-
The International Journal of... Dec 2023Purpose/aim of the study:Central nervous system (CNS), skull, and vertebral metastases from anal squamous cell carcinoma (SCC) are an exceedingly rare entity. We report...
Purpose/aim of the study:Central nervous system (CNS), skull, and vertebral metastases from anal squamous cell carcinoma (SCC) are an exceedingly rare entity. We report the first case of multiple vertebral metastases from a primary anal SCC with the aim of define a target therapeutic strategy. We present the case of a 68-year-old male admitted to our hospital for acute exacerbation chronic low back pain and left L2 radiculopathy. His medical history included the diagnosis of a human papilloma virus related, moderately differentiated anal SCC (cT3N0M0-stage IIB), treated with standard chemoradiotherapy regimen two years earlier. Spinal magnetic resonance imaging revealed an isolated solid lesion of the L2 vertebral body. After the surgical removal, histopathological examination confirmed the diagnosis of moderately differentiated SCC. At 1-month radiological follow-up, two new lesions at the level of T7 to T11 were identified. Additional chemotherapy and radiotherapy for metastatic localization of L2, T7, and T11 were administered. Two-year follow-up demonstrated a radiologically and clinically well-controlled disease. To supplement our case, a systematic literature review on the CNS, skull, and vertebral metastases and their treatments has been performed. Despite several proposed guidelines for the management of vertebral metastases, at present, a universally accepted treatment strategy for vertebral metastases from anal SCC has not been defined. Based on our clinical experience and literature review, in case of vertebral metastases from anal SCC, a prompt and aggressive, local and systemic, and multimodal treatment of the vertebral lesions may be paramount to improve the patient outcomes.
Topics: Male; Humans; Aged; Carcinoma, Squamous Cell; Spine; Combined Modality Therapy; Radiography; Magnetic Resonance Imaging
PubMed: 35369848
DOI: 10.1080/00207454.2022.2052066 -
Langenbeck's Archives of Surgery Mar 2024Magnetic anal sphincter (MAS) augmentation is a novel surgical option for the treatment of fecal incontinence. Current clinical evidence is conflicting. The purpose of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Magnetic anal sphincter (MAS) augmentation is a novel surgical option for the treatment of fecal incontinence. Current clinical evidence is conflicting. The purpose of this meta-analysis was to report the safety profile, potential benefits, and the functional efficacy of this device.
METHODS
The study followed the PRISMA guidelines. Literature databases (Medline, Scopus, Web of Science, CENTRAL) were screened for eligible articles. The primary endpoint was the pooled effect of MAS in the Cleveland Clinic Incontinence Score (CCIS) score. Quality evaluation was based on the ROBINS-I and Risk of Bias 2 tool.
RESULTS
Overall, 8 studies with 205 patients were included. MAS resulted in a significant reduction of CCIS values (p = 0.019), and improvement only in the embarrassment domain of FIQoL scores (p = 0.034). The overall morbidity rate was 61.8%. Postoperative adverse events included MAS explantation in 12%, infection in 5.1%, pain in 10% and obstructed defecation in 5.8% of patients.
CONCLUSION
The application of MAS in patients with fecal incontinence results in the improvement of some clinical parameters with a notable morbidity rate. Due to several study limitations, further, high-quality RCTs are required to delineate the efficacy and safety of MAS.
