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Ma X, Niu T, Peng Y, Xu S. The first case report of rectal artery embolization in the treatment of radiation proctitis. Asian J Surg 2024; 47:1003-1004. [PMID: 37945401 DOI: 10.1016/j.asjsur.2023.10.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Xiaolong Ma
- The First Clinical Medical College of Gansu University of Chinese Medicine, 730000, China
| | - Tao Niu
- The First Clinical Medical College of Gansu University of Chinese Medicine, 730000, China
| | - Yiyun Peng
- The First Clinical Medical College of Gansu University of Chinese Medicine, 730000, China
| | - Shiyun Xu
- Gansu Provincial Hospital, 730000, China.
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Kim MS, Yang SJ, Jung SY, Lee TY, Park JK, Park YG, Woo SY, Kim SE, Lee RA. Combination of phytochemicals, including ginsenoside and curcumin, shows a synergistic effect on the recovery of radiation-induced toxicity. PLoS One 2024; 19:e0293974. [PMID: 38241326 PMCID: PMC10798472 DOI: 10.1371/journal.pone.0293974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/20/2023] [Indexed: 01/21/2024] Open
Abstract
Radiotherapy is commonly used to treat solid cancers located in the pelvis. A considerable number of patients experience proctitis of varying severity, even for a considerable period after radiotherapy. These side effects are often long-lasting or progressively worsen despite multiple therapeutic efforts and are a primary cause of an unexpectedly low quality of life, even after successful cancer treatment. Therefore, this study evaluated the individual and combined efficacy of ginsenoside, curcumin, butyric acid, and sucralfate compounds in treating radiation-induced proctitis. While the candidate compounds did not affect the proliferation and migration of cancer cells, they promoted the recovery of cell activity, including motility. They exhibited anti-inflammatory effects on human dermal fibroblasts or human umbilical vein endothelial cells within in vitro disease models. When each compound was tested, curcumin and ginsenoside were the most effective in cell recovery and promoted the migration of human dermal fibroblasts and cell restoration of human umbilical vein endothelial cells. The combination of ginsenoside and curcumin resulted in cell migration recovery of approximately 54%. In addition, there was a significant improvement in the length of the endothelial tube, with an increase of approximately 25%, suggesting that the ginsenoside-curcumin-containing combination was the most effective against radiation-induced damage. Furthermore, studies evaluating the effects of combined treatments on activated macrophages indicated that the compounds effectively reduced the secretion of inflammatory cytokines, including chemokines, and alleviated radiation-induced inflammation. In conclusion, our study provides valuable insights into using curcumin and ginsenoside as potential compounds for the effective treatment of radiation-induced injuries and highlights the promising therapeutic benefits of combining these two compounds.
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Affiliation(s)
- Min-Sung Kim
- Central Research Center, CORESTEMCHEMON Inc., Seoul, South Korea
| | - Su-Jeong Yang
- Central Research Center, CORESTEMCHEMON Inc., Seoul, South Korea
| | - Seo-Yeong Jung
- Central Research Center, CORESTEMCHEMON Inc., Seoul, South Korea
| | - Tae-Yong Lee
- Central Research Center, CORESTEMCHEMON Inc., Seoul, South Korea
| | - Jin-Kyung Park
- Central Research Center, CORESTEMCHEMON Inc., Seoul, South Korea
| | - Yun-Gyeong Park
- Central Research Center, CORESTEMCHEMON Inc., Seoul, South Korea
| | - So-Youn Woo
- Department of Microbiology, Ewha Womans University, College of Medicine, Seoul, South Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, South Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University, College of Medicine, Seoul, South Korea
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Skvortsova TE, Oganezova IA, Medvedeva OI. [Progressive radiation-induced rectal injury: is there an opportunity to get out of a vicious circle? A clinical case]. TERAPEVT ARKH 2023; 95:870-875. [PMID: 38159020 DOI: 10.26442/00403660.2023.10.202453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
Radiation therapy is one of the main treatment option for prostate cancer used either independently or as a component of combined and complex treatment of the disease. Modern achievements make it possible to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues, however, does not eliminate them. In most patients, clinical manifestations of chronic radiation proctitis occur during the first 2 years after radiation therapy. The article summarizes the current knowledge about pathophysiology, clinical manifestations, diagnostics and treatment options for this condition. In this paper, we present a case of complicated of chronic radiation proctitis.
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Strobel TM, Desai NA, Arrington-Sanders R. Acute Infectious Proctitis in Adolescents. Pediatr Rev 2023; 44:491-497. [PMID: 37653133 DOI: 10.1542/pir.2022-005862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The diagnosis of acute proctitis requires understanding who is at risk, being aware of symptoms, and leveraging a thorough sexual history with appropriate risk stratification to make the diagnosis. Cases have been concentrated in adolescents (ages 15-19 years), young adults (ages 20-24 years), men and transgender women who have sex with men, and those with a history of human immunodeficiency virus infection. Black adolescents experience a disproportionately high number of cases of proctitis due to an intersection of concentrated cases in sexual networks and delayed screening/diagnosis due to health care access barriers. Signs and symptoms include purulent discharge, bleeding, pain, tenesmus, pruritus, diarrhea or constipation, weight loss, or fever. Multisite sexually transmitted infection testing should be offered based on risk stratification (eg, history of condomless anal sex, oral intercourse, number of sex partners). Further management includes promotion of barrier protection and preexposure prophylaxis, routine surveillance, partner notification, and routine access to preventive immunizations.
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Affiliation(s)
| | - Neerav A Desai
- Division of Adolescent and Young Adult Health, Vanderbilt University Medical Center, Nashville, TN
| | - Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Jain N, Mohan JA, Ramita S, Kanchan S, Amandeep K, Meena S. Argon plasma coagulation therapy in hemorrhagic radiation proctitis following pelvic radiation in gynecological malignancies. J Cancer Res Ther 2023; 19:708-712. [PMID: 37470598 DOI: 10.4103/jcrt.jcrt_1364_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Introduction Chronic radiation proctitis is a common chronic complication of malignant pelvic diseases after pelvic radiation therapy. Although, the incidence has decreased after advent of intensity-modulated radiotherapy due to better control of radiation dose to rectum. In the era of conventional two-field radiotherapy to pelvis, this was a common complication usually presenting after 1-2 years of treatment completion. Rectal bleeding caused by radiation proctitis is difficult to manage. Argon plasma coagulation (APC) is an electrocoagulation technique that appears to be an effective and low-cost alternative to the use of lasers in gastrointestinal endoscopy. The aim of this study was to evaluate the efficacy of APC, as well as patients' tolerance of the procedure, in the treatment of bleeding radiation-induced proctitis. Materials and Methods Between January 2015 and August 2017, 29 patients of cancer cervix treated with definite radiotherapy both external and brachytherapy who suffered from rectal bleeding due to radiation proctitis were included for treatment with argon plasma laser (APC). Twenty-three patients suffered from anemia, 16 of whom required blood transfusion. APC was performed, applying the no-touch spotting technique at an electrical power of 40 Watt and an argon gas flow of 1.5-2.0 l/min. Pulse duration was <0.5 s. Treatment sessions were carried out at intervals of 3 weeks. Subjects received 2-4 treatment sessions. Results Twenty-eight out of 29 patients were accessible for effects and results. APC led to persistent clinical and endoscopic remission of rectal bleeding after a median of three sessions. No adverse effects were encountered after initial treatment. All the patients were in complete remission. Conclusions APC is an effective, safe, and well-tolerated treatment for rectal bleeding caused by chronic radiation proctitis. It should be considered as a first-line therapy for radiation proctitis.
