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Effect of soluble fiber or fructooligosaccharide supplementation upon trinitrobenzenesulphonic acid induced colitis in rats
Murad-Regadas Sthela Maria,Souza Marcellus Henrique Loiola Ponte de,Brito Gerly Anne de Castro,Rodrigues Lusmar Veras
Acta Cirurgica Brasileira , 2006,
Abstract: PURPOSE: To evaluate the effect of soluble fiber or fructooligosaccharide (FOS) supplementation upon trinitrobenzene sulphonic acid (TNBS)-induced colitis in rats. METHODS: 64 Wistar rats were given water, soluble fiber or FOS intragastrically during 14 days prior to colitis induction with TNBS (n=48) or rectal enema with water (n=16; control group). On the 7th or 14th day following colitis induction the rats were weighed and euthanized in order to determine the colon weight/length ratio and macroscopic and microscopic scores. RESULTS: On the 7th day following colitis induction the body weight had decreased significantly, the colon weight/length ratio had increased and macroscopic and microscopic colon lesions were observed. On the 14th day following colitis induction no difference in body weight was observed, in spite of the persistence of macroscopic and microscopic lesions and increased colon weight/length ratio. Supplementation with soluble fiber or FOS did not revert colon lesions or any of the study parameters. Supplementation with FOS, but not with fiber, was associated with increased colon weight/length ratio on the 14th day. CONCLUSION: Supplementation with soluble fiber or FOS produced no significant impact on TNBS-induced colitis in rats.
Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry
Murad-Regadas, Sthela Maria;Regadas, Francisco Sérgio P;Barreto, Rosilma Gorete Lima;Rodrigues, Lusmar Veras;Fernandes, Graziela Olivia da Silva;Lima, Doryane Maria dos Reis;
Arquivos de Gastroenterologia , 2010, DOI: 10.1590/S0004-28032010000400009
Abstract: context: anismus is a prevalent functional cause of outlet delay. it is characterized by symptoms of obstructed defecation associated with paradoxical contraction of the pelvic floor muscles. objective: to evaluate the ability of two dimensional anal ultrasonography to identify anismus patients with paradoxical contraction or normal relaxation, comparing findings with manometric measurements. methods: forty-nine women presenting with outlet delay and a mean validated wexner constipation score of 13.5 were included in a prospective study. following screening with anal manometry, the patients were assigned to one of two groups: g-i -with normal relaxation and g-ii -patients with anismus. dynamic anorectal ultrasonography was used to quantifier the movement of the puborectalis muscle and to measure changes in the angle between two converging lines drawn from the 3 o'clock and the 9 o'clock positions of the endoprobe circumference to the internal border of the puborectalis muscle. the angle decreases during straining in patients with normal relaxation, but increases in patients with anismus. the agreement between the two techniques was verified with the kappa index. results: in manometry, during straining the anal canal pressure decreased by 41.3% in g-i and increased by 168.6% in g-ii, indicating a diagnosis of anismus for the second group. in us, during straining, the angle produced by the movement of the puborectalis muscle decreased from 63 ± 1.31 to 58 ± 1.509 degrees (p = 0.0135) in 23 of the 30 patients in g-i, indicating normal relaxation, and increased from 66 ± 0.972 to 72 ± 0.897 degrees (p = 0.0001) in 16 of the 19 patients in g-ii, indicating anismus. the index of agreement between manometry and two dimensional anal ultrasonography was moderate: 77% (23/30) for g-i and 84% (16/19) for g-ii. conclusion: two-dimensional dynamic anal ultrasonography showed similar results previously suggested by anal manometry at identifying patients with normal relaxation or
Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions
Murad-Regadas, Sthela Maria;Regadas, Francisco Sergio P;Rodrigues, Lusmar Veras;Furtado, Débora Couto;Gondim, Ana Cecília;Dealcanfreitas, íris Daiana;
Arquivos de Gastroenterologia , 2011, DOI: 10.1590/S0004-28032011000400009
Abstract: context: the correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. objectives: to determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. methods: four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3d ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade ii or iii, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade iii). in addition, sphincter damage was evaluated. patients were grouped according to age (<50y x >50y) and stratified by mode of delivery and parity: group i (<50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group ii (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. additionally, patients were stratified by number of vaginal deliveries: 0 - nulliparous (n = 135), 1 - vaginal (n = 46), >1 - vaginal (n = 166). results: rectocele grade ii or iii, intussusception, rectocele + intussusception and sphincter damage were more prevalent in group ii (p = 0.0432; p = 0.0028; p = 0.0178; p = 0.0001). the stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. entero/sigmoidocele was more prevalent in the vaginal group <50y and in the nulliparous and vaginal groups >50y. no correlation was found between rectocele and the number of vaginal deliveries. conclusion: higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. however, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.
Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome
Murad-Regadas, Sthela Maria;Regadas, Francisco Sergio P.;Rodrigues, Lusmar Veras;Fernandes, Graziela Olivia da Silva;Buchen, Guilherme;Kenmoti, Viviane T.;
Arquivos de Gastroenterologia , 2012, DOI: 10.1590/S0004-28032012000200008
Abstract: context: management of patients with obstructed defecation syndrome is still controversial. objective: to analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. methods: the study included 103 females aged 26-84 years with obstructed defecation, grade-ii/iii rectocele and multiple dysfunctions on echodefecography. patients were distributed into three treatment groups and constipation scores were assigned. group i: 34 (33%) patients with significant improvement of symptoms through clinical management only. group ii: 14 (14%) with improvement through clinical treatment plus biofeedback. group iii: 55 (53%) referred to surgery due to treatment failure. results: group i: 20 (59%) patients had grade-ii rectocele, 14 (41%) grade-iii. obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). the average constipation score decreased significantly from 11 to 5. group ii: 11 (79%) grade-ii rectocele, 3 (21%) grade-iii, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). there was significant decrease in constipation score from 13 to 6. group iii: 8 (15%) grade-ii rectocele, 47 (85%) grade-iii, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). the constipation score remained unchanged despite clinical treatment and biofeedback. twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. the remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. conclusions: approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. surgical repair was mainly required in pa
Ecodefecografia tridimensional dinamica: nova técnica para avalia??o da Síndrome da Defeca??o Obstruída (SDO)
Murad-Regadas, Sthela Maria;Regadas, Francisco Sérgio Pinheiro;Rodrigues, Lusmar Vera;Escalante, Rodrigo Dorsfeld;Silva, Flavio R.S.;Lima, Doryane M.R.;Soares, Fábio Alves;Barreto, Rosilma Gorete Lima;Regadas Filho, Francisco Sergio Pinheiro;
Revista Brasileira de Coloproctologia , 2006, DOI: 10.1590/S0101-98802006000200008
Abstract: the aim of the present study is to show novel techniques to evaluate the ods using dynamic three-dimensional endorectal ultrasound and comparing the results with defecography. twenty-five adult women were included and distributed in two groups. group i: fifteen normal women, mean age 52,4 years old (range 23-76) submitted to full proctologic exam and dynamic 3d anorectal ultrasonography to establish the normal patterns of the rectum and anal canal. group ii: ten female patients complaining of obstructed defecation, mean age 47,8 years old (33 a 65). the main symptoms were incomplete evacuation, disquezia and vaginal or perineal digitation. they were submitted to full proctologic evaluation, followed by defecography and lastly echodefecography by two examiners without knowing the defecography results. the dynamic echodefecography was performed using b-k medical? equipment, 360o endoprobe, type 2050, with automatic scan during 50 seconds. the mean angle size formed by the pr at rest position (group i) was 87,13o (range 78,9 - 90,8°) (± 1,01) and 99,22o (range 84,9 - 114,5°) (± 1,84) during evacuatory effort.. it was observed that the angle size increased in all normal women, demonstrating pr relaxation during the evacuatory effort. concerning to anorectocele evaluation, the posterior vagina wall was kept at horizontal position during the evacuatory effort, except in patients with anorectocele. all patients from group ii had anorectocele ( grade i = 1, grade ii = 5, grade iii = 4) demonstrated at clinical and defecography evaluation. all cases were also confirmed by echodefecography. based on such results, it was established the reference parameters to classify anorectocele according to echodefecography. (grade i - distance of the vaginal wall positions until 5,0mm, grade ii from 6,0 to 12,0mm, grade iii above 12,0mm). defecography identified anismus in one patient with anorectocele grade ii and in another with grade iii and both were confirmed at echodefecography by d
Effect of soluble fiber or fructooligosaccharide supplementation upon trinitrobenzenesulphonic acid induced colitis in rats
Murad-Regadas, Sthela Maria;Souza, Marcellus Henrique Loiola Ponte de;Brito, Gerly Anne de Castro;Rodrigues, Lusmar Veras;Regadas, Francisco Sérgio Pinheiro;Vasconcelos, Paulo Roberto Leit?o de;
Acta Cirurgica Brasileira , 2006, DOI: 10.1590/S0102-86502006000500008
Abstract: purpose: to evaluate the effect of soluble fiber or fructooligosaccharide (fos) supplementation upon trinitrobenzene sulphonic acid (tnbs)-induced colitis in rats. methods: 64 wistar rats were given water, soluble fiber or fos intragastrically during 14 days prior to colitis induction with tnbs (n=48) or rectal enema with water (n=16; control group). on the 7th or 14th day following colitis induction the rats were weighed and euthanized in order to determine the colon weight/length ratio and macroscopic and microscopic scores. results: on the 7th day following colitis induction the body weight had decreased significantly, the colon weight/length ratio had increased and macroscopic and microscopic colon lesions were observed. on the 14th day following colitis induction no difference in body weight was observed, in spite of the persistence of macroscopic and microscopic lesions and increased colon weight/length ratio. supplementation with soluble fiber or fos did not revert colon lesions or any of the study parameters. supplementation with fos, but not with fiber, was associated with increased colon weight/length ratio on the 14th day. conclusion: supplementation with soluble fiber or fos produced no significant impact on tnbs-induced colitis in rats.
