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P Atienza

Publications and source records attributed to P Atienza.

At least 19 recordsLinked to original sources
PubMed2004

Anal sphincter injury after forceps delivery: myth or reality? A prospective ultrasound study of 93 females.

PURPOSE: This study was designed to estimate the prevalence of anal sphincter injury after forceps delivery in a large population of females managed by trained obstetricians in a French hospital and to identify factors predictive for anal sphincter injury. METHODS: We performed a prospective study of healthy females older than 18 years with no history of anal incontinence, anorectal abnormalities, or anorectal surgery after their first vaginal delivery. All females were interviewed using a standardized questionnaire concerning intestinal transit and continence status. Physical examination and endoanal ultrasonography were performed after delivery. RESULTS: Between November 1999 and November 2000, 93 females were included in the study after their first forceps delivery. Eleven patients (11.8 percent) had a partial defect involving the external sphincter, visible on ultrasonography. One patient (1.1 percent) had a partial defect of external sphincter with complete defect of internal sphincter (sequelae of primary repair of a third-degree perineal tear). Seventeen patients (18.2 percent) had flatus incontinence, and four patients (4.3 percent) had liquid stool incontinence. A high daily number of stools was significantly associated with sphincter defect visible on ultrasonography (P=0.02). The development of anal incontinence was not related to sphincter defect on ultrasonography. There was a strong association between perineal tear and sphincter defect visible on ultrasonography (odds ratio, 4.5 (range, 1.2-16.7)). CONCLUSIONS: Anal sphincter injury after forceps delivery was identified in <13 percent of our large population of healthy females. Our study does not confirm previous observations that anal sphincter injury is common after forceps delivery; previously published studies may have overestimated the prevalence of this condition. The only factor with significant predictive value for anal sphincter injury was perineal tear. Anal endosonography should be recommended after obstetric perineal tear.

Adult↗
PubMed2002

Anoperineal tuberculosis: diagnostic and management considerations in seven cases.

PURPOSE: Anoperineal tuberculosis is a rare extrapulmonary form of the disease that we must learn to recognize because it requires specific treatment. METHODS: Data from seven patients with anoperineal tuberculosis observed in a Parisian proctology unit between 1982 and 1999 were reviewed. RESULTS: All the patients were male (median age, 55 years); five were born in underdeveloped countries, and two were still living there. The average length of time between first manifestation of the disease and diagnosis was three years (range, 3 months to 9 years); all patients had undergone surgery previously. There were six recurring anal fistulas (complex in 5 cases) and one recurring abscess. In every case, the diagnosis had been suspected or confirmed by systematic histologic study of the surgically excised tissue. An association with pulmonary tuberculosis was found in each case. Treatment included two parts: conventional surgical treatment of anal sepsis and specific medical antituberculosis treatment. Evolution was favorable in all cases, with no recurrence of disease. Human immunodeficiency virus infection did not increase the incidence of anoperineal tuberculosis. CONCLUSION: Tuberculosis should be suspected in all recurrent fistulas. Histologic examination of the excised tissue and a lung x-ray should be performed to avoid delay in diagnosing an easily curable disease.

Adult↗
PubMed2001

Prosthetic rectopexy to the pelvic floor and sigmoidectomy for rectal prolapse.

BACKGROUND: Full thickness rectal prolapse in young adults with normal pelvic floor is a disease in which the rectum is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, which is expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. METHODS: Thirty-five patients (30 women) of median age 44 years (range 18 to 74) were operated on for full thickness rectal prolapse with normal pelvic floor. The rectum was mobilized posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired with a nonabsorbable mesh. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in 1 patient. Mean hospital stay was 8 days (range 6 to 14). Mean follow-up was 34 months (range 10 to 93). No recurrence was seen. Preoperatively, 33 patients (94%) complained of constipation mainly with emptying problems (21 patients) and 25 patients (71.5%) were incontinent. Postoperatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 17 patients (81%). Eighteen incontinent patients (72%) regained full continence. On the other hand, 2 patients with normal bowel function worsened and 1 patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal pelvic floor undergoing prosthetic rectopexy and sigmoid resection (a) morbidity was low, (b) anatomical control was obtained in all cases, (c) emptying problems were corrected, and (d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.

