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[PMID]:27771095
[Au] Autor:Bjelanovic Z; Draskovic M; Veljovic M; Lekovic I; Karanikolas M; Stamenkovic D
[Ad] Endereço:Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia. Electronic address: vojislavma2@sbb.rs.
[Ti] Título:Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease.
[Ti] Título:Desarterialización hemorroidal transanal, un procedimiento seguro y eficaz para el tratamiento ambulatorio de la enfermedad hemorroidal..
[So] Source:Cir Esp;94(10):588-594, 2016 Dec.
[Is] ISSN:1578-147X
[Cp] País de publicação:Spain
[La] Idioma:eng; spa
[Ab] Resumo:INTRODUCTION: This prospective, observational study evaluated transanal dearterialization (THD) efficacy and safety in grade 2-4 hemorrhoids (HD). METHODS: THD was performed under sedation-locoregional anesthesia in 402 outpatients. Patients had follow-up evaluation 3 days, 2 weeks, 1, 6 and 12 months postoperatively. Postoperative complications and recurrence of symptoms at 12 months were analyzed. The relationship between the learning curve and the number of postoperative complications was studied. RESULTS: Mean patient age was 46.4 (range 20-85) years. A total of 268 patients (66.6%) were male. Sixteen patients (4.0%) had grade 2 HD, 210 (52.2%) had grade 3 and 176 (43.8%) had grade 4 HD. Surgery lasted 23 (17-34) min. A total of 67 patients had complications: bleeding in 10 patients (2.5%), hemorrhoidal thromboses in 10 (2.5%), perianal fistulas in 5 (1.2%), fissures in 14 (3.5%), urinary retention in 3 (0.8%), residual prolapse in 19 (4.7%), severe anal pain in 3 (0.8%), and perianal abscess in 3 patients (0.8%). Recurrent HD occurred in 6.3% (1/16) of grade 2 HD patients, 5.8% (12/210) of grade 3 patients and 9.7% (17/176) of grade 4 patients. Twelve months after THD, bleeding was controlled in 363 patients (90.5%), prolapse was controlled in 391 (97.3%) and pain markedly improved in 390 patients (97%). CONCLUSION: THD appears safe and effective for grade 2-4 HD, and the number of complications decreased with increasing surgeon experience. THD advantages include mild pain, fast recovery, early return to daily activities and low incidence of complications.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Ambulatórios
Hemorroidectomia/métodos
Hemorroidas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Canal Anal
Artérias/cirurgia
Feminino
Hemorroidectomia/efeitos adversos
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171130
[Lr] Data última revisão:
171130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28991089
[Au] Autor:Celentano V; Banerjee A; Luvisetto F; Naqvi S; Khan J
[Ad] Endereço:Colorectal Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
[Ti] Título:Retained Needle Following Transanal Hemorrhoidal Dearterialization.
[So] Source:Dis Colon Rectum;60(11):1225-1227, 2017 Nov.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: A needle was retained during transanal hemorrhoidal dearterialization. This rare complication has not been described before. TECHNIQUE: A spinal needle was inserted from the perianal skin to localize the retained foreign body that was located at 7 cm from the anal margin. A decision was made to proceed to intersphincteric dissection, and a 3-cm incision was made in the perianal skin from 2 to 4 o'clock. Deep pararectal dissection continued, and the needle was eventually found lying in the muscular layer, parallel to the plane of the dissection. RESULTS: The needle was retrieved intact, and repeat x-ray confirmed that no foreign body was retained. The patient made an uneventful recovery and was discharged home on postoperative day 1 with a 5-day course of oral antibiotics; she was examined in clinic 4 weeks following surgery and reported significant symptomatic improvement with no perianal pain or rectal bleeding. No anal fistula was found on the examination. CONCLUSIONS: X-ray guidance is a helpful adjunct to facilitate 3-dimensional localization. Intersphincteric dissection is a reliable alternative to the transanal approach, particularly when the needle cannot be seen arising from the mucosa or felt on palpation. Repeated attempts to palpate the needle should be avoided, because there is a potential risk of displacing it deeper or higher, making retrieval more difficult.
[Mh] Termos MeSH primário: Corpos Estranhos
Hemorroidas/cirurgia
Complicações Intraoperatórias
Agulhas
Reto
[Mh] Termos MeSH secundário: Adulto
Canal Anal/cirurgia
Artérias/cirurgia
Feminino
Corpos Estranhos/diagnóstico por imagem
Corpos Estranhos/cirurgia
Seres Humanos
Complicações Intraoperatórias/diagnóstico por imagem
Complicações Intraoperatórias/cirurgia
Ligadura
Reto/irrigação sanguínea
Reto/diagnóstico por imagem
Reto/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000899


