Purpose: Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable...Purpose: Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable silicone biomaterial, PTPTM (Bioplastique), used to augment the internal anal sphincter. Method: Eighty-two patients (64 females; median age, 66 years) with severe fecal incontinence and a low anal resting pressure caused by internal anal sphincter dysfunction (defect, n = 11; intact, n = 71) were randomized to PTPTM injection into intersphincteric space and internal anal sphincter with (Group A, n = 42) or without (Group B, n = 40) guidance by endoanal ultrasound. Both groups were similar in terms of age, gender, past anorectal surgery,duration of follow-up (median,6 months; range, 1-12 months), and baseline continence score. Sixty-two percent of Group A and 55 percent of Group B had prolonged pudendal nerve terminal motor latency. Results: There was no significant complication. Two patients in Group A and four patients in Group B noted minor discomfort at injection sites. At one month postprocedure, endoanal ultrasound confirmed retention of silicone biomaterial without migration. In both groups, fecal continence was significantly improved by PTPTM implants 1 month after injection, but continued to improve significantly for up to 12 months in Group A and 6 months in Group B (P< 0.001). Improvement in fecal continence and maximum anal resting pressure was significantly greater in Group A, in whom injection was guided by endoanal ultrasound, than in Group B. At three months after injection, significantly more Group A patients than Group B patients achieved >50 percent improvement in Wexner’s continence score (69 percent vs. 40 percent; P=0.014). Ninety-three percent of Group A and 92 percent of Group B had >50 percent improvement in global quality of life scores (visual analog scale). At a median followup of 6 months, all domains of the fecal incontinence quality of life scale improved significantly in both groups; however, the physical function and mental health scores of Short Form-12 only improved in Group A. A prolonged pudendal nerve terminal motor latency had no effect on functional outcome in either group. Conclusion: Injection of silicone biomaterial provided amarked improvement in fecal continence and quality of life in patients with internal sphincter dysfunction, despite the presence of pudendal neuropathy.展开更多
PURPOSE: This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch- anal...PURPOSE: This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch- anal anastomosis. METHODS: The patients who had at least one live birth after ileal pouch- anal anastomosis were asked to return for a comprehensive assessment. They were asked to complete the following questionnaires: the Short Form- 36, Cleveland Global Quality of Life scale, American Society of Colorectal Surgeons fecal incontinence severity index, and time trade- off method. Additionally, anal sphincter integrity (endosonography) and manometric pressures were measured by a medical physician blinded to the delivery technique. Anal sphincter physiology also was evaluated with electromyography and pudendal nerve function by nerve terminal motor latency technique. RESULTS: Of 110 eligible females who had at least one live birth after ileal pouch- anal anastomosis, 57 participated in the study by returning for clinical evaluation to the clinic and 25 others by returning the quality of life and functional outcome questionnaires. Patients were classified into two groups: patients who had only cesarean section delivery after ileal pouch- anal anastomosis (n = 62) and patients who had at least one vaginal delivery after ileal pouch- anal anastomosis (n = 20). The mean follow- up from the date of the most recent delivery was 4.9 years. The vaginal delivery group had significantly higher incidence of an anterior sphincter defect by anal endosonography (50 percent)vs. cesarean section delivery group (13 percent; P = 0.012). The mean squeeze anal pressure was significantly higher in the patients who had only cesarean section delivery (150 mmHg)after restorative proctocolectomy than patients who had at least one vaginal delivery (120 mmHg) after restorative proctocolectomy (P = 0.049). Quality of life evaluated by time trade- off method also was significantly better in the cesarean section delivery group (1) vs. vaginal delivery group (0.9; P < 0.001). CONCLUSIONS: The risk of the sphincter injury and quality of life measured by time trade- off method are significantly worse after vaginal delivery compared with cesarean section in patients with ileal pouch- anal anastomosis. In the short- term, this does not seem to substantially influence pouch function or quality of life; however, the long- term effects remain unknown, thus obstetric concern may not be the only factor dictating the type of delivery in this group of patients. A planned cesarean section may eliminate these potential and factual concerns in ileal pouch- anal anastomosis patients.展开更多
Objective： Explore the pulmonary embolism nursing intervention implementation.The evaluation of the overall nursing applied to the effect of patients with pulmonary embolism. Methods： A retrospective analysis the da...Objective： Explore the pulmonary embolism nursing intervention implementation.The evaluation of the overall nursing applied to the effect of patients with pulmonary embolism. Methods： A retrospective analysis the data of the nine cases who with pulmonary embolism in our hospital from January 2010 to May 2012, to assess the overall nursing experience. During the period, nurses do a sound basis for nursing, and strengthen the observation close monitoring of adverse reaction and well before discharge health guidance. Results： through the timely diagnosis, standard treatment and careful nursing on a patient ofholistic nursing intervention, thus, reducing the recurrence of pulmonary embolism, to promote the rehabilitation of patients with pulmonary embolism, and effectively reduce mortality. Conclusion： The application of the overall care for patients with pulmonary thromboembolism to provide quality care services, reduce the incidence of acute pulmonary thromboembolism, improve the quality of care and patient satisfaction. Effectively improve patients＇ quality of life.展开更多
