Introdução. Pacientes neutropênicos febris, particularmente os portadores de doenças hematológicas, podem ter como causa de sua descompensação clínica afecções abdominais e anorretais. O acompanhamento do quadro infeccioso é motivo de angústia para o cirurgião coloretal, pois a literatura sobre o tema é restrita e quadros oligosintomáticos eventualmente evoluem para óbito em curto espaço de tempo. Objetivos. Descrever, estratificar e comparar com a literatura a casuística de pacientes hematológicos neutropênicos febris com foco abdominal ou anorretal identificado. Estudar o risco absoluto e relativo de mortalidade de algumas variáveis associadas com a condição. Propor um escore de gravidade das afecções abdominais e anorretais em pacientes hematológicos neutropênicos febris. Materiais e Métodos. Trata-se de um estudo a partir da análise retrospectiva de 897 prontuários médicos de pacientes internados para as equipes de Hematologia e Transplante Células Tronco Hematopoéticas, no Hospital de Clínicas da Universidade de São Paulo, Ribeirão Preto-SP, entre os anos de 2008-2013. Foram elegíveis para o estudo 74 episódios de neutropenia febril com foco infeccioso abdominal ou anorretal, ocorridos em 69 pacientes. Após coletadas as características a respeito da amostra, foram estratificados os dados, comparados com a literatura sobre o tema, realizados os cálculos de medidas de efeito e análise estatística. Por fim, considerando os resultados obtidos, a experiência clínica dos autores e critérios de plausibilidade biológica comum, foram selecionados cinco aspectos como sendo os principais preditores de mortalidade hospitalar em pacientes hematológicos neutropênicos febris, com afecção abdominal ou anorretal. Resultados. O escore proposto demonstrou possuir mortalidade crescente conforme o quadro se agrava e a pontuação se eleva (teste exato de Fischer: 0,001). Ao considerar o modelo logístico de probabilidade de óbito por nível do escore, o valor encontrado AUC foi de 0,82 (0,72-0,925) e o valor de Estatística de Hosmer-Lemeshow de 2,3, com p=0,806. Discussao. Os escores contribuem na prática clínica diária para a tomada objetiva de decisões. De forma semelhante ao escore APACHE e seus refinamentos, o sistema prognóstico proposto possui variáveis de fácil acesso e traduz de maneira satisfatória o comportamento e a confiabilidade dos resultados obtidos, através da AUC>0,8 e estatística de Hosmer-Lemeshow com p> 0,05. Conclusão. O sistema de escore proposto permite predizer a chance de óbito durante a internação em pacientes neutropênicos febris com afeccção abdominal ou anorretal. Novos estudos sobre o tema são necessários e o escore proposto necessita e deve ser validado em uma amostra maior e distinta de pacientes. / Introduction. Febrile neutropenic patients, particularly those with haematological diseases, may have abdominal and anorectal conditions as a cause of their clinical decompensation. The follow-up of the infectious condition is a cause of distress for the colorectal surgeon, because the literature on the subject is restricted and oligosymptomatic conditions can lead to death within a short period of time.Goals. To describe, stratify and compare with the literature the casuistry of febrile neutropenic haematological patients with abdominal or anorectal focus identified. To study the absolute and relative risk of mortality of some variables associated with the condition. To propose a severity score of abdominal and anorectal conditions in neutropenic hematologic febrile patients. Materials and Methods. This is a study based on the analysis of 897 medical records of inpatients for hematology and hematopoietic stem cell transplantation (HSCT) teams at the Hospital de Clínicas of the University of São Paulo, Ribeirão Preto-SP, between the years of 2008-2013. A total of 74 episodes of febrile neutropenia with infectious abdominal or anorectal conditions occurred in 69 patients. After collecting the characteristics regarding the sample, the data were stratified, compared to the literature on the subject, the calculations of effect measures and statistical analysis were performed. Finally, considering the results obtained, the author\'s clinical experience and criteria of common biological plausibility, five aspects were selected as the main predictors of hospital mortality in febrile neutropenic haematological patients with abdominal or anorectal disease. Results. The proposed score showed an increasing mortality rate as the condition worsens and the score rises (Fischer\'s exact test: 0.001). When considering the logistic model of death probability by level of the score, the AUC value found was 0.82 (0.72-0.925) and the Hosmer-Lemeshow statistic value was 2.3, with p = 0.806. Discussion. The scores contribute to daily clinical practice for objective decision making. Similar to the APACHE score and its refinements, the proposed prognostic system has easily accessible variables and satisfactorily translates the behavior and reliability of the results obtained through AUC> 0.8 and Hormer-Lemeshow statistics with p> 0,05. Conclusion. The proposed score system allows predicting the chance of death during hospitalization in febrile neutropenic patients with abdominal or anorectal disease. New studies on the subject are necessary and the proposed score needs and must be validated in a larger and different sample of patients.