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[PMID]:28796742
[Au] Autor:Li HZ; Cheng YS; Liu XF; Zhu XN
[Ad] Endereço:Guangdong, China Guangdong, China Jiangxi, China Jiangxi, China.
[Ti] Título:Metronidazole for Posthemorrhoidectomy Pain: Does No Statistical Significance Mean Insignificant Effect on Pain Relief?
[So] Source:Dis Colon Rectum;60(9):e617-e618, 2017 09.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Metronidazol
Dor
[Mh] Termos MeSH secundário: Hemorroidas
Seres Humanos
Manejo da Dor
Medição da Dor
Dor Pós-Operatória
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
140QMO216E (Metronidazole)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000872


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[PMID]:28767586
[Au] Autor:Chang SS; Sung FC; Lin CL; Hu WS
[Ad] Endereço:aDivision of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital bGraduate Institute of Clinical Medical Science, China Medical University cManagement Office for Health Data, China Medical University Hospital dDepartment of Health Services Administration eSchool of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
[Ti] Título:Association between hemorrhoid and risk of coronary heart disease: A nationwide population-based cohort study.
[So] Source:Medicine (Baltimore);96(31):e7662, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The purpose of the study was to address the association between hemorrhoid and the subsequent risk of coronary heart disease (CHD) development.This retrospective cohort study used reimbursement claims data from the Longitudinal Health Insurance Database 2000 in Taiwan. Thirty-three thousand thirty-four patients with hemorrhoids and 132,136 age-, gender-, and index year matched controls between 2000 and 2010 were identified. Cox model was performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of CHD development for the hemorrhoid cohort compared with the nonhemorrhoid cohort.During a follow-up period of 12 years, the overall incidence rate of CHD was 9.91 per 1000 person-years in the hemorrhoid patients and was 1.36-fold higher than in the nonhemorrhoid cohort (7.28 per 1000 person-years) with an adjusted hazard ratio (aHR) of 1.27 (95% CI = 1.21-1.34). Moreover, compared with the nonhemorrhoid patients without these comorbidities, among patients with hemorrhoids, those with any 2 comorbidities were at a significantly increased risk of CHD (HR = 7.12, 95% CI = 6.61-7.67; P < .001), followed by those with any 1 comorbidity (HR = 3.23, 95% CI = 2.94-3.54; P < .001).We found that hemorrhoid patients had a 1.27-fold higher risk of CHD compared with those without hemorrhoids after adjusting for the potential confounding factors.
[Mh] Termos MeSH primário: Doença das Coronárias/epidemiologia
Hemorroidas/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Comorbidade
Doença das Coronárias/etiologia
Bases de Dados Factuais
Feminino
Seguimentos
Hemorroidas/complicações
Seres Humanos
Incidência
Estudos Longitudinais
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Risco
Medicina Estatal
Taiwan
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007662


