摘要:

PURPOSE:The aims of this review are 1) to critically evaluate the literature on the efficacy of biofeedback treatment for fecal incontinence, 2) to compare different types of biofeedback, and 3) to identify patient characteristics which predict a successful outcome.METHODS:The MEDLINE database was searched for articles published between 1973 and 1999 which included the terms “biofeedback” and “fecal incontinence.” Pediatric and adult articles in any language were screened. Inclusion for review required that the study be prospective, have five or more subjects, and have a description of the treatment protocol.RESULTS:Thirty‐five studies were reviewed. Only six studies used a parallel treatment design and just three of those randomized subjects to treatment groups. A meta‐analysis (weighted by subjects) was performed to compare the results of two treatment protocols that dominate the literature. The mean success rate of studies usingCoordinationtraining (i.e., coordinating pelvic floor muscle contraction with the sensation of rectal filling) was 67 percent, while the mean success rate for studies usingStrengthtraining (i.e., pelvic floor muscle contraction) was 70 percent. Furthermore, the mean success rate for thoseStrengthtraining studies using electromyographic biofeedback was 74 percent, while the mean success rate for studies using anal canal pressure biofeedbackStrengthtraining was 64 percent. However, these conclusions are limited by the absence of clearly identified criteria for determining success. There are also inconsistencies in the literature regarding the patient selection criteria, severity and cause of symptoms, amount of treatment, as well as the type of biofeedback protocols and instrumentation used. Finally, no patient characteristics were identified that would assist in predicting successful outcome.CONCLUSION:Although most studies report positive results using biofeedback to treat fecal incontinence, quality research is lacking. Recommendations are made for future investigations to 1) improve experimental design, 2) include long term follow‐up data, and 3) to use an adequate sample size that allows for meaningful analysis.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

&NA;Biofeedback is established treatment for intractable constipation in patients with an element of pelvic floor dysfunction. In those with intractable slow‐transit constipation and normal pelvic floor function, colectomy is usually recommended. We report four patients with isolated slow‐transit constipation who benefited from biofeedback and avoided surgery. All four patients were extensively investigated for pelvic floor dysfunction before undergoing a standard biofeedback course of four outpatient sessions. All improved in terms of bowel frequency, laxative use, bloating, straining, and lifestyle. Improvement has been maintained for a median of nine (range, 5‐12) months without the requirement for further treatment. Biofeedback represents a safe and inexpensive treatment for these patients and may avoid surgery in a significant proportion.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to assess the efficacy of radiofrequency ablation in the treatment of pelvic recurrent rectal cancer.METHODS:Computed tomography‐guided percutaneous radiofrequency ablation was performed by placing a LeVeen needle electrode into the tumor. Radiofrequency ablation was performed on three lesions in two patients with pelvic recurrent rectal cancer, where the tumors were unresectable and associated with poorly controllable pain despite local treatment consisting of chemoradiotherapy.RESULTS:There were no major complications during the radiofrequency ablation procedure, although one patient complained of a sensation of warmth in the pelvic region, which was reasonably tolerated.Case 1: Each of two lesions of pelvic recurrence, 3 or 4 cm in diameter, was treated once by radiofrequency ablation with placement of a needle electrode into the tumor mass. After the procedure, magnetic resonance imaging confirmed nearly complete necrosis of the tumors, and there was a sufficient relief of pain enabling discontinuation of an opioid. Serum carcinoembryonic antigen returned to normal and there was no evidence of relapse six months after the treatment.Case 2: Radiofrequency ablation was performed by placing a needle electrode at two sites of a recurrent tumor 6 cm in diameter. Postradiofrequency ablation imaging showed viable tissue remnants along the tumor margin, but the treatment produced relief of pain. The procedure was effective in opioid dosage reduction and pain control within a limited time span.CONCLUSION:Radiofrequency ablation is a relatively readily maneuverable and safe local treatment for pelvic recurrence in rectal cancer and is considered a procedure worth applying with further accumulation of experience in clinical cases.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:Patients with colorectal polyps often display a large kink or distinct mucosal fold in the area where the polypectomy is to take place. As a result, there is a higher risk of perforation or partial ablation during an endoscopic polypectomy. Is it safer to perform an endoscopic polypectomy using the control and assistance of a laparoscope? Can a segment resection of the colon that would otherwise be necessary be avoided?METHODS:An endoscopic polypectomy using a laparoscope was conducted on six patients whose colorectal polyps were in an anatomically unfavorable location. The need for an open or laparoscopic segment resection or colotomy was indicated in all cases. The growth was located in the rectosigmoidal transition in five patients and in the region of the left flexure in one patient. We decided that an endoscopic polypectomy using the assistance of a laparoscope would be the most comfortable and technically elegant method, as well as easy. Except the well‐known risks of laparoscopy and endoscopic polypectomy, no other risks have been seen in our patients. The affected area of the colon, the sigma, and the left flexure were mobilized and stretched as much as possible to enable a simultaneous and low‐risk endoscopic polypectomy. In one case, we had to conduct a fractionated ablation because of a very wide‐based finding.RESULTS:The operation averaged 57 minutes, and no operation‐specific complications were observed. Postoperative recovery in the hospital was very short and averaged 2.5 days. The histopathologic findings were benign in all cases, but a serious dysplasia was diagnosed in one patient.CONCLUSIONS:The laparoscopic‐assisted polypectomy is a safe method to remove even complicated polyps in anatomically unfavorable locations.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID