Pelvic floor rehabilitation for defecation disorders

Pelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and agree on treatment protocols for pelvic floor rehabilitation of patients with defecation disorders. This was achieved by means of a modified Delphi method, utilizing a working team (10 members) which developed the statements and a consensus group (15 members, different from the previous ones) which voted twice also suggesting modifications of the statements.

Different perception of chronic constipation between patients and gastroenterologists

BACKGROUND

There is a certain number of subjects that consider themselves to be constipated (self diagnosed constipation; SDC). The Rome Criteria separate FC from IBS-C, but some SDC patients do not meet the Rome criteria (no Rome Constipation; NRC). Our aims were to evaluate the percentage of SDC subjects with a diagnosis of FC and IBS-C and to compare demographic and clinical features, symptoms, and quality of life in the different SDC groups (FC, IBS-C, NRC).

METHODS

During a 2-month period, 934 patients and 980 accompanying persons (AP) were asked to complete a survey. The presence of FC or IBS-C was assessed. SDC subjects were invited to record the stool consistency (Bristol scale) and to fill in the Constipation Severity Index (CSI), obstructed defecation syndrome (ODS) and patient assessment of constipation-quality of life (PAC-QoL). The use of laxatives and enemas was evaluated.

KEY RESULTS

The probability of the ROME III criteria being present was higher in SDC compared with no-SDC (OR 20.5). NRC was present in 13.5% of the SDC. In the patients' group the agreement between a diagnosis of Rome III and SDC was good (K 0.62), whereas in the AP it was moderate (K 0.56). NRC showed lower mean values of ODS, CSI and PAC-QoL, higher Bristol scale and a lower use of laxatives and enemas compared to IBS-C and FC. No differences were found between IBS-C and FC.

CONCLUSIONS AND INFERENCES

The Rome III criteria identify subjects with a greater clinical impact, but separation of FC and IBS-C does not seem justified.

Self-perceived normality in defecation habits

BACKGROUND

Available information on normal bowel habits was mainly gathered by means of telephone interviews or mailed questionnaires.

AIMS

We undertook a prospective study to evaluate the defecatory habits in subjects perceiving themselves as normal concerning this function.

SUBJECTS AND METHODS

A questionnaire (4-week diary with "yes-no" daily answers to six questions concerning bowel habits) was distributed to 204 subjects perceiving their defecation behaviour as normal.

RESULTS

The completed questionnaire was returned by 140 subjects. No significant differences were found between sexes or age groups for any variable, even though straining at stool and feeling of incomplete and/or difficult evacuation showed a trend to increase with age. No subject had less than three bowel movements per week or more than three per day. The percentage of symptoms linked to an abnormal defecatory behaviour was well below 10%. Fifty-five percent of subjects reported at least one parameter of abnormal functioning; the most frequent was straining at stool and the rarer was the manual manoeuvres to help defecation.

CONCLUSIONS

In normal subjects the prevalence of symptoms considered in Rome II criteria as part of an abnormal defecatory behaviour (in more than 25% of defecations) is well below 10%, manual manoeuvres are almost never used to help defecation, and the frequency of defecations is at least three per week.

[Andersson's phenomenon in HLA-B27 negative ankylosing spondylitis]

A computed tomography (CT) and conventional radiography study is reported in a case of HLA-B27 negative ankylosing spondylitis. The value of CT in comparison with conventional radiography in evaluation of anatomic alterations is determined.

[Radiologic evaluation of ileal reservoirs. Our experience]

A radiological investigation was performed in 25 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. Radiology was of great value in the demonstration of post-operative complications.

[Male transsexualism and hormonal therapy: radiologic pictures of the breast]

Often the male transsexual takes hormonal drugs, sometimes under medical prescription but most frequently by his personal choice. They wish to obtain a development of mammary gland and the disappearance of hair from facial skin. Prolonged hormonal and incorrect treatments, mainly for too high dosage and absence of association with progesterone, assumption of oestrogens, can cause the growth of mammary tumours. The Authors present the results of a clinical and radiological study on 15 patients, 12 in treated with hormonal drugs for two years and 3 without any therapy.

[Radiological characteristics of primary hyperoxaluria with oxalosis]

Oxalosis is a rare disorder, in which there are widely and evenly spread deposits of oxalate crystals in the kidneys with progressive renal failure. An inborn error of metabolism is the cause of oxalosis. The incidence of this disease in boys and girls is practically equal. Most patients do not survive their 20th year. In our case there were changes in the skeleton and extensive deposits of oxalates in the kidneys.