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[PMID]:28658138
[Au] Autor:Lin G; Ge Q; He X; Qi H; Xu L
[Ad] Endereço:Department of Anorectal Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
[Ti] Título:A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspension clamp combined with harmonic scalpel.
[So] Source:Medicine (Baltimore);96(26):e7309, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To compare the efficacy of homemade anal cushion suspension clamp combined with harmonic scalpel (ACS) and Milligan-Morgan hemorrhoidectomy combined with electric knife (MMH) in the treatment of stages III to IV hemorrhoids. We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013. Among them, 51 patients were treated with ACS, while 48 patients received MMH. Data from clinical recording and follow-up included operative time, intraoperative blood loss, hospitalization information, postoperative pain, and postoperative complications. Operative time, intraoperative blood loss and hospitalization time in ACS group were significantly less than those in MMH group (P < .05). Compared with MMH group, ACS group had a lower postoperative static pain score from days 1 to 14 (P < .01). The patients in ACS group exhibited less postoperative defecation pain scores from days 3 to 20 than those of MMH group (P < .05). The incidence of postoperative anal edema and delayed wound healing in ACS group was lower than that in MMH group (P < .05). Compared with MMH, our novel technique ACS was more effective and had fewer postoperative complications in the treatment of stages III to IV hemorrhoids.
[Mh] Termos MeSH primário: Hemorroidectomia/instrumentação
Hemorroidectomia/métodos
Hemorroidas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Perda Sanguínea Cirúrgica
Defecação
Edema
Desenho de Equipamento
Feminino
Seguimentos
Seres Humanos
Tempo de Internação
Masculino
Duração da Cirurgia
Medição da Dor
Dor Pós-Operatória
Estudos Retrospectivos
Índice de Gravidade de Doença
Resultado do Tratamento
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007309


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[PMID]:28277767
[Au] Autor:Sait MR; Srinivasaiah N
[Ad] Endereço:Locum Consultant Department of Surgery West Middlesex University Hospital Isleworth Middlesex.
[Ti] Título:Tips for safe stapled haemorrhoidopexy.
[So] Source:Br J Hosp Med (Lond);78(3):176, 2017 Mar 02.
[Is] ISSN:1750-8460
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Hemorroidas/cirurgia
Grampeamento Cirúrgico/métodos
[Mh] Termos MeSH secundário: Seres Humanos
Perfuração Intestinal/prevenção & controle
Complicações Pós-Operatórias/prevenção & controle
Doenças Retais/prevenção & controle
Resultado do Tratamento
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.12968/hmed.2017.78.3.176


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[PMID]:28272246
[Au] Autor:Lin LH; Siu JJ; Liao PC; Chiang JH; Chou PC; Chen HY; Ho TJ; Tsai MY; Chen YH; Chen WC
[Ad] Endereço:aGraduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung bDivision of Chinese Medicine, An Nan Hospital, China Medical University, Tainan cDepartments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital dDepartment of Urology, Taichung Veterans General Hospital eDepartment of Psychology, College of Medical and Health Science, Asia University, Taichung fDivision of Chinese Medicine, China Medical University Beigang Hospital, Yunlin gDepartment of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
[Ti] Título:Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study.
[So] Source:Medicine (Baltimore);96(10):e6281, 2017 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.
[Mh] Termos MeSH primário: Hemorroidas/epidemiologia
Medicina Tradicional Chinesa
Doença Pulmonar Obstrutiva Crônica/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Comorbidade
Feminino
Hemorroidas/etiologia
Seres Humanos
Incidência
Masculino
Meia-Idade
Doença Pulmonar Obstrutiva Crônica/etiologia
Estudos Retrospectivos
Taiwan/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170324
[Lr] Data última revisão:
170324
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006281


