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Fliss E M Murtagh - One of the best experts on this subject based on the ideXlab platform.

  • p 103 a systematic review of the effectiveness of palliative interventions to treat Rectal Tenesmus in cancer
    BMJ, 2017
    Co-Authors: Aine Ni Laoire, Lucy Fettes, Fliss E M Murtagh
    Abstract:

    Background Rectal Tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of Rectal Tenesmus in this patient population. Aim To identify and examine the effectiveness of interventions to palliate Rectal Tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options. Design A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Data sources A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from the date of inception to April 2016. PubMed “related articles”, grey literature, and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat Tenesmus were excluded. Studies involving interventions to treat pelvic pain syndromes without specific outcome measures on severity of Tenesmus were excluded. The quality of the studies was assessed using a National Institute for Health and Clinical Excellence recommended quality assessment tool. Results From 861 studies, nine met full criteria and were selected. All were case series investigating the use of pharmacological interventions (diltiazem, nifedipine, methadone, mexiletine hydrochloride, lidocaine, bupivacaine), anaesthetic interventions (lumbar sympathectomy, neurolytic superior hypogastric plexus block), and endoscopic laser interventions. The included studies showed substantial heterogeneity and therefore a meta-analysis was not feasible. Conclusion From this review we identified a significant gap in research into the palliation of Rectal Tenesmus. A multimodal approach may be necessary due to the complexity of the pathophysiology of Tenesmus. Future research in this area should focus on randomised controlled trials of drug therapies whose potential effectiveness is suggested by case series’.

  • a systematic review of the effectiveness of palliative interventions to treat Rectal Tenesmus in cancer
    Palliative Medicine, 2017
    Co-Authors: Aine Ni Laoire, Lucy Fettes, Fliss E M Murtagh
    Abstract:

    Background:Rectal Tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of Tenesmus in this patient population.Aim:To identify and examine the effectiveness of interventions to palliate Rectal Tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options.Design:A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.Data sources:A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from date of inception to April 2016. PubMed ‘related articles’ search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat Tenesmus were excluded. Studies involving int...

Aine Ni Laoire - One of the best experts on this subject based on the ideXlab platform.

  • p 103 a systematic review of the effectiveness of palliative interventions to treat Rectal Tenesmus in cancer
    BMJ, 2017
    Co-Authors: Aine Ni Laoire, Lucy Fettes, Fliss E M Murtagh
    Abstract:

    Background Rectal Tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of Rectal Tenesmus in this patient population. Aim To identify and examine the effectiveness of interventions to palliate Rectal Tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options. Design A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Data sources A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from the date of inception to April 2016. PubMed “related articles”, grey literature, and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat Tenesmus were excluded. Studies involving interventions to treat pelvic pain syndromes without specific outcome measures on severity of Tenesmus were excluded. The quality of the studies was assessed using a National Institute for Health and Clinical Excellence recommended quality assessment tool. Results From 861 studies, nine met full criteria and were selected. All were case series investigating the use of pharmacological interventions (diltiazem, nifedipine, methadone, mexiletine hydrochloride, lidocaine, bupivacaine), anaesthetic interventions (lumbar sympathectomy, neurolytic superior hypogastric plexus block), and endoscopic laser interventions. The included studies showed substantial heterogeneity and therefore a meta-analysis was not feasible. Conclusion From this review we identified a significant gap in research into the palliation of Rectal Tenesmus. A multimodal approach may be necessary due to the complexity of the pathophysiology of Tenesmus. Future research in this area should focus on randomised controlled trials of drug therapies whose potential effectiveness is suggested by case series’.

  • a systematic review of the effectiveness of palliative interventions to treat Rectal Tenesmus in cancer
    Palliative Medicine, 2017
    Co-Authors: Aine Ni Laoire, Lucy Fettes, Fliss E M Murtagh
    Abstract:

    Background:Rectal Tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of Tenesmus in this patient population.Aim:To identify and examine the effectiveness of interventions to palliate Rectal Tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options.Design:A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.Data sources:A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from date of inception to April 2016. PubMed ‘related articles’ search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat Tenesmus were excluded. Studies involving int...

Lucy Fettes - One of the best experts on this subject based on the ideXlab platform.

  • p 103 a systematic review of the effectiveness of palliative interventions to treat Rectal Tenesmus in cancer
    BMJ, 2017
    Co-Authors: Aine Ni Laoire, Lucy Fettes, Fliss E M Murtagh
    Abstract:

    Background Rectal Tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of Rectal Tenesmus in this patient population. Aim To identify and examine the effectiveness of interventions to palliate Rectal Tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options. Design A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Data sources A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from the date of inception to April 2016. PubMed “related articles”, grey literature, and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat Tenesmus were excluded. Studies involving interventions to treat pelvic pain syndromes without specific outcome measures on severity of Tenesmus were excluded. The quality of the studies was assessed using a National Institute for Health and Clinical Excellence recommended quality assessment tool. Results From 861 studies, nine met full criteria and were selected. All were case series investigating the use of pharmacological interventions (diltiazem, nifedipine, methadone, mexiletine hydrochloride, lidocaine, bupivacaine), anaesthetic interventions (lumbar sympathectomy, neurolytic superior hypogastric plexus block), and endoscopic laser interventions. The included studies showed substantial heterogeneity and therefore a meta-analysis was not feasible. Conclusion From this review we identified a significant gap in research into the palliation of Rectal Tenesmus. A multimodal approach may be necessary due to the complexity of the pathophysiology of Tenesmus. Future research in this area should focus on randomised controlled trials of drug therapies whose potential effectiveness is suggested by case series’.

