1
|
Zhao Z, Bai B, Wang S, Zhou Y, Yu P, Zhao Q, Yang B. Physical and psychological correlates of somatic symptom in patients with functional constipation: a cross-sectional study. BMC Psychiatry 2024; 24:134. [PMID: 38365647 PMCID: PMC10873943 DOI: 10.1186/s12888-024-05559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The symptoms of functional constipation (FC) were obviously affected by mental symptoms, which was consistent with somatic symptoms. However, the characteristics of FC patients with somatic symptom remains unexplored. METHODS Clinical characteristics including somatic symptom (SOM, PHQ-15), depression (PHQ-9), anxiety (GAD-7), quality of life (PAC-QOL), constipation (KESS), demographic variables, anatomical abnormalities and symptoms were investigated. Subsequent analyses encompassed the comparison of clinical parameters between patients with SOM + group (PHQ-15 ≥ 10) and SOM- group (PHQ-15 < 10), subgroup analysis, correlation analysis, and logistic regression. Lastly, we evaluated the somatic symptom severity (SSS) among FC patients subjected to various stressors. RESULTS Notable disparities were observed between SOM + and SOM- groups in variety of physiological and psychological variables, including gender, stressful events, sleep disorders, reduced interest, GAD-7, PHQ-15, PHQ-9, PAC-QOL, anterior rectocele, KESS, and internal anal sphincter achalasia (IASA) (P < 0.05). Subgroup analysis affirmed consistent findings across mental symptoms. Correlation analyses revealed significant associations between SSS and KESS, anterior rectocele, GAD-7, PHQ-9, and PAC-QOL (P < 0.05). Logistic regression identified PHQ-9 (OR = 7.02, CI: 2.06-27.7, P = 0.003), GAD-7 (OR = 7.18, CI: 2.00-30.7, P = 0.004), and KESS (OR = 16.8, CI: 3.09-113, P = 0.002) as independent predictors of SSS. Elevated SSS scores were significantly associated with couple, parental, and work-related stressors (P < 0.05). CONCLUSION A marked heterogeneity was observed between SOM + and SOM- patients of FC, with SOM + accompanied by more severe constipation, anxiety and depression symptoms. This finding underscores the importance of considering somatic symptoms in diagnosis and treatment of FC.
Collapse
Affiliation(s)
- Zhifeng Zhao
- State Key Laboratory of Cancer Biology & National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, No.127, West Changle Road, 710032, Xi'an, Shaanxi Province, People's Republic of China
| | - Bin Bai
- State Key Laboratory of Cancer Biology & National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, No.127, West Changle Road, 710032, Xi'an, Shaanxi Province, People's Republic of China
| | - Shiqi Wang
- State Key Laboratory of Cancer Biology & National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, No.127, West Changle Road, 710032, Xi'an, Shaanxi Province, People's Republic of China
| | - Yin Zhou
- State Key Laboratory of Cancer Biology & National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, No.127, West Changle Road, 710032, Xi'an, Shaanxi Province, People's Republic of China
| | - Pengfei Yu
- State Key Laboratory of Cancer Biology & National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, No.127, West Changle Road, 710032, Xi'an, Shaanxi Province, People's Republic of China
| | - Qingchuan Zhao
- State Key Laboratory of Cancer Biology & National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, No.127, West Changle Road, 710032, Xi'an, Shaanxi Province, People's Republic of China.
| | - Bin Yang
- State Key Laboratory of Cancer Biology & National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, No.127, West Changle Road, 710032, Xi'an, Shaanxi Province, People's Republic of China.
| |
Collapse
|
2
|
Maccioni F, Busato L, Valenti A, Cardaccio S, Longhi A, Catalano C. Magnetic Resonance Imaging of the Gastrointestinal Tract: Current Role, Recent Advancements and Future Prospectives. Diagnostics (Basel) 2023; 13:2410. [PMID: 37510154 PMCID: PMC10378103 DOI: 10.3390/diagnostics13142410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This review focuses on the role of magnetic resonance imaging (MRI) in the evaluation of the gastrointestinal tract (GI MRI), analyzing the major technical advances achieved in this field, such as diffusion-weighted imaging, molecular imaging, motility studies, and artificial intelligence. Today, MRI performed with the more advanced imaging techniques allows accurate assessment of many bowel diseases, particularly inflammatory bowel disease and rectal cancer; in most of these diseases, MRI is invaluable for diagnosis, staging, and disease monitoring under treatment. Several MRI parameters are currently considered activity biomarkers for inflammation and neoplastic disease. Furthermore, in younger patients with acute or chronic GI disease, MRI can be safely used for short-term follow-up studies in many critical clinical situations because it is radiation-free. MRI assessment of functional gastro-esophageal and small bowel disorders is still in its infancy but very promising, while it is well established and widely used for dynamic assessment of anorectal and pelvic floor dysfunction; MRI motility biomarkers have also been described. There are still some limitations to GI MRI related to high cost and limited accessibility. However, technical advances are expected, such as faster sequences, more specific intestinal contrast agents, AI analysis of MRI data, and possibly increased accessibility to GI MRI studies. Clinical interest in the evaluation of bowel disease using MRI is already very high, but is expected to increase significantly in the coming years.