Hirschsprung’s disease is a common pathology in pediatric surgery. Besides, long-term outcome of surgically-treated patients remains a crucial issue. The management of Hirschsprung’s disease has remarkably advanced over the years, but difficulties persist particularly in the developing countries (such as Vietnam), where essential diagnostic procedures, such as preoperative histopathological exploration techniques/ facilities (mainly for acetylcholinesterase staining), or adequate postoperative management and follow-up requirements are unavailable.We, therefore, contemplated to work-out a relevant histo-diagnostic approach to overcome these constraints that limit our diagnostic approaches, namely, in Vietnam, and we introduced a “less-demanding” diagnostic approach, namely calretinin immunohistochemical staining which is known to be adequate for formalin-fixed tissues (and thus not necessitating frozen section equipment). We thus used calretinin immunohistochemistry in a prospective study on a large cohort of Vietnamese HD cases. Results showed that rectal suction biopsy using calretinin immunohistochemistry provides an effective histopathological diagnostic tool that can replace AChE and provides a valuable evaluating approach for both preoperative and postoperative management.In addition, we also studied long-term outcome in operated patients and impact of postoperative morbidities on their quality of life. Indeed, a long-term multidisciplinary management with dedicated procedures such as anorectal manometry is essentially required for patients with severe defecation disorders. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

The aim of this study was to examine young men born between 1990-1995 with anorectal malformations (ARM) whom have undergone the new PSARP-operation starting in 1990, and how they experience their psychosocial and sexual health. The study also examines how they cope with their life situation and what their experience is of the health care and how they were responded to through out the years. This study is a qualitative research and consists seven semi- structured interviews with young men between sixteen and twenty years old. The analyses of this material resulted in three themes around which the study centers: psychosocial health, sexual health and the medical establishment and the informants thoughts about the proposition of counseling for themselves and other individuals born with ARM. The study shows that these young men have a good psychosocial health and a likely reason for that is good parental relationships and close friendships. It is difficult to draw any general conclusions about their sexual health, because there are several factors that played a role in this respect: there is a relatively widespread in their young age, their deformities are of various degrees and requires very different care and they have very different sexual experiences. However, there are factors which indicate that sexual health is affected by the congenital malformation. The study also showed that the young men have different coping strategies to manage their life situation in order to avoid exclusion and stigma. And that there are different needs for counseling among young ARM patients.

Purpose: Anorectal malformations (ARM) are one of the most challenging congenital malformations in pediatric surgery. We aimed to assess the research activity on ARM over the last five decades. Methods: Data on original research publications were retrieved from the Web of Science Core Collection (1970–2020), and analyzed for countries, authors, scientific journals, and top-ten papers. Scientific quantity was assessed by the number of publications. Research quality was estimated from the number of citations, average citation rate per item (ACI), and h-index. Results: A total number of 1595 articles with 19,419 citations (ACI = 12.2; h-index = 54) were identified. The annual number of publications and citations significantly increased over time (p < 0.0001). The USA (n = 386; 24.2%), Japan (n = 153; 9.6%), and China (n = 137; 8.6%) were the most productive countries; and the USA (n = 7850; ACI = 20.3; h-index = 44), Japan (n = 1937; ACI = 12.6; h-index = 21), and the Netherlands (n = 1318; ACI = 17.3; h-index = 22) were the top cited countries. Articles were preferentially published in JPS (n = 391; 24.5%), PSI (n = 181; 11.3%), and EJPS (n = 56; 3.5%). Top-ten cited papers focused on classification (n = 1), surgical technique (n = 3), associated syndromes (n = 2), postoperative outcome (n = 3), and basic research (n = 1). Conclusion: This bibliometric study provides valuable insights into the global development of ARM research, and shows that clinical studies and international collaborations dominate in this field.

