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Clinical and Imaging Research in the Diagnosis of Anorectal Melanoma with Surgical Outcome: A Case Report and Literature Review 直肠肛管黑色素瘤的临床及影像学研究与手术预后:1例报告及文献复习
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1055/s-0043-1774735
Ana Luiza Moraes Rocha, Gabriella Giandotti Gomar, João Pedro Cruz Lima Chagas, Dayara Mussi Salomão, Luciana Clivatti
Abstract Objective This study aims to report the case of a 69-year-old female patient with a diagnosis of anorectal melanoma (AM) established by immunohistochemistry. Methods Clinical case report, a descriptive and qualitative study. Results The patient had a nodular and ulcerative lesion in the anal region, the imaging exams revealed an expansive lesion that affected the rectum and the vaginal wall. The chosen course of treatment was initial surgical intervention, the surgery and postoperative course progressed without complications, and the anatomopathological examination confirmed the diagnosis of invasive malignant melanoma of the distal rectum of anorectal transition. The anatomopathological examination confirmed the diagnosis of invasive malignant melanoma located in the distal rectum of the anorectal transition. Immunohistochemistry analysis showed infiltrative melanoma with microsatellites, as well as peri and intratumoral lymphocytic infiltrate, angiolymphatic invasion, and perineural invasion. The surgical resection margins, ovaries, posterior vaginal wall, and parametrium showed no signs of neoplastic involvement. Following the surgery, the patient began immunotherapy, which she is still undergoing. Conclusions The survival rate of AM can be improved through various diagnostic and therapeutic modalities. However, further exploration of this topic through clinical studies is necessary to enhance both diagnosis and treatment.
摘要目的报告1例69岁女性经免疫组化诊断为肛肠黑色素瘤(AM)的病例。方法采用临床病例报告、定性和描述性研究相结合的方法。结果患者肛门结节性溃疡性病变,影像学检查显示病变扩张性,累及直肠及阴道壁。选择的疗程为初始手术干预,手术及术后病程进展无并发症,解剖病理检查确诊为肛肠过渡直肠远端浸润性恶性黑色素瘤。解剖病理检查证实了位于肛肠过渡直肠远端浸润性恶性黑色素瘤的诊断。免疫组织化学分析显示浸润性黑色素瘤伴微卫星,瘤周和瘤内淋巴细胞浸润,血管淋巴浸润和神经周围浸润。手术切除边缘,卵巢,阴道后壁和参数显示没有肿瘤累及的迹象。手术后,患者开始了免疫治疗,目前仍在接受治疗。结论AM可通过多种诊断和治疗方式提高生存率。然而,有必要通过临床研究进一步探索这一主题,以提高诊断和治疗水平。
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引用次数: 0
Relationship between Age and The Histopathological Features to Chemotherapy Response in Colorectal Cancer Patients: A Prospective Observational Study 年龄与结直肠癌患者化疗反应的组织病理学特征之间的关系:前瞻性观察研究
Q4 Medicine Pub Date : 2023-08-15 DOI: 10.1055/s-0043-1776890
K. Lukman, Gun Gun Gunawan, R. Rudiman, Y. Sribudiani, Lisa Y. Hasibuan, B. Dewayani, Prapanca Nugraha, E. Primastari
Abstract Introduction  Chemotherapy response in early age-onset colorectal cancer patients is still controversial, and the results of chemotherapy response are unknown. Therefore, the purpose of this study is to determine the relationship between the age of colorectal cancer patients and histopathological features and chemotherapy response. Methods  This is a prospective observational study. The subjects in this study were colorectal cancer patients in the Digestive Surgery division at Tertiary Hospital in West Java from September 2021 to September 2022. Results  There were 86 subjects who underwent chemotherapy in accordance with the inclusion and exclusion criteria. Consisting of 39 patients of early age onset and 44 female patients. The most common histopathological feature in early age onset (EAO) and late age onset (LAO) was adenocarcinoma (25% and 46%, respectively). Stage III colorectal cancer affected 38 patients, while stage IV affected 48 patients. There was a significant relationship between early age onset and late age onset with histological features (p < 0.001). The patients with the highest chemotherapy response had stable diseases in EAO (17 patients) and LAO (20 patients). There was no statistically significant relationship between age, histological features, and stage of colorectal cancer and chemotherapy response (p > 0.05). The results of the ordinal logistic regression test showed no systematic relationship between chemotherapy response and age, histopathological features, gender, or cancer stage (p > 0.05). Conclusion  There was no association between age and histopathologic features with chemotherapy response and there is no difference in chemotherapy response between early and late age onset.
