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Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations
Martins, José Luiz;Pinus, José;
Sao Paulo Medical Journal , 1996, DOI: 10.1590/S1516-31801996000600004
Abstract: psarp is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. we studied 27 cases of anorectal malformations operated with psarp from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. from the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by psarp, due to the existence of a relationship between the manometric results and the degree of fecal continence.
A comparison of laparoscopic-assisted (LAARP) and posterior sagittal (PSARP) anorectoplasty in the outcome of intermediate and high anorectal malformations
C De Vos, M Arnold, D Sidler, SW Moore
South African Journal of Surgery , 2011,
Abstract: Introduction. Laparoscopic-assisted anorectoplasty (LAARP) has gained popularity since its introduction in 2000. Further evidence is needed to compare its outcome with the gold standard of posterior sagittal anorectoplasty (PSARP). Method. A retrospective review of patients presenting with anorectal malformation (ARM) in the period 2000 - 2009. Demographics, associated abnormalities, and operative and post-operative complications were assessed. The functional outcome in children older than 3 years was assessed, applying the Krickenbeck scoring system and, where possible, by interviewing parents. Patients with cloacal abnormalities were excluded. Patients with a LAARP were compared with those managed by PSARP. Results. Seventy-three patients with ARM were identified during the study period. Male to female ratio was 1.6:1. All 32 low ARMs (perineal and vestibular fistulae) were excluded. Thirty-nine had levator or supra-levator lesions. Twenty males presented with recto-bulbar, 3 with recto-prostatic, and 1 with a recto-vesical fistula; 2 had no fistula; and in 2 the data were insufficient to determine the level. Among the females, 6 had recto-vaginal fistulae, 4 had cloacas and 1 had an ARM without fistula. There were 3 syndromic ARMs (2 trisomy 21 and 1 Baller-Gerold syndrome). One neonate with a long-gap oesophageal atresia had a successful primary LAARP. Seventy-five per cent of all patients had VACTERL associations. Two early deaths after colostomy formation were related to a cardiac anomaly and an oesophageal atresia. In both groups, mean age at anoplasty was 8 months. Twenty of the intermediate/high lesions were treated with LAARP, and 19 by PSARP. There were slightly more complications in the LAARP group; intra-operative injury to the vas deferens and urethra occurred once each. Post-operatively, 2 port-site hernias and 1 case of pelvic sepsis occurred. A poorly sited colostomy caused difficulty in 2 patients. Two patients were converted to laparotomy: severe adhesions in one and a poorly sited stoma in another. Five patients required redo-anoplasty for mucosal prolapse, anal stenosis, incorrect placement of the anus, retraction of the rectum and an ischaemic rectal stricture. Complications in the PSARP group included 2 wound dehiscences, 1 anal stenosis, 3 mucosal prolapses, 1 recurrent fistula and 2 incorrect anal placements requiring redo surgery. The Krickenbeck questionnaire was used in 70% of PSARPs (mean age 5.9 years) and LAARPs (mean age 5.5 years) for a functional assessment. Both groups showed voluntary bowel movements in 14%. Soiling and overflow incontinence was a significant problem. Grade III constipation was less common in the LAARP (14%) than PSARP (21%) group. Four patients in the LAARP group were reliant on regular rectal washouts compared with 6 in the PSARP group. Conclusion. Both LAARP and PSARP can successfully treat ARM but have specific associated problems.