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Affiliation(s)
- Neeraj Jain
- Department of Radiation Oncology, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India
| | - Jerath Amitabh Mohan
- Department of Gastroenterology, Sarvhit Gastrocity, Smt Parvati Devi Hospital, Amritsar, Punjab, India
| | - Sharma Ramita
- Department of Radiation Oncology, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India
| | - Sachdeva Kanchan
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kaur Amandeep
- Department of Medical Physics, Gujrat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Sudan Meena
- Department of Radiation Oncology, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India
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Kim WH, Yoo JH, Yoo IK, Kwon CI, Hong SP. Effects of Mesenchymal Stem Cells Treatment on Radiation-Induced Proctitis in Rats. Yonsei Med J 2023; 64:167-174. [PMID: 36825342 PMCID: PMC9971437 DOI: 10.3349/ymj.2022.0342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE There are no effective treatment methods with which to control complications of radiation proctitis with fistula or recurrent bleeding following radiation treatment for prostate, cervical, or rectal cancer. Mesenchymal stem cells (MSCs) can induce immune modification, resulting in tissue repair and regeneration. Therefore, we used a rat model of radiation-induced proctitis and observed the effects of using human placenta-derived (PD) and adipose tissue-derived (AD) MSCs. MATERIALS AND METHODS Female Sprague Dawley rats were irradiated at the pelvic area with 25 Gy. We injected 1×106 cells of human PD-MSCs, human AD-MSCs, human foreskin fibroblasts, and control media into the rectal submucosa following irradiation. We sacrificed rats for pathologic evaluation. RESULTS Fibrosis on the rectum was reduced in both MSC groups, compared to the control group. Mucosal Ki-67 indices of both MSC injected groups were higher than those in the control group. Although caspase-3 positive cells in the mucosa gradually increased and decreased in the control group, those in both MSC injected groups increased rapidly and decreased thereafter. CONCLUSION We demonstrated the effects of regional MSC injection treatment for radiation-induced proctitis in rats. MSC injection reduced fibrosis and increased proliferation in rat mucosa. Human AD-MSCs and PD-MSCs had similar effectiveness.
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Affiliation(s)
- Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun Hwan Yoo
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - In Kyung Yoo
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Gaio-Lima C, Castedo J, Cruz M, Candeias M, Camacho Ó. The role of hyperbaric oxygen therapy in the treatment of radiation lesions. Clin Transl Oncol 2022; 24:2466-2474. [PMID: 35976581 DOI: 10.1007/s12094-022-02892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cancer remains one of the leading causes of death worldwide, with 50-60% of patients requiring radiotherapy during the course of treatment. Patients' survival rate has increased significantly, with an inevitable increase in the number of patients experiencing side effects from cancer therapy. One such effect is late radiation injuries in which hyperbaric oxygen therapy appears as complementary treatment. With this work we intend to divulge the results of applying hyperbaric oxygen therapy among patients presenting radiation lesions in our Hyperbaric Medicine Unit. MATERIALS AND METHODS Retrospective analysis of clinical records of patients with radiation lesions treated at the Hyperbaric Medicine Unit assessed by the scale Late Effects of Normal Tissues-Subjective, Objective, Management, Analytical (LENT-SOMA) before and after treatment, between October 2014 and September 2019 were included. Demographic characteristics, primary tumor site, subjective assessment of the LENT-SOMA scale before and after treatment were collected and a comparative analysis (Students t test) was done. RESULTS 88 patients included: 33 with radiation cystitis, 20 with radiation proctitis, 13 with osteoradionecrosis of the mandible and 22 with radiation enteritis. In all groups, there was a significant decrease (p < 0.005) in the subjective parameter of the LENT-SOMA scale. DISCUSSION Late radiation lesions have a major influence on patients' quality of life. In our study hyperbaric oxygen therapy presents as an effective therapy after the failure of conventional treatments. CONCLUSION Hyperbaric oxygen therapy is an effective complementary therapy in the treatment of refractory radiation lesions.
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Affiliation(s)
- Clara Gaio-Lima
- Serviço de Anestesiologia, ULSM (Unidade Local de Saúde de Matosinhos), Matosinhos, Portugal.
- ULSM (Unidade Local de Saúde de Matosinhos), Unidade de Medicina Hiperbárica, Matosinhos, Portugal.
| | - João Castedo
- Serviço de Anestesiologia, ULSM (Unidade Local de Saúde de Matosinhos), Matosinhos, Portugal
| | - Mafalda Cruz
- Serviço de Radioterapia, IPO Porto (Instituto Português de Oncologia do Porto Francisco Gentil), Porto, Portugal
| | | | - Óscar Camacho
- Serviço de Anestesiologia, ULSM (Unidade Local de Saúde de Matosinhos), Matosinhos, Portugal
- ULSM (Unidade Local de Saúde de Matosinhos), Unidade de Medicina Hiperbárica, Matosinhos, Portugal
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Alpuim Costa D, Amaro CE, Nunes A, Cardoso JS, Daniel PM, Rosa I, Branco JV. Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis: Useless or useful? – A literature review. World J Gastroenterol 2021; 27:4413-4428. [PMID: 34366613 PMCID: PMC8316904 DOI: 10.3748/wjg.v27.i27.4413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/02/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is the backbone of multimodality treatment of more than half of cancer cases. Despite new modern RT techniques, late complications may occur such as radiation proctitis (RP). The natural history of RP is unpredictable. Minor symptoms may resolve spontaneously or require conservative treatment. On the other hand, for similar and uncomplicated clinical contexts, symptoms may persist and can even be refractory to the progressive increase in treatment measures. Over the last decades, an enormous therapeutic armamentarium has been considered in RP, including hyperbaric oxygen therapy (HBOT). Currently, the evidence regarding the impact of HBOT on RP and its benefits is conflicting. Additional prospective and randomised studies are necessary to validate HBOT’s effectiveness in the ‘real world’ clinical practice. This article reviewed the relevant literature on pathophysiology, clinical presentation, different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.
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Affiliation(s)
- Diogo Alpuim Costa
- Department of Haematology and Oncology, CUF Oncologia, Lisboa 1998-018, Portugal
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Lisboa 1169-056, Portugal
| | - Carla Espiney Amaro
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- Department of Otorhinolaryngology, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - Ana Nunes
- Department of Gastroenterology, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - Joana Santos Cardoso
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Department of Vascular Surgery, Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Lisboa 1169-024, Portugal
| | - Pedro Modas Daniel
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- Department of Intensive Care Unit, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - Isabel Rosa
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- Department of General Surgery, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - João Vieira Branco
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
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Bejarano Rengifo J, Cañadas Garrido R. [Sexually transmitted infectious proctitis: diagnostic challenge and treatment recommendations]. Rev Gastroenterol Peru 2020; 40:336-341. [PMID: 34087923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexually transmitted infectious proctitis is an inflammatory process of the rectum secondary to infection by sexually transmitted germs. Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex virus (HSV) are the most frequently pathogens. Infectious proctitis is more prevalent in men who have sex with men (MSM) and in patients with human immunodeficiency virus (HIV) infection, however, it is also diagnosed in heterosexuals by changes in sexual behavior. Fecal urgency, purulent or bloody exudate, proctalgia, and tenesmus are the most common clinical manifestations. Detailed clinical history and a high index of suspicion are important to establish the diagnosis of this pathology; supported by endoscopic, histological, serological, and microbiological studies. Empirical treatment with antibiotics or antivirals is recommended, depending on clinical suspicion, and other sexually transmitted infections (STIs) should always be ruled out.