Topics: Humans; Anal Canal; Device Removal; Fecal Incontinence; Magnetic Phenomena; Quality of Life; Treatment Outcome
PubMed: 38499684
DOI: 10.1007/s00423-024-03288-x -
European Journal of Gastroenterology &... Feb 2022Endoscopic submucosal dissection (ESD) is a validated treatment for early rectal tumors, but whether this therapy is efficient or not for rectal tumors extending to the... (Meta-Analysis)
Meta-Analysis
Endoscopic submucosal dissection (ESD) is a validated treatment for early rectal tumors, but whether this therapy is efficient or not for rectal tumors extending to the dentate line (RTDL) remains unclear. We performed a systematic review and meta-analysis to assess the effectiveness and safety of ESD in RTDL compared to non-RTDL. A search in PubMed, Scopus and the Cochrane library up to April 2020 was conducted to identify studies that compared ESD in both localizations (RTDL and non-RTDL), reporting at least one main outcome (en bloc, complete resection, recurrence). Secondary outcomes were adverse event occurrence. Five observational studies including 739 patients with a total of 201 RTDL and 538 non-RTDL were considered. The proportion of female sex (66% vs. 36.9%, P < 0.001) and tumor size [mean difference = 7.75, 95% confidence interval (CI): 3.01-12.49, P = 0.001] were higher in the RTDL group. There were no differences in en bloc resection rates between RTDL and non-RTDL groups [odds ratio (OR): 0.95, 95% CI: 0.50-1.79, P = 0.087]. The complete resection rate was significantly higher in the non-RTDL group (OR: 1.72, 95% CI: 1.18-2.53, P = 0.005, I2 = 0%). However, recurrence rates were comparable (RD: -0.04, 95% CI: -0.07 to 0.00, P = 0.06, I2 = 0%). Concerning adverse events, there were no differences in terms of perforation (OR: 0.9, 95% CI: 0.26-3.08, P = 0.86, I2 = 0%) or delayed bleeding (OR: 0.64, 95% CI: 0.17-2.42, P = 0.51, I2 = 35%). Anal pain rate was 28% (95% CI: 21.4-35.8%). ESD is an effective and safe therapeutic approach for RTDL with comparable recurrence rate to non-RTDL. The lower complete resection rate in RTDL needs to be clarified in studies.
Topics: Endoscopic Mucosal Resection; Female; Humans; Intestinal Mucosa; Neoplasm Recurrence, Local; Rectal Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 34967816
DOI: 10.1097/MEG.0000000000001998 -
International Journal of Colorectal... Sep 2022Squamous cell carcinoma of the anus (SCCA) suffers a constant increase each year in the last decades. Recent studies suggested the possibility of local excision (LE) as...
PURPOSE
Squamous cell carcinoma of the anus (SCCA) suffers a constant increase each year in the last decades. Recent studies suggested the possibility of local excision (LE) as an option for early-stage SCAC patients. This systematic review aims to summarize the available evidence on the comparison of LE vs. chemoradiotherapy (CRT) in the treatment of early SCCA patients.
METHODS
We conducted a literature review including MEDLINE/PubMed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews through June 2022. MOOSE guidelines were followed. We used the methodological index for non-randomized studies (MINORS) tool to assess quality. Data on survival and procedure-associated costs were extracted.
RESULTS
Four retrospective studies including 3323 patients were included. They were all comparative retrospective cohort studies (three were registry-based studies, either NCDB or SEER) with a MINORS score of 16-19 points. Overall survival (OS) was comparable between LE and CRT patients in three studies, with a 5-year OS of 85.3-100% in LE patients and 85-91.6% in CRT patients. One study investigated cancer-specific survival (CSS) and reported similar 5-year CSS in LE (98%) and CRT patients (96%). One investigated progression-free survival (PFS) and did not report any statistically significant difference in 5-year PFS between LE (91%) and CRT patients (83%). Only one study considered the mean costs associated with the two approaches (29,210 USD with LE and 46,350 USD with CRT).
CONCLUSIONS
LE may potentially be considered a valid alternative to CRT for patients with early-stage SCAA. Results of prospective randomized long-term trials comparing LE with CRT are warranted to draw definitive conclusions and consider LE as a true cost-effective strategy for T1N0 SCCA with similar oncologic results offered by CRT, which-to date-remains the "gold standard."
PROSPERO REGISTRATION
CRD42022338750.
Topics: Humans; Anal Canal; Anus Neoplasms; Carcinoma, Squamous Cell; Chemoradiotherapy; Prospective Studies; Retrospective Studies
PubMed: 36002749
DOI: 10.1007/s00384-022-04241-4 -
The Cochrane Database of Systematic... Nov 2019Pouchitis occurs in approximately 50% of patients following ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (UC). (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pouchitis occurs in approximately 50% of patients following ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (UC).
OBJECTIVES
The primary objective was to determine the efficacy and safety of medical therapies for prevention or treatment of acute or chronic pouchitis.
SEARCH METHODS
We searched MEDLINE, Embase and CENTRAL from inception to 25 July 2018. We also searched references, trials registers, and conference proceedings.
SELECTION CRITERIA
Randomized controlled trials of prevention or treatment of acute or chronic pouchitis in adults who underwent IPAA for UC were considered for inclusion.
