1
|
Bugalho A, Guedes F, Freitas F, Rodrigues LV, Clementsen PF, Eberhardt R, Cepeda Ribeiro J. LINEAR ENDOSONOGRAPHY IN LUNG CANCER: A COMPREHENSIVE REVIEW. Port J Card Thorac Vasc Surg 2022; 29:35-43. [PMID: 35471220 DOI: 10.48729/pjctvs.239] [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] [Received: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
The role of endobronchial ultrasound (EBUS) and trans-esophageal endobronchial ultrasound (EUS-B) in lung cancer is well established and scientifically validated. There is increasing data that endosonography is a crucial tool for the diagnosis of central lung lesions, and mediastinal staging and restaging of non-small cell lung cancer patients. The present article reviews the technical aspects of EBUS and EUS-B and focus on the last published research regarding its value in lung cancer.
Collapse
Affiliation(s)
- Antonio Bugalho
- Pulmonology Unit, CUF Tejo Hospital, Lisbon, Portugal; Pulmonology Unit, CUF Descobertas Hospital, Lisbon, Portugal; Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Lisbon, Portugal
| | - Fernando Guedes
- Pulmonology Department, Centre Hospitalier de Luxembourg, Luxembourg
| | - Francisco Freitas
- Pulmonology Unit, CUF Tejo Hospital, Lisbon, Portugal; Pulmonology Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Luis Vaz Rodrigues
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | | | - Ralf Eberhardt
- Pulmonology and Intensive Care Medicine Department, Asklepios KlinikBarmbek, Hamburg, Germany
| | | |
Collapse
|
2
|
Guedes F, Ferreira AJ, Dionísio J, Rodrigues LV, Bugalho A. Pre- and post-COVID practice of interventional pulmonology in adults in Portugal. Pulmonology 2022:S2531-0437(22)00070-8. [PMID: 35339419 DOI: 10.1016/j.pulmoe.2022.02.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES There is a lack of information regarding bronchoscopy practice in adults in Portugal. Our objective was to obtain an overview of the characteristics, resources, techniques and behaviors in national interventional pulmonology (IP) units, before and after SARS-CoV-2 outbreak. MATERIALS AND METHODS An online survey was developed by an expert panel with a total of 46 questions comprising the specifications of each unit, namely physical space, equipment, staff, procedure planning, monitoring, technical differentiation, and numbers pre- and post-COVID-19. Forty-one interventional pulmonology centers were invited to participate between April and May 2021. RESULTS 37 units (90.2%) responded to the survey. The majority (64.9%) have a fully dedicated space with a weekly presence of ≥3 chest physicians (82.1%) and support of an anesthesiologist on specific days (48.6%). There is marked heterogeneity in the IP unit's equipment, and 56.8% acquired disposable bronchoscopes after COVID-19 pandemics. Pre-bronchoscopy hemogram, platelet count and coagulation tests are regularly asked by more than 90% of the units, even when deep sedation or biopsies are not planned. In 97.3% of cases, topical anesthesia and midazolam are utilized. Propofol (21.6%) and fentanyl (29.7%) are occasionally employed in some institutions. Most units use ancillary sampling techniques to diagnose central or peripheral lesions, with radial EBUS being used for guidance of distal procedures in 37.8% of centers, linear EBUS and EUS-B-FNA for mediastinal diagnosis and/or staging in 45.9% and 27.0% of units, respectively. Cryobiopsies are used by 21.6% of respondents to diagnose diffuse lung diseases. Rigid bronchoscopy is performed in 37.8% of centers. There was a decrease in the number of flexible (p < 0.001) and rigid (p = 0.005) bronchoscopies and an upscale of personal protective equipment (PPE) during the COVID-19 outbreak. CONCLUSIONS IP units have variable bronchoscopic practices, but during the COVID-19 pandemic, they complied with most international recommendations, as elective procedures were postponed and PPE levels increased.
Collapse
Affiliation(s)
- F Guedes
- Pulmonology Department, Centre Hospitalier de Luxembourg, Luxembourg; Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Porto, Portugal.
| | - A J Ferreira
- Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Dionísio
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - L V Rodrigues
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - A Bugalho
- Pulmonology Department, CUF Tejo Hospital and CUF Descobertas Hospital, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal
| |
Collapse
|
3
|
Jácome C, Marques A, Oliveira A, Rodrigues LV, Sanches I. Pulmonary telerehabilitation: An international call for action. Pulmonology 2020; 26:335-337. [PMID: 32591279 PMCID: PMC7311341 DOI: 10.1016/j.pulmoe.2020.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- C Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal.
| | - A Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - A Oliveira
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; West Park Healthcare Centre, Toronto, ON, Canada
| | - L V Rodrigues
- Pulmonology Department, Unidade Local de Saúde da Guarda E.P.E. - Hospital Sousa Martins, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - I Sanches
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
4
|
Guedes F, Boléo-Tomé JP, Rodrigues LV, Bastos HN, Campainha S, de Santis M, Mota L, Bugalho A. Recommendations for interventional pulmonology during COVID-19 outbreak: a consensus statement from the Portuguese Pulmonology Society. Pulmonology 2020; 26:386-397. [PMID: 32868252 PMCID: PMC7405831 DOI: 10.1016/j.pulmoe.2020.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a novel SARS-CoV-2 pathogen. Its capacity for human-to-human transmission through respiratory droplets, coupled with a high-level of population mobility, has resulted in a rapid dissemination worldwide. Healthcare workers have been particularly exposed to the risk of infection and represent a significant proportion of COVID-19 cases in the worst affected regions of Europe. Like other open airway procedures or aerosol-generating procedures, bronchoscopy poses a significant risk of spreading contaminated droplets, and medical workers must adapt the procedures to ensure safety of both patients and staff. Several recommendation documents were published at the beginning of the pandemic, but as the situation evolves, our thoughts should not only focus on the present, but should also reflect on how we are going to deal with the presence of the virus in the community until there is a vaccine or specific treatment available. It is in this sense that this document aims to guide interventional pulmonology throughout this period, providing a set of recommendations on how to perform bronchoscopy or pleural procedures safely and efficiently.