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Affiliation(s)
| | - Raúl Cañadas Garrido
- Unidad de Gastroenterología y Endoscopia digestiva, Hospital Universitario San Ignacio. Bogotá, Colombia
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Gentile M, Cestaro G, Formisano C, Sivero L. Treatment and outcomes of patients with chronic radiation proctitis. A single-center experience and review of the literature. Ann Ital Chir 2020; 91:668-672. [PMID: 33554948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chronic radiation proctitis is a frequent complication after radiotherapy for pelvic malignancies. It is reported that 1 to 5% of patients develop chronic radiation proctitis even with recent advances in external radiotherapy. Hematochezia, mucus discharge, urgency and tenesmus are common symptoms and they can vary in severity but bleeding is often the most debilitating to the patient. Different options are reported for treatment of this condition that always should keep in differential diagnosis in patients with history of pelvic radiotherapy. Treatments range from easy, with topic administration of formalina, to expensive and requiring specialized equipment such as hyperbaric oxygen therapy. Surgery is reserved to patients with failure of conservative treatments due to the high risk of leakage and high morbidity up to 60%. KEY WORDS: Argon beam, Bleeding, Formalin, Radiation, Proctitis, Sucralfate enema.
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Wang L, Wang J. [Chinese consensus on diagnosis and treatment of radiation proctitis (2018)]. Zhonghua Wei Chang Wai Ke Za Zhi 2018; 21:1321-1336. [PMID: 30588581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Radiation proctitis denotes the radiation damage of rectum caused by radiotherapy to pelvic malignancy. The clinical practices of radiation proctitis should be fully considered from diagnosis, treatment and prevention. In order to determine appropriate treatment strategies, the diagnosis of radiation proctitis should be based on clinical symptoms, endoscopic findings, imaging and histopathology to assess severity of symptoms and stage of disease. In terms of treatment decisions, non-surgical interventions are generally applied to relieve major symptoms and avoid serious complications. Diverting colostomy and restorative resection are the main surgical treatments for patients with recurrent symptoms. In terms of prevention, radiation proctitis should be prevented by improvement of radiotherapy technology, physical protection and prophylactic medication. This guide aims to provide guidance for the clinical practices of radiation proctitis in China.
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Affiliation(s)
- Lei Wang
- Surgeon Branch of Chinese Medical Doctor Association, Colorectal Surgery Group of Surgery Branch in the Chinese Medical Association.
| | - Jianping Wang
- Surgeon Branch of Chinese Medical Doctor Association, Colorectal Surgery Group of Surgery Branch in the Chinese Medical Association.
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Gjurašin B, Lepej SŽ, Cole MJ, Pitt R, Begovac J. Chlamydia trachomatis in Cervical Lymph Node of Man with Lymphogranuloma Venereum, Croatia, 2014 1. Emerg Infect Dis 2018; 24:806-808. [PMID: 29553338 PMCID: PMC5875274 DOI: 10.3201/eid2404.171872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report an HIV-infected person who was treated for lymphogranuloma venereum cervical lymphadenopathy and proctitis in Croatia in 2014. Infection with a variant L2b genovar of Chlamydia trachomatis was detected in a cervical lymph node aspirate. A prolonged course of doxycycline was required to cure the infection.
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Weiner JP, Wong AT, Schwartz D, Martinez M, Aytaman A, Schreiber D. Endoscopic and non-endoscopic approaches for the management of radiation-induced rectal bleeding. World J Gastroenterol 2016; 22:6972-6986. [PMID: 27610010 PMCID: PMC4988305 DOI: 10.3748/wjg.v22.i31.6972] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023] Open
Abstract
Pelvic radiation is a commonly utilized treatment for malignancy of the genitourinary and lower gastrointestinal tract. Radiation proctitis and the resultant clinical picture varies from asymptomatic to potentially life threatening. Similarly, treatment options also vary greatly, from medical therapy to surgical intervention. Commonly utilized medical therapy includes sucralfate enemas, antibiotics, 5-aminosalicylic acid derivatives, probiotics, antioxidants, short-chain fatty acids, formalin instillation and fractionated hyperbaric oxygen. More invasive treatments include endoscopic-based, focally ablative interventions such as dilation, heater and bipolar cautery, neodymium/yttrium aluminum garnet argon laser, radiofrequency ablation or argon plasma coagulation. Despite its relatively common frequency, there is a dearth of existing literature reporting head-to-head comparisons of the various treatment options via a randomized controlled approach. The purpose of our review was to present the reader a consolidation of the existing evidence-based literature with the goal of highlighting the comparative effectiveness and risks of the various treatment approaches. Finally, we outline a pragmatic approach to the treatment of radiation proctitis. In light of the lack of randomized data, our goal is to pursue as least invasive an approach as possible, with escalation of care tailored to the severity of the patient’s symptoms. For those cases that are clinically asymptomatic or only mildly symptomatic, observation or medical management can be considered. Once a patient fails such management or symptoms become more severe, invasive procedures such as endoscopically based focal ablation or surgical intervention can be considered. Although not all recommendations are supported by level I evidence, reported case series and single-institutional studies in the literature suggest that successful treatment with cessation of symptoms can be obtained in the majority of cases.
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van de Wetering FT, Verleye L, Andreyev HJN, Maher J, Vlayen J, Pieters BR, van Tienhoven G, Scholten RJPM. Non-surgical interventions for late rectal problems (proctopathy) of radiotherapy in people who have received radiotherapy to the pelvis. Cochrane Database Syst Rev 2016; 4:CD003455. [PMID: 27111831 PMCID: PMC7173735 DOI: 10.1002/14651858.cd003455.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2002, and previously updated in 2007. Late radiation rectal problems (proctopathy) include bleeding, pain, faecal urgency, and incontinence and may develop after pelvic radiotherapy treatment for cancer. OBJECTIVES To assess the effectiveness and safety of non-surgical interventions for managing late radiation proctopathy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2015); MEDLINE (Ovid); EMBASE (Ovid); CANCERCD; Science Citation Index; and CINAHL from inception to November 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing non-surgical interventions for the management of late radiation proctopathy in people with cancer who have undergone pelvic radiotherapy for cancer. Primary outcomes considered were: episodes of bowel activity, bleeding, pain, tenesmus, urgency, and sphincter dysfunction. DATA COLLECTION AND ANALYSIS Study selection, 'Risk of bias' assessment, and data extraction were performed in duplicate, and any disagreements were resolved by involving a third review author. MAIN RESULTS We identified 1221 unique references and 16 studies including 993 participants that met our inclusion criteria. One study found through the last update was moved to the 'Studies awaiting classification' section. We did not pool outcomes for a meta-analysis due to variation in study characteristics and endpoints across included studies.Since radiation proctopathy is a condition with various symptoms or combinations of symptoms, the studies were heterogeneous in their intended effect. Some studies investigated treatments targeted at bleeding only (group 1), some investigated treatments targeted at a combination of anorectal symptoms, but not a single treatment (group 2). The third group focused on the treatment of the collection of symptoms referred to as pelvic radiation disease. In order to enable some comparison of this heterogeneous collection of studies, we describe the effects in these three groups separately.Nine studies assessed treatments for rectal bleeding and were unclear or at high risk of bias. The only treatments that made a significant difference on primary outcomes were argon plasma coagulation (APC) followed by oral sucralfate versus APC with placebo (endoscopic score 6 to 9 in favour of APC with placebo, risk ratio (RR) 2.26, 95% confidence interval (CI) 1.12 to 4.55; 1 study, 122 participants, low- to moderate-quality evidence); formalin dab treatment (4%) versus sucralfate steroid retention enema (symptom score after treatment graded by the Radiation Proctopathy System Assessments Scale (RPSAS) and sigmoidoscopic score in favour of formalin (P = 0.001, effect not quantified, 1 study, 102 participants, very low- to low-quality