A. Mirshemirani,J. Kouranloo,M. Rouzrokh,M. N. Sadeghiyan A. Khaleghnejad
Acta Medica Iranica , 2007,
Abstract: The standard approach to management of high imperforate anus is colostomy in the newborn period followed by posterior saggital anorectoplasty (PSARP) at 6 to 12 months of age. The purpose of this study was to determine whether a one-stage repair by primary PSARP in the newborn period could be performed without clear determent to the patient’s functional result. Totally 30 newborns with high imperforate anus who underwent primary PSARP without colostomy were studied retrospectively. All cases were studied by sonography, echocardiography, lower vertebra X-ray and finally routine blood and urine laboratory tests. Incontinence was defined as fecal soiling at least twice a day, and patients requiring more than office dilatation were described to have stricture formation. All patients recovered well and were followed for periods ranging from 1.5 to 10 years. There were 3 cases of postoperative wound infection, but no anastomotic dehiscence, stricture formation and fistula recurrence were seen. In cases of constipation and fecal incontinence there were associated anomalies such as sacral dysplasia, kidney dysplasia, ventricular septal defect and vesicoureteral reflux. There were no complications in other cases. The most important factor is patient selection, and one-stage PSARP spares the patient the morbidity of additional surgeries in the standard multistage approach for high imperforate anus. These preliminary results suggest that one-stage PSARP is a safe and viable approach to the management of high imperforate anus without clear determent to future bowel function.
Sacroperineal mobilization versus posterior sagittal anorectoplasty: A study on outcome  [cached]
Sivakumar K
Journal of Indian Association of Pediatric Surgeons , 2006,
Abstract: The two main surgical procedures for high and intermediate anorectal malformations (ARM), namely, Stephens′ and Peρa′s procedure, are compared in terms of their outcome. Materials and Methods: Fifty-eight patients who had Stephens′ procedure and 28 patients who had posterior sagittal anorectoplasty (PSARP) are clinically analyzed in terms of associated anomalies, procedural complications, anatomical reconstruction and functional results. Functional results were assessed by Kelly score, voluntary bowel movements and sensation. Statistical analysis of data was done by Chi-square test. Results: There were 34 high and 52 intermediate ARM. Associated anomalies were noted in 32%. Procedure-related complications of urethral injury, bladder injury, neurogenic bladder, anal stenosis and mucosal prolapse were seen in both procedures. Ectopic positioning of anus was seen in 25% of PSARP and 19% of sacroperineal mobilization (SPM). Good circular sphincter creation was seen in 43% of PSARP and 40% of Stephens′. Noncontractile sphincter was found more with SPM. In functional results, when assessed by Kelly score, VBM and sensation, there was no difference for high ARM, whereas results were better with SPM for intermediate anomalies. Discussion: A few reports are available in literature comparing PSARP and SPM. Procedural complications of urethral injury and neurogenic bladder are slightly more with PSARP. Ectopic positioning, poor contraction of sphincter are associated with poor results, and creation of good circular sphincter with good squeeze is associated with good results. Functional assessment by Kelly score, VBM and sensation doesn′t reveal any difference between two procedures for high ARM, whereas for intermediate anomalies, Stephens′ procedure seems to give better functional results.
Clinical evaluation of fecal continence after posterior sagittal anorectoplasty in anorectal abnormalities
Bukarica Svetlana S.,Marinkovi? Smiljana P.,Zrni?-Pekovi? Vesna,Dobanova?ki Du?anka S.
Medicinski Pregled , 2004, DOI: 10.2298/mpns0406284b
Abstract: Introduction Posterior sagittal anorectoplasty (PSAKP) was introduced in 1982, by Repa and de Vries, as a new surgical procedure for patients with anorectal malformations. It was supposed to provide better chance for normal fecal continence. Meterial and methods Between 1991 and 2000, 50 patients with anorectal abnormalities underwent PSARP. In 43 patients PSARP was primary operation and in 7 it was a secondary procedure. At the time of study patients were not younger than 3, and not older than 13 years. Patients and their parents were interviewed, and fecal continence was graded as follows: voluntary bowel contractions, soiling less than once a week, soiling more than once a week, daily soiling and constipation. Results Amongst patients who underwent primary surgical correction, 74% had voluntary bowel contractions. Babies with perineal fistula, rectal atresia and stenosis presented with best results in term of voluntary bowel contractions (100%), as with vestibular fistula, ten of eleven patients. Only 18% of patients (atresia without fistula, vestibular fistula and bulbourethral fistula) had soiling. Patients with perineal fistula and rectal atresia and stenosis 40% were totally continent (voluntary bowel movements without soiling). The most frequent sequel was constipation, which appeared in 48%, without coincidence with frequency of soiling. The problem of constipation was surprisingly more frequent in patients with expected better prognosis in fecal continence. Conclusion Although PSARP offers a good esthetic result, only two third of patients have voluntary bowel movements and in about half there exists a problem with constipation, with necessary further treatment.