Collapse
Affiliation(s)
- F Guedes
- Centro Hospitalar do Porto (CHP), Hospital Geral de Santo António (HGSA), Unidade de Broncologia, Serviço de Pneumologia, Porto, Portugal; Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Porto, Portugal; Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Praça Gomes Teixeira, Apartado 55142, 4051-401, Porto, Portugal.
| | - J P Boléo-Tomé
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - L V Rodrigues
- Pulmonology Department, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - H N Bastos
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; IBMC/i3S - Instituto de Biologia Molecular e Celular / Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
| | - S Campainha
- Pulmonology Department, Vila Nova de Gaia-Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - M de Santis
- Pulmonology Department, Instituto Português de Oncologia (IPO), Coimbra, Portugal
| | - L Mota
- Pulmonology Department, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - A Bugalho
- Pulmonology Department, CUF Infante Santo Hospital and CUF Descobertas Hospital, Lisbon, Portugal; Comprehensive Health Research Centre, Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal
| |
Collapse
|
5
|
Regadas FSP, Murad-Regadas SM, Rodrigues LV, Regadas Filho FSP, Vilarinho AS, Morano DP. Impact of TRREMS on symptoms of obstructed defecation due to rectocele: predictive factors and outcomes. Tech Coloproctol 2019; 24:65-73. [PMID: 31828573 DOI: 10.1007/s10151-019-02131-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/22/2018] [Accepted: 11/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of the transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS) on the treatment of obstructed defecation due to rectocele and to identify the predictive factors for unsuccessful results. METHODS Consecutive patients with obstructed defecation symptoms (ODS) associated with rectocele who had the TRREMS procedure were included. Each patient was assessed by echodefecography, manometry, and colonic transit time as well as the Cleveland Clinic constipation score (CCS) before therapy and at follow-up after 6 months. Reduction in the CCS score was calculated as a ratio. Factors correlated with a decrease in the CCS were analyzed in a univariate analysis. RESULTS A total of 81 patients were included. Nineteen patients had postoperative complications that were not severe: 7 (8.6%) had tenesmus, 6 (7.4%) stenosis (4 treated with digital dilatation and 2 with endoscopic stricturectomy), 4 (4.9%) residual mucosal prolapse treated with rubber band ligation, 1 (1.2%) early bleeding, and 1(1.2%) thrombosis. Seventy-nine (97.5%) patients had a significant clinical response with significant reduction of the CCS constipation score from median 13 (range 17-10) to 4 (range, 8-2) (p = 0.0001); only 2 patients (2.5%) had an unsatisfactory response, complaining of straining and vaginal digitation during the evacuatory effort. Patients with anismus previously treated with biofeedback had a lower reduction ratio of the CCS score compared with patients without anismus (61.2 ± 2.8% versus 70.9% ± 1.5, p = 0.0006). There were no significant differences in the reduction of the CCS according to age, parity, type of delivery, previous hysterectomy, post-menopausal status, rectal mucosal prolapse and/or associated rectal intussusception, grade of rectocele and presence of complications. CONCLUSIONS The TRREMS procedure significantly improved evacuation disorders in this study. Appropriate selection of patients is key for the success of this approach. Anismus even if previously treated with biofeedback, was the main predictive factor of unsuccessful treatment.
Collapse
Affiliation(s)
- F S P Regadas
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil.
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil.
| | - S M Murad-Regadas
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Unit of Pelvic Floor and Anorectal Physiology, Clinical Hospital, Federal University of Ceará, Fortaleza, CE, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - L V Rodrigues
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - F S P Regadas Filho
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - A S Vilarinho
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
- Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, CE, Brazil
| | - D P Morano
- Department of Surgery, School of Medicine, School of Medicine of the Federal University of Ceará, Av Atilano de Moura 430, Fortaleza, Ceará, 60810-180, Brazil
| |
Collapse
|
6
|
Rodrigues LV, Gomes R, Samouco G, Guedes F, Ferreira L. Current utilization of pleuroscopy in mainland Portugal. Pulmonology 2019; 25:51-53. [PMID: 30770284 DOI: 10.1016/j.pulmoe.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- L V Rodrigues
- Pulmonology Department, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Portugal; Faculty of Health Sciences, Universidade da Beira Interior, Portugal.
| | - R Gomes
- Pulmonology Department, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Portugal; Faculty of Health Sciences, Universidade da Beira Interior, Portugal
| | - G Samouco
- Pulmonology Department, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Portugal
| | - F Guedes
- Bronchology Unit, Pulmonology Department, Centro Hospitalar e Universitário do Porto, Portugal; Animal Study Sciences Center, Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto, Portugal; Department of Veterinarian Clinics, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
| | - L Ferreira
- Pulmonology Department, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Portugal; Faculty of Health Sciences, Universidade da Beira Interior, Portugal
| |
Collapse
|
7
|
Rodrigues LV, Samouco G, Gomes R, Santos C, Ferreira L. Effectiveness and safety of local anesthetic, semi-flexible pleuroscopy - experience from a peripheral hospital. Pulmonology 2018; 25:9-14. [PMID: 29898873 DOI: 10.1016/j.pulmoe.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/27/2018] [Accepted: 05/06/2018] [Indexed: 10/14/2022] Open
Abstract
If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios. We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017. Data on demographics, previous biochemical, cytological and histopathological analysis, procedure details, diagnostic and therapeutic results, complications and mortality were collected from all patients. Statistical analysis was performed using SPSS v23. A total of 30 patients were included. They were mainly male (66.7%), with a median age of 72 years (minimum 19 years, maximum 87 years). All presented with exudative pleural effusions and the exam was performed for diagnostic reasons. Pleural tissue was obtained in all patients and the overall diagnostic accuracy was 93.3%. Malignancy was the chief group of diagnosis (66.7%), followed by pleural tuberculosis (13.3%). The procedure was well tolerated and self-limited subcutaneous emphysema was the only complication registered (13.3%). No deaths were associated with the procedure. Our results globally overlap those of wider series and reinforce the perception that local anesthetic semi-flexible pleuroscopy is a well-tolerated, safe and highly accurate diagnostic and therapeutic tool which has proved to be both feasible and effective in our experience.