Collapse
Affiliation(s)
- Francesca Maccioni
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Ludovica Busato
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandra Valenti
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Sara Cardaccio
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandro Longhi
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| |
Collapse
|
3
|
Sun B, Liu J, Li S, Lovell JF, Zhang Y. Imaging of Gastrointestinal Tract Ailments. J Imaging 2023; 9:115. [PMID: 37367463 DOI: 10.3390/jimaging9060115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Gastrointestinal (GI) disorders comprise a diverse range of conditions that can significantly reduce the quality of life and can even be life-threatening in serious cases. The development of accurate and rapid detection approaches is of essential importance for early diagnosis and timely management of GI diseases. This review mainly focuses on the imaging of several representative gastrointestinal ailments, such as inflammatory bowel disease, tumors, appendicitis, Meckel's diverticulum, and others. Various imaging modalities commonly used for the gastrointestinal tract, including magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT), and photoacoustic tomography (PAT) and multimodal imaging with mode overlap are summarized. These achievements in single and multimodal imaging provide useful guidance for improved diagnosis, staging, and treatment of the corresponding gastrointestinal diseases. The review evaluates the strengths and weaknesses of different imaging techniques and summarizes the development of imaging techniques used for diagnosing gastrointestinal ailments.
Collapse
Affiliation(s)
- Boyang Sun
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
| | - Jingang Liu
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
| | - Silu Li
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
| | - Jonathan F Lovell
- Department of Biomedical Engineering, The State University of New York at Buffalo, Buffalo, NY 14260, USA
| | - Yumiao Zhang
- Key Laboratory of Systems Bioengineering, School of Chemical Engineering and Technology, Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin 300350, China
| |
Collapse
|
4
|
Corrêa Neto IJF, Oliveira MCD, Robles L, Santos LML, Rolim AS, Souza RFL, Watté HH, Cecchini ARDS. Is There a Precise Correlation between the Lengths of the Peritoneal Reflection and the Middle Rectal Valve? JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0041-1739550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Introduction Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma.
Objectives To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity.
Design We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery.
Results We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32).
Conclusion There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries.
Collapse
Affiliation(s)
| | | | - Laercio Robles
- Department of General Surgery and Coloproctology Service, Faculdade de Medicina Santa Marcelina, São Paulo, SP, Brazil
| | | | - Alexander Sá Rolim
- Coloproctology Assistant Physicians from Faculdade de Medicina Santa Marcelina, São Paulo, SP, Brazil
| | | | - Hugo Henriques Watté
- Coloproctology Assistant Physicians from Faculdade de Medicina Santa Marcelina, São Paulo, SP, Brazil
| | | |
Collapse
|
5
|
Gregersen H, Chen SC, Leung WW, Wong C, Mak T, Ng S, Daming S, Futaba K. Characterization of Patients With Obstructed Defecation and Slow Transit Constipation With a Simulated Stool. Clin Transl Gastroenterol 2021; 12:e00354. [PMID: 33949343 PMCID: PMC8099406 DOI: 10.14309/ctg.0000000000000354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Defecatory disorders including obstructed defecation (OD) are currently diagnosed using specialized investigations including anorectal manometry and the balloon expulsion test. Recently, we developed a simulated stool named Fecobionics that provides a novel type of pressure measurements and analysis. The aim was to study OD phenotypes compared with slow transit constipation (STC) patients and normal subjects (NS). METHODS Fecobionics expulsion parameters were assessed in an interventional study design. The Fecobionics device contained pressure sensors at the front, rear, and inside a bag. All constipation patients had colon transit study, defecography, anorectal manometry, and balloon expulsion test performed. The Fecobionics bag was distended in the rectum until desire-to-defecate in 26 OD compared with 8 STC patients and 10 NS. Rear-front pressures (preload-afterload parameters) and defecation indices (DIs) were compared between groups. RESULTS The Wexner constipation scoring system score was 13.8 ± 0.9 and 14.6 ± 1.5 in the OD and STC patients (P > 0.5). The median desire-to-defecate volume was 80 (quartiles 56-80), 60 (54-80), and 45 (23-60) mL in OD, STC, and NS, respectively (P < 0.01). The median expulsion duration was 37 (quartiles 15-120), 6 (3-11), and 11 (8-11) seconds for the 3 groups (P < 0.03). Fecobionics rear-front pressure diagrams demonstrated clockwise loops with distinct phenotype differences between OD and the other groups. Most DIs differed between OD and the other groups, especially those based on the anal afterload reflecting the nature of OD constipation. Several OD subtypes were identified. DISCUSSION Fecobionics obtained novel pressure phenotypes in OD patients. DIs showed pronounced differences between groups. Larger studies are needed on OD subtyping.