evidence), and colonic irrigation plus ciprofloxacin and metronidazole versus formalin application (4%) (bleeding (P = 0.007, effect not quantified), urgency (P = 0.0004, effect not quantified), and diarrhoea (P = 0.007, effect not quantified) in favour of colonic irrigation (1 study, 50 participants, low-quality evidence).Three studies, of unclear and high risk of bias, assessed treatments targeted at something very localised but not a single pathology. We identified no significant differences on our primary outcomes. We graded all studies as very low-quality evidence due to unclear risk of bias and very serious imprecision.Four studies, of unclear and high risk of bias, assessed treatments targeted at more than one symptom yet confined to the anorectal region. Studies that demonstrated an effect on symptoms included: gastroenterologist-led algorithm-based treatment versus usual care (detailed self help booklet) (significant difference in favour of gastroenterologist-led algorithm-based treatment on change in Inflammatory Bowel Disease Questionnaire-Bowel (IBDQ-B) score at six months, mean difference (MD) 5.47, 95% CI 1.14 to 9.81) and nurse-led algorithm-based treatment versus usual care (significant difference in favour of the nurse-led algorithm-based treatment on change in IBDQ-B score at six months, MD 4.12, 95% CI 0.04 to 8.19) (1 study, 218 participants, low-quality evidence); hyperbaric oxygen therapy (at 2.0 atmospheres absolute) versus placebo (improvement of Subjective, Objective, Management, Analytic - Late Effects of Normal Tissue (SOMA-LENT) score in favour of hyperbaric oxygen therapy (HBOT), P = 0.0019) (1 study, 150 participants, moderate-quality evidence, retinol palmitate versus placebo (improvement in RPSAS in favour of retinol palmitate, P = 0.01) (1 study, 19 participants, low-quality evidence) and integrated Chinese traditional plus Western medicine versus Western medicine (grade 0 to 1 radio-proctopathy after treatment in favour of integrated Chinese traditional medicine, RR 2.55, 95% CI 1.30 to 5.02) (1 study, 58 participants, low-quality evidence).The level of evidence for the majority of outcomes was downgraded using GRADE to low or very low, mainly due to imprecision and study limitations. AUTHORS' CONCLUSIONS Although some interventions for late radiation proctopathy look promising (including rectal sucralfate, metronidazole added to an anti-inflammatory regimen, and hyperbaric oxygen therapy), single small studies provide limited evidence. Furthermore, outcomes important to people with cancer, including quality of life (QoL) and long-term effects, were not well recorded. The episodic and variable nature of late radiation proctopathy requires large multi-centre placebo-controlled trials (RCTs) to establish whether treatments are effective. Future studies should address the possibility of associated injury to other gastro-intestinal, urinary, or sexual organs, known as pelvic radiation disease. The interventions, as well as the outcome parameters, should be broader and include those important to people with cancer, such as QoL evaluations.
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Affiliation(s)
- Fleur T van de Wetering
- Julius Center for Health Sciences and Primary Care / University Medical Center UtrechtDutch Cochrane CentrePO Box 85500UtrechtNetherlands3508 GA
| | - Leen Verleye
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | | | - Jane Maher
- Mount Vernon HospitalDepartment of Radiotherapy and OncologyRickmansworth RoadNorthwoodMiddlesexUKHA6 2RN
| | - Joan Vlayen
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Bradley R Pieters
- Academic Medical Center / University of AmsterdamDepartment of Radiation OncologyMeibergdreef 9AmsterdamNetherlands1105
| | - Geertjan van Tienhoven
- Academic Medical CenterRadiation Oncology and HyperthermiaP.O. Box 22700Meibergdreef 9AmsterdamNetherlands1100 DE
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care / University Medical Center UtrechtDutch Cochrane CentrePO Box 85500UtrechtNetherlands3508 GA
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15
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Nash GF. Minimally invasive treatment of radiation proctitis and piles - a video vignette. Colorectal Dis 2015; 17:1122-4. [PMID: 26382829 DOI: 10.1111/codi.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/26/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Guy F Nash
- Department of Surgery, Poole Hospital, Poole, BH15 2JB, UK.
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16
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Ma TH, Yuan ZX, Zhong QH, Wang HM, Qin QY, Chen XX, Wang JP, Wang L. Formalin irrigation for hemorrhagic chronic radiation proctitis. World J Gastroenterol 2015; 21:3593-3598. [PMID: 25834325 PMCID: PMC4375582 DOI: 10.3748/wjg.v21.i12.3593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/19/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy and safety of a modified topical formalin irrigation method in refractory hemorrhagic chronic radiation proctitis (CRP).
METHODS: Patients with CRP who did not respond to previous medical treatments and presented with grade II-III rectal bleeding according to the Common Terminology Criteria for Adverse Events were enrolled. Patients with anorectal strictures, deep ulcerations, and fistulas were excluded. All patients underwent flexible endoscopic evaluation before treatment. Patient demographics and clinical data, including primary tumor, radiotherapy and previous treatment options, were collected. Patients received topical 4% formalin irrigation in a clasp-knife position under spinal epidural anesthesia in the operating room. Remission of rectal bleeding and related complications were recorded. Defecation, remission of bleeding, and other symptoms were investigated at follow-up. Endoscopic findings in patients with rectovaginal fistulas were analyzed.
RESULTS: Twenty-four patients (19 female, 5 male) with a mean age of 61.5 ± 9.5 years were enrolled. The mean time from the end of radiotherapy to the onset of bleeding was 11.1 ± 9.0 mo (range: 2-24 mo). Six patients (25.0%) were blood transfusion dependent. The median preoperative Vienna Rectoscopy Score (VRS) was 3 points. Nineteen patients (79.2%) received only one course of topical formalin irrigation, and five (20.8%) required a second course. No side effects were observed. One month after treatment, bleeding cessation was complete in five patients and obvious in 14; the effectiveness rate was 79.1% (19/24). For long-term efficacy, 5/16, 1/9 and 0/6 patients complained of persistent bleeding at 1, 2 and 5 years after treatment, respectively. Three rectovaginal fistulas were found at 1 mo, 3 mo and 2 years after treatment. Univariate analysis showed associations of higher endoscopic VRS and ulceration score with risk of developing rectovaginal fistula.
CONCLUSION: Modified formalin irrigation is an effective and safe method for hemorrhagic CRP, but should be performed cautiously in patients with a high endoscopic VRS.
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17
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Mamedov MM, Mustafayeva MF. [New approaches in surgical treatment of acute paraproctitis]. Klin Khir 2015:20-21. [PMID: 25985689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The results of treatment of 77 patients, ageing 18-71 yrs old, for an acute paraproctitis in 2010-2014 yrs were analyzed. A preventive puncture-flush enzymosanation of purulent foci, using immobilized bacterial proteinases (imozimase), metrogyl P in conjunction with low-intensive laser irradiation have permitted to conduct the optimal preoperative preparation of patients, to improve their state, to reduce the local inflammatory reactions intensity significantly.
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18
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Koessler T, Servois V, Mariani P, Aubert E, Cacheux W. Rectal ulcer: Due to ketoprofen, argon plasma coagulation and prostatic brachytherapy. World J Gastroenterol 2014; 20:17244-17246. [PMID: 25493041 PMCID: PMC4258597 DOI: 10.3748/wjg.v20.i45.17244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/19/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
Prostatic brachytherapy with permanent seed implants is a recent and safe radiation therapy technique associated with radiation-induced digestive disease. Argon plasma coagulation procedure is a validated modality in the management of haemorrhagic radiation proctitis, which is known to occasionally induce chronic rectal ulcers. We report here an original case report of an acute painful rectal ulcer as a consequence of the combination of short-term therapy with non-steroidal anti-inflammatory drugs therapy, prostatic brachytherapy with malposition of seed implants and argon plasma coagulation procedure in a patient with haemorrhagic radiation proctitis. The description of this clinical observation is essential to recommend the discontinuation of non-steroidal anti-inflammatory drugs therapy and the control of the position of seed implants in case of prostatic brachytherapy before argon plasma coagulation for radiation-induced proctitis.
