roper JC, Thakar R, Sultan AH. Isolated rectal buttonhole tears in obstetrics: case series and review of the literature. Int Urogynecol J 2020; 32:1761-1769. [PMID: 32930849 PMCID: PMC8295104 DOI: 10.1007/s00192-020-04502-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022]
Abstract
Introduction and hypothesis The management of isolated rectal buttonhole tears is not standardised and can be challenging in an acute obstetric setting. Our aim was to review the published literature and describe management and repair techniques in a case series. Methods A literature search was carried out. All results were screened and reviewed. Rectal buttonhole tears following vaginal delivery between April 2012 and January 2020 in our institution were identified. Repair technique and post-operative management were recorded. Results There were nine published case reports (four instrumental deliveries, two vaginal breech and three normal vaginal deliveries). Four case reports described a two-layer closure and five described a three-layer closure. Two cases were repaired in collaboration with colorectal surgeons. All nine cases made an uneventful recovery. We identified three patients with buttonhole tears all of whom had instrumental deliveries. A colorectal surgeon repaired the tear in two layers in one case, and an obstetrician performed the repair in the other two cases, one in three layers and the other in two layers. One patient had a de-functioning stoma at a later date due to a second breakdown of the recto-vaginal fistula repair. Conclusion Buttonhole tears are rare but techniques of repair vary. Most cases reviewed had an uneventful recovery after repair. We provide standardised steps for repair and management of isolated rectal buttonhole tears along with a video demonstrating the repair technique in an animal tissue (pig) model. Electronic supplementary material The online version of this article (10.1007/s00192-020-04502-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanna C Roper
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK
| | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK
- St George's University of London, London, UK
| | - Abdul H Sultan
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK.
- St George's University of London, London, UK.
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Marcello M, Denham JW, Kennedy A, Haworth A, Steigler A, Greer PB, Holloway LC, Dowling JA, Jameson MG, Roach D, Joseph DJ, Gulliford SL, Dearnaley DP, Sydes MR, Hall E, Ebert MA. Relationships between rectal and perirectal doses and rectal bleeding or tenesmus in pooled voxel-based analysis of 3 randomised phase III trials. Radiother Oncol 2020; 150:281-292. [PMID: 32745667 DOI: 10.1016/j.radonc.2020.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to identify anatomically-localised regions where planned radiotherapy dose is associated with gastrointestinal toxicities in healthy tissues throughout the pelvic anatomy. MATERIALS AND METHODS Planned dose distributions for up to 657 patients of the Trans Tasman Radiation Oncology Group 03.04 RADAR trial were deformably registered onto a single exemplar computed tomography dataset. Voxel-based multiple comparison permutation dose difference testing, Cox regression modelling and LASSO feature selection were used to identify regions where dose-increase was associated with grade ≥2 rectal bleeding (RB) or tenesmus, according to the LENT/SOMA scale. This was externally validated by registering dose distributions from the RT01 (n = 388) and CHHiP (n = 241) trials onto the same exemplar and repeating the tests on each of these data sets, and on all three datasets combined. RESULTS Voxel-based Cox regression and permutation dose difference testing revealed regions where increased dose was correlated with gastrointestinal toxicity. Grade ≥2 RB was associated with posteriorly extended lateral beams that manifested high doses (>55 Gy) in a small rectal volume adjacent to the clinical target volume. A correlation was found between grade ≥2 tenesmus and increased low-intermediate dose (∼25 Gy) at the posterior beam region, including the posterior rectum and perirectal fat space (PRFS). CONCLUSIONS The serial response of the rectum with respect to RB has been demonstrated in patients with posteriorly extended lateral beams. Similarly, the parallel response of the PRFS with respect to tenesmus has been demonstrated in patients treated with the posterior beam.
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Affiliation(s)
- Marco Marcello
- Department of Physics, University of Western Australia, Crawley, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia.
