scholarly journals Rectosigmoid carcinoma presenting as full-thickness rectal prolapse

2019 ◽  
Vol 12 (12) ◽  
pp. e230409
Author(s):  
Daniel Montwedi
Keyword(s):  
Rectal Prolapse ◽  
Pelvic Floor ◽  
Microsatellite Instability ◽  
Colonic Obstruction ◽  
Full Thickness ◽  
Rectosigmoid Junction ◽  
Colorectal Tumour ◽  
Recent Onset ◽  
Rectal Tumour

A 34-year-old man with recent-onset constipation presented with colonic obstruction due to a palpable rectal tumour. Colostomy relieved the obstruction and biopsy revealed carcinoma. During workup, full-thickness rectal prolapse occurred with the tumour at the apex of an intussusception. Imaging revealed a low rectal tumour and no metastases. An abdominal oncological rather than perineal resection of the rectum was planned. At laparotomy, the tumour was reduced and was seen to originate at the rectosigmoid junction. Surgery was successful and follow-up has been clear. Histology revealed an adenocarcinoma with microsatellite instability. Rectal prolapse due to tumour intussusception is very rare. In this young man, it was due to straining at stool because of constipation and tenesmus rather than pelvic floor abnormality. An associated colorectal tumour should be considered in patients with rectal prolapse. In such cases, surgical and adjuvant management may need to be modified.

scholarly journals Paediatric Rectal Prolapse in Rwanda

1996 ◽  
Vol 89 (12) ◽  
pp. 688-689 ◽  
Author(s):  
EJ Chaloner ◽  
J Duckett ◽  
J Lewin
Keyword(s):  
Rectal Prolapse ◽  
Refugee Children ◽  
Anal Margin ◽  
Full Thickness ◽  
Short Term ◽  
South West ◽  
Worm Infestation ◽  
High Incidence ◽  
Underlying Illness

During the 1994 crisis in Rwanda, a high incidence of full-thickness rectal prolapse was noted among the refugee children in the south-west of the country. The prolapses arose as a result of acute diarrhoeal illness superimposed on malnutrition and worm infestation. We used a modification of the Thiersch wire technique in 40 of these cases during two months working in a refugee camp. A catgut pursestring was tied around the anal margin under local, regional or general anaesthesia. This was effective in achieving short-term control of full-thickness prolapse until the underlying illness was corrected. Under the circumstances, no formal follow-up could be arranged; however, no complications were reported and only one patient presented with recurrence.

scholarly journals Outcome of Delorme's Procedure for Full-Thickness Rectal Prolapse: Our experience in Bangabandhu Sheikh Mujib Medical University, Dhaka

2016 ◽  
Vol 10 (2) ◽  
pp. 55-58
Author(s):  
Tariq Akhtar Khan ◽  
Md Shahadot Hossain Sheikh ◽  
Md Abu Taher ◽  
Md Rayhanur Rahman ◽  
Md Rashidul Islam ◽  
...  
Keyword(s):  
Rectal Prolapse ◽  
Operative Time ◽  
Complete Rectal Prolapse ◽  
Full Thickness ◽  
Patient Reported ◽  
Delorme’S Procedure ◽  
The Mean ◽  
Medical University ◽  
Delorme's Procedure

The study was undertaken to determine the efficacy and safety profile of Delorme's procedure as the treatment for full-thickness rectal prolapse. In this study, outcome of Delorme's procedure for full-thickness rectal prolapse were assessed retrospectively. All the patients who underwent this surgery (22 patients) from July, 2013 to June, 2015 were included in the study. There were 18 males and 4 females with mean age of 37.4 years (range 12-70). The mean operative time was 92.6 minutes (Range 60-180 minutes). There was no mortality and blood loss was minimal. Mean hospital stay was 3.5 days (2-6 days). Outcomes of the procedure were satisfactory and no patient reported recurrence of the disease within the follow up period. Delorme's operation is safe and effective treatment for complete rectal prolapse in patients of all age and sex.Faridpur Med. Coll. J. Jul 2015;10(2): 55-58

