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Sample records for rectal prolapse clinical

  1. Rectal prolapse repair - slideshow

    MedlinePlus

    ... the anus. This is called rectal prolapse. Update Date 7/30/2014 Updated by: Jon A. Daller, MD, PhD, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. Review provided by VeriMed Healthcare ...

  2. Optimizing Treatment for Rectal Prolapse.

    PubMed

    Hrabe, Jennifer; Gurland, Brooke

    2016-09-01

    Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexistence of vaginal prolapse, severe constipation, surgical fitness, and whether the patient has had a previous prolapse procedure. Consideration of a multidisciplinary approach is critical in patients with concomitant vaginal prolapse. Surgeons must weigh their familiarity with each approach and should have in their armamentarium both perineal and abdominal approaches. Previous barriers to abdominal procedures, such as age and comorbidities, are waning as minimally invasive approaches have gained acceptance. Laparoscopic ventral rectopexy is one such approach offering relatively low morbidity, low recurrence rates, and good functional improvement. However, proficiency with this procedure may require advanced training. Robotic rectopexy is another burgeoning approach which facilitates suturing in the pelvis. Successful rectal prolapse surgeries improve function and have low recurrence rates, though it is important to note that correcting the prolapse does not assure functional improvement. PMID:27582654

  3. Surgical Correction of Rectal Prolapse in Laboratory Mice (Mus musculus).

    PubMed

    Uchihashi, Mayu; Wilding, Laura A; Nowland, Megan H

    2015-07-01

    Rectal prolapse is a common clinical problem in laboratory mice. This condition may occur spontaneously, develop after genetic manipulations, result from infections with pathogens such as Citrobacter species, or arise secondary to experimental design such as colitis models. The current standard of care at our institution is limited to monitoring mice until tissue becomes ulcerated or necrotic; this strategy often leads to premature euthanasia of valuable animals prior to the study endpoint. Surgical correction of rectal prolapse is performed routinely and with minimal complications in larger species by using manual reduction with placement of a pursestring suture. In this report, we investigated whether the use of a pursestring suture was an effective treatment for mice with rectal prolapse. The procedure includes anesthetizing mice with isoflurane, manually reducing prolapsed tissue, and placing a pursestring suture of 4-0 polydioxanone. We have performed this procedure successfully in 12 mice. Complications included self-trauma, fecal impaction due to lack of defecation, and mutilation of the surgical site by cage mates. Singly housing mice for 7 d postoperatively, applying multimodal analgesia, and releasing the pursestring when indicated eliminated these complications. The surgical repair of rectal prolapses in mice is a minimally invasive procedure that resolves the clinical symptoms of affected animals and reduces the number of mice that are euthanized prematurely prior to the study endpoint. PMID:26442289

  4. Surgical Correction of Rectal Prolapse in Laboratory Mice (Mus musculus)

    PubMed Central

    Uchihashi, Mayu; Wilding, Laura A; Nowland, Megan H

    2015-01-01

    Rectal prolapse is a common clinical problem in laboratory mice. This condition may occur spontaneously, develop after genetic manipulations, result from infections with pathogens such as Citrobacter species, or arise secondary to experimental design such as colitis models. The current standard of care at our institution is limited to monitoring mice until tissue becomes ulcerated or necrotic; this strategy often leads to premature euthanasia of valuable animals prior to the study endpoint. Surgical correction of rectal prolapse is performed routinely and with minimal complications in larger species by using manual reduction with placement of a pursestring suture. In this report, we investigated whether the use of a pursestring suture was an effective treatment for mice with rectal prolapse. The procedure includes anesthetizing mice with isoflurane, manually reducing prolapsed tissue, and placing a pursestring suture of 4-0 polydioxanone. We have performed this procedure successfully in 12 mice. Complications included self-trauma, fecal impaction due to lack of defecation, and mutilation of the surgical site by cage mates. Singly housing mice for 7 d postoperatively, applying multimodal analgesia, and releasing the pursestring when indicated eliminated these complications. The surgical repair of rectal prolapses in mice is a minimally invasive procedure that resolves the clinical symptoms of affected animals and reduces the number of mice that are euthanized prematurely prior to the study endpoint. PMID:26442289

  5. Perineal rectosigmoidectomy for gangrenous rectal prolapse.

    PubMed

    Voulimeneas, Ioannis; Antonopoulos, Constantine; Alifierakis, Evangelos; Ioannides, Pavlos

    2010-06-01

    Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse. Even more rarely, it becomes strangulated, necessitating emergency surgery. We describe an extremely rare case of incarcerated acute rectal prolapse, without a relevant previous history or symptoms of predisposing pathology. The patient underwent emergency perineal proctosigmoidectomy, the Altemeier operation, combined with diverting loop sigmoid colostomy. The postoperative course was quite uneventful with an excellent final result after colostomy closure. The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration. PMID:20518093

  6. Case report: Sigmoid strangulation from evisceration through a perforated rectal prolapse ulcer – An unusual complication of rectal prolapse

    PubMed Central

    Li, Jennifer Z.; Kittmer, Tiffaney; Forbes, Shawn; Ruo, Leyo

    2015-01-01

    Introduction Rectal prolapse occurs particularly in elder females and presentation can sometimes lead to complications such as strangulation and evisceration of other organs through the necrotic mucosa. Presentation of case This is a case of a 61 year-old female with rectal prolapse complicated by rectal perforation through which a segment of sigmoid colon eviscerated and became strangulated. This patient initially presented with sepsis requiring ICU admission, but fully recovered following a Hartmann’s procedure with a sacral rectopexy. Discussion Complications of rectal prolapse include incarceration, strangulation, and rarely, perforation with evisceration of other viscera requiring urgent operation. This report provides a brief overview of complications associated with rectal prolapse, reviews similar cases of transrectal evisceration, and discusses the management of chronic rectal prolapse. Conclusion Prompt surgical consult is warranted if any signs or symptoms suggestive of complications from prolapse are present. PMID:25680532

  7. [Rectal prolapse revealing a tumor: The role of abdominal ultrasound].

    PubMed

    Bequet, E; Stiennon, L; Lhomme, A; Piette, C; Hoyoux, C; Rausin, L; Guidi, O

    2016-07-01

    Rectal prolapse is rare in children and usually benign. However, there are various diseases that can be associated with it, such as cystic fibrosis or other causes of increased abdominal pressure. Here, we review the various underlying conditions that pediatricians or pediatric gastroenterologists should consider in the case of rectal prolapse. We report on three cases of children with a rectal prolapse and intra-abdominal tumors. Current recommendations and practice do not include a systematic check via abdominal imaging in cases of rectal prolapse. However, in some situations, imaging is indicated to detect a possible expansive process. Thus, in the presence of recurrent prolapse or of associated urinary or neurological signs, imaging is justified so as to allow for an early diagnosis and treatment of these neoplasms. Given its lack of radiation exposure and good sensitivity in children, ultrasound imaging is the first choice. PMID:27265581

  8. Adult rectosigmoid junction intussusception presenting with rectal prolapse.

    PubMed

    Du, Jing Zeng; Teo, Li Tserng; Chiu, Ming Terk

    2015-05-01

    Most cases of intussusception in adults present with chronic and nonspecific symptoms, and can sometimes be challenging to diagnose. We herein report on a patient with the rare symptom of colonic intussusceptions presenting with rectal prolapse and review the existing literature of similar case reports to discuss how to reach an accurate diagnosis. A 75-year-old woman with dementia presented with per rectal bleeding, rectal prolapse and lower abdominal pain. An operation was scheduled and a large sigmoid intussusception with a polyp as a leading point was found intraoperatively. She subsequently recovered well and was discharged. As large sigmoid intussusceptions may present as rectal prolapse, intussusception should be considered as a differential diagnosis for immobile patients, especially when the leading point is a lesion. PMID:26034324

  9. Anal encirclement with polypropylene mesh for rectal prolapse and incontinence.

    PubMed

    Sainio, A P; Halme, L E; Husa, A I

    1991-10-01

    Seventeen selected patients (mean age, 74 years)--14 with rectal prolapse and 3 with persisting anal incontinence after previous operations--underwent high anal encirclement with polypropylene mesh. There was no operative mortality. Prolapse recurred in 2 (15 percent) of the 13 patients followed up for 6 months or more (mean, 3.5 years). Three (27 percent) of the 11 patients with associated anal incontinence improved functionally, as did the three operated on for persisting incontinence, but only one patient regained normal continence. No breakage, cutting out, or infection related to the mesh was observed. Because of the risk of fecal impaction encountered in three of our patients, the procedure is not advocated for severely constipated patients. Despite the somewhat disappointing results regarding restoration of continence, we find this method useful in patients with rectal prolapse who are unfit for more extensive surgery, in controlling the prolapse to an acceptable degree. PMID:1914725

  10. Concurrent Occurrence of Uterovaginal and Rectal Prolapse: An Uncommon Presentation

    PubMed Central

    Umeh, UA; Ugwu, EO; Obi, SN; Nnagbo, JE

    2015-01-01

    Concomitant uterovaginal and rectal prolapse is an uncommon occurrence. Where laparoscopic equipment and skills are lacking, sacrohysteropexy with synthetic mesh and rectopexy can be accomplished by laparotomy, especially in women who desire to retain their uterus for either biological or psychological reasons. A 40-year-old primipara with a history of concomitant mass protruding from both her vagina and anus following a spontaneous unsupervised delivery at home. Following pelvic examination, a diagnosis of uterovaginal and rectal prolapse was made. In view of her parity and desire to retain her reproductive function, she was offered abdominal sacrohysteropexy with synthetic mesh and rectopexy with satisfactory postoperative recovery. In resource-limited settings with concomitant uterine and rectal prolapse, open abdominal sacrohysteropexy with synthetic mesh and rectopexy is an effective and safe alternative to Manchester operation in the absence of laparoscopic equipment and skills. PMID:26500795

  11. Concurrent Occurrence of Uterovaginal and Rectal Prolapse: An Uncommon Presentation.

    PubMed

    Umeh, U A; Ugwu, E O; Obi, S N; Nnagbo, J E

    2015-01-01

    Concomitant uterovaginal and rectal prolapse is an uncommon occurrence. Where laparoscopic equipment and skills are lacking, sacrohysteropexy with synthetic mesh and rectopexy can be accomplished by laparotomy, especially in women who desire to retain their uterus for either biological or psychological reasons. A 40-year-old primipara with a history of concomitant mass protruding from both her vagina and anus following a spontaneous unsupervised delivery at home. Following pelvic examination, a diagnosis of uterovaginal and rectal prolapse was made. In view of her parity and desire to retain her reproductive function, she was offered abdominal sacrohysteropexy with synthetic mesh and rectopexy with satisfactory postoperative recovery. In resource-limited settings with concomitant uterine and rectal prolapse, open abdominal sacrohysteropexy with synthetic mesh and rectopexy is an effective and safe alternative to Manchester operation in the absence of laparoscopic equipment and skills. PMID:26500795

  12. Perineal rectosigmoidectomy for incarcerated rectal prolapse (Altemeier’s procedure)

    PubMed Central

    Sipahi, Mesut; Arslan, Ergin; Börekçi, Hasan; Aytekin, Faruk Önder; Külah, Bahadır; Banlı, Oktay

    2016-01-01

    Perineal procedures have higher recurrence and lower mortality rates than abdominal alternatives for the treatment of rectal prolapse. Presence of incarceration and strangulation also influences treatment choice. Perineal rectosigmoidectomy is one of the treatment options in patients with incarceration and strangulation, with low mortality and acceptable recurrence rates. This operation can be performed especially to avoid general anesthesia in old patients with co-morbidities. We aimed to present perineal rectosigmoidectomy and diverting loop colostomy in a patient with neurological disability due to spinal trauma and incarcerated rectal prolapse. PMID:27528816

  13. What operation for recurrent rectal prolapse after previous Delorme’s procedure? A practical reality

    PubMed Central

    Javed, Muhammad A; Afridi, Faryal G; Artioukh, Dmitri Y

    2016-01-01

    AIM: To report our experience with perineal repair (Delorme’s procedure) of rectal prolapse with particular focus on treatment of the recurrence. METHODS: Clinical records of 40 patients who underwent Delorme’s procedure between 2003 and 2014 were reviewed to obtain the following data: Gender; duration of symptoms, length of prolapse, operation time, ASA grade, length of post-operative stay, procedure-related complications, development and treatment of recurrent prolapse. Analysis of post-operative complications, rate and time of recurrence and factors influencing the choice of the procedure for recurrent disease was conducted. Continuous variables were expressed as the median with interquartile range (IQR). Statistical analysis was carried out using the Fisher exact test. RESULTS: Median age at the time of surgery was 76 years (IQR: 71-81.5) and there were 38 females and 2 males. The median duration of symptoms was 6 mo (IQR: 3.5-12) and majority of patients presented electively whereas four patients presented in the emergency department with irreducible rectal prolapse. The median length of prolapse was 5 cm (IQR: 5-7), median operative time was 100 min (IQR: 85-120) and median post-operative stay was 4 d (IQR: 3-6). Approximately 16% of the patients suffered minor complications such as - urinary retention, delayed defaecation and infected haematoma. One patient died constituting post-operative mortality of 2.5%. Median follow-up was 6.5 mo (IQR: 2.15-16). Overall recurrence rate was 28% (n = 12). Recurrence rate for patients undergoing an urgent Delorme’s procedure who presented as an emergency was higher (75.0%) compared to those treated electively (20.5%), P value 0.034. Median time interval from surgery to the development of recurrence was 16 mo (IQR: 5-30). There were three patients who developed an early recurrence, within two weeks of the initial procedure. The management of the recurrent prolapse was as follows: No further intervention (n = 1

  14. Rectal Duplication Cyst: A Rare Cause of Rectal Prolapse in a Toddler.

    PubMed

    Khushbakht, Samreen; ul Haq, Anwar

    2015-12-01

    Rectal duplication cysts are rare congenital anomalies. They constitute only 4% of the total gastrointestinal anomalies. They usually present in childhood. The common presenting symptoms are mass or pressure effects like constipation, tenesmus, urinary retention, local infection or bleeding due to presence of ectopic gastric mucosa. We are reporting a rare presenting symptom of rectal duplication cyst in a 4-year-old boy/toddler who presented with rectal prolapse. He also had bleeding per rectum. Rectal examination revealed a soft mass palpable in the posterior rectal wall. CT scan showed a cystic mass in the posterior wall of the rectum. It was excised trans-anally and the postoperative recovery was uneventful. Biopsy report showed rectal duplication cyst. PMID:26691370

  15. Preserving the superior rectal artery in laparoscopic [correction of laparoscopis] anterior resection for complete rectal prolapse.

    PubMed

    Ignjatovic, D; Bergamaschi, R

    2002-01-01

    Anterior resection for the treatment of full thickness rectal prolapse has been around for over four decades. 1 However, its use has been limited due to fear of anastomotic leakage and related morbidity. It has been shown that high anterior resection is preferable to its low counterpart as the latter increases complication rates. 2 Although sparing the inferior mesenteric artery in sigmoid resection for diverticular disease has been shown to decrease leak rates in a randomized setting, 3 vascular division is current practice. We shall challenged this current practice of dividing the mesorectum in anterior resection for complete rectal prolapse developing a technique that allows the preservation of the superior rectal artery. PMID:12587465

  16. Precipitous intussusception with anal protrusion and complete overt rectal prolapse presenting with intestinal obstruction and an associated rectal adenoma in a young man: a case report

    PubMed Central

    2013-01-01

    Background Intestinal obstruction secondary to intussusception, occurring simultaneously with complete rectal prolapse, is an unusual entity among young adults. When it occurs the intussusceptum may protrude per anus. Few cases are cited in literature; each with a unique clinical presentation. There is apparently no uniform trend in its clinical and pathological picture. Case presentation A 38-year-old, African-Ugandan man presented with sudden occurrence of rectal prolapse for one day. He had otherwise been in good health. Symptoms were precipitous. A clinical diagnosis of intussusception of the lower gut with rectal prolapse, and intestinal obstruction, was made. The intussusception was found to have a polyp as the ‘lead point’. He was treated by manual reduction of the intussusception and the prolapse under general anesthesia. Histopathologic examination of the polyp showed it to be an adenoma. Definitive surgical treatment of the patient was not completed due to socioeconomic challenges. Conclusions Rectal prolapse and intussusception are commonly childhood conditions. Rectal prolapse alone is commoner in the middle-aged and elderly; females in particular. The finding of this combined clinical entity in a young, adult male is therefore a unique condition with an unusual presentation. It is the first case of its kind reported in East Africa. It is also an example of an adenoma constituting a ‘lead point’ for an intussusception at the gastrointestinal tract’s terminus. Even in the presence of a pre-existing adenoma, a relatively common lesion, other differential diagnoses acting as ‘lead points’ ought to be considered in perspective. This characteristic, along with other features described in this case, is useful knowledge for colorectal surgeons, general surgeons, gastrointestinal pathologists, and gastroenterologists given their involvement in the diagnosis and management of anorectal disease of peculiar presentation. PMID:24093478

  17. [Laparoscopic Resection Rectopexy for the Treatment of External Rectal Prolapse].

    PubMed

    Axt, S; Falch, C; Müller, S; Kirschniak, A; Glatzle, J

    2015-06-01

    Laparoscopic resection rectopexy is one of the surgical options for the treatment of external rectal prolapse. A standardised and reproducible procedure for this operation is a decisive advantage for such cases. The operation can be divided in 11 substeps, so-called nodal points, which must be reached before further progress can be made and simplify the operation by dividing the procedure into substeps. This manuscript and the accompanying film demonstrate the standardised laparoscopic resection rectopexy as taught in the "Surgical Training Center Tübingen," and performed at the University Hospital of Tübingen. PMID:26114633

  18. Evisceration of the small bowel through a perforated and prolapsed sigmoid colon: an unusual presentation of rectal prolapse.

    PubMed

    Ahmad, Arshad; Kumar, Suresh; Sonkar, Abhinav Arun; Kumar, Sanjeev

    2016-01-01

    Spontaneous prolapse of the sigmoid colon and evisceration of the small bowel through a rupture in the rectosigmoid is a rare presentation. We report a case of a 60-year-old man presenting with massive small bowel evisceration through a perforation in a prolapsed sigmoid colon. The patient had a 2-year history of rectal prolapse. He was also incontinent for flatus and liquid stool. There was no other significant medical history. After reduction of the small intestine, a large perforation was seen in the prolapsed sigmoid colon. The sigmoid colon was identified by presence of appendices epiploicae and taeniae coli. After initial resuscitation, an emergency laparotomy was performed. The perforated sigmoid colon was resected and a Hartmann's colostomy was created. This resulted in complete recovery. Reversal of the Hartmann's colostomy was performed after 6 weeks. PMID:27084900

  19. Effect of submucosal alcohol injection on prolonged rectal prolapse in infants and children

    PubMed Central

    Bahador, Abi; Foroutan, Hamid Reza; Hosseini, Seyed Mohammad Vahid; Davani, Sam Zeraatian Nejad

    2008-01-01

    Aim: Our aim in this study is to evaluate the effect of ethanol as a sclerosing agent on subset of pediatric patients with prolonged rectal prolapse. Materials and Methods: From 1997 to 2003, 165 cases of primary rectal prolapse were treated by submucosal injection of ethyl alcohol (96%) after 8 weeks of conservative therapy. Around 1.5-2 ml of alcohol was linearly injected in three sites (two laterals and one posterior). Results: Twelve of the 165 cases lost the follow-up and 153 cases were followed from 9 months to 6 years. One hundred and six patients (69.3%) had a duration of prolapse for 3-7 months. Forty patients (26.1%) had prolapse for more than 7 months and seven patients had prolapse for more than 1 year. One hundred and forty-seven out of 153 (96%) patients responded to single injection. Three of the children required a second injection. Three patients with age of more than 13 did not respond to the treatment. Twenty five cases had fecal soilage for few days. No infectious complication and no recurrence were observed. Conclusion: We concluded that 4-6 ml of ethyl alcohol (96%) is effective for the treatment of rectal prolapse. The duration of rectal prolapse had no deleterious effect on treatment; however, patients with age more than 13 years did not respond to sclerosing agent, probably due to different etiology. PMID:20177479

  20. Multidisciplinary Approach to the Treatment of Concomitant Rectal and Vaginal Prolapse.

    PubMed

    Jallad, Karl; Gurland, Brooke

    2016-06-01

    Rectal prolapse and vaginal prolapse have traditionally been treated as separate entities despite sharing a common pathophysiology. This compartmentalized approach often leads to frustration and suboptimal outcomes. In recent years, there has been a shift to a more patient-centered, multidisciplinary approach. Procedures to repair pelvic organ prolapse are divided into three categories: abdominal, perineal, and a combination of both. Most commonly, a combined minimally invasive abdominal sacral colpopexy and ventral rectopexy is performed to treat concomitant rectal and vaginal prolapse. Combining the two procedures adds little operative time and offers complete pelvic floor repair. The choice of minimally invasive abdominal prolapse repair versus perineal repair depends on the patient's comorbidities, previous surgeries, preference to avoid mesh, and physician's expertise. Surgeons should at least be able to identify these patients and provide the appropriate treatment or refer them to specialized centers. PMID:27247534

  1. [Total rectal prolapse in young adults. Apropos of 10 cases in Africans].

    PubMed

    Ribault, L; Gournier, J P

    1988-12-01

    The authors described their African experience on the basis of ten cases of total rectal prolapse in the young adult and child. Total rectal prolapse and internal procidentia fall within the general context of disorders of rectal mechanics. In most instances, such forced prolapse occurs in young individuals who are usually muscular and used to difficult work. Nevertheless, defecation efforts in these chronically constipated patients play a significant role. Furthermore, there is frequently a concomitant presence of a megadolichosigmoid colon. In all cases treatment was surgical, involving rectopexy at the promontory using strips of fascia lata or even peritoneum. The post-operative course was in all cases uneventful with no recurrences and the routine prescription of adjuvant treatment for constipation. PMID:3230110

  2. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse

    PubMed Central

    van Iersel, Jan J; Paulides, Tim J C; Verheijen, Paul M; Lumley, John W; Broeders, Ivo A M J; Consten, Esther C J

    2016-01-01

    External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented. PMID:27275090

  3. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse.

    PubMed

    van Iersel, Jan J; Paulides, Tim J C; Verheijen, Paul M; Lumley, John W; Broeders, Ivo A M J; Consten, Esther C J

    2016-06-01

    External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented. PMID:27275090

  4. Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse.

    PubMed

    Bergamaschi, R; Lovvik, K; Marvik, R

    2004-01-01

    Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use however has been limited due to fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During 30 months data on 33 selected patients with CRP were prospectively collected. Three patients were withdrawn from the analysis, as they had neither resection nor anastomosis. Twenty-nine women and one man (median age 55 range 21-83 years) underwent LSR with preservation of SRA for a median CRP of 8 (3-15) cm. There were 20 ASA I and 10 ASA II patients. Ten patients had undergone previous surgery. Four patients complained of dyschezia, whereas incontinence was present in 26 patients. Anal ultrasound showed isolated internal sphincter defects in two patients. Four young adults (21-32 years) had normal CTT, whereas 26 older patients had a median CTT of 5 (4-6) days. Defecography demonstrated 10 enteroceles, two sigmoidoceles, and one rectal hernia through the levator ani muscle. Mortality was nil. Median operating room time was 180 (120-330) min, suprapubic incision length 5 (3-7) cm, estimated blood loss 150 (50-500) ml, specimen length 20 (12-45) cm, solid food resumption 3 (1-6) days, and length of stay 4.5 (2-7) days. Thirty-day complications were not related to anastomosing and occurred in 20% of the patients. Although the evidence provided by the present study suggests that sparing SRA has a favorable impact on anastomotic leak rates, these nonrandomized results need further evaluation. The division of the mesorectum at the rectosigmoid junction seems not necessary, and its sparing should therefore be considered as it may contain anastomotic leak rates. PMID:15771289

  5. Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients.

    PubMed

    Keighley, M R; Fielding, J W; Alexander-Williams, J

    1983-04-01

    One hundred and six consecutive patients were seen between January 1973 and January 1982 with a circumferential full thickness rectal prolapse. One hundred were treated by abdominal rectopexy using a rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum and to the lateral ligaments of the mobilized rectum. There were only 9 men in the series and 23 per cent of the patients were over the age of 80 years. Sixty-seven of the patients gave a history of faecal incontinence. Previous unsuccessful treatment for rectal prolapse included a Thiersch wire or a Silastic perianal sling in 19, electrical therapy in 12, rectopexy with polyvinyl alcohol sponge (Ivalon) in 5 and pelvic floor repair in 2. There were no operative deaths following Marlex mesh rectopexy. Twelve patients had their operation performed under spinal anaesthesia because they were considered unfit for general anaesthesia. No patient developed a recurrent rectal prolapse, but 24 of the 67 patients who had incontinence experienced persistent incontinence after rectopexy (36 per cent); 10 of these patients subsequently had a postanal repair with good results. Rectopexy had no influence on anal canal pressures. Marlex mesh rectopexy is a safe and effective operation for rectal prolapse. It appears to be superior to other operations in that, so far, there has been no recurrence. PMID:6831177

  6. Giant rectal polyp prolapse in an adult patient with the Peutz-Jeghers syndrome.

    PubMed

    Cano-Contreras, Ana Delfina; Meixueiro-Daza, Arturo; Grube-Pagola, Peter; Remes-Troche, Jose Maria

    2016-01-01

    Peutz-Jeghers Syndrome (PJS) is an autosomal dominant intestinal polyposis syndrome characterised by the presence of hamartomatous polyps and mucocutaneous pigmentation. Prolapse of the polyps through the anus is an infrequent manifestation in children with PJS, and this complication is extremely rare in adult patients. We report the case of a 30-year-old man recently diagnosed with PJS who was seen at the emergency department because of the abrupt onset of severe anal pain with a foreign body sensation in the anal canal and rectal bleeding.Physical examination revealed a giant prolapsed polyp. PMID:27444139

  7. Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse.

    PubMed

    Bergamaschi, Roberto; Lovvik, Kari; Marvik, Ronald

    2003-12-01

    Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use, however, has been limited because of fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During a 30-month period, data on 33 selected patients with CRP were prospectively collected. Three patients were withdrawn from the analysis, as they had neither resection nor anastomosis. Twenty-nine women and 1 man (median age 55 range 21-83 years) underwent LSR with preservation of SRA for a median CRP of 8 (3-15) cm. There were 20 ASA I and 10 ASA II patients. Ten patients had undergone previous surgery. Four patients complained of dyschezia, whereas incontinence was present in 26 patients. Anal ultrasound showed isolated internal sphincter defects in 2 patients. Four young adults (21-32 years) had normal CTT, whereas 26 older patients had a median CTT of 5(4-6) days. Defecography demonstrated 10 enteroceles, two sigmoidoceles, and one rectal hernia through the levator ani muscle. Mortality was nil. Median operating room time was 180 (120-330) min, suprapubic incision length 5(3-7) cm, estimated blood loss 150 (50-500) mL, specimen length 20 (12-45) cm, solid food resumption 3(1-6) days, and length of stay 4.5(2-7) days. Thirty-day complications were not related to anastomosing and occurred in 20% of the patients. Median follow-up was 34.1 (18-48) months. One patient had a recurrence. Although the evidence provided by the present study suggests that sparing SRA has a favorable impact on anastomotic leak rates, these nonrandomized results need further evaluation. The division of the mesorectum at the rectosigmoid junction seems not necessary, and its sparing should therefore be considered as it may contain anastomotic leak rates. PMID

  8. Laparoscopic surgery for rectal prolapse and pelvic floor disorders

    PubMed Central

    Rickert, Alexander; Kienle, Peter

    2015-01-01

    Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders. PMID:26380050

  9. Rectal prolapse

    MedlinePlus

    ... Constipation Cystic fibrosis Malabsorption Mucosa Whipworm infection Update Date 7/30/2014 Updated by: Jon A. Daller, MD, PhD, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. Review provided by VeriMed Healthcare ...

  10. Rectal Prolapse

    MedlinePlus

    Skip to main content ASCRS Patients Educational Resources Diseases and Conditions Patient Education Library Patient Success Stories Treatments and Screening Resources Find a Surgeon Hereditary Colorectal Cancer Registries Helpful Links Physicians ...

  11. Delorme's Procedure for Complete Rectal Prolapse: A Study of Recurrence Patterns in the Long Term

    PubMed Central

    Placer, Carlos; Enriquez-Navascués, Jose M.; Timoteo, Ander; Elorza, Garazi; Borda, Nerea; Gallego, Lander; Saralegui, Yolanda

    2015-01-01

    Introduction. The objective of this study was to determine the recurrence rate and associated risk factors of full-thickness rectal prolapse in the long term after Delorme's procedure. Patients and Methods. The study involved adult patients with rectal prolapse treated with Delorme's surgery between 2000 and 2012 and followed up prospectively in an outpatient unit. We assessed epidemiological data, Wexner constipation and incontinence score, recurrence patterns, and risk factors. Data were analyzed by univariate and multivariate studies and follow-up was performed according to Kaplan-Meier technique. The primary outcome was recurrence. Results. A total of 42 patients, where 71.4% (n = 30) were women, with a median age of 76 years (IQR 66 to 86), underwent Delorme's surgery. The median follow-up was 85 months (IQR 28 to 132). There was no mortality, and morbidity was 9.5%. Recurrence occurred in five patients (12%) within 14 months after surgery. Actuarial recurrence at five years was 9.9%. According to the univariate analysis, constipation and concomitant pelvic floor repair were the only factors found to be associated with recurrence. Multivariate analysis showed no statistically significant differences among variables studied. Kaplan-Meier estimate revealed that constipation was associated with a higher risk of recurrence (log-rank test, p = 0.006). Conclusions. Delorme's procedure is a safe technique with an actuarial recurrence at five years of 9.9%. The outcomes obtained in this study support the performance of concomitant postanal repair and levatorplasty to reduce recurrences. Also, severe constipation is associated with a higher recurrence rate. PMID:26783557

  12. An unusual hamartomatous malformation of the rectosigmoid presenting as an irreducible rectal prolapse and necessitating rectosigmoid resection in a 14-week-old infant.

    PubMed

    Lamesch, A J

    1983-07-01

    A 14-week-old female infant presented with an irreducible rectal prolapse and a large polypoid tumor at the tip of the prolapsed mucosa. The tumor and prolapsed rectum were resected. Four weeks after the operation, profuse rectal bleeding occurred and a second similar tumor was diagnosed by endoscopy in the sigmoid colon. Laparotomy, rectosigmoid resection, and endorectal pull-through were performed. At operation, the serosal surface showed ragged polypoid lesions and an abnormal angiomatous vascularization. The postoperative course was uneventful. The histology suggested a congenital mucosal malformation. This pathology is unique in our experience and we have been unable to find anything resembling it in the literature. At age two years a Sertoli cell tumor developed in the girl with pubertas precox and a recurrent colonic polyp of the Peutz-Jeghers type. PMID:6861577

  13. Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population

    PubMed Central

    Chandra, Abhijit; Kumar, Saket; Maurya, Ajeet Pratap; Gupta, Vishal; Gupta, Vivek; Rahul

    2016-01-01

    AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse (CRP) in North Indian patients with inherent bulky and redundant colon. METHODS: The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. RESULTS: Fifteen patients (9 female) with a median age of 50 years (range, 15-68) were included in the study. The median operative time was 200 min (range, 180-350 min) and the median post-operative stay was 4 d (range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo (range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17 (range, 5-24) to 6 (range, 0-23) (P < 0.001) and the fecal incontinence severity index score from 24 (range, 0-53) to 2 (range, 0-53) (P = 0.007). No de novo constipation or fecal incontinence was recorded during the follow-up. On personal conversation, all patients expressed satisfaction with the outcome of their treatment. CONCLUSION: Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon. PMID:27152139

  14. The pathophysiology of pelvic floor disorders: evidence from a histomorphologic study of the perineum and a mouse model of rectal prolapse

    PubMed Central

    YIOU, RENÉ; DELMAS, VINCENT; CARMELIET, PETER; GHERARDI, ROMAIN K.; BARLOVATZ-MEIMON, GEORGIA; CHOPIN, DOMINIQUE K.; ABBOU, CLÉMENT-CLAUDE; LEFAUCHEUR, JEAN-PASCAL

    2001-01-01

    The muscle changes related to pelvic floor disorders are poorly understood. We conducted an anatomical and histological study of the perineum of the normal mouse and of a transgenic mouse strain deficient in urokinase-type plasminogen activator (uPA−/−) that was previously reported to develop a high incidence of rectal prolapse. We could clearly identify the iliococcygeus (ILC) and pubococcygeus (PC) muscles and anal (SPA) and urethral (SPU) sphincters in male and female mice. The bulbocavernosus (BC), ischiocavernosus (ISC) and levator ani (LA) muscles could be found only in male mice. Histochemical analysis of the pelvic floor muscles revealed a majority of type IIA fibres. Rectal prolapses were observed only in male uPA−/− mice. The most obvious finding was an irreducible evagination of the rectal mucosa and a swelling of the entire perineal region corresponding to an irreducible hernia of the seminal vesicles through the pelvic outlet. The hernia caused stretching and thinning of the ISC, BC and LA. Myopathic damage, with degenerated and centronucleated myofibres, were observed in these muscles. The PC, ILC, SPA and SPU were not affected. This study provides an original description of a model of pelvic floor disorder and illustrates the differences existing between the perineum of humans and that of a quadruped species. In spite of these differences, the histopathologic changes observed in the pelvic floor muscles of uPA−/− mice with rectal prolapse suggest that prolonged muscular stretching causes a primary myopathic injury. This should be taken into account in the evaluation of pelvic floor disorders. PMID:11760891

  15. Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

    PubMed Central

    Zhu, Qing-Chao; Shen, Rong-Rong; Qin, Huan-Long; Wang, Yu

    2014-01-01

    Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differentiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. PMID:24574747

  16. Immunological Landscape and Clinical Management of Rectal Cancer

    PubMed Central

    Pérez-Ruiz, Elísabeth; Berraondo, Pedro

    2016-01-01

    The clinical management of rectal cancer and colon cancer differs due to increased local relapses in rectal cancer. However, the current molecular classification does not differentiate rectal cancer and colon cancer as two different entities. In recent years, the impact of the specific immune microenvironment in cancer has attracted renewed interest and is currently recognized as one of the major determinants of clinical progression in a wide range of tumors. In colorectal cancer, the density of lymphocytic infiltration is associated with better overall survival. Due to the need for biomarkers of response to conventional treatment with chemoradiotherapy in rectal tumors, the immune status of rectal cancer emerges as a useful tool to improve the management of patients. PMID:26941741

  17. Delorme's Procedure: An Effective Treatment for a Full-Thickness Rectal Prolapse in Young Patients

    PubMed Central

    Fazeli, Mohammad Sadegh; Kazemeini, Ali Reza; Keshvari, Amir

    2013-01-01

    Purpose Delorme's procedure is infrequently applied in young adults because of its assumed higher recurrence rate. The aim of this prospective study was to assess the efficacy of the Delorme's technique in younger adults. Methods Fifty-two consecutive patients were entered in our study. We followed patients for at least 30 months. Their complaints and clinical exam results were noted. Results Our study included 52 patients (mean age, 38.44 years; standard deviation, 13.7 years). Of the included patients, 41 (78.8%) were younger than 50 years of age, and 11 (21.1%) were older than 50 years of age. No postoperative mortalities or major complications were noted. Minor complications were seen in 5 patients (9.6%) after surgery. The mean hospital stay was 2.5 days. In the younger group (age ≤50 years), fecal incontinence was improved in 92.3% (12 out of 13 with previous incontinence) of the patients, and recurrence was seen in 9.75% (4 patients). In the older group (age >50 years), fecal incontinence was improved in 20% (1 out of 5 with previous incontinence) of the patients, and recurrence was seen in 18.2% (2 patients). In 50% of the patients with a previous recurrence (3 out of 6 patients) following Delorme's procedure as a secondary procedure, recurrence was observed. Conclusion Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases. PMID:23700572

  18. Rectal prolapse repair

    MedlinePlus

    ... other medical problems, an approach through the anus (perineal approach) might be less risky. It might also ... lead to a shorter recovery. But with the perineal approach, the condition is more likely to come ...