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Annette Haworth
- School of Physics, University of Sydney, Camperdown, Australia
| | - Allison Steigler
- Prostate Cancer Trials Group, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia; Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, Australia
| | - Lois C Holloway
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia
| | - Jason A Dowling
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia; CSIRO, Herston, Australia
| | - Michael G Jameson
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia; Cancer Research Team, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Dale Roach
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Cancer Research Team, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - David J Joseph
- School of Surgery, University of Western Australia, Crawley, Australia; 5D Clinics, Claremont, Australia; GenesisCare WA, Wembley, Australia
| | - Sarah L Gulliford
- Radiotherapy Department, University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - David P Dearnaley
- Academic UroOncology Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, London, Australia
| | - Mathew R Sydes
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Martin A Ebert
- Department of Physics, University of Western Australia, Crawley, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia; 5D Clinics, Claremont, Australia
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Opluštil Š. Enteral cystic duplicature in peripartum period - case report. Ceska Gynekol 2020; 85:120-123. [PMID: 32527106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Author demonstrates case of enteral cystic duplicature located between coccyx and rectum in peripartal period. DESIGN Case report. SETTING Masarykova městská nemocnice, Jilemnice. SUBJECT AND METHOD Case of enteral cystic duplicature in adult, 25-29 year female, first case after natural birth, second one in the end of second pregnancy. Open surgical solution with exstirpation. CONCLUSION Cystic duplication of the rectum belongs to congenital anomalies, rarely occurring even in adulthood. The second opinion and quality preoperative diagnostics played a key role in the case, leading in both cases to primary, complete exstirpation, without any reoperation or complications. The surgical approach was chosen parasacral section, laterally differentiated according to the location of the dominant part of the cyst.
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Kanikovskyi OE, Osadchyі AV, Androsov SI, Tomashevsky AV, Yarmak OA, Bakhnivskyi VS. Therapeutic tactics in the deep forms of rectal abscesses complicated by fournie gangrene. Wiad Lek 2020; 73:293-297. [PMID: 32248162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim: To conduct an analysis of the complex treatment of severe forms of rectal abscesses complicated by NF. PATIENTS AND METHODS Materials and methods: The results of treatment in 471 patients with deep forms of RA was performed. In 38(8%) the spread of the process and rotten-necrotic affection of the perineal fascia. Patients were treated at the surgical clinic of the medical faculty №2, VNPMMU, and Vinnytsya Clinical Emergency Hospital in the period from 2010-2018. RESULTS Results: Total lethality 8(1,7%). Mortality in GF was 8(19,5%). It is worth noting the reduction of the treatment duration against the background of the modern technologies usage in the period from 2016 to 12 days in relation to the total figure of 15 days. CONCLUSION Conclusions: Early surgical treatment, adequate necrectomy, fasciotomy and antibacterial therapy stop the necrotic process. The active aspiration reduces the timing of wound cleansing and further ensures the accelerated implementation of reconstructive surgical interventions.