Biofeedback: Infant asthma Biofeedback: asma infantil  [cached]
L. P. Rodríguez,J. J. Nombela,J. Ponce
Motricidad : European Journal of Human Movement , 2010,
Abstract: The present study is a revision of the different applications of biofeedback in infantile bronchial asthma. The technique may be used on its own (preferably in the motor area) or in conjunction with other techniques such as hypnosis, relaxation, etc. However, it should be stated that previous work published in this field is difficult to interpret since results are inconclusive, it is, therefore, difficult to produce a scientific summary. KEY WORDS: Biofeedback; infantile asthma; respiratory biofeedback. Con este trabajo se pretende hacer una revisión sobre las distintas aplicaciones del biofeedback en el asma bronquial infantil, bien solo (preferentemente en el campo motriz) o bien asociado a otras técnicas de hipnosis, relajación, etc. Aunque es necesario manifestar que la producción científica relacionada con el tema, hace que tenga una difícil valoración dado que sus resultados son no concluyentes y discutibles, lo cual dificulta la elaboración de un resumen científico. PALABRAS CLAVE: Biofeedback; asma infantil; biofeedback respiratorio
The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial
Christanell Franz,Hoser Christian,Huber Reinhard,Fink Christian
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology , 2012, DOI: 10.1186/1758-2555-4-41
Abstract: Background Loss of knee extension and a deficit in quadriceps strength are frequently found following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate whether the addition of Eletromyographic Biofeedback (EMG BFB) therapy for the vastus medialis muscle to the in the early phase of the standard rehabilitation programme could improve the range of knee extension and strength after ACL reconstruction more than a standard rehabilitation programme. The correlation between EMG measurement and passive knee extension was also investigated. Method Sixteen patients, all of whom underwent endoscopic ACL reconstruction using patellar tendon autograft, were randomly assigned to two groups: Control group (8 patients): standard rehabilitation protocol; with full weight-bearing postoperative, knee brace (0° extension, 90° flexion), electrical stimulation, aquatics and proprioceptive training. The EMG BFB group (8 patients): EMG BFB was added to the standard rehabilitation protocol within the first postoperative week and during each session for the next 6 weeks. Each patent attended a total of 16 outpatient physiotherapy sessions following surgery. High-Heel-Distance (HHD) Test, range of motion (ROM) and integrated EMG (iEMG) for vastus medialis were measured preoperatively, and at the 1, 2, 4 and 6-week follow ups. Additionally, knee function, swelling and pain were evaluated using standardized scoring scales. Results At 6 weeks, passive knee extension (p < 0.002) and the HHD Test were significantly (p < 0.01) better in the EMG BFB group compared to controls. Integrated EMG (vastus medialis) of the EMG BFB group also showed a significant increase after 2 (p < 0.01) and 6 (p < 0.01) weeks. At the 6-week follow up, no significant (p > 0.01) differences were found between the two groups for the assessment of knee function, swelling and pain. Conclusion The results indicate that EMG BFB therapy, in the early phase of rehabilitation after ACL reconstruction, is useful in enhancing knee extension. Improved innervation of the vastus medialis can play a key role in the development of postoperative knee extension. EMG BFB therapy is a simple, inexpensive and valuable adjunct to conventional therapeutic modalities.