  19. Rectal prolapse repair

    MedlinePlus

    ... smaller procedure that reinforces the sphincter muscles. This technique encircles the muscles with a ... If a piece of rectum or colon is removed, the bowel needs to be reconnected. In rare cases, this ...

  20. Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice.

    PubMed

    Deffieux, Xavier; Letouzey, Vincent; Savary, Denis; Sentilhes, Loïc; Agostini, Aubert; Mares, Pierre; Pierre, Fabrice

    2012-12-01

    The objective of the study was to provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning adverse events related to surgical procedures involving the use of prosthetic meshes. French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh; pelvic organ prolapse; cystocele; rectocele; uterine prolapse; complications; adverse event; sacral colpopexy; extrusion; infection). As with any surgery, recommendations include perioperative smoking cessation (Expert opinion) and compliance with the prevention of nosocomial infections (regulatory recommendation). There is no evidence to recommend routine local or systemic estrogen therapy before or after prolapse surgery using mesh, regardless of the surgical approach (Grade C). Antibiotic prophylaxis is recommended, regardless of the approach (Expert opinion). It is recommended to check for pre-operative urinary tract infection and treat it (Expert opinion). The first procedure should be undertaken under the guidance of a surgeon experienced in the relevant technique (Grade C). It is recommended not to place a non-absorbable synthetic mesh into the rectovaginal septum when a rectal injury occurs (Expert opinion). Placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after suturing of a bladder injury if the suture is considered to be satisfactory (Expert opinion). If a synthetic mesh is placed by vaginal route, it is recommended to use a macroporous polypropylene monofilament mesh (Grade B). It is recommended not to use polyester mesh for vaginal surgery (Grade B). It is permissible to perform hysterectomy associated with the placement of a non-absorbable synthetic mesh placed by the vaginal route but this is not routinely recommended (Expert opinion). It is recommended to minimize the extent of the colpectomy (Expert opinion). The

  1. PELVIC FLOOR SYMPTOMS AND QUALITY OF LIFE ANALYSES IN WOMEN UNDERGOING SURGERY FOR RECTAL PROLPASE

    PubMed Central

    ELLINGTON, DR; MANN, M; BOWLING, CB; DRELICHMAN, ER; GREER, WJ; SZYCHOWSKI, JM; RICHTER, HE

    2014-01-01

    Objective Characterize pelvic floor symptom distress and impact, sexual function and quality of life in women who underwent rectal prolapse surgery. Methods Subjects undergoing rectal prolapse surgery from 2004–2009 completed questionnaires including the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and the Prolapse/Urinary Incontinence Sexual Questionnaire. Baseline demographic, medical, and surgical characteristics were extracted by chart review. Demographic and clinic outcomes of women undergoing transperineal and abdominal approaches were compared. Wilcoxon rank-sum test was used for continuous variables and Fisher’s exact test for categorical measures. Results 45 were identified; two deceased at follow-up. 28/43 subjects (65.1%) responded to the questionnaires. Mean time from original procedure was 3.9 ± 3.1 years. No differences in median total Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and subscale scores, and Prolapse/Urinary Incontinence Sexual Questionnaire scores in women undergoing open rectopexy versus transperineal proctectomy were seen (all p>0.05). 26 (60%) participants answered the Prolapse/Urinary Incontinence Sexual Questionnaire, nine reported sexual activity within the last month. All underwent abdominal procedures. Conclusion There are few colorectal or other pelvic floor symptoms after rectal prolapse repair. Robust prospective studies are needed to more fully characterize and understand issues associated with rectal prolapse surgery in women. PMID:25379122

  2. Prevalence and clinical picture of gastroesophageal prolapse in gastroesophageal reflux disease.

    PubMed

    Aramini, B; Mattioli, S; Lugaresi, M; Brusori, S; Di Simone, M P; D'Ovidio, F

    2012-08-01

    The prevalence of gastroesophageal (GE) mucosal prolapse in patients with gastroesophageal reflux disease (GERD) was investigated as well as the clinical profile and treatment outcome of these patients. Of the patients who were referred to our service between 1980 and 2008, those patients who received a complete diagnostic work-up, and were successively treated and followed up at our center with interviews, radiology studies, endoscopy, and, when indicated, esophageal manometry and pH recording were selected. The prevalence of GE prolapse in GERD patients was 13.5% (70/516) (40 males and 30 females with a median age of 48, interquartile range 38-57). All patients had dysphagia and reflux symptoms, and 98% (69/70) had epigastric or retrosternal pain. Belching decreased the intensity or resolved the pain in 70% (49/70) of the cases, gross esophagitis was documented in 90% (63/70) of the cases, and hiatus hernias were observed in 62% (43/70) of the cases. GE prolapse in GERD patients was accompanied by more severe pain (P < 0.05) usually associated with belching, more severe esophagitis, and dysphagia (P < 0.05). A fundoplication was offered to 100% of the patients and was accepted by 56% (39/70) (median follow up 60 months, interquartile range 54-72), which included two Collis-Nissen techniques for true short esophagus. Patients who did not accept surgery were medically treated (median follow up 60 months, interquartile range 21-72). Persistent pain was reported in 98% (30/31) of medical cases, belching was reported in 45% (14/31), and GERD symptoms and esophagitis were reported in 81% (25/31). After surgery, pain was resolved in 98% (38/39) of the operative cases, and 79% (31/39) of them were free of GERD symptoms and esophagitis. GE prolapse has a relatively low prevalence in GERD patients. It is characterized by epigastric or retrosternal pain, and the need to belch to attenuate or resolve the pain. The pain is allegedly a result of the mechanical consequences of

  3. Endometrial Cholesterol Granuloma Associated with Prolapsed Uterus- A Rare Case Report with Unusual Clinical Presentation

    PubMed Central

    2016-01-01

    Cholesterol granuloma is a chronic inflammatory reaction to cholesterol deposition. It may develop in variety of sites including middle ear, mastoid process, para nasal sinuses, mediastinum, breast, testis and kidney. But endometrial cholesterol granuloma is a rarely reported case and is usually presented clinically as pyometra. This article reports a case of cholesterol granuloma in the endometrium associated with prolapsed uterus. In this case the patient clinically presented with urinary retention and overflow incontinence of urine. The reason of acute urinary retention in this case was pelvic fibrosis and adhesion secondary to this chronic inflammatory reaction. This was supported by the presence of pus like yellowish material over the uterine surface and pelvic adhesion, noted during surgery. Endometrial biopsy revealed cholesterol granuloma that confirmed the source of chronic inflammatory reaction and pelvic fibrosis. PMID:27134881

  4. Endometrial Cholesterol Granuloma Associated with Prolapsed Uterus- A Rare Case Report with Unusual Clinical Presentation.

    PubMed

    Sumathi, S

    2016-03-01

    Cholesterol granuloma is a chronic inflammatory reaction to cholesterol deposition. It may develop in variety of sites including middle ear, mastoid process, para nasal sinuses, mediastinum, breast, testis and kidney. But endometrial cholesterol granuloma is a rarely reported case and is usually presented clinically as pyometra. This article reports a case of cholesterol granuloma in the endometrium associated with prolapsed uterus. In this case the patient clinically presented with urinary retention and overflow incontinence of urine. The reason of acute urinary retention in this case was pelvic fibrosis and adhesion secondary to this chronic inflammatory reaction. This was supported by the presence of pus like yellowish material over the uterine surface and pelvic adhesion, noted during surgery. Endometrial biopsy revealed cholesterol granuloma that confirmed the source of chronic inflammatory reaction and pelvic fibrosis. PMID:27134881

  5. The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases

    PubMed Central

    2012-01-01

    Background Solitary rectal ulcer syndrome (SRUS) is an uncommon although benign defecation disorder. The aim of this study was to evaluate the variable endoscopic manifestations of SRUS and its association with other diseases. Methods All the patients diagnosed with SRUS histologically from January 1990 to February 2011 at The Aga Khan University, Karachi were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings. Results A total of 116 patients were evaluated. The mean age was 37.4 ± 16.6 (range: 13–80) years, 61 (53%) of the patients were male. Bleeding per rectum was present in 82%, abdominal pain in 49%, constipation in 23% and diarrhea in 22%. Endoscopically, solitary and multiple lesions were present in 79 (68%) and 33 (28%) patients respectively; ulcerative lesions in 90 (78%), polypoidal in 29 (25%), erythematous patches in 3 (2.5%) and petechial spots in one patient. Associated underlying conditions were hemorrhoids in 7 (6%), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2(2%), history of ulcerative colitis in 3 (2.5%) while adenocarcinoma of colon was observed in two patients. One patient had previous surgery for colonic carcinoma. Conclusion SRUS may manifest on endoscopy as multiple ulcers, polypoidal growth and erythematous patches and has shown to share clinicopathological features with rectal prolapse, proctitis cystica profunda (PCP) and inflammatory cloacogenic polyp; therefore collectively grouped as mucosal prolapse syndrome. This may be associated with underlying conditions such as polyps, ulcerative colitis, hemorrhoids and malignancy. High index of suspicion is required to diagnose potentially serious disease by repeated endoscopies with biopsies to look for potentially serious underlying conditions associated with SRUS. PMID:22697798

  6. Relationship between levator ani and bony pelvis morphology and clinical grade of prolapse in women.

    PubMed

    Li, Ran; Song, Yanfeng; Ma, Ming

    2015-09-01

    The aim of this study was to assess the morphological features of the levator ani and bony pelvis in women with different grades of prolapse. Ninety Chinese women with different grades of uterine prolapse were studied, 18 in each stage of prolapse from I to IV, and 18 asymptomatic nulliparous volunteers as normal controls. Three-dimensional (3D) models that included the pelvic bones, levator ani, pubic symphysis, sacrum, and coccyx were generated from magnetic resonance (MR) images. The width and length of the levator hiatus and levator symphysis gap, the width of the iliococcygeus, and the iliococcygeal angle were measured to quantify levator ani morphology; the intertuberous diameter, interspinous diameter, subpubic angle, and pubococcygeal line were measured to characterize the morphology of the bony pelvis. Four patterns of levator ani morphology among women with and without prolapse were distinguished. Among the bony pelvis parameters, no measurement differed significantly between the subjects with prolapse and normal controls, or among subjects with different grades of prolapse. There were significant differences in the width and length of the levator hiatus and levator symphysis gap between women with prolapse and normal controls. Our pilot data help to elucidate bony pelvis and levator ani morphology in women with and without pelvic organ prolapse. In contrast to the iliococcygeus muscle, changes in the morphological features of the pubovisceral muscle are more likely to accompany prolapse. PMID:25864568

  7. Rectal microbicides: clinically relevant approach to the design of rectal specific placebo formulations

    PubMed Central

    2011-01-01

    Background The objective of this study is to identify the critical formulation parameters controlling distribution and function for the rectal administration of microbicides in humans. Four placebo formulations were designed with a wide range of hydrophilic characteristics (aqueous to lipid) and rheological properties (Newtonian, shear thinning, thermal sensitive and thixotropic). Aqueous formulations using typical polymers to control viscosity were iso-osmotic and buffered to pH 7. Lipid formulations were developed from lipid solvent/lipid gelling agent binary mixtures. Testing included pharmaceutical function and stability as well as in vitro and in vivo toxicity. Results The aqueous fluid placebo, based on poloxamer, was fluid at room temperature, thickened and became shear thinning at 37°C. The aqueous gel placebo used carbopol as the gelling agent, was shear thinning at room temperature and showed a typical decrease in viscosity with an increase in temperature. The lipid fluid placebo, myristyl myristate in isopropyl myristate, was relatively thin and temperature independent. The lipid gel placebo, glyceryl stearate and PEG-75 stearate in caprylic/capric triglycerides, was also shear thinning at both room temperature and 37°C but with significant time dependency or thixotropy. All formulations showed no rectal irritation in rabbits and were non-toxic using an ex vivo rectal explant model. Conclusions Four placebo formulations ranging from fluid to gel in aqueous and lipid formats with a range of rheological properties were developed, tested, scaled-up, manufactured under cGMP conditions and enrolled in a formal stability program. Clinical testing of these formulations as placebos will serve as the basis for further microbicide formulation development with drug-containing products. PMID:21385339

  8. Pilot Study of a Clinical Pathway Implementation in Rectal Cancer

    PubMed Central

    Uña, Esther; López-Lara, Francisco

    2010-01-01

    Background: Rectal cancer is a highly prevalent disease which needs a multidisciplinary approach to be treated. The absence of specific protocols implies a significant and unjustifiable variability among the different professionals involved in this disease. The purpose is to develop a clinical pathway based on the analysis process and aims to reduce this variability and to reduce unnecessary costs. Methods: We created a multidisciplinary team with contributors from every clinical area involved in the diagnosis and treatment in this disease. We held periodic meetings to agree on a protocol based on the best available clinical practice guidelines. Once we had agreed on the protocol, we implemented its use as a standard in our institution. Every patient older than 18 years who was diagnosed with rectal cancer was considered a candidate to be treated via the pathway. Results: We evaluated 48 patients during the course of this study. Every parameter measured was improved after the implementation of the pathway, except the proportion of patients with 12 nodes or more analysed. The perception that our patients had about this project was very good. Conclusions: Clinical pathways are needed to improve the quality of health care. This kind of project helps reduce hospital costs and optimizes the use of limited resources. On the other hand, unexplained variability is also reduced, with consequent benefits for the patients. PMID:21151842

  9. Two dimensional echocardiography in mitral, aortic and tricuspid valve prolapse - The clinical problem, cardiac nuclear imaging considerations and a proposed standard for diagnosis

    SciTech Connect

    Morganroth, J.; Jones, R.H.; Chen, C.C.; Naito, M.

    1980-12-18

    The mitral valve prolapse syndrome may present with a variety of clinical manifestations and has proved to be a common cause of nonspecific cardiac symptoms in clinical practice. Primary and secondary forms must be distinguished. Myxomatous degeneration appears to be the common denominator of the primary form. The diagnostic standard of this form has not previously been defined because the detection of mitral leaflet tissue in the left atrium (prolapse) on physical examination or angiography is nonspecific. M mode echocardiography has greatly enhanced the recognition of this syndrome but has not proved to be the best diagnostic standard because of its limited view of mitral valve motion. The advent of two-dimensional echocardiography has provided the potential means for specific identification of the mitral leaflet motion in systole and can be considered the diagnostic standard for this syndrome. Primary myxomatous degeneration with leaflet prolapse is not localized to the mitral valve. Two-dimensional echocardiography has detected in preliminary studies tricuspid valve prolapse in up to 50% and aortic valve prolapse in about 20% of patients with idiopathic mitral valve prolapse.

  10. Characterisation of clinical and newly fabricated meshes for pelvic organ prolapse repair.

    PubMed

    Edwards, Sharon L; Werkmeister, Jerome A; Rosamilia, Anna; Ramshaw, John A M; White, Jacinta F; Gargett, Caroline E

    2013-07-01

    Clinical meshes used in pelvic organ prolapse (POP) repair are predominantly manufactured from monofilament polypropylene (PP). Complications from the use of these meshes in transvaginal kits, including mesh exposure and pain, have prompted two public health notifications by the FDA. The aim of this study was to compare several clinical PP POP meshes to new fabricated POP meshes, knitted from alternative polymers, for their mechanical properties using standard and clinically relevant multi-axial testing methods. Five new meshes were warp knitted to different architectures and weights from polyamide and polyetheretherketone monofilaments. A composite mesh of a polyamide mesh incorporating a gelatin layer was also fabricated to enable the potential delivery of cells on these meshes. Meshes were assessed for their structural characteristics and mechanical properties, using uniaxial stiffness, permanent strain, bending rigidity and multi-axial burst strength methods. Results were compared to three clinical urogynaecological polypropylene meshes: Polyform®, Gynemesh(TM)PS, and IntePro®. New fabricated meshes were uniaxially less stiff (less than 0.24 N/mm and 1.20 N/mm in toe and linear regions, respectively) than the Gynemesh (0.48 N/mm and 2.08 N/mm in toe and linear regions, respectively) and IntePro (0.57 N/mm in toe region) clinical meshes, with the gelatin coated PA mesh exhibiting lower permanent strain than Polyform clinical mesh (8.1% vs. 23.5%). New meshes had lower burst stiffness than Polyform (less than 16.9 N/mm for new meshes and 26.6N/mm for Polyform). Within the new mesh prototypes, the PA meshes, either uncoated (4.7-5.7 μN m) or with gelatin coating (16.7 μN m) possessed lower bending rigidity than both Polyform and Gynemesh (46.2 μN m and 36.4 μN m, respectively). The new fabricated mesh designs were of similar architecture, but with some improved mechanical properties, compared to clinical POP meshes. Multi-axial analysis of new and clinical

  11. Uterine prolapse

    MedlinePlus

    ... VL, eds. Comprehensive Gynecology . 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 20. Maher CF, Karram M. ... Surgical Management of Pelvic Organ Prolapse . Philadelphia, PA: Elsevier Saunders; 2013:chap 5. Payne CK. Conserative management ...

  12. Uterine prolapse

    MedlinePlus

    ... include: Pressure or heaviness in the pelvis or vagina Problems with sexual intercourse Leaking urine or sudden ... cervix drops into the lower part of the vagina . Uterine prolapse is moderate when the cervix drops ...

  13. Lamellipodin-Deficient Mice: A Model of Rectal Carcinoma

    PubMed Central

    Miller, Cassandra L.; Muthupalani, Sureshkumar; Shen, Zeli; Drees, Frauke; Ge, Zhongming; Feng, Yan; Chen, Xiaowei; Gong, Guanyu; Nagar, Karan K.; Wang, Timothy C.; Gertler, Frank B.; Fox, James G.

    2016-01-01

    During a survey of clinical rectal prolapse (RP) cases in the mouse population at MIT animal research facilities, a high incidence of RP in the lamellipodin knock-out strain, C57BL/6-Raph1tm1Fbg (Lpd-/-) was documented. Upon further investigation, the Lpd-/- colony was found to be infected with multiple endemic enterohepatic Helicobacter species (EHS). Lpd-/- mice, a transgenic mouse strain produced at MIT, have not previously shown a distinct immune phenotype and are not highly susceptible to other opportunistic infections. Predominantly male Lpd-/- mice with RP exhibited lesions consistent with invasive rectal carcinoma concomitant to clinically evident RP. Multiple inflammatory cytokines, CD11b+Gr1+ myeloid-derived suppressor cell (MDSC) populations, and epithelial cells positive for a DNA damage biomarker, H2AX, were elevated in affected tissue, supporting their role in the neoplastic process. An evaluation of Lpd-/- mice with RP compared to EHS-infected, but clinically normal (CN) Lpd-/- animals indicated that all of these mice exhibit some degree of lower bowel inflammation; however, mice with prolapses had significantly higher degree of focal lesions at the colo-rectal junction. When Helicobacter spp. infections were eliminated in Lpd-/- mice by embryo transfer rederivation, the disease phenotype was abrogated, implicating EHS as a contributing factor in the development of rectal carcinoma. Here we describe lesions in Lpd-/- male mice consistent with a focal inflammation-induced neoplastic transformation and propose this strain as a mouse model of rectal carcinoma. PMID:27045955

  14. A clinical study on the trocar-guided mesh repair system for pelvic organ prolapse surgery

    PubMed Central

    Bak, Seul Gi; Moon, Jeong Beom; Kim, Kyoung Jin; Kim, Kyoung A; Lee, Ju Hyang

    2016-01-01

    Objective To evaluate the complication and recurrence rates in patients undergoing trocar-guided mesh implant for pelvic organ prolapse (POP) treatment. Methods A retrospective study was performed based on the medical records of patients who had undergone mesh implant by one surgeon from May 2006 to August 2013 at the Presbyterian Medical Center in Korea. We evaluated perioperative complications such as bladder injury, mesh exposure, urinary symptoms, infections, and chronic pelvic pain. Recurrence was defined as a POP-quantification system stage ≥II or any symptomatic prolapse. Results Sixty-seven patients were evaluated, and the mean age of patients was 65.4±7.2 years. Stage ≥III POP-quantification Ba was noted in 61 patients (91%). Intraoperative complications included three cases of bladder injury (4.5%). The mean follow-up period was 44.1±7.9 months. Postoperative complications occurred in seven women (10.5%): four cases of urinary symptoms (6%), two cases of infections (3%), and one case of chronic pelvic pain (1.5%). Mesh exposure did not occur (0%). Prolapse recurrence was reported in five patients (7.5%). Conclusion Based on our operational result, the trocar-guided mesh implant seems to provide safe and effective outcomes. PMID:27200311

  15. Pelvic Organ Prolapse

    MedlinePlus

    ... Prosthetics Urogynecologic Surgical Mesh Implants Pelvic Organ Prolapse (POP) Share Tweet Linkedin Pin it More sharing options ... What is Pelvic Organ Prolapse? Pelvic organ prolapse (POP) occurs when the tissue and muscles of the ...

  16. Functional disorders of the ano-rectal compartment of the pelvic floor: clinical and diagnostic value of dynamic MRI.

    PubMed

    Maccioni, Francesca

    2013-10-01

    The obstructed defecation syndrome is the main functional disorder of the posterior or ano-rectal pelvic floor compartment. Different mechanical and functional rectal disorders may cause this syndrome, including rectocele, rectal invagination, rectal prolapse, and pubo-rectalis muscle dyskinesia. Since pelvic floor muscles and fasciae act as a unique functional entity, dysfunctions of the posterior compartment are usually associated to variable dysfunctions of the anterior and middle urogenital compartments as well. Over 50% of postmenopause women are affected by severe symptoms due to pelvic floor disorders, with frequent need of surgical invasive treatments. Both diagnosis of the specific ano-rectal dysfunction and identification of all possible associated disorders are mandatory for an effective surgical or conservative treatment. Currently, dynamic MRI provides an excellent morphological and functional display of the pelvic floor like no other imaging modality. Pros and cons of posterior pelvic floor MRI, different evaluation techniques, reference lines and grading systems together with the main imaging findings will be discussed and illustrated. PMID:23090206

  17. The modified Altemeier procedure for a loop colostomy prolapse.

    PubMed

    Watanabe, Makoto; Murakami, Masahiko; Ozawa, Yoshiaki; Uchida, Marie; Yamazaki, Kimiyasu; Fujimori, Akira; Otsuka, Koji; Aoki, Takeshi

    2015-11-01

    Loop colostomy prolapse is associated with an impaired quality of life. Surgical treatment may sometimes be required for cases that cannot be closed by colon colostomy because of high-risk morbidities or advanced disease. We applied the Altimeter operation for patients with transverse loop colostomy. The Altemeier operation is therefore indicated for rectal prolapse. This technique involves a simple operation, which includes a circumferential incision through the full thickness of the outer and inner cylinder of the prolapsed limb, without incising the abdominal wall, and anastomosis with sutures using absorbable thread. We performed the Altemeier operation for three cases of loop stomal prolapse. Those patients demonstrated no postoperative complications (including obstruction, prolapse recurrence, or hernia). Our findings suggest that this procedure is useful as an optional surgical treatment for cases of transverse loop colostomy prolapse as a permanent measure in patients with high-risk morbidities or advanced disease. PMID:26024782

  18. Reduction of an incarcerated, prolapsed ileostomy with the assistance of sugar as a desiccant.

    PubMed

    Shapiro, R; Chin, E H; Steinhagen, R M

    2010-09-01

    Prolapse is a well-described complication after ileostomy or colostomy, and is typically asymptomatic and easily reduced. Acute incarceration of a prolapsed stoma is a rare event, however. A patient presented with an incarcerated, prolapsed ileostomy causing small bowel obstruction and stomal ischemia. Successful reduction was performed with the assistance of sugar as a desiccant. Incarceration of a prolapsed ileostomy is highly atypical, but can be approached in a similar manner to an incarcerated rectal prolapse. Successful reduction can prevent an emergent operation, allowing for medical optimization and elective surgical treatment if necessary. PMID:19593624

  19. An unusual pediatric case of chronic constipation and rectosigmoid prolapse diagnosed by video defecography.

    PubMed

    Lesher, Aaron P; Hill, Jeanne G; Schabel, Stephen I; Morgan, Katharine A; Hebra, Andre

    2010-05-01

    Rectal prolapse is a relatively common, benign condition in the pediatric population. Conservative management usually results in resolution of the problem. Persistent rectal prolapse with chronic constipation suggests more serious underlying pathologic condition that may be challenging to diagnose. We present a case of severe recurrent rectal prolapse with chronic constipation in a 13-year-old boy. Using video defecography, an unusual radiographic modality in children, a functional sigmoid obstruction was observed that was not found on more routine imaging studies. Laparoscopic sigmoidectomy provided an excellent outcome in this patient who previously had a lifestyle-limiting, chronic condition. PMID:20438953

  20. Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility

    PubMed Central

    2013-01-01

    Background Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. Methods We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Results Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = −0.438 and −0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Conclusions Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials. PMID:23688510

  1. Definition and delineation of the clinical target volume for rectal cancer

    SciTech Connect

    Roels, Sarah; Duthoy, Wim; Haustermans, Karin . E-mail: Karin.Haustermans@uzleuven.be; Penninckx, Freddy; Vandecaveye, Vincent; Boterberg, Tom; Neve, Wilfried de

    2006-07-15

    Purpose: Optimization of radiation techniques to maximize local tumor control and to minimize small bowel toxicity in locally advanced rectal cancer requires proper definition and delineation guidelines for the clinical target volume (CTV). The purpose of this investigation was to analyze reported data on the predominant locations and frequency of local recurrences and lymph node involvement in rectal cancer, to propose a definition of the CTV for rectal cancer and guidelines for its delineation. Methods and Materials: Seven reports were analyzed to assess the incidence and predominant location of local recurrences in rectal cancer. The distribution of lymphatic spread was analyzed in another 10 reports to record the relative frequency and location of metastatic lymph nodes in rectal cancer, according to the stage and level of the primary tumor. Results: The mesorectal, posterior, and inferior pelvic subsites are most at risk for local recurrences, whereas lymphatic tumor spread occurs mainly in three directions: upward into the inferior mesenteric nodes; lateral into the internal iliac lymph nodes; and, in a few cases, downward into the external iliac and inguinal lymph nodes. The risk for recurrence or lymph node involvement is related to the stage and the level of the primary lesion. Conclusion: Based on a review of articles reporting on the incidence and predominant location of local recurrences and the distribution of lymphatic spread in rectal cancer, we defined guidelines for CTV delineation including the pelvic subsites and lymph node groups at risk for microscopic involvement. We propose to include the primary tumor, the mesorectal subsite, and the posterior pelvic subsite in the CTV in all patients. Moreover, the lateral lymph nodes are at high risk for microscopic involvement and should also be added in the CTV.

  2. Mitral valve prolapse

    MedlinePlus

    ... Systolic click-murmur syndrome; Prolapsing mitral leaflet syndrome; Chest pain - mitral valve prolapse ... often affects thin women who may have minor chest wall deformities, scoliosis, or other disorders. Some forms ...

  3. Mitral Valve Prolapse

    MedlinePlus

    ... Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis ... Stroke Sudden Cardiac Arrest Valve Disease Vulnerable Plaque Mitral Valve Prolapse | Share Related terms: MVP, disease of the ...

  4. Mitral Valve Prolapse

    MedlinePlus

    Mitral valve prolapse (MVP) occurs when one of your heart's valves doesn't work properly. The flaps of ... Migraine headaches Chest discomfort Most people who have mitral valve prolapse (MVP) don't need treatment because they ...

  5. Pelvic organ prolapse: a review of the current literature.

    PubMed

    South, M; Amundsen, C L

    2007-12-01

    Pelvic organ prolapse has afflicted women since the beginning of mankind. Even though we have been faced with this problem for so many centuries, we still have not found a way to overcome gravity and prevent prolapse. We continue to make efforts to manage prolapse, modifying our techniques based on burgeoning research. This knowledge helps us to avoid repetitive complications from surgery and to improve techniques to prevent recurrent prolapse. In addition, we are constantly adapting our methods depending on available technology. With an aging population, the demand for physicians and surgeons trained in management of pelvic organ prolapse will increase. The rapidly evolving literature on pelvic organ prolapse makes a comprehensive review difficult. However, based on the current literature, randomized controlled trials are needed to compare new prolapse repair techniques to traditional techniques. Physicians specializing in surgical management of pelvic organ prolapse will need to work together to complete quality clinical trials. The primary focus of this review will be on the recent research concerning the epidemiology, etiology, presenting symptoms, and diagnosis of pelvic organ prolapse. We will also discuss the different types of prolapse by compartments of the vagina in which they occur and how each of these types of prolapse can be managed. Finally, we will review recent literature evaluating surgical repairs using transvaginal mesh kits. PMID:18043574

  6. Sacral Insufficiency Fractures After Preoperative Chemoradiation for Rectal Cancer: Incidence, Risk Factors, and Clinical Course

    SciTech Connect

    Herman, Michael P.; Kopetz, Scott; Bhosale, Priya R.; Eng, Cathy; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J.; Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H.; Das, Prajnan

    2009-07-01

    Purpose: Sacral insufficiency (SI) fractures can occur as a late side effect of pelvic radiation therapy. Our goal was to determine the incidence, risk factors, and clinical course of SI fractures in patients treated with preoperative chemoradiation for rectal cancer. Materials and Methods: Between 1989 and 2004, 562 patients with non-metastatic rectal adenocarcinoma were treated with preoperative chemoradiation followed by mesorectal excision. The median radiotherapy dose was 45 Gy. The hospital records and radiology reports of these patients were reviewed to identify those with pelvic fractures. Radiology images of patients with pelvic fractures were then reviewed to identify those with SI fractures. Results: Among the 562 patients, 15 had SI fractures. The 3-year actuarial rate of SI fractures was 3.1%. The median time to SI fractures was 17 months (range, 2-34 months). The risk of SI fractures was significantly higher in women compared to men (5.8% vs. 1.6%, p = 0.014), and in whites compared with non-whites (4% vs. 0%, p = 0.037). On multivariate analysis, gender independently predicted for the risk of SI fractures (hazard ratio, 3.25; p = 0.031). Documentation about the presence or absence of pain was available for 13 patients; of these 7 (54%) had symptoms requiring pain medications. The median duration of pain was 22 months. No patient required hospitalization or invasive intervention for pain control. Conclusions: SI fractures were uncommon in patients treated with preoperative chemoradiation for rectal cancer. The risk of SI fractures was significantly higher in women. Most cases of SI fractures can be managed conservatively with pain medications.

  7. General Information about Rectal Cancer

    MedlinePlus

    ... Research Rectal Cancer Treatment (PDQ®)–Patient Version General Information About Rectal Cancer Go to Health Professional Version ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

  8. Solitary rectal ulcer syndrome in children: A literature review

    PubMed Central

    Dehghani, Seyed Mohsen; Malekpour, Abdorrasoul; Haghighat, Mahmood

    2012-01-01

    Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less in children. It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding, copious mucus discharge, feeling of incomplete defecation, and rarely rectal prolapse. SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings. The current treatments are suboptimal, and despite correct diagnosis, outcomes can be unsatisfactory. Some treatment protocols for SRUS include conservative management such as family reassurance, regulation of toilet habits, avoidance of straining, encouragement of a high-fiber diet, topical treatments with salicylate, sulfasalazine, steroids and sucralfate, and surgery. In children, SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases, however, it is being reported more than in the past. This condition in children is benign; however, morbidity is an important problem as reflected by persistence of symptoms, especially rectal bleeding. In this review, we discuss current diagnosis and treatment for SRUS. PMID:23236227

  9. Mitral Valve Prolapse.

    ERIC Educational Resources Information Center

    Bergy, Gordon G.

    1980-01-01

    Mitral valve prolapse is the most common heart disease seen in college and university health services. It underlies most arrhythmia and many chest complaints. Activity and exercise restrictions are usually unnecessary. (Author/CJ)

  10. Clinical Parameters Predicting Pathologic Tumor Response After Preoperative Chemoradiotherapy for Rectal Cancer

    SciTech Connect

    Yoon, Sang Min; Kim, Dae Yong Kim, Tae Hyun; Jung, Kyung Hae; Chang, Hee Jin; Koom, Woong Sub; Lim, Seok-Byung; Choi, Hyo Seong; Jeong, Seung-Yong; Park, Jae-Gahb

    2007-11-15

    Purpose: To identify pretreatment clinical parameters that could predict pathologic tumor response to preoperative chemoradiotherapy (CRT) for rectal cancer. Methods and Materials: The study involved 351 patients who underwent preoperative CRT followed by surgery between October 2001 and July 2006. Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and tumor regression. Statistical analyses were performed to identify clinical factors associated with pathologic tumor response. Results: Tumor downstaging (defined as ypT2 or less) was observed in 167 patients (47.6%), whereas tumor regression (defined as Dworak's Regression Grades 3 or 4) was observed in 103 patients (29.3%) and complete regression in 51 patients (14.5%). Multivariate analysis found that predictors of downstaging were pretreatment hemoglobin level (p = 0.045), cN0 classification (p < 0.001), and serum carcinoembryonic antigen (CEA) level (p < 0.001), that predictors of tumor regression were cN0 classification (p = 0.044) and CEA level (p < 0.001), and that the predictor of complete regression was CEA level (p = 0.004). Conclusions: The data suggest that pretreatment CEA level is the most important clinical predictor of pathologic tumor response. It may be of benefit in the selection of treatment options as well as the assessment of individual prognosis.

