Maria Auxiliadora Prolungatti Cesar
Universidade de Taubaté
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Revista Brasileira De Coloproctologia | 2008
Maria Auxiliadora Prolungatti Cesar; Wilmar Artur Klug; Helly Angela Caram Aguida; Jorge Alberto Ortiz; Chia Bin Fang; Peretz Capelhuchnik
BACKGROUND: constipation is a complex problem and precise diagnosis is required for adequate therapy. When treating patients with obstructed defecation, many factors as gender, age, personal habits, childbirth, associated diseases and other specific pelvic disorders must be considered. Manometry is the preferred diagnosis method due to its simplicity and general availability. OBJECTIVE: the aim of this work was to determine rectal and anal pressures in patients with outlet constipation. METHOD: forty patients diagnosed with outlet constipation were examined using manometry by Coloproctology Ambulatory of Santa Casa of Sao Paulo. The results were compared with a control group of 60 normal. Rectal and anal pressures were measured by ballon manometry , with the patients grouped by type of constipation. RESULTS: we observed alterations in rectal and anal resting and anal squeese pressures in constipated individuals, but no pressure differences between the various types of constipation. CONCLUSION: the different diagnostic methods are relevant for a correct diagnosis. Although baloon manometry should be one of these procedures, it should not be used as the only diagnosis method.
Revista Brasileira De Coloproctologia | 2009
Maria Auxiliadora Prolungatti Cesar; Wilmar Artur Klug; Jorge Alberto Ortiz; Fang Chia Bin; Peretz Kapelhuchnik
Amongst the causes of outlet obstruction, the anismus is most frequent and its diagnosis is made more frequently through electromyografy, considered as optimum examination for this diagnosis. The objective of this work is to verify the influence of anismus in the examinations of anal physiology. For this work 40 patients with diagnosis of outlet obstruction were separate in two groups had been studied: with and without anismus. All of the patients were submitted to manometric exams, rectal sensibility, electromyography, pudendal latency and defecography with the purpose of serving which ones exams would be important in the presence or not of the anismus. We didn´t observe differences between the two groups in relation to the carried through examinations, except in the electromyography that is considered standard gold and in the angle retal year in the defecography where in the patients with anismus it was significantly lesser. CONCLUSION: the presence of anismus intervened with the results of the examinations of anal physiology only in the electromyography, considered standard gold for this diagnosis.
Revista Brasileira De Coloproctologia | 2007
Maria Auxiliadora Prolungatti Cesar; Wilmar Artur Klug; Peretz Capelhuchnick; Jorge Alberto Ortiz; Anandréa Piva Mantovani; Carlos André de Barros Antunes; Ruy Charles Cardoso de Souza; Cyntia Daniela Resende de Vasconcelos
INTRODUCTION: The anal manometry is an approach for the study of the anal sphincter including the muscles internal and external anal sphincter being responsible for the pressures of rest and contraction. METHOD: retrospective study through the analysis of examinations of anal manometry of 10 patients with diagnosis of constipation taken care of in the clinic of Anal Physiology of the Service of Coloproctologia of the College of Medical Sciences of the Casa Saint of Sao Paulo in the period of January of 2004 the July of 2004. All the examinations had been analyzed by 3 different examiners being a teacher in anal physiology, a doctor in recent learning and a resident doctor in training and each one supply a finding each examination. RESULT: the examiners are different statistical in the evaluation of the evacuation and contraction pressure. In some situations examiner 1 is different of the other examiners and in a situation examiner 3 is different of excessively. It did not have difference in relation to the findings of presence of anismus, length of the anal canal, final finding of the examination fails esfincteriana and. CONCLUSION: statistical differences had been observed between the examiners, however, these differences had not modified the final finding of the examination. Its final result is not influenced by the reproduction of it by different professionals.
