| 1 | Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders显示文摘AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.METHODS:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for STARR.Thirty comparable patients(Female,30;age 53 ± 13 years),who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol,were assessed.Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment.A responder was def ined as an absence of the Rome Ⅲ diagnostic criteria for functional constipation.Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients,respectively.RESULTS:After STARR,53% of patients were responders;during conservative treatment,75% were responders.After STARR,30% of the patients reported the use of laxatives,17% had intermittent anal pain,13% had anal leakage,13% required digital facilitation,6% experienced defecatory urgency,6% experienced fecal incontinence,and 6% required re-intervention.During macrogol therapy,23% of the patients complained of abdominal bloating and 13% of borborygmi,and 3% required digital facilitation.No preoperative symptom,defecographic,or manometric finding predicted the outcome of STARR.Post-operative defecography showed a statistically significant reduction(P < 0.05) of the rectal diameter and rectocele.The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified,and that rectal compliance was reduced(P = 0.01).CONCLUSION:STARR is not better and is less safe than macrogol in the treatment of defecation disorders.It could be considered as an alternative therapy in patients unresponsive to macrogol. | Ivano Biviano Danilo Badiali Laura Candeloro Fortunée Irene Irene Habib Massimo Mongardini Angelo Caviglia Fiorella Anzini Enrico S Corazziari | 2011 | World Journal of Gastroenterology2011，17，37： | 3 |
| 2 | The Neurologist in the Emergency Room: Prospective Study of the Neurological Emergency Group in Lombardia显示文摘Purpose of the work was to quantify the workloads and the neurologist’s commitment in ER, to verify the management of urgencies and appropriateness of neurological counseling requests. Neurologic emergencies are frequent in elderly patients and are associated with high morbidity and mortality. Due to the aging population, neurologic pathologies in emergency room (ER) are widely expected to increase. The role of the neurologist in this context is controversial. Methods: in 14 operative units of neurology a prospective collection of neurological evaluations in ER was carried out using boards of detection of the most frequent neurological clinical pictures seen in the course of a week. Data were collected from 738 cases. Attention was focused on cerebrovascular diseases (CVD), impairment of consciousness, epilepsy, headache, dizziness, head trauma and disorders of the peripheral nervous system (PNS). Achievements: neurological consultations were on average 5% of total accesses to ER. The most common pathology seen was ischemic stroke. After counseling most patients were discharged home. The CVD required the greatest commitment to the specialist. The usefulness of the specialized neurological “filter” has been confirmed in a non-simple operative context, aimed at optimizing the appropriateness of the hospitalization and the economy of the diagnostic path. | MariaLuisa Delodovici Marco Mauri Megi Meneri Marco Gallazzi Elena Ballabio Giuseppina Borutti Maria Vittoria Calloni Elisa Candeloro Bruno Censori Claudio De Piazza Laura Fusi Franca Mazzucchelli Ignazio Santilli Elisabetta Forapani Chiara Scaccabarozzi Maria Sessa Lucia Tancredi Massimiliano Braga | 2019 | Journal of Health Science2019，7，4： | 0 |
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