Ultrassom anorretal tri-dimensional pode selecionar pacientes com tumor no reto após neoadjuvancia para cirurgia de preserva??o esfincteriana?
Murad-Regadas, Sthela Maria;Regadas, Francisco Sérgio P.;Rodrigues, Lusmar V.;Crispin, Francisco Jean;Monteiro, Francisco Coracy C.;Holanda, Erico C;Oliveira, Letícia;Nogueira, Felipe Ramos;
Revista Brasileira de Coloproctologia , 2009, DOI: 10.1590/S0101-98802009000300002
Abstract: proposal: evaluate the post-chemoradiotherapy response for treatment of rectal tumor using three-dimensional anorectal ultrasound-3d-us to determine the best surgical approach methods: 32 patients with lower and middle rectal cancer were prospectively staged using 3d-us to identify anal canal invasion and the distance(cm) between tumor and the internal anal sphincter-ias, group l:with anal canal invasion; group ii-with distance =2cm; group iii-with distance >2. they were submitted to neoadjuvant chemoradiation-crt and the 3-d us was repeated 50-55 days later. the choice of the surgical approach was based on the post-chemoradiation response identified by the 3d-us comparing with pathologic findings. results: the post-chemoradiation/3d-us findings were concordant with pathologic results in 31/32(97%). it was identified residual tumors in 26/27(96% sensibility), 19(59%) with partial response and 7(22%) without response. complete response was demonstrated in 5/5 by 3d-us, with specificity and predictive valor in 100%. negative predictive valor in 83% since one(3%) case was inconclusive. sphincter-saving resection was performed in 16 patients, 5 with complete response, 10 with partial response and one inconclusive, with distal margin >2cm. the pathologic findings confirmed distal margins without tumor. it was demonstrated high concordance(87.5%) concerning the lymph nodes evaluation(kappa test). conclusion: 3d-us can be useful to determine the patients who should be submitted to sphincter-saving resections.
TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial
Cruz, José Vinicius;Regadas, Francisco Sergio P.;Murad-Regadas, Sthela Maria;Rodrigues, Lusmar Veras;Benicio, Fernando;Leal, Rogério;Carvalho, César G.;Fernandes, Margarete;Roche, Lucimar M. C.;Miranda, Ant?nio Carlos;Camara, Lucia;Pereira, Joaquim Costa;Parra, Antonio Mallén;Leal, Vilmar Moura;
Arquivos de Gastroenterologia , 2011, DOI: 10.1590/S0004-28032011000100002
Abstract: context: since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. objective: to report the results of transanal repair of rectocele and rectal mucosectomy with one circular stapler (trrems procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. methods: it was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated wexner constipation score of 16. all patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. the trrems procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. the mean follow-up time was 21 months. results: all patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. the mean operative time was 42 minutes. in 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. stapling was incomplete in 2 (2.6%). forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). postoperative cinedefecography showed residual grade i anorectoceles in 8 (10.6%). the mean wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (p<0.0001). conclusion: current trial results suggest that trrems procedure is a safe and effective technique for the treatment of
Utiliza??o do método videolaparoscopico na reconstitui??o do transito intestinal após a opera??o de Hartmann
Regadas, Francisco Sérgio P.;Regadas, Sthela M. Murad;Rodrigues, Lusmar Veras;
Revista do Colégio Brasileiro de Cirurgi?es , 2000, DOI: 10.1590/S0100-69912000000100003
Abstract: we present the operative technique and the results of the laparoscopic approach for hartmann's colostomy reversal. thirty two patients were prospectively analysed from december 1991 to june 1997. they presented a similar incidence regarding sex distribution, and a median age of 42.4 years old. ali patients underwent the same preoperative preparation and operative technique. three (9.3%) intraoperative complications were observed: an uncompleted anastomosis (3.1%), requiring an endosuture, a rectal perforation by the mechanical stapler and a right epigastric artery lesion. there were convertion to open surgery in three (9.3%) patients: one (3.1%) due to rectal perforation by the mechanical staple1; one (3.1%) for tumoral pelvic invasion and another because of excessive intra-peritoneal adhesions. operative time varied from 30 to 240 minutes, with a mean time of 126;2 minutes. nine (31.0%) patients didn't present pain, while 13 (44.8%) referred minimal pain and seven (24.0%) complained severe pain. oral liquid diet intake occurred within a mean time of 1.6 days and the first evacuation observed after a mean 3.2 postoperative days. mean hospitalization time was 4.7 days. postoperative complications occurred in eight (27.5%) patients. two (6.8%) stoma wound infections, right shoulder pain in two (6.8%) patients, one (3.4%) anastomotic dehiscence, one peritonitis probably due to contaminationfrom surgical instruments, a liquid pelvic coliection and an incisional haernia. 1n conclusion, videolaparoscopic restoration of the intestinal transit demonstrated to be safe and effective. it could be the method of choice because of its success in 90.6 per cent of the patients.