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[PMID]:28268046
[Au] Autor:Hu WS; Lin CL
[Ad] Endereço:School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: weisyunhu@gmail.com.
[Ti] Título:Hemorrhoid is associated with increased risk of peripheral artery occlusive disease: A nationwide cohort study.
[So] Source:J Epidemiol;27(12):574-577, 2017 Dec.
[Is] ISSN:1349-9092
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study was conducted to evaluate the association between hemorrhoid and risk of incident peripheral artery occlusive disease (PAOD). METHODS: Using the Taiwanese Longitudinal Health Insurance Database 2000, we compared the incident PAOD risk between the hemorrhoid and the non-hemorrhoid cohorts. Both of these cohorts were followed up from the index date until the date of PAOD diagnosis, withdrawal from the National Health Insurance program, or the end of 2011. RESULTS: The mean follow-up period was 6.82 (standard deviation [SD], 3.22) and 6.70 (SD, 3.23) years in the hemorrhoid and non-hemorrhoid cohorts, respectively. The plot of the Kaplan-Meier analysis showed that, by the end of the 12-year follow-up period, the cumulative incidence of PAOD was significantly higher for the hemorrhoid cohort than for the non-hemorrhoid cohort (log-rank test: P < 0.001). CONCLUSIONS: A significantly increased PAOD risk in patients with hemorrhoids was found in this nationwide cohort study.
[Mh] Termos MeSH primário: Hemorroidas/epidemiologia
Doença Arterial Periférica/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Bases de Dados Factuais
Feminino
Seres Humanos
Incidência
Japão/epidemiologia
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170308
[St] Status:MEDLINE


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[PMID]:28267013
[Au] Autor:Wanis KN; Emmerton-Coughlin HM; Coughlin S; Foley N; Vinden C
[Ad] Endereço:1 Department of Surgery, Western University, London Health Sciences Centre, London, Canada 2 Department of Physical Medicine & Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
[Ti] Título:Systemic Metronidazole May Not Reduce Posthemorrhoidectomy Pain: A Meta-Analysis of Randomized Controlled Trials.
[So] Source:Dis Colon Rectum;60(4):446-455, 2017 Apr.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hemorrhoidectomy is associated with significant postoperative pain. Oral metronidazole has been recommended as an adjunct to improve posthemorrhoidectomy analgesia. OBJECTIVE: This study aimed to evaluate the impact of oral metronidazole on patient-reported pain following hemorrhoidectomy. DATA SOURCES: We conducted a systematic search in the MEDLINE, EMBASE, ISI Web of Science, and Cochrane Central Register of Controlled Trials databases. STUDY SELECTION: Randomized controlled trials examining adults who underwent surgical hemorrhoidectomy were included. Participants in an active intervention group received oral metronidazole postoperatively, and those in a control group received placebo or usual care. Postoperative pain was assessed for at least 3 days postoperatively. INTERVENTION: A random-effects model was used. MAIN OUTCOMES MEASURES: The primary outcome was pain during the first 2 postoperative weeks, measured on a visual analogue scale. The secondary outcome was time to return to normal activities. RESULTS: Patients who received oral metronidazole had significantly lower reported pain scores on postoperative day 1 (standardized mean difference, -0.87 ± 0.44; 95% CI, -1.73 to -0.015; p = 0.046; n = 4) and day 4 (standardized mean difference, -1.43 ± 0.71; 95% CI, -2.83 to -0.037; p = 0.044; n = 3). Metronidazole use was associated with a significantly shorter time to return to normal activities (standardized mean difference, -0.76 ± 0.34; 95% CI, -1.43 to -0.088, p = 0.027). The improvements disappeared in a sensitivity analysis excluding the largest trial with a high risk of bias, and no significance was observed during the remaining postoperative days. LIMITATIONS: The meta-analysis was limited by lack of double blinding, absence of a placebo, and unclear or high risk of bias in a proportion of the included trials. CONCLUSIONS: Although a favorable adverse effect profile supports consideration of oral metronidazole to reduce posthemorrhoidectomy pain, pooled analysis reveals inconsistent results with no pain reduction on most postoperative days. The current recommendation for routine prescription of oral metronidazole should be reevaluated in the absence of additional well-designed trials.
[Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico
Hemorroidectomia
Hemorroidas/cirurgia
Metronidazol/uso terapêutico
Dor Pós-Operatória/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração Oral
Analgésicos/uso terapêutico
Seres Humanos
Medição da Dor
Ensaios Clínicos Controlados Aleatórios como Assunto
Recuperação de Função Fisiológica
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Analgesics); 0 (Anti-Infective Agents); 140QMO216E (Metronidazole)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170308
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000792


