PURPOSE: This study was designed to evaluate the safety, efficacy, and impact on quality of life of the perineal puborectalis sling operation for fecal incontinence. METHODS: Since August 2001, we performed the perine...
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PURPOSE: This study was designed to evaluate the safety, efficacy, and impact on quality of life of the perineal puborectalis sling operation for fecal incontinence. METHODS: Since August 2001, we performed the perineal puborectalis sling operation on eight patients with idiopathic fecal incontinence. A specially designed polyester mesh sling was introduced along the puborectalis muscle, from a posterior perianal incision, running to a small suprapubic incision. The ends were tied together with moderate tension. Patients were evaluated with the Fecal Incontinence Severity Index, the Cleveland Clinic Score of Incontinence, and the Fecal Incontinence Quality of Life Scale. Manometry and defecography were performed before and six months after the operation. RESULTS: Eight patients (7 females; mean age, 63 (range, 44-77) years) were evaluated. A wound infection developed in one patient, which subsided with antibiotics. A rectal ulcer developed in one patient, necessitating sling removal. In the remaining seven patients, the Fecal Incontinence Severity Index improved from 27 to 9, and the Cleveland Clinic Score of Incontinence improved from 13 to 5 (P < 0.05). All parameters in the Fecal Incontinence Quality of Life Scale improved: lifestyle from 2.1 to 3.6; coping/behavior from 1.5 to 3.4; depression/self perception from 2.3 to 3.7; and embarrassment from 2 to 3.6 (P < 0.05). No significant difference was found between preoperative and postoperative maximum resting pressure and maximum squeeze pressure. However, the median anorectal angle on defecography after the operation was significantly reduced (P < 0.05). CONCLUSIONS: We believe that the perineal puborectalis sling operation is technically feasible, with low morbidity, and can be an effective procedure for idiopathic fecal incontinence.
Aims: To evaluate whether anti- aldosteronic treatment influences lung diffusion(DLco) in chronic heart failure(HF) patients. Spironolactone improves clinical conditions and prognosis in chronic HF and reduces connect...
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Aims: To evaluate whether anti- aldosteronic treatment influences lung diffusion(DLco) in chronic heart failure(HF) patients. Spironolactone improves clinical conditions and prognosis in chronic HF and reduces connective tissue matrix turnover; DLco abnormalities in chronic HF are related to increase in fibrosis and connective tissue derangement. Methods and results: Thirty stable chronic HF patients, with reduced DLco(< 80% of predicted), were randomly assigned to active treatment(25 mg spironolactone daily) or placebo in addition to conventional anti- failure treatment. They were evaluated by quality of life questionnaire, laboratory investigations, cardiopulmonary exercise test, and pulmonary function test, which included DLco and membrane diffusing capacity(DM). The evaluation was done before treatment and 6 months after. Quality of life score and standard pulmonary function tests were not significantly affected by spironolactone, while active treatment increased DLco due to an increase of DM(DLco: 18.3± 3.9 vs. 19.9± 5.5 mL/min/mmHg; DM: 28.1± 7.7 vs. 33.3± 8.6 mL/min/mmHg) and peak oxygen consumption(peak VO2 16.8± 1.9 vs. 18.6± 2.2mL/min/kg). Increments of DLco and peak VO2 were linearly related(R=0.849, P< 0.001). Conclusion: These data showa positive effect of spironolactone on gas diffusion and exercise capacity suggesting a novel mechanism by which anti- aldosteronic drugs improve HF clinical condition and prognosis.
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