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G C Roviaro - One of the best experts on this subject based on the ideXlab platform.
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stapled transanal rectal resection in solitary rectal ulcer associated with Prolapse of the rectum a prospective study
Diseases of The Colon & Rectum, 2008Co-Authors: P Boccasanta, Marco Venturi, Giuseppe Calabro, M Maciocco, G C RoviaroAbstract:Purpose At present, none of the conventional surgical treatments of solitary rectal ulcer associated with internal rectal Prolapse seems to be satisfactory because of the high incidence of recurrence. The stapled transanal rectal resection has been demonstrated to successfully cure patients with internal rectal Prolapse associated with rectocele, or Prolapsed hemorrhoids. This prospective study was designed to evaluate the short-term and long-term results of stapled transanal rectal resection in patients affected by solitary rectal ulcer associated with internal rectal Prolapse and nonresponders to biofeedback therapy.
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stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal Prolapse a randomized controlled trial
International Journal of Colorectal Disease, 2007Co-Authors: P Boccasanta, Marco Venturi, G C RoviaroAbstract:Purpose A remarkable incidence of failures after stapled axopexy (SA) for hemorrhoids has been recently reported by several papers, with an incomplete resection of the Prolapsed tissue, due to the limited volume of the stapler casing as possible cause. The stapled transanal rectal resection (STARR) was demonstrated to successfully cure the association of rectal Prolapse and rectocele by using two staplers. The aim of this randomized study was to evaluate the incidence of residual disease after SA and STARR in patients affected by Prolapsed hemorrhoids associated with rectal Prolapse.
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Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal Prolapse : a randomized controlled trial
'Springer Science and Business Media LLC', 2007Co-Authors: P Boccasanta, Marco Venturi, G C RoviaroAbstract:Purpose A remarkable incidence of failures after stapled axopexy (SA) for hemorrhoids has been recently reported by several papers, with an incomplete resection of the Prolapsed tissue, due to the limited volume of the stapler casing as possible cause. The stapled transanal rectal resection (STARR) was demonstrated to successfully cure the association of rectal Prolapse and rectocele by using two staplers. The aim of this randomized study was to evaluate the incidence of residual disease after SA and STARR in patients affected by Prolapsed hemorrhoids associated with rectal Prolapse. Methods Sixty-eight patients were selected on the basis of validated constipation and continence scorings, clinical examination, colonoscopy, anorectal manometry, and defecography and randomized: 34 underwent a SA and 34 a STARR operation. The operated patients were followed-up with clinical examination, visual analog scale for postoperative pain, a satisfaction index, and defecography. Results At a mean follow-up of 8.1 +/ 12 2.0 and 7.9 +/ 12 1.8 months for the SA and STARR groups, respectively, the incidence of residual disease was significantly higher in the first group (29.4 vs 5.9 in the STARR group, p=0.007), while a significantly lower incidence of residual skin-tags was found after STARR (23.5% vs 58.8 after SA, p=0.03). All patients with residual disease showed Prolapsed tissue over half the length of the anal dilator at the time of the operation. Operative time and incidence of transient fecal urgency were significantly higher in the STARR group (with p=0.001 and 0.08, respectively), while SA was followed by a significantly higher incidence of poor results at the overall patient satisfaction index (p=0.04). No significant differences were found in hospital stay, operative complications, postoperative pain, time to return to normal activity, continence, and constipation scores. All the defecographic parameters significantly improved after STARR, while SA was followed only by a trend to a reduction of rectal Prolapse. Conclusions STARR provides a more complete resection of the Prolapsed tissue than SA in patients with association of Prolapsed hemorrhoids and rectal Prolapse with equal morbidity and significantly lower incidence of residual disease and skin-tags. The anal dilator can be used for selecting the surgical techniqu
Philippe E Zimmern - One of the best experts on this subject based on the ideXlab platform.