Collapse
Affiliation(s)
- L V Rodrigues
- Pulmonology Department, Unidade Local de Saúde da Guarda, Portugal; Faculty of Health Sciences, University of Beira Interior, Portugal.
| | - G Samouco
- Pulmonology Department, Unidade Local de Saúde da Guarda, Portugal
| | - R Gomes
- Pulmonology Department, Unidade Local de Saúde da Guarda, Portugal; Faculty of Health Sciences, University of Beira Interior, Portugal
| | - C Santos
- Pulmonology Department, Unidade Local de Saúde da Guarda, Portugal
| | - L Ferreira
- Pulmonology Department, Unidade Local de Saúde da Guarda, Portugal; Faculty of Health Sciences, University of Beira Interior, Portugal
| |
Collapse
|
8
|
Samouco G, Maurício M, Ferreira L, Sanches I, Martins V, Rodrigues LV. Pulmonary rehabilitation at primary care - The results of a local survey. Rev Port Pneumol (2006) 2017; 23:356-357. [PMID: 28843517 DOI: 10.1016/j.rppnen.2017.07.005] [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: 07/11/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023] Open
Affiliation(s)
- G Samouco
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - M Maurício
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - L Ferreira
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal; University of Beira Interior, Covilhã, Portugal
| | - I Sanches
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
| | - V Martins
- Pulmonology Department, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - L V Rodrigues
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal; University of Beira Interior, Covilhã, Portugal.
| |
Collapse
|
9
|
Rodrigues LV, Moreira MSC, Oliveira CR, Medeiros JJ, Lima Neto EA, Valença AMG. Factors Associated with Toothache in Patients Affected by Hereditary Coagulopathies. Pesqui bras odontopediatria clín integr 2017. [DOI: 10.4034/pboci.2017.171.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
10
|
Murad-Regadas SM, Fernandes GODS, Regadas FSP, Rodrigues LV, Pereira JDJR, Dealcanfreitas ID, Regadas Filho FSP. Assessment of pubovisceral muscle defects and levator hiatal dimensions in women with faecal incontinence after vaginal delivery: is there a correlation with severity of symptoms? Colorectal Dis 2014; 16:1010-8. [PMID: 25110122 DOI: 10.1111/codi.12740] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/04/2014] [Indexed: 02/08/2023]
Abstract
AIM We assessed pubovisceral muscle (PVM) defects, levator hiatal dimensions and anal sphincter defects using three-dimensional (3D) endovaginal and anorectal ultrasonography in women with previous vaginal delivery and faecal incontinence to determine the relationship between anatomic/functional findings and severity of faecal incontinence symptoms. METHOD This was a prospective, observational study including 52 women with faecal incontinence symptoms who had undergone vaginal delivery. Asymptomatic nulliparous women (n = 17) served as controls to provide reference values for pelvic floor measurements. All participants underwent 3D endovaginal and anorectal ultrasonography. We used an ultrasound score to identify and quantify the extent of PVM defects and sphincter damage and to measure levator hiatal dimensions. Incontinence was assessed using the Cleveland Clinic Florida Incontinence Scoring System. RESULTS Defects of the PVM were identified with 3D endovaginal ultrasonography in 27% of women with faecal incontinence who had undergone vaginal delivery. The incontinence score and the ultrasound score were significantly higher in women with a PVM defect. A significant, positive correlation was found between the incontinence score and the ultrasound score. The levator hiatal dimensions were significantly greater, and the positions of the anorectal junction and bladder neck were lower, in women who had undergone vaginal delivery than in nulliparous women. CONCLUSION As determined by the 3D ultrasound score, severity of incontinence is related to the extent of damage of the PVM, as well as of the anal sphincters. Additionally, vaginal delivery results in enlargement of the levator hiatus and a lower position of the anorectal junction and bladder neck compared with nulliparous women.
Collapse
Affiliation(s)
- S M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Anorectal Physiology and Pelvic Floor Dysfunctions, Clinical Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | | | | | | | | |
Collapse
|
11
|
Murad-Regadas SM, Regadas FSP, Rodrigues LV, Kenmoti VT, Fernandes GODS, Buchen G, Regadas Filho FSP. Effect of vaginal delivery and ageing on the anatomy of the female anal canal assessed by three-dimensional anorectal ultrasound. Colorectal Dis 2012; 14:1521-7. [PMID: 22429657 DOI: 10.1111/j.1463-1318.2012.03033.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The effect of vaginal delivery and ageing on the anatomy of the anal canal was assessed using three-dimensional anorectal ultrasound to determine the interobserver reliability. METHOD One-hundred and eighteen asymptomatic women without sphincter damage were grouped according to parity and mode of delivery. They were then stratified by age (≤50 years vs >50 years). Group I consisted of 35 nulliparous women, of mean ages 36 years (n = 20) and 62 years (n = 15), Group II consisted of multiparous women, having one or more vaginal deliveries (n = 43), of mean ages 43 years (n = 20) and 60 years (n = 23) and Group III consisted of women who had a Caesarean section (n = 40) of mean ages 41 years (n = 20) and 56 years (n = 20). The groups were compared with regard to the length and the thickness of the external anal sphincter, the internal anal sphincter, the posterior external sphincter and the puborectalis in all quadrants and the anterior gap. Interobserver variability was assessed. RESULTS In women having vaginal delivery the length of the anterior external sphincter was shorter (P = 0.0004) and the gap was longer (P = 0.0306). The external sphincter tended to be thinner in individuals having vaginal delivery (P = 0.0677) and in those subjects over 50 years of age having had a vaginal delivery (P = 0.0164). In nulliparous women, the internal sphincter was thicker in subjects over 50 years of age (P = 0.0229). The intraclass correlation coefficient was 0.755-0.916 for sphincter muscle and gap length and 0.446-0.769 for muscle thickness. CONCLUSION Vaginal delivery was associated with a shorter anterior external sphincter, a longer gap and a thinner anterior external sphincter in asymptomatic women. Age was correlated with sphincter thickness, and nulliparous women >50 years of age had a thicker internal sphincter. Three-dimensional ultrasound was found to be a reliable method for measuring anal structures.
