Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, t...Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. Results： The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month, but had no significant difference one year after. On the other hand, the indexes of vectorial manometry still had significant difference one year later. The indexes after intersphincteric resection could not reach the normal level. Conclusion： The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term, although the long-term results can be accepted, it still can not reach the normal level.展开更多
Objective： To evaluate the influence of complete and incomplete pelvic autonomic nerve preservation （PANP） on urination function in patients with resection of rectal carcinoma. Methods： The changes of pre-and post...Objective： To evaluate the influence of complete and incomplete pelvic autonomic nerve preservation （PANP） on urination function in patients with resection of rectal carcinoma. Methods： The changes of pre-and post-operative residual urine volume （RUV） in patient undergoing complete PANP （n = 15） and incomplete PANP （n = 17） were observed. Results： In fifteen cases with complete PANP, preoperative RUV was 4.09 ml, 14 days and 3 months after operation RUV were 8.00 ml and 7.02 ml （P 〉 0.05）. In seventeen cases with incomplete PANP, preoperative RUV was 3.90 ml, 14 days and 3 months after operation RUV were 36.55 ml and 22.64 ml （P 〈 0.001 ）. Conclusion： Complete and incomplete pelvic autonomic preservation may affect urination function in patients with resection of rectal carcinoma and RUV is an effective indicator if the pelvic autonomic nerves are preserved completely.展开更多
AIM:To assess the clinical diagnostic value of functional imaging,combining quantitative parameters of apparent diffusion coefficient(ADC) and standardized uptake value(SUV)max,before and after chemo-radiation therapy...AIM:To assess the clinical diagnostic value of functional imaging,combining quantitative parameters of apparent diffusion coefficient(ADC) and standardized uptake value(SUV)max,before and after chemo-radiation therapy,in prediction of tumor response of patients with rectal cancer,related to tumor regression grade at histology.METHODS:A total of 31 patients with biopsy proven diagnosis of rectal carcinoma were enrolled in our study.All patients underwent a whole body ^(18)FDG positron emission tomography(PET)/computed tomography(CT) scan and a pelvic magnetic resonance(MR)examination including diffusion weighted(DW) imaging for staging(PET1,RM1) and after completion(6.6 wk)of neoadjuvant treatment(PET2,RM2).Subsequently all patients underwent total mesorectal excision and the histological results were compared with imaging findings.The MR scanning,performed on 1.5 T magnet(Philips,Achieva),included T2-weighted multiplanar imaging and in addition DW images with b-value of 0 and 1000 mm^2/s.On PET/CT the SUVmax of the rectal lesion were calculated in PET1 and PET2.The percentage decrease of SUVmax(△SUV) and ADC(△ADC) values from baseline to presurgical scan were assessed and correlated with pathologic response classified as tumor regression grade(Mandard's criteria;TRG1 = complete regression,TRG5 = no regression).RESULTS:After completion of therapy,all the patients were submitted to surgery.According to the Mandard's criteria,22 tumors showed complete(TRG1) or subtotal regression(TRG2) and were classified as responders;9tumors were classified as non responders(TRG3,4 and5).Considering all patients the mean values of SUVmax in PET 1 was higher than the mean value of SUVmax in PET 2(P < 0.001),whereas the mean ADC values was lower in RM1 than RM2(P < 0.001),with a △SUV and △ADC respectively of 60.2%and 66.8%.The best predictors for TRG response were SUV2(threshold of4.4) and ADC2(1.29 × 10^(-3) mm^2/s) with high sensitivity and specificity.Combining in a single analysis both the obtained median value,the positive predictive value,in predicting the different group category response in related to TRG system,presented R^2 of 0.95.CONCLUSION:The functional imaging combining ADC and SUVmax in a single analysis permits to detect changes in cellular tissue structures useful for the assessment of tumour response after the neoadjuvant therapy in rectal cancer,increasing the sensitivity in correct depiction of treatment response than either method alone.展开更多
AIM To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODS A comprehensive questionnaire was distributed to general pediatricians from ...AIM To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODS A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.RESULTS Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements(according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools(83%), blood in the stools(36%), fecal incontinence(33%), and/or difficulty in defecating(47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly(according to 68%) The preferred nonpharmacologic treatment are high-fiber diet(96%), increased fluid intake(90%), toilet training(74%), and abdominal massage(49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used(87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment(85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians(69%) expect a positive response during the first week with a mean(± SD) of 4.1(± 2.56) d. Most participants(86%) treat during one month or even less. And the majority(67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.CONCLUSION These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.展开更多
基金This work was supported by a grant from the Education Department of Liaoning Province(No.05L484).