摘要 引言 早发年龄结直肠癌患者的化疗反应仍存在争议,化疗反应的结果尚不清楚。因此,本研究旨在确定结直肠癌患者的年龄与组织病理学特征和化疗反应之间的关系。方法 这是一项前瞻性观察研究。研究对象为 2021 年 9 月至 2022 年 9 月期间在西爪哇第三医院消化外科就诊的结直肠癌患者。结果 86 名受试者按照纳入和排除标准接受了化疗。其中包括 39 名早年发病的患者和 44 名女性患者。早发(EAO)和晚发(LAO)患者最常见的组织病理学特征是腺癌(分别占 25% 和 46%)。38 名患者为 III 期结直肠癌,48 名患者为 IV 期。早期发病年龄和晚期发病年龄与组织学特征有明显关系(P 0.05)。序数逻辑回归检验结果显示,化疗反应与年龄、组织病理学特征、性别或癌症分期之间没有系统性关系(P > 0.05)。结论 年龄和组织病理学特征与化疗反应之间没有关联,发病年龄早晚的化疗反应也没有差异。
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引用次数: 0
Evaluation of Proactive Therapeutic Drug Monitoring Application in Infliximab Users in Ulcerative Colitis 评估溃疡性结肠炎患者使用英夫利西单抗时的主动治疗药物监测应用
Q4 Medicine Pub Date : 2023-08-15 DOI: 10.1055/s-0043-1776889
Gabriela Maria Henz Giovelli, O. Cassol, Marcio Lubini, Angelina Dantas Costa, Édina Gaviraghi, Laura de Cezaro Martini
Abstract Objective  To evaluate the application of proactive pro-drug therapy (TDM) at week six in users of infliximab therapy in ulcerative colitis patients and to analyze the need for further disease optimization. Method  This is a retrospective analysis that will be carried out simultaneously at the Hospital de Clínicas de Passo Fundo and at the Endoclin Diagnostic Center in the city of Passo Fundo, with secondary data collection between January 2020 and May 2022. The sample included patients from both sexes, regardless of age, who are being followed up in the services mentioned above, by signing the informed Free and Clarified Consent Term. Results  63.2% of patients required optimization of their treatment based on the serum level assessment at week six. Conclusion  Proactive TDM performed at week six benefits patients in order to complete indications for treatment to avoid lack of drug response and complications from the disease.
摘要 目的 评估英夫利西单抗治疗溃疡性结肠炎患者第6周时前瞻性药物治疗(TDM)的应用情况,并分析进一步优化病情的必要性。方法 这是一项回顾性分析,将在帕索芬多临床医院和帕索芬多市 Endoclin 诊断中心同时进行,并在 2020 年 1 月至 2022 年 5 月期间收集二次数据。样本包括在上述服务机构接受随访并签署知情自由和明确同意书的男女患者,不分年龄。结果 根据第六周的血清水平评估,63.2% 的患者需要优化治疗。结论 在第六周进行积极的 TDM 可使患者受益,以完成治疗适应症,避免药物反应不足和疾病并发症。
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引用次数: 0
Assessment of Functional Outcome Following Duhamel Retro-Rectal Pull-Through Surgery for Hirschsprung's Disease - A Follow-up Study 杜哈梅尔直肠后拉通手术治疗赫氏贲门失弛缓症的功能效果评估 - 一项随访研究
Q4 Medicine Pub Date : 2023-08-08 DOI: 10.1055/s-0043-1776891
Raghunath S. M., Raghul Maniam, Vembar Dhanasekarapandian, H. Govindarajan
Abstract Context  Hirschsprung's disease (HD) is one of the commonest problems requiring surgery in children. More than 95% of children present during new-born period, when they are treated with leveling colostomy and are followed with pull-through surgery a few months later, once the child has gained adequate weight to withstand a major surgery. The commonest pull through surgery done is the Duhamel retro-rectal pull-through (DRPT) repair. Settings and Design  This is a retrospective study of children who presented to one unit in our institute, a tertiary care referral hospital for children less than 12 years, with HD and underwent DRPT procedure during the period between July 2017 to June 2020. The children were evaluated after three years of follow-up for fecal incontinence and constipation. The study was conducted in children diagnosed with classical segment recto-sigmoid HD who underwent surgery. The children who were diagnosed with HD other than classical segment, who underwent primary pull through surgery and who underwent other repairs for HD were excluded from the study. Results  Thirty-two children underwent DRPT procedure during the study period. Of them, five (15.6%) children were lost on follow-up and one (3.1%) child had expired in the immediate post-operative period. Twenty-six children were included in the study. The bowel function score was calculated. The mean age of definitive surgery was 4.2 years. The follow-up period was a minimum of three years. Only two children had a “good” score of eighteen and above. Nineteen children had a “fair” score of 13–17. Five children had a “poor” score of less than thirteen, and among them, two had a “very poor” score of less than nine. The mean BFS was 13.72. Conclusions  Functional outcomes following Duhamel procedure are satisfactory, with 7.7% of children are in the fringe of requiring another surgery for constipation and pseudo-incontinence.
