A. Guglielmi

Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence

INTRODUCTION:Sacral nerve modulation has been demonstrated to be a new efficacious treatment for fecal incontinence. The effectiveness of the procedure is preliminarily tested by means of a peripheral nerve evaluation. Integrity of the sacral neural pathway is generally believed to be a necessary condition for a good response, but no data are available to confirm whether electrophysiologic anal tests are predictive of the clinical outcome of the peripheral nerve evaluation.METHODS:Eighty-two incontinent patients underwent the peripheral nerve evaluation after full evaluation of the anorectal physiology. Univariate analysis was performed, and the positive predictive value, sensitivity, and specificity were calculated for each of the tests.RESULTS:Forty-six patients had successful results to the peripheral nerve evaluation and were subjected to permanent implant of a sacral electrostimulator. Anal sphincter electromyography had been performed in 60 patients, whereas pudendal nerve terminal motor latency had been assessed in 68 and evoked sacral potentials in 29 patients. Anal electromyography was statistically related to the outcome of the peripheral nerve evaluation (P = 0.0004) with a positive predictive value of 81 percent, a sensitivity of 44 percent, and a specificity of 81 percent. Pudendal nerve terminal motor latency on the right side did not correlate with the outcome, but left pudendal nerve terminal motor latency was weakly correlated (P = 0.02), although both tests had a low positive predicting value and sensitivity vs. good specificity. Evoked sacral potentials did not correlate with the outcome and had a low positive predictive value, sensitivity, and specificity.CONCLUSIONS:Simple anal sphincter electromyography can predict the outcome of the peripheral nerve evaluation with good positive predictive value and specificity in patients with fecal incontinence. Other, more expensive, electrophysiologic anal tests do not add further prognostic information.

Catheter-related complications in long-term home parenteral nutrition patients with chronic intestinal failure.

Background Home Parenteral Nutrition is a therapeutic option to improve quality of life in chronic intestinal failure. Aims To describe frequency of complications both in cancer and non-cancer patients. Methods This study was performed on 270 adult patients (52% with cancer, 48% without cancer) followed for a total of 371 years of treatment. Mean duration of therapy was 191±181 for cancer and 830±1168 days/patient for non-cancer. The treatment was administered by a competent, dedicated provider. Patients received our prescribed “all-in-one admixtures” at their homes. Results Catheter-related complications/1000-days-catheter was 1.40; mechanical complications were comparable in cancer (0.82) and non-cancer (0.91) patients while a statistically significant difference was observed between cancer (0.71) and non-cancer (0.46) patients for sepsis. Bacterial infections were more frequent in non-cancer, mycotic infections primarily affected cancer patients. In our experience 49% of the patients were readmitted, with a low incidence rate of 0.89/1000 days-catheter. The incidence of hepatobiliary complications in our population was 65%. The degree of liver damage was related to short bowel syndrome and to length of treatment. Conclusions This study indicated that cancer patients are more vulnerable to CVC-related infections during Home Parenteral Nutrition and that a safer Home Parenteral Nutrition protocol should be adopted in order to contain CVC-related complications.

Strangulated ileal trans-coloanal-anastomotic hernia: A complication of Altemeier’s procedure previously never reported

A postoperative complication after Altemeier operation, so far never reported, is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation. After 6 d from perineal rectosigmoidectomy, the patient, was discharged free of complications. Four days later he was readmitted in emergency for strangulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate. The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen, resection of the necrotic ileum, and end colostomy. The outcome of the second operation was free of complication and the patient was discharged on the 6(th) postoperative day. In conclusion, after Altemeier operation prolonged straining at defecation should be carefully avoided.

The use of the PEN3 e-nose in the screening of colorectal cancer and polyps

Colorectal cancer (CRC) still afflicts a large number of patients worldwide and is the third most common cancer diagnosed in Western countries as well as the third most common cause of cancer deaths. Colonoscopy is the gold standard for CRC diagnosis but is unsuitable for mass screening, while fecal immunochemical testing (FIT) for occult blood in the feces suffers from low specificity (particularly for polyps) and insufficient patient compliance. Recent studies using a metabolomic approach with gas chromatography-mass spectrometry (GC–MS) analysis of the exhaled breath of these patients have demonstrated the occurrence of significant changes in the pattern of their volatile organic compounds (VOCs) compared to healthy controls. Therefore, detection of an altered pattern of VOCs has been proposed as a potential screening tool in CRC [1]. However, the identification and analysis of these molecules by GC/MS is complex and time consuming. Several commercial and/or custom electronic noses (enose) that try to reproduce human senses using sensor arrays and systems have been developed and are currently used in several research fields including medicine. The aim of this study was to test the reliability of a commercial e-nose as screening tool for patients with CRC and polyps.

Restoration of Anal Continence with the Artificial Bowel Sphincter (Abs Acticon TM)

Background A new prosthetic device, the ActiconTM artificial anal sphincter, has recently been introduced for treating severe faecal incontinence. We review the results of our experience with this procedure.