  11. Anatomical basis and clinical research of pelvic autonomic nerve preservation with laparoscopic radical resection for rectal cancer.

    PubMed

    Liu, Yan; Lu, Xiao-ming; Tao, Kai-xiong; Ma, Jian-hua; Cai, Kai-lin; Wang, Lin-fang; Niu, Yan-feng; Wang, Guo-bin

    2016-04-01

    The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation (PANP) was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP) from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients (18.37%) presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients (21.82%) in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed (P>0.05). It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction. PMID:27072964

  12. Clinical factors of post-chemoradiotherapy as valuable indicators for pathological complete response in locally advanced rectal cancer

    PubMed Central

    Peng, Jianhong; Lin, Junzhong; Qiu, Miaozhen; Wu, Xiaojun; Lu, Zhenhai; Chen, Gong; Li, Liren; Ding, Peirong; Gao, Yuanhong; Zeng, Zhifan; Zhang, Huizhong; Wan, Desen; Pan, Zhizhong

    2016-01-01

    OBJECTIVES: Pathological complete response has shown a better prognosis for patients with locally advanced rectal cancer after preoperative chemoradiotherapy. However, correlations between post-chemoradiotherapy clinical factors and pathologic complete response are not well confirmed. The aim of the current study was to identify post-chemoradiotherapy clinical factors that could serve as indicators of pathologic complete response in locally advanced rectal cancer. METHODS: This study retrospectively analyzed 544 consecutive patients with locally advanced rectal cancer treated at Sun Yat-sen University Cancer Center from December 2003 to June 2014. All patients received preoperative chemoradiotherapy followed by surgery. Univariate and multivariate regression analyses were performed to identify post-chemoradiotherapy clinical factors that are significant indicators of pathologic complete response. RESULTS: In this study, 126 of 544 patients (23.2%) achieved pathological complete response. In multivariate analyses, increased pathological complete response rate was significantly associated with the following factors: post-chemoradiotherapy clinical T stage 0-2 (odds ratio=2.098, 95% confidence interval=1.023-4.304, p=0.043), post-chemoradiotherapy clinical N stage 0 (odds ratio=2.011, 95% confidence interval=1.264-3.201, p=0.003), interval from completion of preoperative chemoradiotherapy to surgery of >7 weeks (odds ratio=1.795, 95% confidence interval=1.151-2.801, p=0.010) and post-chemoradiotherapy carcinoembryonic antigen ≤2 ng/ml (odds ratio=1.579, 95% confidence interval=1.026-2.432, p=0.038). CONCLUSIONS: Post-chemoradiotherapy clinical T stage 0-2, post-chemoradiotherapy clinical N stage 0, interval from completion of chemoradiotherapy to surgery of >7 weeks and post-chemoradiotherapy carcinoembryonic antigen ≤2 ng/ml were independent clinical indicators for pathological complete response. These findings demonstrate that post-chemoradiotherapy clinical

  13. Vaginal Vault Prolapse

    PubMed Central

    Uzoma, Azubuike; Farag, K. A.

    2009-01-01

    Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life. Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward

  14. Mesh for prolapse surgery: Why the fuss?

    PubMed

    Rajshekhar, Smita; Mukhopadhyay, Sambit; Klinge, Uwe

    2015-06-01

    Pelvic organ prolapse is a common gynaecological problem. Surgical techniques to repair prolapse have been constantly evolving to reduce the recurrence of prolapse and need for reoperation. Grafts made of synthetic and biological materials became popular in the last decade as they were intended to provide extra support to native tissue repairs. However, serious complications related to use of synthetic meshes have been reported and there is increasing medico-legal concern about mesh use in prolapse surgery. Some mesh products already have been withdrawn from the market and the FDA has introduced stricter surveillance of new and existing products. Large randomized studies comparing mesh with non-mesh procedures are lacking which creates uncertainty for the surgeon and their patients.The small cohorts of the RCTs available with short follow-up periods just allow the conclusion that the mesh repair can be helpful in the short to medium term but unfortunately are not able to prove safety for all patients. In particular, current clinical reports cannot define for which indication what material may be superior compared to non-mesh repair.Quality control through long-term individual and national mesh registries is needed to keep a record of all surgeons using mesh and all devices being used, monitoring their effectiveness and safety data. Meshes with better biocompatibility designed specifically for use in vaginal surgery may provide superior clinical results, where the reduction of complications may allow a wider range of indications. PMID:25952907

  15. The Benefits of Including Clinical Factors in Rectal Normal Tissue Complication Probability Modeling After Radiotherapy for Prostate Cancer

    SciTech Connect

    Defraene, Gilles; Van den Bergh, Laura; Al-Mamgani, Abrahim; Haustermans, Karin; Heemsbergen, Wilma; Van den Heuvel, Frank; Lebesque, Joos V.

    2012-03-01

    Purpose: To study the impact of clinical predisposing factors on rectal normal tissue complication probability modeling using the updated results of the Dutch prostate dose-escalation trial. Methods and Materials: Toxicity data of 512 patients (conformally treated to 68 Gy [n = 284] and 78 Gy [n = 228]) with complete follow-up at 3 years after radiotherapy were studied. Scored end points were rectal bleeding, high stool frequency, and fecal incontinence. Two traditional dose-based models (Lyman-Kutcher-Burman (LKB) and Relative Seriality (RS) and a logistic model were fitted using a maximum likelihood approach. Furthermore, these model fits were improved by including the most significant clinical factors. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminating ability of all fits. Results: Including clinical factors significantly increased the predictive power of the models for all end points. In the optimal LKB, RS, and logistic models for rectal bleeding and fecal incontinence, the first significant (p = 0.011-0.013) clinical factor was 'previous abdominal surgery.' As second significant (p = 0.012-0.016) factor, 'cardiac history' was included in all three rectal bleeding fits, whereas including 'diabetes' was significant (p = 0.039-0.048) in fecal incontinence modeling but only in the LKB and logistic models. High stool frequency fits only benefitted significantly (p = 0.003-0.006) from the inclusion of the baseline toxicity score. For all models rectal bleeding fits had the highest AUC (0.77) where it was 0.63 and 0.68 for high stool frequency and fecal incontinence, respectively. LKB and logistic model fits resulted in similar values for the volume parameter. The steepness parameter was somewhat higher in the logistic model, also resulting in a slightly lower D{sub 50}. Anal wall DVHs were used for fecal incontinence, whereas anorectal wall dose best described the other two endpoints. Conclusions: Comparable

  16. Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation.

    PubMed

    Dietz, H P; Beer-Gabel, M

    2012-07-01

    Recent developments in diagnostic imaging have made gynecologists, colorectal surgeons and gastroenterologists realize as never before that they share a common interest in anorectal and pelvic floor dysfunction. While we often may be using different words to describe the same phenomenon (e.g. anismus/vaginismus) or attributing different meanings to the same words (e.g. rectocele), we look after patients with problems that transcend the borders of our respective specialties. Like no other diagnostic modality, imaging helps us understand each other and provides new insights into conditions we all need to learn to investigate better in order to improve clinical management. In this review we attempt to show what modern ultrasound imaging can contribute to the diagnostic work-up of patients with posterior vaginal wall prolapse, obstructed defecation and rectal intussusception/prolapse. In summary, it is evident that translabial/perineal ultrasound can serve as a first-line diagnostic tool in women with such complaints, replacing defecation proctography and MR proctography in a large proportion of female patients. This is advantageous for the women themselves because ultrasound is much better tolerated, as well as for healthcare systems since sonographic imaging is much less expensive. However, there is a substantial need for education, which currently remains unmet. PMID:22045564

  17. Distribution pattern of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs in males

    PubMed Central

    Nnamdi, Ibe Michael Onwuzuruike

    2013-01-01

    Background: The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. Materials and Methods: We treated 88 locations of this lesion in 68 males. The clinical features were those of lower back pains, with or without radiation into the lower extremities, sensory loss and paresis of the limbs. There was a case of loss of urinary bladder and ano-rectal control. All lesions were confirmed through cauda-equinograms and treated under general anaesthesia in knee-chest position (MECCA position). The patients were followed up for 3-6 months post-operatively. Results: There were 88 locations in 68 males of 21-70 years of age, with 29 prolapses occurring during the age range 31-40 years, while 54 locations were on the left and 48 at L4/5. The procedures were well tolerated by all patients and there were no post-operative complications. Conclusion: This lesion in our series occurred mostly on the left, at the L4/5 level and peaked at 31-40 years age range. The predictability of occurrence of this disease, using side, level and age is still not feasible in males from our series. PMID:24403714

  18. Laparoscopic rectopexy in solitary rectal ulcer.

    PubMed

    Kargar, Saeed; Salmanroughani, Hassan; Binesh, Fariba; Taghipoor, Shokoh; Kargar, Shady

    2011-01-01

    Patients with Solitary Rectal Ulcer Syndrome (SRUS) come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8%) was significantly higher than cases without that (P=0.04). Complete recovery rate in cases that had finger defecation (85%) was significantly higher than cases without that (50%) (P=0.03). Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management. PMID:22174170

  19. The evaluation of a rectal cancer decision aid and the factors influencing its implementation in clinical practice

    PubMed Central

    2014-01-01

    Background Colorectal cancer is common in North America. Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. A rectal cancer decision aid was developed using the International Patient Decision Aid Standards to facilitate patients being more actively involved in making this decision with the surgeon. The overall aim of this study is to evaluate this decision aid and explore barriers and facilitators to implementing in clinical practice. Methods First, a pre- and post- study will be guided by the Ottawa Decision Support Framework. Eligible patients from a colorectal cancer center include: 1) adult patients diagnosed with rectal cancer, 2) tumour at a maximum of 10 cm from anal verge, and 3) surgeon screened candidates eligible to consider both low anterior resection and abdominoperineal resection. Patients will be given a paper-version and online link to the decision aid to review at home. Using validated tools, the primary outcomes will be decisional conflict and knowledge of surgical options. Secondary outcomes will be patient’s preference, values associated with options, readiness for decision-making, acceptability of the decision aid, and feasibility of its implementation in clinical practice. Proposed analysis includes paired t-test, Wilcoxon, and descriptive statistics. Second, a survey will be conducted to identify the barriers and facilitators of using the decision aid in clinical practice. Eligible participants include Canadian surgeons working with rectal cancer patients. Surgeons will be given a pre-notification, questionnaire, and three reminders. The survey package will include the patient decision aid and a facilitators and barriers survey previously validated among physicians and nurses. Principal component analysis will be performed to determine common themes, and logistic regression will be used to identify variables

  20. Locally Advanced Rectal Cancer Patients Receiving Radio-Chemotherapy: A Novel Clinical-Pathologic Score Correlates With Global Outcome

    SciTech Connect

    Berardi, Rossana; Mantello, Giovanna; Scartozzi, Mario; Del Prete, Stefano; Luppi, Gabriele; Martinelli, Roberto; Fumagalli, Marco; Grillo-Ruggieri, Filippo; Bearzi, Italo; Mandolesi, Alessandra; Marmorale, Cristina; Cascinu, Stefano

    2009-12-01

    Purpose: To determine the importance of downstaging of locally advanced rectal cancer after neoadjuvant treatment. Methods and Materials: The study included all consecutive patients with locally advanced rectal cancer who underwent neoadjuvant treatment (chemotherapy and/or radiotherapy) in different Italian centers from June 1996 to December 2003. A novel score was used, calculated as the sum of numbers obtained by giving a negative or positive point, respectively, to each degree of increase or decrease in clinical to pathologic T and N status. Results: A total of 317 patients were eligible for analysis. Neoadjuvant treatments performed were as follows: radiotherapy alone in 75 of 317 patients (23.7%), radiotherapy plus chemotherapy in 242 of 317 patients (76.3%). Worse disease-free survival was observed in patients with a lower score (Score 1 = -3 to +3 vs. Score 2 = +4 to +7; p = 0.04). Conclusions: Our results suggest that a novel score, calculated from preoperative and pathologic tumor and lymph node status, could represent an important parameter to predict outcome in patients receiving neoadjuvant treatment for rectal cancer. The score could be useful to select patients for adjuvant chemotherapy after neoadjuvant treatment and surgery.

  1. Distal intramural spread of rectal cancer after preoperative radiotherapy: The results of a multicenter randomized clinical study

    SciTech Connect

    Chmielik, Ewa; Bujko, Krzysztof . E-mail: bujko@coi.waw.pl; Nasierowska-Guttmejer, Anna; Nowacki, Marek P.; Kepka, Lucyna; Sopylo, Rafal; Wojnar, Andrzej; Majewski, Przemyslaw; Sygut, Jacek; Karmolinski, Andrzej; Huzarski, Tomasz; Wandzel, Piotr

    2006-05-01

    Purpose: To evaluate the extent of distal intramural spread (DIS) after preoperative radiotherapy for rectal cancer. Methods and Materials: A total of 316 patients with T{sub 3-4} primary resectable rectal cancer were randomized to receive either preoperative 5x5 Gy radiation with immediate surgery or chemoradiation (50.4 Gy, 1.8 Gy per fraction plus boluses of 5-fluorouracil and leucovorin) with delayed surgery. The slides of the 106 patients who received short-course radiation and of the 86 who received chemoradiation were available for central microscopic evaluation of DIS. Results: The length of DIS did not differ significantly (p = 0.64) between the short-course group and the chemoradiation group and was 0 in 47% vs. 49%; 1 to 5 mm in 41% vs. 42%; 6 to 10 mm in 8% vs. 9%, and greater than 10 mm in 4% vs. 0, respectively. Among the 11 clinically complete responders, DIS was found 1 to 5 mm from the microscopically detected ulceration of the mucosa in 5 patients. The discontinuous DIS was more frequent in the chemoradiation group as compared with the short-course group (i.e., 57% vs. 16% of cases, p < 0.001). Conclusions: Approximately 1 out of 10 advanced rectal cancers after preoperative radiotherapy or radiochemotherapy was characterized by DIS of over 5 mm. No significant difference was seen in the length of DIS between the 2 groups.

  2. Morphine Rectal

    MedlinePlus

    Rectal morphine is used to relieve moderate to severe pain. Morphine is in a class of medications called opiate ( ... Rectal morphine comes as a suppository to insert in the rectum. It is usually inserted every 4 hours. Use ...

  3. Etiologic and clinical analysis of chronic complex anal and rectal inflammation in children less than 3 years old

    PubMed Central

    Huang, Yanlei; Zheng, Shan; Xiao, Xianmin

    2014-01-01

    Objective: To analyze the etiology and clinical diagnostic method for chronic complex anal and rectal inflammation in children less than 3 years old. Method: Seven children (5 males and 2 females; 1 year 8 months to 3 years of age at the time of physician evaluation) with chronic complex anal and rectal inflammation were enrolled between May 2008 and May 2013 at our hospital. Clinical history, results of auxiliary examinations, and empirical treatment of the children were analyzed retrospectively combined with the etiologic diagnosis. Results: Four patients were confirmed to have Crohn’s disease and one patient was confirmed to have intestinal tuberculosis; two patients were suspected to have Crohn’s disease. Anemia and low pre-albumin level were common (seven patients); serologic testing revealed four patients with elevated IgG levels and seven patients with elevated IgA levels; there were no patients with positive tuberculosis antibody titers and two patients were weakly positive for C-ANCA (one patient with Crohn’s disease and one patient intestinal tuberculosis). Colonoscopies revealed that the entire colon was affected in one patient, the left hemicolon was affected in four patients, and the sigmoid colon and rectum were affected in two patients. Two patients with Crohn’s disease and one patient with intestinal tuberculosis were diagnosed by colonoscopies in combination with histopathologic examinations. Two patients with Crohn’s disease were confirmed after empirical drug treatment, and two other patients were not definitely diagnosed. Conclusion: The possibility of Crohn’s disease or intestinal tuberculosis should be considered in the clinical diagnosis of complex chronic anal and rectal inflammation in younger children. Local surgery is sometimes unnecessary. Empirical drug treatment should be used if necessary. PMID:25550910

  4. Conservative Operations in Genital Prolapse.

    PubMed

    Virkud, Ajit

    2016-06-01

    This review article highlights the contributions of various gynecologists from India toward surgical management of pelvic organ prolapse. It will provide an overview of the different sling operations for conservative treatment of genital prolapse. A new classification of the sling operations is put forth. The advantages and disadvantages of these operations will be discussed. PMID:27298521

  5. Clinical predictive circulating peptides in rectal cancer patients treated with neoadjuvant chemoradiotherapy.

    PubMed

    Crotti, Sara; Enzo, Maria Vittoria; Bedin, Chiara; Pucciarelli, Salvatore; Maretto, Isacco; Del Bianco, Paola; Traldi, Pietro; Tasciotti, Ennio; Ferrari, Mauro; Rizzolio, Flavio; Toffoli, Giuseppe; Giordano, Antonio; Nitti, Donato; Agostini, Marco

    2015-08-01

    Preoperative chemoradiotherapy is worldwide accepted as a standard treatment for locally advanced rectal cancer. Current standard of treatment includes administration of ionizing radiation for 45-50.4 Gy in 25-28 fractions associated with 5-fluorouracil administration during radiation therapy. Unfortunately, 40% of patients have a poor or absent response and novel predictive biomarkers are demanding. For the first time, we apply a novel peptidomic methodology and analysis in rectal cancer patients treated with preoperative chemoradiotherapy. Circulating peptides (Molecular Weight <3 kDa) have been harvested from patients' plasma (n = 33) using nanoporous silica chip and analyzed by Matrix-Assisted Laser Desorption/Ionization-Time of Flight mass spectrometer. Peptides fingerprint has been compared between responders and non-responders. Random Forest classification selected three peptides at m/z 1082.552, 1098.537, and 1104.538 that were able to correctly discriminate between responders (n = 16) and non-responders (n = 17) before therapy (T0) providing an overall accuracy of 86% and an area under the receiver operating characteristic (ROC) curve of 0.92. In conclusion, the nanoporous silica chip coupled to mass spectrometry method was found to be a realistic method for plasma-based peptide analysis and we provide the first list of predictive circulating biomarker peptides in rectal cancer patients underwent preoperative chemoradiotherapy. PMID:25522009

  6. A Multi-institutional Clinical Trial of Rectal Dose Reduction via Injected Polyethylene-Glycol Hydrogel During Intensity Modulated Radiation Therapy for Prostate Cancer: Analysis of Dosimetric Outcomes

    SciTech Connect

    Song, Danny Y.; Herfarth, Klaus K.; Uhl, Matthias; Eble, Michael J.; Pinkawa, Michael; Triest, Baukelien van; Kalisvaart, Robin; DeWeese, Theodore L.; Ford, Eric C.

    2013-09-01

    Purpose: To characterize the effect of a prostate-rectum spacer on dose to rectum during external beam radiation therapy for prostate cancer and to assess for factors correlated with rectal dose reduction. Methods and Materials: Fifty-two patients at 4 institutions were enrolled into a prospective pilot clinical trial. Patients underwent baseline scans and then were injected with perirectal spacing hydrogel and rescanned. Intensity modulated radiation therapy plans were created on both scans for comparison. The objectives were to establish rates of creation of ≥7.5 mm of prostate-rectal separation, and decrease in rectal V70 of ≥25%. Multiple regression analysis was performed to evaluate the associations between preinjection and postinjection changes in rectal V70 and changes in plan conformity, rectal volume, bladder volume, bladder V70, planning target volume (PTV), and postinjection midgland separation, gel volume, gel thickness, length of PTV/gel contact, and gel left-to-right symmetry. Results: Hydrogel resulted in ≥7.5-mm prostate-rectal separation in 95.8% of patients; 95.7% had decreased rectal V70 of ≥25%, with a mean reduction of 8.0 Gy. There were no significant differences in preinjection and postinjection prostate, PTV, rectal, and bladder volumes. Plan conformities were significantly different before versus after injection (P=.02); plans with worse conformity indexes after injection compared with before injection (n=13) still had improvements in rectal V70. In multiple regression analysis, greater postinjection reduction in V70 was associated with decreased relative postinjection plan conformity (P=.01). Reductions in V70 did not significantly vary by institution, despite significant interinstitutional variations in plan conformity. There were no significant relationships between reduction in V70 and the other characteristics analyzed. Conclusions: Injection of hydrogel into the prostate-rectal interface resulted in dose reductions to rectum

  7. Pregnancy with Irreducible Utero-Vaginal Prolapse.

    PubMed

    Saha, Pradip Kumar; Suri, Vanita; Sikka, Puja

    2015-09-01

    Pregnancy with uterine prolapse is a relatively rare condition. Irreducible prolapse occurring during pregnancy is even rarer. There is still a need for obstetricians to be aware about the management of uterine prolapse which allows for an uneventful pregnancy, labour and delivery. Here we present a case of a woman who developed irreducible uterine prolapse during pregnancy and the issues surrounding its management. We had to abort her pregnancy to reduce her prolapse which could otherwise have been life threatening. PMID:26500961

  8. Rectal Thiopental versus Intramuscular Ketamine in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial

    PubMed Central

    Azizkhani, Reza; Esmailian, Mehrdad; shojaei, Azadeh; Golshani, Keihan

    2015-01-01

    Introduction: Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. Methods: The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. Results: In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df

  9. Fallopian Tube Prolapse after Hysterectomy: A Systematic Review

    PubMed Central

    Ouldamer, Lobna; Caille, Agnès; Body, Gilles

    2013-01-01

    Background Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this disregarded complication when dealing with post-hysterectomy vaginal bleeding. Objectives We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcome of fallopian tube prolapse occurring after hysterectomy. Search Strategy A systematic search of MEDLINE and EMBASE references from January 1980 to December 2010 was performed. We included articles that reported cases of fallopian tube prolapse after hysterectomy. Data from eligible studies were independently extracted onto standardized forms by two reviewers. Results Twenty-eight articles including 51 cases of fallopian tube prolapse after hysterectomy were included in this systematic review. Clinical presentations included abdominal pain, dyspareunia, post- coital bleeding, and/or vaginal discharge. Two cases were asymptomatic and diagnosed at routine checkup. The surgical management reported comprised partial or total salpingectomy, with vaginal repair in some cases combined with oophorectomy using different approaches (vaginal approach, combined vaginal-laparoscopic approach, laparoscopic approach, or laparotomy). Six patients were initially treated by silver nitrate application without success. Conclusions This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with fallopian tube prolapse following hysterectomy published in the past 30 years. We anticipate that these results will help inform current investigations and treatment. PMID:24116117

  10. Rectal cancer: a review

    PubMed Central

    Fazeli, Mohammad Sadegh; Keramati, Mohammad Reza

    2015-01-01

    Rectal cancer is the second most common cancer in large intestine. The prevalence and the number of young patients diagnosed with rectal cancer have made it as one of the major health problems in the world. With regard to the improved access to and use of modern screening tools, a number of new cases are diagnosed each year. Considering the location of the rectum and its adjacent organs, management and treatment of rectal tumor is different from tumors located in other parts of the gastrointestinal tract or even the colon. In this article, we will review the current updates on rectal cancer including epidemiology, risk factors, clinical presentations, screening, and staging. Diagnostic methods and latest treatment modalities and approaches will also be discussed in detail. PMID:26034724

  11. New Perspectives on Predictive Biomarkers of Tumor Response and Their Clinical Application in Preoperative Chemoradiation Therapy for Rectal Cancer.

    PubMed

    Kim, Nam Kyu; Hur, Hyuk

    2015-11-01

    Preoperative chemoradiation therapy (CRT) is the standard treatment for patients with locally advanced rectal cancer (LARC) and can improve local control and survival outcomes. However, the responses of individual tumors to CRT are not uniform and vary widely, from complete response to disease progression. Patients with resistant tumors can be exposed to irradiation and chemotherapy that are both expensive and at times toxic without benefit. In contrast, about 60% of tumors show tumor regression and T and N down-staging. Furthermore, a pathologic complete response (pCR), which is characterized by sterilization of all tumor cells, leads to an excellent prognosis and is observed in approximately 10-30% of cases. This variety in tumor response has lead to an increased need to develop a model predictive of responses to CRT in order to identify patients who will benefit from this multimodal treatment. Endoscopy, magnetic resonance imaging, positron emission tomography, serum carcinoembryonic antigen, and molecular biomarkers analyzed using immunohistochemistry and gene expression profiling are the most commonly used predictive models in preoperative CRT. Such modalities guide clinicians in choosing the best possible treatment options and the extent of surgery for each individual patient. However, there are still controversies regarding study outcomes, and a nomogram of combined models of future trends is needed to better predict patient response. The aim of this article was to review currently available tools for predicting tumor response after preoperative CRT in rectal cancer and to explore their applicability in clinical practice for tailored treatment. PMID:26446626

  12. New Perspectives on Predictive Biomarkers of Tumor Response and Their Clinical Application in Preoperative Chemoradiation Therapy for Rectal Cancer

    PubMed Central

    Hur, Hyuk

    2015-01-01

    Preoperative chemoradiation therapy (CRT) is the standard treatment for patients with locally advanced rectal cancer (LARC) and can improve local control and survival outcomes. However, the responses of individual tumors to CRT are not uniform and vary widely, from complete response to disease progression. Patients with resistant tumors can be exposed to irradiation and chemotherapy that are both expensive and at times toxic without benefit. In contrast, about 60% of tumors show tumor regression and T and N down-staging. Furthermore, a pathologic complete response (pCR), which is characterized by sterilization of all tumor cells, leads to an excellent prognosis and is observed in approximately 10-30% of cases. This variety in tumor response has lead to an increased need to develop a model predictive of responses to CRT in order to identify patients who will benefit from this multimodal treatment. Endoscopy, magnetic resonance imaging, positron emission tomography, serum carcinoembryonic antigen, and molecular biomarkers analyzed using immunohistochemistry and gene expression profiling are the most commonly used predictive models in preoperative CRT. Such modalities guide clinicians in choosing the best possible treatment options and the extent of surgery for each individual patient. However, there are still controversies regarding study outcomes, and a nomogram of combined models of future trends is needed to better predict patient response. The aim of this article was to review currently available tools for predicting tumor response after preoperative CRT in rectal cancer and to explore their applicability in clinical practice for tailored treatment. PMID:26446626

  13. Thymidine phosphorylase and hypoxia-inducible factor 1-α expression in clinical stage II/III rectal cancer: association with response to neoadjuvant chemoradiation therapy and prognosis.

    PubMed

    Lin, Shuhan; Lai, Hao; Qin, Yuzhou; Chen, Jiansi; Lin, Yuan

    2015-01-01

    The aim of this study was to determine whether pretreatment status of thymidine phosphorylase (TP), and hypoxia-inducible factor alpha (HIF-1α) could predict pathologic response to neoadjuvant chemoradiation therapy with oxaliplatin and capecitabine (XELOXART) and outcomes for clinical stage II/III rectal cancer patients. A total of 180 patients diagnosed with clinical stage II/III rectal cancer received XELOXART. The status of TP, and HIF-1α were determined in pretreatment biopsies by immunohistochemistry (IHC). Tumor response was assessed in resected regimens using the tumor regression grade system and TNM staging system. 5-year disease free survival (DFS) and 5-year overall survival (OS) were evaluated with the Kaplan-Meier method and were compared by the log-rank test. Over expression of TP and low expression of HIF-1α were associated with pathologic response to XELOXART and better outcomes (DFS and OS) in clinical stage II/III rectal cancer patients (P < 0.05). Our result suggested that pretreatment status of TP and HIF-1α were found to predict pathologic response and outcomes in clinical stage II/III rectal cancer received XELOXART. Additional well-designed, large sample, multicenter, prospective studies are needed to confirm the result of this study. PMID:26617778

  14. Prognostic Factors Affecting Locally Recurrent Rectal Cancer and Clinical Significance of Hemoglobin

    SciTech Connect

    Rades, Dirk Kuhn, Hildegard; Schultze, Juergen; Homann, Nils; Brandenburg, Bernd; Schulte, Rainer; Krull, Andreas; Schild, Steven E.; Dunst, Juergen

    2008-03-15

    Purpose: To investigate potential prognostic factors, including hemoglobin levels before and during radiotherapy, for associations with survival and local control in patients with unirradiated locally recurrent rectal cancer. Patients and Methods: Ten potential prognostic factors were investigated in 94 patients receiving radiotherapy for recurrent rectal cancer: age ({<=}68 vs. {>=}69 years), gender, Eastern Cooperative Oncology Group performance status (0-1 vs. 2-3), American Joint Committee on Cancer (AJCC) stage ({<=}II vs. III vs. IV), grading (G1-2 vs. G3), surgery, administration of chemotherapy, radiation dose (equivalent dose in 2-Gy fractions: {<=}50 vs. >50 Gy), and hemoglobin levels before (<12 vs. {>=}12 g/dL) and during (majority of levels: <12 vs. {>=}12 g/dL) radiotherapy. Multivariate analyses were performed, including hemoglobin levels, either before or during radiotherapy (not both) because these are confounding variables. Results: Improved survival was associated with better performance status (p < 0.001), lower AJCC stage (p = 0.023), surgery (p = 0.011), chemotherapy (p = 0.003), and hemoglobin levels {>=}12 g/dL both before (p = 0.031) and during (p < 0.001) radiotherapy. On multivariate analyses, performance status, AJCC stage, and hemoglobin levels during radiotherapy maintained significance. Improved local control was associated with better performance status (p = 0.040), lower AJCC stage (p = 0.010), lower grading (p = 0.012), surgery (p < 0.001), chemotherapy (p < 0.001), and hemoglobin levels {>=}12 g/dL before (p < 0.001) and during (p < 0.001) radiotherapy. On multivariate analyses, chemotherapy, grading, and hemoglobin levels before and during radiotherapy remained significant. Subgroup analyses of the patients having surgery demonstrated the extent of resection to be significantly associated with local control (p = 0.011) but not with survival (p = 0.45). Conclusion: Predictors for outcome in patients who received radiotherapy for

  15. The Role of Synthetic and Biologic Materials in the Treatment of Pelvic Organ Prolapse

    PubMed Central

    Brown, Ramon A.; Ellis, C. Neal

    2014-01-01

    Pelvic organ prolapse is a significant medical problem that poses a diagnostic and management dilemma. These diseases cause serious morbidity in those affected and treatment is sought for relief of pelvic pain, rectal bleeding, chronic constipation, obstructed defecation, and fecal incontinence. Numerous procedures have been proposed to treat these conditions; however, the search continues as colorectal surgeons attempt to find the procedure that would optimally treat these conditions. The use of prosthetics in the repair of pelvic organ prolapse has become prevalent as the benefits of their use are realized. While advances in biologic mesh and new surgical techniques promise improved functional outcomes with decreased complication rates without de novo symptoms, the debate concerning the best prosthetic material, synthetic or biologic, remains controversial. Furthermore, laparoscopic ventral mesh rectopexy has emerged as a procedure that could potentially fill this role and is rapidly becoming the procedure of choice for the surgical treatment of pelvic organ prolapse. PMID:25435827

  16. A case of a large rectovaginal mass presenting as posterior vaginal wall prolapse.

    PubMed

    Cui, Nuan; Zormpa, Maria; Lazarou, George

    2011-09-01

    A 66-year-old female presented with symptoms suggestive of pelvic organ prolapse, history of fibroid uterus, and rectal pressure. Pelvic examination revealed a large pelvic mass filling the posterior cul-de-sac, occupying the rectovaginal septum, and compressing the rectum. There was a stage II pelvic organ prolapse of the posterior vaginal wall with distal vaginal wall extending to the hymen during valsalva. A CT scan confirmed the large pelvic mass distinct from the uterus measuring 9.4 × 9.8 × 6.2 cm. Colorectal workup revealed adenocarcinoma of colon on screening colonoscopy with biopsies. Patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, colon resection, and abdominal resection of the pelvic mass in the rectovaginal septum and inferior to the uterus. The patient did not require any concomitant pelvic reconstruction and the posterior vaginal wall prolapse resolved after resecting the pelvic mass. PMID:21416285

  17. Magnitude and Complexity of Rectal Mucosa HIV-1-Specific CD8+ T-Cell Responses during Chronic Infection Reflect Clinical Status

    PubMed Central

    Critchfield, J. William; Young, Delandy H.; Hayes, Timothy L.; Braun, Jerome V.; Garcia, Juan C.; Pollard, Richard B.; Shacklett, Barbara L.

    2008-01-01

    Background The intestinal mucosa displays robust virus replication and pronounced CD4+ T-cell loss during acute human immunodeficiency virus type 1 (HIV-1) infection. The ability of HIV-specific CD8+ T-cells to modulate disease course has prompted intensive study, yet the significance of virus-specific CD8+ T-cells in mucosal sites remains unclear. Methods and Findings We evaluated five distinct effector functions of HIVgag-specific CD8+ T-cells in rectal mucosa and blood, individually and in combination, in relationship to clinical status and antiretroviral therapy (ART). In subjects not on ART, the percentage of rectal Gag-specific CD8+ T-cells capable of 3, 4 or 5 simultaneous effector functions was significantly related to blood CD4 count and inversely related to plasma viral load (PVL) (p<0.05). Polyfunctional rectal CD8+ T-cells expressed higher levels of MIP-1β and CD107a on a per cell basis than mono- or bifunctional cells. The production of TNFα, IFN-γ, and CD107a by Gag-specific rectal CD8+ T-cells each correlated inversely (p<0.05) with PVL, and MIP-1β expression revealed a similar trend. CD107a and IFN-γ production were positively related to blood CD4 count (p<0.05), with MIP-1β showing a similar trend. IL-2 production by rectal CD8+ T-cells was highly variable and generally low, and showed no relationship to viral load or blood CD4 count. Conclusions The polyfunctionality of rectal Gag-specific CD8+ T-cells appears to be related to blood CD4 count and inversely related to PVL. The extent to which these associations reflect causality remains to be determined; nevertheless, our data suggest a potentially important role for mucosal T-cells in limiting virus replication during chronic infection. PMID:18974782

  18. How Is Mitral Valve Prolapse Diagnosed?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Mitral Valve Prolapse Diagnosed? Mitral valve prolapse (MVP) most often is detected during a ... a clicking sound as they shut. If the mitral valve is leaking blood back into the left atrium, ...

  19. Diazepam Rectal

    MedlinePlus

    Diazepam rectal gel is used in emergency situations to stop cluster seizures (episodes of increased seizure activity) in people who are taking other medications to treat epilepsy (seizures). Diazepam is in ...