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Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc 2014; 80:689-706. [PMID: 25070906 DOI: 10.1016/j.gie.2014.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- M Aamir Ali
- Department of Gastroenterology, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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20
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Parejo S, Vázquez-Sequeiros E. Argon gas in the management of radiation proctitis--effective and safe for everyone? Rev Esp Enferm Dig 2014; 106:155-158. [PMID: 25007013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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21
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Hortelano E, Gómez-Iturriaga A, Ortiz-de-Zárate R, Zaballa M, Barturen Á, Casquero F, San-Miguel Í, Carvajal C, Cacicedo J, Del-Hoyo O, Lupiani J, Pérez F, Bilbao P. Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? Rev Esp Enferm Dig 2014; 106:165-170. [PMID: 25007015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION In severe cases refractory to medical treatment, APC appears to be the preferred alternative to control persistent rectal bleeding of patients with chronic radiation proctitis. Although successful outcomes have been demonstrated in patients previously treated with moderate doses of radiotherapy, there is reluctance towards its indication due to the concern of severe adverse events in patients treated with high doses of radiation. OBJECTIVES The aim of this study was to assess the efficacy and toxicity of APC in the management of bleeding radiationinduced proctitis in patients treated with high doses of radiation for prostate cancer. METHODS AND MATERIALS Data from 30 patients were treated with APC due to chronic radiation proctitis, were reviewed retrospectively. All cases had prostate cancer and 9 of them (30 %) underwent previous radical prostatectomy. The median dose of conformal 3D External Beam Radiotherapy (EBRT) delivered was 74 Gy (range 46-76). Median rectal D1cc and D2cc was 72.5 and 72.4 Gy respectively. Median rectal V70, V60 and V40 was 12, 39.5 and 80 %. Cardiovascular and digestive disease, diabetes, smoking behaviour, lowest haemoglobin and transfusion requirements were recorded. Indications for treatment with APC were anemia and persistent bleeding despite medical treatment. Argon gas flow was set at 1.8 l/min with an electrical power setting of 50 W. RESULTS Median age of all patients was 69.6 years. The median lowest haemoglobin level was 9.6 g/dL. Median time between completion of radiotherapy and first session of APC was 13 months. Ninety-four therapeutic sessions were performed (median 3 sessions). Median time follow-up was 14.5 months (range 2-61). Complete response with resolved rectal bleeding was achieved in 23 patients (77 %), partial response in 5 (16 %) and no control in 2 (6 %). No patients required transfusion following therapy. Two patients developed long-term (> 6 weeks) grade 2 rectal ulceration and grade 2 rectal incontinence, respectively. CONCLUSIONS The argon plasma coagulation is an effective and safe management option in patients with medically refractory rectal bleeding after high doses of radiation for prostate cancer.
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22
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I recently developed proctitis after completing radiation treatment for prostate cancer. What should I do? Johns Hopkins Med Lett Health After 50 2014; 25:7. [PMID: 25122934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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23
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Perotti C, Del Fante C, Alvisi C, Cervio M, Scudeller L. A cure for post-radiation proctitis? Blood Transfus 2014; 12 Suppl 1:s243-s244. [PMID: 23736909 PMCID: PMC3934213 DOI: 10.2450/2013.0272-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 01/30/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Cesare Perotti
- Immuno-haematology and Transfusion Service and Centre for Transplant Immunology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Claudia Del Fante
- Immuno-haematology and Transfusion Service and Centre for Transplant Immunology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Costanza Alvisi
- Endoscopic unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marila Cervio
- Immuno-haematology and Transfusion Service and Centre for Transplant Immunology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Luigia Scudeller
- Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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24
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Abstract
Sexually transmitted diseases (STDs) are common and they can involve the anus and rectum in both men and women. In this article, the main bacterial and viral STDs that affect the anus and rectum are discussed, including their prevalence, presentation, and treatment.
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Affiliation(s)
- Molly M Cone
- Department of Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Clavo B, Ceballos D, Gutierrez D, Rovira G, Suarez G, Lopez L, Pinar B, Cabezon A, Morales V, Oliva E, Fiuza D, Santana-Rodriguez N. Long-term control of refractory hemorrhagic radiation proctitis with ozone therapy. J Pain Symptom Manage 2013; 46:106-12. [PMID: 23102757 DOI: 10.1016/j.jpainsymman.2012.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/21/2012] [Accepted: 07/01/2012] [Indexed: 11/26/2022]
Abstract
CONTEXT Persistent or severe hemorrhagic radiation proctitis (HRP) has limited therapeutic options. OBJECTIVES To describe our experience with ozone therapy (O3T) in the management of refractory HRP. METHODS Patients (n=17; median age 69 years [range 42-80 years]) previously irradiated for prostate or uterine cancer and suffering persistent or severe HRP without response to conventional treatment were enrolled to receive an O3/O2 gas mixture via rectal insufflations and topical application of ozonized oil. Most of the patients (83%) had Grade 3 or Grade 4 toxicity. Median follow-up post-O3T was 40 months (range 3-56 months). RESULTS Endoscopic treatments required were: 43 (median 1; range 0-10) pre-O3T; 17 (median 0; range 0-8; P=0.063) during O3T; and five (median 0; range 0-2; P=0.008) during follow-up. Hemoglobin levels were 10.35g/dL (7-14g/dL) pre-O3T and 13g/dL (9-15g/dL) (P=0.001) post-O3T. Median toxicity grades were 3 (range 2-4) pre-O3T, 1 (range 0-2; P<0.001) at the end of O3T, and 0 (range 0-1; P<0.001) at the last follow-up. CONCLUSION Persistent advanced HRP was significantly improved with O3T. The addition of O3T can be useful as a complementary treatment in the long-term management of HRP and, as such, merits further evaluation.
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Affiliation(s)
- Bernardino Clavo
- Radiation Oncology Department, Dr. Negrin University Hospital, Las Palmas, Spain.
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26
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Feldmeier JJ. Hyperbaric oxygen therapy and delayed radiation injuries (soft tissue and bony necrosis): 2012 update. Undersea Hyperb Med 2012; 39:1121-1139. [PMID: 23342770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Informal surveys at CME meetings have shown that approximately one-third of patients in the United States receive hyperbaric oxygen (HBO2) for delayed radiation injury. More than 600,000 patients receive radiation for malignancy in our country annually, and about one-half will be long-term survivors. Serious radiation complications occur in 5-10% of survivors. A large population of patients is therefore at risk for radiation injury. HBO2 has been applied to treat patients with radiation injury since the mid-1970s. Published results are consistently positive, but the level of evidence for individual publications is usually not high level, consisting mostly of case series and case reports. Only a rare randomized controlled trial has been accomplished. Radiation injury is one of the UHMS "approved" indications, and third-party payors will usually reimburse for this application. This updated review summarizes the publications available reporting results in treating radiation-injured patients. Mechanisms of HBO2 in radiation injury are discussed briefly. Outcome is reported on a mostly anatomic basis though due to the nature of the injury a positive outcome at one anatomic site is supportive of HBO2 at other sites. The potential benefit of prophylactic HBO2 before frank damage is also discussed in high-risk patients. The concerns of HBO2 enhancing growth of or precipitating recurrence of malignancy is discussed and largely refuted.
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Affiliation(s)
- John J Feldmeier
- Radiation Oncology, University of Toledo Medical Center, Toledo, Ohio, USA.
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27
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Fujii T, Sutoh T, Morita H, Katoh T, Yajima R, Yamaguchi S, Tsutsumi S, Asao T, Kuwano H. Perianal abscess and sigmoidocutaneous fistula due to diverticulitis. Am Surg 2012; 78:62-63. [PMID: 22369795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Takaaki Fujii
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan.