国际功能、残疾和健康分类（International Classification of Functioning,Disability and Health,ICF）是世界卫生组织设计的一种可以用于不同学科和领域的多目的性的分类[1]。以ICF理论为指导的作业疗法,强调以患者的喜好和愿望为中...国际功能、残疾和健康分类（International Classification of Functioning,Disability and Health,ICF）是世界卫生组织设计的一种可以用于不同学科和领域的多目的性的分类[1]。以ICF理论为指导的作业疗法,强调以患者的喜好和愿望为中心,同时考虑环境和个人因素的影响,强调人在社会中的功能,加强患者的活动水平,提高患者整体生活质量和功能情况,最终目的是使患者回归家庭和社会。展开更多
文摘Purpose: Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable silicone biomaterial, PTPTM (Bioplastique), used to augment the internal anal sphincter. Method: Eighty-two patients (64 females; median age, 66 years) with severe fecal incontinence and a low anal resting pressure caused by internal anal sphincter dysfunction (defect, n = 11; intact, n = 71) were randomized to PTPTM injection into intersphincteric space and internal anal sphincter with (Group A, n = 42) or without (Group B, n = 40) guidance by endoanal ultrasound. Both groups were similar in terms of age, gender, past anorectal surgery,duration of follow-up (median,6 months; range, 1-12 months), and baseline continence score. Sixty-two percent of Group A and 55 percent of Group B had prolonged pudendal nerve terminal motor latency. Results: There was no significant complication. Two patients in Group A and four patients in Group B noted minor discomfort at injection sites. At one month postprocedure, endoanal ultrasound confirmed retention of silicone biomaterial without migration. In both groups, fecal continence was significantly improved by PTPTM implants 1 month after injection, but continued to improve significantly for up to 12 months in Group A and 6 months in Group B (P< 0.001). Improvement in fecal continence and maximum anal resting pressure was significantly greater in Group A, in whom injection was guided by endoanal ultrasound, than in Group B. At three months after injection, significantly more Group A patients than Group B patients achieved >50 percent improvement in Wexner’s continence score (69 percent vs. 40 percent; P=0.014). Ninety-three percent of Group A and 92 percent of Group B had >50 percent improvement in global quality of life scores (visual analog scale). At a median followup of 6 months, all domains of the fecal incontinence quality of life scale improved significantly in both groups; however, the physical function and mental health scores of Short Form-12 only improved in Group A. A prolonged pudendal nerve terminal motor latency had no effect on functional outcome in either group. Conclusion: Injection of silicone biomaterial provided amarked improvement in fecal continence and quality of life in patients with internal sphincter dysfunction, despite the presence of pudendal neuropathy.
文摘PURPOSE: This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch- anal anastomosis. METHODS: The patients who had at least one live birth after ileal pouch- anal anastomosis were asked to return for a comprehensive assessment. They were asked to complete the following questionnaires: the Short Form- 36, Cleveland Global Quality of Life scale, American Society of Colorectal Surgeons fecal incontinence severity index, and time trade- off method. Additionally, anal sphincter integrity (endosonography) and manometric pressures were measured by a medical physician blinded to the delivery technique. Anal sphincter physiology also was evaluated with electromyography and pudendal nerve function by nerve terminal motor latency technique. RESULTS: Of 110 eligible females who had at least one live birth after ileal pouch- anal anastomosis, 57 participated in the study by returning for clinical evaluation to the clinic and 25 others by returning the quality of life and functional outcome questionnaires. Patients were classified into two groups: patients who had only cesarean section delivery after ileal pouch- anal anastomosis (n = 62) and patients who had at least one vaginal delivery after ileal pouch- anal anastomosis (n = 20). The mean follow- up from the date of the most recent delivery was 4.9 years. The vaginal delivery group had significantly higher incidence of an anterior sphincter defect by anal endosonography (50 percent)vs. cesarean section delivery group (13 percent; P = 0.012). The mean squeeze anal pressure was significantly higher in the patients who had only cesarean section delivery (150 mmHg)after restorative proctocolectomy than patients who had at least one vaginal delivery (120 mmHg) after restorative proctocolectomy (P = 0.049). Quality of life evaluated by time trade- off method also was significantly better in the cesarean section delivery group (1) vs. vaginal delivery group (0.9; P < 0.001). CONCLUSIONS: The risk of the sphincter injury and quality of life measured by time trade- off method are significantly worse after vaginal delivery compared with cesarean section in patients with ileal pouch- anal anastomosis. In the short- term, this does not seem to substantially influence pouch function or quality of life; however, the long- term effects remain unknown, thus obstetric concern may not be the only factor dictating the type of delivery in this group of patients. A planned cesarean section may eliminate these potential and factual concerns in ileal pouch- anal anastomosis patients.
文摘Objective： Explore the pulmonary embolism nursing intervention implementation.The evaluation of the overall nursing applied to the effect of patients with pulmonary embolism. Methods： A retrospective analysis the data of the nine cases who with pulmonary embolism in our hospital from January 2010 to May 2012, to assess the overall nursing experience. During the period, nurses do a sound basis for nursing, and strengthen the observation close monitoring of adverse reaction and well before discharge health guidance. Results： through the timely diagnosis, standard treatment and careful nursing on a patient ofholistic nursing intervention, thus, reducing the recurrence of pulmonary embolism, to promote the rehabilitation of patients with pulmonary embolism, and effectively reduce mortality. Conclusion： The application of the overall care for patients with pulmonary thromboembolism to provide quality care services, reduce the incidence of acute pulmonary thromboembolism, improve the quality of care and patient satisfaction. Effectively improve patients＇ quality of life.
文摘国际功能、残疾和健康分类（International Classification of Functioning,Disability and Health,ICF）是世界卫生组织设计的一种可以用于不同学科和领域的多目的性的分类[1]。以ICF理论为指导的作业疗法,强调以患者的喜好和愿望为中心,同时考虑环境和个人因素的影响,强调人在社会中的功能,加强患者的活动水平,提高患者整体生活质量和功能情况,最终目的是使患者回归家庭和社会。