摘要 背景 赫氏胃肠病(Hirschsprung's disease,HD)是儿童中需要手术治疗的最常见疾病之一。95%以上的患儿在新生儿期发病,当时采用平整结肠造口术治疗,几个月后,当患儿体重增加到足以承受大手术时,再进行牵拉手术。最常见的拉通手术是 Duhamel 直肠后拉通(DRPT)修复术。设置与设计 这是一项回顾性研究,研究对象是 2017 年 7 月至 2020 年 6 月期间在我院(一家 12 岁以下儿童的三级转诊医院)的一个科室就诊并接受 DRPT 手术的 HD 患儿。随访三年后,对患儿的大便失禁和便秘情况进行了评估。研究对象是被诊断为经典节段直肠乙状结肠HD并接受了手术的患儿。研究排除了被诊断为经典节段以外的 HD、接受过初级拉通手术和接受过其他 HD 修复手术的患儿。结果 32 名儿童在研究期间接受了 DRPT 手术。其中,5 名儿童(15.6%)失去了随访机会,1 名儿童(3.1%)在术后立即死亡。本研究共纳入 26 名患儿。研究计算了肠道功能评分。明确手术的平均年龄为 4.2 岁。随访期至少为三年。只有两名患儿的评分达到或超过 18 分。19名患儿的 "一般 "评分为13-17分。五名儿童的 "差 "分低于 13 分,其中两名儿童的 "极差 "分低于 9 分。平均 BFS 为 13.72 分。结论 Duhamel 术后的功能效果令人满意,7.7% 的患儿处于需要再次手术治疗便秘和假性尿失禁的边缘。
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引用次数: 0
Therapeutic Drug Monitoring in Inflammatory Bowel Disease 炎症性肠病的治疗药物监测
Q4 Medicine Pub Date : 2023-08-07 DOI: 10.1055/s-0043-1776892
Manoel Álvaro de Freitas Lins Neto, João Otávio de Moraes Rolim, D. C. M. D. O. Jatobá, Júnia Elisa Carvalho de Meira, Luís Henrique Salvador Filho, Lucas Correia Lins, Jorge Artur Coelho Peçanha
Abstract Inflammatory bowel disease (IBD) is a problem that directly affects the quality of life of patients suffering from this condition. Monitoring the serum level of infliximab (IFX) (TDM) is an important tool for guiding therapeutic decisions in IBD patients. The purpose of this study was to determine the significance of quantitatively measuring the serum level of IFX (TDM) and antibody to IFX (ATI). Methods and materials: Prospective observational study involving 40 IBD patients on IFX therapy, including 14 Proactive (week 06 of the induction phase) and 26 Reactive (maintenance phase). Immediately prior to the infusion, blood samples were drawn and measured using a Bulhlmann rapid test instrument. Serum concentrations of IFX were categorized as supratherapeutic (>7.0 micrograms/ml), therapeutic (between 3.0 and 7.0 micrograms/ml), and subtherapeutic (3.0 micrograms/ml). When the serum concentration of IFX was 3 mcg/ml (subtherapeutic), the ATI was measured. 25 patients with CD and 15 patients with UC were evaluated. Only three of the twenty patients with subtherapeutic serum levels had a positive ATI, and both were reactive; two had CD and one had UC. There was a statistically significant difference between reactive and proactive patients with respect to levels of CRP (p = 0.042), with proactive DNS patients suffering greater alterations in CRP and albumin.