  • a systematic review of the effectiveness of palliative interventions to treat Rectal Tenesmus in cancer
    Palliative Medicine, 2017
    Co-Authors: Aine Ni Laoire, Lucy Fettes, Fliss E M Murtagh
    Abstract:

    Background:Rectal Tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of Tenesmus in this patient population.Aim:To identify and examine the effectiveness of interventions to palliate Rectal Tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options.Design:A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.Data sources:A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from date of inception to April 2016. PubMed ‘related articles’ search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat Tenesmus were excluded. Studies involving int...

A. Picciocchi - One of the best experts on this subject based on the ideXlab platform.

  • Use of a self-expanding stent in the palliation of Rectal cancer recurrences
    Surgical Endoscopy, 2000
    Co-Authors: C. Coco, S. Cogliandolo, M. E. Riccioni, S. Ciletti, L. Marino-consentino, R. Coppola, A. Picciocchi
    Abstract:

    Background: Patients with nonresectable Rectal cancer recurrences and elderly high risk patients are currently given a colostomy as a palliative therapy. To improve the quality of life in these patients, we inserted a self-expanding metal stent to relieve the symptoms of obstruction caused by a Rectal cancer recurrence. Methods: Three patients (two male, one female; ages 61, 69, and 59), all suffering from a Rectal cancer pelvic recurrence and diffuse metastases, had a stent inserted. Using fluoroscopic and endoscopic control, a metal guidewire was passed through the obstruction. A mild dilatation of the stenosis was carried out before positioning of the expandable metal stent. Results: The procedure was successful at the first attempt in all the patients, and stool evacuation was immediate. Patients complained of Rectal Tenesmus during the first 48 h, which was treated with nonsteroid anti-inflammatory drugs. However, there were no serious complications related to the procedure. Regular endoscopic and clinical follow-up were carried out. No patient had any evidence of recurrent obstruction. Conclusion: In cases of inoperable Rectal cancer recurrence, the placement of self-expanding metal stents is technically feasible and safe, and it avoids a permanent colostomy.

Pravin J Gupta - One of the best experts on this subject based on the ideXlab platform.

  • Radiofrequency coagulation versus rubber band ligation in early hemorrhoids: pain versus gain.
    Medicina-lithuania, 2020
    Co-Authors: Pravin J Gupta
    Abstract:

    OBJECTIVE: Band ligation of internal hemorrhoids is a well-established and accepted office procedure. However, there are several reports focusing on problems associated with this technique, which is perceived by many to be risk-free. This randomized study is aimed to compare radiofrequency coagulation and rubber band ligation of hemorrhoids on the parameters of effectiveness and comfort. MATERIAL AND METHODS: Eighty patients of 2nd degree bleeding piles were randomized prospectively for band ligation (44 patients) or radiofrequency coagulation (36 patients) technique. Parameters measured included postoperative discomfort and pain, time taken to return to work, complications accompanying the procedure and recurrence rate. RESULTS: The post defecation pain was more severe with band ligation (p=0.01) and so was Rectal Tenesmus (p=0.01). The patients from radiofrequency coagulation group resumed their duties early (2 versus 5 days, p=0.05). Recurrence rate was higher in radiofrequency coagulation group. CONCLUSION: Rubber band ligation is associated with significantly higher post treatment pain and discomfort. As against this, radiofrequency coagulation results in significantly less pain and post defecation discomfort. However, chances of recurrence of bleeding and prolapse of hemorrhoids are comparatively higher using radiofrequency coagulation of hemorrhoids.

  • Infrared coagulation versus rubber band ligation in early stage hemorrhoids
    Brazilian Journal of Medical and Biological Research, 2003
    Co-Authors: Pravin J Gupta
    Abstract:

    The ideal therapy for early stages of hemorrhoids is always debated. Some are more effective but are more painful, others are less painful but their efficacy is also lower. Thus, comfort or efficacy is a major concern. In the present randomized study, a comparison is made between infrared coagulation and rubber band ligation in terms of effectiveness and discomfort. One hundred patients with second degree bleeding piles were randomized prospectively to either rubber band ligation (N = 54) or infrared coagulation (N = 46). Parameters measured included postoperative discomfort and pain, time to return to work, relief in incidence of bleeding, and recurrence rate. The mean age was 38 years (range 19-68 years). The mean duration of disease was 17.5 months (range 12 to 34 months). The number of male patients was double that of females. Postoperative pain during the first week was more intense in the band ligation group (2-5 vs 0-3 on a visual analogue scale). Post-defecation pain was more intense with band ligation and so was Rectal Tenesmus (P = 0.0059). The patients in the infrared coagulation group resumed their duties earlier (2 vs 4 days, P = 0.03), but also had a higher recurrence or failure rate (P = 0.03). Thus, we conclude that band ligation, although more effective in controlling symptoms and obliterating hemorrhoids, is associated with more pain and discomfort to the patient. As infrared coagulation can be conveniently repeated in case of recurrence, it could be considered to be a suitable alternative office procedure for the treatment of early stage hemorrhoids.