  20. Uterine prolapse in a primigravid woman

    PubMed Central

    Kim, Jeong Ok; Jang, Shin A; Yun, Nae Ri; Lee, Sang-Hun; Hwang, Sung Ook

    2016-01-01

    Uterine prolapse during pregnancy is an uncommon condition. It can cause preterm labor, spontaneous abortion, fetal demise, maternal urinary complication, maternal sepsis and death. We report the case of uterine prolapse in a 32-year-old healthy primigravid woman. She had no risk factors associated with uterine prolapse. She was conservatively treated, resulting in a successful vaginal delivery. This report is a very rare case of uterine prolapse in a young healthy primigravid woman, resulting in a successful vaginal delivery. PMID:27200317

  1. Uterine prolapse in a primigravid woman.

    PubMed

    Kim, Jeong Ok; Jang, Shin A; Lee, Ji Yeon; Yun, Nae Ri; Lee, Sang-Hun; Hwang, Sung Ook

    2016-05-01

    Uterine prolapse during pregnancy is an uncommon condition. It can cause preterm labor, spontaneous abortion, fetal demise, maternal urinary complication, maternal sepsis and death. We report the case of uterine prolapse in a 32-year-old healthy primigravid woman. She had no risk factors associated with uterine prolapse. She was conservatively treated, resulting in a successful vaginal delivery. This report is a very rare case of uterine prolapse in a young healthy primigravid woman, resulting in a successful vaginal delivery. PMID:27200317

  2. Immunoscore in Rectal Cancer

    ClinicalTrials.gov

    2016-03-28

    Cancer of the Rectum; Neoplasms, Rectal; Rectal Cancer; Rectal Tumors; Rectal Adenocarcinoma; Melanoma; Breast Cancer; Renal Cell Cancer; Lung Cancer; Bladder Cancer; Head and Neck Cancer; Ovarian Cancer; Thyroid Cancer

  3. Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

    PubMed Central

    INOUE, YASUHIRO; SAIGUSA, SUSUMU; HIRO, JUNICHIRO; TOIYAMA, YUJI; ARAKI, TOSHIMITSU; TANAKA, KOJI; MOHRI, YAUSHIKO; KUSUNOKI, MASATO

    2016-01-01

    Preoperative chemoradiotherapy (CRT) with total mesorectal excision (TME) is the widely accepted treatment for rectal cancer (RC) in Western countries. However, there remains controversy as to whether preoperative CRT is useful in tumors that extend beyond the mesorectum, including metastasis to the lateral pelvic lymph nodes (LPLN). The aim of this study was to assess the prognostic significance of LPLN enlargement in patients with RC who receive preoperative CRT followed by TME without LPLN dissection. We evaluated the prognostic effect of radiographic LPLN enlargement before and after CRT, as well as the patients' clinicopathological and genetic profiles. Of the 104 patients investigated, pretreatment imaging identified 19 (18%) as LPLN-positive (>7 mm in diameter). Of these 19 patients, 7 (37%) exhibited LPLN downsizing to <7 mm following CRT. The median follow-up period was 52 months. The 5-year cancer-specific survival (CSS) or relapse-free survival (RFS) did not differ significantly between patients who did and those who did not have positive LPLN on pretreatment imaging. However, LPLN that remained positive after CRT were significantly associated with poorer 5-year CSS (73 vs. 84%, respectively; P=0.0052) and RFS (32 vs. 78%, respectively; P=0.0264). None of the patients whose LPLN were downsized to <7 mm following CRT developed recurrence; however, those with positive LPLN after CRT had a 55% higher recurrence rate, characterized by delayed local recurrence, a pattern that may be affected by certain chemokines. In conclusion, changes in initially positive LPLN (>7 mm) may predict the prognosis of patients with RC who receive preoperative CRT-TME. LPLN positivity after CRT was associated with shorter CSS and RFS. Strategies to improve patient survival may include selective LPLN dissection or more aggressive multimodality therapy. PMID:27313860

  4. Management of Pelvic Organ Prolapse

    PubMed Central

    Choi, Kyung Hwa

    2014-01-01

    Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse. PMID:25405010

  5. Surgical treatments for vaginal apical prolapse.

    PubMed

    Kong, Mi Kyung; Bai, Sang Wook

    2016-07-01

    Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits. PMID:27462591

  6. Surgical treatments for vaginal apical prolapse

    PubMed Central

    Kong, Mi Kyung

    2016-01-01

    Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits. PMID:27462591

  7. Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective case-control study

    PubMed Central

    Huang, Chen; Shen, Jia-Cheng; Zhang, Jing; Jiang, Tao; Wu, Wei-Dong; Cao, Jun; Huang, Ke-Jian; Qiu, Zheng-Jun

    2015-01-01

    AIM: To assess the diverse immediate and long-term clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed. METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection (LRR) and 424 cases in open radical resection (ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation. RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index (BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients (P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time (P < 0.001), a lower blood loss (P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay (P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR (P = 0.338). There were no obvious differences in the lengths and margins (P = 0.182). And the occurrence rate in the two groups was similar (P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6% (P = 0.534), 78.1% and 80.9% (P = 0.284) and 75.2% and 77.0% (P = 0.416), respectively. CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation. PMID:26730165

  8. A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse.

    PubMed

    Clemens, J D; Horwitz, R I; Jaffe, C C; Feinstein, A R; Stanton, B F

    1982-09-23

    The absence of controlled evidence and the high prevalence of mitral-valve prolapse have created substantial uncertainty about whether this condition is an important risk factor for bacterial endocarditis. We evaluated this risk in a case-control study of hospital inpatients who had undergone echocardiography and who lacked any known cardiovascular risk factors for endocarditis, apart from mitral-valve prolapse and isolated mitral-regurgitant murmurs. Thirteen (25 per cent) of 51 patients with endocarditis had mitral-valve prolapse, as compared with 10 (seven per cent) of the 153 matched controls without endocarditis. For the 51 matched case-control sets, the odds ratio (8.2; 95 per cent confidence interval, 2.4 to 28.4) indicated a substantially higher risk of endocarditis for people with mitral-valve prolapse than for those without it. This association remained statistically significant when parenteral drug abuse and routine antibiotic prophylaxis preceding dental work and other forms of instrumentation were taken into account. Furthermore, the risk may be higher than is indicated by this study, since 46 per cent of the controls underwent echocardiography for clinically suspected mitral-valve prolapse, suggesting an overrepresentation of mitral prolapse in the control group. The results support the contention that mitral-valve prolapse is a significant risk factor for bacterial endocarditis. PMID:7110242

  9. A clinical trial of single dose rectal and oral administration of diazepam for the prevention of serial seizures in adult epileptic patients.

    PubMed Central

    Milligan, N M; Dhillon, S; Griffiths, A; Oxley, J; Richens, A

    1984-01-01

    The clinical anticonvulsant efficacy of single dose rectal and oral administration of diazepam 20 mg was examined in two double-blind placebo-controlled trials in adult epileptic patients. All subjects suffered from drug resistant epilepsy and frequently experienced serial seizures. Diazepam was administered rectally as a new experimental suppository formulation immediately after a seizure and was highly effective in preventing recurrent fits within a 24 h observation period (p less than 0.001). Pharmacokinetic studies revealed a wide range of serum diazepam concentrations 60 min after administration of the suppository (mean serum diazepam level 190 +/- 73 (SD ng/ml). In a similar study oral administration of diazepam 20 mg significantly reduced the incidence of serial seizures compared with a placebo (p less than 0.01) and the mean 60 min serum diazepam level was 273 +/- 190 (SD) ng/ml. PMID:6368753

  10. Bisacodyl Rectal

    MedlinePlus

    Rectal bisacodyl is used on a short-term basis to treat constipation. It also is used to empty the bowels before surgery and certain medical procedures. Bisacodyl is in a class of medications called stimulant laxatives. It works by increasing activity of the intestines ...

  11. Bisacodyl Rectal

    MedlinePlus

    Rectal bisacodyl is used on a short-term basis to treat constipation. It also is used to empty the bowels before surgery and certain medical procedures. Bisacodyl is in a class of medications called stimulant laxatives. It works by increasing activity of the intestines to cause a bowel movement.

  12. Rectal culture

    MedlinePlus

    ... the best treatment. How to Prepare for the Test The health care provider does a rectal exam and collects the ... vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results. What Abnormal Results Mean Abnormal results may ...

  13. Transanal Evisceration Caused by Rectal Laceration

    PubMed Central

    Torres Sánchez, María Teresa; Richart Aznar, Jose Manuel; Martí Martínez, Eva María; Martínez-Abad, Manuel

    2014-01-01

    Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained. PMID:24639971

  14. Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS.

    PubMed

    Gupta, Satish Kumar; Nutan

    2013-01-01

    Microbicides, primarily used as topical pre-exposure prophylaxis, have been proposed to prevent sexual transmission of HIV. This review covers the trends and challenges in the development of safe and effective microbicides to prevent sexual transmission of HIV Initial phases of microbicide development used such surfactants as nonoxynol-9 (N-9), C13G, and sodium lauryl sulfate, aiming to inactivate the virus. Clinical trials of microbicides based on N-9 and C31G failed to inhibit sexual transmission of HIV. On the contrary, N-9 enhanced susceptibility to sexual transmission of HIV-1. Subsequently, microbicides based on polyanions and a variety of other compounds that inhibit the binding, fusion, or entry of virus to the host cells were evaluated for their efficacy in different clinical setups. Most of these trials failed to show either safety or efficacy for prevention of HIV transmission. The next phase of microbicide development involved antiretroviral drugs. Microbicide in the form of 1% tenofovir vaginal gel when tested in a Phase IIb trial (CAPRISA 004) in a coitally dependent manner revealed that tenofovir gel users were 39% less likely to become HIV-infected compared to placebo control. However, in another trial (VOICE MTN 003), tenofovir gel used once daily in a coitally independent mode failed to show any efficacy to prevent HIV infection. Tenofovir gel is currently in a Phase III safety and efficacy trial in South Africa (FACTS 001) employing a coitally dependent dosing regimen. Further, long-acting microbicide-delivery systems (vaginal ring) for slow release of such antiretroviral drugs as dapivirine are also undergoing clinical trials. Discovering new markers as correlates of protective efficacy, novel long-acting delivery systems with improved adherence in the use of microbicides, discovering new compounds effective against a broad spectrum of HIV strains, developing multipurpose technologies incorporating additional features of efficacy against other

  15. Clinical use of vaginal or rectally applied microbicides in patients suffering from HIV/AIDS

    PubMed Central

    Gupta, Satish Kumar; Nutan

    2013-01-01

    Microbicides, primarily used as topical pre-exposure prophylaxis, have been proposed to prevent sexual transmission of HIV. This review covers the trends and challenges in the development of safe and effective microbicides to prevent sexual transmission of HIV Initial phases of microbicide development used such surfactants as nonoxynol-9 (N-9), C13G, and sodium lauryl sulfate, aiming to inactivate the virus. Clinical trials of microbicides based on N-9 and C31G failed to inhibit sexual transmission of HIV. On the contrary, N-9 enhanced susceptibility to sexual transmission of HIV-1. Subsequently, microbicides based on polyanions and a variety of other compounds that inhibit the binding, fusion, or entry of virus to the host cells were evaluated for their efficacy in different clinical setups. Most of these trials failed to show either safety or efficacy for prevention of HIV transmission. The next phase of microbicide development involved antiretroviral drugs. Microbicide in the form of 1% tenofovir vaginal gel when tested in a Phase IIb trial (CAPRISA 004) in a coitally dependent manner revealed that tenofovir gel users were 39% less likely to become HIV-infected compared to placebo control. However, in another trial (VOICE MTN 003), tenofovir gel used once daily in a coitally independent mode failed to show any efficacy to prevent HIV infection. Tenofovir gel is currently in a Phase III safety and efficacy trial in South Africa (FACTS 001) employing a coitally dependent dosing regimen. Further, long-acting microbicide-delivery systems (vaginal ring) for slow release of such antiretroviral drugs as dapivirine are also undergoing clinical trials. Discovering new markers as correlates of protective efficacy, novel long-acting delivery systems with improved adherence in the use of microbicides, discovering new compounds effective against a broad spectrum of HIV strains, developing multipurpose technologies incorporating additional features of efficacy against other

  16. Multivisceral resections for rectal cancers: short-term oncological and clinical outcomes from a tertiary-care center in India

    PubMed Central

    Pai, Vishwas D.; Jatal, Sudhir; Ostwal, Vikas; Engineer, Reena; Arya, Supreeta; Patil, Prachi; Bal, Munita

    2016-01-01

    Background Locally advanced rectal cancers (LARCs) involve one or more of the adjacent organs in upto 10-20% patients. The cause of the adhesions may be inflammatory or neoplastic, and the exact causes cannot be determined pre- or intra-operatively. To achieve complete resection, partial or total mesorectal excision (TME) en bloc with the involved organs is essential. The primary objective of this study is to determine short-term oncological and clinical outcomes in these patients undergoing multivisceral resections (MVRs). Methods This is a retrospective review of a prospectively maintained database. Between 1 July 2013 and 31 May 2015, all patients undergoing MVRs for adenocarcinoma of the rectum were identified from this database. All patients who had en bloc resection of an adjacent organ or part of an adjacent organ were included. Those with unresectable metastatic disease after neoadjuvant therapy were excluded. Results Fifty-four patients were included in the study. Median age of the patients was 43 years. Mucinous histology was detected in 29.6% patients, and signet ring cell adenocarcinoma was found in 24.1% patients. Neoadjuvant therapy was given in 83.4% patients. R0 resection was achieved in 87% patients. Five-year overall survival (OS) was 70% for the entire cohort of population. Conclusions In Indian subcontinent, MVRs in young patients with high proportion of signet ring cell adenocarcinomas based on magnetic resonance imaging (MRI) of response assessment (MRI 2) is associated with similar circumferential resection margin (CRM) involvement and similar adjacent organ involvement as the western patients who are older and surgery is being planned on MRI 1 (baseline pelvis). However, longer follow-up is needed to confirm noninferiority of oncological outcomes. PMID:27284465

  17. AEG-1 expression is an independent prognostic factor in rectal cancer patients with preoperative radiotherapy: a study in a Swedish clinical trial

    PubMed Central

    Gnosa, S; Zhang, H; Brodin, V P; Carstensen, J; Adell, G; Sun, X-F

    2014-01-01

    Background: Preoperative radiotherapy (RT) is widely used to downstage rectal tumours, but the rate of recurrence varies significantly. Therefore, new biomarkers are needed for better treatment and prognosis. It has been shown that astrocyte elevated gene-1 (AEG-1) is a key mediator of migration, invasion, and treatment resistance. Our aim was to analyse the AEG-1 expression in relation to RT in rectal cancer patients and to test its radiosensitising properties. Methods: The AEG-1 expression was examined by immunohistochemistry in 158 patients from the Swedish clinical trial of RT. Furthermore, we inhibited the AEG-1 expression by siRNA in five colon cancer cell lines and measured the survival after irradiation by colony-forming assay. Results: The AEG-1 expression was increased in the primary tumours compared with the normal mucosa independently of the RT (P<0.01). High AEG-1 expression in the primary tumour of the patients treated with RT correlated independently with higher risk of distant recurrence (P=0.009) and worse disease-free survival (P=0.007). Downregulation of AEG-1 revealed a decreased survival after radiation in radioresistant colon cancer cell lines. Conclusions: The AEG-1 expression was independently related to distant recurrence and disease-free survival in rectal cancer patients with RT and could therefore be a marker to discriminate patients for distant relapse. PMID:24874474

  18. Effects of a single rectal dose of Misoprostol prior to abdominal hysterectomy in women with symptomatic leiomyoma: a randomized double blind clinical trial

    PubMed Central

    Tabatabai, Afsarosadat; Karimi-Zarchi, Mojgan; Meibodi, Bahare; Vaghefi, Marzie; Yazdian, Pouria; Zeidabadi, Mahbube; Dehghani, Atefe; Teimoori, Soraya; Jamali, Azadeh; Akhondi, Mehdi

    2015-01-01

    Background Fibroma, the most common benign pelvic tumor in women, affects 25 to 30% of women of reproductive age. Primary treatment for patients with symptomatic or large fibroma is surgery. Objective The purpose of this study was to investigate the effect of a single rectal dose of Misoprostol on bleeding during abdominal hysterectomy. Methods This double blind randomized clinical trial was conducted with 80 candidates for abdominal hysterectomy, due to uterine myoma, in the Shahid Sadoughi hospital of Yazd in 2012. The aim of this study was to assess the effect of single rectal dose of Misoprostol on peri-operational abdominal hysterectomy bleeding. Following administration of 400 micrograms of Misoprostol in the case group (n=40), predetermined criteria were compared with control group (n=40). Results Volume of bleeding during the operation was significantly lower in cases where Misoprostol was used. (268.71 ± 156.85 vs. 350.38 ± 152.61 cc in the case and control groups, respectively). Our findings also showed that Hemoglobin (Hb) levels before, 8, and 30 hours following the operation differed significantly (p=0.001), but these changes were similar in both groups. Pre-operative Hb levels were 11.90 ± 1.7 and 11.90 ± 2.0 in the case and control groups, respectively. Conclusion A single rectal dose of Misoprostol has positive effect on reducing peri-operational bleeding in women undergoing abdominal hysterectomy due to symptomatic leiomyoma. PMID:26516444

  19. Use of Molecular Imaging to Predict Clinical Outcome in Patients With Rectal Cancer After Preoperative Chemotherapy and Radiation

    SciTech Connect

    Konski, Andre Li Tianyu; Sigurdson, Elin; Cohen, Steven J.; Small, William; Spies, Stewart; Yu, Jian Q.; Wahl, Andrew; Stryker, Steven; Meropol, Neal J.

    2009-05-01

    Purpose: To correlate changes in 2-deoxy-2-[18F]fluoro-D-glucose (18-FDG) positron emission tomography (PET) (18-FDG-PET) uptake with response and disease-free survival with combined modality neoadjuvant therapy in patients with locally advanced rectal cancer. Methods and Materials: Charts were reviewed for consecutive patients with ultrasound-staged T3x to T4Nx or TxN1 rectal adenocarcinoma who underwent preoperative chemoradiation therapy at Fox Chase Cancer Center (FCCC) or Robert H. Lurie Comprehensive Cancer Center of Northwestern University with 18-FDG-PET scanning before and after combined-modality neoadjuvant chemoradiation therapy . The maximum standardized uptake value (SUV) was measured from the tumor before and 3 to 4 weeks after completion of chemoradiation therapy preoperatively. Logistic regression was used to analyze the association of pretreatment SUV, posttreatment SUV, and % SUV decrease on pathologic complete response (pCR), and a Cox model was fitted to analyze disease-free survival. Results: A total of 53 patients (FCCC, n = 41, RLCCC, n = 12) underwent pre- and postchemoradiation PET scanning between September 2000 and June 2006. The pCR rate was 31%. Univariate analysis revealed that % SUV decrease showed a marginally trend in predicting pCR (p = 0.08). In the multivariable analysis, posttreatment SUV was shown a predictor of pCR (p = 0.07), but the test results did not reach statistical significance. None of the investigated variables were predictive of disease-free survival. Conclusions: A trend was observed for % SUV decrease and posttreatment SUV predicting pCR in patients with rectal cancer treated with preoperative chemoradiation therapy. Further prospective study with a larger sample size is warranted to better characterize the role of 18-FDG-PET for response prediction in patients with rectal cancer.

  20. Incidence of pelvic organ prolapse in Nigerian women.

    PubMed Central

    Okonkwo, J. E. N.; Obiechina, N. J. A.; Obionu, C. N.

    2003-01-01

    OBJECTIVE: To establish the incidence and types of utero-vaginal prolapse. METHODS: Retrospective medical records analyses of women who were subjected to reconstructive pelvic surgery for various types of pelvic relaxation at the Nnamdi Azikiwe University Teaching Hospital, Nnewi and the University Of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. The study was conducted from January 1996 to December 1999 during which there were 7515 surgical admissions. The inclusion criteria were those women who complained of feeling a mass in the vagina with demonAstrable descent of the anterior and/or posterior and/or apical vaginal walls and/or perineal descent. Excluded were patients who had other symptoms other than utero-vaginal prolapse and those whose grades and sites of prolapse were not determinable from the clinical or surgical notes. Also excluded were patients with nerve injury or disease, connective tissue disorders and neuromuscular diseases. The subjects were divided into two groups. Group I consisted of 54 women (age < or = 40 years), and group II included 105 women (age > or = 40 years). The findings between those two groups were compared with reference to sites, types and degree of prolapse. Also, coexistence of pelvic relaxation and underlying medical conditions were evaluated. RESULTS: A total of 159 subjects out of 492 charts studied met the inclusion criteria for the study. In group I, mean age was 32.839 with a standard deviation (SD) of +/- 6.012 years; and in group II the mean age was 56.543 with a SD of 8.094. Hypertrophic (elongated) cervix was determined in 15 (6.3%) subjects in group I for an incidence of 1.58% per year, cystocele (vaginal anterior wall descent) was present in 21 (8.9%) women for an incidence of 2.2% per year; rectocele (posterior vaginal wall descent) was identified in 15 (6.3%) women for an incidence of 1.58% per year; vaginal cough prolapse (apical descent) was present 21 (8.9%) women for an incidence of 2.2% per year

  1. Neoadjuvant Chemoradiation Therapy Using Concurrent S-1 and Irinotecan in Rectal Cancer: Impact on Long-Term Clinical Outcomes and Prognostic Factors

    SciTech Connect

    Nakamura, Takatoshi; Yamashita, Keishi; Sato, Takeo; Ema, Akira; Naito, Masanori; Watanabe, Masahiko

    2014-07-01

    Purpose: To assess the long-term outcomes of patients with rectal cancer who received neoadjuvant chemoradiation therapy (NCRT) with concurrent S-1 and irinotecan (S-1/irinotecan) therapy. Methods and Materials: The study group consisted of 115 patients with clinical stage T3 or T4 rectal cancer. Patients received pelvic radiation therapy (45 Gy) plus concurrent oral S-1/irinotecan. The median follow-up was 60 months. Results: Grade 3 adverse effects occurred in 7 patients (6%), and the completion rate of NCRT was 87%. All 115 patients (100%) were able to undergo R0 surgical resection. Twenty-eight patients (24%) had a pathological complete response (ypCR). At 60 months, the local recurrence-free survival was 93%, disease-free survival (DFS) was 79%, and overall survival (OS) was 80%. On multivariate analysis with a proportional hazards model, ypN2 was the only independent prognostic factor for DFS (P=.0019) and OS (P=.0064) in the study group as a whole. Multivariate analysis was additionally performed for the subgroup of 106 patients with ypN0/1 disease, who had a DFS rate of 85.3%. Both ypT (P=.0065) and tumor location (P=.003) were independent predictors of DFS. A combination of these factors was very strongly related to high risk of recurrence (P<.0001), which occurred most commonly in the lung. Conclusions: NCRT with concurrent S-1/irinotecan produced high response rates and excellent long-term survival, with acceptable adverse effects in patients with rectal cancer. ypN2 is a strong predictor of dismal outcomes, and a combination of ypT and tumor location can identify high-risk patients among those with ypN0/1 disease.

  2. Tafazzin Protein Expression Is Associated with Tumorigenesis and Radiation Response in Rectal Cancer: A Study of Swedish Clinical Trial on Preoperative Radiotherapy

    PubMed Central

    Pathak, Surajit; Meng, Wen-Jian; Zhang, Hong; Gnosa, Sebastian; Nandy, Suman Kumar; Adell, Gunnar; Holmlund, Birgitta; Sun, Xiao-Feng

    2014-01-01

    Background Tafazzin (TAZ), a transmembrane protein contributes in mitochondrial structural and functional modifications through cardiolipin remodeling. TAZ mutations are associated with several diseases, but studies on the role of TAZ protein in carcinogenesis and radiotherapy (RT) response is lacking. Therefore we investigated the TAZ expression in rectal cancer, and its correlation with RT, clinicopathological and biological variables in the patients participating in a clinical trial of preoperative RT. Methods 140 rectal cancer patients were included in this study, of which 65 received RT before surgery and the rest underwent surgery alone. TAZ expression was determined by immunohistochemistry in primary cancer, distant, adjacent normal mucosa and lymph node metastasis. In-silico protein-protein interaction analysis was performed to study the predictive functional interaction of TAZ with other oncoproteins. Results TAZ showed stronger expression in primary cancer and lymph node metastasis compared to distant or adjacent normal mucosa in both non-RT and RT patients. Strong TAZ expression was significantly higher in stages I-III and non-mucinious cancer of non-RT patients. In RT patients, strong TAZ expression in biopsy was related to distant recurrence, independent of gender, age, stages and grade (p = 0.043, HR, 6.160, 95% CI, 1.063–35.704). In silico protein-protein interaction study demonstrated that TAZ was positively related to oncoproteins, Livin, MAC30 and FXYD-3. Conclusions Strong expression of TAZ protein seems to be related to rectal cancer development and RT response, it can be a predictive biomarker of distant recurrence in patients with preoperative RT. PMID:24858921

  3. Preoperative Treatment of Locally Advanced Rectal Cancer: Assets and Drawbacks of Short Course and Long Course in Clinical Practice.

    PubMed

    Ngan, Samuel Y

    2016-07-01

    Preoperative short-course radiotherapy and preoperative long-course chemoradiotherapy are the standards of care for high-risk rectal cancer in different parts of the world. Both treatments are effective in local control and carry a low morbidity. The advantage of short course is its simplicity, whereas long course has the advantage of downsizing tumors thus increasing the chance of sphincter preservation. Although 2 randomized trials comparing short course and long course have been performed, the better form of preoperative treatment remains a subject of discussion. This article reviews the evidence supporting each approach, and it discusses their relative merits and future directions. PMID:27238469

  4. Personalized Computational Modeling of Mitral Valve Prolapse: Virtual Leaflet Resection

    PubMed Central

    Rim, Yonghoon; Choi, Ahnryul; McPherson, David D.; Kim, Hyunggun

    2015-01-01

    Posterior leaflet prolapse following chordal elongation or rupture is one of the primary valvular diseases in patients with degenerative mitral valves (MVs). Quadrangular resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of posterior leaflet prolapse. Virtual MV repair simulation of leaflet resection in association with patient-specific 3D echocardiographic data can provide quantitative biomechanical and physiologic characteristics of pre- and post-resection MV function. We have developed a solid personalized computational simulation protocol to perform virtual MV repair using standard clinical guidelines of posterior leaflet resection with annuloplasty ring implantation. A virtual MV model was created using 3D echocardiographic data of a patient with posterior chordal rupture and severe mitral regurgitation. A quadrangle-shaped leaflet portion in the prolapsed posterior leaflet was removed, and virtual plication and suturing were performed. An annuloplasty ring of proper size was reconstructed and virtual ring annuloplasty was performed by superimposing the ring and the mitral annulus. Following the quadrangular resection and ring annuloplasty simulations, patient-specific annular motion and physiologic transvalvular pressure gradient were implemented and dynamic finite element simulation of MV function was performed. The pre-resection MV demonstrated a substantial lack of leaflet coaptation which directly correlated with the severe mitral regurgitation. Excessive stress concentration was found along the free marginal edge of the posterior leaflet involving the chordal rupture. Following the virtual resection and ring annuloplasty, the severity of the posterior leaflet prolapse markedly decreased. Excessive stress concentration disappeared over both anterior and posterior leaflets, and complete leaflet coaptation was effectively restored. This novel personalized virtual MV repair strategy has great

  5. Native Tissue Prolapse Repairs: Comparative Effectiveness Trials.

    PubMed

    Siff, Lauren N; Barber, Matthew D

    2016-03-01

    This report reviews the success rates and complications of native tissue (nonmesh) vaginal reconstruction of pelvic organ prolapse by compartment. For apical prolapse, both uterosacral ligament suspensions and sacrospinous ligament fixations are effective and provided similar outcomes in anatomy and function with few adverse events. In the anterior compartment, traditional colporrhaphy technique is no different than ultralateral suturing. In the posterior compartment, transvaginal rectocele repair is superior to transanal repair. For uterine preservation, sacrospinous hysteropexy is not inferior to vaginal hysterectomy with uterosacral ligament suspension for treatment of apical uterovaginal prolapse. PMID:26880509

  6. The role of two- and three-dimensional dynamic ultrasonography in pelvic organ prolapse.

    PubMed

    Dietz, Hans Peter

    2010-01-01

    The assessment of pelvic organ prolapse has to date been limited to the clinical evaluation of surface anatomy. This is clearly insufficient. As a result, imaging of pelvic floor function and anatomy is moving from the fringes to the mainstream of obstetrics and gynecology. This is mainly due to the realization that pelvic floor trauma in labor is common, generally overlooked, and a major factor in the causation of pelvic organ prolapse. Modern imaging methods such as magnetic resonance and 3-dimensional ultrasonography have enabled us to diagnose such abnormalities reliably and accurately, most commonly in the form of an avulsion of the puborectalis muscle off its insertion on the os pubis. However, ultrasonography has other advantages in the assessment of pelvic organ prolapse, most notably in the differential diagnosis of posterior compartment prolapse, which can be due to at least 5 different conditions. In this review I will try to summarize the methods of prolapse and pelvic floor assessment by translabial ultrasonography and to describe the most common abnormalities and their consequences. This article will not deal with magnetic resonance imaging because I consider this technology to be of limited clinical utility due to technical restrictions, expense, and access issues. PMID:20171938

  7. Simple device for treating prolapsing loop colostomy.

    PubMed

    Hsieh, Ming-Yu; Liu, Chinsu; Ho, Shin-Huei; Wung, Shin-Huev; Chin, Taiwai; Wei, Choufu

    2006-03-01

    Stoma prolapse is a common complication of intestinal stoma. Although various surgical methods yield satisfactory results, nonsurgical treatment may be better for a temporary stoma. We report a case of a patient with a distal limb prolapse of a right transverse colostomy who received nonsurgical treatment with satisfactory results. For the treatment of a temporary transverse loop colostomy with distal limb prolapse, we designed a simple device consisting of a pediatric plastic medicine cup, which was rolled into a towel to shape the bottom of the cup into a compressor. The towel was put on the stoma outside of the colostomy bag with the compressor above the prolapsing limb of the colostomy. An abdominal binder was applied to fix the towel. PMID:16599021

  8. Can I prevent Pelvic Organ Prolapse

    MedlinePlus

    ... Pelvic Organ Prolapse POP Symptoms & Types Can I Prevent POP? POP Diagnosis POP Treatments 3 Resources + More Bladder Control UI Symptoms & Types Can I Prevent UI? UI Diagnosis UI Treatments 3 Resources + More ...

  9. Pessary use in advanced pelvic organ prolapse.

    PubMed

    Powers, Kenneth; Lazarou, George; Wang, Andrea; LaCombe, Julie; Bensinger, Giti; Greston, Wilma M; Mikhail, Magdy S

    2006-02-01

    The objective of this study was to review our experience with pessary use for advanced pelvic organ prolapse. Charts of patients treated for Stage III and IV prolapse were reviewed. Comparisons were made between patients who tried or refused pessary use. A successful trial of pessary was defined by continued use; a failed trial was defined by a patient's discontinued use. Thirty-two patients tried a pessary; 45 refused. Patients who refused a pessary were younger, had lesser degree of prolapse, and more often had urinary incontinence. Most patients (62.5%) continued pessary use and avoided surgery. Unsuccessful trial of pessary resorting to surgery included four patients (33%) with unwillingness to maintain, three patients (25%) with inability to retain and two patients (17%) with vaginal erosion and/or discharge. Our findings suggest that pessary use is an acceptable first-line option for treatment of advanced pelvic organ prolapse. PMID:15883856

  10. KRAS Mutation Status and Clinical Outcome of Preoperative Chemoradiation With Cetuximab in Locally Advanced Rectal Cancer: A Pooled Analysis of 2 Phase II Trials

    SciTech Connect

    Kim, Sun Young; Shim, Eun Kyung; Yeo, Hyun Yang; Baek, Ji Yeon; Hong, Yong Sang; Kim, Dae Yong; Kim, Tae Won; Kim, Jee Hyun; Im, Seock-Ah; Jung, Kyung Hae; Chang, Hee Jin

    2013-01-01

    Purpose: Cetuximab-containing chemotherapy is known to be effective for KRAS wild-type metastatic colorectal cancer; however, it is not clear whether cetuximab-based preoperative chemoradiation confers an additional benefit compared with chemoradiation without cetuximab in patients with locally advanced rectal cancer. Methods and Materials: We analyzed EGFR, KRAS, BRAF, and PIK3CA mutation status with direct sequencing and epidermal growth factor receptor (EGFR) and Phosphatase and tensin homolog (PTEN) expression status with immunohistochemistry in tumor samples of 82 patients with locally advanced rectal cancer who were enrolled in the IRIX trial (preoperative chemoradiation with irinotecan and capecitabine; n=44) or the ERBIRIX trial (preoperative chemoradiation with irinotecan and capecitabine plus cetuximab; n=38). Both trials were similarly designed except for the administration of cetuximab; radiation therapy was administered at a dose of 50.4 Gy/28 fractions and irinotecan and capecitabine were given at doses of 40 mg/m{sup 2} weekly and 1650 mg/m{sup 2}/day, respectively, for 5 days per week. In the ERBIRIX trial, cetuximab was additionally given with a loading dose of 400 mg/m{sup 2} on 1 week before radiation, and 250 mg/m{sup 2} weekly thereafter. Results: Baseline characteristics before chemoradiation were similar between the 2 trial cohorts. A KRAS mutation in codon 12, 13, and 61 was noted in 15 (34%) patients in the IRIX cohort and 5 (13%) in the ERBIRIX cohort (P=.028). Among 62 KRAS wild-type cancer patients, major pathologic response rate, disease-free survival and pathologic stage did not differ significantly between the 2 cohorts. No mutations were detected in BRAF exon 11 and 15, PIK3CA exon 9 and 20, or EGFR exon 18-24 in any of the 82 patients, and PTEN and EGFR expression were not predictive of clinical outcome. Conclusions: In patients with KRAS wild-type locally advanced rectal cancer, the addition of cetuximab to the chemoradiation with

  11. [Occupation and lumbar disk prolapse].