Collapse
Affiliation(s)
- Hans Gregersen
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ssu-Chi Chen
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing Wa Leung
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cherry Wong
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tony Mak
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Ng
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sun Daming
- School of Microelectronics and Communication Engineering, Chongqing University, Shapingba, China
| | - Kaori Futaba
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
6
|
Steiner A, Marks R, Bahrami S, Arif-Tiwari H. How to develop and sustain a successful pelvic floor MRI practice. Abdom Radiol (NY) 2021; 46:1443-1450. [PMID: 31485786 DOI: 10.1007/s00261-019-02204-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) of the pelvic floor has become a commonly requested diagnostic tool for pelvic floor assessment. We provide a practical guide for developing, growing, and troubleshooting a dedicated pelvic floor imaging service. METHODS The authors provide an organized approach to the development of a pelvic floor MRI program based on the experience of the SAR Pelvic Floor Disease Focused Panel in academic and private practice settings. Topics addressed include creating interest, staff education, patient preparation both before and after arrival to the imaging center, image acquisition, reporting, and troubleshooting. RESULTS Using the organization and approach in this guide, the challenge of growing this relatively complex imaging program can be simplified. Familiarity with best practices and established techniques used by successful programs will allow new sites to avoid early pitfalls and quickly develop a mature and autonomous workflow. CONCLUSIONS The development and growing of a pelvic floor MRI program presents its own set of challenges and unique workflow issues which can create anxiety in both patients and providers. We systematically present an approach to streamline the development of a successful pelvic floor MRI program.
Collapse
Affiliation(s)
- Ari Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Robert Marks
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Simin Bahrami
- Division of Abdominal Imaging & Interventions, Department of Radiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
7
|
Pelvic floor dysfunctions: how to image patients? Jpn J Radiol 2019; 38:47-63. [DOI: 10.1007/s11604-019-00903-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022]
|
8
|
Prasad R, Gelder K, Wiles R. The patient's experience of defaecating proctography: Comparing magnetic resonance with conventional fluoroscopy techniques. Radiography (Lond) 2019; 25:24-27. [PMID: 30599825 DOI: 10.1016/j.radi.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fluoroscopy and MRI are currently used to investigate defaecation and pelvic floor dysfunction, with advantages and disadvantages to both modalities. Anecdotally it is suspected that MRI, allowing more privacy, may be better tolerated by patients but that symptoms may be more easily replicated with fluoroscopic technique due to the physiological position. The aim of this study was to evaluate the patient experience of both techniques to potentially help guide the choice of defaecating proctography modality in the future. METHODS This prospective study was conducted June 2015-March 2017 in a large teaching hospital. Patients undergoing fluoroscopy (FDP) or MR defaecating proctography (MRDP) completed a post-procedure questionnaire rating their satisfaction (1-5, 5 being most satisfied) of different aspects of the test. RESULTS 24 patients underwent FDP and 17 MRDP. Both procedures were scored highly in general for all questions with mean >4.1 and median 5, out of 5. Though not statistically significant, the mean scores for all aspects of the test were slightly higher for fluoroscopy than MR. As well as scoring higher for comfort (4.8 vs 4.4) and dignity maintained (4.6 vs 4.1), the patients who underwent fluoroscopy thought it was easier to replicate symptoms than the patient who underwent MR defaecating proctography (4.6 vs 4.2). CONCLUSION This study shows that both FDP and MRDP are well tolerated in the investigation of defaecation and pelvic floor dysfunction. FDP was scored consistently higher than MRDP, but this was not statistically significant. Thus, this study suggests that patient tolerance of the test is unlikely to be any worse for FDP than for MRDP. Clinicians and radiologists should take into account risks of radiation exposure as well as potential for surgical management when making their decision as to which test is appropriate. The authors recommend that if the patient is unable to replicate their symptoms in MRDP, fluoroscopy should be performed to ensure significant pathology is not being missed.