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Affiliation(s)
| | | | | | | | - Oleh A Yarmak
- National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Valentyn S Bakhnivskyi
- Cracow University Of Economics, Cracow, Poland, Stefan Żeromski Hospital In Cracow, Poland
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Cossi P, Schor E, Gonçalves LF, Werner H. Assessment of rectovaginal endometriosis using three-dimensional gel-infusion sonovaginography. Ultrasound Obstet Gynecol 2019; 53:558-560. [PMID: 30288806 DOI: 10.1002/uog.20135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/26/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Affiliation(s)
- P Cossi
- Departamento de Ginecologia UNIFESP, Setor de Endometriose e Algia Pélvica, São Paulo, Brazil
| | - E Schor
- Departamento de Ginecologia UNIFESP, Setor de Endometriose e Algia Pélvica, São Paulo, Brazil
| | - L F Gonçalves
- Department of Medical Imaging, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - H Werner
- Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
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Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018; 33:835-847. [PMID: 29744578 DOI: 10.1007/s00384-018-3082-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE "Endometriosis" is defined such as the presence of endometrial glands and stroma outside the uterine cavity. This ectopic condition may develop as deeply infiltrating endometriosis (DIE) when a solid mass is located deeper than 5 mm underneath the peritoneum including the intestinal wall. The ideal surgical treatment is still under search, and treatment may range from simple shaving to rectal resection. The aim of the present systematic review is to report and analyze the postoperative outcomes after rectosigmoid resection for endometriosis. METHODS We performed a systematic review according to Meta-analysis of Observational Studies in Epidemiology guidelines. The search was carried out in the PubMed database, using the keywords: "rectal resection" AND "endometriosis" and "rectosigmoid resection" AND "endometriosis." The search revealed 380 papers of which 78 were fully analyzed. RESULTS Thirty-eight articles published between 1998 and 2017 were included. Three thousand seventy-nine patients (mean age 34.28 ± 2.46) were included. Laparoscopic approach was the most employed (90.3%) followed by the open one (7.9%) and the robotic one (1.7%). Overall operative time was 238.47 ± 66.82. Conversion rate was 2.7%. In more than 80% of cases, associated procedures were performed. Intraoperative complications were observed in 1% of cases. The overall postoperative complications rate was 18.5% (571 patients), and the most frequent complication was recto-vaginal fistula (74 patients, 2.4%). Postoperative mortality rate was 0.03% and mean hospital stay was 8.88 ± 3.71 days. CONCLUSIONS Despite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - José D Subiela
- Department of Urology, Fundació Puigvert, Carrer de Cartegena 340, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain
| | - Mostafa Shalaby
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Giuseppe Petrella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Siegel R. [Iron deficiency anaemia and rectal bleeding - advanced haemorrhoidal disease]. MMW Fortschr Med 2018; 160:48-50. [PMID: 29855901 DOI: 10.1007/s15006-018-0583-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert Siegel
- Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, D-13125, Berlin, Deutschland.
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Xia J, Chen H, Yan J, Wu H, Wang H, Guo J, Zhang X, Zhang S, Zhao C, Chen Y. High-Purity Magnesium Staples Suppress Inflammatory Response in Rectal Anastomoses. ACS Appl Mater Interfaces 2017; 9:9506-9515. [PMID: 28240546 DOI: 10.1021/acsami.7b00813] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Magnesium-based materials are promising biodegradable implants, although the impact of magnesium on rectal anastomotic inflammation is poorly understood. Thus, we investigated the inflammatory effects of high-purity Mg staples in rectal anastomoses by in vivo luciferase reporter gene expression in transgenic mice, hematoxylin-eosin staining, immunohistochemistry, and Western blotting. As expected, strong IL-1β-mediated inflammation and inflammatory cell infiltration were observed 1 day after rectal anastomoses were stapled with high-purity Mg or Ti. However, inflammation and inflammatory cell infiltration decreased more robustly 4-7 days postoperation in tissues stapled with high-purity Mg. This rapid reduction in inflammation was confirmed by immunohistochemical analysis of IL-6 and TNF-α. Western blot also suggested that the reduced inflammatory response is due to suppressed TLR4/NF-κB signaling. In contrast, MCP-1, uPAR, and VEGF were abundantly expressed, in line with the notion that expression of these proteins is regulated by feedback between the VEGF and NF-κB pathways. In vitro expression of MCP-1, uPAR, and VEGF was also similarly high in primary rectal mucosal epithelial cells exposed to extracts from Mg staples, as measured by antibody array. Collectively, the results suggest that high-purity Mg staples suppress the inflammatory response during rectal anastomoses via TLR4/NF-κB and VEGF signaling.
