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Biomedical subjects

G Maria

Publications and source records attributed to G Maria.

At least 37 records · Page 2Linked to original sources
PubMed1999

Identification of anti-endothelial cell antibodies in patients with chronic anal fissure.

BACKGROUND: Recent studies demonstrate that chronic anal fissure can be the consequence of a local ischemic process. Thus hypothesizing that at the perianal level the interaction of immune component with endothelium could constitute a mechanism determining ischemia and hypertonia, the presence or absence of circulating anti-endothelial cell antibodies (AECAs) was determined in the serum of patients with anal fissure. METHODS: The study was carried out on 30 patients: 10 with posterior chronic anal fissure (group 1), 10 with grades III and IV hemorrhoids (group 2), and 10 without previous or active anorectal disease, or both (group 3). An indirect immunofluorescence assay on sections of rat kidney tissue was used to identify AECA in the peripheral blood. RESULTS: The assay result was positive for AECAs in 12 patients, all with anorectal disease when compared to the control group (P = .001). The basal anal tone was higher in the AECA-positive patients than in the AECA-negative patients (P = .001). CONCLUSIONS: Only the patients with anal fissure or hemorrhoids were AECA positive. All healthy controls tested negative for AECA. Although the number of subjects studied is small, the presence of auto-antibodies directed against the endothelial cells in the serum of these patients supports the hypothesis that the endothelium is involved in the anal disease.

Adult↗
PubMed1998

A comparison of botulinum toxin and saline for the treatment of chronic anal fissure.

BACKGROUND: Chronic anal fissure is a tear in the lower half of the anal canal that is maintained by contraction of the internal anal sphincter. Sphincterotomy, the most widely used treatment, is a surgical procedure that permanently weakens the internal sphincter and may lead to anal deformity and incontinence. METHODS: We conducted a double-blind, placebo-controlled study of botulinum toxin for the treatment of chronic anal fissure in 30 consecutive symptomatic adults. All the patients received two injections (total volume, 0.4 ml) into the internal anal sphincter; the treated group (15 patients) received 20 U of botulinum toxin A, and the control group (15 patients) received saline. Success was defined as healing of the fissure (formation of a scar), and symptomatic improvement was defined as the presence of a persistent fissure without symptoms. RESULTS: After two months, 11 patients in the treated group and 2 in the control group had healed fissures (P=0.003); 13 in the treated group and 4 in the control group had symptomatic relief (P=0.003). The maximal voluntary pressures were similar to those at base line in both groups, and the resting anal pressure was reduced by 25 percent in the treated group but not in the control group. Three patients in the control group later underwent sphincterotomy, and 10 received botulinum-toxin injections (20 U). Of the latter, seven had healed fissures after two months; the other three left the study and underwent surgery. Four patients in the treated group were later re-treated (with 25 U of botulinum toxin); all had healed fissures after two months. One patient in the control group had temporary flatus incontinence after treatment with botulinum toxin. No relapses occurred during an average of 16 months of follow-up. CONCLUSIONS: Local infiltration of botulinum toxin into the internal anal sphincter is an effective treatment of chronic anal fissure.

Adult↗
PubMed1998

Anoplasty for the treatment of anal stenosis.

BACKGROUND: Cicatricial stenosis of the anal canal is a disabling complication of anal surgery. Many different surgical techniques have been described for the management of this disorder. METHODS: In this study we report 42 patients with severe anal stricture treated with anoplasty. Twenty-nine of these patients underwent a Y-V anoplasty while 13 had a diamond flap anoplasty. All patients were seen 4 weeks, 6 months, and 2 years after surgery. RESULTS: Three patients who had undergone Y-V anoplasty experienced, as a minor early operative complication, a suture dehiscence and 1 patient had an ischemic contracture of the leading edge of the flap. Two patients had urinary infections. None of these complications needed further surgical intervention and were all managed with local and medical therapy. At 2 years follow-up 93% of patients had been successfully treated while the remaining 7% had improved. Fifteen percent of patients who had undergone Y-V anoplasty complained of postoperative complications, and all patients with incomplete results had been treated with an Y-V anoplasty. CONCLUSIONS: Based on our cohort of patients we believe that both techniques are satisfactory in treating anal stricture but diamond flap anoplasty seems more reliable because of the reduced tension at the suture line and the better blood supply to the flap.

Adult↗
PubMed1998

Botulinum toxin injections in the internal anal sphincter for the treatment of chronic anal fissure: long-term results after two different dosage regimens.