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28
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Wang L, Ma TH, Peng H, Cao XP, Guo XF, Lan P, Wang JP. [Risk factors associated with prognosis in patients with radiation proctitis]. Zhonghua Wei Chang Wai Ke Za Zhi 2011; 14:188-191. [PMID: 21442481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate risk factors associated with prognosis in patients with radiation proctitis (RP). METHODS Between August 2007 and February 2010, 33 patients diagnosed with radiation proctitis were identified. Data pertaining to treatments and quality of life(QOL) were analyzed retrospectively. RESULTS Indication for radiation included cervical cancer(n=22), prostate cancer (n=3), ovary cancer (n=2), rectal cancer (n=2), endometrial cancer(n=2), cervical cancer (n=1), and vaginal cancer(n =1). Data regarding radiation were available in 18 patients, and the mean dose was (61.3±12.9) Gy with a median dose of 61 Gy. Eleven were treated with enema therapy, 9 formalin dab, 12 surgical operations. Clinical improvement was noticed in 75% of the patients with a mean QOL score of 63.79±20.92. Prognosis was favorable in 75% of the patients. Surgical treatment was effective in 91.7% of the patients with severe complications. Univariate analysis showed that gender was associated with the prognosis of RP, while the severity of RP and treatment method were not predictive for RP prognosis. CONCLUSIONS Gender but not disease severity is associated with the prognosis of radiation proctitis. Surgery may be beneficial to RP patients with severe complications.
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Affiliation(s)
- Lei Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
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29
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Affiliation(s)
- Geoffrey Williams
- Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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30
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Affiliation(s)
- A-C Riehemann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstrasse 55, 45122, Essen, Deutschland
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Piccolomini A, Francioli N, Verre L, Guarnieri A, Vuolo G, Di Cosmo L, Tirone A, Chieca R, Tucci E, Carli AF. [Radiation proctitis: description of two cases refractory to pharmacological treatment]. Chir Ital 2009; 61:341-346. [PMID: 19694237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Radiation proctitis, is a relatively frequent complication resulting from the direct or collateral irradiation of the rectum in radiotherapy treatment for genito-urinary or anorectal malignancies. The main symptoms are diarrhoea, tenesmus, proctorrhagia, anal pain, mucorrhoea and faecal incontinence. The evolution of chronic radiation proctitis requires treatment for related anaemia, anal incontinence and micturition disorders. The approach and type of treatment depend on the severity of the symptoms and on the endoscopic aspect, in relation to the response to previous medical therapy performed. In our experience, endoscopic treatment is the best choice in the presence of ongoing bleeding and the possible development of severe anaemia. The surgical option is mandatory in patients at high risk of sepsis, requiring a faecal diversion constructed using the Hartmann technique. We report two cases, observed during the last two years, one treated with endoscopic bipolar coagulation and the other with a double urinary and faecal diversion.
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Affiliation(s)
- Alessandro Piccolomini
- U O C Chirurgia 2, Dipartimento di Chirurgia e Bioingegneria, Azienda Ospedaliera Universitaria Senese, Siena
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32
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Adler DC, Zhou C, Tsai TH, Schmitt J, Huang Q, Mashimo H, Fujimoto JG. Three-dimensional endomicroscopy of the human colon using optical coherence tomography. Opt Express 2009; 17:784-96. [PMID: 19158891 PMCID: PMC2886288 DOI: 10.1364/oe.17.000784] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Three-dimensional (3D) endomicroscopy imaging of the human gastrointestinal tract is demonstrated in vivo using a swept source optical coherence tomography (OCT) system. 3D datasets of normal and pathologic regions of the colon, rectum, and anal verge were obtained from seven volunteers undergoing diagnostic or therapeutic colonoscopy. 3D-OCT enables high resolution endomicroscopy examination through visualization of tissue architectural morphology using virtual cross-sectional images with arbitrary orientations as well as en face projection images. Axial image resolutions of 6 mum in tissue are obtained over a approximately 180 mm2 field with an imaging range of 1.6 mm. A Fourier domain mode locked (FDML) laser providing a tuning range of 180 nm at a sweep rate of 62 kHz is used as the system light source. This clinical pilot study demonstrates the potential of 3D-OCT for distinguishing normal from pathologic colorectal tissue, assessing endoscopic therapies and healing progression.
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Affiliation(s)
- Desmond C. Adler
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Chao Zhou
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Tsung-Han Tsai
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Joe Schmitt
- LightLab Imaging Inc., Westford, Massachusetts 01886
| | - Qin Huang
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts 02130
- Harvard Medical School, Harvard University, Cambridge, Massachusetts 02139
| | - Hiroshi Mashimo
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts 02130
- Harvard Medical School, Harvard University, Cambridge, Massachusetts 02139
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Corresponding Author:
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33
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Clarke D. Effective patient blinding during hyperbaric trials. Undersea Hyperb Med 2009; 36:13-17. [PMID: 19341123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hyperbaric medicine is applied for several disease states. Laboratory evidence is compelling but clinical efficacy remains incompletely validated. The standard by which supportive research is measured is termed evidence-based medicine, with results of randomized, blinded trials being most desirable. Blinding patients during hyperbaric exposure poses unique challenges. Few such studies are reported and confirmation of its success lacking. A study of patients suffering radiation-induced proctitis was conducted. It involved blinding of sham controls via a minimal air compression technique. Prior to unblinding 72 patients were surveyed using a standardized questionnaire to determine if they had been aware of their treatment allocation. Twenty of the 33 in the treatment group answered that they were in the treatment group, one answered sham and 12 did not know. Twenty-three of 39 in the sham group thought they were in the treatment group, two said sham and 14 did not know. A Chi-square analysis detected no relationship between what treatment was provided and what patients thought they received (p = 0.9058). Eliminating those who did not know, a Kappa statistic was p = 0.0299, indicating that there was no agreement beyond chance. Minimal air compression is an effective blinding tool for patients enrolled in hyperbaric trials.
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Affiliation(s)
- D Clarke
- The Baromedical Research Foundation, Columbia, South Carolina, USA
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34
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Huang H, Lu JG, Cao YQ. [Advances in treatment of radiation proctitis]. Zhong Xi Yi Jie He Xue Bao 2008; 6:975-978. [PMID: 18782547 DOI: 10.3736/jcim20080921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- He Huang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
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35
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Juviler A, Hyman N. Anorectal sepsis and fistula-in-ano. Surg Technol Int 2008; 17:139-149. [PMID: 18802894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Anorectal abscesses and fistulas are common maladies that are usually readily diagnosed and effectively treated. However, complex fistulous disease challenges even the most expert of surgical specialists. The management options in this subset of patients are suboptimal, with treatment often requiring multiple procedures, putting the patient at risk for continued symptoms and fecal incontinence. In this chapter, the clinical aspects of perianal suppurative disease are discussed and an attempt is made to deal with many of the more challenging aspects of patient management.
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Affiliation(s)
- Adam Juviler
- Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA
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Bednarek M, Drozdz W. [A rare case of the extensive Fournier's gangrene developed in the course of a perianal abscess]. Przegl Lek 2008; 65:410-412. [PMID: 19140392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fournier's gangrene is a rare necrotising fascitis of the perineum and genitals caused by mixture of aerobic and anaerobic microorganism. Despite appropriate therapy mortality in this disease is still high. We report a case of Fournier's syndrome which developed in the course of a perianal abscess. Due to the aggressive nature of this condition, early diagnosis is crucial. Treatment involves extensive soft tissue debridement and broad-spectrum antibiotic therapy. The clinical applicability of the so called Fournier's gangrene severity index score (FGSIS) was discussed.