Adolescent↗
PubMed2000

[Anal fistula].

Explore the source record for details and available documents.

Anal Canal↗
PubMed1998

[Effect of delivery on the anal sphincter].

SPHINCTER TEARS: Vaginal delivery can lead to tears in the anal sphincters. Total perineal distension following expulsion concerns less than 1% of all deliveries. Initially, sphincter tears generally go unnoticed although echographically detectable defects can be found in one-third of all primiparturients. The inner or outer sphincter may be involved alone or in combination as is seen in half of the cases. NEUROLOGICAL LESIONS: Moderate signs of incontinence (gas, urge) are frequently reversible although the long-term outcome remains unknown. In half of the cases, perineal denervation is secondary to stretch lesions of the pudendal nerve terminasions. FAVORING FACTORS: Primiparity, forceps delivery, fetal macrosomy, and certain presentations (breech, occipitoposterior) may favor sphincter lesions. DIAGNOSIS: A complete examination of the posterior perineum is required with anorectal manometry, a perineal electrophysiologic study, and a transanal ultrasound study whenever function signs are found at the post partum follow-up. TREATMENT: The therapeutic strategy is guided by the exploration results. In case of symptomatic rupture of the external sphincter, sphicteroplasty is needed followed by functional rehabilitation therapy with biofeedback. Women who have suffered traumatic lesions of the posterior perineum should be carefully followed for signs of secondary incontinence. Cesarean section may be indicated as a preventive measure in case of a new pregnancy.

Anal Canal↗
PubMed1998

[Treatment of complete rectal prolapse with rectopexy to the pelvic floor with prosthesis and sigmoid resection. Anatomoclinical results of a prospective study].

UNLABELLED: BACKGROUND, AIM OF THE STUDY: Full thickness rectal prolapse in young adults with normal perineal structures is a disease of the rectum which is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. PATIENTS AND METHODS: Twenty patients (16 women and four men) of median age 41 years were operated on for full thickness rectal prolapse with normal perineal structures. The rectum was mobilised posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired, with a semi-absorbable prosthesis. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in one patient. Mean hospital stay was 8.7 days. Mean follow up was 30 (range 9-75) months. No recurrence was seen. Pre-operatively, 18 patients (90%) complained of constipation mainly with emptying problems (15 patients) and 13 patients (65%) were incontinent. Post-operatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 13 patients (86.5%). Eight incontinent patients (61.5%) regained full continence. On the other hand, two patients with normal bowel function worsened and one patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal perineal structures undergoing prosthetic rectopexy and sigmoid resection: a) morbidity was low, b) anatomical control was obtained in all cases, c) emptying problems were corrected, d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.

Adult↗
PubMed1988

[Comparative serum pharmacokinetics of prednisone and prednisolone methylsulfobenzoate after oral administration].

Pharmacokinetic values of prednisone and prednisolone were measured in the serum of 6 healthy volunteers after oral administration of either prednisolone methylsulfobenzoate 30 mg or prednisone 30 mg. Peak serum concentrations of prednisolone obtained after dosing with prednisone occurred earlier and were higher (473 +/- 106 ng/ml) than those obtained after dosing with prednisolone methylsulfobenzoate (232 +/- 70 ng/ml; P less than 0.01). Similarly, areas under the 0-8 h concentration curves were significantly greater after dosing with prednisone than after dosing with prednisolone methylsulfobenzoate (prednisolone: P less than 0.001; prednisone: P less than 0.02). The differences may be due to prednisolone methylsulfobenzoate not being absorbed as well as prednisone. These kinetic data may warrant a reappraisal of the therapeutic equivalence of the two drugs taken for granted in France.

Administration, Oral↗