Revista Brasileira De Coloproctologia | 2008
Maria Auxiliadora Prolungatti Cesar; Wilmar Artur Klug; Helly Angela Caram Aguida; Jorge Alberto Ortiz; Fang Chia Bin; Peretz Kapelhuchnik
INTRODUCTION: Rectocele is a common cause of constipation for obstructed defecation. It often is related with other causes of outlet obstruction and the examinations of anal physiology tests are important for necessary diagnosis of the constipation cause. OBJECTIVE: To observe the influence of rectocele in the anal physiology tests and the necessity of its accomplishment to the diagnosis of rectocele. METHOD: In this study, 40 patients with diagnosis of outlet obstruction had been analyzed. All the patients had been submitted to manometry, rectal sensitivity, electromyography, pudendal nerve latency and proctography and they had been separated in 2 groups: carriers and non-carriers of rectocele. 18 patients with rectocele had been found and the diagnosis often associated was anismus. In relation to the examination there was significant difference only in the proctography in the rectal angle, demonstrating that the presence of rectocele did not intervene with the results of the examination of anal physiology when compared with the other constipated, but it was associated with other causes of constipation such as anismus that needs another type of treatment. CONCLUSAO: Rectocele did not intervene with the values of the examination of anal physiology, but it was associated with other diagnosis, therefore it is important the accomplishment of the examination.
Revista Brasileira De Coloproctologia | 2007
Maria Auxiliadora Prolungatti Cesar; Wilmar Artur Klug; Deomir Germano Bassi; Pedro Roberto de Paula; Rosana Prolungatti Cesar; Jorge Alberto Ortiz; Manilio Basilio Speranzini
INTRODUCTION: Hemorrhoids are very common and pain following their surgical treatment causes great suffering. Various alternatives have been studied for reducing postoperative pain. Among these is surgical sphincterotomy, which may in some cases cause some degree of fecal incontinence. For this reason, several studies have used chemical sphincterotomy, with nifedipine, diltiazem, glycerin trinitrate or botulinum toxin. The objective of the present study was to investigate the effects of topical nifedipine for reducing anal canal pressures and consequently reducing postoperative pain. MATERIAL AND METHOD: Topical gels of 0.2% nifedipine plus 2% lidocaine (Group 1) and 2% lidocaine alone (Group 2) were used following hemorrhoidectomy. Pressures were measured before the operation and on the first, fourth and seventh days after the operation. Pain was also evaluated on all of the first seven postoperative days using a visual analog scale. RESULTS: There were no differences in relation to anal canal pressures, but lower pain levels were reported in the group that received nifedipine. CONCLUSION: Nifedipine gel was efficient for postoperative analgesia, but did not alter anal canal pressures.
Revista Brasileira De Coloproctologia | 2009
Maria Auxiliadora Prolungatti Cesar; Camila Carneiro de Oliveira
INTRODUCAO: Em alguns pacientes a sindrome do intestino irritavel e a constipacao funcional se confundem, principalmente quando o sintoma predominante na sindrome do colon irritavel e a constipacao. Dentre os varios exames alguns testes fisiologicos ano retais avaliam a funcao esfincteriana e sensibilidade retal OBJETIVO: Verificar se existem diferencas entre as manometrias anais dos pacientes com constipacao funcional e sindrome do intestino irritavel. METODO: Trata-se de estudo de 55 manometrias e testes de sensibilidade anais realizadas em pacientes atendidos no ambulatorio de Fisiologia Anal do Servico de Clinica Cirurgica do Hospital Universitario de Taubate com diagnostico de constipacao intestinal ou sindrome do intestino irritavel no periodo de janeiro de 2006 a maio de 2007. Todos os pacientes possuiam colonoscopia a normal e foram incluidos nos criterios diagnosticos de Roma II para Constipacao Funcional e Sindrome do Intestino Irritavel. As manometrias foram realizadas com aparelho ALACER, de perfusao com 8 canais. RESULTADOS: Nao foram encontradas diferencas entre as manometrias quanto as pressoes de repouso, contracao e evacuacao, assim como nos valores de sensibilidade retal. Encontramos diferencas quanto a dor abdominal desencadeada nos pacientes com sindrome do intestino irritavel no momento do volume maximo toleravel em que 69,2% destes pacientes apresentaram dor abdominal. CONCLUSAO: Os pacientes com a sindrome do intestino irritavel apresentam dor a distensao da ampola retal, que nao ocorre nos pacientes constipados, na afericao do volume maximo toleravel, nao houve diferenca em relacao aos outros dados da manometria.