No description available.

Introdução: Os distúrbios funcionais colorretoanais, frequentemente representados por constipação intestinal, incontinência anal e dor anorretal apresentam alta prevalência na população geral. De etiologia multifatorial onde estão envolvidas causas orgânicas, funcionais, culturais e psicológicas. Dados bibliográficos apontam que a depressão, a ansiedade e o estresse estão entre os fatores psicológicos mais presentes nesse grupo de pacientes. Representam um desafio para abordagem gerando impacto significativo na qualidade de vida. Objetivo: Este estudo prospectivo teve como objetivo avaliar o perfil de psicológico de pacientes com distúrbios funcionais colorretais: constipação intestinal crônica (CIC), incontinência anal (IA) e dor anal (DA), utilizando uma versão reduzida, mais aplicáveis do MMPI, o MMPI- IRF (Minnesota Multiphafic Personality Inventory Improved Readability Form). Métodos: Um total de 90 pacientes, sendo 30 de cada grupo sintomático, CIC, AI e DA, respectivamente, e 60 indivíduos controle foram avaliados. Todos os grupos foram igualmente distribuídos por sexo. Os dados foram obtidos através de semi-dirigidas e MMPI-IRF, que consiste de 167 propostas divididas em quatro escalas de validade (\"não posso dizer \", mentira, defensividade) e 10 escalas clínicas (hipocondria, depressão, histeria, desvio- psicopático, masculinidade e feminilidade , paranóia, psicastenia, esquizofrenia, hipomania e introversão-extroversão social). O estudo estatístico incluiu o teste ANOVA, Belferroni e exato de Fisher sendo considerados significativos quando os calores de p<0,05. Resultados: A média de idade os valores foram 48, 52, 49 e 43 anos para o CIC, IA, DA e grupos de controle, respectivamente. O IA se destacou por apresentar menor escolaridade 36% nao concluíram o 1° grau. Quanto aos antecedentes psiquiátricos DA obteve maior porcentagem de pacientes que já estiveram em tratamento psiquiátrico (43%). O início da depressão precedeu o início da queixa funcionais em 36% dos pacientes do CIC, mas em apenas 20% e 23%, respectivamente, IA e pacientes DA. Os escores de depressão, hipocondria e histeria escalas foram significativamente maiores em todos os grupos de pacientes quando comparados aos indivíduos do grupo controle. Conclusão: As elevações nas escalas hipocondria, depressão e histeria são indicativos que os sintomas funcionais colorretoanias são mecanismos de defesa que atuam protegendo os indivíduos da ansiedade e da depressão excessivos. Confirmando a importância de combinar a abordagem psicológica aos cuidados médicos convencionais desses pacientes / Introduction: The functional colorectal disorders frequently represented by constipation, anal incontinence and anorectal pain with a high prevalence in the general population. The multifactorial etiology which are involved in organic, functional, cultural and psychological. Bibliographic conclusions suggest that depression, anxiety and stress are among the psychological factors present in most of this patients. Represent a challenge to approach generating significant impact on quality of life.. Objective: This prospective study aimed to evaluate the psychological profile of patients with colorectal functional disorders: chronic idiophatic constipation (CIC), anal incontinence (AI) and chronic idiopathic rectal pain (CIRP), using a reduced version, the MMPI more applicable, the MMPI- IRF (Minnesota Multiphafic Personality Inventory-Improved Readability Form). Methods: A total of 90 patients, 30 of each symptomatic group, CIC, AI and CIRP, respectively, and 60 control subjects were evaluated. All groups were equally distributed by gender. Data were obtained through semi-directed interviews and MMPIIRF, which consists of 167 proposals divided into four scales of validity (\"I can not say,\" lie, infrequency, defensiveness) and 10 clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, masculinity- femininity, paranoia, psychaesthenia, schizophrenia, mania, and social introversion-extroversion). Statistical analysis included ANOVA, Fisher\'s exact and Belferroni were considered significant when the heats of p <0.05. Results: Mean age values were 48, 52, 49 and 43 years for the CIC, AI, CIRP and control groups, respectively. The AI was noted for 36% less education have not completed a degree. The psychiatric history\'s got higher percentage of patients who have been in psychiatric treatment (43%). The onset of depression preceded the onset of functional complaints in 36% of patients in the CIC, but in only 20% and 23%, respectively, and AI patients. The scores of depression, hypochondria and hysteria scales were significantly higher in all patient groups compared to control subjects. Conclusion: The elevations on the scales hypochondria, depression and hysteria are indicative that the colorectal functional symptoms are defense mechanisms that act to protect individuals from excessive anxiety and depression. Confirming the importance of combining a psychological approach to conventional medical care for these patients