DATA COLLECTION AND ANALYSIS
Two authors independently screened studies for eligibility, extracted data and assessed the risk of bias. The certainty of the evidence was evaluated using GRADE. The primary outcome was clinical improvement or remission in participants with acute or chronic pouchitis, or the proportion of participants with no episodes of pouchitis after IPAA. Adverse events (AEs) was a secondary outcome. We calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for each dichotomous outcome.
MAIN RESULTS
Fifteen studies (547 participants) were included. Four studies assessed treatment of acute pouchitis. Five studies assessed treatment of chronic pouchitis. Six studies assessed prevention of pouchitis. Three studies were low risk of bias. Three studies were high risk of bias and the other studies were unclear. Acute pouchitis: All ciprofloxacin participants (7/7) achieved remission at two weeks compared to 33% (3/9) of metronidazole participants (RR 2.68, 95% CI 1.13 to 6.35, very low certainty evidence). No ciprofloxacin participants (0/7) had an AE compared to 33% (3/9) of metronidazole participants (RR 0.18, 95% CI 0.01 to 2.98; very low certainty evidence). AEs included vomiting, dysgeusia or transient peripheral neuropathy. Forty-three per cent (6/14) of metronidazole participants achieved remission at 6 weeks compared to 50% (6/12) of budesonide enema participants (RR 0.86, 95% CI 0.37 to 1.96, very low certainty evidence). Fifty per cent (7/14) of metronidazole participants improved clinically at 6 weeks compared to 58% (7/12) of budesonide enema participants (RR 0.86, 95% CI 0.42 to 1.74, very low certainty evidence). Fifty-seven per cent (8/14) of metronidazole participants had an AE compared to 25% (3/12) of budesonide enema participants (RR 2.29, 95% CI 0.78 to 6.73, very low certainty evidence). AEs included anorexia, nausea, headache, asthenia, metallic taste, vomiting, paraesthesia, and depression. Twenty-five per cent (2/8) of rifaximin participants achieved remission at 4 weeks compared to 0% (0/10) of placebo participants (RR 6.11, 95% CI 0.33 to 111.71, very low certainty evidence). Thirty-eight per cent (3/8) of rifaximin participants improved clinically at 4 weeks compared to 30% (3/10) of placebo participants (RR 1.25, 95% CI 0.34 to 4.60, very low certainty evidence). Seventy-five per cent (6/8) of rifaximin participants had an AE compared to 50% (5/10) of placebo participants (RR 1.50, 95% CI 0.72 to 3.14, very low certainty evidence). AEs included diarrhea, flatulence, nausea, proctalgia, vomiting, thirst, candida, upper respiratory tract infection, increased hepatic enzyme, and cluster headache. Ten per cent (1/10) of Lactobacillus GG participants improved clinically at 12 weeks compared to 0% (0/10) of placebo participants (RR 3.00, 95% CI 0.14 to 65.90, very low certainty evidence). Chronic pouchitis: Eighty-five per cent (34/40) of De Simone Formulation (a probiotic formulation) participants maintained remission at 9 to 12 months compared to 3% (1/36) of placebo participants (RR 20.24, 95% CI 4.28 to 95.81, 2 studies; low certainty evidence). Two per cent (1/40) of De Simone Formulation participants had an AE compared to 0% (0/36) of placebo participants (RR 2.43, 95% CI 0.11 to 55.89; low certainty evidence). AEs included abdominal cramps, vomiting and diarrhea. Fifty per cent (3/6) of adalimumab patients achieved clinical improvement at 4 weeks compared to 43% (3/7) of placebo participants (RR, 1.17, 95% CI 0.36 to 3.76, low certainty evidence). Sixty per cent (6/10) of glutamine participants maintained remission at 3 weeks compared to 33% (3/9) of butyrate participants (RR 1.80, 95% CI 0.63 to 5.16, very low certainty evidence). Forty-five per cent (9/20) of patients treated with bismuth carbomer foam enema improved clinically at 3 weeks compared to 45% (9/20) of placebo participants (RR 1.00, 95% CI 0.50 to 1.98, very low certainty evidence). Twenty-five per cent (5/20) of participants in the bismuth carbomer foam enema group had an AE compared to 35% (7/20) of placebo participants (RR 0.71, 95% CI 0.27 to 1.88, very low certainty evidence). Adverse events included diarrhea, worsening symptoms, cramping, sinusitis, and abdominal pain.
