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Biomedical subjects

F Candela

Publications and source records attributed to F Candela.

At least 19 recordsLinked to original sources
PubMed2006

Is anal endosonography useful in the study of recurrent complex fistula-in-ano?

INTRODUCTION: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. PATIENTS AND METHOD: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. RESULTS: we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. CONCLUSION: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.

Anal Canal↗
PubMed2004

Long-term results of botulinum toxin for the treatment of chronic anal fissure: prospective clinical and manometric study.

BACKGROUND: The aim of this prospective trial was to analyse the effectiveness and morbidity of chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up. METHODS: One hundred consecutive patients with chronic anal fissures were treated by chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter. Clinical and manometric results were recorded. RESULTS: No major complications were found; initial incontinence at the 2-month review (6%) spontaneously reversed at 6 months. There was a tendency of progressive recurrence over time, with an overall healing after 3 years of 47%. We found a group of patients with clinical (symptoms longer than 12 months and presence of a sentinel pile before treatment) and manometric factors (persistently elevated mean resting pressure, percentage of time with slow waves, and number of patients or percentage of time with ultra slow waves after treatment) associated with a higher recurrence of anal fissures. CONCLUSION: Since it avoids the greater risk of incontinence associated with surgical sphincterotomy, we recommend the use of botulinum toxin as the first therapeutic approach for patients with chronic anal fissure and risk factors for incontinence; despite the higher rate of recurrence associated with this treatment. In patients with factors related to recurrence, re-injection with higher doses of botulinum toxin or complementary medical-surgical treatment should be considered.

Adult↗
PubMed2004

Open versus closed day-case haemorrhoidectomy: is there any difference? Results of a prospective randomised study.

BACKGROUND AND AIMS: Nowadays there is still controversy as to whether open or closed haemorrhoidectomy is the surgical treatment of choice for haemorrhoidal pathology. PATIENTS AND METHODS: We carried out a randomised prospective study in the Day Surgery Unit comparing 100 patients undergoing Milligan-Morgan haemorrhoidectomy (group A) versus 100 patients undergoing Ferguson haemorrhoidectomy (group B) for symptomatic haemorrhoids, in whom medical treatment or rubber band ligation had failed. RESULTS: Characteristics of the population were: mean age 43.5 years, with predominance of males, 123 vs. 77; 88% ASA I-II. CLINICAL PRESENTATION: 95% rectal bleeding; 87.5% third-fourth degree. The anaesthetic technique of choice was local anaesthesia plus sedation in 180 patients (90%). Length of surgery: 24 min (group A) and 30 min (group B) (p=n.s.). Resection of three haemorrhoidal cushions was done in 87.5% of cases. There were no re-operations or re-admissions after discharge. Symptomatic recurrence, stenosis and incontinence were not found during the follow-up of the first year. Postoperative pain during the first postoperative week was greater in the open haemorrhoidectomy group, but the difference was statistically significant (p<0.05) only during bowel movements. There was complete healing in 40% of the patients in group A and 90% of those in group B (p<0.05) after 1 month. After 1 year, the results and complications were similar in both groups (p=n.s.). CONCLUSIONS: Closed haemorrhoidectomy gives better results in terms of pain and healing than open haemorrhoidectomy, whereas recurrence and complications are similar after 1 year.

Adult↗
PubMed2002

Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment.

BACKGROUND AND AIMS: Anal abscess is a frequent acute proctological disorder and whether the underlying fistula should be treated at the same time when the abscess is drained remains controversial. We examined indications for drainage alone versus drainage plus fistulotomy in terms of recurrence and continence. PATIENTS AND METHODS: We carried out a randomized prospective study of 200 consecutive patients with anal abscess. One group received drainage alone, while in the other group drainage plus fistulotomy was performed when a subcutaneous-mucosa, low transsphincteral, or intersphincteral fistula was found. Delayed progressive fistulotomy with suture threads was performed in cases of high transsphincteric or suprasphincteric fistula. RESULTS: The internal opening of the fistula track was found in 83% of the patients. The recurrence rate was related to the surgical technique employed: 29% in the group with drainage alone and 5% in the group for which treatment of the fistula track was attempted. The incontinence rate was also related to the surgical option. In those receiving drainage and treatment of the fistula track incontinence was restricted mostly to patients with delayed fistulotomy (36.7%), compared to 2.8% of patients when simple fistulotomy was performed. There was no incontinence in the drainage alone group. CONCLUSION: Drainage of anal abscess with fistulotomy can be safely performed in cases of subcutaneous, intersphincteral, or low transsphincteral fistulae with a minimal recurrence rate. However, drainage alone and posterior treatment of the fistula track is recommended for high transsphincteral or suprasphincteral fistulae.