OBJECTIVE: To investigate the effects of two different dosage regimens of botulinum toxin to induce healing in patients with idiopathic anal fissure. SUMMARY BACKGROUND DATA: Chronic anal fissure is maintained by contraction of the internal anal sphincter. Sphincterotomy, which is successful in 85% to 95% of patients, permanently weakens the sphincter and therefore might be associated with anal deformity and incontinence. METHODS: Fifty-seven consecutive outpatients were evaluated. Type A botulinum toxin was injected into the internal anal sphincter. RESULTS: Patients were divided into two treatment groups based on the number of botulinum toxin units injected. Patients in the first group were treated with 15 units and retreated with 20 units. Patients in the second group were treated with 20 units and retreated with 25 units. Two months after treatment, 10 patients in the first group and 23 patients in the second group had a healing scar. Symptomatic improvement was observed in 13 patients in the first group and in 24 patients in the second group. Statistical analysis showed that resting anal pressure varied from baseline values as a function of treatment; in contrast, the treatment had no effect on maximum voluntary pressure. Long-term healing was achieved in 13 patients in the first group and in all patients in the second group who underwent a complete treatment. CONCLUSIONS: Botulinum toxin is safe and effective in the treatment of anal fissure. It is less expensive and easier to perform than surgical treatment. No adverse effects resulted from injections of the toxin. The higher dosage is effective in producing long-term healing without complications.

Adult↗
PubMed1998

Truncal vagotomy, antrectomy and Roux-en-Y gastrojejunostomy in the treatment of duodenogastric reflux disease.

BACKGROUND/AIMS: The surgical treatment of duodenogastric reflux (DGR), resistant to medical therapy, in patients with intact stomach is difficult to standardize. The aim of this study is to present our experience on 5 patients, all cholecystectomized, with severe DGR disease treated surgically. METHODS: Out of a group of 223 patients suffering from nonulcerous dispeptic pathology presenting to our department, we selected 5 patients suffering from alkaline reflux gastritis in intact stomach. The diagnosis of primary DGR was made using Wilson's criteria. The surgical procedure adopted consisted of a truncal vagotomy, antrectomy, and a Roux-en-Y gastrojejunostomy. RESULTS: No perioperative mortality was observed. Twelve months after surgery all patients expressed satisfaction with the result of the operation and complained of no severe disturbances. A sense of postprandial fullness with a sense of pain in the left shoulder persisted in one case only, requiring the consumption of small and frequent meals. Radiological examination of the upper gastrointestinal tract of these patients showed notably delayed emptying of the gastric stump, while the endoscopic picture was completely normal. CONCLUSION: The antrectomy and Roux-en-Y gastrojejunostomy is a better known operation, easily executed, and has the advantage that it can be performed on patients previously operated on for gastric resection and therefore suffering from secondary reflux. It also has the advantage of removing the gastric antrum where mucous atrophy is more frequent and is susceptible to neoplastic degeneration. However, at the present time the choice between different types of operation depends exclusively on the personal conviction and experience of the surgeon.

Anastomosis, Roux-en-Y↗
PubMed1997

Severe constipation in Parkinson's disease relieved by botulinum toxin.

A parkinsonian patient with severe outlet-type constipation was treated with injection of botulinum toxin into the puborectalis muscle. A total of 30 units (Botox) was injected in two sites. Resting anal pressure, maximum voluntary contraction, and pressure on straining were evaluated before treatment and 4, 8, 12, and 16 weeks afterward. Pressure values declined following treatment, the decline of pressure on straining ending by week 12. Proctography performed 8 weeks after treatment showed improvement in the anorectal angle and evacuation of barium paste. The clinical benefit lasted for approximately 12 weeks. The present data show that botulinum toxin is a promising tool for treating outlet-type constipation in Parkinson's disease.

Anti-Dyskinesia Agents↗
PubMed1997

Treatment of puborectalis syndrome with progressive anal dilation.