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Affiliation(s)
- Marcin Bednarek
- II Katedra Chirurgii Collegium Medicum, Uniwersytet Jagielloński, Kraków
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37
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Hampson NB, Corman JM. Rate of delivery of hyperbaric oxygen treatments does not affect response in soft tissue radionecrosis. Undersea Hyperb Med 2007; 34:329-334. [PMID: 18019083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Soft tissue radiation necrosis (STRN) is effectively treated with hyperbaric oxygen (HBO,), believed to result from stimulation ofangiogenesis in radiation-injured tissue. Thirty to forty HBO2 treatments are usually recommended for STRN. For various reasons, different hyperbaric facilities offer these treatments once or twice daily and from 5-7 days weekly. It is not known whether the clinical response differs as a result of the rate of administration of HBO2 treatments. METHODS Details of hyperbaric treatment courses of patients treated for radiation enteritis/proctitis (n = 65) and cystitis (n = 94) at a single institution were reviewed. Outcomes were compared with the total number of HBO2 treatments administered and also rate of treatment administration. RESULTS Responses were similar for both forms of STRN whether the patient averaged fewer or greater than 5 treatments per week, or even < or = 3 versus > or = 7 treatments weekly. Outcome did differ, however, dependant on the total number of treatments administered. Response was better in patients receiving 30 or more total treatments, as compared with fewer. CONCLUSIONS Soft tissue radionecrosis of the gastrointestinal tract or bladder is (1) effectively treated with hyperbaric oxygen, (2) has a higher response rate if at least 30 treatments are administered, and (3) is equally responsive to rates of hyperbaric treatment ranging from 3 or fewer to 7 or more treatments per week.
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Affiliation(s)
- N B Hampson
- Center for Hyperbaric Medicine, Section of Pulmonary and Critical Care Medicine, Virginia Mason Medical Center Seattle, Washington, USA
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Abstract
Late complications of pelvic radiotherapy occur in 5-20% of patients, particularly chronic radiation proctitis (CRP). Rectal bleeding is the most common symptom. Other symptoms include difficulty in defaecation or tenesmus because of loss of distensibility of the rectum or rectal structuring. Treatment options of CRP include oral therapy (5-aminosalicylates, metronidazole), rectal instillation therapy (hydrocortisone, sucralfate, 5-aminosalicylates, formalin), thermal therapy (argon plasma coagulation, heater probe or laser) and hyperbaric oxygen. It is difficult to recommend evidence-based therapy. There are no adequately powered studies of the treatment of CRP and most data are uncontrolled, non-blinded observation studies from single sites. There are no standard evaluation tools (including endoscopic grading, symptom scores and quality-of-life scores), adequate description of preceding radiotherapy dose or adequate follow-up in most studies. Many studies have poor documentation of complications and few are carried out prospectively. A pragmatic approach is to use sucralfate enemas and oral metronidazole. Thermal methods seem to be effective and safe. Simple heater probe treatment or argon plasma coagulation are the preferred methods due to their better safety profile. Intra-rectal formalin seems to be effective, but possibly has a higher rate of complications. For resistant disease, hyperbaric oxygen may be an option.
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Affiliation(s)
- K Leiper
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK.
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Abstract
PURPOSE The short-term safety and efficacy of 2 percent formalin administered as a retention enema for hemorrhagic radiation proctitis was studied. METHODS A group of 24 patients with hemorrhagic radiation proctitis who received radical radiotherapy were administered 2 percent formalin as a retention enema and the treatment was followed up from 1 to 29 (mean, 15.34) weeks. The enema was performed on an outpatient basis under sedation with pentazocine and promethazine with a retention time of two minutes. The symptoms and proctoscope findings were graded and converted into a numeric score, ranging from 1 to 4. The mean improvements in scores before treatment and after the last follow-up were analyzed for statistical significance by using the paired t-test. RESULTS There was complete cessation of bleeding in 47.8 percent of patients and very negligible bleeding in 30.4 percent. A total of 78.2 percent responded positively to treatment with 2 percent formalin retention enema. More than one application was required in 34.7 percent of the patients. The procedure was well tolerated and most of the side effects were mild. Side effects were diarrhea in 23.5 percent, abdominal pain and tenesmus in 8.8 percent, and fever with vomiting in 2.9 percent of patients. There was a statistically significant reduction in bleeding and proctoscopy scores (P<0.01). None of the patients in this study required surgery to palliate their symptoms. CONCLUSIONS Two percent formalin when given as a retention enema is a safe, inexpensive, and effective intervention for hemorrhagic radiation proctitis. Any trained health worker using simple precautions can perform this procedure. The long-term efficacy and safety of 2 percent formalin retention enemas need further assessment with randomized, controlled trials.
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Affiliation(s)
- Ramaiyer Raghu Raman
- Department of Radiation Oncology, MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India.
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Seksik P, Daniel F, Marteau P, Beaugerie L, Cosnes J. [Refractory proctitis]. ACTA ACUST UNITED AC 2007; 31:393-7. [PMID: 17483776 DOI: 10.1016/s0399-8320(07)89398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Philippe Seksik
- Service de Gastroentérologie et Nutrition, Hôpital Saint-Antoine, Paris, France.
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Gau JT, Acharya U, Marx T, Verne GN, Carlsen W. Megacolon and stercoral proctitis after frequent fecal impactions: report of an unusual case and review of the literature. J Am Med Dir Assoc 2007; 8:338-41. [PMID: 17570316 DOI: 10.1016/j.jamda.2007.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 01/04/2007] [Indexed: 10/23/2022]
Abstract
Persistent megacolon that results from frequent episodes of fecal impaction without adequate treatment is a rare and seldom reported condition in the elderly. This report discusses a 72-year-old white woman presenting with a large abdominal mass, who had at least 4 episodes of radiographically demonstrated fecal impaction over the previous year without adequate treatment. The patient required hospitalization for a bleeding rectal ulcer during the second episode of fecal impaction. Computed tomography (CT) scans on this admission revealed a dilated colon up to 16 x 14 cm in maximal dimensions extending over 30 cm, filled with massive fecal material. Several follow-up abdominal radiographs revealed a persistent megacolon after 10 months despite the absence of significant fecal material in the rectosigmoid colon. While multiple contributing factors were likely involved in her frequent fecal impactions, the clinical course of this case suggests that frequent fecal impactions without adequate treatment can lead to megacolon in high-risk patients. Clinicians should aggressively treat fecal impaction and monitor the adequacy of treatment with abdominal radiography in order to avoid significant complications. Complications and management of fecal impaction and the pathophysiology of megacolon in the literature are reviewed and discussed.
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Affiliation(s)
- Jen-Tzer Gau
- Department of Geriatric Medicine/Gerontology, College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA.
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Abstract
Sexually transmitted infections such as chlamydia, gonorrhoea, herpes simplex virus and syphilis commonly present with rectal symptoms. Recent outbreaks of lymphogranuloma venereum among homosexual men throughout Europe highlight the need to consider sexually transmitted infections in the differential diagnosis of proctitis. This article examines the causative organisms, clinical features, diagnosis and treatment of sexually transmitted proctitis.
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Affiliation(s)
- E Hamlyn
- Department of Sexual Health and HIV Medicine, Caldecot Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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Abstract
OBJECTIVE To evaluate the efficacy of hyperbaric oxygen therapy in treatment of severe refractory radiation-induced hemorrhagic proctitis. METHODS Nine patients with median age 75 (range, 66-83) treated with hyperbaric oxygen (HBO) at University of Cincinnati were reviewed. Pre- and post-therapy bleeding was graded on a 5-point scale. Five patients had previous hospitalizations for anemia and required transfusions. Three patients had undergone electrocautery or argon plasma coagulation before hyperbaric oxygen therapy (HBOT). The remainder had medical therapy before HBO. No patients experienced resolution of symptoms before HBO. The median follow-up after HBO was 17 months (range, 1-77). RESULTS Seven patients had complete resolution of rectal bleeding. Two patients exhibited a partial response, but continued to experience intermittent bleeding. The Wilcoxon signed rank test determined that HBOT significantly reduced rectal bleeding. CONCLUSIONS HBOT is a very effective treatment of hemorrhagic radiation-induced proctitis.