PREVENTION
At 12 months, 90% (18/20) of De Simone Formulation participants had no episodes of acute pouchitis compared to 60% (12/20) of placebo participants (RR 1.50, 95% CI 1.02 to 2.21, low certainty evidence). Another study found 100% (16/16) of De Simone Formulation participants had no episodes of acute pouchitis at 12 months compared to 92% (11/12) of the no treatment control group (RR 1.10, 95% 0.89 to 1.36, very low certainty evidence). Eighty-six per cent (6/7) of Bifidobacterium longum participants had no episodes of acute pouchitis at 6 months compared to 60% (3/5) of placebo participants (RR 1.43, 95% CI 0.66 to 3.11, very low certainty evidence). Eleven per cent (1/9) of Clostridium butyricum MIYAIRI participants had no episodes of acute pouchitis at 24 months compared to 50% (4/8) of placebo participants (RR 0.22, 95% CI 0.03 to 1.60, very low certainty evidence). Forty-six per cent (43/94) of allopurinol participants had no episodes of pouchitis at 24 months compared to 43% (39/90) of placebo participants (RR 1.06, 95% CI 0.76 to 1.46; low certainty evidence). Eighty-one per cent (21/26) of tinidazole participants had no episodes of pouchitis over 12 months compared to 58% (7/12) of placebo participants (RR 1.38, 95% CI 0.83 to 2.31, very low certainty evidence).
AUTHORS' CONCLUSIONS
The effects of antibiotics, probiotics and other interventions for treating and preventing pouchitis are uncertain. Well designed, adequately powered studies are needed to determine the optimal therapy for the treatment and prevention of pouchitis.
Topics: Anastomosis, Surgical; Anti-Bacterial Agents; Budesonide; Ciprofloxacin; Colitis, Ulcerative; Enema; Gastrointestinal Agents; Humans; Metronidazole; Postoperative Complications; Pouchitis; Probiotics; Randomized Controlled Trials as Topic; Remission Induction
PubMed: 31785173
DOI: 10.1002/14651858.CD001176.pub5 -
Journal of Obstetrics and Gynaecology... Jan 2020This study aimed to review the literature to establish the prevalence of pelvic floor disorders in the fibromyalgia population. A systematic literature search through...
This study aimed to review the literature to establish the prevalence of pelvic floor disorders in the fibromyalgia population. A systematic literature search through computerized databases including PubMed and EMBASE was completed using medical subject heading (MeSH) terms from January 1, 1990 to November 1, 2017. Articles were included if the focus was prevalence of pelvic floor disorders in the population of persons with fibromyalgia. To provide consistency of diagnosis, use of the American College of Rheumatology 1990 or 2010 criteria was required. Evidence was graded according to Canadian Task Force on Preventive Health Care and Newcastle-Ottawa quality assessment scales. A total of 11 studies were deemed eligible for inclusion from 1024 articles initially identified. Only one study used the most recent 2010 American College of Rheumatology diagnostic criteria. There was significant heterogeneity in the reporting of fibromyalgia populations. Outcomes reported were variable and not consistent across studies; thus, data could not be pooled. There appears to be a high prevalence of gastrointestinal, genitourinary, and gynaecological dysfunction. In case-control studies, these dysfunctions appeared to be more prevalent in the fibromyalgia group than in the control populations. However, this difference could not be quantified more specifically. In conclusion, the small number of eligible studies and the variety of pelvic floor outcomes reported limited formation of conclusive prevalence of pelvic floor disorders in the fibromyalgia population. From the small number of studied patients, there may be a higher prevalence of gastrointestinal, genitourinary, and gynaecological concerns in women with fibromyalgia.
Topics: Female; Fibromyalgia; Humans; Pelvic Floor Disorders; Prevalence
PubMed: 31320239
DOI: 10.1016/j.jogc.2019.02.013 -
Journal of Pediatric Gastroenterology... May 2024Refractory functional constipation is a challenging condition to manage in children. The use of transanal irrigation (TAI) is well reported in children with neurological... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Refractory functional constipation is a challenging condition to manage in children. The use of transanal irrigation (TAI) is well reported in children with neurological disorders as well as anorectal malformations but less so in children with functional disorders of defecation. The objective of our study was to evaluate the effectiveness, safety and outcomes of TAI in children with functional constipation.