Collapse
Affiliation(s)
- R Prasad
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - K Gelder
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - R Wiles
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
| |
Collapse
|
9
|
Abdominal Hernias, Giant Colon Diverticulum, GIST, Intestinal Pneumatosis, Colon Ischemia, Cold Intussusception, Gallstone Ileus, and Foreign Bodies: Our Experience and Literature Review of Incidental Gastrointestinal MDCT Findings. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28638830 PMCID: PMC5468579 DOI: 10.1155/2017/5716835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Incidental gastrointestinal findings are commonly detected on MDCT exams performed for various medical indications. This review describes the radiological MDCT spectrum of appearances already present in the past literature and in today's experience of several gastrointestinal acute conditions such as abdominal hernia, giant colon diverticulum, GIST, intestinal pneumatosis, colon ischemia, cold intussusception, gallstone ileus, and foreign bodies which can require medical and surgical intervention or clinical follow-up. The clinical presentation of this illness is frequently nonspecific: abdominal pain, distension, nausea, fever, rectal bleeding, vomiting, constipation, or a palpable mass, depending on the disease. A proper differential diagnosis is essential in the assessment of treatment and in this case MDCT exam plays a central rule. We wish that this article will familiarize the radiologist in the diagnosis of this kind of incidental MDCT findings for better orientation of the therapy.
Collapse
|
10
|
Iacobellis F, Brillantino A, Renzi A, Monaco L, Serra N, Feragalli B, Iacomino A, Brunese L, Cappabianca S. MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position. Gastroenterol Res Pract 2016; 2016:6594152. [PMID: 26880893 PMCID: PMC4737448 DOI: 10.1155/2016/6594152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/13/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction. Functional disorders of the pelvic floor represent have a significant impact on the quality of life. The advent of open-configuration systems allowed for the evaluation of defecation with MR imaging in sitting position. The purpose of the present study is to compare the results of static and dynamic pelvic MR performed in supine position versus sitting position, using a new MR prototype machine, in the diagnosis of pelvic floor descent. Materials and Methods. Thirty-one patients with pelvic floor disorders were enrolled, and underwent MR Defecography in supine position with 1.5 T closed magnet (MAGNETOM Symphony, Siemens, Germany) and in sitting position with a 0.25-Tesla open magnet system (G-Scan ESAOTE, Italy). Results. In rest and squeezing phases, positions of bladder, vagina, and ARJ were significantly different when the patient was imaged in supine versus sitting position. In the defecation phase, a significant difference for the bladder and vagina position was detected between the two exams whereas a significant difference for the ARJ was not found. A statistically significant difference exists when the pelvic floor descent is evaluated in sitting versus supine position. Conclusion. Our results show that MR Defecography in sitting position may represent a useful tool to correctly diagnose and grade the pelvic organ descent.
Collapse
Affiliation(s)
- Francesca Iacobellis
- Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Antonio Brillantino
- “Villa delle Querce” Hospital, Via Battistello Caracciolo 48, 80136 Napoli, Italy
| | - Adolfo Renzi
- “Villa delle Querce” Hospital, Via Battistello Caracciolo 48, 80136 Napoli, Italy
| | - Luigi Monaco
- “Villa Esther” Hospital, Via Due Principati 169, 83100 Avellino, Italy
| | - Nicola Serra
- Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Beatrice Feragalli
- Department of Medical, Oral and Biotechnological Sciences, “G. D'Annunzio” University, Via dei Vestini, 66013 Chieti, Italy
| | - Aniello Iacomino
- Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Luca Brunese
- Department of Health Science, University of Molise, Viale Giovanni Paolo II 1, 86100 Campobasso, Italy
| | - Salvatore Cappabianca
- Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy
| |
Collapse
|
11
|
Salzano A, Rocca A, Arcopinto M, Amato B, Marra AM, Simonelli V, Mozzillo P, Giuliani A, Tafuri D, Cinelli M. Bowel Angiodysplasia and Myocardial Infarction secondary to an ischaemic imbalance: a case report. Open Med (Wars) 2015; 10:543-548. [PMID: 28352752 PMCID: PMC5368879 DOI: 10.1515/med-2015-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022] Open
Abstract
Angiodysplasia, defined as a vascular ectasia or arteriovenous malformation, is the most frequent cause of occult bleeding in patients older than 60 years and a significant association with several cardiac condition is described. Patients with anemia and negative findings on upper endoscopy and colonoscopy should be referred for further investigation of the small bowel. The investigation of choice, when available, is wireless capsule endoscopy. Several therapeutic options are available in this cases, as we reviewed in this report. We report a case of 78-year old man admitted to our Intensive Coronary Unit for dyspnea and chest pain. A diagnosis of non-ST-segment elevation acute coronary syndrome was made and a concomintant, significant anemia was found (hemoglobin 8.2 g/dl). No cororary disease was found by an angiography though the past medical history revealed systemic hypertension, chronic kidney disease (KDOQY stage III), and diabetes mellitus type II on insuline therapy. A Wireless Video capsule examination was positive for jejunum angiodysplasia and an argon plasma coagulation was chosen as terapeutic option. No subsequent supportive therapy and interventions were required in subsequent one year of follow-up.
