1,721,183 research outputs found
La sindrome del perineo discendente: patologia iatrogena o spontanea?
No full textAmong the causes of constipation, there is an infrequently recognised condition
called descending perineum syndrome. This pelvic floor dysfunction causes a
rectal tone disorder, and the clinical features include excessive and frequent
straining and incomplete evacuation. Electrophysiological studies have shown a
pelvic neuropathy in incontinent patients with descending perineum. The
aetiological agents have been identified as follows: greater parity, dystocias
and obstinate constipation, particularly if caused by expulsion difficulty. It
has been observed that pelvic floor surgery may have physiopathological
consequences that bring on the onset of dynamic disorders. The diagnosis may
present difficulties and failure to identify the syndrome leads to inadequate and
repetitive treatment of no real benefit to the patient. Since it is impossible to
correct the excessive descent of the pelvic floor, the treatment will be aimed at
resolving the predominant symptom in relation to the physiopathological factors
causing it
Health related quality of life after surgery for Crohn's disease.
No full textCrohn’s disease cannot be healed but just taken into remission. Intestinal obstruction and fistulization, lack of response to medical management and perianal disease are the most frequent indication for intestinal surgery.
Why is it necessary to measure quality of life after surgery for Crohn’s disease? Firstly, morbidity and mortality provide a partial and, very often, incomplete picture of outcome. Secondarily, nowadays, indications for surgery for Crohn’s disease are broader and not limited to life saving procedures but in many cases they include chronic conditions such as failure of medical therapy, or poor quality of life on it self. Finally, quality of life is a more patient orientated measure of outcome that can give the patients’ point of view about the procedure that is proposed.
HRQL is a multi-dimensional concept which includes several dimensions based on biological and symptom variables. Disease-related worries and concerns about the disease on itself and its therapy reflect one of these dimensions and they are considered to be a major determinant of HRQL in patients with IBD. In fact, concerns about having surgery and having an ostomy bag have a relevant impact on HRQL of Crohn’s disease patients and having surgery increases concerns about body stigma.
The early impact of surgery on HRQL is an important component of the patient’s decision regarding immediate and future surgery and understanding his or her recovery. Obviously, HRQL is expected to improve after operative procedures. In effect, in most of the studies, a significant improvement in HRQL early in the postoperative period was observed. Improvement, apparently, occurred irrespective of the disease activity measured with CDAI, the indication for surgery, type of procedure (abdominal or perineal), and history of previous surgery.
On the contrary, the long-term impact of surgery on HRQL is more controversial. Some studies, mainly those performed with generic questionnaires, reported an improved HRQL while other (those performed with disease specific instruments) described a decreased HRQL. According to these authors, HRQL, apparently, depends mainly on the long-term disease activity
A Systematic Review On the Surgical Treatment of Rectovaginal Fistulas in Crohn's Disease: Rectal vs Vaginal Advancement Flap
No full textRelationship between pouch microbiota and pouchitis following restorative proctocolectomy for ulcerative colitis.
No full textRestorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for many patients with medically refractory ulcerative colitis (UC) and familial adenomatous polyposis (FAP). UC patients with IPAA (UC-IPAA) are, nevertheless, susceptible to inflammatory and noninflammatory sequelae such as pouchitis, which is only rarely noted in FAP patients with IPAA. Pouchitis is the most frequent long-term complication of UC-IPAA patients, with a cumulative prevalence of up to 50%. Although the aetiology of pouchitis remains unclear, accumulating evidence suggests that a dysbiosis of the pouch microbiota and an abnormal mucosal immune response are implicated in its pathogenesis. Studies using culture and molecular techniques have detected a dysbiosis of the pouch microbiota in patients with pouchitis. Risk factors, genetic associations, and serological markers suggest that interactions between the host immune response and the pouch microbiota underlie the aetiology of this idiopathic inflammatory condition. This systematic review focuses on the dysbiosis of the microbiota that inhabit the pouch in UC and FAP patients and its interaction with the mucosal immune system. A meta-analysis was not attempted due to the highly heterogeneous microbiota composition and the different detection methods used by the various studies. Although no specific bacterial species, genus, or family has as yet been identified as pathogenic, there is evidence that a dysbiosis characterized by decreased gut microbiota diversity in UC-IPAA patients may, in genetically predisposed subjects, lead to aberrant mucosal immune regulation triggering an inflammatory process
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