PURPOSE: The aim of this study is to assess the ability of progressive anal dilations to improve frequency of spontaneous bowel movements in patients with puborectalis syndrome (PRS). METHOD: Thirteen patients (9 females and 4 males; mean age, 37 years) with severe, chronic constipation caused by PRS were treated with daily, progressive anal dilation for a three-month period. Three dilators of 20, 23, and 27 mm in diameter were used. Dilators were inserted every day for 30 minutes (10 minutes each dilator). Patients were evaluated with anorectal manometry and defecography halfway through treatment, at the end of treatment, and six months after the end of treatment. At six months, patients also underwent physical examination. RESULTS: There was a significant improvement of weekly mean spontaneous bowel movements from zero to six (P < 0.0001), and the need for laxatives decreased from 12 patients with a weekly mean of 4.6 to 2 patients once per week (P < 0.001). Enemas used before treatment by eight patients who had a weekly mean of 2.3 were, after treatment, needed only by three patients once per week (P < 0.01). During straining, tone measured with anorectal manometry decreased from 93 to 62 mmHg after six months of the end of therapy (F = 6.97; P < 0.01), and anorectal angle measured with defecography during the strain increased from 95 degrees to 110 degrees (P = not significant). CONCLUSIONS: Daily progressive anal dilation should be considered as the first and most simple therapeutic approach in patients with PRS.

Adolescent↗
PubMed1997

[Stromal tumors of the stomach. Review of the literature and description of a case of "uncommitted" stromal tumor].

Non-epithelial non-lymphomatous neoplasms of the gastrointestinal tract are known as stromal tumors (GISTs) because of the tissues in which they originate (4), (16). These neoplasms are rare and account for about 4% of all the tumors of the stomach. Their malignancy and biological and anatomopathological behaviour are related to clinical problems, since their histopathological picture is both complex and controversial. Modern immunohistochemical and ultrastructural (12), (26) studies have identified forms of myogenic or neural origin, which are more differentiated, as well as mixed types with both components, and types, though surely stromal, of uncertain origin, therefore called "uncommitted" (22), (25). The latter are extremely rare and, since it is not yet possible to classify them, some Authors use the term GIST only for these groups. A report of a clinical case of "uncommitted" GIST offers the opportunity to review the literature, highlighting the increased incidence of these tumors (which is probably related partially to the improved diagnostic techniques (3)), their potential malignancy and the difficulty of a correct classification and, therefore, a clear prognosis.

Humans↗
PubMed1995

Review article: the use of botulinum toxin in the alimentary tract.

New and future indications for the treatment of disorders of the alimentary tract using local injections of botulinum toxin are reviewed. Clinical experience shows that overactive smooth muscle sphincters may be weakened to treat disorders such as achalasia or chronic anal fissure. By contrast, injections placed into the sphincter of Oddi have proven less effective for postcholecystectomy pain syndrome. Experimental evidence suggests that food intake may be reduced by weakening the distal stomach with botulinum toxin. This approach may possibly lead to the treatment of obesity. There are some new possible indications for the use of botulinum toxin on the alimentary tract, and infantile hypertrophic pyloric stenosis seems to be the most promising new development.

Animals↗
PubMed1994

Botulinum toxin for chronic anal fissure.

Botulinum toxin can chemically denervate striated muscle. Botulinum toxin A (15 U) was used to treat ten patients with chronic anal fissure by injection in the internal sphincter. In seven patients, the lesion healed at 2 months after treatment; one relapsed at 3 months. In one patient the lesion healed at 1 month, but partly relapsed a month later. Mild faecal incontinence lasting for 1 day was observed in one patient. We propose that botulinum toxin injections in the internal anal sphincter be considered an alternative approach to surgical therapy of anal fissure.

Adult↗
PubMed1993

[Binswanger disease. Tomographic picture and clinical correlations].

The authors explore the correlation between the neuroradiologic and clinical patterns of "subcortical arteriosclerotic encephalopathy" (SAE) or Binswanger's disease. The typical neuroradiologic pattern has been found in 62 of the 1804 CT scans of the department's archive. Available patients were enrolled for neuropsychologic evaluation. The authors point out that there is no correlation whatever between severity of the CT pattern and findings of psychological decline. Therefore SAE may be considered merely a neuroradiologic pattern. The discrepancy between neuroradiologic and clinical pattern depends on the individual history of every single patient as well as on the quality of the neuronal cells involved in vascular pathology. It may in fact be thought that the injury to command neurones plays a fundamental role in bringing about the psychopathologic picture.

Aged↗
PubMed1992

Effect of omega-3 fatty acids on rectal mucosal cell proliferation in subjects at risk for colon cancer.