Ten-year follow up after laparoscopic suture rectopexy for full-thickness rectal prolapse

2014 ◽  
Vol 16 (10) ◽  
pp. 809-814 ◽  
Author(s):  
C. Foppa ◽  
L. Martinek ◽  
J. P. Arnaud ◽  
R. Bergamaschi
Keyword(s):  
Rectal Prolapse ◽  
Full Thickness ◽  
Laparoscopic Suture ◽  
Suture Rectopexy

Improvement in prefrontal thalamic connectivity during the early course of the illness in recent-onset psychosis: a 12-month longitudinal follow-up resting-state fMRI study

2020 ◽  
pp. 1-9
Author(s):  
Daniel Bergé ◽  
Tyler A. Lesh ◽  
Jason Smucny ◽  
Cameron S. Carter
Keyword(s):  
Resting State ◽  
Resting State Fmri ◽  
Functional Changes ◽  
Recent Onset ◽  
Fmri Study ◽  
Clinical Meaning ◽  
Mixed Pattern ◽  
The Right ◽  
Over Time

Abstract Background Previous research in resting-state functional magnetic resonance imaging (rs-fMRI) has shown a mixed pattern of disrupted thalamocortical connectivity in psychosis. The clinical meaning of these findings and their stability over time remains unclear. We aimed to study thalamocortical connectivity longitudinally over a 1-year period in participants with recent-onset psychosis. Methods To this purpose, 129 individuals with recent-onset psychosis and 87 controls were clinically evaluated and scanned using rs-fMRI. Among them, 43 patients and 40 controls were re-scanned and re-evaluated 12 months later. Functional connectivity between the thalamus and the rest of the brain was calculated using a seed to voxel approach, and then compared between groups and correlated with clinical features cross-sectionally and longitudinally. Results At baseline, participants with recent-onset psychosis showed increased connectivity (compared to controls) between the thalamus and somatosensory and temporal regions (k = 653, T = 5.712), as well as decreased connectivity between the thalamus and left cerebellum and right prefrontal cortex (PFC; k = 201, T = −4.700). Longitudinal analyses revealed increased connectivity over time in recent-onset psychosis (relative to controls) in the right middle frontal gyrus. Conclusions Our results support the concept of abnormal thalamic connectivity as a core feature in psychosis. In agreement with a non-degenerative model of illness in which functional changes occur early in development and do not deteriorate over time, no evidence of progressive deterioration of connectivity during early psychosis was observed. Indeed, regionally increased connectivity between thalamus and PFC was observed.

The role of inflammation in recent-onset dilated cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Chaloupka ◽  
J Krejci ◽  
H Poloczkova ◽  
P Hude ◽  
E Ozabalova ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Pcr Analysis ◽  
Myocardial Inflammation ◽  
Gene Variants ◽  
Absolute Increase ◽  
Recent Onset ◽  
Cardiotropic Viruses