Revista Brasileira De Coloproctologia | 2007
Maria Auxiliadora Prolungatti Cesar; Mariana Rubez Jehá; Carlos Eduardo Azevedo Ferretti; Rosana Prolungatti Cesar; Pedro Roberto de Paula; Deomir Germano Bassi; Manlio Basílio Speranzini; Jorge Alberto Ortiz
In the treatment of the anal fissure, calcium channel blockers are among the new drugs which have been used. The objective of this research was the manometric evaluation of patients with chronic anal fissure after topic treatment with 0.2% nifedipine and correlation with the healing and pain. This is a prospective study of patients from Coloproctology Clinic of the University of Taubate Hospital. The patients had been submitted to a manometric examination before and after 30 days of the use of topic 0.2% nifedipine gel three times a day in the anus and anal edge. For the statistics analysis Mann-Whitney test was applied to a significance of p= 0,05. Ten patients did not exihibit manometric alteration associated with nifedipina treatment, however 50% of them reported improvement of the symptoms and 40% depicted healing of the fissure. The results demonstrated that nifedipine was effective and safe for anal fissure treatment and considering the functional point of view it did not cause injuries as well. The manometric evaluation did not demonstrate alterations in the anal pressure; however, it was observed that 50% of the patients had improvement in pain and 40% in healing.
Revista Brasileira De Coloproctologia | 2009
Maria Auxiliadora Prolungatti Cesar; Lívia Alkmin Uemura; Mariah Prata Soldi Passos
The anal fissure is a laceration of the anal canal related to trauma, hypertonic sphincter and ischemia. The majority heals spontaneously or with conservative treatment and only a few requires surgical treatment. The objective of this study is to verify the clinical results and manometric alterations of patients submitted to the surgical treatment of the anal fissure with advance of v-y skin flaps. Methods: Prospective study, accomplished in 2007,2008 and 2009, in witch nine patients with chronic anal fissure were submitted to v-y advance. The pressures of the anal canal at rest, contraction and at evacuation effort were evaluated in the pre and postoperative. Results: In the sample, all the patients had presented previous hypertonic sphincter. six (66.6%) had gotten total resolution of the symptoms and the injuries. One (16.6%) suffered partial dehiscence of the flap, without clinical symptoms; and another two (22,2%), infection with loss of the same and persistence of the fissure. The manometric analysis of the pressures at rest, contraction and evacuation did not show significant statistical alteration (p> 0,05), what proves that the surgery did not manipulated the sphincters. Conclusion: The anal flap had revealed an effective treatment of the anal fissure with total healing of the injury, without alterations in the pressures of the sphincters.
Revista Brasileira De Coloproctologia | 2011
Maria Auxiliadora Prolungatti Cesar; Júlia Mota Leite; Rafaela Cristina Coelho Muniz; Jorge Alberto Ortiz
AbsTRACT: Introduction: evacuatories disturbances are described in the literature related to vaginal delivery and episiotomy. ob-jective: To study the incidence of evacuatories disturbances in primiparous undergoing episiotomy during vaginal delivery. methods: Prospective study in 32 primiparous patients submitted to episotomy during vaginal delivery. For the study the patients answered in relation to the period before pregnancy and 90 days postpartum questionnaires with the score of Agachan constipation and incon - tinence score of Jorge and Wexner. Results: No statistically significant differences were found when comparing the results from the questionnaires in relation to the period before pregnancy and 90 days postpartum. Conclusions: episiotomy in vaginal delivery in primiparous women with no prior history of intestinal symptoms, caused no disorders of anal continence postpartum in the pacients of this study.Keywords: natural childbirth; constipation; incontinence; episiotomy; pregnancy.
Journal of Coloproctology | 2011
Pedro Roberto de Paula; Maria Auxiliadora Prolungatti Cesar; Eduardo Fortes De Albuquerque; Fernanda Perez Adorno da Silva
A intussuscepcao intestinal e uma doenca rara em adultos, sendo na maior parte dos casos causada por neoplasia maligna. Os sintomas sao geralmente inespecificos e cronicos, na maioria das vezes sugerindo obstrucao intestinal. O tratamento consiste na remocao oncologica do tumor. Este artigo relata o caso de uma paciente com quadro de hematoquezia e exteriorizacao de massa atraves do ânus que foi submetido a retossigmoidectomia anterior alta em bloco e confirmado o diagnostico de adenocarcinoma de sigmoide.