摘要 炎症性肠病(IBD)是一个直接影响患者生活质量的问题。监测英夫利昔单抗(IFX)的血清水平(TDM)是指导 IBD 患者治疗决策的重要工具。本研究旨在确定定量测量 IFX(TDM)和 IFX 抗体(ATI)血清水平的意义。方法和材料:前瞻性观察研究,涉及 40 名接受 IFX 治疗的 IBD 患者,包括 14 名前瞻性患者(诱导阶段第 06 周)和 26 名反应性患者(维持阶段)。输液前立即抽取血样,并使用 Bulhlmann 快速检测仪进行测量。IFX 的血清浓度分为超治疗浓度(大于 7.0 微克/毫升)、治疗浓度(介于 3.0 和 7.0 微克/毫升之间)和亚治疗浓度(3.0 微克/毫升)。当 IFX 的血清浓度为 3 微克/毫升(亚治疗)时,则测量 ATI。对 25 名 CD 患者和 15 名 UC 患者进行了评估。在血清浓度低于治疗水平的 20 位患者中,只有 3 位患者的 ATI 呈阳性,而且都是反应性的;其中 2 位是 CD 患者,1 位是 UC 患者。在 CRP 水平方面,反应性和主动性患者之间的差异有统计学意义(p = 0.042),主动性 DNS 患者的 CRP 和白蛋白变化更大。
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引用次数: 0
Development of a Low-Cost Simulator for Training in Hemorrhoidal Ligation 开发用于痔疮结扎培训的低成本模拟器
Q4 Medicine Pub Date : 2023-07-07 DOI: 10.1055/s-0043-1776905
Carlos Magno Queiroz da Cunha, João Víctor Liberalino Costa, Maria Valquídia Nogueira Pessoa, Lavier Kelvin Holanda Vidal, Lara Burlamaqui Veras
Abstract Introduction  Rubber band ligation is a minimally invasive outpatient hemorrhoid treatment with low cost, low complication rates, and rapid realization. It is performed with the aid of an anoscope and uses a rubber ring that surrounds the hemorrhoidal nipple, causing compression of the vascular structures of the tissue, leading to necrosis and remission of the hemorrhoid. No device for training this essential procedure for treating this pathology has been identified in the literature. Therefore, we aim to develop a low-cost simulator for training hemorrhoidal rubber ligation. Methods  The model was constructed using PVC pipe wrapped in neoprene fabric. Hemorrhoidal nipples and the pectineal line were also simulated using fabric and sewing threads. The procedure is performed with conventional anoscope and ligature forceps. Conclusion  The device in question is a low-cost simulation model designed to train the skills required to perform a rubber band ligation and review the basic anatomy of the anal canal during anoscopy. Given these qualities, the model can be used for academic training due to its low cost and simplicity of application.
摘要 引言 胶圈结扎术是一种微创门诊痔疮治疗方法,具有费用低、并发症发生率低、见效快等优点。它是在肛门镜的辅助下进行的,使用一个橡胶圈环绕痔疮乳头,压迫组织的血管结构,导致痔疮坏死和缓解。在文献中,还没有发现用于训练这种治疗病理的重要程序的设备。因此,我们旨在开发一种用于训练痔疮橡胶结扎术的低成本模拟器。方法 该模型由氯丁橡胶布包裹的 PVC 管制成。痔核乳头和栉水母线也是用织物和缝纫线模拟的。手术使用传统的肛门镜和结扎钳进行。结论 该设备是一种低成本的模拟模型,旨在培训在肛门镜检查过程中进行橡皮筋结扎和复习肛管基本解剖所需的技能。鉴于这些特点,该模型可用于学术培训,因为其成本低廉,应用简单。
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引用次数: 0
Assessment of Quality-of-Life in Cancer Patients at Tertiary Care Hospital in North India 印度北部三级医院癌症患者的生活质量评估
Q4 Medicine Pub Date : 2023-06-23 DOI: 10.1055/s-0043-1776979
Bintoo Sharma, Harsh Tyagi, Ranjeet Kumar, Amit Sharma
Abstract Introduction  Cancer is a disease that emerges as a result of abnormal cell proliferation and their propensity to spread from one bodily region to another. There are over a hundred different types of cancer that impact individuals all over the world. It is difficult to identify in the early stages, but there are certain warning signals that the cells will turn malignant. Quality of life (QOL) is described by the World Health Organisation as “individuals' perception of life, values, objectives, standards, and interests within the cultural framework of the social environment in which they live and in relation to their goals, expectations, standards, and concerns.” QOL assessment in health system is a multidimensional construct that can be measured by evaluating objective levels of health status filtered by the subjective perceptions and expectations of the individual. Aim and Objective  To assess socio-demographic factors and quality of life among cancer patients in tertiary care hospital. Materials and Methods  A hospital-based prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital Faridkot district, Punjab (India). The study was conducted for a period of six months after getting approval from Institutional Ethical Committee (IEC). Generic instrument, SF-36 was used to assess the QOL. The study was analyzed on SPSS version 26.0 software. Descriptive and analytical analysis was used to describe the results. Results  Linear regression was conducted to see the relationship of physical functioning score with age and weight of the patients. The descriptive statistics shows the mean and standard deviation of the variable. The mean of physical functioning score was found to be (M = 27.82, SD = 15.635). The physical functioning score and age, weight of the patients in linear regression shows that the age and weight explain 17.5% Conclusion  Treatment revealed that severe and moderate activities restricted nearly half of the assessed patients, with body pain interfering with employment and routine activities. According to the findings of the current study, QOL deteriorates as the disease progresses. Cancer unquestionably has a detrimental influence on patients' quality of life, which is connected to the illness process itself, the therapy administered, and the length of the disease.
摘要 引言 癌症是一种由于细胞异常增殖及其从一个身体区域扩散到另一个身体区域的倾向而产生的疾病。全世界有一百多种不同类型的癌症。癌症在早期阶段很难识别,但有一些警告信号表明细胞将转变为恶性。世界卫生组织将生活质量(QOL)描述为 "个人在其生活的社会环境的文化框架内,对生活、价值观、目标、标准和兴趣的感知,并与他们的目标、期望、标准和关注点相关联"。卫生系统中的 QOL 评估是一个多维度的概念,可通过评估经个人主观感知和期望过滤的客观健康状况水平来衡量。目的和目标 评估三级医院癌症患者的社会人口学因素和生活质量。材料和方法 在印度旁遮普省法里德科特地区的古鲁-戈宾德-辛格医学院和医院开展了一项基于医院的前瞻性观察研究。在获得医院伦理委员会(IEC)的批准后,研究进行了六个月。采用通用工具 SF-36 评估 QOL。研究使用 SPSS 26.0 版软件进行分析。使用描述性和分析性分析来描述结果。结果 对患者的身体机能评分与年龄和体重的关系进行了线性回归。描述性统计显示了变量的平均值和标准差。结果发现,身体功能得分的平均值为(M = 27.82,SD = 15.635)。身体功能得分与患者年龄、体重的线性回归结果显示,年龄和体重可解释 17.5% 的问题。根据本次研究的结果,随着病情的发展,患者的生活质量会下降。癌症无疑会对患者的生活质量产生不利影响,这与疾病过程本身、治疗方法和病程长短有关。
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引用次数: 0
Laparoscopic Cecectomy for Diseases of the Appendix and Cecum 阑尾和盲肠疾病的腹腔镜盲肠切除术
Q4 Medicine Pub Date : 2023-06-03 DOI: 10.1055/s-0043-1776904
Muharrem Oner, M. Abbas
Abstract Introduction  The cecum is the first part of the large bowel. Cecectomy is a sufficient treatment for some patients, avoiding overtreatment by ileocolic resection. Purpose  The goal of this study was to review a surgeon's experience with laparoscopic cecectomy and provide a technical video demonstration of this uncommon operation. Methods  A retrospective chart review was conducted of all consecutive patients treated with laparoscopic cecectomy over a 16-year period. All operations were performed using a 3-trocar technique. The cecum was transected with 1 to 2 firings of a 60 millimeters linear stapler, preserving the ileocecal valve and ascending colon. Results  19 patients were identified including 12 females (63.2%). Median age was 42 years (range 16-84). Indication for surgery included appendiceal pathology in 12 patients (63.2%) and cecal abnormality in 7 (38.9%). There was no conversion to open surgery. Median intraoperative blood loss was 25 ml (range 0-150 ml) and no patient received a blood transfusion. No intraoperative or postoperative complication was noted. The median length stay was 1 day (range 0-6). Readmission rate was 0%. Final appendiceal histopathology revealed acute/chronic appendicitis in 5 patients, mucinous cystadenoma in 4 patients. Cecal histopathology revealed adenoma in 4 patients. Median follow-up was 16 months (range 4-53). Conclusions  Laparoscopic cecectomy is a sufficient treatment for some patients with benign conditions of the appendix and cecum. It carries minimal morbidity. It should be considered as an alternative to segmental bowel resection in a select group of patients.