    PubMed

    Jensen, M V; Tüchsen, F

    1995-03-13

    All Danish occupational groups were screened for an increased risk of hospitalization due to a prolapsed lumbar intervertebral disc (PLID) (ICD-8: 725.11). A cohort of all gainfully employed Danes aged 20 to 59 years in 1981 was followed-up for 10 years for first hospitalization with PLID. A Standardized Hospitalization Ratio was calculated using all economically active persons as the reference group. Male groups with an elevated risk were found in building and construction, the iron and metal industry, in the food and nutrition sector and in occupational driving. Almost all groups of professional drivers had an elevated risk. Female groups with an elevated risk were mainly found in the same industries, but home helps, service workers in the private sector and sewing machine operators also had an elevated risk. We conclude that there are significant and systematic differences between occupational groups as concerns the risk of hospital admission due to PLID. PMID:7725550

  12. Mesh–related and intraoperative complications of pelvic organ prolapse repair

    PubMed Central

    Abramyan, Karina; Popov, Alexander A.; Gvozdev, Mikhail; Pushkar, Dmitry

    2014-01-01

    Introduction To evaluate the rates of complications of pelvic organ prolapse repair and to determine their risk factors. Material and methods The study included 677 patients operated for pelvic organ prolapse with trocar guided Prolift mesh. Patients were followed up within 1 and 3 months. A phone interview was conducted and patients with complaints were invited and evaluated in office settings. Results Mean age was 60 years. For the phone interview, 86.5% of patients were available. Overall complication rates were 22.5% (152/677). Fifteen patients (2.2%) developed bleeding over 500 cc; pelvic hematomas – 5.5%; perineal hematomas – 2.5%; urethral injuries – 0.3%; bladder injury in 1.6%; rectal damage in 0.7% and ureteral trauma in 0.2%. Mesh related complications included: erosions in 4.8%; vaginal synechiae – 0.3%; protrusion of mesh into the bladder – 0.15%; vesicovaginal fistula with mesh protrusion – 0.3%; mesh shrinkage – 1%; dyspareunia and pain in 2.4% cases. Pelvic abscess was found in 0.6% including one case of lethal necrotizing fasciitis. The risk factors of complications were assessed via logistic regression analysis. Conclusions Younger age, less prominent prolapse, hematomas and concomitant hysterectomies are associated with higher risk of complications. PMID:25247091

  13. Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse.

    PubMed

    Rosenzweig, B A; Pushkin, S; Blumenfeld, D; Bhatia, N N

    1992-04-01

    Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results. PMID:1553172

  14. Perineal herniation of an ileal neobladder following radical cystectomy and consecutive rectal resection for recurrent bladder carcinoma.

    PubMed

    Neumann, P A; Mehdorn, A S; Puehse, G; Senninger, N; Rijcken, E

    2016-04-01

    Secondary perineal herniation of intraperitoneal contents represents a rare complication following procedures such as abdominoperineal rectal resection or cystectomy. We present a case of a perineal hernia formation with prolapse of an ileum neobladder following radical cystectomy and rectal resection for recurrent bladder cancer. Following consecutive resections in the anterior and posterior compartment of the lesser pelvis, the patient developed problems emptying his neobladder. Clinical examination and computed tomography revealed perineal herniation of his neobladder through the pelvic floor. Through a perineal approach, the hernial sac could be repositioned, and via a combination of absorbable and non-absorbable synthetic mesh grafts, the pelvic floor was stabilised. Follow-up review at one year after hernia fixation showed no signs of recurrence and no symptoms. In cases of extensive surgery in the lesser pelvis with associated weakness of the pelvic compartments, meshes should be considered for closure of the pelvic floor. Development of biological meshes with reduced risk of infection might be an interesting treatment option in these cases. PMID:26985818

  15. Concomitant boost IMRT-based neoadjuvant chemoradiotherapy for clinical stage II/III rectal adenocarcinoma: results of a phase II study

    PubMed Central

    2014-01-01

    Aim This study was designed to evaluate the efficacy and toxicities of concomitant boost intensity-modulated radiation therapy (IMRT) along with capecitabine and oxaliplatin, followed by a cycle of Xelox, in neoadjuvant course for locally advanced rectal cancer. Materials and methods Patients with histologically confirmed, newly diagnosed, locally advanced rectal adenocarcinoma (cT3-T4 and/or cN+) located within 12 cm of the anal verge were included in this study. Patients received IMRT to the pelvis of 50 Gy and a concomitant boost of 5 Gy to the primary tumor in 25 fractions, and concurrent with oxaliplatin (50 mg/m2 d1 weekly) and capecitabine (625 mg/m2 bid d1–5 weekly). One cycle of Xelox (oxaliplatin 130 mg/m2 on d1 and capecitabine 1000 mg/m2 twice daily d1–14) was given two weeks after the completion of chemoradiation, and radical surgery was scheduled eight weeks after chemoradiation. Tumor response was evaluated by tumor regression grade (TRG) system and acute toxicities were evaluated by NCI-CTC 3.0 criteria. Survival curves were estimated using the Kaplan-Meier method and compared with Log-rank test. Results A total of 78 patients were included between March 2009 and May 2011 (median age 54 years; 62 male). Seventy-six patients underwent surgical resection. Twenty-eight patients underwent sphincter-sparing lower anterior resection and 18 patients (23.7%) were evaluated as pathological complete response (pCR). The incidences of grade 3 hematologic toxicity, diarrhea, and radiation dermatitis were 3.8%, 10.3%, and 17.9%, respectively. The three-year LR (local recurrence), DFS (disease-free survival) and OS (overall survival) rates were 14.6%, 63.8% and 77.4%, respectively. Initial clinical T stage and tumor regression were independent prognostic factors to DFS. Conclusion An intensified regimen of concomitant boost radiotherapy plus concurrent capecitabine and oxaliplatin, followed by one cycle of Xelox, can be safely administered in patients

  16. Laparoscopic sacrocolpopexy in a patient with vault prolapse of the sigmoid stump.

    PubMed

    Popov, Alexandr; Gumina, Dina; Mironenko, Kseniya; Slobodyanyuk, Boris; Manannikova, Tatiana; Fedorov, Anton; Tyurina, Svetlana; Koval, Alexey

    2016-02-01

    Surgical creation of a neovagina using the sigmoid was one of the main techniques used in patients with Mayer-Rokinatsky-Küster-Hauser syndrome. Nowadays, this surgery is not common as a result of the high frequency of complications and adverse outcomes, one of which is sigmoid neovagina prolapse. There are no standards of treatment because of the rarity of these clinical events; therefore, any medical case is important. We present a case report of a 72-year-old patient with prolapse of the sigmoid stump. Perscrutation of this example allows us to conclude that laparoscopic sacrocolpopexy is the optimal operation for patients with apical prolapse and a history of sigmoidal colpopoiesis owing to its high level of safety and excellent outcomes. PMID:26179551

  17. [Immune state in athletes with mitral valve prolapse].

    PubMed

    Maslennikova, O M; Reznichenko, T A; Firsakova, V Iu

    2013-01-01

    The authors evaluated immune state in 541 professional athletes. The athletes with vitral valve prolapse (132 subjects) appeared to have immune changes - lower immunoglobulines levels, general leucocytes count, if compared to the athletes without mitral valve prolapse. PMID:24340766

  18. Correlation in Rectal Cancer Between Clinical Tumor Response After Neoadjuvant Radiotherapy and Sphincter or Organ Preservation: 10-Year Results of the Lyon R 96-02 Randomized Trial

    SciTech Connect

    Ortholan, Cecile; Romestaing, Pascale; Chapet, Olivier; Gerard, Jean Pierre

    2012-06-01

    Purpose: To investigate, in rectal cancer, the benefit of a neoadjuvant radiation dose escalation with endocavitary contact radiotherapy (CXRT) in addition to external beam radiotherapy (EBRT). This article provides an update of the Lyon R96-02 Phase III trial. Methods and Materials: A total of 88 patients with T2 to T3 carcinoma of the lower rectum were randomly assigned to neoadjuvant EBRT 39 Gy in 13 fractions (43 patients) vs. the same EBRT with CXRT boost, 85 Gy in three fractions (45 patients). Median follow-up was 132 months. Results: The 10-year cumulated rate of permanent colostomy (CRPC) was 63% in the EBRT group vs. 29% in the EBRT+CXRT group (p < 0.001). The 10-year rate of local recurrence was 15% vs. 10% (p = 0.69); 10-year disease-free survival was 54% vs. 53% (p = 0.99); and 10-year overall survival was 56% vs. 55% (p = 0.85). Data of clinical response (CR) were available for 78 patients (36 in the EBRT group and 42 in the EBRT+CXRT group): 12 patients were in complete CR (1 patient vs. 11 patients), 53 patients had a CR {>=}50% (24 patients vs. 29 patients), and 13 patients had a CR <50% (11 patients vs. 2 patients) (p < 0.001). Of the 65 patients with CR {>=}50%, 9 had an organ preservation procedure (meaning no rectal resection) taking advantage of major CR. The 10-year CRPC was 17% for patients with complete CR, 42% for patients with CR {>=}50%, and 77% for patients with CR <50% (p = 0.014). Conclusion: In cancer of the lower rectum, CXRT increases the complete CR, turning in a significantly higher rate of long-term permanent sphincter and organ preservation.

  19. Local Recurrence After Complete Clinical Response and Watch and Wait in Rectal Cancer After Neoadjuvant Chemoradiation: Impact of Salvage Therapy on Local Disease Control

    SciTech Connect

    Habr-Gama, Angelita; Gama-Rodrigues, Joaquim; São Julião, Guilherme P.; Proscurshim, Igor; Sabbagh, Charles; Lynn, Patricio B.; Perez, Rodrigo O.

    2014-03-15

    Purpose: To review the risk of local recurrence and impact of salvage therapy after Watch and Wait for rectal cancer with complete clinical response (cCR) after chemoradiation therapy (CRT). Methods and Materials: Patients with cT2-4N0-2M0 distal rectal cancer treated with CRT (50.4-54 Gy + 5-fluorouracil-based chemotherapy) and cCR at 8 weeks were included. Patients with cCR were enrolled in a strict follow-up program with no immediate surgery (Watch and Wait). Local recurrence-free survival was compared while taking into account Watch and Wait strategy alone and Watch and Wait plus salvage. Results: 90 of 183 patients experienced cCR at initial assessment after CRT (49%). When early tumor regrowths (up to and including the initial 12 months of follow-up) and late recurrences were considered together, 28 patients (31%) experienced local recurrence (median follow-up time, 60 months). Of those, 26 patients underwent salvage therapy, and 2 patients were not amenable to salvage. In 4 patients, local re-recurrence developed after Watch and Wait plus salvage. The overall salvage rate for local recurrence was 93%. Local recurrence-free survival at 5 years was 69% (all local recurrences) and 94% (after salvage procedures). Thirteen patients (14%) experienced systemic recurrence. The 5-year cancer-specific overall survival and disease-free survival for all patients (including all recurrences) were 91% and 68%, respectively. Conclusions: Local recurrence may develop in 31% of patients with initial cCR when early regrowths (≤12 months) and late recurrences are grouped together. More than half of these recurrences develop within 12 months of follow-up. Salvage therapy is possible in ≥90% of recurrences, leading to 94% local disease control, with 78% organ preservation.

  20. Rectal Cancer, Version 2.2015.

    PubMed

    Benson, Al B; Venook, Alan P; Bekaii-Saab, Tanios; Chan, Emily; Chen, Yi-Jen; Cooper, Harry S; Engstrom, Paul F; Enzinger, Peter C; Fenton, Moon J; Fuchs, Charles S; Grem, Jean L; Grothey, Axel; Hochster, Howard S; Hunt, Steven; Kamel, Ahmed; Kirilcuk, Natalie; Leong, Lucille A; Lin, Edward; Messersmith, Wells A; Mulcahy, Mary F; Murphy, James D; Nurkin, Steven; Rohren, Eric; Ryan, David P; Saltz, Leonard; Sharma, Sunil; Shibata, David; Skibber, John M; Sofocleous, Constantinos T; Stoffel, Elena M; Stotsky-Himelfarb, Eden; Willett, Christopher G; Gregory, Kristina M; Freedman-Cass, Deborah

    2015-06-01

    The NCCN Guidelines for Rectal Cancer begin with the clinical presentation of the patient to the primary care physician or gastroenterologist and address diagnosis, pathologic staging, surgical management, perioperative treatment, posttreatment surveillance, management of recurrent and metastatic disease, and survivorship. The NCCN Rectal Cancer Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize major discussion points from the 2015 NCCN Rectal Cancer Panel meeting. Major discussion topics this year were perioperative therapy options and surveillance for patients with stage I through III disease. PMID:26085388

  1. Efficacy and Safety of Low-Dose-Rate Endorectal Brachytherapy as a Boost to Neoadjuvant Chemoradiation in the Treatment of Locally Advanced Distal Rectal Cancer: A Phase-II Clinical Trial

    PubMed Central

    Omidvari, Shapour; Zohourinia, Shadi; Ansari, Mansour; Ghahramani, Leila; Zare-Bandamiri, Mohammad; Mosalaei, Ahmad; Ahmadloo, Niloofar; Pourahmad, Saeedeh; Nasrolahi, Hamid; Hamedi, Sayed Hasan

    2015-01-01

    Purpose Despite advances in rectal cancer treatment over the last decade, local control and risk of late side effects due to external beam radiation therapy (EBRT) remain as concerns. The present study aimed to investigate the efficacy and the safety of low-dose-rate endorectal brachytherapy (LDRBT) as a boost to neoadjuvant chemoradiation for use in treating locally advanced distal rectal adenocarcinomas. Methods This phase-II clinical trial included 34 patients (as the study arm) with newly diagnosed, locally advanced (clinical T3-T4 and/or N1/N2, M0) lower rectal cancer. For comparative analysis, 102 matched patients (as the historical control arm) with rectal cancer were also selected. All the patients were treated with LDRBT (15 Gy in 3 fractions) and concurrent chemoradiation (45-50.4 Gy). Concurrent chemotherapy consisted of oxaliplatin 130 mg/m2 intravenously on day 1 plus oral capecitabine 825 mg/m2 twice daily during LDRBT and EBRT. Results The study results revealed a significant differences between the study arm and the control arm in terms in the pathologic tumor size (2.1 cm vs. 3.6 cm, P = 0.001), the pathologic tumor stage (35% T3-4 vs. 65% T3-4, P = 0.003), and the pathologic complete response (29.4% vs. 11.7%, P < 0.028). Moreover, a significantly higher dose of EBRT (P = 0.041) was found in the control arm, and a longer time to surgery was observed in the study arm (P < 0.001). The higher rate of treatment-related toxicities, such as mild proctitis and anemia, in the study arm was tolerable and easily manageable. Conclusion A boost of LDRBT can optimize the pathologic complete response, with acceptable toxicities, in patients with distal rectal cancer. PMID:26361613

  2. Functional Status in Older Women Diagnosed with Pelvic Organ Prolapse

    PubMed Central

    SANSES, Tatiana V.D.; SCHILTZ, Nicholas K.; COURI, Bruna M.; MAHAJAN, Sangeeta T.; RICHTER, Holly E.; WARNER, David F.; GURALNIK, Jack; KOROUKIAN, Siran M.

    2016-01-01

    -reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with pelvic organ prolapse. PMID:26704893

  3. Prevention and management of pelvic organ prolapse

    PubMed Central

    Giarenis, Ilias

    2014-01-01

    Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery. PMID:25343034

  4. Optimism in Women Undergoing Abdominal Sacrocolpopexy for Pelvic Organ Prolapse

    PubMed Central

    Wren, Patricia A; Janz, Nancy K; FitzGerald, Mary P; Barber, Matthew D; Burgio, Kathryn L; Cundiff, Geoffrey W; Nygaard, Ingrid E; Zyczynski, Halina M; Gao, Xin

    2013-01-01

    Background While studies suggest optimism can predict health outcomes, the relationship has not been tested in women with pelvic organ prolapse (POP). This study seeks to (1) explore the relationship between optimism, prolapse severity, and symptoms before surgery; and (2) examine whether optimism predicts post-surgical functional status, treatment satisfaction, and treatment success. Study Design Data from the randomized Colpopexy And Urinary Reduction Efforts (CARE) study in which stress continent women undergoing sacrocolpopexy to repair Stage II-IV POP completed a baseline assessment of optimism and validated symptom and quality of life (QOL) measures at baseline and 24-months. Relationships between optimism and demographics, clinical status, and functional and QOL outcomes were assessed. Results Of 322 CARE participants, 305 (94.7%) completed 24-month follow-up interviews. At baseline, there were no significant differences in optimism with respect to POP stage or history of prior surgery for prolapse or urinary incontinence. At baseline, women with greater optimism reported significantly better physical and mental functioning (p≤0.001), and less symptom distress (p≤0.01). Two years after surgery, the difference in symptom experience across the three optimism categories narrowed as all women reported improved health status, fewer symptoms, and less impact on daily activities. Satisfaction with treatment and perception of treatment success were not associated with optimism. Conclusions In women planning surgery for POP, optimism is related to pelvic symptom severity but is not associated with satisfaction with treatment or treatment success. Abdominal sacrocolpopexy resulted in substantial improvements in QOL and functional outcomes that were not significantly influenced by optimism. PMID:18656053

  5. Uterine Prolapse: From Antiquity to Today

    PubMed Central

    Downing, Keith T.

    2012-01-01

    Uterine prolapse is a condition that has likely affected women for all of time as it is documented in the oldest medical literature. By looking at the watershed moments in its recorded history we are able to appreciate the evolution of urogynecology and to gain perspective on the challenges faced by today's female pelvic medicine and reconstructive surgeons in their attempts to treat uterine and vaginal vault prolapse. “He who cannot render an account to himself of at least three thousand years of time, will always grope in the darkness of inexperience” —Goethe, Translation of Panebaker PMID:22262975

  6. Anterior vaginal wall prolapse and voiding dysfunction in urogynecology patients.

    PubMed

    Schimpf, Megan O; O'Sullivan, David M; LaSala, Christine A; Tulikangas, Paul K

    2007-07-01

    We investigated whether women with and without anterior vaginal wall prolapse have voiding differences. Women (n=109) who presented to a urogynecology practice were categorized into two groups based on anterior vaginal wall prolapse: stages 0 and 1 and stages 2, 3, and 4. Women with prolapse were older than the women without prolapse but the groups were otherwise similar demographically. There was a higher rate of activity-related urine loss and use of wetness protection amongst women without prolapse. There was no significant difference for urgency symptoms or urge incontinence. Urodynamic testing found no significant differences for maximal flow rate or maximal urethral closing pressures. Postvoid residual volume and detrusor overactivity were not different but approached significance. Anterior vaginal wall prolapse of stage 2 or greater was not associated with urge incontinence or voiding function in this population. Women without prolapse were more likely to report stress incontinence. PMID:17031486

  7. Urinary Problems Amongst Gynecological Consultations. Association Between Prolapse, Gynecological Surgery and Diabetes

    PubMed Central

    Saadia, Zaheera

    2015-01-01

    Background: Urinary incontinence is the inability of a woman to maintain bladder control. Symptoms range from urgency, frequency, nocturia to urge incontinence (1). It limits functional and social activities and leads to depression and social withdrawal. (2). This observational study aimed to describe the common urinary problems amongst gynecological consultations. It also describes the relationship of urinary incontinence with history of diabetes, previous gynecological surgery and prolapse. Methods: The study was conducted as a descriptive cross sectional study from Jan-May 2015 at Qassim University Clinic, Buraidah. Women with urinary problem and those without urinary problems were compared for risk factors including diabetes, prolapse and previous gynecological surgery. The Statistical Package for the Social Sciences 22 (SPSS 22) was used to conduct proportion z-tests to determine the association of prolapse, gynecological surgeries and diabetes with urinary incontinence. To test the hypothesis, differences between two groups on the aforementioned factors were examined. The groups included participants that reported having urinary problems (n = 111) and those who do not have urinary problems (n = 100). Results: The most frequent complaints of participants with urinary problems were urgency (n = 66, 59.46%), Stress incontinence (SI) (n = 65, 58.56%) and frequency (n = 62, 55.86%). For participants with a urinary problem, 89.19% have not had a gynecological surgery (n = 99) and the remaining 10.81% of participants had a gynecological surgery (n = 12). For participants without a urinary problem, 97.0% have not had a gynecological surgery (n = 97) and the remaining 3.0% had a gynecological surgery (n = 3). For participants with a urinary problem, 72.97% did not have diabetes (n = 81) and the remaining 27.03% of participants did have diabetes (n = 30). For participants without a urinary problem, 92.0% did not have diabetes (n = 92) and the remaining 8.0% did report

  8. URINARY PROBLEMS AMONGST GYNECOLOGICAL CONSULTATIONS. ASSOCIATION BETWEEN PROLAPSE, GYNECOLOGICAL SURGERY AND DIABETES

    PubMed Central

    Saadia, Zaheera

    2016-01-01

    Background: Urinary incontinence is the inability of a woman to maintain bladder control. Symptoms range from urgency, frequency, nocturia to urge incontinence (1). It limits functional and social activities and leads to depression and social withdrawal. (2). This observational study aimed to describe the common urinary problems amongst gynecological consultations. It also describes the relationship of urinary incontinence with history of diabetes, previous gynecological surgery and prolapse. Methods: The study was conducted as a descriptive cross sectional study from Jan-May 2015 at Qassim University Clinic, Buraidah. Women with urinary problem and those without urinary problems were compared for risk factors including diabetes, prolapse and previous gynecological surgery. The Statistical Package for the Social Sciences 22 (SPSS 22) was used to conduct proportion z-tests to determine the association of prolapse, gynecological surgeries and diabetes with urinary incontinence. To test the hypothesis, differences between two groups on the aforementioned factors were examined. The groups included participants that reported having urinary problems (n = 111) and those who do not have urinary problems (n = 100). Results: The most frequent complaints of participants with urinary problems were urgency (n = 66, 59.46%), Stress incontinence (SI) (n = 65, 58.56%) and frequency (n = 62, 55.86%). For participants with a urinary problem, 89.19% have not had a gynecological surgery (n = 99) and the remaining 10.81% of participants had a gynecological surgery (n = 12). For participants without a urinary problem, 97.0% have not had a gynecological surgery (n = 97) and the remaining 3.0% had a gynecological surgery (n = 3). For participants with a urinary problem, 72.97% did not have diabetes (n = 81) and the remaining 27.03% of participants did have diabetes (n = 30). For participants without a urinary problem, 92.0% did not have diabetes (n = 92) and the remaining 8.0% did report

  9. Vaginal fold prolapse in a dog with pyometra and ovarian papillary cystadenocarcinoma.

    PubMed

    Zedda, Maria-Teresa; Bogliolo, Luisa; Ariu, Federica; Ledda, Mauro; Falchi, Laura; Pinna-Parpaglia, Maria-Luisa; Pau, Salvatore

    2016-04-01

    CASE DESCRIPTION A 7-year-old 42-kg (92.4-lb) sexually intact nulliparous female Italian Mastiff was examined because of a history of vaginal prolapse during diestrus. CLINICAL FINDINGS A physical examination revealed vaginal fold prolapse. Abdominal ultrasonography revealed an enlarged uterus with hypoechogenic content, corpora lutea in the ovaries, and a cyst in the right ovary. Hematologic abnormalities included leukocytosis, neutrophilia, mild anemia, and low Hct. Progesterone and estradiol concentrations were 9.36 ng/mL and 30.42 pg/mL, respectively, in serum and 72.72 ng/mL and 792 pg/mL, respectively, in the ovarian cystic fluid. TREATMENT AND OUTCOME Ovariohysterectomy was performed; the prolapsed tissue was repositioned by external manipulation and maintained in situ by temporary apposition of the vulvar lips with a retention suture. Anatomic and histologic examinations of the excised tissues revealed pyometra and papillary cystadenocarcinoma in the right ovary. The vaginal hyperplasia completely regressed at 35 days after surgery; 5 months after surgery, the dog's general condition was considered good. CLINICAL RELEVANCE Findings in this case were indicative of a hormonally active ovarian papillary cystadenocarcinoma in a female dog in diestrus. Hormone production by the cystadenocarcinoma was the predisposing factor that induced pyometra, mucosal hyperplasia, and vaginal fold prolapse in the dog. On the basis of these concurrent disorders, ovariohysterectomy was an appropriate treatment. (J Am Vet Med Assoc 2016;248:822-826). PMID:27003024

  10. Clinical and Dosimetric Predictors of Late Rectal Syndrome After 3D-CRT for Localized Prostate Cancer: Preliminary Results of a Multicenter Prospective Study

    SciTech Connect

    Fiorino, Claudio Fellin, Gianni; Rancati, Tiziana; Vavassori, Vittorio; Bianchi, Carla; Borca, Valeria Casanova; Girelli, Giuseppe; Mapelli, Marco; Menegotti, Loris; Nava, Simona; Valdagni, Riccardo

    2008-03-15

    Purpose: To assess the predictors of late rectal toxicity in a prospectively investigated group of patients treated at 70-80 Gy for prostate cancer (1.8-2 Gy fractions) with three-dimensional conformal radiotherapy. Methods and Materials: A total of 1,132 patients were entered into the study between 2002 and 2004. Three types of rectal toxicity, evaluated by a self-administered questionnaire, mainly based on the subjective objective management, analytic late effects of normal tissue system, were considered: stool frequency/tenesmus/pain, fecal incontinence, and bleeding. The data from 506 patients with a follow-up of 24 months were analyzed. The correlation between a number of clinical and dosimetric parameters and Grade 2 or greater toxicity was investigated by univariate and multivariate (MVA) logistic analyses. Results: Of the 1,132 patients, 21, 15, and 30 developed stool frequency/tenesmus/pain, fecal incontinence, and bleeding, respectively. Stool frequency/tenesmus/pain correlated with previous abdominal/pelvic surgery (MVA, p = 0.05, odds ratio [OR], 3.3). With regard to incontinence, MVA showed the volume receiving {>=}40 Gy (V{sub 40}) (p = 0.035, OR, 1.037) and surgery (p = 0.02, OR, 4.4) to be the strongest predictors. V{sub 40} to V{sub 70} were highly predictive of bleeding; V{sub 70} showed the strongest impact on MVA (p = 0.03), together with surgery (p = 0.06, OR, 2.5), which was also the main predictor of Grade 3 bleeding (p = 0.02, OR, 4.2). Conclusions: The predictive value of the dose-volume histogram was confirmed for bleeding, consistent with previously suggested constraints (V{sub 50} <55%, V{sub 60} <40%, V{sub 70} <25%, and V{sub 75} <5%). A dose-volume histogram constraint for incontinence can be suggested (V{sub 40} <65-70%). Previous abdominal/pelvic surgery correlated with all toxicity types; thus, a modified constraint for bleeding (V{sub 70} <15%) can be suggested for patients with a history of abdominal/pelvis surgery, although

  11. Does prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse.

    PubMed

    Ridgeway, Beri M

    2015-12-01

    Hysterectomy has historically been a mainstay in the surgical treatment of uterovaginal prolapse, even in cases in which the removal of the uterus is not indicated. However, uterine-sparing procedures have a long history and are now becoming more popular. Whereas research on these operations is underway, hysteropexy for the treatment of prolapse is not as well studied as hysterectomy-based repairs. Compared with hysterectomy and prolapse repair, hysteropexy is associated with a shorter operative time, less blood loss, and a faster return to work. Other advantages include maintenance of fertility, natural timing of menopause, and patient preference. Disadvantages include the lack of long-term prolapse repair outcomes and the need to continue surveillance for gynecological cancers. Although the rate of unanticipated abnormal pathology in this population is low, women who have uterine abnormalities or postmenopausal bleeding are not good candidates for uterine-sparing procedures. The most studied approaches to hysteropexy are the vaginal sacrospinous ligament hysteropexy and the abdominal sacrohysteropexy, which have similar objective and subjective prolapse outcomes compared with hysterectomy and apical suspension. Pregnancy and delivery have been documented after vaginal and abdominal hysteropexy approaches, although very little is known about outcomes following parturition. Uterine-sparing procedures require more research but remain an acceptable option for most patients with uterovaginal prolapse after a balanced and unbiased discussion reviewing the advantages and disadvantages of this approach. PMID:26226554

  12. Mitral Valve Prolapse in Young Patients.

    ERIC Educational Resources Information Center

    McFaul, Richard C.

    1987-01-01

    A review of research regarding mitral valve prolapse in young children indicates that up to five percent of this population have the condition, with the majority being asymptomatic and requiring reassurance that the condition usually remains mild. Beta-blocking drugs are prescribed for patients with disabling chest pain, dizziness, palpitation, or…

  13. [A Case of Locally Advanced Rectal Cancer Successfully Treated by Conversion Surgery after Multidisciplinary Treatment].

    PubMed

    Shimizu, Yosuke; Yamashita, Shinya; Tominaga, Harumi; Kimura, Yuri; Odagiri, Kazuki; Kurokawa, Tomoaki; Yamaguchi, Megumi; Takahashi, Gen; Sawada, Genta; Jeongho, Moon; Inoue, Masasi; Irei, Toshimitsu; Nakahira, Sin; Hatanaka, Nobutaka

    2015-10-01

    A 70-year-old woman who complained of abdominal pain and a prolapsed tumor from the anus was diagnosed with an intestinal obstruction resulting from anal canal cancer. Computed tomography (CT) and magnetic resonance imaging revealed a huge tumor (11×5×12 cm) invading the vagina and levator ani muscle. Enlarged inguinal lymph nodes on both sides indicated metastasis. The clinical stage was T4b (vagina, levator ani muscle, and pudenda) N0H0M1a (LYM), stage IV (Japanese Classification of Colorectal Carcinoma: 8th edition). As curative resection was not possible, a transvers colostomy was performed to relieve the intestinal obstruction. This was followed by chemoradiotherapy (45 Gy/1.8 Gy×25; TS-1, 80 mg/body for 2 weeks and a 1-week interval, for 2 courses) and up to 10 courses of Bev+mFOLFOX6 continuously. After this regimen, there was a remarkable reduction in tumor size. Positron emission tomography-CT revealed no FDG uptake in the primary rectal site or inguinal lymph nodes, but a maximum standardized uptake value (SUVmax) of 6.3 was detected in the vagina. Six weeks after chemotherapy, the patient underwent a pelvic exenteration including resection of the vagina, bladder, and pudenda. The pathological stage was yp T4b (vagina) N0H0M0, stageⅡ. Curative resection was performed, and the patient had a Grade 2 pathological response after chemoradiotherapy. PMID:26489576

  14. Transanal endoscopic microsurgery in the management of rectal wall endometriosis.

    PubMed

    Banky, Balazs; Saleki, Mahsa; Gill, Talvinder S

    2016-01-01

    A 29-year-old woman with known history of endometriosis was referred to colorectal outpatient clinic from gynaecology with a history of intermittent rectal bleeding and no associated bowel symptoms. Flexible sigmoidoscopy in concordance with pelvic MRI revealed a 3×2×2 cm sessile lesion in the anterior rectal wall. The lesion was also palpable as a firm mass on digital rectal examination. From the gynaecological point of view no intra-abdominal exploration was required; the sole rectal wall lesion was removed with the minimally invasive surgical technique of transanal endoscopic microsurgery. Full thickness rectal wall excision sample was reported to be histologically complete and confirmed endometriosis. No recurrence was detected at endoscopic follow-up at 6 months. The patient remained symptom free. Therefore, we demonstrated a case of minimally invasive removal of a rectal wall large endometriosis nodule in a fertile woman with a complete, symptomatic, uneventful recovery. PMID:27495176

  15. Cloacal Prolapse in Raptors: Review of 16 Cases.

    PubMed

    Dutton, Thomas A G; Forbes, Neil A; Carrasco, Daniel Calvo

    2016-06-01

    Sixteen cases of cloacal prolapse in raptors were reviewed in this study. Colonic prolapse was the most common presentation (56% of cases). Red-tailed hawks ( Buteo jamaicensis ) were overrepresented, comprising 66% of colonic prolapse cases. In cases of colonic prolapse, postsurgical stricture formation was a commonly identified complication after resection and anastomosis of the colon. A novel technique was used in 2 cases of colonic prolapse, in which sterile, semirigid rubber tubing was placed in the distal colon and removed per-cloaca at the end of the procedure; this facilitated a secure, fluid-tight anastomosis while maintaining sufficient intestinal lumen. Oviductal prolapse (31% of cases) was associated with the most guarded prognosis (40% treatment success). Cloacoliths were treated successfully in 2 birds (13% of cases) by minimally invasive per-cloacal manual removal. PMID:27315380

  16. Predictors of outcome of mitral valve prolapse in patients with the Marfan syndrome.

    PubMed

    Rybczynski, Meike; Treede, Hendrik; Sheikhzadeh, Sara; Groene, Eike F; Bernhardt, Alexander M J; Hillebrand, Mathias; Mir, Thomas S; Kühne, Kristine; Koschyk, Dietmar; Robinson, Peter N; Berger, Jürgen; Reichenspurner, Hermann; Meinertz, Thomas; von Kodolitsch, Yskert

    2011-01-15

    Mitral valve prolapse has a prevalence of 2% to 3% in the general population, with adverse outcomes such as mitral valve regurgitation (MVR), heart failure, and endocarditis. Predictors of outcomes are used in idiopathic mitral valve prolapse for the timing of surgery, but such predictors are unknown in Marfan syndrome. Therefore, a population-based cohort study of 112 patients (49 male, 63 female; mean age 34 ± 15 years) with classic Marfan syndrome and mitral valve prolapse with moderate or less MVR at baseline was conducted. During 4.6 ± 3.6 years of follow-up, progression of MVR was observed in 41 patients and valve-related events, which comprised mitral valve endocarditis (7 events), heart failure (5 events), and mitral valve surgery (25 events), were observed in 31 patients. Multivariate Cox proportional-hazards regression analysis identified a flail mitral leaflet (hazard ratio [HR] 3.262, 95% confidence interval [CI] 1.406 to 7.566, p = 0.006) and increased indexed end-systolic left ventricular diameters (HR 1.113, 95% CI 1.043 to 1.188, p = 0.001) as independent predictors of progression of MVR. Similarly, mitral valve-related events were independently predicted by a flail mitral leaflet (HR 5.343, 95% CI 2.229 to 12.808, p <0.001), and mild (HR 14.336, 95% CI 1.873 to 109.755, p = 0.01) or moderate (HR 16.849, 95% CI 2.205 to 128.76, p = 0.006) degree of MVR. Conversely, aortic dilatation, dural ectasia, and sporadic mode of inheritance were not associated with outcome. In conclusion, the same clinical determinants that predict outcomes in idiopathic mitral valve prolapse also predict outcomes in mitral valve prolapse associated with Marfan syndrome. PMID:21211604

  17. [Translabial ultrasonography in pelvic floor prolapse and urinary incontinence diagnostics].