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Abstract
Delayed radiation-induced injuries are difficult to treat. The treatment of delayed radiation injuries with hyperbaric oxygen therapy (HBOT) is reported in small case series and case reports. This study reports the experience of a single institution with HBOT in delayed radiation injuries in patients with gynecological cancers. At least 20 sessions of 100% oxygen inhalation at 2.4 Atmospheric Absolutes (ATA) for 90 min in a hyperbaric chamber were carried out. Of the 14 patients included in the study, 10 patients have healed or showed improvement of more than 50%, resulting in a success rate of 71%. Mean follow-up was 31.6 months (range 6-70 months). The adverse events were acceptable. HBOT should be considered for patients with delayed radiation injuries, not responding to other treatments.
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Affiliation(s)
- D Fink
- Gynaecological Cancer Centre, Royal Hospital for Women, Sydney, Australia.
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Abstract
BACKGROUND The goal of this work was to critically evaluate the published studies on the treatment of ulcerative proctitis (UP) and left-sided ulcerative colitis (L-UC). The results of this review provided the content for the accompanying treatment guidelines, Clinical Guidelines for the Medical Management of Left-sided Ulcerative Colitis and Ulcerative Proctitis: Summary Statement. METHODS All English language articles published between 1995 and September 2005 were identified through a comprehensive literature search using OVID and PubMed. The quality of the data supporting or rejecting the use of specific therapies was categorized by a data quality grading scale. An "A+" grade was assigned to treatment supported by multiple high-quality randomized controlled trials with consistent results, whereas a "D" grade was given to therapy supported only by expert opinion. The therapeutic efficacy of a treatment was defined by its success in treating UP and L-UC compared with placebo. A medication was ranked as "excellent" if it was specifically studied for UP and L-UC and had consistently positive results compared with placebo or another agent. Quality and efficacy scores were agreed on by author consensus. RESULTS For the acute treatment of UP or L-UC, the rectally administered corticosteroids and mesalazine (5-ASA), either alone or in combination with oral 5-ASAs, are the most effective therapy: evidence quality, A+; efficacy, excellent. Only rectally administered 5-ASA received an A+/excellent rating for maintenance of remission. Infliximab received an A+ grade for induction and maintenance of remission but only a "good" rating because the studies were performed in all UC, not specifically UP or L-UC. CONCLUSIONS This critical evaluation of treatment provides a "report card" on medications available for the management of patients with UP and L-UC. The guidelines should provide a useful reference and supplement for physicians treating UC patients.
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Affiliation(s)
- Miguel Regueiro
- Inflammatory Bowel Disease Center and Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Regueiro M, Loftus EV, Steinhart AH, Cohen RD. Clinical guidelines for the medical management of left-sided ulcerative colitis and ulcerative proctitis: summary statement. Inflamm Bowel Dis 2006; 12:972-8. [PMID: 17012968 DOI: 10.1097/01.mib.0000231496.92013.85] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are few published guidelines for the treatment of inflammatory bowel disease. Physicians choose therapy based on evidence-based data, peer and expert opinion, and personal experience. This article provides treatment guidelines for the induction and maintenance of ulcerative proctitis and left-sided colitis and the management of disease refractory to 5-aminosalicylic acid (5-ASA) compounds and corticosteroids The guidelines are derived from evidence-based data and, when lacking, expert opinion or the authors' experience. The comprehensive review of the literature is presented in the accompanying article, "The Medical Management of Left-Sided Ulcerative Colitis and Ulcerative Proctitis: Critical Evaluation of Therapeutic Trials". Rectally administered 5-ASA and corticosteroid suppositories are effective treatment for most ulcerative proctitis patients. Corticosteroid and 5-ASA enemas, which reach the splenic flexure of the colon, are recommended for patients with left-sided ulcerative colitis. The combination of rectally administered 5-ASA enemas and oral 5-ASA agents may afford better treatment of left-sided colitis and possibly prevent proximal extension of disease. Patients refractory to 5-ASAs and corticosteroids may require an immunomodulator or biological response modifier therapy. Those who have ongoing signs and symptoms of ulcerative proctitis and left-sided ulcerative colitis despite maximal medical therapy require a proctocolectomy.
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Affiliation(s)
- Miguel Regueiro
- Inflammatory Bowel Disease Center and Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Dall'Era MA, Hampson NB, Hsi RA, Madsen B, Corman JM. Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer. J Urol 2006; 176:87-90. [PMID: 16753375 DOI: 10.1016/s0022-5347(06)00491-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Indexed: 02/06/2023]
Abstract
PURPOSE Radiation proctitis is a common complication following external beam radiation therapy and brachytherapy for prostate cancer. While 95% percent of radiation induced proctitis is temporary and self-limiting, up to 5% of patients experience toxicities that are refractory to conservative management. Hyperbaric oxygen has a well-defined role in treating chronic wounds, osteomyelitis, hemorrhagic cystitis and necrotizing fasciitis. We reviewed our experience with hyperbaric oxygen therapy for radiation induced proctitis in patients undergoing radiation treatment for prostate cancer. MATERIALS AND METHODS From October 1998 to December 2003, 27 patients with radiation induced proctitis secondary to brachytherapy (4), external beam radiation therapy (16) or combined modality (7) for prostate cancer were treated with hyperbaric oxygen therapy at Virginia Mason Medical Center in Seattle, Washington. In all patients primary medical or endoscopic management had failed. Patients received 100% oxygen in a multiplace hyperbaric chamber at a pressure of 2.4 atmospheres absolute for 90 minutes 5 to 7 days weekly for an average of 36 sessions (range 29 to 60). Data were collected from a retrospective review of medical records following approval by the Institutional Review Board at Virginia Mason Medical Center. RESULTS All 27 men completed the planned course of therapy. Of patients with bleeding 48% showed complete resolution after therapy, while 28% reported significantly fewer bleeding episodes. Of patients 50% noted complete resolution of fecal urgency. Six of the 8 patients (75%) with pain noticed some improvement after therapy, although no patients reported complete resolution of rectal pain. Of patients with rectal ulceration 21% showed complete resolution of the ulcer on posttreatment endoscopy, while 29% showed evidence of improvement. Six patients (43%) had no change or worsening of rectal ulcers. Overall 67% of patients had a partial to good response, while 33% showed no response or disease progression. CONCLUSIONS This series of patients showed a good overall response rate to hyperbaric oxygen for radiation induced proctopathy after other attempts at management had failed. Hyperbaric oxygen is generally well tolerated and it remains an important treatment option for managing this common and difficult disease.
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Affiliation(s)
- Marc A Dall'Era
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center and Department of Urology, University of Washington, 1100 Ninth Avenue, Seattle, WA 98111, USA
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Abstract
Acute ischemic proctitis is a rare pathological condition. We report here a patient presented with massive rectal haemorrhage from a bleeding vessel superimposed on an underlying pathology of ischemic proctitis. This case report illustrates the difficulties in making the clinical distinction between ischemic proctitis and other pathological entities. We also discussed the beneficial role of arteriogram with embolotherapy as an effective therapeutic measure in the management of lower gastrointestinal bleeding. The literature on the subject is reviewed.
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Affiliation(s)
- Vincent-S K Yip
- Department of Surgery, Southern General Hospital, Glasgow, UK.
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Affiliation(s)
- Paul E Wise
- Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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