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[PMID]:28267007
[Au] Autor:Cosman BC; Cajas-Monson LC; Ramamoorthy SL
[Ad] Endereço:1 Halasz General Surgery Service, VA San Diego Healthcare System, San Diego, California 2 Department of Surgery, University of California San Diego School of Medicine, San Diego, California.
[Ti] Título:Twenty Years of a Veterans' Spinal Cord Injury Colorectal Clinic: Flexible Sigmoidoscopy and Multiple Hemorrhoid Ligation.
[So] Source:Dis Colon Rectum;60(4):399-404, 2017 Apr.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Colorectal and anal problems arise in chronic spinal cord injury care. We review 20 years of experience in a colorectal clinic at a veterans medical center treating mostly male veterans who have spinal cord injury. OBJECTIVE: We aim to show the results of colorectal interventions in a population with chronic spinal cord injury. DESIGN: This study is a retrospective records review. SETTINGS: This study was conducted at a Department of Veterans Affairs regional spinal cord injury center. PATIENTS: Six hundred forty-one individuals (625 males) made 1208 visits. Mean age was 56 ± 13 years; ages ranged from 21 to 90 years. INTERVENTIONS: Flexible sigmoidoscopy was done for diagnosis and screening, and hemorrhoid ligation was performed for symptomatic hemorrhoids. MAIN OUTCOME MEASURES: The primary outcomes measured were the frequency, timing, and results of procedures. RESULTS: Five hundred forty-eight people had 781 flexible sigmoidoscopies. At first examination, mean age was 65 ± 12 and the duration of injury was 19 ± 15 years. Sixty examinations (7.7%) displayed poor preparation. The interval between adequate-prepared examinations was 5.7 ± 2.0 years. The adenoma detection rate was 4.7%. Two hundred fifteen people had 406 hemorrhoid ligations. At first banding, the mean age was 52 ± 13 and the duration of injury was 20 ± 15 years. Mean number of ligations per procedure was 4.9 ± 2.0; a range of 1 to 20. Nine hemorrhoid operations were done in this period. Regarding the futility of procedures, 250 people died, with a mean age at death of 69 ± 11. The median time between any procedure and death was 4.4 years. Seventeen procedures were done within 6 months of death; these deaths were either unexpected or because of conditions identified at or after the procedure. LIMITATIONS: This was a retrospective review of a single institution, it involved a mostly male population, and it used a subjective assessment of bowel preparation. CONCLUSIONS: In a spinal cord injury colorectal clinic, sigmoidoscopy can keep screening current, with an acceptable level of poor preparation. The adenoma detection rate may or may not be adequate. Hemorrhoid ligation can be expanded beyond its limits in the non-spinal cord-injured population, including multiple and external banding, taking the place of an operation in most cases. These procedures are well tolerated and rarely futile.
[Mh] Termos MeSH primário: Adenoma/diagnóstico
Neoplasias Colorretais/diagnóstico
Hemorroidas/cirurgia
Traumatismos da Medula Espinal/complicações
[Mh] Termos MeSH secundário: Adenoma/complicações
Adulto
Idoso
Idoso de 80 Anos ou mais
Catárticos/uso terapêutico
Neoplasias Colorretais/complicações
Cirurgia Colorretal
Colostomia
Detecção Precoce de Câncer
Enema
Feminino
Hemorroidas/complicações
Seres Humanos
Ligadura
Masculino
Meia-Idade
Estudos Retrospectivos
Sigmoidoscopia
Estados Unidos
United States Department of Veterans Affairs
Veteranos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cathartics)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170417
[Lr] Data última revisão:
170417
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170308
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000773



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