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extracellular matrix expression of human Prolapsed vaginal wall
Neurourology and Urodynamics, 2010Co-Authors: Elizabeth Mosier, Victor K Lin, Philippe E ZimmernAbstract:Objective To compare the mRNA expression of extracellular matrix (ECM) proteins in postmenopausal Prolapsed versus non-Prolapsed anterior vaginal wall (AVW) tissue. We hypothesized that the weakening of the tissue leading to Prolapse was due to decreased collagen production from a downregulation at the transcriptional level. Methods Following IRB approval, full thickness samples of redundant AVW were excised from consecutive age-equivalent, postmenopausal, women undergoing cystocele repair (Prolapse, stage III or IV), or radical cystectomy (control, no clinical findings of Prolapse). Total RNA was isolated, cDNA was synthesized, and quantitative real-time polymerase chain reaction (PCR) was conducted to assess the mRNA expression of collagens type I and III, pro-elastin, MMP3, MMP10, and MMP11. The significance of the difference of mRNA expression between Prolapse and control tissues was tested using Student's t-test followed by Mann–Whitney Rank Sum Test. Results A 5.3-fold increase in collagen type I mRNA was found in Prolapse (n = 47) over control (n = 7) tissues (P = 0.009). Type III collagen mRNA was also significantly increased to a 3.3 times higher level (P = 0.017). The ratio of type III to type I was decreased from 15.6 in controls to 9.7 in Prolapse. An increasing trend in pro-elastin and MMP mRNA expression was found in Prolapse, but this was not statistically significant. Conclusion In this controlled study, the increase found in collagen mRNA expression disproved our hypothesis. To the contrary, this defective Prolapsed tissue can signal its need for ECM replenishment. The message, however, is not being effectively translated to assist in tissue remodeling. Neurourol. Urodynam. 29:582–586, 2010. © 2009 Wiley-Liss, Inc.
P Boccasanta - One of the best experts on this subject based on the ideXlab platform.
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stapled transanal rectal resection in solitary rectal ulcer associated with Prolapse of the rectum a prospective study
Diseases of The Colon & Rectum, 2008Co-Authors: P Boccasanta, Marco Venturi, Giuseppe Calabro, M Maciocco, G C RoviaroAbstract:Purpose At present, none of the conventional surgical treatments of solitary rectal ulcer associated with internal rectal Prolapse seems to be satisfactory because of the high incidence of recurrence. The stapled transanal rectal resection has been demonstrated to successfully cure patients with internal rectal Prolapse associated with rectocele, or Prolapsed hemorrhoids. This prospective study was designed to evaluate the short-term and long-term results of stapled transanal rectal resection in patients affected by solitary rectal ulcer associated with internal rectal Prolapse and nonresponders to biofeedback therapy.
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stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal Prolapse a randomized controlled trial
International Journal of Colorectal Disease, 2007Co-Authors: P Boccasanta, Marco Venturi, G C RoviaroAbstract:Purpose A remarkable incidence of failures after stapled axopexy (SA) for hemorrhoids has been recently reported by several papers, with an incomplete resection of the Prolapsed tissue, due to the limited volume of the stapler casing as possible cause. The stapled transanal rectal resection (STARR) was demonstrated to successfully cure the association of rectal Prolapse and rectocele by using two staplers. The aim of this randomized study was to evaluate the incidence of residual disease after SA and STARR in patients affected by Prolapsed hemorrhoids associated with rectal Prolapse.
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Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal Prolapse : a randomized controlled trial
'Springer Science and Business Media LLC', 2007Co-Authors: P Boccasanta, Marco Venturi, G C RoviaroAbstract:Purpose A remarkable incidence of failures after stapled axopexy (SA) for hemorrhoids has been recently reported by several papers, with an incomplete resection of the Prolapsed tissue, due to the limited volume of the stapler casing as possible cause. The stapled transanal rectal resection (STARR) was demonstrated to successfully cure the association of rectal Prolapse and rectocele by using two staplers. The aim of this randomized study was to evaluate the incidence of residual disease after SA and STARR in patients affected by Prolapsed hemorrhoids associated with rectal Prolapse. Methods Sixty-eight patients were selected on the basis of validated constipation and continence scorings, clinical examination, colonoscopy, anorectal manometry, and defecography and randomized: 34 underwent a SA and 34 a STARR operation. The operated patients were followed-up with clinical examination, visual analog scale for postoperative pain, a satisfaction index, and defecography. Results At a mean follow-up of 8.1 +/ 12 2.0 and 7.9 +/ 12 1.8 months for the SA and STARR groups, respectively, the incidence of residual disease was significantly higher in the first group (29.4 vs 5.9 in the STARR group, p=0.007), while a significantly lower incidence of residual skin-tags was found after STARR (23.5% vs 58.8 after SA, p=0.03). All patients with residual disease showed Prolapsed tissue over half the length of the anal dilator at the time of the operation. Operative time and incidence of transient fecal urgency were significantly higher in the STARR group (with p=0.001 and 0.08, respectively), while SA was followed by a significantly higher incidence of poor results at the overall patient satisfaction index (p=0.04). No significant differences were found in hospital stay, operative complications, postoperative pain, time to return to normal activity, continence, and constipation scores. All the defecographic parameters significantly improved after STARR, while SA was followed only by a trend to a reduction of rectal Prolapse. Conclusions STARR provides a more complete resection of the Prolapsed tissue than SA in patients with association of Prolapsed hemorrhoids and rectal Prolapse with equal morbidity and significantly lower incidence of residual disease and skin-tags. The anal dilator can be used for selecting the surgical techniqu
Hellú, José Abdo De Andrade - One of the best experts on this subject based on the ideXlab platform.