Biofeedback for robotic gait rehabilitation
Lars Lünenburger, Gery Colombo, Robert Riener
Journal of NeuroEngineering and Rehabilitation , 2007, DOI: 10.1186/1743-0003-4-1
Abstract: Optimal training effects during gait therapy generally depend on appropriate feedback about performance. Compared to manual treadmill therapy, there is a loss of physical interaction between therapist and patient with robotic gait retraining. Thus, it is difficult for the therapist to assess the necessary feedback and instructions. The aim of this study was to define a biofeedback system for a gait training robot and test its usability in subjects without neurological disorders.To provide an overview of biofeedback and motivation methods applied in gait rehabilitation, previous publications and results from our own research are reviewed. A biofeedback method is presented showing how a rehabilitation robot can assess the patients' performance and deliver augmented feedback. For validation, three subjects without neurological disorders walked in a rehabilitation robot for treadmill training. Several training parameters, such as body weight support and treadmill speed, were varied to assess the robustness of the biofeedback calculation to confounding factors.The biofeedback values correlated well with the different activity levels of the subjects. Changes in body weight support and treadmill velocity had a minor effect on the biofeedback values. The synchronization of the robot and the treadmill affected the biofeedback values describing the stance phase.Robot-aided assessment and feedback can extend and improve robot-aided training devices. The presented method estimates the patients' gait performance with the use of the robot's existing sensors, and displays the resulting biofeedback values to the patients and therapists. The therapists can adapt the therapy and give further instructions to the patients. The feedback might help the patients to adapt their movement patterns and to improve their motivation. While it is assumed that these novel methods also improve training efficacy, the proof will only be possible with future in-depth clinical studies.Walking ability,
Vulvodynia Treated with Acupuncture or Electromyographic Biofeedback  [PDF]
Oroma B. Nwanodi, Melanie M. Tidman
Chinese Medicine (CM) , 2014, DOI: 10.4236/cm.2014.52007

First, second, and third line medical treatments of vulvodynia are of limited efficacy. Surgical resection, the fourth line treatment of vulvodynia, may have unforgiving sequela. Therefore, acupuncture and electromyographic (EMG) biofeedback could bridge between medical and surgical treatments of vulvodynia. Of note, EMG biofeedback is more frequently recommended in treatment algorithms for vulvodynia than is acupuncture. Trials of acupuncture for unprovoked vulvodynia demonstrate variable efficacy, whereas trials of EMG biofeedback for provoked vulvodynia demonstrate consistent efficacy. Trials of acupuncture for treatment of provoked and unprovoked vulvodynia using identical acupoints, a vulvar algesiometer for objective pain measurement, and standardized, validated, tools for outcome assessment are needed. Such trials may enable comparison of acupuncture to EMG biofeedback for the treatment of provoked and unprovoked vulvodynia. Similarly, trials of EMG biofeedback for treatment of unprovoked vulvodynia would increase the knowledge base of EMG biofeedback for treatment of vulvodynia.

Effect of Pelvic Floor Electrical Stimulation and Biofeedback on the Recovery of Urinary Continence after Radical Prostatectomy  [cached]
Mohammed Taher AHMED,Ashraf Hassan MOHAMMED,Abozeid AMANSOUR
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2012,
Abstract: bjective: Urinary incontinence (UI) is one of the most distressing postoperative problems of radical prostatectomy (RP) and negatively affects the quality of life (QOL). We assessed the effect of pelvic muscle exercises (PME), electrical stimulation (ES) and biofeedback (BFB) on UI after RP. Materials and Methods: 80 patients, who underwent RP, were randomized into three groups. Group I (n=26) received instructions about PME, group II (n=26) received ES and group III (n=28) received ES plus BFB. The treatment was started one week after catheter removal, twice a week for 12 weeks. The evaluation of continence was performed at time 0, 6, 12 weeks, and 24 weeks during follow-up, using the 24-hour pad test and the QOL using the incontinence impact questionnaire -7 (IIQ-7). Results: The mean leakage weight became significantly lower (p<0.05) in group III than in groups II and I starting at 6 weeks until 24 weeks of follow-up. A significant difference (p<0.05) between the groups in terms of percentage of continent patients was achieved from 12 weeks (71.42%, 53.85% and 34.62%) to 24 weeks (96.43%, 76.92% and 65.38%) for groups III, II and I, respectively. Conclusion: Early, noninvasive therapy with ES and BFB has a significant positive effect on the duration and the degree of UI and QOL. Turk J Phys Med Re-hab 2012;58:170-6.
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