METHODS
PubMed, Scopus and Google Scholar were searched for publications related to the use of TAI in functional constipation. Data regarding the study design, sample size, patient characteristics, investigator-reported response to TAI and adverse effects were extracted from studies that met the selection criteria. The inverse variance heterogeneity model was used for ascertaining the summary effect in this meta-analysis.
RESULTS
The search strategy yielded 279 articles of which five studies were included in the final review. The studies were from the United Kingdom (n = 2), Netherlands (n = 2) and Denmark (n = 1). These studies included 192 children with a median age ranging from 7 to 12.2 years old. The TAI systems used in these studies were: Peristeen (n = 2), Peristeen or Qufora (n = 1), Alterna (n = 1) and Navina (n = 1). The follow-up duration ranged from 5.5 months to 3 years. Eleven (5.7%) children did not tolerate TAI and withdrew from treatment soon after initiation. The pooled investigator-reported success of TAI was 62% (95% CI: 52%-71%). The most common adverse event was pain which was experienced by 21.7% of children. A total of 27 (14%) were successfully weaned off TAI at the last follow-up.
CONCLUSIONS
TAI is reported to be successful in 62% of children with refractory functional constipation. There is a need for well-designed prospective trials to evaluate this treatment option in children with refractory functional constipation.
Topics: Humans; Constipation; Child; Therapeutic Irrigation; Anal Canal; Treatment Outcome
PubMed: 38558090
DOI: 10.1002/jpn3.12200 -
Urology Jun 2020We performed a systematic review to examine the efficacy and outcomes of Botulinum Toxin A (BoNT-A) as the primary intervention strategy for patients with detrusor... (Meta-Analysis)
Meta-Analysis
We performed a systematic review to examine the efficacy and outcomes of Botulinum Toxin A (BoNT-A) as the primary intervention strategy for patients with detrusor external sphincter dyssynergia. Eleven studies were included in the analysis (n = 353; 16% female, 84% male). BoNT-A was effective in 60%-78% of patients for reducing postvoid residual, mean detrusor pressure, detrusor leak point pressure, and mean urethral pressure 1 month after injection. Most patients required reinjection after an average of 4-9 months. BoNT-A was not associated with any significant adverse events, and may improve quality of life, as well as urodynamic parameters for detrusor external sphincter dyssynergia.
Topics: Adult; Anal Canal; Anus Diseases; Ataxia; Botulinum Toxins, Type A; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Neuromuscular Agents; Prospective Studies; Quality of Life; Retreatment; Retrospective Studies; Treatment Outcome; Urethra
PubMed: 32197987
DOI: 10.1016/j.urology.2020.03.007 -
Medicine Jul 2023Heterotopic gastric mucosa (HGM) can occur in all segments of the gastrointestinal tract, but rectal is very rare. In recent years, rectal HGM is more often treated by...
RATIONALE
Heterotopic gastric mucosa (HGM) can occur in all segments of the gastrointestinal tract, but rectal is very rare. In recent years, rectal HGM is more often treated by endoscopic resection (ER).
PATIENT CONCERNS
A 28-year-old female was admitted to the hospital with the chief complaint of "a rectal lesion found on physical examination".
DIAGNOSES
Heterotopic gastric mucosa (HGM).
INTERVENTIONS
An endoscopic submucosal dissection (ESD) was performed to completely dissect the lesion.
OUTCOMES
The patient recovered well at 1 month of follow-up and did not suffer from further blood in the stool.
LESSONS
Rectal HGM has acid secretion function and HP can be colonized, causing a variety of symptoms such as abdominal pain, bloody stool, and anal pain and has the potential risk of malignant transformation; resection is the best treatment method, and ESD has its unique advantages and can be promoted in the clinic.
Topics: Female; Humans; Adult; Rectum; Endoscopic Mucosal Resection; Pelvis; Gastric Mucosa; Intestinal Mucosa; Treatment Outcome
PubMed: 37505175
DOI: 10.1097/MD.0000000000034491 -
Journal of Clinical Nursing Mar 2024
Topics: Humans; Self-Management; Randomized Controlled Trials as Topic; Pain; Pain Management; Neoplasms
PubMed: 37818964
DOI: 10.1111/jocn.16903