Abscess↗
PubMed2001

Hernia surgery for the third millennium. Does classical herniorraphy still play a role?

The steadily increasing use of prosthetic grafts in hernia repairs can be said to play down the classical approach for repairing groin hernia. We retrospectively report on 894 patients operated on for groin hernia at our out-patient surgery clinic from June 1992 to May 1998. Herniorraphy was widely performed (96.3%). The recurrence rate was of 1.6% (overall). For patients younger than 45 yr with no systemic concurrent disease, as few as 0.1% relapsed after a 58-month average follow-up. According to our results, ambulatory herniorraphy can provide an excellent degree of efficiency in selected young patients suffering from indirect unilateral primary groin hernia. Likewise, we regard the prosthetic repair as the gold standard technique in those patients with a weakened posterior inguinal wall.

Journal Article↗
PubMed2001

Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults.

BACKGROUND: Prosthetic repair has become the standard method for inguinal hernia and has excellent results. The question remains of whether the mesh technique could also improve results for umbilical defects. METHODS: The study was a randomized clinical trial comparing herniorrhaphy (primary suture) with hernioplasty (polypropylene mesh or plug) in 200 adult patients with a primary umbilical hernia. Patients at high anaesthetic risk (American Society of Anesthesiologists (ASA) grade IV) or those who needed emergency surgery were excluded. The mean postoperative follow-up was 64 months. The population studied included 118 women and 82 men with a mean age at presentation of 57 years. Some 173 patients were ASA grade I-II and 27 were ASA III. The anaesthetic technique of choice was local anaesthetic infiltration plus sedation (98 per cent). RESULTS: There were no significant anaesthetic complications or surgical deaths. The mean duration of surgery was greater for mesh than for suture repair (45 versus 38 min). Rates of early complications such as seroma, haematoma or wound infection were similar in the two groups. The hernia recurrence rate was higher after suture repair (11 per cent) than after mesh repair (1 per cent) (P = 0.0015). CONCLUSION: Prosthetic repair could become the standard treatment for primary umbilical hernia in adults.

Adolescent↗
PubMed1999

Perianal disease of tuberculous origin: report of a case and review of the literature.

PURPOSE: A case of anal tuberculosis in an otherwise asymptomatic patient with bleeding anal ulcers is presented. The clinical features of this entity and the problems in differential diagnosis between anal infectious vs. inflammatory diseases are discussed. METHODS: The management and outcome of the case of an adult patient who presented with perianal ulcers is described. RESULTS: On a three-drug antituberculous regimen, symptoms abated, radiographic infiltrates improved, and perianal ulcers healed. CONCLUSION: Anal tuberculosis is an extremely rare disease. A tuberculous origin must be considered when the cause of perianal ulcers is unclear to avoid undesirable delays in the diagnosis and treatment of this disease.

Anus Diseases↗
PubMed1998

Canine pancreatic responses to intracolonic perfused nutrients.

To study the effect intracolonic perfusion of nutrients has on exocrine pancreatic secretion, six dogs were prepared with gastric, duodenal, and cecal cannulas using a modified Thomas technique. In our study protocol, we collected pancreatic juice by selective ductal cannulation after having applied several types of intracolonic stimulation: perfusion of sodium chloride, tryptophan, rice starch + glucose, or sodium oleate. All these solutions were applied together with a background dose of intravenous secretin. Our results showed a significant increase in the volume of pancreatic juice and bicarbonate output after intracolonic perfusion of sodium oleate. Other perfusions did not change these parameters. Protein output did not change in any of the cases. It seems that the ascending colon plays a regulating role in pancreatic secretion; in some conditions the colon could increase exocrine pancreatic function.

Animals↗
PubMed1997

[Biomechanics and semiology of transient lateral patellar dislocation: reliability of magnetic resonance diagnosis].

Transient patellar dislocation is a rare finding. It is usually due to direct trauma in mediolateral direction or to indirect trauma related to violent quadriceps muscle contraction. The clinical diagnosis of transient forms is usually rather difficult because the associated signs (hemarthros and pain at the joint and/or at the vastus medialis insertion) are not specific. Conventional radiography and CT are very accurate in bone studies, but exhibit major limitations in the detection of capsular injuries with intramedullary and/or cartilaginous bone involvement. We investigated MR diagnostic reliability in the study of the injuries caused by transient patellar dislocation. 526 MR examinations of the knee were reviewed retrospectively; fifteen of them were positive for transient patellar dislocation. We used a .5 T superconductive MR unit with a circumferential extremity coil. Axial, coronal and sagittal T1-weighted spin echo, T2*-weighted gradient echo and axial STIR images were acquired. The following criteria were considered specific for the diagnosis of former lateral patellar dislocation: retinacular changes; patella site; signal intensity changes in femoral and patellar intramedullary bone; joint effusion; cartilage and subchondral bone changes. All the patients with transient patellar dislocation had hemarthros with inner retinaculum involvement. The femoropatellar joint was incongruous in 115 cases; patellar subluxation was external in 8/11 patients and lateral in the remaining 3 patients. Medullary bruises were found in 8/15 cases and cartilage injuries in 13/15. Finally, other joint components, such as the posterior horn of the medial meniscus or the anterior cruciate ligament were involved in 6/13 cases. Arthroscopy was performed in 6 patients with associated injuries and confirmed all MR findings (100% agreement). To conclude, in our experience MRI was a very reliable tool to study the injuries due to transient patellar dislocation because it showed specific changes and possible associated traumas, which helps choose the most suitable treatment.