Collapse
Affiliation(s)
- S M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Brazil, Av Pontes Vieira, Fortaleza, Ceará, Brazil.
| | | | | | | | | | | | | |
Collapse
|
12
|
Murad-Regadas SM, dos Santos D, Soares G, Regadas FSP, Rodrigues LV, Buchen G, Kenmoti VT, Surimã WS, Fernandes GODS. A novel three-dimensional dynamic anorectal ultrasonography technique for the assessment of perineal descent, compared with defaecography. Colorectal Dis 2012; 14:740-7. [PMID: 21781232 DOI: 10.1111/j.1463-1318.2011.02729.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The purpose of the study was to describe a novel three-dimensional dynamic anorectal ultrasonography technique (dynamic 3-DAUS) for assessment of perineal descent (PD) and establishment of normal range values, comparing it with defaecography. Secondarily, the study compares the ability of the two techniques to identify various pelvic floor dysfunctions. METHOD A prospective study was undertaken in 29 women (mean age 43 years) with obstructed defecation disorder. All patients underwent defaecography and dynamic 3-DAUS and the results were compared. Lee kappa coefficients (K) were used. RESULTS On defaecography, PD > 3 cm was detected in 12 patients. On dynamic 3-DAUS, 10 of these patients had PD > 2.5 cm. Seventeen had normal PD on defaecography and PD ≤ 2.5 cm on dynamic 3-DAUS (K 0.85). Normal relaxation was observed in 10 patients and anismus in 14 with both techniques (K 0.65). Both techniques identified five patients without rectocele, two with grade I rectocele (K 0.89 and 1.00, respectively) and 10 with grade II and nine with grade III (K 0.72 and 0.77, respectively). Rectal intussusception was identified in six patients on defaecography. These were confirmed on dynamic 3-DAUS in addition to the identification of another seven cases indicating moderate agreement (K 0.46). Enterocele/sigmoidocele grade III was identified in one patient with both techniques, indicating substantial agreement (K 0.65). CONCLUSION Dynamic 3-DAUS was shown to be a reliable technique for the assessment of PD and pelvic floor dysfunctions, identifying all disorders and confirming findings from defaecography.
Collapse
Affiliation(s)
- S M Murad-Regadas
- Department of Surgery, Clinical Hospital, Federal University of Ceará, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Murad-Regadas SM, Regadas FSP, Rodrigues LV, Crispin FJ, Kenmoti VT, Fernandes GODS, Buchen G, Monteiro FCC. Criteria for three-dimensional anorectal ultrasound assessment of response to chemoradiotherapy in rectal cancer patients. Colorectal Dis 2011; 13:1344-50. [PMID: 20969716 DOI: 10.1111/j.1463-1318.2010.02471.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study was to identify criteria for three-dimensional anorectal ultrasonography (3D-AUS) to assess the response of rectal cancer to chemoradiotherapy; the 3D-AUS results were compared with the histopathological findings of the resected specimen. METHOD Thirty-five patients underwent 3D-AUS and were grouped according to the presence (GI; n = 19) or absence (GII; n = 16) of anal canal invasion. All patients received chemoradiotherapy, then underwent a second 3D-AUS. The response (complete, partial or insignificant and lymph node metastasis) was evaluated. Tumour length (cm) and volume (cm(3) ), length and volume regression percentage (%), distal length regression, and distance between the distal tumour edge and the proximal border of the internal anal sphincter were measured before and after chemoradiotherapy. All patients underwent surgery, and the 3D-AUS image was compared with the histopathological findings. RESULTS Before chemoradiotherapy, the average tumour length was similar in G1 and GII, but the volume differed significantly (P = 0.0408). The response was insignificant in seven (37%) patients, partial in 10 (53%) patients and complete in two (10%) patients in GI. The corresponding figures for GII were one (6%) patient, 12 (75%) patients and three (19%) patients (P = 0.0318). The agreement between pathological and post-chemoratherapy 3D-AUS findings was almost identical for the identification of residual tumour or complete response (κ = 1.0) and substantial for lymph node metastases (κ = 0.74). The mean distance to the internal anal sphincter was greater in GII. A sphincter-saving resection was performed in 2/19 patients in GI and in 14/16 patients in GII (P < 0.0001). The histopathological examination revealed a free distal margin. CONCLUSION 3D-AUS was shown to evaluate accurately the response to chemoradiotherapy, helping in the selection of patients for a sphincter-saving resection. The distance between the tumour and the internal anal sphincter was the most important parameter in this respect.
