24 research outputs found
Epidemiology, Anorectal Anatomy, Physiology and Pathophysiology of Continence
No full textContinence can be defined as the ability to retain flatus, liquid, or solid stools during
normal daily life, including while physically exercising, coughing, sneezing, and
changing positio
Editorial: Advances in proctology and colorectal surgery
No full textProctology and colorectal surgery for benign disorders and neoplasia represent a broad field of general surgery. Their relevance is well known, on the one hand because of the still extremely high frequency in Western countries of colon-rectal cancer (currently estimated as the third most frequent cancer in the world), and on the other hand because of the serious impact on the quality of life (QoL) of patients suffering from benign, inflammatory, and functional diseases of the lower gastrointestinal tract. This Research Topic of Frontiers in Surgery, composed by forty-five original articles on colorectal surgery and proctology addresses several topics including non-surgical solutions, diagnostic aspects, translational research, and specific scenarios
Use of mesoglycan in the acute phase of hemorrhoidal disease (the CHORMES study): study protocol for a double-blind, randomized controlled trial
No full textAbstract Background Hemorrhoidal disease (HD) is associated with substantial economic burden and negative effects on health-related quality of life (HRQoL). The aCute HaemORrhoids treatment with MESoglycan (CHORMES) study aims to evaluate the effects of orally administered mesoglycan, a natural preparation of glycosaminoglycans with antithrombotic and profibrinolytic properties, as an acute treatment in patients with HD. Methods CHORMES is a phase 2, double-blind, randomized controlled trial being conducted at two centers in Italy. Adults aged 18–75 years with Grade I–III HD according to Goligher classification or external thrombosed hemorrhoids, and a Hemorrhoidal Disease Symptom Score (HDSS) of ≥ 5, will be randomly allocated in a 1:1 ratio to mesoglycan or placebo and will be treated for 40 days (two capsules for the first 5 days and one capsule for the subsequent 35 days twice daily [after breakfast and dinner], equivalent to 200 mg in the first 5 days and 100 mg subsequently). Concomitant use of analgesics is permitted in both treatment groups. The trial aims to enroll 50 patients, with 25 patients in each treatment group. The primary objective of the trial is to evaluate the efficacy of mesoglycan in reducing symptoms of HD, assessed via change in HDSS from baseline (day 0) to day 40 in the intention-to-treat population. Secondary objectives include changes in HRQoL from baseline to day 40 using the Short Health Scale for Hemorrhoidal Disease, safety (adverse effects, physical assessments, vital signs and laboratory parameters in the safety population), fecal continence assessed using the Vaizey score, bleeding assessed using the Bleeding score, the amount and type of analgesic taken, and pain. Patient enrolment began on 11 December 2023, and trial completion is expected by December 2024. Discussion The CHORMES trial will evaluate the efficacy and safety of mesoglycan, in addition to its impact on HRQoL, analgesic use and pain, in patients with HD. The results of the trial will assist clinicians in determining the most effective treatment for patients with HD. Trial registration ClinicalTrials.gov NCT06101992. Prospectively registered on 26 October 2023 at https://clinicaltrials.gov/ct2/show/NCT06101992
Altemeier’s procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients
No full textAbstract Background The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier’s rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. Methods Peri-operative data on 43 consecutive female patients were reviewed. At follow-up any change in pelvic floor function and recurrences were determined. Thirty four patients were assessed at a median interval of 49 (2–135) months, six being deceased for reason not related to the prolapse and three lost to follow-up. Results Post-operative complications at 30 days occurred in 18 patients (38%). Major complication occurred in only one patient that was pneumonia with lung failure. Major complications were not related to the ASA score, BMI or age [average age 76.4]. There was no post-operative mortality at 30 days. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48 months of 40%. There were no statistically significant differences between patients with and without recurrence regarding age (p = 0.188), BMI (p = 0.864), ASA score (p = 0.433), previously repaired prolapse (p = 0.398), previous hysterectomy (p = 0.705), length of resected bowel (p = 0.126), and levatorplasty (p = 0.304). Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p = 0.012). Conclusions Altemeier’s procedure had in our series low complications rate and no mortality. It offered improved evacuation in constipated patients while didn’t improve fecal and urinary continence. Recurrence of prolapse was 40% at four years
Short-Term Outcomes of Polycarbophil and Propionibacterium acnes Lysate Gel after Open Hemorrhoidectomy: A Prospective Cohort Study
No full textBackground: Pain is the most common complication after open excisional hemorrhoidectomy (OEH). We assessed the effectiveness of polycarbophil and Propionibacterium acnes lysate gel (Emorsan®Gel) on pain control after OEH. Research design and methods: Fifty consecutive patients undergoing OEH were included. All patients received stool softeners and oral analgesia in the post-operative period. Emorsan®Gel was also used topically by the last 25 patients (Emorsan®Gel group (EG)) until Post-Operative Day 20 (POD 20). The primary outcome was the effectiveness of Emorsan®Gel on pain relief using an 11-point visual analogue scale (VAS). Morbidity, wound healing (WH), and time to work were documented at POD 1, POD 10, POD 20, and POD 40. Results: Of the 50 patients enrolled, twenty-eight (56%) were males; median age, 49 (range, 28–73) years. The VAS score decreased over time in all patients, with significantly lower scores at POD 20 in the EG (1.44 (SD, 1.16) vs. 2.12 (0.93) in the control group (CG); p = 0.045). All patients in the EG achieved complete WH at last follow-up, compared to only 17 (68%) in the CG (p = 0.004). The likelihood of WH was 66% higher in the EG (OR, 1.66 [95%CI, 0.80–3.44; p = 0.172). Conclusions: Emorsan®Gel is safe and effective at reducing pain after EOH, promoting earlier WH compared to standard care treatment
The 8q24 region hosts miRNAs altered in biospecimens of colorectal and bladder cancer patients
No full textBackground: The 8q24 locus is enriched in cancer-associated
polymorphisms
and, despite containing relatively few protein-coding
genes, it hosts
the MYC oncogene and other genetic elements connected to tumorigenesis,
including microRNAs (miRNAs). Research on miRNAs may provide insights
into the transcriptomic regulation of this multiple cancer-associated
region.