Abstract Background The aetiology of recent-onset dilated cardiomyopathy (RODCM) includes inflammatory, genetic, toxic and metabolic causes. Delineating the role of inflammation on the genetic background could improve risk stratification. Purpose We aimed to ascertain the role of inflammation evaluated by serum CRP immunohistochemical and PCR analysis of endomyocardial biopsy (EMB) in conjunction with genetic testing in left ventricular reverse remodelling (LVRR) in 12-month follow-up. Methods 83 RODCM patients enrolled in this prospective observational study underwent 12-month echocardiographic follow up whole-exome sequencing, and EMB. Presence of cardiotropic viruses was determined by PCR analysis of the EMB samples. Inflammation was defined according to TIMIC immunohistochemical criteria as the presence of >7 CD3+ lymphocytes/mm2 and/or >14 infiltrating leukocytes (LCA+ cells/mm2). LVRR was defined as an absolute increase in LV ejection fraction > +10% and a relative decrease of LV end-diastolic diameter >−10% at 12 months. Results LVRR occurred in 28 (34%) of all cases. PCR analysis uncovered cardiotropic viruses in 55 (66%) patients, with highest prevalence of parvovirus B19 (47%). (Figure 1) EMB analysis detected inflammation in 28 (34%) cases and inflammation significantly positively predicted LVRR (P=0.019). Sequencing identified disease-related gene variants (ACMG class 3–5) in 45 (54%) patients. Carriers of non-titin gene variants showed a lowest probability of 12-month LVRR (19%) P=0.041. Combination of genetic findings and inflammation did not improve the prediction of LVRR in 12 months. (Table 1) Conclusion Both myocardial inflammation and disease-causing variants can be identified in a large proportion of RODCM cases. Prognostic value of CRP and virus detection is low. Non-titin disease-related variants carriers of are less likely to reach LVRR. In contrast, myocardial inflammation detected by EMB predicts favourable remodelling in 12 months. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Allogeneic Umbilical Cord Blood–Derived Mesenchymal Stem Cell Implantation Versus Microfracture for Large, Full-Thickness Cartilage Defects in Older Patients: A Multicenter Randomized Clinical Trial and Extended 5-Year Clinical Follow-up

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097305
Author(s):  
Hong-Chul Lim ◽  
Yong-Beom Park ◽  
Chul-Won Ha ◽  
Brian J. Cole ◽  
Beom-Koo Lee ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Adverse Events ◽  
Cartilage Repair ◽  
Older Patients ◽  
Cartilage Defects ◽  
Full Thickness ◽  
Phase 3 ◽  
Randomized Controlled ◽  
Cartilage Restoration

Background: There is currently no optimal method for cartilage restoration in large, full-thickness cartilage defects in older patients. Purpose: To determine whether implantation of a composite of allogeneic umbilical cord blood–derived mesenchymal stem cells and 4% hyaluronate (UCB-MSC-HA) will result in reliable cartilage restoration in patients with large, full-thickness cartilage defects and whether any clinical improvements can be maintained up to 5 years postoperatively. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A randomized controlled phase 3 clinical trial was conducted for 48 weeks, and the participants then underwent extended 5-year observational follow-up. Enrolled were patients with large, full-thickness cartilage defects (International Cartilage Repair Society [ICRS] grade 4) in a single compartment of the knee joint, as confirmed by arthroscopy. The defect was treated either with UCB-MSC-HA implantation through mini-arthrotomy or with microfracture. The primary outcome was proportion of participants who improved by ≥1 grade on the ICRS Macroscopic Cartilage Repair Assessment (blinded evaluation) at 48-week arthroscopy. Secondary outcomes included histologic assessment; changes in pain visual analog scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) score from baseline; and adverse events. Results: Among 114 randomized participants (mean age, 55.9 years; 67% female; body mass index, 26.2 kg/m2), 89 completed the phase 3 clinical trial and 73 were enrolled in the 5-year follow-up study. The mean defect size was 4.9 cm2 in the UCB-MSC-HA group and 4.0 cm2 in the microfracture group ( P = .051). At 48 weeks, improvement by ≥1 ICRS grade was seen in 97.7% of the UCB-MSC-HA group versus 71.7% of the microfracture group ( P = .001); the overall histologic assessment score was also superior in the UCB-MSC-HA group ( P = .036). Improvement in VAS pain, WOMAC, and IKDC scores were not significantly different between the groups at 48 weeks, however the clinical results were significantly better in the UCB-MSC-HA group at 3- to 5-year follow-up ( P < .05). There were no differences between the groups in adverse events. Conclusion: In older patients with symptomatic, large, full-thickness cartilage defects with or without osteoarthritis, UCB-MSC-HA implantation resulted in improved cartilage grade at second-look arthroscopy and provided more improvement in pain and function up to 5 years compared with microfracture. Registration: NCT01041001, NCT01626677 (ClinicalTrials.gov identifier).

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