Collapse
Affiliation(s)
- S M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Ceará, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Filho FLA, Macedo GM, Dos Santos AA, Rodrigues LV, Oliveira RB, Nobre E Souza MA. Stapled haemorrhoidopexy transiently decreases rectal compliance and sensitivity. Colorectal Dis 2011; 13:219-24. [PMID: 19888951 DOI: 10.1111/j.1463-1318.2009.02103.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Stapled haemorrhoidopexy may damage the anorectal musculature and its sensorimotor function. Most studies have not used a barostat for the measurement of compliance. This study aimed to investigate the effect of stapled haemorrhoidopexy on rectal compliance and sensitivity. METHOD After Ethical Committee approval, we studied 10 male patients (mean age 33.8 years) with third- or fourth-degree haemorrhoids. Rectal compliance and sensitivity were measured with a 600-ml bag and an electronic barostat. Volunteers were submitted to two consecutive rectal distension protocols, including continuous distension at 2, 4 and 6 months after stapled haemorrhoidopexy. Intraluminal volume and pressure were recorded, including the first rectal sensation, desire to defecate and onset of rectal pain. Another group of 10 male control patients (mean age 24.9 years) with pilonidal sinus and no haemorrhoids was also included in the study. RESULTS Two months after stapled haemorrhoidopexy, rectal compliance decreased (7.1 ± 0.2 vs 5.3 ± 0.1, 6.4 ± 0.1 vs 5.1 ± 0.1 and 5.6 ± 0.2 vs 4.7 ± 0.1 ml/mmHg for first rectal sensation, desire to defecate and rectal pain, respectively; P < 0.05). The sensitivity threshold volume did not change for the first sensation but decreased significantly for the desier to defecate and pain (p <0.05) (116.8 ± 13.8 vs 148.4 ± 14.61, 251.1 ± 8.9 vs 185.8 ± 8.6 and 293.3 ± 16.6 vs 221.2 ± 6.0 ml for first rectal sensation, desire to defecate and rectal pain, respectively). Four and 6 months after surgery, rectal compliance and sensitivity returned to levels similar to those in the basal period. Muscle tissue was found in only three of the 10 resected doughnuts. Controls remained without any change in rectal compliance and sensitivity. CONCLUSION Stapled haemorrhoidopexy transiently decreases rectal compliance and sensitivity threshold in young male patients.
Collapse
Affiliation(s)
- F L A Filho
- Departments of Surgery Physiology and Pharmacology and Clinical Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | | | | | | | | |
Collapse
|
15
|
De Santis M, Vaz Rodrigues L, Matos F. [Hepatopulmonary syndrome: case report and literature review]. Rev Port Pneumol 2010; 16:679-685. [PMID: 20700565] [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: 05/29/2023] Open
Abstract
Hepatopulmonary syndrome is an important complication of chronic liver disease occurring in 16 24% of patients. It is characterized by an increase in alveolar -capillary gradient, with or without hypoxemia, due to intrapulmonary vasodilatation. The course of the disease is progressive and associated with increased morbidity and mortality. There is no effective medical treatment and liver transplant is a priority. To exemplify the authors present the case of a 39 year -old male patient sent to the Pulmonology outpatient clinic and presenting with secondary polycythemia and progressive exertional dyspnoea. Clinical investigation identified a hepatopulmonary syndrome.
Collapse
|
16
|
De Santis M, Rodrigues LV, Matos F. Síndroma hepatopulmonar: Relato de um caso clínico e revisão do tema. Revista Portuguesa de Pneumologia 2010. [DOI: 10.1016/s0873-2159(15)30062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
17
|
Soares FA, Regadas FSP, Murad-Regadas SM, Rodrigues LV, Silva FRS, Escalante RD, Bezerra RF. Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation. Colorectal Dis 2009; 11:947-50. [PMID: 19207704 DOI: 10.1111/j.1463-1318.2008.01761.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The study aimed to verify the role of parity, age and bowel function in the pathogenesis of anorectocele. METHOD A cross-sectional study was conducted regarding age, obstetrical history, Cleveland Clinic Constipation Score (CCCS), cinedefecography and anal manometry findings. Forty-five adult women complaining of obstructed defecation were evaluated; the median age was 46 years and median CCCS, 13. Fifteen patients were nulliparous and 23 multiparous (median parity 2). Eighteen had a history of episiotomy, fourteen delivered large babies and two had forceps-assisted delivery. Statistical analysis was performed using Spearman's correlation test and Fisher's exact test. RESULTS Anal hypertonia was found in 14 (31.1%) patients, anal hypotonia in eight (17.8%), anismus in 13 (28.9%) and anorectoceles in 34 (75.6%) [median size 2.8 cm (0-6.4)]. There were no correlations between anorectocele and anal hypertonia (P = 0.7171), anismus (P = 0.4666), parity comparing nulliparous and multiparous patients (P = 1.000), episiotomy (P = 1.0000), forceps assistance (P = 1.0000), delivery of a large baby (P = 1.0000) anal resting pressure (P = 0.0883), anal voluntary pressure (P = 0.7327), parity (P = 0.4987) and age (P = 0.8603). There were correlations between anorectocele and the CCCS (P = 0.0082) and anal hypotonia (P = 0.0141). CONCLUSION Anorectocele is not correlated with parity, age, episiotomy, delivery of a large baby and anismus. It was more frequent in patients with severe constipation and less common in patients with anal hypotonia.
Collapse
Affiliation(s)
- F A Soares
- Department of Surgery, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | | | | | | | | | | | | |
Collapse
|
18
|
Murad-Regadas SM, Regadas FSP, Barreto RGL, Rodrigues LV, de Souza MHLP. A novel two-dimensional dynamic anal ultrasonography technique to assess anismus comparing with three-dimensional echodefecography. Colorectal Dis 2009; 11:872-7. [PMID: 19681980 DOI: 10.1111/j.1463-1318.2009.02018.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this prospective study was to test two-dimensional dynamic anorectal ultrasonography (2D-DAUS) in the assessment of anismus and compare it with echodefecography (ECD). METHOD Fifty consecutive female patients with outlet delay were submitted to 2D and 3D-DAUS, measuring the relaxing or contracting puborectalis muscle angle during straining. The patients were assigned to one of two groups based on ECD findings. Group I consisted of 29 patients without anismus and group II included 21 patients diagnosed with anismus. Subsequently 2D-DAUS images were checked for anismus and compared with ECD findings. RESULTS Upon straining, the angle produced by the movement of the puborectalis muscle decreased in 26 out of the 29 (89.6%) patients of group I and increased 19 out of the 21 (90.4%) patients of group II. The mean angle during straining differed significantly between group I and group II. The index of agreement between the two scanning modes was 89.6% (26/29) for group I (Kappa: 0.796; CI: 95%; range: 0.51-1.0) and 90.4% (19/21) for group II (Kappa: 0.796; CI: 95%; range: 0.51-1.0). CONCLUSION Two-dimensional dynamic anal ultrasonography can be used as an alternative method to assess patients with anismus, although the 3-D modality is more precise to evaluate the PR angle as the sphincters integrity as the whole muscle length is clearly visualized.
