Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical and manometric results of Delorme's operation and sphincteroplasty were assessed retrospectively in patients undergoing this procedure for fecal incontinence and rectal prolapse. A series of 33 patients (11 males, 22 females; aged 18-83 years, mean 59) with external rectal prolapse were treated by Delorme's operation between 1989 and 1996. Mean follow-up was 39 months (range 7-84). Sphincteroplasty was associated in 12 cases with severe fecal incontinence due to striated muscle defects. Good results were achieved in 27 patients (79%); prolapse recurrence was observed in 6 (21%), the mean recurrence time being 9 months (range 1-24 months). There were no postoperative deaths. Minor complications occurred in 15 patients. Changes in preoperative and postoperative manometric patterns were as follows (mean +/- SEM): voluntary contraction from 59 +/- 6.9 to 66 +/- 7.1 mmHg (P = 0.05), resting tone from 33 +/- 5 to 32 +/- 4.3 mmHg, rectal sensation from 59 +/- 5 to 61 +/- 5.2 ml of air (n.s.). A solitary rectal ulcer syndrome was detected in five patients. The histological pattern demonstrated pathological changes in 40% of cases. Fecal incontinence was resolved in 6 of 20 cases (30%) and chronic constipation in 4 of 9 (44%). Failure (n = 3) was related primarily to postoperative sepsis. The incontinence score showed a mean improvement of 35% decreasing, from 4.5 +/- 0.39 to 2.9 +/- 0.44 after surgery (P < 0.01). In conclusion, Delorme's procedure did not lead to constipation and improved anal continence when associated with sphincteroplasty.
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PMID:Delorme's operation and sphincteroplasty for rectal prolapse and fecal incontinence. 987 Jan 65

Retrograde irrigation enemas are commonly used in the treatment of chronic constipation especially in the elderly. We report a case of colorectal perforation due to self-administered retrograde water enema. A 55 year-old chronically constipated male patient was admitted to the emergency unit with severe diffuse abdominal pain. He administered rectal enema using a garden hose directly connected to the water two hours before admission, until he felt a sudden sharp abdominal pain. At the operation he was found to have a perforation along the antimesenteric border of distal sigmoid colon extending to the upper rectum. Primary resection and anastomosis with intraoperative colonic lavage was performed. Postoperative course was favorable without any wound infection or intraabdominal sepsis.
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PMID:[Colorectal perforation due to self administered retrograde enema]. 1456 89

The autosomal dominant Currarino anomaly (CA) comprises a presacral mass, partial sacral agenesis, and anorectal defects. Chronic constipation in childhood related to anorectal defects is the most common presenting symptom and hemisacrum the most frequent malformation. The presacral mass may be an anterior meningomyelocele, teratoma, hamartoma, dermoid cyst, neuroenteric cyst, or a combination of these. Sepsis and meningitis are frequent serious problems related to the anterior meningomyelocele, whilst malignant transformation of presacral teratoma is a rare, severe complication in CA. Here, we report on a three-generation family segregating the CA, presenting with anorectal defects, severe constipation, and sacral involvement in affected relatives. Teratoma was the most frequent component of the presacral mass. In this kindred a 22-year-old man died of a neuroendocrine tumor, probably related to malignant change in a presacral teratoma. A novel mutation in HLXB9 consisting of a 24-bp deletion and insertion of 2-bp into exon 1, was identified in all patients and in also three asymptomatic members of this family. Anterior meningomyelocele is the most frequently reported component of the presacral masses in CA; however, presacral teratomas carry an inherent risk for malignancy that must be considered in the counseling, surgical treatment options, and follow-up of CA patients.
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PMID:Malignant degeneration of presacral teratoma in the Currarino anomaly. 1521 52

To our knowledge, stercoral perforation of the colon is rarely seen with fewer than 90 cases reported in the literature till date. We explored the principles of management to prevent impending mortality in five patients with this condition. Five patients, two males and three females, whose median age was 64 years, had sustained stercoral perforation of the sigmoid colon. Chronic constipation was the common symptom among these patients. Three patients underwent a Hartmannos procedure and another two were treated with segmental colectomy with anastomosis and diverting colostomy. There was one surgical mortality and the other patients had an uneventful hospital stay. Timely intervention to prevent and/or treat any associated sepsis along with extensive peritoneal lavage and surgical intervention to remove diseased colonic tissue at the primary stercoral ulceration site coupled with aggressive therapy for peritonitis are key treatment modalities in salvaging patients presenting with stercoral perforation of the colon.
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PMID:Management of patients with stercoral perforation of the sigmoid colon: report of five cases. 1648 60

Currarino syndrome consists of autosomal dominant hereditary sacral dysgenesis that is caused by mutations of the HOX gene, HLXB9. Sacral malformation, presacral mass, and anorectal malformations comprise the classic triad, but other common symptoms and malformations include neonatal-onset bowel obstruction, chronic constipation, recurrent perianal sepsis, renal/urinary tract anomalies, female internal genital anomalies, tethered spinal cord, and anterior meningocele. Up to 33% of patients are asymptomatic. There is marked inter- and intrafamilial variability in expression, and no genotype/phenotype correlations have been identified. To date, 32 different mutations have been identified in HLXB9: all nine missense mutations were found in the homeodomain, while the others were nonsense, frameshift, splice site mutations, or heterozygous whole-gene deletions. We report a four-generation family with Currarino syndrome varying in severity from very mild to full expression of the Currarino triad. They were found to carry a previously unreported nonsense mutation, E283X, absent in tested asymptomatic first-degree relatives. This family provides additional information on the degree of intrafamilial variability associated with HLXB9 mutations.
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PMID:A previously unreported mutation in a Currarino syndrome kindred. 1690 59