    PubMed

    Pietrus, Miłosz; Pityński, Kazimierz; Bałajewicz-Nowak, Marta; Wiecheć, Marcin; Knafel, Anna; Ludwin, Artur; Dziechciowski, Marek; Nocuń, Agnieszka

    2012-09-01

    increasingly frequent in the surgical treatment of pelvic organs prolapse. The remedial kits currently in use are not visible in classic X-ray examinations and CT however, they can be easily visualized by means of a sonographic test. This way it is possible to locate the positioned tapes or meshes and to establish their orientation towards the urethra, the bladder and the anus. It is also possible to observe the complications (e.g. hematomas) following the surgical procedures via the transvaginal access. Transperineal sonography is a relatively inexpensive method that may be performed in almost every ultrasonographic laboratory Its value, approaching the MRI diagnostic value in the assessment of the pelvic floor defects and its low cost, place ultrasonography on the first place among the methods of imaging the pelvic and uro-genital diaphragm. The results of diagnostics of pelvic organs prolapse obtained by placing the sonographic head on the patient's perineum may also help in establishing the changes of the support apparatus for the uterus and the vagina, bladder urethra and perineum during functional testing and, thus, to verify the clinically established degree of the prolapse. It seems, also, that this method may be used during peri-urethral injections of specific substances and post-application follow-up, an increasingly frequently employed method of urinary incontinence treatment. PMID:23342899

  18. Geometric modeling, functional parameter calculation, and visualization of the in-vivo distended rectal wall

    NASA Astrophysics Data System (ADS)

    Haider, Clifton R.; Manduca, Armando; Camp, Jon J.; Fletcher, Joel G.; Robb, Richard A.; Bharucha, Adil E.

    2006-03-01

    The rectum can distend to accommodate stool, and contracts in response to distention during defecation. Rectal motor dysfunctions are implicated in the pathophysiology of functional defecation disorders and fecal incontinence. These rectal motor functions can be studied by intra-luminal measurements of pressure by manometry, or combined with volume during rectal balloon distention. Pressure-volume (p-v) relationships provide a global index of rectal mechanical properties. However, balloon distention alone does not measure luminal radius or wall thickness, which are necessary to compute wall tension and stress respectively. It has been suggested that the elastic modulus, which is the linear slope of the stress-strain relationship, is a more accurate measure of wall stiffness. Also, measurements of compliance may not reflect differences in rectal diameter between subjects prior to inflation, and imaging is necessary to determine if, as has been suggested, rectal pressure-volume relationships are affected by extra-rectal structures. We have developed a technique to measure rectal stress:strain relationships in humans, by simultaneous magnetic resonance imaging (MRI) during rectal balloon distention. After a conditioning distention, a rectal balloon was distended with water from 0 to 400 ml in 50 ml steps, and imaged at each step with MRI. The fluid filled balloon was segmented from each volume, the phase-ordered binary volumes were transformed into a geometric characterization of the inflated rectal surface. Taken together with measurements of balloon pressure and of rectal wall thickness, this model of the rectal surface was used to calculate regional values of curvature, tension, strain, and stress for the rectum. In summary, this technique has the unique ability to non-invasively measure the rectal stress:strain relationship and also determine if rectal expansion is limited by extra-rectal structures. This functional information allows the direct clinical analysis

  19. A Rare Case of Mitral Valve Prolapse in Endomyocardial Fibrosis.

    PubMed

    Xavier, Joseph; Haranal, Maruti Yamanappa; Reddy, Shashidhar Ranga; Suryaprakash, Sharadaprasad

    2016-09-01

    Mitral valve prolapse in endomyocardial fibrosis (EMF) is an unusual entity. Literature search reveals only 1 report of mitral valve prolapse assosiated with EMF. A 32-year-old woman, of African origin, who presented with features of right heart failure, was diagnosed to have mitral valve prolapse of rheumatic origin with severe mitral regurgitation and severe pulmonary hypertension (PAH). Intraoperative findings lead to the diagnosis of EMF. We report this rare case of mitral valve prolapse in EMF, in a geographical area where rheumatic heart disease is endemic, to showcase how a rare manifestation of EMF can be misdiagnosed as that of rheumatic heart disease. PMID:27549547

  20. Lymphangiosarcoma in a 3.5-year-old Bullmastiff bitch with vaginal prolapse, primary lymph node fibrosis and other congenital defects.

    PubMed

    Williams, J H; Birrell, J; Van Wilpe, E

    2005-09-01

    the ventral rectal serosa, and the 'prolapsed' tissue was found to be expanded vaginal wall. The bitch was euthanased and necropsied, Histological examination confirmed lymphangiosarcomatous invasion of the submucosal and muscular layers of the retroperitoneal, traumatised, prolapsed part of the vagina, the urethra and the ventral rectal wall. The broad ligament was diffusely invaded with tumour which had proliferated into the caudal abdominal space, and 3 small intra-trabecular foci of tumour were found in the right popliteal lymph node near the hilus. Mitotic figures were generally scarce. There was mild subcutaneous oedema of the ventral trunk extending from the axillae to the inner proximal thighs, which had not been evident clinically, and the lymph nodes (peripheral more so than internal) microscopically showed marked trabecular and perivascular fibrosis especially in hilar regions. Other congenital defects were hepatic capsular and central venous fibrosis with lymphatic duplication and dilatation in all areas of connective tissue, ventrally-incongruous half-circular tracheal rings, and multifocal renal dysplasia affecting the right kidney. There was locally-extensive subacute pyelonephritis of the left kidney. PMID:16300186

  1. Rectal mucosa in cows' milk allergy.

    PubMed Central

    Iyngkaran, N; Yadav, M; Boey, C G

    1989-01-01

    Eleven infants who were suspected clinically of having cows' milk protein sensitive enteropathy were fed with a protein hydrolysate formula for six to eight weeks, after which they had jejunal and rectal biopsies taken before and 24 hours after challenge with cows' milk protein. When challenged six infants (group 1) developed clinical symptoms and five did not (group 2). In group 1 the lesions developed in both the jejunal mucosa (four infants at 24 hours and one at three days), and the rectal mucosa, and the injury was associated with depletion of alkaline phosphatase activity. Infants in group 2 were normal. It seems that rectal injury that develops as a direct consequence of oral challenge with the protein in reactive infants may be used as one of the measurements to confirm the diagnosis of cows' milk protein sensitive enteropathy. Moreover, ingestion of such food proteins may injure the distal colonic mucosa without affecting the proximal small gut in some infants. PMID:2817945

  2. Chemoradiation of rectal cancer.

    PubMed

    Arrazubi, V; Suárez, J; Novas, P; Pérez-Hoyos, M T; Vera, R; Martínez Del Prado, P

    2013-02-01

    The treatment of locally advanced rectal cancer is a challenge. Surgery, chemotherapy and radiotherapy comprise the multimodal therapy that is administered in most cases. Therefore, a multidisciplinary approach is required. Because this cancer has a high rate of local recurrence, efforts have been made to improve clinical outcomes while minimizing toxicity and maintaining quality of life. Thus, total mesorectal excision technique was developed as the standard surgery, and chemotherapy and radiotherapy have been established as neoadjuvant treatment. Both approaches reduce locoregional relapse. Two neoadjuvant treatments have emerged as standards of care: short-course radiotherapy and long-course chemoradiotherapy with fluoropyrimidines; however, long-course chemoradiotherapy might be more appropriate for low-lying neoplasias, bulky tumours or tumours with near-circumferential margins. If neoadjuvant treatment is not administered and locally advanced stage is demonstrated in surgical specimens, adjuvant chemoradiotherapy is recommended. The addition of chemotherapy to the treatment regimen confers a significant benefit. Adjuvant chemotherapy is widely accepted despite scarce evidence of its benefit. The optimal time for surgery after neoadjuvant therapy, the treatment of low-risk T3N0 neoplasms, the convenience of avoiding radiotherapy in some cases and tailoring treatment to pathological response have been recurrent subjects of debate that warrant more extensive research. Adding new drugs, changing the treatment sequence and selecting the treatment based on prognostic or predictive factors other than stage remain experimental. PMID:23584263

  3. Understanding Minor Rectal Bleeding

    MedlinePlus

    ... fever or significant rectal bleeding. Laser or infrared coagulation and sclerotherapy (injection of medicine directly into the ... or if symptoms persist despite rubber band ligation, coagulation or sclerotherapy. What are anal fissures? Tears that ...

  4. Rectal culture (image)

    MedlinePlus

    A rectal culture test is performed by inserting a cotton swab in the rectum. The swab is rotated gently, and withdrawn. A smear of the swab is placed in culture media to encourage the growth of microorganisms. The ...

  5. Digital rectal exam

    MedlinePlus

    ... Elsevier Saunders; 2012:chap 99. Read More Colon cancer Prostate cancer Update Date 11/1/2015 Updated by: ... Health Topics Anal Disorders Enlarged Prostate (BPH) Prostate Cancer Prostate Cancer Screening Prostate Diseases Rectal Disorders Browse the ...

  6. Rectal strictures following abdominal aortic aneurysm surgery.

    PubMed Central

    Lane, T. M.; Bentley, P. G.

    2000-01-01

    Rectal stricture formation is a rare complication of aortic aneurysm repair. Two case are described here. A combination of hypotension, a compromised internal iliac circulation and poor collateral supply following inferior mesenteric artery ligation can result in acute ischaemic proctitis--an infrequently described clinical entity. Ulceration and necrosis are the sequelae of prolonged ischaemia and fibrous stricture formation may result. One patient responded to dilatation and posterior mid-rectal myotomy; the other failed to respond to conservative measures and eventually had an end colostomy fashioned following intractable symptoms. PMID:11103163

  7. Urethral mucosa prolapse in an 18-year-old adolescent.

    PubMed

    Olumide, Akadiri; Kayode Olusegun, Ajenifuja; Babatola, Bakare

    2013-01-01

    Urethra mucosa prolapse is a benign condition in which there is a circular protrusion of the distal urethra through the external urethra meatus. It is more commonly seen in prepubertal black girls and postmenopausal white women. It is rare in the reproductive age group. This case describes the presentation and management of an 18-year-old adolescent with urethra mucosa prolapse. PMID:24109533

  8. Mitral Valve Prolapse in Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Pueschel, Siegfried M.; Werner, John Christian

    1994-01-01

    Examination of 36 home-reared young adults with Down's syndrome found that 20 had abnormal echocardiographic findings. Thirteen had mitral valve prolapse, three had mitral valve prolapse and aortic insufficiency, two had only aortic insufficiency, and two had other mitral valve disorders. Theories of pathogenesis and relationship to exercise and…

  9. Recognition of Anterior Peritoneal Reflections and Their Relationship With Rectal Tumors Using Rectal Magnetic Resonance Imaging

    PubMed Central

    Yiqun, Sun; Tong, Tong; Fangqi, Liu; Sanjun, Cai; Chao, Xin; Yajia, Gu; Ye, Xu

    2016-01-01

    Abstract Our goal was to explore the factors influencing the visualization of anterior peritoneal reflections (APRs) using rectal MRI. We evaluated the usefulness of rectal MRI in measuring the distance from the anal verge to the APR and determining the relationship between the APR and the rectal tumor. Clinical and imaging data from 319 patients who underwent surgery after MRI examination between October 2010 and December 2013 were retrospectively analyzed. The distance from the anal verge to the APR and the relationship between the APR and the location of the rectal tumor was evaluated. analysis of variance, logistic regression, independent samples t tests, and Kappa tests were used for statistical analysis. The APR was visible in 283 of 319 cases using rectal MRI. The APR was more readily observed in patients who were older than 58 years (P = 0.046), in patients whose subcutaneous fat thicknesses were >22.2 mm (P = 0.004), in patients with nondistended bladders (P = 0.001), and in those with an anteversion of the uterus (P = 0.001). There was a significant difference between the distance from the anal verge to the APR between females (10.4 ± 1.1 cm) and males (10.0 ± 1.2 cm; P = 0.014). The accuracy in predicting tumor location with respect to the APR was 70%, 50%, 98.2%, respectively for patients with tumors located above, at, and below the APR (compared with the location determined during surgery). Most of the APRs were visible using rectal MRI, whereas certain internal factors influence visualization. Rectal MRI could be a useful tool for evaluating the distance from the anal verge to the APR and relationship between rectal tumors and the APR. PMID:26945377

  10. Predictive Biomarkers to Chemoradiation in Locally Advanced Rectal Cancer.

    PubMed

    Conde-Muíño, Raquel; Cuadros, Marta; Zambudio, Natalia; Segura-Jiménez, Inmaculada; Cano, Carlos; Palma, Pablo

    2015-01-01

    There has been a high local recurrence rate in rectal cancer. Besides improvements in surgical techniques, both neoadjuvant short-course radiotherapy and long-course chemoradiation improve oncological results. Approximately 40-60% of rectal cancer patients treated with neoadjuvant chemoradiation achieve some degree of pathologic response. However, there is no effective method of predicting which patients will respond to neoadjuvant treatment. Recent studies have evaluated the potential of genetic biomarkers to predict outcome in locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation. The articles produced by the PubMed search were reviewed for those specifically addressing a genetic profile's ability to predict response to neoadjuvant treatment in rectal cancer. Although tissue gene microarray profiling has led to promising data in cancer, to date, none of the identified signatures or molecular markers in locally advanced rectal cancer has been successfully validated as a diagnostic or prognostic tool applicable to routine clinical practice. PMID:26504848

  11. Predictive Biomarkers to Chemoradiation in Locally Advanced Rectal Cancer

    PubMed Central

    Conde-Muíño, Raquel; Cuadros, Marta; Zambudio, Natalia; Segura-Jiménez, Inmaculada; Cano, Carlos; Palma, Pablo

    2015-01-01

    There has been a high local recurrence rate in rectal cancer. Besides improvements in surgical techniques, both neoadjuvant short-course radiotherapy and long-course chemoradiation improve oncological results. Approximately 40–60% of rectal cancer patients treated with neoadjuvant chemoradiation achieve some degree of pathologic response. However, there is no effective method of predicting which patients will respond to neoadjuvant treatment. Recent studies have evaluated the potential of genetic biomarkers to predict outcome in locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation. The articles produced by the PubMed search were reviewed for those specifically addressing a genetic profile's ability to predict response to neoadjuvant treatment in rectal cancer. Although tissue gene microarray profiling has led to promising data in cancer, to date, none of the identified signatures or molecular markers in locally advanced rectal cancer has been successfully validated as a diagnostic or prognostic tool applicable to routine clinical practice. PMID:26504848

  12. Rectal Microbicide Development

    PubMed Central

    Dezzutti, Charlene

    2014-01-01

    The last few years have seen important progress in demonstrating the efficacy of oral pre-exposure prophylaxis, vaginal microbicides, and treatment as prevention as effective strategies for reducing the risk of acquiring or transmitting HIV infection. There has also been significant progress in the development of rectal microbicides. Preclinical non-human primate studies have demonstrated that antiretroviral microbicides can provide significant protection from rectal challenge with SIV or SHIV. Recent Phase 1 rectal microbicide studies have characterized the safety, acceptability, compartmental pharmacokinetics (PK), and pharmaco-dynamics (PD) of both UC781 and tenofovir gels. The tenofovir gel formulation used in vaginal studies was not well tolerated in the rectum and newer rectal-specific formulations have been developed and evaluated in Phase 1 studies. The PK/PD data generated in these Phase 1 studies may reduce the risk of advancing ineffective candidate rectal microbicides into late stage development. Tenofovir gel is currently poised to move into Phase 2 evaluation and it is possible that a Phase 2B/3 effectiveness study with this product could be initiated in the next 2–3 years. PMID:23612991

  13. Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

    PubMed Central

    Xynos, Evaghelos; Tekkis, Paris; Gouvas, Nikolaos; Vini, Louiza; Chrysou, Evangelia; Tzardi, Maria; Vassiliou, Vassilis; Boukovinas, Ioannis; Agalianos, Christos; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Dervenis, Christos; Emmanouilidis, Christos; Georgiou, Panagiotis; Katopodi, Ourania; Kountourakis, Panteleimon; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pechlivanides, George; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Triantopoulou, Charina; Xynogalos, Spyridon; Karachaliou, Niki; Ziras, Nikolaos; Zoras, Odysseas; Souglakos, John

    2016-01-01

    In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. PMID:27064746

  14. Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO).

    PubMed

    Xynos, Evaghelos; Tekkis, Paris; Gouvas, Nikolaos; Vini, Louiza; Chrysou, Evangelia; Tzardi, Maria; Vassiliou, Vassilis; Boukovinas, Ioannis; Agalianos, Christos; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Dervenis, Christos; Emmanouilidis, Christos; Georgiou, Panagiotis; Katopodi, Ourania; Kountourakis, Panteleimon; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pechlivanides, George; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Triantopoulou, Charina; Xynogalos, Spyridon; Karachaliou, Niki; Ziras, Nikolaos; Zoras, Odysseas; Souglakos, John

    2016-01-01

    In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. PMID:27064746

  15. Variability of Marker-Based Rectal Dose Evaluation in HDR Cervical Brachytherapy

    SciTech Connect

    Wang Zhou; Jaggernauth, Wainwright; Malhotra, Harish K.; Podgorsak, Matthew B.

    2010-01-01

    In film-based intracavitary brachytherapy for cervical cancer, position of the rectal markers may not accurately represent the anterior rectal wall. This study was aimed at analyzing the variability of rectal dose estimation as a result of interfractional variation of marker placement. A cohort of five patients treated with multiple-fraction tandem and ovoid high-dose-rate (HDR) brachytherapy was studied. The cervical os point and the orientation of the applicators were matched among all fractional plans for each patient. Rectal points obtained from all fractions were then input into each clinical treated plan. New fractional rectal doses were obtained and a new cumulative rectal dose for each patient was calculated. The maximum interfractional variation of distances between rectal dose points and the closest source positions was 1.1 cm. The corresponding maximum variability of fractional rectal dose was 65.5%. The percentage difference in cumulative rectal dose estimation for each patient was 5.4%, 19.6%, 34.6%, 23.4%, and 13.9%, respectively. In conclusion, care should be taken when using rectal markers as reference points for estimating rectal dose in HDR cervical brachytherapy. The best estimate of true rectal dose for each fraction should be determined by the most anterior point among all fractions.

  16. High-Volume Transanal Surgery with CPH34 HV for the Treatment of III-IV Degree Haemorrhoids: Final Short-Term Results of an Italian Multicenter Clinical Study

    PubMed Central

    Reboa, Giuliano; Gipponi, Marco; Gallo, Maurizio; Ciotta, Giovanni; Tarantello, Marco; Caviglia, Angelo; Pagliazzo, Antonio; Masoni, Luigi; Caldarelli, Giuseppe; Gaj, Fabio; Masci, Bruno; Verdi, Andrea

    2016-01-01

    The clinical chart of 621 patients with III-IV haemorrhoids undergoing Stapled Hemorrhoidopexy (SH) with CPH34 HV in 2012–2014 was consecutively reviewed to assess its safety and efficacy after at least 12 months of follow-up. Mean volume of prolapsectomy was significantly higher (13.0 mL; SD, 1.4) in larger prolapse (9.3 mL; SD, 1.2) (p < 0.001). Residual or recurrent haemorrhoids occurred in 11 of 621 patients (1.8%) and in 12 of 581 patients (1.9%), respectively. Relapse was correlated with higher preoperative Constipation Scoring System (CSS) (p = 0.000), Pescatori's degree (p = 0.000), Goligher's grade (p = 0.003), prolapse exceeding half of the length of the Circular Anal Dilator (CAD) (p = 0.000), and higher volume of prolapsectomy (p = 0.000). At regression analysis, only the preoperative CSS, Pescatori's degree, Goligher's grade, and volume of resection were significantly predictive of relapse. A high level of satisfaction (VAS = 8.6; SD, 1.0) coupled with a reduction of 12-month CSS (Δ preoperative CSS/12 mo CSS = 3.4, SD, 2.0; p < 0.001) was observed. The wider prolapsectomy achievable with CPH34 HV determined an overall 3.7% relapse rate in patients with high prevalence of large internal rectal prolapse, coupled with high satisfaction index, significant reduction of CSS, and very low complication rates. PMID:26998510

  17. High-Volume Transanal Surgery with CPH34 HV for the Treatment of III-IV Degree Haemorrhoids: Final Short-Term Results of an Italian Multicenter Clinical Study.

    PubMed

    Reboa, Giuliano; Gipponi, Marco; Gallo, Maurizio; Ciotta, Giovanni; Tarantello, Marco; Caviglia, Angelo; Pagliazzo, Antonio; Masoni, Luigi; Caldarelli, Giuseppe; Gaj, Fabio; Masci, Bruno; Verdi, Andrea

    2016-01-01

    The clinical chart of 621 patients with III-IV haemorrhoids undergoing Stapled Hemorrhoidopexy (SH) with CPH34 HV in 2012-2014 was consecutively reviewed to assess its safety and efficacy after at least 12 months of follow-up. Mean volume of prolapsectomy was significantly higher (13.0 mL; SD, 1.4) in larger prolapse (9.3 mL; SD, 1.2) (p < 0.001). Residual or recurrent haemorrhoids occurred in 11 of 621 patients (1.8%) and in 12 of 581 patients (1.9%), respectively. Relapse was correlated with higher preoperative Constipation Scoring System (CSS) (p = 0.000), Pescatori's degree (p = 0.000), Goligher's grade (p = 0.003), prolapse exceeding half of the length of the Circular Anal Dilator (CAD) (p = 0.000), and higher volume of prolapsectomy (p = 0.000). At regression analysis, only the preoperative CSS, Pescatori's degree, Goligher's grade, and volume of resection were significantly predictive of relapse. A high level of satisfaction (VAS = 8.6; SD, 1.0) coupled with a reduction of 12-month CSS (Δ preoperative CSS/12 mo CSS = 3.4, SD, 2.0; p < 0.001) was observed. The wider prolapsectomy achievable with CPH34 HV determined an overall 3.7% relapse rate in patients with high prevalence of large internal rectal prolapse, coupled with high satisfaction index, significant reduction of CSS, and very low complication rates. PMID:26998510

  18. Significance of Paneth Cells in Histologically Unremarkable Rectal Mucosa.

    PubMed

    Pezhouh, Maryam K; Cheng, Edaire; Weinberg, Arthur G; Park, Jason Y

    2016-07-01

    Paneth cell metaplasia of the rectal epithelium is a common histologic finding in patients with chronic inflammatory bowel disease. However, the clinical significance of isolated Paneth cells in otherwise unremarkable rectal mucosa has not been extensively examined. This study examined the frequency and clinical correlates of rectal Paneth cells in 245 biopsies obtained from patients between the ages of 2 weeks to 20 years in a pediatric tertiary care facility from 2010 to 2011. The specimens comprised 193 endoscopic pinch biopsies and 52 rectal suction biopsies. All 245 cases were endoscopically and histologically unremarkable with no prominence of eosinophils, no altered mucosal architecture, and no inflammation. Paneth cells were present in 42 cases (17.1%), which is higher than previous reports. Only 1 of 42 patients with rectal Paneth cells was subsequently diagnosed with Crohn disease. In our study population, the finding of Paneth cells was associated with young age, and the incidence of Paneth cell cases decreased with increasing age (χ=13.69, P=0.0002). Constipation was the most common presenting symptom in patients with rectal Paneth cells and was highly associated with the presence of Paneth cells (odds ratio 4.5, 95% confidence interval: 2.2-9.0). Paneth cells in otherwise unremarkable pediatric rectal biopsies are not rare and frequently occur in common conditions such as idiopathic constipation. PMID:26900817

  19. Frequency of recurrent urinary tract infection in patients with pelvic organ prolapse

    PubMed Central

    Töz, Emrah; Kurt, Sefa; Sahin, Çağdaş; Canda, Mehmet Tunç

    2015-01-01

    Purpose The aim of the study was to investigate the existence of a relationship between pelvic organ prolapse (POP) and recurrent urinary tract infection (UTI). Materials and methods The hospital database was searched for women diagnosed with pelvic floor disorders and all medical records were reviewed for recurrent UTI, diagnosed by two or more positive urine cultures taken within 12 months of each other. The control group was created using one-to-one matching for age and menopausal status. The prevalence of recurrent UTI in these patients were compared. Results The mean age of the 210 participants was 54.64±5.15 years. We found no association between POP and recurrent UTI. In the prolapse group, 22 women (21%) had recurrent UTI compared with 19 women (18%) in the control group (P=0.316). Post-void residual (PVR) volumes >50 mL were associated with increased prevalence of recurrent UTI. Conclusion POP is not a risk factor for recurrent UTI, but women with POP are more likely to have high PVR volumes. High PVR volumes increase the risk of recurrent UTI. Clinical examination and ultrasound assessment of PVR should be performed in all women presenting with prolapse and UTI. Elevated PVR is the most significant risk factor, linking POP with recurrent UTI. PMID:25671221

  20. Prevalence of reproductive tract infections, genital prolapse, and obesity in a rural community in Lebanon.

    PubMed Central

    Deeb, Mary E.; Awwad, Johnny; Yeretzian, Joumana S.; Kaspar, Hanna G.

    2003-01-01

    OBJECTIVE: To determine the prevalence of reproduction-related illnesses in a rural community in Lebanon. METHODS: Data were collected through interviews with women in their homes, physical examinations and history taking by physicians in a clinic in the community, and laboratory tests. A total of 557 ever-married women aged 15-60 years were selected randomly. FINDINGS: Just over half of the sample (268, 50.6%) had five or more children, and (320, 78.9%) of women aged < 45 years were using contraception. The prevalence of reproductive tract infections was very low: six (1.2%) women had sexually transmitted diseases and 47 (9.3%) had endogenous reproductive tract infections. None had chlamydial infection or a positive serological finding of syphilis. None had invasive cervical cancer, and only one had cervical dysplasia. In contrast, genital prolapse and gynaecological morbidity were elevated. Half of the women studied (251, 49.6%) had genital prolapse, and 153 (30.2%) were obese. CONCLUSION: The prevalence of reproductive tract infections in this conservative rural community in east Lebanon was low. Possible explanations include the conservative nature of the community, the high rate of utilization of health care services, and the liberal use of antibiotics without a prescription. More importantly, the study showed an unexpectedly high prevalence of genital prolapse and obesity--a finding that has clear implications for primary health care priorities in such rural communities. PMID:14710505

  1. [Prolapse of the urethra in black girls. Personal experience in 11 cases].

    PubMed

    Falandry, L

    1994-01-01

    The author describes 11 cases of prolapse of the urethral meatus observed in black girls between January 1987 and July 1993 first in Gabon (n = 7) and subsequently in Niger (n = 4). All patients were under the age of 10 years. The revealing symptom was vulvar bleeding (n = 8) or blood in urine (n = 2). In the remaining case prolapse was discovered incidentally. In all cases diagnosis was achieved by physical examination revealing a soft mass that bled on contact. Treatment consisted in surgical resection which was always followed by an uneventful recovery. This experience confirms a predisposition to this uncommon disorder in black children in whom the incidence is probably underestimated. The clinical presentation is consistently the same and the mass can be mistaken for a malignant tumor or for injuries related to sexual abuse. The results of this study demonstrate that the treatment of choice for prolapse of the urethra is surgical resection which is simple, safe, and immediately and lastingly effective. PMID:7934783

  2. Adaptive Image-Guided Radiotherapy (IGRT) Eliminates the Risk of Biochemical Failure Caused by the Bias of Rectal Distension in Prostate Cancer Treatment Planning: Clinical Evidence

    SciTech Connect

    Park, Sean S.; Yan Di; McGrath, Samuel; Dilworth, Joshua T.; Liang Jian; Ye Hong; Krauss, Daniel J.; Martinez, Alvaro A.; Kestin, Larry L.

    2012-07-01

    Purpose: Rectal distension has been shown to decrease the probability of biochemical control. Adaptive image-guided radiotherapy (IGRT) corrects for target position and volume variations, reducing the risk of biochemical failure while yielding acceptable rates of gastrointestinal (GI)/genitourinary (GU) toxicities. Methods and Materials: Between 1998 and 2006, 962 patients were treated with computed tomography (CT)-based offline adaptive IGRT. Patients were stratified into low (n = 400) vs. intermediate/high (n = 562) National Comprehensive Cancer Network (NCCN) risk groups. Target motion was assessed with daily CT during the first week. Electronic portal imaging device (EPID) was used to measure daily setup error. Patient-specific confidence-limited planning target volumes (cl-PTV) were then constructed, reducing the standard PTV and compensating for geometric variation of the target and setup errors. Rectal volume (RV), cross-sectional area (CSA), and rectal volume from the seminal vesicles to the inferior prostate (SVP) were assessed on the planning CT. The impact of these volumetric parameters on 5-year biochemical control (BC) and chronic Grades {>=}2 and 3 GU and GI toxicity were examined. Results: Median follow-up was 5.5 years. Median minimum dose covering cl-PTV was 75.6 Gy. Median values for RV, CSA, and SVP were 82.8 cm{sup 3}, 5.6 cm{sup 2}, and 53.3 cm{sup 3}, respectively. The 5-year BC was 89% for the entire group: 96% for low risk and 83% for intermediate/high risk (p < 0.001). No statistically significant differences in BC were seen with stratification by RV, CSA, and SVP in quartiles. Maximum chronic Grades {>=}2 and 3 GI toxicities were 21.2% and 2.9%, respectively. Respective values for GU toxicities were 15.5% and 4.3%. No differences in GI or GU toxicities were noted when patients were stratified by RV. Conclusions: Incorporation of adaptive IGRT reduces the risk of geometric miss and results in excellent biochemical control that is

  3. Rectal-specific microbicide applicator: evaluation and comparison with a vaginal applicator used rectally.

    PubMed

    Carballo-Diéguez, Alex; Giguere, Rebecca; Dolezal, Curtis; Bauermeister, José; Leu, Cheng-Shiun; Valladares, Juan; Rohan, Lisa C; Anton, Peter A; Cranston, Ross D; Febo, Irma; Mayer, Kenneth; McGowan, Ian

    2014-09-01

    An applicator designed for rectal delivery of microbicides was tested for acceptability by 95 young men who have sex with men, who self-administered 4 mL of placebo gel prior to receptive anal intercourse over 90 days. Subsequently, 24 of the participants self-administered rectally 4 mL of tenofovir or placebo gel over 7 days using a vaginal applicator, and compared both applicators on a Likert scale of 1-10, with 10 the highest rating. Participants reported high likelihood to use either applicator in the future (mean scores 9.3 and 8.8 respectively, p = ns). Those who tested both liked the vaginal applicator significantly more than the rectal applicator (7.8 vs. 5.2, p = 0.003). Improvements in portability, conspicuousness, aesthetics, tip comfort, product assembly and packaging were suggested for both. This rectal-specific applicator was not superior to a vaginal applicator. While likelihood of future use is reportedly high, factors that decrease acceptability may erode product use over time in clinical trials. Further attention is needed to develop user-friendly, quick-acting rectal microbicide delivery systems. PMID:24858481

  4. RECTAL-SPECIFIC MICROBICIDE APPLICATOR: EVALUATION AND COMPARISON WITH A VAGINAL APPLICATOR USED RECTALLY

    PubMed Central

    Carballo-Diéguez, Alex; Giguere, Rebecca; Dolezal, Curtis; Bauermeister, José; Leu, Cheng-Shiun; Valladares, Juan; Rohan, Lisa C.; Anton, Peter A.; Cranston, Ross D.; Febo, Irma; Mayer, Kenneth; McGowan, Ian

    2014-01-01

    An applicator designed for rectal delivery of microbicides was tested for acceptability by 95 young men who have sex with men, who self-administered 4mL of placebo gel prior to receptive anal intercourse over 90 days. Subsequently, 24 of the participants self-administered rectally 4mL of tenofovir or placebo gel over 7 days using a vaginal applicator, and compared both applicators on a Likert scale of 1–10, with 10 the highest rating. Participants reported high likelihood to use either applicator in the future (mean scores 9.3 and 8.8 respectively, p= ns). Those who tested both liked the vaginal applicator significantly more than the rectal applicator (7.8 vs. 5.2, p=0.003). Improvements in portability, conspicuousness, aesthetics, tip comfort, product assembly and packaging were suggested for both. This rectal-specific applicator was not superior to a vaginal applicator. While likelihood of future use is reportedly high, factors that decrease acceptability may erode product use over time in clinical trials. Further attention is needed to develop user-friendly, quick-acting rectal microbicide delivery systems. PMID:24858481

  5. What Are the Signs and Symptoms of Mitral Valve Prolapse?

    MedlinePlus

    ... from the NHLBI on Twitter. What Are the Signs and Symptoms of Mitral Valve Prolapse? Most people ... major mitral valve backflow. When MVP does cause signs and symptoms, they may include: Palpitations (feelings that ...

  6. Rectal wall sparing by dosimetric effect of rectal balloon used during Intensity-Modulated Radiation Therapy (IMRT) for prostate cancer

    SciTech Connect

    Teh, Bin S.

    2005-03-31

    The use of an air-filled rectal balloon has been shown to decrease prostate motion during prostate radiotherapy. However, the perturbation of radiation dose near the air-tissue interfaces has raised clinical concerns of underdosing the prostate gland. The aim of this study was to investigate the dosimetric effects of an air-filled rectal balloon on the rectal wall/mucosa and prostate gland. Clinical rectal toxicity and dose-volume histogram (DVH) were also assessed to evaluate for any correlation. A film phantom was constructed to simulate the 4-cm diameter air cavity created by a rectal balloon. Kodak XV2 films were utilized to measure and compare dose distribution with and without air cavity. To study the effect in a typical clinical situation, the phantom was computed tomography (CT) scanned on a Siemens DR CT scanner for intensity-modulated radiation therapy (IMRT) treatment planning. A target object was drawn on the phantom CT images to simulate the treatment of prostate cancer. Because patients were treated in prone position, the air cavity was situated superiorly to the target. The treatment used a serial tomotherapy technique with the Multivane Intensity Modulating Collimator (MIMiC) in arc treatment mode. Rectal toxicity was assessed in 116 patients treated with IMRT to a mean dose of 76 Gy over 35 fractions (2.17-Gy fraction size). They were treated in the prone position, immobilized using a Vac-LokTM bag and carrier-box system. Rectal balloon inflated with 100 cc of air was used for prostate gland immobilization during daily treatment. Rectal toxicity was assessed using modifications of the Radiation Therapy Oncology Group (RTOG) and late effects Normal Tissue Task Force (LENT) scales systems. DVH of the rectum was also evaluated. From film dosimetry, there was a dose reduction at the distal air-tissue interface as much as 60% compared with the same geometry without the air cavity for 15-MV photon beam and 2 x 2-cm field size. The dose beyond the

  7. Pelvic Organ Prolapse---Vaginal and Laparoscopic Mesh: The Evidence.

    PubMed

    Richter, Lee A; Sokol, Andrew I

    2016-03-01

    This report summarizes the current literature on abdominal, laparoscopic, and transvaginal mesh for the treatment of pelvic organ prolapse. This article reviews objective and subjective cure rates as well as complications associated with synthetic mesh use for pelvic organ prolapse repair. The focus is on the latest literature that provides evidence for when synthetic mesh use is most appropriate. The use of mesh for the repair of urinary incontinence is not reviewed in this article. PMID:26880510

  8. Spontaneous Postmenopausal Urethral Prolapse Treated Surgically and Successfully

    PubMed Central

    Klein, I.; Dekel, Y.; Stein, A.