摘要 简介 盲肠是大肠的第一部分。对某些患者来说,切除盲肠足以避免回结肠切除术的过度治疗。目的 本研究旨在回顾一位外科医生的腹腔镜盲肠切除术经验,并提供这种不常见手术的技术视频演示。方法 对 16 年间所有连续接受腹腔镜头盖切除术治疗的患者进行回顾性病历审查。所有手术均采用三套管技术。在保留回盲瓣和升结肠的情况下,使用 60 毫米线性订书机 1 至 2 次横切盲肠。结果 共发现 19 名患者,其中包括 12 名女性(63.2%)。中位年龄为 42 岁(16-84 岁不等)。手术指征包括 12 名患者(63.2%)的阑尾病变和 7 名患者(38.9%)的盲肠异常。没有患者转为开放手术。术中出血量中位数为 25 毫升(0-150 毫升不等),没有患者输血。未发现术中或术后并发症。中位住院时间为 1 天(0-6 天不等)。再入院率为 0%。最终阑尾组织病理学显示,5 名患者为急性/慢性阑尾炎,4 名患者为粘液性囊腺瘤。4名患者的盲肠组织病理学检查结果为腺瘤。中位随访时间为 16 个月(4-53 个月)。结论 腹腔镜盲囊切除术足以治疗部分阑尾和盲肠良性疾病患者。其发病率极低。对于部分患者,腹腔镜盲肠切除术可作为节段性肠道切除术的替代方案。
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引用次数: 0
Prevalence of IgA Anti-tissue Transglutaminase Antibody in a Cohort of Iranians Patients with Inflammatory Bowel Disease 伊朗炎症性肠病患者队列中 IgA 抗组织转谷氨酰胺酶抗体的流行率
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1055/s-0043-1776888
B. Memar, Maryam Naghavi, H. Vosoughinia, Sakineh Amouian, Mohammadreza Farzanehfar, A. Namdar, M. Ahadi, Hassan Mehrad-Majd
Abstract Background and Aims  Some studies have reported the coexistence of inflammatory bowel disease (IBD) and celiac disease (CD). However, the prevalence of anti-tissue transglutaminase antibodies (IgA and IgG) and their screening value in patients with IBD is not yet clear. This study aimed to assess the prevalence of IgA anti-tTG and its potential correlation with disease status in patients with IBD. Materials and Methods  This cross-sectional study was conducted on 110 patients with confirmed IBD diagnosis at Ghaem Hospital, Mashhad, Iran. For each patient, all demographic and clinical data including age, extra intestinal manifestations, underlying diseases, types of diseases, and surgical history were collected. IgA anti-tissue transglutaminase titers were assessed by enzyme-linked immunosorbent assay. Results  None of the patients with IBD were positive for IgA anti-tTG antibodies, with a mean titer of 3.31 ± 1.3 AU/mL. Also, the mean titers were not associated with age, gender and various disease clinical features including the disease history, underlying disease, diagnosis type, extraintestinal manifestations, and surgery history. Conclusion  No significant prevalence pattern of IgA anti-tTG antibody was observed in patients with IBD. Accordingly, serological screening for CeD is not recommended in IBD patients, unless in a relevant clinical CeD suspicion.