This Research thesis is focused on the influence of body position on the function of pelvic floor muscles (PFM). Anatomical structures, kinesiology and neurophysiology of the PFM are described in the theoretical part of this thesis. It also discusses the methodology used for objective evaluation of the PFM. For the practical part of this thesis, 30 healthy subjects (aged 20 - 30 years, 15 male, 15 female) where chosen via a questionnaire. The subjects were examined via the method of anorectal manometry. The goal of the examination was to measure the distribution of a) resting pressure in the anal canal in selected positions, b) pressure during voluntary maximal contraction of PFM and sphincters in selected positions, c) pressure during 20 seconds of voluntary contraction. Selected positions are: lying on the back; lying on the back with legs elevated and held in "three flexion"; kneeling on all fours with palm support; kneeling on all fours with elbow support; squatting, and standing. Results: a) The resting pressure is influenced by the body position. Highest resting pressure was observed in squatting and standing positions, lowest resting pressure was measured on subjects while kneeling on all fours with elbow support. No significant difference was observed between male and female subjects in...

Introdução: Os distúrbios funcionais colorretoanais, frequentemente representados por constipação intestinal, incontinência anal e dor anorretal apresentam alta prevalência na população geral. De etiologia multifatorial onde estão envolvidas causas orgânicas, funcionais, culturais e psicológicas. Dados bibliográficos apontam que a depressão, a ansiedade e o estresse estão entre os fatores psicológicos mais presentes nesse grupo de pacientes. Representam um desafio para abordagem gerando impacto significativo na qualidade de vida. Objetivo: Este estudo prospectivo teve como objetivo avaliar o perfil de psicológico de pacientes com distúrbios funcionais colorretais: constipação intestinal crônica (CIC), incontinência anal (IA) e dor anal (DA), utilizando uma versão reduzida, mais aplicáveis do MMPI, o MMPI- IRF (Minnesota Multiphafic Personality Inventory Improved Readability Form). Métodos: Um total de 90 pacientes, sendo 30 de cada grupo sintomático, CIC, AI e DA, respectivamente, e 60 indivíduos controle foram avaliados. Todos os grupos foram igualmente distribuídos por sexo. Os dados foram obtidos através de semi-dirigidas e MMPI-IRF, que consiste de 167 propostas divididas em quatro escalas de validade (\"não posso dizer \", mentira, defensividade) e 10 escalas clínicas (hipocondria, depressão, histeria, desvio- psicopático, masculinidade e feminilidade , paranóia, psicastenia, esquizofrenia, hipomania e introversão-extroversão social). O estudo estatístico incluiu o teste ANOVA, Belferroni e exato de Fisher sendo considerados significativos quando os calores de p<0,05. Resultados: A média de idade os valores foram 48, 52, 49 e 43 anos para o CIC, IA, DA e grupos de controle, respectivamente. O IA se destacou por apresentar menor escolaridade 36% nao concluíram o 1° grau. Quanto aos antecedentes psiquiátricos DA obteve maior porcentagem de pacientes que já estiveram em tratamento psiquiátrico (43%). O início da depressão precedeu o início da queixa funcionais em 36% dos pacientes do CIC, mas em apenas 20% e 23%, respectivamente, IA e pacientes DA. Os escores de depressão, hipocondria e histeria escalas foram significativamente maiores em todos os grupos de pacientes quando comparados aos indivíduos do grupo controle. Conclusão: As elevações nas escalas hipocondria, depressão e histeria são indicativos que os sintomas funcionais colorretoanias são mecanismos de defesa que atuam protegendo os indivíduos da ansiedade e da depressão excessivos. Confirmando a importância de combinar a abordagem psicológica aos cuidados médicos convencionais desses pacientes / Introduction: The functional colorectal disorders frequently represented by constipation, anal incontinence and anorectal pain with a high prevalence in the general population. The multifactorial etiology which are involved in organic, functional, cultural and psychological. Bibliographic conclusions suggest that depression, anxiety and stress are among the psychological factors present in most of this patients. Represent a challenge to approach generating significant impact on quality of life.. Objective: This prospective study aimed to evaluate the psychological profile of patients with colorectal functional disorders: chronic idiophatic constipation (CIC), anal incontinence (AI) and chronic idiopathic rectal pain (CIRP), using a reduced version, the MMPI more applicable, the MMPI- IRF (Minnesota Multiphafic Personality Inventory-Improved Readability Form). Methods: A total of 90 patients, 30 of each symptomatic group, CIC, AI and CIRP, respectively, and 60 control subjects were evaluated. All groups were equally distributed by gender. Data were obtained through semi-directed interviews and MMPIIRF, which consists of 167 proposals divided into four scales of validity (\"I can not say,\" lie, infrequency, defensiveness) and 10 clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, masculinity- femininity, paranoia, psychaesthenia, schizophrenia, mania, and social introversion-extroversion). Statistical analysis included ANOVA, Fisher\'s exact and Belferroni were considered significant when the heats of p <0.05. Results: Mean age values were 48, 52, 49 and 43 years for the CIC, AI, CIRP and control groups, respectively. The AI was noted for 36% less education have not completed a degree. The psychiatric history\'s got higher percentage of patients who have been in psychiatric treatment (43%). The onset of depression preceded the onset of functional complaints in 36% of patients in the CIC, but in only 20% and 23%, respectively, and AI patients. The scores of depression, hypochondria and hysteria scales were significantly higher in all patient groups compared to control subjects. Conclusion: The elevations on the scales hypochondria, depression and hysteria are indicative that the colorectal functional symptoms are defense mechanisms that act to protect individuals from excessive anxiety and depression. Confirming the importance of combining a psychological approach to conventional medical care for these patients