    2014-01-01

    Urethral prolapse (UP) is a circular complete eversion of the distal urethral mucosa through the external meatus. It is a rare condition seen mostly in African-American premenarcheal girls. Both a medical and a surgical approach to this condition have been described. We present a case of a spontaneous urethral prolapse in a 60-year-old postmenopausal Caucasian woman, who failed medical management and underwent successful surgical management. The patient is asymptomatic 18 months following the procedure. PMID:25140273

  9. Clinical management of constipation.

    PubMed

    Lennard-Jones, J E

    1993-10-01

    First, it is important to find out whether the patient is complaining of infrequent defaecation, excessive straining at defaecation, abdominal pain or bloating, a general sense of malaise attributed to constipation, soiling, or a combination of more than one symptom. Second, one must decide if there is a definable abnormality as a cause of the symptom(s). Is the colon apparently normal or is its lumen widened (megacolon)? Is the upper gut normal or is there evidence of neuropathy or myopathy? Is the ano-rectum normal or is there evidence of a weak pelvic floor, mucosal prolapse, major rectocele, an internal intussusception or solitary rectal ulcer? Is there any systemic component such as hypothyroidism, hypercalcaemia, neurological or psychiatric disorder or relevant drug therapy? Choice of treatment will depend on this clinical evaluation. The range of treatments available is: Reassurance and stop current treatment: Patients with a bowel obsession may take laxatives or rectal preparations regularly without need. Increase dietary fibre: Most cases of 'simple' constipation respond to increased dietary fibre, possibly with an added supplement of natural bran. Toilet training and altered routine of life: Young people particularly may need to recognise the call to stool and alter their daily routine to permit and encourage regular defaecation. Medicinal bulking agent: Ispaghula, methyl cellulose, concentrated wheat germ or bran, and similar preparations are useful when patients with a normal colon find it difficult to take adequate dietary fibre. These preparations increase the bulk of stool and soften its consistency. They may be useful for those patients with the constipated form of irritable bowel syndrome.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8234432

  10. [Posterior genital prolapse following the Burch method of colposuspension].

    PubMed

    Flores Rosas, S; Flores Carreras, O; Cabrera Jacome, R

    1999-10-01

    The aim of this paper was to know the prevalence of genital prolapse after the Burch procedure. Also to intend knowing if the associate surgery for vaginal relaxation used in our Urogynecologic Service is working well. Seventy four patients with more than six months after the Burch procedure were addressed from October 1995 to January 1996. Special attention was put to detect pelvis floor defects in specific vaginal sites (urethra, bladder, vaginal ápex, cul de sac and distal posterior wall). The prevalence of urethrocele was 2.7%, cystocele 50.6%, almost of all were mild. None severe cystocele was detected. Cervical prolapse was present in 21.3%, vault prolapse in 9.3% and enterocele 41.9%. The posterior colporraphy seems to be useful to prevent the vault prolapse and the enterocele. On the contrary the Moschowitz procedure seems not to be useful in this aspect. In order to diminish the prevalence of genital prolapse posterior to Burch procedure it would be better to improve the preoperative vaginal examination in order to do segmentary prolapse diagnosis and also to stablish an individualized surgical treatment of them. PMID:10582398

  11. [Nursing care in the initial phases of pelvic floor prolapse].

    PubMed

    Hernández-González, Ana Maria

    2008-01-01

    Uterine prolapse consists of a falling or sliding of the uterus from its normal position in the pelvic cavity inside the vagina and is one of the most frequent alterations secondary to pelvic floor dysfunction in gynecology consultations. Although patients are reluctant to talk about this sensitive issue, they complain of feeling a lump in their genitals, urinary incontinence, and problems in their sexual relations. In fact, uterine prolapse is not a disease but an alteration of the elements suspending and containing the uterus, which are almost always injured by pregnancy and childbirth. Other causes in addition to trauma of the endopelvic fascia (mainly cardinal and uterosacral ligaments) are injuries or relaxations of the pelvic floor (the muscles lifting the anus and the fascia that covers the bladder, vagina and rectum). Causes of uterine prolapse without obstetric antecedents are usually those that involve an increase in abdominal pressure and respiratory diseases causing severe coughing. The incidence of uterine prolapse is highest in multiparous women, with prolonged deliveries, a long second stage involving marked straining, in forceps deliveries and in women with perineal tears. Nursing care is essential, both in the prevention and the detection of prolapse, so that women can express their needs without fear and are aware of the need for appropriate treatment in the incipient stages of prolapse. PMID:19080886

  12. Myxomatous Mitral Valve with Prolapse and Flail Scallop

    PubMed Central

    Fan, Jerry; Timbrook, Alexa; Said, Sarmad; Babar, Kamran; Teleb, Mohamed; Mukherjee, Debabrata; Abbas, Aamer

    2016-01-01

    Summary Background Myxomatous mitral valve with prolapse are classically seen with abnormal leaflet apposition during contraction of the heart. Hemodynamic disorders can result from eccentric mitral regurgitation usually caused by chordae tendinae rupture or papillary muscle dysfunction. Echocardiography is the gold standard for evaluation of leaflet flail and prolapse due to high sensitivity and specificity. Though most mitral valve prolapse are asymptomatic those that cause severe regurgitation need emergent surgical intervention to prevent disease progression. Case Report We report a 54 year old Hispanic male who presented with progressively worsening dyspnea and palpitations. Initial evaluation was significant for atrial fibrillation on electrocardiogram with subsequent echocardiography revealing myxomatous mitral valve with prolapse. Following surgical repair of the mitral valve, the dyspnea and palpitations resolved. Conclusions Mitral valve prolapse is a common valvular abnormality but the pathogenic cause of myxomatous valves has not been elucidated. Several theories describe multiple superfamilies of proteins to be involved in the process. Proper identification of these severe mitral regurgitation due to these disease valves will help relieve symptomatic mitral valve prolapse patients. PMID:27279924

  13. Pelvic Organ Prolapse-Associated Cystitis.

    PubMed

    Hamid, Rizwan; Losco, Giovanni

    2014-01-01

    Pelvic organ prolapse (POP) and urinary tract infection (UTI) are important problems, estimated to affect around 14 and 40 % of women, respectively, at some point in their lives. Positive urine culture in the presence of symptoms is the cornerstone of diagnosis of UTI and should be performed along with ultrasound assessment of postvoid residual (PVR) in all women presenting with POP and UTI. PVR over 30 mL is an independent risk factor for UTI, although no specific association with POP and UTI has been demonstrated. The use of prophylactic antibiotics remains controversial. The major risk factors for postoperative UTI are postoperative catheterisation, prolonged catheterisation, previous recurrent UTI and an increased urethro-anal distance-suggesting that global pelvic floor dysfunction may play a role. PMID:25170365

  14. Piezogenic Pedal Papules with Mitral Valve Prolapse.

    PubMed

    Altin, Cihan; Askin, Ulku; Gezmis, Esin; Muderrisoglu, Haldun

    2016-01-01

    Piezogenic pedal papules (PPP) are herniations of subcutaneous adipose tissue into the dermis. PPP are skin-colored to yellowish papules and nodules on lateral surfaces of feet that typically become apparent when the patient stands flat on his/her feet. Some connective tissue diseases and syndromes have been reported in association with PPP. Mitral valve prolapse (MVP) is a myxomatous degeneration of the mitral valve, characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. MVP may be isolated or part of a heritable connective tissue disorder. PPP, which is generally considered as an isolated lesion, might be also a predictor of some cardiac diseases associated with connective tissue abnormalities such as MVP. A detailed systemic investigation including cardiac examination should be done in patients with PPP. Since in the literature, there are no case reports of association of PPP with MVP, we report these cases. PMID:27057041

  15. Piezogenic Pedal Papules with Mitral Valve Prolapse

    PubMed Central

    Altin, Cihan; Askin, Ulku; Gezmis, Esin; Muderrisoglu, Haldun

    2016-01-01

    Piezogenic pedal papules (PPP) are herniations of subcutaneous adipose tissue into the dermis. PPP are skin-colored to yellowish papules and nodules on lateral surfaces of feet that typically become apparent when the patient stands flat on his/her feet. Some connective tissue diseases and syndromes have been reported in association with PPP. Mitral valve prolapse (MVP) is a myxomatous degeneration of the mitral valve, characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. MVP may be isolated or part of a heritable connective tissue disorder. PPP, which is generally considered as an isolated lesion, might be also a predictor of some cardiac diseases associated with connective tissue abnormalities such as MVP. A detailed systemic investigation including cardiac examination should be done in patients with PPP. Since in the literature, there are no case reports of association of PPP with MVP, we report these cases. PMID:27057041

  16. Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

    PubMed Central

    Mettler, Liselotte; Peters, Goentje; Noé, Günter; Holthaus, Bernd; Jonat, Walter; Schollmeyer, Thoralf

    2014-01-01

    Background and Objectives: Today, laparoscopic intrafascial hysterectomy and laparoscopic supracervical hysterectomy are well-accepted techniques. With our multimodal concept of laparoscopic hysterectomy for benign indications, preservation of the pelvic floor as well as reconstruction of pelvic floor structures and pre-existing prolapse situations can be achieved. Methods: The multimodal concept consists of 3 steps: Intrafascial hysterectomy with preservation of existing structures Technique 1: Primary uterine artery ligationTechnique 2: Classic intrafascial hysterectomyA technique for the stable fixation of the vaginal or cervical stumpA new method of pectopexy to correct a pre-existing descensus situation Results and Conclustion: This well-balanced concept can be used by advanced endoscopic gynecologic surgeons as well as by novices in our field. PMID:24680150

  17. A randomized trial of prophylactic uterosacral ligament suspension at the time of hysterectomy for Prevention of Vaginal Vault Prolapse (PULS): design and methods.

    PubMed

    Alperin, Marianna; Weinstein, Milena; Kivnick, Seth; Duong, Thinh H; Menefee, Shawn

    2013-07-01

    The primary aim of this randomized trial is to evaluate whether a standardized uterosacral ligament suspension colpopexy (USLSC), added to a planned hysterectomy for an indication other than pelvic organ prolapse (POP), decreases the rate of subsequent vaginal vault prolapse in women without preoperative symptomatic POP. Secondary aims include comparison of perioperative complications, urinary, bowel and sexual functions between subjects with and without concomitant USLSC. If shown to be beneficial, the cost-effectiveness of prophylactic USLSC at the time of hysterectomy will be evaluated. This trial will be performed at 4 centers across the United States. The data will be analyzed by the data-coordinating center of the Southern California Kaiser Permanente. Standardized questionnaires and objective measurements will be obtained. The patients and providers performing assessments are masked to treatment assignment. The primary outcome, defined as absence of POP at/distal to the hymen on Pelvic Organ Prolapse Quantitative examination, will be determined 12 months post-operatively. Secondary outcomes include: no prolapse symptoms by questionnaires, and no treatment for POP besides the prophylactic study intervention. Additional follow-up occurs annually for a total of 5 years. Accrual is projected to take 3 years. Given cost and morbidity of surgical repair of post-hysterectomy prolapse, preventive strategies are of outmost importance. The risks and benefits of prophylactic USLSC have never been studied prospectively. This trial is designed to determine if USLSC is an appropriate clinical adjunct at the time of hysterectomy, with subsequent reduction of symptomatic POP. PMID:23587538

  18. Butyrylated starch intake can prevent red meat-induced O6-methyl-2-deoxyguanosine adducts in human rectal tissue: a randomised clinical trial.

    PubMed

    Le Leu, Richard K; Winter, Jean M; Christophersen, Claus T; Young, Graeme P; Humphreys, Karen J; Hu, Ying; Gratz, Silvia W; Miller, Rosalind B; Topping, David L; Bird, Anthony R; Conlon, Michael A

    2015-07-01

    Epidemiological studies have identified increased colorectal cancer (CRC) risk with high red meat (HRM) intakes, whereas dietary fibre intake appears to be protective. In the present study, we examined whether a HRM diet increased rectal O(6)-methyl-2-deoxyguanosine (O(6)MeG) adduct levels in healthy human subjects, and whether butyrylated high-amylose maize starch (HAMSB) was protective. A group of twenty-three individuals consumed 300 g/d of cooked red meat without (HRM diet) or with 40 g/d of HAMSB (HRM+HAMSB diet) over 4-week periods separated by a 4-week washout in a randomised cross-over design. Stool and rectal biopsy samples were collected for biochemical, microbial and immunohistochemical analyses at baseline and at the end of each 4-week intervention period. The HRM diet increased rectal O(6)MeG adducts relative to its baseline by 21% (P < 0.01), whereas the addition of HAMSB to the HRM diet prevented this increase. Epithelial proliferation increased with both the HRM (P < 0.001) and HRM + HAMSB (P < 0.05) diets when compared with their respective baseline levels, but was lower following the HRM + HAMSB diet compared with the HRM diet (P < 0.05). Relative to its baseline, the HRM + HAMSB diet increased the excretion of SCFA by over 20% (P < 0.05) and increased the absolute abundances of the Clostridium coccoides group (P < 0.05), the Clostridium leptum group (P < 0.05), Lactobacillus spp. (P < 0.01), Parabacteroides distasonis (P < 0.001) and Ruminococcus bromii (P < 0.05), but lowered Ruminococcus torques (P < 0.05) and the proportions of Ruminococcus gnavus, Ruminococcus torques and Escherichia coli (P < 0.01). HRM consumption could increase the risk of CRC through increased formation of colorectal epithelial O(6)MeG adducts. HAMSB consumption prevented red meat-induced adduct formation, which may be associated with increased stool SCFA levels and/or changes in the microbiota composition. PMID:26084032

  19. Systematic review and metaanalysis of genetic association studies of urinary symptoms and prolapse in women

    PubMed Central

    Cartwright, Rufus; Kirby, Anna C.; Tikkinen, Kari A.O.; Mangera, Altaf; Thiagamoorthy, Gans; Rajan, Prabhakar; Pesonen, Jori; Ambrose, Chris; Gonzalez-Maffe, Juan; Bennett, Phillip; Palmer, Tom; Walley, Andrew; Järvelin, Marjo-Riitta; Chapple, Chris; Khullar, Vik

    2015-01-01

    Objective Family studies and twin studies demonstrate that lower urinary tract symptoms and pelvic organ prolapse are heritable. This review aimed to identify genetic polymorphisms tested for an association with lower urinary tract symptoms or prolapse, and to assess the strength, consistency, and risk of bias among reported associations. Study Design PubMed and HuGE Navigator were searched up to May 1, 2014, using a combination of genetic and phenotype key words, including “nocturia,” “incontinence,” “overactive bladder,” “prolapse,” and “enuresis.” Major genetics, urology, and gynecology conference abstracts were searched from 2005 through 2013. We screened 889 abstracts, and retrieved 78 full texts. In all, 27 published and 7 unpublished studies provided data on polymorphisms in or near 32 different genes. Fixed and random effects metaanalyses were conducted using codominant models of inheritance. We assessed the credibility of pooled associations using the interim Venice criteria. Results In pooled analysis, the rs4994 polymorphism of the ADRB3 gene was associated with overactive bladder (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7–3.6; n = 419). The rs1800012 polymorphism of the COL1A1 gene was associated with prolapse (OR, 1.3; 95% CI, 1.0–1.7; n = 838) and stress urinary incontinence (OR, 2.1; 95% CI, 1.4–3.2; n = 190). Other metaanalyses, including those for polymorphisms of COL3A1,LAMC1,MMP1,MMP3, and MMP9 did not show significant effects. Many studies were at high risk of bias from genotyping error or population stratification. Conclusion These metaanalyses provide moderate epidemiological credibility for associations of variation in ADRB3 with overactive bladder, and variation of COL1A1 with prolapse. Clinical testing for any of these polymorphisms cannot be recommended based on current evidence. PMID:25111588

  20. Postoperative rectal anastomotic complications.

    PubMed

    Polanecky, O; Adamek, S; Sedy, J; Skorepa, J; Hladik, P; Smejkal, M; Pafko, P; Lischke, R

    2014-01-01

    Colorectal cancer represents the most common tumour of the gastrointestinal tract and the second most common tumour in men as well as women. The trend of increasing incidence of colorectal cancer is alerting. We undertook a retrospective study on 588 patients with rectal cancer and operated by rectal resection with anastomosis between the years 2002-2012. In our sample, we observed 54 (9.2 %) cases of anastomosis insufficiencies requiring reoperation. Out of 54 insufficient anastomoses, 36 (66 %) were in the lower two thirds of the rectum and only 18 (34 %) in the oral one. Although we have observed similar occurrences of anastomosis insufficiency in both groups - classical vs. staple suture (9.5 % and 9.0 %, respectively), the majority of stapler anastomoses (94 %) were made in the aboral part of the rectum. However, we can state that a majority of authors prefer the staple anastomosis as the one with lowest risk, mainly in the distal region of anastomosis. The high ligation of inferior mesenteric artery was performed in 182 (31 %) patients; out of these, we observed anastomosis insufficiency in 12 cases (22 %), which is exactly similar to that in the group of patients without high ligation of the inferior mesenteric artery. We did not observe the use of antibiotics in therapeutical doses as a positive factor for anastomosis insufficiencies, and neither was oncological therapy observed as a risk factor. In our group of patients we agreed that age, level of anastomosis and corticosteroids are high-risk factors. The purpose of these reports, is for the sake of future to share and reference our experiences with cases of rectal and rectosigmoideal resection over the last 11 years. We consider it important to reference our results, especially the risk factors regarding the healing of rectal anastomosis, because anastomotic healing is a surgical problem with potentially deadly consequences for patients (Tab. 4, Ref. 24). PMID:25520228

  1. [Laparoscopic rectal resection technique].

    PubMed

    Anthuber, M; Kriening, B; Schrempf, M; Geißler, B; Märkl, B; Rüth, S

    2016-07-01

    The quality of radical oncological operations for patients with rectal cancer determines the rate of local recurrence and long-term survival. Neoadjuvant chemoradiotherapy for locally advanced tumors, a standardized surgical procedure for rectal tumors less than 12 cm from the anus with total mesorectal excision (TME) and preservation of the autonomous nerve system for sexual and bladder function have significantly improved the oncological results and quality of life of patients. The TME procedure for rectal resection has been performed laparoscopically in Germany for almost 20 years; however, no reliable data are available on the frequency of laparoscopic procedures in rectal cancer patients in Germany. The rate of minimally invasive procedures is estimated to be less than 20 %. A prerequisite for using the laparoscopic approach is implicit adherence to the described standards of open surgery. Available data from prospective randomized trials, systematic reviews and meta-analyses indicate that in the early postoperative phase the generally well-known positive effects of the minimally invasive approach to the benefit of patients can be realized without any long-term negative impact on the oncological results; however, the results of many of these studies are difficult to interpret because it could not be confirmed whether the hospitals and surgeons involved had successfully completed the learning curve. In this article we would like to present our technique, which we have developed over the past 17 years in more than 1000 patients. Based on our experiences the laparoscopic approach can be highly recommended as a suitable alternative to the open procedure. PMID:27277556

  2. Multicentric neurofibromatosis with rectal prolapse in a California sea lion (Zalophus californianus).

    PubMed

    Rush, Elizabeth M; Ogburn, Anna L; Garner, Michael M

    2012-03-01

    An approximately 31-yr-old California sea lion (Zalophus californianus) with a history of chronic visual impairment and corneal disease presented with slow onset, progressive neurologic deficits. Treatment for rear flipper paresis was not effective and the animal was euthanatized. Histopathologic findings included hepatocellular and biliary neoplasia, ocular amyloidosis, adrenal adenoma and pheochromocytoma, and spinal cord changes consistent with multicentric neurofibromatosis. This is the first documentation of these conditions in a California sea lion. PMID:22448517

  3. A Phase II Trial of Neoadjuvant Preoperative Chemoradiotherapy With S-1 Plus Irinotecan and Radiation in Patients With Locally Advanced Rectal Cancer: Clinical Feasibility and Response Rate

    SciTech Connect

    Sato, Takeo; Ozawa, Heita; Hatate, Kazuhiko; Onosato, Wataru; Naito, Masanori; Nakamura, Takatoshi; Ihara, Atsushi; Koizumi, Wasaburo; Hayakawa, Kazushige; Okayasu, Isao; Yamashita, Keishi; Watanabe, Masahiko

    2011-03-01

    Purpose: We aimed to validate our hypothesis that a preoperative chemoradiotherapy regimen with S-1 plus irinotecan is feasible, safe, and active for the management of locally advanced rectal cancer in a single-arm Phase II setting. Methods and Materials: Eligible patients had previously untreated, locally advanced rectal adenocarcinoma. Radiotherapy was administered in fractions of 1.8Gy/d for 25 days. S-1 was administered orally in a fixed daily dose of 80mg/m{sup 2} on Days 1 to 5, 8 to 12, 22 to 26, and 29 to 33. Irinotecan (80mg/m{sup 2}) was infused on Days 1, 8, 22, and 29. Four or more weeks after the completion of the treatment, total mesorectal excision with lateral lymph node dissection was performed. The primary endpoint was the rate of completing treatment in terms of feasibility. The secondary endpoints were the response rate and safety. Results: We enrolled 43 men and 24 women in the study. The number of patients who completed treatment was 58 (86.6%). Overall, 46 patients (68.7%) responded to treatment and 24 (34.7%) had a complete histopathologic response. Three patients had Grade 3 leukopenia, and another three patients had Grade 3 neutropenia. Diarrhea was the most common type of nonhematologic toxicity: 3 patients had Grade 3 diarrhea. Conclusions: A preoperative regimen of S-1, irinotecan, and radiotherapy to the rectum was feasible, and it appeared safe and effective in this nonrandomized Phase II setting. It exhibited a low incidence of adverse events, a high rate of completion of treatment, and an extremely high rate of pathologic complete response.

  4. Rectal Douching and Implications for Rectal Microbicides among Populations Vulnerable to HIV in South America: A Qualitative Study

    PubMed Central

    Galea, Jerome T.; Kinsler, Janni J.; Imrie, John; Nureña, César R.; Sánchez, Jorge; Cunningham, William E.

    2014-01-01

    Objective While gel-formulated Rectal Microbicides (RM) are the first to enter clinical trials, rectal douching in preparation for anal intercourse is a common practise, thus RMs formulated as douches may be a convenient alternative to gels. Nonetheless, little is known about potential users’ thoughts regarding douche-formulated RMs or rectal douching practises, data needed to inform the advancement of douche-based RMs. This qualitative study examined thoughts regarding douches, their use as a RM and current douching practises among men who have sex with men and transgender women. Methods Ten focus groups and 36 in-depth interviews were conducted (N=140) to examine the overall acceptability of RM, of which one component focused on rectal douching. Focus groups and interviews were recorded, transcribed verbatim and coded; text relating to rectal douching was extracted and analysed. Sociodemographic information was collected using a self-administered questionnaire. Results Support for a douche-formulated RM centred on the possibility of combined pre-coital hygiene and HIV protection, and it was believed that a deeply-penetrating liquid douche would confer greater HIV protection than a gel. Drawbacks included rectal dryness; impracticality and portability issues; and, potential side effects. Non-commercial douching apparatus use was common and liquids used included detergents, vinegar, bleach, lemon juice and alcohol. Conclusions A douche-formulated RM while desirable and perceived as more effective than a gel-formulated RM also generated questions regarding practicality and side-effects. Of immediate concern were the non-commercial liquids already being used which likely damage rectal epithelia, potentially increasing HIV infection risk. Pre-coital rectal douching is common and a RM formulated as such is desirable, but education on rectal douching practices is needed now. PMID:23966338

  5. Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children

    PubMed Central

    Sharif, Mohammad Reza; Haji Rezaei, Mostafa; Aalinezhad, Marzieh; Sarami, Golbahareh; Rangraz, Masoud

    2016-01-01

    Background Fever is the most common complaint in pediatric medicine and its treatment is recommended in some situations. Paracetamol is the most common antipyretic drug, which has serious side effects such as toxicity along with its positive effects. Diclofenac is one of the strongest non-steroidal anti-inflammatory (NSAID) drugs, which has received little attention as an antipyretic drug. Objectives This study was designed to compare the antipyretic effectiveness of the rectal form of Paracetamol and Diclofenac. Patients and Methods This double-blind controlled clinical trial was conducted on 80 children aged six months to six years old. One group was treated with rectal Paracetamol suppositories at 15 mg/kg dose and the other group received Diclofenac at 1 mg/kg by rectal administration (n = 40). Rectal temperature was measured before and one hour after the intervention. Temperature changes in the two groups were compared. Results The average rectal temperature in the Paracetamol group was 39.6 ± 1.13°C, and 39.82 ± 1.07°C in the Diclofenac group (P = 0.37). The average rectal temperature, one hour after the intervention, in the Paracetamol and the Diclofenac group was 38.39 ± 0.89°C and 38.95 ± 1.09°C, respectively (P = 0.02). Average temperature changes were 0.65 ± 0.17°C in the Paracetamol group and 1.73 ± 0.69°C in the Diclofenac group (P < 0.001). Conclusions In the first one hour, Diclofenac suppository is able to control the fever more efficient than Paracetamol suppositories. PMID:26889398

  6. An analysis of survival and treatment failure following abdominoperineal and sphincter-saving resection in Dukes' B and C rectal carcinoma. A report of the NSABP clinical trials. National Surgical Adjuvant Breast and Bowel Project.

    PubMed Central

    Wolmark, N; Fisher, B

    1986-01-01

    Abdominoperineal resections for rectal carcinoma are being performed with decreasing frequency in favor of sphincter-saving resections. It remains, however, to be unequivocally demonstrated that sphincter preservation has not resulted in compromised local disease control, disease-free survival, and survival. Accordingly, it is the specific aim of this endeavor to compare local recurrence, disease-free survival, and survival in patients with Dukes' B and C rectal cancer undergoing curative abdominoperineal resection or sphincter-saving resection. For the purpose of this study, 232 patients undergoing abdominoperineal resection and 181 subjected to sphincter-saving resections were available for analysis from an NSABP randomized prospective clinical trial designed to ascertain the efficacy of adjuvant therapy in rectal carcinoma (protocol R-01). The mean time on study was 48 months. Analyses were carried out comparing the two operations according to Dukes' class, the number of positive nodes, and tumor size. The only significant differences in disease-free survival and survival were observed for the cohort characterized by greater than 4 positive nodes and were in favor of patients treated with sphincter-saving resections. A patient undergoing sphincter-saving resection was 0.62 times as likely to sustain a treatment failure as a similar patient undergoing abdominoperineal resection (p = 0.07) and 0.49 times as likely to die (p = 0.02). The inability to demonstrate an attenuated disease-free survival and survival for patients treated with sphincter-saving resection was in spite of an increased incidence of local recurrence (anastomotic and pelvic) observed for the latter operation when compared to abdominoperineal resection (13% vs. 5%). A similar analysis evaluating the length of margins of resection in patients undergoing sphincter-preserving operations indicated that treatment failure and survival were not significantly different in patients whose distal resection

  7. Irinotecan and radiosensitization in rectal cancer.

    PubMed

    Illum, Henrik

    2011-04-01

    Neoadjuvant radiation therapy with concurrent 5-fluorouracil-based chemotherapy is currently considered the standard of care for locally advanced rectal cancer. Pathologically complete response is a desirable outcome and has been associated with increased disease-free survival. There is a need to improve on this approach given that only approximately 10% achieve a pathologically complete response. Irinotecan has an established role in the treatment of metastatic rectal cancer. Both in-vitro and in-vivo data have shown promising radiosensitization properties. This study provides an overview of the published clinical trials evaluating the role of irinotecan as a radiosensitizer in the management of locally advanced rectal cancer. Although early-phase clinical trials initially showed promising results, this did not translate into improved outcome in a larger randomized phase II trial. Increased topoisomerase I expression has recently been identified as a possible predictive marker for improved response to irinotecan-based radiosensitization. This finding could help identify a subset of patients more likely to benefit from the addition of irinotecan in future trials. PMID:21160419

  8. Successful resolution of a preputial prolapse in an alpaca using medical therapy

    PubMed Central

    Koziol, Jennifer H.; Edmondson, Misty A.; Wolfe, Dwight F.; Bayne, Jenna E.

    2015-01-01

    A 2-year-old intact male alpaca was presented for a post-breeding preputial prolapse of 5 days duration. The internal lamina of the prepuce was prolapsed approximately 6 cm and the exposed preputial epithelium was edematous and necrotic. Following 7 days of medical treatment, resolution of the preputial prolapse was achieved. PMID:26130840

  9. Successful resolution of a preputial prolapse in an alpaca using medical therapy.

    PubMed

    Koziol, Jennifer H; Edmondson, Misty A; Wolfe, Dwight F; Bayne, Jenna E

    2015-07-01

    A 2-year-old intact male alpaca was presented for a post-breeding preputial prolapse of 5 days duration. The internal lamina of the prepuce was prolapsed approximately 6 cm and the exposed preputial epithelium was edematous and necrotic. Following 7 days of medical treatment, resolution of the preputial prolapse was achieved. PMID:26130840

  10. Prostatic carcinoma: rectal bleeding after radiation therapy

    SciTech Connect

    Kagan, A.R.; Steckel, R.J.

    1981-06-01

    A 64-year-old man had a prostatic nodule on routine physical examination; per-rectal needle biopsies revealed a single focus of well differentiated adenocarcinoma. The patient had no history of urinary obstruction or of bowel difficulties. Accordingly, this was clinical stage II carcinoma of the prostate. The patient chose to receive external radiation therapy and was given small-field rotational treatment to a dose of 7000 rad (70 Gy) at a rate of 800 rad (8 Gy) weekly. Late in treatment, he experienced transitory diarrhea with flatulence, but this cleared with completion of treatment. Twenty months later he began to note frequent soft bowel movements, occasionally with red blood. At sigmoidoscopy 24 months after completion of treatment, the rectal mucosa was noted to be friable with minimal bleeding, presumably the result of radiation proctitis.

  11. Comparison of Digital Rectal and Microchip Transponder Thermometry in Ferrets (Mustela putorius furo).

    PubMed

    Maxwell, Branden M; Brunell, Marla K; Olsen, Cara H; Bentzel, David E

    2016-01-01

    Body temperature is a common physiologic parameter measured in both clinical and research settings, with rectal thermometry being implied as the 'gold standard.' However, rectal thermometry usually requires physical or chemical restraint, potentially causing falsely elevated readings due to animal stress. A less stressful method may eliminate this confounding variable. The current study compared 2 types of digital rectal thermometers-a calibrated digital thermometer and a common digital thermometer-with an implantable subcutaneous transponder microchip. Microchips were implanted subcutaneously between the shoulder blades of 16 ferrets (8 male, 8 female), and temperatures were measured twice from the microchip reader and once from each of the rectal thermometers. Results demonstrated the microchip temperature readings had very good to good correlation and agreement to those from both of the rectal thermometers. This study indicates that implantable temperature-sensing microchips are a reliable alternative to rectal thermometry for monitoring body temperature in ferrets. PMID:27177569

  12. MicroRNA in rectal cancer

    PubMed Central

    Azizian, Azadeh; Gruber, Jens; Ghadimi, B Michael; Gaedcke, Jochen

    2016-01-01

    In rectal cancer, one of the most common cancers worldwide, the proper staging of the disease determines the subsequent therapy. For those with locally advanced rectal cancer, a neoadjuvant chemoradiotherapy (CRT) is recommended before any surgery. However, response to CRT ranges from complete response (responders) to complete resistance (non-responders). To date we are not able to separate in advance the first group from the second, due to the absence of a valid biomarker. Therefore all patients receive the same therapy regardless of whether they reap benefits. On the other hand almost all patients receive a surgical resection after the CRT, although a watch-and-wait procedure or an endoscopic resection might be sufficient for those who responded well to the CRT. Being highly conserved regulators of gene expression, microRNAs (miRNAs) seem to be promising candidates for biomarkers. Many studies have been analyzing the miRNAs expressed in rectal cancer tissue to determine a specific miRNA profile for the ailment. Unfortunately, there is only a small overlap of identified miRNAs between different studies, posing the question as to whether different methods or differences in tissue storage may contribute to that fact or if the results simply are not reproducible, due to unknown factors with undetected influences on miRNA expression. Other studies sought to find miRNAs which correlate to clinical parameters (tumor grade, nodal stage, metastasis, survival) and therapy response. Although several miRNAs seem to have an impact on the response to CRT or might predict nodal stage, there is still only little overlap between different studies. We here aimed to summarize the current literature on rectal cancer and miRNA expression with respect to the different relevant clinical parameters. PMID:27190581

  13. Complete uterine prolapse without uterine mucosal eversion in a queen.

    PubMed

    Bigliardi, E; Di Ianni, F; Parmigiani, E; Cantoni, A M; Bresciani, C

    2014-04-01

    A five-year-old female cat weighing 3 kg was presented by the owner after noticing a large pink, bilobed mass protruding through the vulva during labour. The cat was in good condition, with appropriate lactation, and the newborn kittens were nursing normally. The uterus was not reverted or invaginated at examination, and there was rupture of the mesovarium, mesometrium and uterine-vaginal connection around the cervix. Manual reduction of the prolapsed uterus was not possible because of torn ligaments. A coeliotomy was performed to remove the ovaries, and the apex of the uterine horns was passed by the vaginal route. The remaining part of the mesometrium was disconnected, and the prolapsed uterus was removed. The queen and kittens were discharged from the hospital on the second day after surgery. An unusual feature of this case is that the prolapse was complete, without eversion of any part of the uterus through a vaginal tear. PMID:24697408

  14. Pelvic Organ Prolapse: New Concepts in Pelvic Floor Anatomy.

    PubMed

    Maldonado, Pedro A; Wai, Clifford Y

    2016-03-01

    As the field of reconstructive pelvic surgery continues to evolve, with descriptions of new procedures to repair pelvic organ prolapse, it remains imperative to maintain a functional understanding of pelvic floor anatomy and support. The goal of this review was to provide a focused, conceptual approach to differentiating anatomic defects contributing to prolapse in the various compartments of the vagina. Rather than provide exhaustive descriptions of pelvic floor anatomy, basic pelvic floor anatomy is reviewed, new and historical concepts of pelvic floor support are discussed, and relevance to the surgical management of specific anatomic defects is addressed. PMID:26880505

  15. [Prognostic evaluation of the flying longevity of pilots with idiopathic mitral valve prolapse].