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Descrição de duas novas técnicas cirúrgicas para o tratamento de prolapso vaginal em vacas zebuinas: vaginectomia parcial e vaginopexia dorsal
Universidade Estadual Paulista (UNESP), 2012Co-Authors: Hellú, José Abdo De AndradeAbstract:No final da década de 1990 observou-se um aumento significativo de uma nova modalidade de afecção, o prolapso vaginal parcial ou total recorrente não associado à gestação, principalmente em vacas zebuínas. Em razão do alto valor comercial dos animais acometidos, inicialmente, indicou-se as técnicas convencionais como as de Caslick, Bühner ou Flessa, porém sem o sucesso esperado devido à recorrência da alteração. Considerando esta dificuldade, este trabalho objetivou descrever duas novas técnicas cirúrgicas na correção do prolapso vaginal, denominadas vaginectomia parcial e vaginopexia dorsal em vacas. A condução do estudo foi a campo, utilizando-se 812 vacas zebuínas em idade reprodutiva, alojadas em diversas propriedades de diferentes estados brasileiros. Foram selecionados animais que apresentavam a afecção e que mantiveram os parâmetros clínicos de frequência cardíaca, frequência respiratória e temperatura retal, dentro da normalidade. O diagnóstico do prolapso vaginal foi realizado por meio de anamnese e dos sinais clínicos como exposição da vagina pela rima vulvar, tenesmo, inquietação, lesões da porção evertida, retenção urinária e vaginite. A avaliação dos animais permitiu definir o estágio do prolapso, com a finalidade de eleger a técnica cirúrgica mais adequada. Os protocolos anestésicos foram cumpridos, considerando-se a técnica cirúrgica eleita. A vaginectomia parcial foi utilizada para o tratamento do prolapso vaginal de grau 1 e a vaginopexia dorsal para os de grau 2 e 3. Os resultados pós-cirúrgicos das duas técnicas indicaram alta porcentagem de recuperação (93.44% para vaginectomia parcial e 96,14% para vaginopexia dorsal) e baixo número de recidivas (6,25% e 3,66%, para vaginectomia parcial e vaginopexia dorsal, respectivamente, e baixa mortalidade (entre 0,20 a 0,31%), podendo...At the end of the decade of 1990, a significant increase of a new affection was observed in the field. This occurrence, recurrent partial or total vaginal Prolapse is not associated with gestation, is seen primarily in zebu cows where, in extreme cases, resulted in a total Prolapse of the vagina, which included exteriorization of the cervix. Given the high commercial value of elite animals presenting this condition, the increase in cases observed led to attempts to solve the condition with conventional techniques such as those of Caslick, Bühner and Flessa. However, reoccurrence of the Prolapse was commonly observed soon after the use of these techniques. Considering these difficulties, the aim of the present work was to develop two new surgical techniques employed in the correction of vaginal Prolapse, named partial vaginectomy and dorsal vaginopexy in cows. The research was conducted in the field, using 812 zebu cows of reproductive age, maintained in several properties in different Brazilian states. The animals selected had the vaginal alteration while maintaining all clinical parameters of heart rate, respiratory rate and body temperature, all within normal range. The diagnosis of a vaginal Prolapse was performed by anamnesis and analysis of the clinical signs, such as visualization of the vagina through the vulva, tenesmus, agitation, lesions in the everted portin and vaginitis. Evaluation of the animals allowed for the definition of stages of the disease, aiding the choice of an adequate surgical technique. Anesthetic protocols were performed taking into consideration the selected surgery. Partial vaginectomy was employed for the treatment of vaginal Prolapses of grade 1, whereas dorsal vaginopexy was used for the grade 2 and 3 Prolapses. Post-surgical results for both techniques indicated a high percentage of recovery... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES
Hellú, José Abdo De Andrade [unesp] - One of the best experts on this subject based on the ideXlab platform.