文摘Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. Results： The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month, but had no significant difference one year after. On the other hand, the indexes of vectorial manometry still had significant difference one year later. The indexes after intersphincteric resection could not reach the normal level. Conclusion： The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term, although the long-term results can be accepted, it still can not reach the normal level.
文摘Objective： To evaluate the influence of complete and incomplete pelvic autonomic nerve preservation （PANP） on urination function in patients with resection of rectal carcinoma. Methods： The changes of pre-and post-operative residual urine volume （RUV） in patient undergoing complete PANP （n = 15） and incomplete PANP （n = 17） were observed. Results： In fifteen cases with complete PANP, preoperative RUV was 4.09 ml, 14 days and 3 months after operation RUV were 8.00 ml and 7.02 ml （P 〉 0.05）. In seventeen cases with incomplete PANP, preoperative RUV was 3.90 ml, 14 days and 3 months after operation RUV were 36.55 ml and 22.64 ml （P 〈 0.001 ）. Conclusion： Complete and incomplete pelvic autonomic preservation may affect urination function in patients with resection of rectal carcinoma and RUV is an effective indicator if the pelvic autonomic nerves are preserved completely.
文摘AIM:To assess the clinical diagnostic value of functional imaging,combining quantitative parameters of apparent diffusion coefficient(ADC) and standardized uptake value(SUV)max,before and after chemo-radiation therapy,in prediction of tumor response of patients with rectal cancer,related to tumor regression grade at histology.METHODS:A total of 31 patients with biopsy proven diagnosis of rectal carcinoma were enrolled in our study.All patients underwent a whole body ^(18)FDG positron emission tomography(PET)/computed tomography(CT) scan and a pelvic magnetic resonance(MR)examination including diffusion weighted(DW) imaging for staging(PET1,RM1) and after completion(6.6 wk)of neoadjuvant treatment(PET2,RM2).Subsequently all patients underwent total mesorectal excision and the histological results were compared with imaging findings.The MR scanning,performed on 1.5 T magnet(Philips,Achieva),included T2-weighted multiplanar imaging and in addition DW images with b-value of 0 and 1000 mm^2/s.On PET/CT the SUVmax of the rectal lesion were calculated in PET1 and PET2.The percentage decrease of SUVmax(△SUV) and ADC(△ADC) values from baseline to presurgical scan were assessed and correlated with pathologic response classified as tumor regression grade(Mandard's criteria;TRG1 = complete regression,TRG5 = no regression).RESULTS:After completion of therapy,all the patients were submitted to surgery.According to the Mandard's criteria,22 tumors showed complete(TRG1) or subtotal regression(TRG2) and were classified as responders;9tumors were classified as non responders(TRG3,4 and5).Considering all patients the mean values of SUVmax in PET 1 was higher than the mean value of SUVmax in PET 2(P < 0.001),whereas the mean ADC values was lower in RM1 than RM2(P < 0.001),with a △SUV and △ADC respectively of 60.2%and 66.8%.The best predictors for TRG response were SUV2(threshold of4.4) and ADC2(1.29 × 10^(-3) mm^2/s) with high sensitivity and specificity.Combining in a single analysis both the obtained median value,the positive predictive value,in predicting the different group category response in related to TRG system,presented R^2 of 0.95.CONCLUSION:The functional imaging combining ADC and SUVmax in a single analysis permits to detect changes in cellular tissue structures useful for the assessment of tumour response after the neoadjuvant therapy in rectal cancer,increasing the sensitivity in correct depiction of treatment response than either method alone.
文摘AIM To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODS A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.RESULTS Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements(according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools(83%), blood in the stools(36%), fecal incontinence(33%), and/or difficulty in defecating(47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly(according to 68%) The preferred nonpharmacologic treatment are high-fiber diet(96%), increased fluid intake(90%), toilet training(74%), and abdominal massage(49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used(87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment(85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians(69%) expect a positive response during the first week with a mean(± SD) of 4.1(± 2.56) d. Most participants(86%) treat during one month or even less. And the majority(67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.CONCLUSION These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.