[Role of computerized tomography in Poland syndrome]

A morphological CT study in Poland syndrome is presented. The osteomuscular anomalies of the chest, which are not demonstrated by usual x-Ray, are well defined by CT scans. The usefulness of CT in postoperative controls of muscles transfers is stressed.

[A rare case of sirenomelia. Possibility of prenatal ultrasonic and radiologic diagnosis]

A rare case of sirenomelia malformation in a fetus of 33 weeks is reported. Besides typical fusion of the lower extremities, important alterations of the urogenital system and large intestine are present. A review of the literature on the subject is presented. The usefulness of ultrasonography in the prenatal diagnosis of this malformation is then stressed.

[X-ray computed tomography in latero-cervical lymph nodes, clinically undetectable, in preoperative staging of malignant neoplasms of the larynx]

Postoperative CT of the latero-cervical lymph nodes was carried out in 25 patients suffering from laryngeal cancer. The surgically removed lymph nodes themselves were measured and examined histologically. 529/621 removed lymph nodes (about 85%) were recognisable with CT. The metastasized lymph nodes were clearly identified because of the presence of hypodense, poorly vascularised central foci. Some lymph nodes with a diameter of more than 15 mm on CT investigation proved free from metastatic lesions. This criterion should therefore be considered inadequate for diagnostic purposes. The CT cannot be held to be sufficiently precise to avoid conservative functional latero-cervical emptying as it is probably not able to recognise metastases without capsular rupture, not present in this series.

[A case of giant lumbar neurinoma]

A rare case of a giant extradural neurinoma of the IV lumbar root with an anterior development and a soft neurological picture is reported. The Authors stress the important role of CT both in the neurinoma diagnosis and in the correct preoperative evaluation of its extension and its relationship with contiguous organs.

[Is it still useful to integrate cholecystography with direct radiography in the cholecystokinetic test?]

There are discordant opinions in literature on the techniques of execution of the cholecystography. The authors have examined 104 consecutive patients with the clinical suspicion of gallstones in order to verify the usefulness of the plain radiogram and of the cholecystokinetic test. All the patients have been studied systematically with the plain radiogram of the hepatic region, with cholecystography completed by cholecystokinetic test and with ultrasound. In two cases of radiopaque gallstones (7.1%) the plain radiogram was indispensable for the diagnosis while the cholecystokinetic test has permitted to visualize, in one patient (3.5%), a small radiopaque gallstone previously hidden by the gallbladder opacity. In one subject (50%) the cholecystokinetic test has permitted the identification of a small adenomyoma later confirmed by ultrasound. As a conclusion, the diagnostic accuracy of the cholecystography is inferior to that of ultrasound (in the diagnosis of gallbladder stones and adenomyoma) if the first one is not integrated both with the plain radiogram and with the cholecystokinetic test; the Authors consider on the other side, that this last procedures can be substituted if cholecystography is systematically associated to ultrasound examination.

Oesophagitis in Italian and Hungarian asymptomatic subjects

It is known that chronic inflammatory phenomena of the gastric mucosa fairly often occur in asymptomatic subjects. Starting from this fact, the authors decided to investigate possible non-symptomatic oesophageal inflammatory lesions referable to oesophagitis and any other digestive and/or systemic pathology. Furthermore it was also intended to ascertain the possible existence of geographical differences. 108 subjects, 65 Italians and 43 Hungarians, were studied. The endoscopic examination revealed congestion of the lower third of the oesophageal tract in 5 Italians out of 65, whereas all the Hungarians presented normal oesophageal findings. The histological examination showed inflammatory lesions in 13 Italians and 10 Hungarians. The incidence of lesions was higher in the fifth and the sixth decade of life. The results suggest that oesophageal inflammatory lesions are fairly frequent in asymptomatic subjects, with no significant differences between the two groups considered; the role of the histological bioptic investigation in the diagnosis of oesophageal inflammatory lesions is underlined.

Chenodeoxycholic acid (CDCA) versus ursodeoxycholic acid (UDCA): a comparison of their effects in pregnant rats

Treatment of pregnant rats with ursodeoxycholic acid or chenodeoxycholic acid at 3 dose levels resulted in no dismorphogenic effects although embryotoxicity and fatty infiltration in maternal liver were more frequent after CDCA. Light microscopic examination showed no evidence of derangement in fetal liver. Electron microscopic study, carried out in maternal liver, showed that changes were present only in dams treated with the highest doses of both bile acids.