Collapse
Affiliation(s)
- Andrea Salzano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University of Naples "Federico II" Naples, Italy, Via Sergio Pansini, 80131 Naples, Italy
| | - Michele Arcopinto
- Department of Cardiac Surgery, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Alberto Maria Marra
- Pulmonary Hypertension Center, Thoraxclinic at the University of Heidelberg, Heidelberg, Germany
| | | | - Pasquale Mozzillo
- Centre Hospitalier intercommunal de Poissy, Saint-Germain-en-Laye, France
| | - Antonio Giuliani
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation, "A. Cardarelli" Hospital, Naples, Italy
| | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Mariapia Cinelli
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
12
|
Pellino G, Selvaggi F. From colon-sparing techniques to pelvic ileal pouch: history and evolution of surgery for ulcerative colitis. Eur Surg 2015. [DOI: 10.1007/s10353-015-0309-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
13
|
Reginelli A, Russo A, Pinto A, Stanzione F, Martiniello C, Cappabianca S, Brunese L, Squillaci E. The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients. Int J Surg 2014; 12 Suppl 2:S181-S186. [DOI: 10.1016/j.ijsu.2014.08.345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/19/2023]
|
14
|
Reginelli A, Di Grezia G, Izzo A, D'andrea A, Gatta G, Cappabianca S, Squillaci E, Grassi R. Imaging of adrenal incidentaloma: our experience. Int J Surg 2014; 12 Suppl 1:S126-31. [PMID: 24862667 DOI: 10.1016/j.ijsu.2014.05.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate clinical, biochemical and radiological features in 35 patients with adrenal incidentaloma found on CT and/or MRI and to define the management of patients with adrenal masses. MATHERIAL AND METHODS From January 2011 and May 2013, 35 patients (19F, 16M) with an adrenal mass incidentally discovered on CT and/or MRI were enrolled in a retrospective study. Thirthy-two patients underwent MDCT and eight 1.5 MRI. RESULTS Patients consisted in 16 males and 19 females, aged between 25 and 89 yo. Adrenal lesions were most commonly found in the sixth decade; in relation to the side of the mass, 20 were found on left side, 15 on the right. Of all the mass analyzed, 3 were <1 cm diameter, 29 between 1 and 4 cm, 3 > 4 cm. The most common finding on CT was adenoma-like appearance (19 cases in relation to size, 14 in relation to attenuation values). Hormonal analysis showed 32 cases of nonfunctional masses and 3 cases of hormone activity. Adrenalectomy was performed in ten patients having adenoma (5 cases), malignant lesions (2 cases), pheocromocitoma, cyst and myelolipoma (1 case). CONCLUSION Diagnostic approach to adrenal incidentaloma is focused on the definition of malignancy and hormonal activity; the characterization is needs hormonal and radiological (CT and/or MRI) evaluation, even if a fine needle aspiration is needed in selected cases. Benign and/or non-hypersecreting hormone lesion with <4 cm diameter could be sent to follow-up; active adrenal tumors or >4 cm diameter lesions with malignancy suspicious or growth during follow-up could be treated with surgical adrenalectomy.
Collapse
Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy.
| | - Graziella Di Grezia
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Andrea Izzo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Alfredo D'andrea
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Gianluca Gatta
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Ettore Squillaci
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| |
Collapse
|