    PubMed

    Godilo-Godlevskiĭ, V A; Sinopal'nikov, V I

    2003-01-01

    In the period of 1995-2001, 576 17- to 49-yr. old pilots of fighters and fighter-bombers with the idiopathic mitral valve prolapse (IMVP) were investigated at the Seventh Central military aviation clinical hospital. In this group, a very feebly marked mitral valve prolapse was found in 98.7% of cases. In 96.7% class-1 IMVP was accompanied by a mitral reguragitation, most often the first-degree one. Based on results of comprehensive examination, medically qualified to fly were 560 out of 576 pilots from the main group (97.0%) and 144 out of 150 pilots from the group of control (97.2%). In the next 5 years the flying career was continued by 76.3% and 78.7% of the pilots, respectively. A clinical-diagnostic and expert algorithm for medical certification of pilots of highly maneuverable aircraft with IMVP was developed which will reduce time of in-hospital medical certification and facilitate more accurately determination of the criteria for immediate and long-range estimation of the flying longevity. PMID:12696502

  16. Rectal Lymphogranuloma Venereum in HIV-infected Patients Can Mimic Lymphoma.

    PubMed

    Crickx, Etienne; Meignin, Véronique; Gérard, Laurence; Plantier-Colcher, Isabelle; Walker-Combrouze, Francine; Boutboul, David; Galicier, Lionel; Fieschi, Claire; Oksenhendler, Eric

    2016-01-01

    An outbreak of rectal lymphogranuloma venereum (LGV) has been reported since 2003 in men who have sex with men, most of them being infected with human immunodeficiency virus. In these patients, unusual clinical presentations such as rectal tumor or intense lymphoproliferation on rectal biopsies may lead to an erroneous diagnosis of aggressive non-Hodgkin lymphoma. Three patients were referred to our center for the management of rectal B-cell non-Hodgkin lymphoma on the basis of a rectal pathologic specimen showing intense lymphoproliferation, the very suspect of lymphoma. Because of anamnesis of anal intercourses and venereal diseases, additional study revealed that all 3 had a positive Chlamydia trachomatis polymerase chain reaction on the rectal biopsy specimen. Rectal LGV was therefore considered and successfully treated with antibiotics. We propose that all patients presenting with a suspected rectal lymphoma should have a careful anamnesis of sexual behavior and a specific detection of C. trachomatis using polymerase chain reaction analysis on biopsy specimen to rule out the possibility of rectal LGV. PMID:26166139

  17. Toward Restored Bowel Health in Rectal Cancer Survivors.

    PubMed

    Steineck, Gunnar; Schmidt, Heike; Alevronta, Eleftheria; Sjöberg, Fei; Bull, Cecilia Magdalena; Vordermark, Dirk

    2016-07-01

    As technology gets better and better, and as clinical research provides more and more knowledge, we can extend our ambition to cure patients from cancer with restored physical health among the survivors. This increased ambition requires attention to grade 1 toxicity that decreases quality of life. It forces us to document the details of grade 1 toxicity and improve our understanding of the mechanisms. Long-term toxicity scores, or adverse events as documented during clinical trials, may be regarded as symptoms or signs of underlying survivorship diseases. However, we lack a survivorship nosology for rectal cancer survivors. Primarily focusing on radiation-induced side effects, we highlight some important observations concerning late toxicity among rectal cancer survivors. With that and other data, we searched for a preliminary survivorship-disease nosology for rectal cancer survivors. We disentangled the following survivorship diseases among rectal cancer survivors: low anterior resection syndrome, radiation-induced anal sphincter dysfunction, gut wall inflammation and fibrosis, blood discharge, excessive gas discharge, excessive mucus discharge, constipation, bacterial overgrowth, and aberrant anatomical structures. The suggested survivorship nosology may form the basis for new instruments capturing long-term symptoms (patient-reported outcomes) and professional-reported signs. For some of the diseases, we can search for animal models. As an end result, the suggested survivorship nosology may accelerate our understanding on how to prevent, ameliorate, or eliminate manifestations of treatment-induced diseases among rectal cancer survivors. PMID:27238476

  18. Proctoclysis: emergency rectal fluid infusion.

    PubMed

    Tremayne, Vincent

    This article describes the use and effectiveness of proctoclysis (rectal fluid infusion) in providing fluid resuscitation in the absence of intravenous access in rural and remote environments. PMID:19856644

  19. Biomechanical properties of synthetic surgical meshes for pelvic prolapse repair.

    PubMed

    Todros, S; Pavan, P G; Natali, A N

    2015-03-01

    Synthetic meshes are widely used for surgical repair of different kind of prolapses. In the light of the experience of abdominal wall repair, similar prostheses are currently used in the pelvic region, to restore physiological anatomy after organ prolapse into the vaginal wall, that represent a recurrent dysfunction. For this purpose, synthetic meshes are surgically positioned in contact with the anterior and/or posterior vaginal wall, to inferiorly support prolapsed organs. Nonetheless, while mesh implantation restores physiological anatomy, it is often associated with different complications in the vaginal region. These potentially dangerous effects induce the surgical community to reconsider the safety and efficacy of mesh transvaginal placement. For this purpose, the evaluation of state-of-the-art research may provide the basis for a comprehensive analysis of mesh compatibility and functionality. The aim of this work is to review synthetic surgical meshes for pelvic organs prolapse repair, taking into account the mechanics of mesh material and structure, and to relate them with pelvic and vaginal tissue biomechanics. Synthetic meshes are currently available in different chemical composition, fiber and textile conformations. Material and structural properties are key factors in determining mesh biochemical and mechanical compatibility in vivo. The most significant results on vaginal tissue and surgical meshes mechanical characterization are here reported and discussed. Moreover, computational models of the pelvic region, which could support the surgeon in the evaluation of mesh performances in physiological conditions, are recalled. PMID:26615384

  20. [Association of anorexia nervosa and mitral valve prolapse].

    PubMed

    Amano, K; Sakamoto, T; Hada, Y; Hasegawa, I; Takahashi, T; Suzuki, J; Takahashi, H

    1986-01-01

    Four cases of anorexia nervosa recently encountered were reported in respect to their cardiovascular manifestations including prolapse of the cardiac valves and other poorly recognized cardiac findings. All four patients, aged 13 to 32 years, were women and had marked emaciation (35 to 44% weight loss of the ideal body weight) with typical hormone abnormalities. Chest radiographs showed a small cardiac shadow, and sinus bradycardia with low voltage was present in their electrocardiograms. One case, 13-year-old, had a mid-systolic click and occasionally a late systolic murmur, and also an abdominal continuous hum. Echocardiography including two-dimensional color flow-mapping disclosed mitral valve prolapse in all, and tricuspid valve prolapse in two. Mild to moderate pericardial effusion was noted in all between the right ventricle and diaphragm, and pericardiocentesis in one case had no effect on the valve movements. No inflammatory changes were observed in the specimen of the pericardium and also of the fluid. An association of mitral valve prolapse and anerexia nervosa was discussed based on the previous studies, but the final conclusion remains unknown. PMID:3681005

  1. Genetic epidemiology of pelvic organ prolapse: a systematic review.

    PubMed

    Ward, Renée M; Velez Edwards, Digna R; Edwards, Todd; Giri, Ayush; Jerome, Rebecca N; Wu, Jennifer M

    2014-10-01

    Given current evidence supporting a genetic predisposition for pelvic organ prolapse, we conducted a systematic review of published literature on the genetic epidemiology of pelvic organ prolapse. Inclusion criteria were linkage studies, candidate gene association and genome-wide association studies in adult women published in English and indexed in PubMed through Dec. 2012, with no limit on date of publication. Methodology adhered to the PRISMA guidelines. Data were systematically extracted by 2 reviewers and graded by the Venice criteria for studies of genetic associations. A metaanalysis was performed on all single nucleotide polymorphisms evaluated by 2 or more studies with similar methodology. The metaanalysis suggests that collagen type 3 alpha 1 (COL3A1) rs1800255 genotype AA is associated with pelvic organ prolapse (odds ratio, 4.79; 95% confidence interval, 1.91-11.98; P = .001) compared with the reference genotype GG in populations of Asian and Dutch women. There was little evidence of heterogeneity for rs1800255 (P value for heterogeneity = .94; proportion of variance because of heterogeneity, I(2) = 0.00%). There was insufficient evidence to determine whether other single nucleotide polymorphisms evaluated by 2 or more papers were associated with pelvic organ prolapse. An association with pelvic organ prolapse was seen in individual studies for estrogen receptor alpha (ER-α) rs2228480 GA, COL3A1 exon 31, chromosome 9q21 (heterogeneity logarithm of the odds score 3.41) as well as 6 single nucleotide polymorphisms identified by a genome-wide association study. Overall, individual studies were of small sample size and often of poor quality. Future studies would benefit from more rigorous study design as outlined in the Venice recommendations. PMID:24721264

  2. Management of rectal foreign bodies

    PubMed Central

    2013-01-01

    Background Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault. Methods Between 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. Results All patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died. Conclusions Foreign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body. PMID:23497492

  3. Robotic Surgery for Rectal Cancer: An Update in 2015

    PubMed Central

    Kwak, Jung Myun; Kim, Seon Hahn

    2016-01-01

    During the last decade, robotic surgery for rectal cancer has rapidly gained acceptance among colorectal surgeons worldwide, with well-established safety and feasibility. The lower conversion rate and better surgical specimen quality of robotic compared with laparoscopic surgery potentially improves survival. Earlier recovery of voiding and sexual function after robotic total mesorectal excision is another favorable outcome. Long-term survival data are sparse with no evidence that robotic surgery offers major benefits in oncological outcomes. Although initial reports are promising, more rigorous scientific evaluation in multicenter, randomized clinical trials should be performed to definitely determine the advantages of robotic rectal cancer surgery. PMID:26875201

  4. Current Status of Minimally Invasive Surgery for Rectal Cancer.

    PubMed

    Fleshman, James

    2016-05-01

    Recent randomized controlled data have shown possible limitations to laparoscopic treatment of rectal cancer. The retrospective data, used as the basis for designing the trials, and which showed no problems with the technique, are discussed. The design of the randomized trials is discussed relative to the future meta-analysis of the recent data. The implications of the current findings on practice are discussed as surgeons try to adjust their practice to the new findings. The possible next steps for clinical and research innovations are put into perspective as new technology is considered to compensate for newly identified limitations in the laparoscopic treatment of rectal cancer. PMID:26831061

  5. Recent advances in robotic surgery for rectal cancer.

    PubMed

    Ishihara, Soichiro; Otani, Kensuke; Yasuda, Koji; Nishikawa, Takeshi; Tanaka, Junichiro; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Kazama, Shinsuke; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki

    2015-08-01

    Robotic technology, which has recently been introduced to the field of surgery, is expected to be useful, particularly in treating rectal cancer where precise manipulation is necessary in the confined pelvic cavity. Robotic surgery overcomes the technical drawbacks inherent to laparoscopic surgery for rectal cancer through the use of multi-articulated flexible tools, three-dimensional stable camera platforms, tremor filtering and motion scaling functions, and greater ergonomic and intuitive device manipulation. Assessments of the feasibility and safety of robotic surgery for rectal cancer have reported similar operation times, blood loss during surgery, rates of postoperative morbidity, and circumferential resection margin involvement when compared with laparoscopic surgery. Furthermore, rates of conversion to open surgery are reportedly lower with increased urinary and male sexual functions in the early postoperative period compared with laparoscopic surgery, demonstrating the technical advantages of robotic surgery for rectal cancer. However, long-term outcomes and the cost-effectiveness of robotic surgery for rectal cancer have not been fully evaluated yet; therefore, large-scale clinical studies are required to evaluate the efficacy of this new technology. PMID:26059248

  6. [Robot-assisted rectal surgery: hype or progress?].

    PubMed

    Becker, T; Egberts, J E; Schafmayer, C; Aselmann, H

    2016-07-01

    Minimally invasive laparoscopic surgery for rectal cancer has undergone a significant evolution during the last decades and has become the standard approach in specialized centers with better short-term and comparable oncological outcome to open surgery. The laparoscopic approach remains challenging and has various inherent technical challenges particularly associated with rectal cancer resection. Robotic colorectal surgery using the da Vinci® surgical system has been successfully introduced into clinical practice during recent years and provides specific technical advantages. Studies have shown that the robotic approach in colorectal surgery is safe and feasible with comparable results. It is associated with low conversion rates, more R0 situations for low rectal cancer with larger tumors and more neoadjuvant treatment compared to standard laparoscopy. Robot-assisted surgery is an attractive development of minimally invasive surgery and should also be further evaluated with mandatory monitoring of outcome parameters in registries in Germany. PMID:27334630

  7. Drugs Approved for Colon and Rectal Cancer

    MedlinePlus

    ... Professionals Questions to Ask about Your Treatment Research Drugs Approved for Colon and Rectal Cancer This page ... and rectal cancer that are not listed here. Drugs Approved for Colon Cancer Avastin (Bevacizumab) Bevacizumab Camptosar ( ...

  8. Successful treatment of rectal cancer with perineal invasion: Three case reports

    PubMed Central

    KITAHARA, TOMOHIRO; UEMURA, MAMORU; HARAGUCHI, NAOTSUGU; NISHIMURA, JUNICHI; SHINGAI, TATSUSHI; HATA, TAISHI; TAKEMASA, ICHIRO; MIZUSHIMA, TSUNEKAZU; DOKI, YUICHIRO; MORI, MASAKI; YAMAMOTO, HIROFUMI

    2014-01-01

    Rectal cancer occasionally invades adjacent organs. However, rectal cancer with perineal invasion is uncommon and difficult to treat. Locally advanced colorectal cancer may be clinically treated with neoadjuvant therapy, followed by en bloc resection. Skin invasion may lead to tumor dissemination via cutaneous blood flow and lymphatic routes. There is currently no firm evidence regarding the treatment of these significantly advanced rectal cancers. In this study, we report 3 cases of rectal cancer with perineal invasion, successfully managed by multimodality treatment. Case 1 is a 52-year-old man with rectal cancer that had invaded the perineum; case 2 is a 38-year-old man with rectal cancer infiltrating the perineal skin and liver metastasis; and case 3 is a 50-year-old woman with rectal cancer and perineal invasion. All the cases were treated with radical excision. No severe complications were observed in the perioperative period. Case 2, in particular, was confirmed to remain alive 5 years after the surgery. Our experience suggests that multimodality treatment, including extended radical surgery, may be a feasible approach to the treatment of rectal cancer with perineal skin invasion. PMID:24940483

  9. Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

    PubMed Central

    Bruketa, Tomislav; Majerovic, Matea; Augustin, Goran

    2015-01-01

    Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects. PMID:26290629

  10. Transforming growth factor-β1 and extracellular matrix protease expression in the uterosacral ligaments of patients with and without pelvic organ prolapse

    PubMed Central

    Leegant, Ava; Zuckerwise, Lisa C.; Downing, Keith; Brouwer-Visser, Jurriaan; Zhu, Changcheng; Cossio, Maria Jose; Strube, Felix; Xie, Xianhong; Banks, Erika; Huang, Gloria S

    2015-01-01

    Objectives This study was undertaken to evaluate the expression of transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 9 (MMP-9), key regulators of the extracellular matrix composition, in the uterosacral ligaments (USL) of women with pelvic organ prolapse compared with controls. Methods Under IRB approval, USL samples were obtained from women undergoing vaginal hysterectomy for stage two or greater pelvic organ prolapse (cases, n=21) and from women without pelvic organ prolapse undergoing vaginal hysterectomy for benign indications (controls, n=19). Hematoxylin and eosin and trichrome staining were performed on the USL sections, and the distribution of smooth muscle and fibrous tissue quantified. Immunohistochemical staining was performed using anti-TGF-β1 and anti-MMP-9 antibodies. The expression of TGF-β1 and MMP-9 was evaluated by the pathologist, who was blinded to all clinical data. Results TGF-β1 expression positively correlated with MMP-9 expression (R=0.4, P=0.01). The expression of TGF-β1 and MMP-9 were similar in subjects with pelvic organ prolapse versus controls. There was a significant increase in fibrous tissue (P=0.008), and a corresponding decrease in smooth muscle (P=0.03), associated with increasing age. TGF-β1 expression, but not MMP-9 expression, also significantly increased with age (P=0.02). Discussion Although our study uncovered age-related alterations in USL composition and TGF-β1 expression, there was no difference in the expression of TGF-β1 or MMP-9 in the subjects with pelvic organ prolapse versus controls. PMID:25185601

  11. Chemotherapy, Radiation Therapy, and Surgery in Treating Patients With Locally Advanced Rectal Cancer

    ClinicalTrials.gov

    2013-01-09

    Adenocarcinoma of the Rectum; Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Rectum; Stage IIA Rectal Cancer; Stage IIB Rectal Cancer; Stage IIC Rectal Cancer; Stage IIIA Rectal Cancer; Stage IIIB Rectal Cancer; Stage IIIC Rectal Cancer

  12. Synchronous rectal adenocarcinoma and splenic marginal zone lymphoma.

    PubMed

    Srikumar, T; Markow, M; Centeno, B; Hoffe, S; Tao, J; Fernandez, H; Strosberg, J; Shibata, D

    2016-02-01

    Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl). A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made. The patient's management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil-leucovorin-oxaliplatin) chemotherapy and has remained disease-free for 7 years. To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation. PMID:26966416

  13. Synchronous rectal adenocarcinoma and splenic marginal zone lymphoma

    PubMed Central

    Srikumar, T.; Markow, M.; Centeno, B.; Hoffe, S.; Tao, J.; Fernandez, H.; Strosberg, J.; Shibata, D.

    2016-01-01

    Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl). A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made. The patient’s management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil–leucovorin–oxaliplatin) chemotherapy and has remained disease-free for 7 years. To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation. PMID:26966416

  14. Maggots in prolapsed uterus - Polluted progress of life style.

    PubMed

    Ray, Sabyasachi; Basak, Subhadeep; Konar, Hiralal

    2012-07-01

    Myiasis is infestation by dipterous larva that thrives on host's living or necrotic tissue and cause massive tissue infection. We present a case of Myiasis in uterine cavity of a prolapsed uterus of a 77-year-old multiparous lady of West Midnapore District, West Bengal, India. It is a very rare case as only a few reports have been previously published in literature. She had presented with genital pruritus and vague perennial discomfort for last 1 month along with bleeding and foul smelling discharge from vagina for last 2 days. Pelvic examination revealed 'Stage-IV' genitourinary prolapse according to POP-Q classification, with a big excavatory ulcer indwelled with maggots of Musca domestica. About 80 to 90 such maggots were subsequently manually removed with a forceps under anaesthesia. She was advised to undergo definitive surgical treatment for prolapsed uterus. Owing to very low socioeconomic condition or for the fear of the operation, the patient ultimately never turned up. PMID:24532876

  15. Surgical techniques for advanced stage pelvic organ prolapse.

    PubMed

    Brown, Douglas N; Strauchon, Christopher; Gonzalez, Hector; Gruber, Daniel

    2016-02-01

    Pelvic organ prolapse is an extremely common condition, with approximately 12% of women requiring surgical correction over their lifetime. This manuscript reviews the most recent literature regarding the comparative efficacy of various surgical repair techniques in the treatment of advanced stage pelvic organ prolapse. Uterosacral ligament suspension has similar anatomic and subjective outcomes when compared to sacrospinous ligament fixation at 12 months and is considered to be equally effective. The use of transvaginal mesh has been shown to be superior to native tissue vaginal repairs with respect to anatomic outcomes but at the cost of a higher complication rate. Minimally invasive sacrocolpopexy appears to be equivalent to abdominal sacrocolpopexy (ASC). Robot-assisted sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy (LSC) appear as effective as abdominal sacrocolpopexy, however, prospective studies of comparing long-term outcomes of ASC, LSC, and RSC in relation to health care costs is paramount in the near future. Surgical correction of advanced pelvic organ prolapse can be accomplished via a variety of proven techniques. Selection of the correct surgical approach is a complex decision process and involves a multitude of factors. When deciding on the most suitable surgical intervention, the chosen route must be individualized for each patient taking into account the specific risks and benefits of each procedure. PMID:26448444

  16. Proteomic analysis of colon and rectal carcinoma using standard and customized databases

    PubMed Central

    Slebos, Robbert J.C.; Wang, Xia; Wang, Xaojing; Zhang, Bing; Tabb, David L.; Liebler, Daniel C.

    2015-01-01

    Understanding proteomic differences underlying the different phenotypic classes of colon and rectal carcinoma is important and may eventually lead to a better assessment of clinical behavior of these cancers. We here present a comprehensive description of the proteomic data obtained from 90 colon and rectal carcinomas previously subjected to genomic analysis by The Cancer Genome Atlas (TCGA). Here, the primary instrument files and derived secondary data files are compiled and presented in forms that will allow further analyses of the biology of colon and rectal carcinoma. We also discuss new challenges in processing these large proteomic datasets for relevant proteins and protein variants. PMID:26110064

  17. Rectal neuroendocrine tumor with uncommon metastatic spread: A case report and review of literature

    PubMed Central

    Tsoukalas, Nikolaos; Galanopoulos, Michail; Tolia, Maria; Kiakou, Maria; Nakos, Georgios; Papakostidi, Aristoula; Koumakis, Georgios

    2016-01-01

    Neuroendocrine tumors of the gastrointestinal tract are rare neoplasms. Rectal neuroendocrine tumors consist approximately the 5%-14% of all neuroendocrine neoplasms in Europe. These tumors are diagnosed in relatively young patients, with a mean age at diagnosis of 56 years. Distant metastases from rectal neuroendocrine tumors are not very common. Herein we describe a case of a rectal neuroendocrine tumor which metastasized to the lung, mediastinum and orbit. This case underscores the importance of early identification and optimal management to improve patient’s prognosis. Therefore, the clinical significance of this case is the necessity of physicians’ awareness and education regarding neuroendocrine tumors’ diagnosis and management. PMID:26909138

  18. Rectal adenocarcinoma infiltrating the bulbar urethra and metastasising to the penis.

    PubMed

    James, Mathews; Amaranathan, Anandhi; Nelamangala Ramakrishnaiah, Vishnu Prasad; Toi, Pampa Chakrabarty

    2016-01-01

    Secondary penile tumours from rectal carcinoma is a known clinical entity but can be missed unless carefully evaluated. We report a case of rectal adenocarcinoma with synchronous painless penile nodules. A patient presented with constipation and rectal bleeding. He had an anorectal growth as well as palpable nodules on his penis. Rectal biopsy yielded adenocarcinoma. Imaging revealed direct infiltration of tumour into the bulb of the penis as well as distal shaft lesions. Fine-needle aspiration cytology of the penile nodule showed metastatic adenocarcinoma. Diversion colostomy was performed and the patient referred for chemoradiation. Since he did not have any urinary symptoms, the penile lesions were left unaltered. Repeat imaging after concurrent chemoradiotherapy showed no response. The prognosis was explained and the patient was given palliative clinic care. PMID:27312852

  19. Neovaginal Prolapse in Male-to-Female Transsexuals: An 18-Year-Long Experience

    PubMed Central

    Bucci, Stefano; Liguori, Giovanni; Bormioli, Susanna; De Concilio, Bernardino; Trombetta, Carlo

    2014-01-01

    Neovaginal prolapse is a rare and distressing complication after male-to-female sexual reassignment surgery. We retrospectively analysed the prevalence of partial and total neo-vaginal prolapses after sexual reassignment surgery in our institute. During the years, two different techniques have been adopted with the aim of fixing the neovaginal cylinder. In the first, two absorbable sutures are placed at the top of the penoscrotal cylinder and fixed to the Denonvilliers fascia. In the second, two additional sutures are added from the posterior/midpoint of the flap to the prerectal fascia. We enrolled 282 consecutive transsexual patients. 65 (23.04%) out of the 282 were treated with the first technique and the following 217 (76.96%) with the last technique. In the first technique, 1 case (1.53%) of total prolapse and 7 cases (10.76%) of partial prolapse were observed, while in the other 217 patients treated with the second technique only 9 cases of partial prolapse were observed (4.14%) and no cases of total prolapse. All prolapses occurred within 6 months from the procedure. In our experience, the use of 4 stitches and a more proximal positioning of the sutures to fix the penoscrotal apex with the Denonvilliers fascia guarantees a lower risk of prolapse. PMID:24895556

  20. How Is Mitral Valve Prolapse Treated?

    MedlinePlus

    ... Living With Clinical Trials Links Related Topics Arrhythmia Endocarditis Heart Valve Disease How the Heart Works Marfan ... underlying mitral valve problem, if necessary Preventing infective endocarditis , arrhythmias , and other complications Relieving symptoms Medicines Medicines ...

  1. Uterine Leiomyoma and Prolapse in a Live-stranded Atlantic Spotted Dolphin (Stenella frontalis).

    PubMed

    Díaz-Delgado, J; Fernández, A; Edwards, J F; Sierra, E; Xuriach, A; García-Álvarez, N; Sacchini, S; Groch, K R; Andrada, M; Arbelo, M

    2015-07-01

    A uterine prolapse associated with a leiomyoma (fibroid) was observed in a live-stranded Atlantic spotted dolphin (Stenella frontalis). A 7 cm segment of the reproductive tract including the cervix, uterine neck and caudal uterine body had intussuscepted and prolapsed into the cranial vaginal vault. In the leading edge of the intussuscepted/prolapsed uterine wall was a 6 × 3 × 3.5 cm leiomyoma expanding the myometrium. The leiomyoma and prolapse were associated with necrotizing exposure endometritis. This is the first report of a uterine prolapse associated with a leiomyoma in a cetacean. This lesion was believed to be the underlying cause of the live stranding. PMID:25979681

  2. Rectal cancer: An evidence-based update for primary care providers

    PubMed Central

    Gaertner, Wolfgang B; Kwaan, Mary R; Madoff, Robert D; Melton, Genevieve B

    2015-01-01

    Rectal adenocarcinoma is an important cause of cancer-related deaths worldwide, and key anatomic differences between the rectum and the colon have significant implications for management of rectal cancer. Many advances have been made in the diagnosis and management of rectal cancer. These include clinical staging with imaging studies such as endorectal ultrasound and pelvic magnetic resonance imaging, operative approaches such as transanal endoscopic microsurgery and laparoscopic and robotic assisted proctectomy, as well as refined neoadjuvant and adjuvant therapies. For stage II and III rectal cancers, combined chemoradiotherapy offers the lowest rates of local and distant relapse, and is delivered neoadjuvantly to improve tolerability and optimize surgical outcomes, particularly when sphincter-sparing surgery is an endpoint. The goal in rectal cancer treatment is to optimize disease-free and overall survival while minimizing the risk of local recurrence and toxicity from both radiation and systemic therapy. Optimal patient outcomes depend on multidisciplinary involvement for tailored therapy. The successful management of rectal cancer requires a multidisciplinary approach, with the involvement of enterostomal nurses, gastroenterologists, medical and radiation oncologists, radiologists, pathologists and surgeons. The identification of patients who are candidates for combined modality treatment is particularly useful to optimize outcomes. This article provides an overview of the diagnosis, staging and multimodal therapy of patients with rectal cancer for primary care providers. PMID:26167068

  3. Comparison of rectal suction versus rectal tube insertion for reducing abdominal symptoms immediately after unsedated colonoscopy

    PubMed Central

    Liu, Tso-Tsai; Yi, Chih-Hsun; Lei, Wei-Yi; Yu, Hao-Chun; Hung, Jui-Sheng; Chen, Chien-Lin

    2016-01-01

    Background and study aims: Abdominal discomfort and bloating are common symptoms after colonoscopy. We aimed to compare the effects of direct rectal suction with insertion of a rectal tube on reducing abdominal symptoms after unsedated colonoscopy. Patients and methods: Consecutive patients undergoing colonoscopy were randomized to have direct rectal suction or placement of a rectal tube immediately after colonoscopy. Post-procedure abdominal pain and bloating were measured with a 0 – 100 visual analogue scale. All participants ranked their satisfaction with either direct rectal suction or insertion of a rectal tube. Results: Abdominal pain and bloating were significantly reduced by direct rectal suction and placement of a rectal tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05) after the colonoscopy. Direct rectal suction significantly reduced abdominal pain at 1 minute (P = 0.001) and 3 minutes (P = 0.005) after colonoscopy compared with rectal tube insertion. Bloating was significantly lower in patients with direct rectal suction compared to those with rectal tube insertion at 1 minute (P = 0.03) after colonoscopy. Greater satisfaction was found in patients with direct rectal suction compared to those with rectal tube insertion (P = 0.009). Conclusion: Direct rectal suction is more effective than rectal tube placement in reducing abdominal symptoms immediately after colonoscopy. Our study suggests that direct rectal suction is useful in providing relief of symptoms when patients are having difficulty expelling air or are experiencing abdominal symptoms following colonoscopy. PMID:27336061

  4. Evaluation and Management of Pelvic Organ Prolapse in Elderly Women.

    PubMed

    Pizarro-Berdichevsky, Javier; Clifton, Marisa M; Goldman, Howard B

    2015-11-01

    Pelvic organ prolapse is a common disease in elderly patients. The most important symptom is vaginal bulge (bulge sensation or the sensation of something coming down through the vaginal introitus). This symptom is not different than in the general population. Diagnosis can be confirmed using just vaginal examinations to identify the presence of protrusion beyond the hymen, and is not different than in the general population. Different treatment options are available, including observation, nonsurgical, and surgical techniques. Pessaries and colpocleisis are the treatment options used more often in elderly patients than in the general population. PMID:26476112

  5. Gynaecological Prolapse Surgery in Very Old Female Patients

    PubMed Central

    Mothes, A. R.; Lehmann, T.; Kwetkat, A.; Radosa, M. P.; Runnebaum, I. B.

    2016-01-01

    Background: The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. Method: In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Studentʼs t, Fisherʼs exact and Mann-Whitney U tests. Results: The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p < 0.001), apical fixations were more frequent (p < 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p < 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p < 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p < 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p < 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p < 0.001). Conclusions: A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities. PMID:27582580

  6. [Rectal resection with colo-anal anastomosis for ergotamine-induced rectal stenosis].

    PubMed

    Panis, Y; Valleur, P; Kleinmann, P; Willems, G; Hautefeuille, P

    1990-01-01

    Anorectal ulcers due to ergotamine suppositories are extremely rare. We report the first case of rectal stenosis following regular abuse of ergotamine suppositories which required rectal resection and coloanal anastomosis, despite stopping the intoxication 1 year previously. The rectal eversion during the perineal procedure allowed a low anastomosis to be performed, on the dentate line. One year later, the functional result was considered to be good, demonstrating the place of coloanal anastomosis in benign rectal pathology. PMID:2100123

  7. Rectal Swabs for Analysis of the Intestinal Microbiota

    PubMed Central

    Budding, Andries E.; Grasman, Matthijs E.; Eck, Anat; Bogaards, Johannes A.; Vandenbroucke-Grauls, Christina M. J. E.; van Bodegraven, Adriaan A.; Savelkoul, Paul H. M.

    2014-01-01

    The composition of the gut microbiota is associated with various disease states, most notably inflammatory bowel disease, obesity and malnutrition. This underlines that analysis of intestinal microbiota is potentially an interesting target for clinical diagnostics. Currently, the most commonly used sample types are feces and mucosal biopsy specimens. Because sampling method, storage and processing of samples impact microbiota analysis, each sample type has its own limitations. An ideal sample type for use in routine diagnostics should be easy to obtain in a standardized fashion without perturbation of the microbiota. Rectal swabs may satisfy these criteria, but little is known about microbiota analysis on these sample types. In this study we investigated the characteristics and applicability of rectal swabs for gut microbiota profiling in a clinical routine setting in patients presenting with various gastro-intestinal disorders. We found that rectal swabs appeared to be a convenient means of sampling the human gut microbiota. Swabs can be performed on demand, whenever a patient presents; swab-derived microbiota profiles are reproducible, whether they are gathered at home by patients or by medical professionals in an outpatient setting and may be ideally suited for clinical diagnostics and large-scale studies. PMID:25020051

  8. Magnamosis: a novel technique for the management of rectal atresia

    PubMed Central

    Russell, Katie W; Rollins, Michael D; Feola, G Peter; Scaife, Eric R

    2014-01-01

    We report a case of rectal atresia treated using magnets to create a rectal anastomosis. This minimally invasive technique is straightforward and effective for the treatment of rectal atresia in children. PMID:25096648

  9. The role of the robotic technique in minimally invasive surgery in rectal cancer

    PubMed Central

    Bianchi, Paolo Pietro; Luca, Fabrizio; Petz, Wanda; Valvo, Manuela; Cenciarelli, Sabine; Zuccaro, Massimiliano; Biffi, Roberto

    2013-01-01

    Laparoscopic rectal surgery is feasible, oncologically safe, and offers better short-term outcomes than traditional open procedures in terms of pain control, recovery of bowel function, length of hospital stay, and time until return to working activity. Nevertheless, laparoscopic techniques are not widely used in rectal surgery, mainly because they require a prolonged and demanding learning curve that is available only in high-volume and rectal cancer surgery centres experienced in minimally invasive surgery. Robotic surgery is a new technology that enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, promising to overcome some of the technical difficulties associated with standard laparoscopy. The aim of this review is to summarise the current data on clinical and oncological outcomes of minimally invasive surgery in rectal cancer, focusing on robotic surgery, and providing original data from the authors’ centre. PMID:24101946

  10. Early Proctoscopy is a Surrogate Endpoint of Late Rectal Toxicity in Prostate Cancer Treated With Radiotherapy

    SciTech Connect

    Ippolito, Edy; Massaccesi, Mariangela; Digesu, Cinzia; Deodato, Francesco; Macchia, Gabriella; Pirozzi, Giuseppe Antonio; Cilla, Savino; Cuscuna, Daniele; Di Lallo, Alessandra; Mattiucci, Gian Carlo; Mantini, Giovanna; Pacelli, Fabio; Valentini, Vincenzo; Cellini, Numa; Ingrosso, Marcello; Morganti, Alessio Giuseppe

    2012-06-01

    Purpose: To predict the grade and incidence of late clinical rectal toxicity through short-term (1 year) mucosal alterations. Methods and Materials: Patients with prostate adenocarcinoma treated with curative or adjuvant radiotherapy underwent proctoscopy a year after the course of radiotherapy. Mucosal changes were classified by the Vienna Rectoscopy Score (VRS). Late toxicity data were analyzed according to the Kaplan-Meier method. Comparison between prognosis groups was performed by log-rank analysis. Results: After a median follow-up time of 45 months (range, 18-99), the 3-year incidence of grade {>=}2 rectal late toxicity according to the criteria of the European Organization for Research and Treatment of Cancer and the Radiation Therapy Oncology Group was 24%, with all patients (24/24; 100%) experiencing rectal bleeding. The occurrence of grade {>=}2 clinical rectal late toxicity was higher in patients with grade {>=}2 (32% vs. 15 %, p = 0.02) or grade {>=}3 VRS telangiectasia (47% vs. 17%, p {<=} 0.01) and an overall VRS score of {>=}2 (31% vs. 16 %, p = 0.04) or {>=}3 (48% vs. 17%, p = 0.01) at the 1-year proctoscopy. Conclusions: Early proctoscopy (1 year) predicts late rectal bleeding and therefore can be used as a surrogate endpoint for late rectal toxicity in studies aimed at reducing this frequent complication.