Collapse
Affiliation(s)
- S M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceara, Ceará, Brazil.
| | | | | | | | | |
Collapse
|
19
|
Rodrigues LV, Lopes C, Castel-Branco G. Recurrent wheezing … is it only asthma? BMJ Case Rep 2009; 2009:bcr04.2009.1731. [PMID: 21829429 DOI: 10.1136/bcr.04.2009.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of an 18-year-old female patient observed in our allergy clinic with a diagnosis of uncontrolled asthma. The unexpected behaviour of the disease led us to consider other diagnoses and we finally diagnosed Churg-Strauss syndrome, a rare multisystem disorder requiring a different clinical approach.
Collapse
Affiliation(s)
- Luis Vaz Rodrigues
- Centro Hospitalar de Coimbra, Pulmunology, Quinta dos Vales, S Martinho do Bispo, Coimbra 3041-801, Portugal
| | | | | |
Collapse
|
20
|
Regadas FSP, Regadas SMM, Rodrigues LV, Misici R, Silva FR, Regadas Filho FSP. Transanal repair of rectocele and full rectal mucosectomy with one circular stapler: a novel surgical technique. Tech Coloproctol 2009; 9:63-6. [PMID: 15868504 DOI: 10.1007/s10151-005-0197-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [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] [Received: 09/28/2004] [Accepted: 11/03/2004] [Indexed: 02/07/2023]
Abstract
We present a new surgical stapling technique for treatment of rectocele when associated with internal mucosal prolapse or haemorrhoids using only one circular mechanical stapler. Eight female patients, mean age 53 years (range, 42-70), complaining of obstructed defecation with vaginal digitation because of rectocele associated with internal mucosal prolapse underwent transanal repair of rectocele and rectal mucosectomy using one circular stapler between April and July 2004. A running horizontal mattress suture was placed through the base of the rectocele including mucosa, submucosa and the muscle layer of the whole anterior anorectal junction wall. The prolapsed mucosa and the muscular layer were then excised with an electrical scapel. A continuous pursestring rectal mucosa suture was placed 0.5 cm before the previous anterior mucosa and muscle layers resected wound, including the anorectal junction wall which was kept separate from the posterior vaginal wall by a Babcock forceps. Posteriorly, the pursestring suture included only mucosal and submucosal layers. The stapled suture was positioned between normal anterior rectal wall and the anal canal, 0.5 cm above the pectinate line. The stapler was then closed, fired and withdrawn. One patient complained of a perianal hematoma on the seventh postoperative day, requiring surgical excision. Postoperative defecography showed correction of the rectocele and outlet obstruction disappeared in all patients. This novel combined manual-stapled technique for rectocele and rectal internal mucosal prolapse seems to be a safe procedure and the preliminary results are encouraging. Further investigations have to be performed to assess long-term outcome in a larger number of patients.
Collapse
Affiliation(s)
- F S P Regadas
- Department of Surgery, Medical School, Federal University of Ceara, Fortaleza Ceara, Brazil.
| | | | | | | | | | | |
Collapse
|
21
|
Rodrigues LV, Gandara J, Pires J, Duarte R, Calvário F, Dominguez M, Carvalho A, Seca R. Post liver transplant tuberculosis. BMJ Case Rep 2009; 2009:bcr05.2009.1847. [PMID: 21847423 DOI: 10.1136/bcr.05.2009.1847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We report on a patient diagnosed with disseminated (hepatic and pulmonary) tuberculosis in the context of immunosuppression following liver transplant. During the administration of anti-tuberculosis drugs an abrupt elevation of liver enzymes was detected leading us to suspect drug toxicity rather than graft rejection. Nevertheless, careful surveillance and adjustment of serum levels of immunosuppressant drugs permitted continuance of tuberculosis treatment with no further side effects.
Collapse
Affiliation(s)
- Luis Vaz Rodrigues
- Centro Hospitalar de Coimbra, Pulmunology, Quinta dos Vales, S. Martinho do Bispo, Coimbra, 3041-801, Portugal
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Monteiro FJR, Regadas FSP, Murad-Regadas SM, Rodrigues LV, Leal VM. Comparative evaluation of the effect of sustained inflation and rapid inflation/deflation of the intrarectal balloon upon rectoanal inhibitory reflex parameters in asymptomatic subjects. Tech Coloproctol 2007; 11:323-6. [PMID: 18058066 DOI: 10.1007/s10151-007-0374-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 08/14/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE The effects of rapid sustained inflation versus rapid inflation/deflation of the intrarectal balloon upon rectoanal inhibitory reflex (RAIR) parameters were evaluated in asymptomatic subjects. METHODS Forty asymptomatic adults were submitted to anorectal manometry with rapid or sustained inflation with 30 and 60 mL air. The average age was 27.4 years (range, 20-40). The subjects were divided into Group I (20 men) and Group II (20 women) for analysis. RAIR parameters were registered in order to compare the inflation patterns within each group, and Groups I and II were compared for each inflation pattern with regard to RAIR parameters. RESULTS Sustained inflation significantly increased IAS relaxation time and duration of the reflex in both groups, and IAS tone recovery time in Group I. CONCLUSIONS RAIR parameters are influenced by the choice of inflation pattern. Further studies are required to establish a standard intrarectal balloon inflation pattern.