Material and methods: We profiled all miRNAs located in the 8q24 region in
120 colorectal cancer (CRC) patients and 80 controls. miRNA profiling was performed
on cancer/non-malignant
adjacent mucosa, stool, and plasma extracellular
vesicles (EVs), and the results validated with The Cancer Genome Atlas
(TCGA) data. To verify if the 8q24-annotated
miRNAs altered in CRC were dysregulated
in other cancers and biofluids, we evaluated their levels in bladder cancer
(BC) cases from the TCGA dataset and in urine and plasma EVs from a set of
BC cases and healthy controls.
Results: Among the detected mature miRNAs in the region, 12 were altered
between CRC and adjacent mucosa (adj. p < 0.05). Five and four miRNAs
were confirmed as dysregulated in the CRC and BC TCGA dataset, respectively.
A co-expression
analysis of tumor/adjacent tissue data from the CRC
group revealed a correlation between the dysregulated miRNAs and CRC-related
genes (PVT1 and MYC) annotated in 8q24 region. miR-30d-
5p
and
miR-151a-
3p,
altered in CRC tissue, were also dysregulated in stool of CRC
patients and urine of BC cases, respectively. Functional enrichment of dysregulated
miRNA target genes highlighted terms related to TP53-mediated
cell cycle control.
Conclusions: Altered expression of 8q24-annotated
miRNAs may be relevant for
the initiation and/or progression of cancer
Sclerotherapy with 3% polidocanol foam to treat second-degree haemorrhoidal disease. Three-year follow-up of a multicentre, single arm, IDEAL phase 2b trial
No full textBackground Sclerotherapy with 3% polidocanol foam is becoming increasingly popular for the treatment of symptomatic I-II or III degree haemorrhoidal disease (HD). However, there are no studies that have reported a follow-up of more than 1 year. The purpose of this study was to analyse the long-term outcomes of sclerotherapy with 3% polidocanol foam in the treatment of II-degree HD. Methods This was an open label, single-arm, phase 2b trial conducted in 10 tertiary referral centres for HD. A total of 183 patients with II-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment, were included in the study and underwent sclerotherapy with 3% polidocanol foam. The efficacy was evaluated in terms of bleeding score, haemorrhoidal disease symptom score (HDSS) and short health scale for HD (SHS-HD) score. Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score. Results The overall success rate ranged from 95.6% (175/183) at 1 year to 90.2% (165/183) after the final 3 year follow-up. The recurrence rate, based on the primary outcome, ranged from 12% (15/125) to 28% (35/125). The greatest increase in recurrence (15) was recorded between 12 and 18 months of follow-up, then another five between 18 and 24 months. Both the HDSS and the SHS score remained statistically significant (p < 0.001) from a median preoperative value of 11 (10-13) and 18 (15-20) to 0 (0-2) and 4 (0-4), respectively. Symptom-free (HDSS = 0) patients, excluding patients converted to surgery, increased from 55.5% (101/182) at 1 year to 65.1% at 3 years (110/169). There were no intraoperative complications in redo-sclerotherapy nor additional adverse events (AEs) compared to the first 12 months. Conclusions Sclerotherapy with 3% polidocanol foam is gradually establishing itself in the treatment of bleeding HD due to its repeatability, safety, convenience in terms of direct and indirect costs with the absence of discomfort for the patient as well as AEs rather than an excellent overall success rate
Martius’ flap for recurrent perineal and rectovaginal fistulae in a patient with Crohn’s disease, endometriosis and a mullerian anomaly
No full textAdditional file 1: of Altemeierâs procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients
No full textData on follow-up and recurrences. Pre and post-operative functional scores and data above recurrences and time to recurrences collected from each patient. (XLSX 20 kb
