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D Koutsomanis

Publications and source records attributed to D Koutsomanis.

5 recordsLinked to original sources
PubMed2000

Pelvic floor study in patients with obstructive defecation: influence of biofeedback.

The aim of this study was to evaluate the pathophysiologic abnormalities in patients with obstructive defecation or dyssynergia and to assess the role of biofeedback treatment. Three groups were studied. Group A had 24 patients with obstructive defecation; B, 25 patients with constipation; and C, 22 healthy volunteers. Rectosigmoid segmental transit time of group A was 28.5 hours (SD +/- 13.4); B, 17.2 hours (SD +/- 11.5); and C, 8.5 hours (SD +/- 6.3) (p < 0.05). There was no statistical difference in resting and squeezing anal pressure among the three groups. Anorectal angle at rest revealed no difference among the three groups. At strain, a statistically significant difference between groups A and C (p < 0.05) and a marginal difference between groups A and B was noted. Rectocele of the anterior rectal wall was present at strain in 17/24 patients of group A and 7/22 patients of group C (p < 0.05). Electromyography during strain revealed abnormal contractions of puborectalis muscle and external anal sphincter, in 13 and 14 patients of group A, respectively, which differed from that observed in groups B and C (p < 0.001). Biofeedback treatment was applied with good results in 7 of 11 patients of group A. At six months, constipation relapsed in only one of treated patients. Patients suffering from obstructive defecation seem to have slower rectosigmoid transit time than the others. Defecography shows smaller anorectal angle at strain and rectocele of the anterior rectal wall more often. Abnormal pelvic floor contraction at strain is often noted in anal electromyography. Some of these patients seem to respond favorably to biofeedback treatment.

Adult↗
PubMed1995

Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation.

Training to contract the abdominal muscles effectively and to relax the pelvic floor during defecation straining helps some patients with severe constipation. Hitherto all such training has used a visible or audible signal of sphincter muscle activity as a biofeedback method to assist in relaxation. A randomised controlled trial comparing the outcome of muscular training without any biofeedback device with the same training supplemented by an electromyographic (EMG) record visible to the patient is reported. Significant symptomatic improvement was noted and electromyographic measurements confirmed a decrease in pelvic floor muscle activity during defecation straining after treatment in both groups. The outcome was similar in the two treatment groups. Muscular coordination training using personal instruction and encouragement without a visual display is thus a potentially successful treatment suitable for outpatient use by paramedical personnel.

Adult↗
PubMedDate not supplied

Fractal-assisted EUS image-analysis in the evaluation of variceal eradication after elastic band ligation.

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is a strongly operator-dependent method. Mathematical algorithms in image-analysis are likely to enhance diagnostic accuracy. Incomplete eradication of esophageal varices can be demonstrated with EUS. The presence of paraesophageal varices, visible only with EUS, has been recently identified as a predictor of recurrence. The object of this study was to evaluate the usefulness of fractal-geometry-algorithms for the interpretation of EUS images and their impact on treatment decisions. METHODOLOGY: EUS was performed in 5 consecutive patients in order to detect the presence of paraesophageal varices after complete eradication of esophageal varices with elastic banding. Static images were analyzed and the fractal dimension was calculated. Follow-up ranged from 8-12 months. RESULTS: Fractal dimension was related to a) the presence and size of paraesophageal varices b) Child-Pugh Score c) rebleeding rate. Patients with a fractal dimension > 1.5 rebled. CONCLUSIONS: The use of mathematical algorithms derived from fractal geometry enhances interpretation in endosonographic imaging, increases the diagnostic yield and may prove helpful in making individual-tailored treatment decisions.

Adult↗
PubMedDate not supplied

Colonic metastasis of breast carcinoma.

Metastasis of breast carcinoma to the colon is a rare occurrence. We report here the case of a 65-year-old patient who presented a stenosing tumor of breast origin, located in the right colon. Some of the regional lymph nodes were infiltrated but no distant metastasis were detected. The primary breast lesion was a 4-cm infiltrating adenocarcinoma, operated 4 years earlier. Surgical removal of the lesion was followed by Endoxan-Epirubicin and 5-Fluororacil chemotherapy and the patient remained disease-free during the 3 years of follow-up. We could find only 2 similar cases reported in the world literature until now. Profound anemia in a patient with a past history of breast carcinoma may indicate colonic metastasis; treatment should be surgery followed by chemotherapy.

Adenocarcinoma↗