Collapse
Affiliation(s)
- F J R Monteiro
- Department of Surgery, Federal University of Ceara, Fortaleza, Ceara, Brazil.
| | | | | | | | | |
Collapse
|
23
|
Murad-Regadas SM, Regadas FSP, Rodrigues LV, Souza MHLP, Lima DMR, Silva FRS, Filho FSPR. A novel procedure to assess anismus using three-dimensional dynamic anal ultrasonography. Colorectal Dis 2007; 9:159-65. [PMID: 17223941 DOI: 10.1111/j.1463-1318.2006.01157.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 01/08/2023]
Abstract
OBJECTIVE This study aimed to determine the value of three-dimensional (3D) dynamic endosonography in the assessment of anismus. METHOD Sixty-one women submitted to anorectal manometry were enrolled including 40 healthy women and 21 patients with anismus diagnosed by manometry. Patients were submitted to 3D endosonography. Images were acquired at rest and during straining and analysed in axial and midline longitudinal planes. Sphincter integrity was quantified. The angle between the internal edge of the puborectalis with a vertical line according to the anal canal axis was calculated at rest and during straining. RESULTS The angle increased in 39 of the 40 normal individuals and decreased in all patients with anismus during straining compared with the angle at rest (88.36 degrees ) and straining (98.65 degrees ) in normal individuals. In the anismus group, the angle decreased at rest (90.91 degrees ) and straining (84.89 degrees ). The difference between angle sizes in normal and anismus patients during straining was statistically significant (P < 0.5). CONCLUSION Three-dimensional endosonography is a useful method to assess patients with anismus confirming the anorectal manometric results.
Collapse
Affiliation(s)
- S M Murad-Regadas
- Anorectal Physiology Unit, Clinic Hospital, Federal University of Ceara, Fortaleza, Ceara, Brazil.
| | | | | | | | | | | | | |
Collapse
|
24
|
Regadas FSP, Murad-Regadas SM, Wexner SD, Rodrigues LV, Souza MHLP, Silva FR, Lima DMR, Regadas Filho FSP. Anorectal three-dimensional endosonography and anal manometry in assessing anterior rectocele in women: a new pathogenesis concept and the basic surgical principle. Colorectal Dis 2007; 9:80-5. [PMID: 17181850 DOI: 10.1111/j.1463-1318.2006.01088.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [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: 02/08/2023]
Abstract
OBJECTIVE The anatomy of the anal canal, the anorectal junction and the lower rectum was studied with 3-D ultrasound. METHOD Seventeen women with normal bowel transit, without rectocele (group 1) and 17 female patients with a large anterior rectocele (group 2) were examined with a B&K Medical Rawk. Mean age was 44.5 and 51.6 years respectively. In group 1, one (5.8%) patient was nuliparous, five (29.4%) had a caesarian section, 11 (64.7%) had a vaginal delivery while in group 2, two (11.7%) patients were nuliparous, four (23.5%) had a caesarian section and 11 (64.7%) had a vaginal delivery. Images were reconstructed in midline longitudinal (ML) and transverse (T) planes. The external (EAS) and internal (IAS) anal sphincters were measured in both projections. RESULTS In the ML plane, the EAS length was longer in group 1 (1.94 cm vs 1.61 cm, P < 0.05), the gap length was shorter (1.54 cm vs 1.0 cm P < 0.01) and the wall thickness was shorter in group 2 (0.40 cm vs 0.50 cm P < 0.01). The IAS (0.18 cm vs 0.23 cm P < 0.01) and EAS thickness (0.68 cm vs 0.77 cm, P < 0.05) (left lateral of the posterior quadrant) was greater in group 2. In group 1, the anterior upper anal canal wall in normal females was an extension of the rectal wall and the circular muscle was thicker in the mid-anal canal to form the IAS. In group 2, however, the wall layers were not identified and the IAS was found to be more distal. The differences were not statistically significant in the anal canal resting and squeeze pressures in the two groups. CONCLUSION Obstetric trauma does not seem to play any role in rectocele pathogenesis because the anal sphincter muscles are anatomically and functionally normal and rectocele is also present in nuliparous and in women with caesarian sections. It seems that it is associated with the absence of EAS and thinner IAS in the anterior upper anal canal. Herniation starts at the upper anal canal extending to the lower rectum in high or large rectoceles and maybe produced by rectal intussusception because of excessive and prolonged straining during defecation. In fact, the denomination 'rectocele' should be changed to 'anorectocele'.