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Affiliation(s)
- Jiazeng Xia
- Department of General Surgery, Wuxi Second Hospital, Nanjing Medical University , Jiangsu 214002, People's Republic of China
| | - Hui Chen
- Department of Pathology, Nanjing General Hospital , Jiangsu 210002, People's Republic of China
| | - Jun Yan
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai 200233, People's Republic of China
| | - Hongliu Wu
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University , Shanghai 200240, People's Republic of China
| | - Hao Wang
- Department of General Surgery, Wuxi Second Hospital, Nanjing Medical University , Jiangsu 214002, People's Republic of China
| | - Jian Guo
- Department of General Surgery, Wuxi Second Hospital, Nanjing Medical University , Jiangsu 214002, People's Republic of China
| | - Xiaonong Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University , Shanghai 200240, People's Republic of China
| | - Shaoxiang Zhang
- Suzhou Origin Medical Technology Company Ltd. , 2 Haicheng Road, Changshu Economic and Technology Development Zone, Jiangsu 215513, People's Republic of China
| | - Changli Zhao
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University , Shanghai 200240, People's Republic of China
| | - Yigang Chen
- Department of General Surgery, Wuxi Second Hospital, Nanjing Medical University , Jiangsu 214002, People's Republic of China
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De Parade V. [Anorectal emergencies]. Rev Prat 2017; 67:147. [PMID: 30512846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Vincent De Parade
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris-Saint-Joseph, Paris, France
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Anjum MN, Cheema HA, Malik HS, Hashmi MA. Clinical Spectrum Of Solitary Rectal Ulcer In Children Presenting With Per-Rectal Bleed. J Ayub Med Coll Abbottabad 2017; 29:74-77. [PMID: 28712179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less common in children. The objective of this study was to determine the frequency and clinical spectrum of solitary rectal ulcer in children with bleeding per rectum. METHODS This study was conducted in the Department of Paediatric Gastroenterology Hepatology& Nutrition; The Children's Hospital & The Institute of Child Health, Lahore, from January-December 2015. Total 187 children presenting with per-rectal bleeding who underwent colonoscopy were entered in the study. Demographic and presenting clinical features; colonoscopy and histopathology findings were recorded. Data was analysed using SPSS-20. RESULTS Out of a total of 187 children with bleeding per rectum, 21 (11.23%) were diagnosed with solitary rectal ulcer. Males were 15 (71.43%) and females were 6 (28.57%) with age range 8-12 years. Mucus in stool 14 (66.7%), constipation 12 (57.1%) and tenesmus 10 (47.6%) were the most common clinical presentations. Colonoscopic finding are solitary erythmatous ulcerative lesion was seen in 8 (38.09%) children, multiple ulcerative lesions in colon 6 (28.57%), multiple ulcerative lesions in rectum 5 (23.81%), polypoidal growth in colon and hyperaemic rectal mucosa in 1 (4.76%) each. Histopathological findings were consistent with SRUS in all the cases. CONCLUSIONS The frequency of SRUS was high (19.6%) in patients with per-rectal bleed. Mucus in stool, constipation and tenesmus were the most common clinical presentations. Colonoscopic and histopathological findings were helpful in the confirmation of the underlying aetiology.
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Affiliation(s)
- Muhammad Nadeem Anjum
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
| | - Huma Arshad Cheema
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
| | - Hassan Suleman Malik
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
| | - Muhammad Almas Hashmi
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, The Children's Hospital & The Institute of Child Health, Lahore, Pakistan
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De Parades V. [Anorectal disorders: feared and underestimated]. Rev Prat 2016; 66:899-900. [PMID: 30512546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Vincent De Parades
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris-Saint-Joseph, institut Léopold-Bellan, Paris, France
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Gupta R, Sharma SB. Pneumoscrotum. Indian Pediatr 2014; 51:942. [PMID: 25432240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Rahul Gupta
- Department of Paediatric Surgery, NIMS University Medical College, Jaipur, Rajasthan, India.