Rectal cancer is a common malignancy treated with surgical resection and curative intent in the majority of cases. One treatment option is low anterior resection (LAR) with preserved bowel continuity, often involving the formation of a temporary defunctioning stoma (DS). The general aim of this thesis was to improve understanding of the role of DS in rectal cancer surgery with regard to timing of stoma reversal and development of anastomotic leakage (AL), impact on long-term anorectal function (AF), as well as aspects of cost-effectiveness. Study I addressed the timing of stoma reversal following LAR. We found that 19% of reversed patients were reversed within 4 months of LAR, while 81% of reversals were delayed. In 58% of delayed reversals the delay was due to low priority on surgical waiting lists. Studies II-IV were based on 234 patients randomized to receive a DS or no DS following LAR. Study II compared patients with AL following LAR diagnosed during the initial hospital stay (early leakage, EL) with patients diagnosed after hospital discharge (late leakage, LL). LL was more common in females, and originated more frequently from the transverse stapler line. EL was more common in males, and originated more frequently from the circular stapler line. Study III assessed AF 5 years after LAR with regard to whether patients initially had a DS or no DS. We found no difference in AF between the two randomized groups. When comparing with a 1-year follow-up in the same patient cohort, there were no further changes in AF over time. Study III assessed necessary healthcare resources and cost within 5 years of LAR, depending on whether patients initially had a DS or no DS. The overall cost analysis revealed a higher cost for patients randomized to DS, regardless of the cost-savings associated with a reduced frequency of anastomotic leakage.

The thesis examines the relationship between the level of intra-abdominal pressure and abdominal wall expansion. The theoretical part brings an overview of knowledge about the function of intra-abdominal pressure and about the possibilities of objectification of postural functions. There are described studies which dealt with the influence of intra-abdominal pressure on the stability of spine. Theoretical part also includes detailed description of individual invasive and non-invasive methods of measurement of intra-abdominal pressure and activation of abdominal muscles. Work methodology: In the practical part the intra-abdominal pressure was measured using anorectal manometry and abdominal wall expansion by utilizing DNS brace device. 31 healthy examinees with average age of 26.77 (SD 3.01) were measured in five different standing postural situations: during resting breathing, Valsalva Maneuver, Müller's maneuver, diaphragm test and in the situation with added external load in the form of static holding of dumbbell. Results of the thesis: Among the values of the pressure gathered from the DNS brace device and from anorectal manometry was proven statistically important correlation (p < 0.001) in all five tested situations. In all situations the Pearson Correlation Coefficient was higher than 0.6...