Collapse
Affiliation(s)
- F S P Regadas
- Department of Surgery, Medical School of the Federal University of Ceara, Edson Queiroz, Fortaleza, Ceara, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Regadas FSP, Regadas SMM, Rodrigues LV, Misici R, Tramujas I, Barreto JB, Lins MA, Silva FR, Filho FSPR. New devices for stapled rectal mucosectomy: a multicenter experience. Tech Coloproctol 2005; 9:243-6. [PMID: 16328119 DOI: 10.1007/s10151-005-0237-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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] [Received: 06/27/2005] [Accepted: 07/05/2005] [Indexed: 11/25/2022]
Abstract
Stapled mucosectomy is widely performed, but in patients with deep gluteal cleft and small distance between the ischial tuberosities, it is difficult to insert the PPH dilator. We report the results achieved with a new device, the EEA 34-mm circular stapler (Auto-Suture, New Haven, USA). Eighty-five patients (45 men) were submitted to stapled mucosectomy for treatment of third- (n=70) or fourth-degree (n=10) hemorrhoids or mucosal prolapse (n=5) by surgeons at four different centers. The patients' mean age was 53.9 years (range, 45-70 years). ASA Kit (Advanced Surgical Anoscope, Tecplast Company, Fortaleza, Brazil) consists of four devices: a circular anal dilator (CAD) with anterior and posterior wings, an accessory device for insertion of CAD into the anal canal, a circular surgical anoscope (CSA) with proximal and distal openings for placing the rectal mucosal purse-string sutures, and a CSA insertion device. The middle part of the CSA is fully circular in order to avoid that the piles or the prolapsed mucosa fall into the anoscope. The mean excised mucosal band width was 4.7 cm. The mean operative time was 16 min (range, 12-25 min). Bleeding from the stapled suture was observed in 10 patients (11.7%). There were 5 postoperative complications (5.9%): 3 perianal hematomas and 2 stapled suture strictures. Anopexy was considered excellent by the surgeons in 50 patients (58.8%), good in 25 (29.4%) and poor in 10 (11.7%). At a mean follow-up of 12 months, proctoscopy demonstrated residual asymptomatic small internal prolapses in 15 patients (17.6%). Full pile prolapses recurred in 2 (2.3%) and required diathermy excision. ASA Kit made stapled mucosectomy easier to perform, but it's necessary to improve the circular staplers to adequately treat all sizes of mucosal and hemorrhoidal prolapses in order to reduce the recurrence rates.
Collapse
Affiliation(s)
- F S Pinheiro Regadas
- Department of Digestive Surgery, Medical School, Federal University of Ceara, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Regadas FS, Rodrigues LV, Nicodemo AM, Siebra JA, Furtado DC, Regadas SM. Complications in laparoscopic colorectal resection: main types and prevention. Surg Laparosc Endosc Percutan Tech 1998; 8:189-92. [PMID: 9649041] [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: 02/08/2023]
Abstract
Most colorectal procedures can be done laparoscopically, as has been described by many authors. In the first 5 years of colorectal laparoscopic surgery, many complications have ensued, such as intestinal perforation, bleeding, infection, anastomotic leakage, and dehiscence. In 146 patients who underwent laparoscopic procedures from December 1991 to August 1996, 92 colorectal resections were performed. Most resections were performed for malignant diseases (48.9%) and the most common surgical procedure was rectosigmoidectomy (32.6%). Sixty-six patients (71.7%) were female, and the mean age was 59.4 years. Transoperative complications occurred in three patients (3.3%): one sigmoid perforation, one rectal perforation, and one case of left ureter transection. Postoperative complications occurred in 24 patients (29.3%): anastomotic leakage (4), intestinal perforation (1), incisional hernia (4), wound infection (8), shoulder pain (1), dehiscence of perineal wound (4), and colostomy necrosis (2). We concluded that laparoscopic colorectal resection is a safe surgical method and that the rate of complications is similar to that of the conventional method.
Collapse
Affiliation(s)
- F S Regadas
- Colo-Proctology Clinic, Department of Surgery, Medical School of the Federal University of Ceará, Fortaleza Ceará, Brazil
| | | | | | | | | | | |
Collapse
|
27
|
Regadas FS, Siebra JA, Rodrigues LV, Nicodemo AM, Reis Neto JA. Laparoscopically assisted colorectal anastomose post-Hartmann's procedure. Surg Laparosc Endosc Percutan Tech 1996; 6:1-4. [PMID: 8808550] [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: 02/02/2023]
Abstract
We present 20 cases (10 men, 10 women) of laparoscopically assisted colorectal anastomose. The patients' mean age was 52.8 years. The mean length of procedure was 130 min. There were two transoperative complications, a rectal perforation with the stapler and an incomplete anastomose. Six (35.2%) patients said they had no postoperative pain. Bowel sounds occurred in a mean time of 18.2 h, flatus in 26.4 h, and bowel movement in an average of 2.5 postoperative days. Liquid diet was started after an average of 1.5 days, and the mean hospital stay was 4 days. There were three (15%) conversions because of excessive pelvic adherence, pelvic neoplastic invasion, and rectal perforation with a stapler. Postoperative complications occurred in seven (41.1%) cases: an incisional hernia, two wound infections, one wound bleeding, an acute renal failure, an undetermined peritonitis, and a small pelvic abscess. No mortality occurred in these cases.
Collapse
Affiliation(s)
- F S Regadas
- Department of Surgery, Medical School of the Federal University of Ceará, Brazil
| | | | | | | | | |
Collapse
|
28
|
MacLennan AH, Rodrigues LV, Krutli DR, Klomp A. Post-operative discomfort after ring or clip tubal ligation--is there any difference and do indomethacin suppositories help? Contraception 1990; 42:309-13. [PMID: 2289390 DOI: 10.1016/0010-7824(90)90018-q] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
One-hundred patients undergoing Falope ring or clip laparoscopic tubal ligation were given either a placebo or a 100 mg indomethacin rectal suppository one hour pre-operatively. Treatment was randomised and double-blind. Post-operative analgesic requirements and side effects were monitored. Forty-seven patients receiving indomethacin and 48 patients receiving placebo were available for analysis. Thirty-five patients in the indomethacin group required Meperidine (pethidine) analgesia (mean dose 58 mg) compared to 41 patients (mean dose 65 mg) in the placebo group. These differences were not significant. There were no significant differences in the non-narcotic analgesia given to each group, the side effects or the number requiring to stay overnight in the hospital. Analysis of the analgesic requirements of the 53 patients having clip sterilization and the 42 patients sterilized with Falope rings showed no statistical differences. This trial suggests that the immediate post-operative discomfort rates between ring and clip tubal occlusion are not different and that there is no significant benefit from the use of an indomethacin suppository pre-operatively.
Collapse
Affiliation(s)
- A H MacLennan
- Department of Obstetrics and Gynecology, Queen Victoria Hospital, University of Adelaide, South Australia
| | | | | | | |
Collapse
|
29
|
|