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Cervasi B, Carnathan DG, Sheehan KM, Micci L, Paiardini M, Kurupati R, Tuyishime S, Zhou XY, Else JG, Ratcliffe SJ, Ertl HCJ, Silvestri G. Immunological and virological analyses of rhesus macaques immunized with chimpanzee adenoviruses expressing the simian immunodeficiency virus Gag/Tat fusion protein and challenged intrarectally with repeated low doses of SIVmac. J Virol 2013; 87:9420-30. [PMID: 23804645 PMCID: PMC3754116 DOI: 10.1128/jvi.01456-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 06/20/2013] [Indexed: 11/20/2022] Open
Abstract
Human adenovirus (AdHu)-based candidate AIDS vaccine can provide protection from simian immunodeficiency virus (SIV) transmission and disease progression. However, their potential use may be limited by widespread preexisting immunity to the vector. In contrast, preexisting immunity to chimpanzee adenoviruses (AdC) is relatively rare. In this study, we utilized two regimens of prime-boost immunizations with AdC serotype SAd-V23 (also called AdC6) and SAd-V24 (also called AdC7) expressing SIV Gag/Tat to test their immunogenicity and ability to protect rhesus macaques (RMs) from a repeated low-dose SIVmac239 challenge. Both AdC6 followed by AdC7 (AdC6/7) and AdC7 followed by AdC6 (AdC7/6) induced robust SIV Gag/Tat-specific T cell responses as measured by tetramer staining and functional assays. However, no significant protection from SIV transmission was observed in either AdC7/6- or AdC7/6-vaccinated RMs. Interestingly, in the RMs showing breakthrough infections, AdC7/6-SIV immunization was associated with a transient but significant (P = 0.035 at day 90 and P = 0.033 at day 120 postinfection) reduction in the setpoint viral load compared to unvaccinated controls. None of the measured immunological markers (i.e., number or functionality of SIV-specific CD8(+) and CD4(+) T cell responses and level of activated and/or CCR5(+) CD4(+) target cells) at the time of challenge correlated with protection from SIV transmission in the AdC-SIV-vaccinated RMs. The robust immunogenicity observed in all AdC-immunized RMs and the transient signal of protection from SIV replication exhibited by AdC7/6-vaccinated RMs even in the absence of any envelope immunogen suggest that AdC-based vectors may represent a promising platform for candidate AIDS vaccines.
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Affiliation(s)
- Barbara Cervasi
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Diane G. Carnathan
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Katherine M. Sheehan
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Luca Micci
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Mirko Paiardini
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Raj Kurupati
- Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Steven Tuyishime
- Wistar Institute, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - James G. Else
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Sarah J. Ratcliffe
- Biomedical Graduate Group, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Guido Silvestri
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
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Abstracts of the Association of Coloproctology of Great Britain and Ireland Annual Meeting. July 1-3, 2013. Liverpool, United Kingdom. Colorectal Dis 2013; 15 Suppl 1:1-65. [PMID: 23829675 DOI: 10.1111/codi.12259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstracts of the 7th Scientific and Annual Meeting of the European Society of Coloproctology. September 26-28, 2012. Vienna, Austria. Colorectal Dis 2012; 14 Suppl 2:1-76. [PMID: 22928603 DOI: 10.1111/j.1463-1318.2012.03153.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstracts of the Association of Coloproctology of Great Britain and Ireland Annual Meeting. July 1-3, 2012. Dublin, Ireland. Colorectal Dis 2012; 14 Suppl 1:1-46. [PMID: 22747963 DOI: 10.1111/j.1463-1318.2012.03071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Penninckx F, Krivokapic Z, O'Connell R, Pfeifer J, Schiedeck T, Tiret E, Påhlman L, Haboubi N, Post S, Kassai M, Engel A, Pfeifer J, Martling A. Letter from the ESCP Executive. Colorectal Dis 2011; 13:1188-9. [PMID: 21812900 DOI: 10.1111/j.1463-1318.2011.02743.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstracts of the Fifth Annual Meeting of the European Society of Coloproctology. September 22-25, 2010. Sorrento, Italy. Colorectal Dis 2010; 12 Suppl 3:1-53. [PMID: 20701622 DOI: 10.1111/j.1463-1318.2010.02363.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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