摘要 背景和目的 一些研究报告称,炎症性肠病(IBD)和乳糜泻(CD)同时存在。然而,抗组织转谷氨酰胺酶抗体(IgA 和 IgG)在 IBD 患者中的流行率及其筛查价值尚不明确。本研究旨在评估 IgA 抗-tTG 的流行率及其与 IBD 患者疾病状态的潜在相关性。材料和方法 本横断面研究针对伊朗马什哈德加埃姆医院确诊的 110 名 IBD 患者。收集了每位患者的所有人口统计学和临床数据,包括年龄、肠道外表现、基础疾病、疾病类型和手术史。通过酶联免疫吸附试验评估 IgA 抗组织转谷氨酰胺酶滴度。结果 没有一名 IBD 患者的 IgA 抗-tTG 抗体呈阳性,平均滴度为 3.31 ± 1.3 AU/mL。此外,平均滴度与年龄、性别和各种疾病临床特征(包括病史、基础疾病、诊断类型、肠道外表现和手术史)无关。结论 在 IBD 患者中未观察到明显的 IgA 抗-tTG 抗体流行模式。因此,不建议对 IBD 患者进行 CeD 血清学筛查,除非有相关的临床 CeD 嫌疑。
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引用次数: 0
Functional Outcomes and Satisfaction Rates of Sacral Nerve Stimulation in the Treatment of One and Multiples Pelvic Floor Dysfunctions 骶神经刺激治疗一次和多次盆底功能障碍的疗效和满意率
Q4 Medicine Pub Date : 2023-03-18 DOI: 10.1055/s-0043-1769923
S. Murad-Regadas, E. C. Holanda, C. M. Regadas, Amanda Souza Moreira, Larissa M. Camara Fernandes, Érica Uchoa Holanda, M. M. Regadas, Emanuella C. Murad da Cruz
Abstract Objective  Few studies have addressed the use of sacral nerve stimulation (SNS) in the treatment of patients with multiple pelvic floor dysfunctions (PFD). So, we evaluated the functional outcomes and level of satisfaction with SNS in selected patients with one or multiples PFD. Methods  A prospective database was used to collect information on eligible patients treated for PFD with SNS, and severity of symptoms was assessed with scores and satisfaction rates by visual analogue scale (VAS) at baseline and by the end of follow-up. Results  We recruited 70 patients, 98.6% of whom responded positively during the evaluation period (Global Response Assessment ≥ 50% for at least one type of PFD), resulting in the implantation of a permanent SNS device. Additionally, 49 of the patients (71%) had a single PFD (fecal incontinence [FI] = 38; constipation/obstructed defecation syndrome [C/ODS] = 11), while 20 (29%) had more than one PFD (double incontinence/n = 12; double incontinence + C/ODS/n = 8). All scores improved significantly between baseline (pre-SNS) and the end of follow-up (post-SNS), as did VAS in all groups (single and multiple PFD). The pre-SNS scores were higher in patients with a single PFD, including FI (Cleveland clinic Florida incontinence score [CCF-FI]) and C/ODS (Cleveland clinic constipation score [C-CCF] and the Renzi ODS score). The pre-SNS impact of VAS scores was similar in all groups (single and multiple PFD), but the VAS (post-SNS) was significantly lower (better response) for FI alone compared with multiple PFD. Conclusion  The SNS technique is an effective and safe option for patients with one or more PFD refractory to conservative measures. Response was positive for at least two PFD, based on reduced correspondent scores and satisfaction rate.
抽象目标 很少有研究涉及骶神经刺激(SNS)在治疗多发性盆底功能障碍(PFD)患者中的应用。因此,我们评估了一个或多个PFD患者的功能结果和对SNS的满意度。方法 使用前瞻性数据库收集接受PFD伴SNS治疗的合格患者的信息,并在基线和随访结束时通过视觉模拟量表(VAS)对症状的严重程度进行评分和满意度评估。后果 我们招募了70名患者,其中98.6%的患者在评估期间反应积极(至少一种PFD的总体反应评估≥50%),植入了永久性SNS装置。此外,49名患者(71%)有单一PFD(大便失禁[FI] = 38;便秘/排便障碍综合征 = 11) ,而20人(29%)有一个以上的PFD(双失禁/n = 12;双重失禁 + C/ODS/n = 8) 。在基线(SNS前)和随访结束(SNS后)之间,所有评分都有显著改善,所有组的VAS也有显著改善(单个和多个PFD)。单一PFD患者的SNS前评分较高,包括FI(克利夫兰诊所-佛罗里达失禁评分[CCF-FI])和C/ODS(克利夫兰诊所便秘评分[C-CF]和Renzi ODS评分)。所有组(单次和多次PFD)的VAS评分在SNS前的影响相似,但与多次PFD相比,单独FI的VAS(SNS后)明显较低(反应更好)。结论 SNS技术对于一个或多个PFD患者来说是一种有效且安全的选择,这些PFD对保守措施难以治疗。根据相应分数和满意度的降低,至少两个PFD的反应是积极的。
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Journal of Coloproctology
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