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Descrição de duas novas técnicas cirúrgicas para o tratamento de prolapso vaginal em vacas zebuinas: vaginectomia parcial e vaginopexia dorsal
Universidade Estadual Paulista (UNESP), 2012Co-Authors: Hellú, José Abdo De Andrade [unesp]Abstract:No final da década de 1990 observou-se um aumento significativo de uma nova modalidade de afecção, o prolapso vaginal parcial ou total recorrente não associado à gestação, principalmente em vacas zebuínas. Em razão do alto valor comercial dos animais acometidos, inicialmente, indicou-se as técnicas convencionais como as de Caslick, Bühner ou Flessa, porém sem o sucesso esperado devido à recorrência da alteração. Considerando esta dificuldade, este trabalho objetivou descrever duas novas técnicas cirúrgicas na correção do prolapso vaginal, denominadas vaginectomia parcial e vaginopexia dorsal em vacas. A condução do estudo foi a campo, utilizando-se 812 vacas zebuínas em idade reprodutiva, alojadas em diversas propriedades de diferentes estados brasileiros. Foram selecionados animais que apresentavam a afecção e que mantiveram os parâmetros clínicos de frequência cardíaca, frequência respiratória e temperatura retal, dentro da normalidade. O diagnóstico do prolapso vaginal foi realizado por meio de anamnese e dos sinais clínicos como exposição da vagina pela rima vulvar, tenesmo, inquietação, lesões da porção evertida, retenção urinária e vaginite. A avaliação dos animais permitiu definir o estágio do prolapso, com a finalidade de eleger a técnica cirúrgica mais adequada. Os protocolos anestésicos foram cumpridos, considerando-se a técnica cirúrgica eleita. A vaginectomia parcial foi utilizada para o tratamento do prolapso vaginal de grau 1 e a vaginopexia dorsal para os de grau 2 e 3. Os resultados pós-cirúrgicos das duas técnicas indicaram alta porcentagem de recuperação (93.44% para vaginectomia parcial e 96,14% para vaginopexia dorsal) e baixo número de recidivas (6,25% e 3,66%, para vaginectomia parcial e vaginopexia dorsal, respectivamente, e baixa mortalidade (entre 0,20 a 0,31%), podendo...At the end of the decade of 1990, a significant increase of a new affection was observed in the field. This occurrence, recurrent partial or total vaginal Prolapse is not associated with gestation, is seen primarily in zebu cows where, in extreme cases, resulted in a total Prolapse of the vagina, which included exteriorization of the cervix. Given the high commercial value of elite animals presenting this condition, the increase in cases observed led to attempts to solve the condition with conventional techniques such as those of Caslick, Bühner and Flessa. However, reoccurrence of the Prolapse was commonly observed soon after the use of these techniques. Considering these difficulties, the aim of the present work was to develop two new surgical techniques employed in the correction of vaginal Prolapse, named partial vaginectomy and dorsal vaginopexy in cows. The research was conducted in the field, using 812 zebu cows of reproductive age, maintained in several properties in different Brazilian states. The animals selected had the vaginal alteration while maintaining all clinical parameters of heart rate, respiratory rate and body temperature, all within normal range. The diagnosis of a vaginal Prolapse was performed by anamnesis and analysis of the clinical signs, such as visualization of the vagina through the vulva, tenesmus, agitation, lesions in the everted portin and vaginitis. Evaluation of the animals allowed for the definition of stages of the disease, aiding the choice of an adequate surgical technique. Anesthetic protocols were performed taking into consideration the selected surgery. Partial vaginectomy was employed for the treatment of vaginal Prolapses of grade 1, whereas dorsal vaginopexy was used for the grade 2 and 3 Prolapses. Post-surgical results for both techniques indicated a high percentage of recovery... (Complete abstract click electronic access below