The effects of 12 weeks of omega-3 fatty acid supplementation on rectal mucosal proliferation were assessed with [3H]thymidine autoradiography in a double-blind, placebo-controlled study of 20 patients with sporadic adenomatous colorectal polyps. In the group of 10 that received fish oil containing eicosapentaenoic acid (4.1 g/day) and docosahexaenoic acid (3.6 g/day), the mean percentage of replicative "S"-phase cells in the upper part of colonic crypts (considered a reliable marker of colon cancer risk) significantly dropped from the baseline level after only 2 weeks of treatment and remained lower throughout the study period; no change in upper-crypt labeling was observed in the 10 placebo patients. Rectal mucosal eicosapentaenoic acid content increased in fish oil patients, whereas arachidonic acid levels decreased. The fish oil-induced kinetic changes represent contraction of the proliferative compartment to the levels of a low-risk population and may be related to omega-3 fatty acid effects on the arachidonic prostaglandin pathway. In this short-term trial, fish oil appeared to exert a rapid effect that may protect high-risk subjects from colon cancer.

Autoradiography↗
PubMed1989

Anal manometry improves the outcome of surgery for fistula-in-ano.

The aim of this prospective study is to investigate whether anal manometry is useful in orienting the surgical policy and improving the clinical and functional results following surgery for fistula-in-ano. Anal manometry was performed preoperatively and postoperatively in 96 patients. The results of surgery, in terms of both fecal soiling and recurrence rate, were analyzed and compared with those of another group of 36 subjects. Some operative maneuvers, such as internal sphincterotomy, laying open of the fistula with division of striated muscle, or use of a seton, were carried out according to the preoperative sphincter pattern as shown by anal manometry in the first group. A standard procedure was followed in the control group. The recurrence rate was 3 percent in the anal manometry group and 13 percent in the control group (P less than 0.01); postoperative soiling occurred in 14 percent of patients in the anal manometry group compared with 31 percent of patients in the control group (P less than 0.001). The functional results in transsphincteric and suprasphincteric fistulas, which are usually considered at higher risk for postoperative incontinence, were better in the anal manometry group, due to greater use of the seton. No increase in recurrence rate was observed in these complex fistulas after anal manometry. Internal sphincterotomy led to a disordered continence, mainly when associated with division of striated muscle; a significant decrease in resting tone from 56 +/- 22 to 47 +/- 50 and voluntary contraction from 114 +/- 30 to 85 +/- 28 mm Hg (mean +/- S) was found after surgery in patients with soiling. In conclusion, the routine use of anal manometry may be recommended in the management of patients with fistula-in-ano as it improves the clinical and functional outcome of surgery.

Adult↗
PubMed1989

Rubber band ligation of hemorrhoids and rectal mucosal prolapse in constipated patients.

Rubber band ligation was used in 160 patients with internal hemorrhoids; 43 of them also had rectal anterior mucosal prolapse; 13 had prolapse alone. Two thirds of the patients underwent a single rubber band ligation and one third a double rubber band ligation in one session without anesthesia. Ninety-four required repeated ligations. A follow-up of 25 +/- 16 months (mean +/- SD) was carried out in 153 of them. Rubber band ligation was followed by prolonged bleeding in six patients and severe pain requiring removal of the rubber band in 12 patients. The complication rate decreased significantly (P less than .05) in the last 80 patients. Compared with multiple ligation, single rubber band ligation in one sitting was followed by a lower complication rate (P less than .01). Long-term results were good in 71 percent of the patients. (A formal hemorrhoidectomy was needed within two years in 6 percent.) A significantly lower recurrence rate of 9 percent was noted in those with normal bowel habits, when compared with constipated subjects whose symptoms recurred in 85 percent (P less than .001). Constipation seems to be a predictable factor in worsening the outcome of rubber band ligation. Rubber band ligation is followed by a lower complication rate when performed in a single ligation.

Constipation↗
PubMed1987

Outcome of colorectal cancer.

The outcome of 454 patients who presented with colorectal carcinoma during a 16 year period is reviewed: 54 per cent were males, 58 per cent were aged more than 60 and 10 per cent had an emergency admission, 42 per cent of tumours occurred in the rectum. A curative resection was possible in 68 per cent. Postoperative mortality was 7 per cent. The overall crude 5-year survival was 41 per cent. The mortality from local recurrence was significantly higher in rectal (11.7 per cent) than in colonic cancer (8.8 per cent; P less than 0.01). The rate of recurrence and metastases was higher in patients with low rectal cancer than in patients with cancer of the middle and the upper rectum (P less than 0.01). Distant metastases were the cause of death in 94 per cent of the patients who had a Miles' operation for cancer of the middle rectum, whereas local recurrence was responsible for late mortality in 80 per cent of patients who underwent an anterior resection. No difference in 5-year survival was found in the restorative and in the excisional group.

Adult↗