Rectocele is defined as the herniation of rectal wall due to a rectovaginal septum defect in direction of the vagina. In most of cases it is a result of vaginal delivery or repeated increases of intra-abdominal pressure due to chronic constipation. Some patients can develop rectocele as a consequence of congenital or inherited weakness of the pelvic support system. The rectopexy procedure by a single mechanical stapler allows to ablate the exceeding tissue. This surgery is performed through transanal access without laparotomy, by means of a circular stapler which simultaneously resects portion of the rectal wall and re-anastomizes it. Also the technique of sequential transfixed stitches (TSTS) represents a minimally invasive procedure for the rectocele treatment, allowing the performance of a complete plasty of rectal wall through transanal access. Hence, starting from a more effective stadiation of rectocele, the authors of this study will show the advantages of an endorectal approach for the treatment of the above-mentioned disease using both methods. A total of 25 female patients attending our colonproctology outpatient department, with an age ranging between 38 and 63 years, have been selected for our study; following a careful assessment of stadiation, they have undergone rectopexy with circular stapler first, thereafter fulfilling the surgery with TSTS. the mean duration of hospital stay was 2.5 days (range 2-3). Twelve patients out of 25 have shown early complications, and 11 patients late ones. Among the early complications, 3 patients reported pain (12 %), 3 patients urinary retention (12 %), and 2 patients bleeding (8 %). Among late complications, 5 cases of urgency defecation disorders (>4 months) (20 %), 1 intestinal flatus incontinence (4 %), 1 stenosis (4 %), 2 prolonged pain and 2 cases of persistent obstructive defecation syndrome were reported. No cases of life-threatening local or pelvic sepsis as well as of rectovaginal fistulae were reported. At the 6 months post-surgery evaluation, neither rectocele recurrence nor prolapse was observed. The association of circular stapler and TSTS in the rectopexy treatment of rectocele showed its short-term efficacy, producing an improvement of patient's clinical conditions, without inducing further alterations of pelvic statics, of the sphincteric tone as well as of rectum emptiness deficit.
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PMID:Efficacy of two different surgical techniques combined in the treatment of rectocele. 2252 8

Spinal cord injury (SCI) leads generally to an irreversible loss of sensory functions and voluntary motor control below injury level. Cures that could repair SCI and/or restore voluntary walking have not been yet developed nor commercialized. Beyond the well-known loss of walking capabilities, most SCI patients experience also a plethora of motor problems and health concerns including specific bladder and bowel dysfunctions. Indeed, chronic constipation and urinary retention, two significant life-threatening complications, are typically found in patients suffering of traumatic (e.g., falls or car accidents) or non-traumatic SCI (e.g., multiple sclerosis, spinal tumors). Secondary health concerns associated with these dysfunctions include hemorrhoids, abdominal distention, altered visceral sensitivity, hydronephrosis, kidney failure, urinary tract infections, sepsis and, in some cases, cardiac arrest. Consequently, individuals with chronic SCI are forced to regularly seek emergency and critical care treatments when some of these conditions occur or become intolerable. Increasing evidence supports the existence of a novel experimental approach that may be capable of preventing the occurrence or severity of bladder and bowel problems. Indeed, recent findings in animal models of SCI have revealed that, despite paraplegia or tetraplegia, it remains possible to elicit episodes of micturition and defecation by acting pharmacologically or electrically upon specialized lumbosacral neuronal networks, namely the spinal or sacral micturition center (SMC) and lumbosacral defecation center (LDC). Daily activation of SMC and LDC neurons could potentially become, new classes of minimally invasive treatments (i.e., if orally active) against these dysfunctions and their many life-threatening complications.
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PMID:New pharmacological approaches against chronic bowel and bladder problems in paralytics. 2685 87

We present the case of a 25-aged woman who consulted due to refractory chronic constipation and fecal incontinence. She had bowel movements every 7-30 days of increased consistency (1-2 Bristol type stools), together with soiling and passive fecal incontinence (Wexner Scale: 12/20). She had undergone surgery shortly after birth for anorectal malformation repair. The colonoscopy and histological study of the rectum were normal. A pelvic magnetic resonance imaging (MRI) was performed which showed a right pararectal mass compressing the rectum without invading it. This mass was compatible with a presacral teratoma or hamartoma. MRI also revealed coccyx agenesis and hypoplasia of the last sacral vertebrae (image 1), all consistent with a Currarino syndrome (CS). The patient received 14 sessions of transcutaneous electrostimulation of the posterior tibial nerve resulting in an increase in bowel movements (every 3 days) and a reduction in fecal incontinence. She was then referred to surgery for presacral mass removal. CS is a congenital disorder characterized by the triad of anorectal malformations, sacral dysgenesis and presacral mass. It is thought to be caused by malformation of the caudal notochord during embryonic development. It is often diagnosed during childhood, although several cases in adults have been reported. This syndrome is associated with a very high rate (95%) of severe chronic and refractory constipation(1). Interestingly, constipation does not appear to be due to mechanical obstruction but to a poorly known intestinal pseudo-obstruction. No defects in the innervation or the musculature of the gut have been identified(2). Complications include ascending meningitis, sepsis, and malignant degeneration of the presacral masses(1). Pelvic and spinal MRI are required for the evaluation of the presacral mass and to rule out communication with the spinal space. Treatment is frequently surgical to prevent complications such as infections and malignant transformation of the presacral masses(3).
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PMID:A CASE OF CURRARINO SYNDROME IN AN ADULT WOMAN PRESENTING WITH REFRACTORY CHRONIC CONSTIPATION. 3320 5