Adolescent↗
PubMed1995

[Neoadjuvant intralesional chemotherapy for breast neoplasm in advanced stage. Assessment of its efficacy with Doppler color].

Twenty women with breast cancer confirmed at cyto-histology, 4 of them with axillary lymph node metastases, were submitted to neo-adjuvant chemotherapy with the conventional systemic treatment combined with intralesion drug administration and monitored by means of color-Doppler ultrasonography (CDU). Before treatment, CDU demonstrated marked color signal increase in 18 cases. After treatment, tumor vascularity clearly decreased and response was more apparent since treatment had been local rather than systemic. In this paper, the consistent semiology of breast cancer is discussed together with the progressive changes in CDU color signal, the latter a valuable parameter for surgical timing. Histology, performed during treatment and on the surgical specimen, allowed treatment results to be monitored, showing a rich proliferation of connective tissue and the persistence of rare neoplastic nests. In 2/4 patients with lymph node metastases, the latter lesions reduced in size. The postoperative follow-up of these patients, which was the object of our study, currently ranges 4 to 36 months, in which period of time no relapses have been observed. The results obtained so far suggest the effectiveness of combined parenteral and local drug administration in the preoperative treatment of breast cancer. Moreover, this approach makes surgery feasible even in the most advanced forms (T3-T4). CDU is the most accurate method to monitor neo-adjuvant treatment effectiveness.

Aged↗
PubMed1994

Coeliac disease in the year 2000: exploring the iceberg.

It is now generally believed that subclinical coeliac disease is common in the general population. We have undertaken screening for this disorder in a school district in central Italy. Screening was divided into three levels: first, IgG and IgA antigliadin antibody (AGA) assay on capillary blood obtained by finger prick; second, AGA plus IgA anti-endomysium antibody (AEA) test and measurement of serum immunoglobulins in venous blood; and third, intestinal biopsy. 3351 students (66% of the eligible population) aged 11-15 years attended first-level screening. 71 (2%) were recalled because of AGA positivity; 18 of these satisfied second-level criteria and underwent intestinal biopsy. Coeliac disease was diagnosed in 11 subjects, most of whom had no serious symptoms. Selective IgA deficiency was found in 4 subjects, 1 of whom also had coeliac disease. The prevalence of subclinical coeliac disease in the study group was 3.28 per 1000. Coeliac disease screening is feasible and involves only slight discomfort to the general population. Such screening can detect large numbers of cases of coeliac disease, which can be treated with a gluten-free diet. Many subclinical cases of coeliac disease would not be detected by screening only a selected group of at-risk patients.

Adolescent↗
PubMed1991

Prognosis of node-positive colon cancer.

The most recent American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging system subgroups patients into one to three and four or more positive nodes. However, the Gastrointestinal Study Group and the National Surgical Adjuvant Breast and Bowel Project divides node-positive patients into one to four and five or greater. A Cox multi-variate retrospective analysis was done of the overall survival of node-positive colon cancer patients with the specific objective of determining the most appropriate subcategorization. Data on 306 patients with node-positive colon cancer who underwent potentially curative surgery from 1970 to 1984 were analyzed retrospectively. No patient received adjuvant chemotherapy. Also excluded were patients with synchronous resected metastatic disease or those with rectal primaries. The median follow-up was 6 years, and the median survival for the entire group was 8.6 years. By univariate analysis, the following were significant prognostic features: number of positive nodes (P less than 0.0001), degree of differentiation (P less than 0.0001), colon primary site (P = 0.009), tumor stage (P = 0.001), and tumor size (P less than 0.0001). Lymphatic/blood vessel invasion and a mucinous histology were not significant. By Cox multivariate analysis the number of positive lymph nodes remained the best discriminant of survival (P = 0.0001). The number of positive nodes was related inversely to prognosis with the optimal dichotomization between one to three (66% 5-year survival) and four or greater nodes (37% 5-year survival).

Colonic Neoplasms↗