Modelo experimental de sutura manual em colon de c o por vídeo-laparoscopia
Regadas Sthela Maria Murad,Regadas Francisco Sérgio P.,Rodrigues Lusmar Veras,Carvalho Mauricio C.G.S.
Acta Cirurgica Brasileira , 2005,
Abstract: OBJETIVO: Desenvolver um modelo experimental de endo-sutura manual laparoscópica em cólon destinado principalmente ao treinamento de cirurgi es. MéTODOS: Foram operados 40 c es mesti os, machos, com peso entre 15 e 20 kg, provenientes do laboratório da Faculdade de Veterinária da Universidade Estadual do Ceará. Foram distribuídos aleatoriamente em dois grupos de 20 animais cada: GI-sec o e hemostasia do colon com bisturi elétrico e GII-sec o do colon com tesoura. Cada grupo foi subdividido em dois subgrupos com 10 animais cada, conforme o acesso abdominal utilizado - A-acesso laparot mico e B-laparoscópico. Sob anestesia geral endovenosa, foi realizada incis o transversal no cólon sigmóide, numa extens o de 50% da circunferência, distando 15 cm da reflex o peritoneal, sendo em seguida suturada em plano único, extra-mucoso, com pontos separados de fio de polidioxanona 000 (PDS ). Os animais foram avaliados quanto à evolu o clínica, análise macroscópica, teste de tens o da sutura e estudo histológico qualitativo. Foram sacrificados no 7o dia de pós-operatório. Para analise estatística, foram utilizados os testes Qui-quadrado corrigido de Yates e o teste exato de Fisher. RESULTADOS: Todos os animais cuja colotomia foi realizada com tesoura (GIIA IIB) e 9 operados com bísturi elétrico (GI), sendo 5 (50,0%) operados pelo acesso laparot mico (GIA) e 4 (40,0%) pelo laparoscópico (GIB), apresentaram evolu o clínica satisfatória, deambulando e aceitando bem a dieta oral a partir do primeiro dia de pós-operatório. A primeira evacua o ocorreu entre 48 a 72 horas de pós-operatório. N o apresentaram diarréia nem v mitos. Onze animais do grupo GI, sendo 5 (50%) do subgrupo IA e 6 (60,0%) do IB n o aceitaram bem a dieta oral, apresentando diarréia (3 a 5 evacua es líquidas por dia) e v mitos (1 a 3 episódios por dia) evoluindo para óbito entre o quarto e o sétimo dia do pós-operatório. Comparando os grupos GI com GII, foi observada diferen a significante (p<0,005), sem no entanto observar-se diferen a quando comparados os subgrupos IA e IB. A sutura permaneceu íntegra em todos (100,0 %) os animais GII e em 5 GI, demonstrando portanto diferen a estatisticamente significante (p<0,005). Desses, 3 (30,0%) eram do subgrupo IA e 2 (20,0%) do IB. Foi evidenciada sutura bloqueada com epíplon em quatro animais, sendo dois (20%) do subgrupo IA e dois (20%) do IB. Houve deiscência da sutura com peritonite em 11 (55%) animais do grupo I (p<0,005), sendo 5 (50%) do subgrupo IA e 6 (60%) do IB (p>0,005). Todos evoluíram para óbito entre o quarto e o sétimo d.p.o. O teste de t
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