PubMed Health⌕ Search

Biomedical subjects

Francesco Brandara

Publications and source records attributed to Francesco Brandara.

5 recordsLinked to original sources
PubMed2006

Experience with type A botulinum toxin for treatment of outlet-type constipation.

BACKGROUND: Puborectalis syndrome remains a therapeutic challenge for today's physicians. Traditional approaches include use of fiber, laxatives, enemas, biofeedback training, and surgery. These often were tried sequentially and had conflicting or even disappointing results. We investigated the efficacy of injections of botulinum toxin in improving rectal emptying in patients with defecatory disorders involving spastic pelvic-floor muscles. METHODS: Twenty-four consecutive patients with chronic outlet obstruction constipation resulting from puborectalis syndrome were included in the study. The patients were treated with 60 units of type A botulinum toxin, injected into two sites on either side of the puborectalis muscle under ultrasonographic guidance. RESULTS: At 2 months, evaluation inspection revealed a symptomatic improvement in 19 patients. Anorectal manometry demonstrated decreased tone during straining from 98 +/- 24 to 56 +/- 20 mmHg at a 1-month evaluation (p < 0.01) and 56 +/- 29 mmHg at a 2-month follow-up (p < 0.01). Pressure during straining was lower than resting anal pressure at the same time in all patients. Defecography after the treatment showed improvement in anorectal angle during straining, which increased from 98 +/- 9 degrees to 121 +/- 15 degrees (p < 0.01). CONCLUSIONS: Botulinum toxin injections should be considered as a simple therapeutic approach in patients with obstructed defecation. The treatment is safe and effective, especially with the use of the ultrasonographic guidance that accounts for a more precise injection and consequently better long-term results. Otherwise, given the limited effect of the toxin, repeated injections may be necessary to maintain the clinical improvement.

Botulinum Toxins, Type A↗
PubMed2004

Treating chronic anal fissure with botulinum neurotoxin.

Recent reports confirm that the management of chronic anal fissure has undergone extensive re-evaluation during the past few years. This rejuvenation of interest is attributable to the application of neurochemical treatment, which has contributed to the tendency to treat the disease on an outpatient basis. The use of botulinum neurotoxin seems to be a promising and safe approach for the treatment of chronic anal fissure, particularly in patients at high risk for incontinence. Indeed, botulinum neurotoxin has been successfully used selectively to weaken the internal anal sphincter as a treatment for chronic anal fissure. It is also more efficacious than nitrate therapy, and is not related to the patient's willingness to complete treatment.

Botulinum Toxins↗
PubMedDate not supplied

[Treatment of pancreatic necrosis and secondary pancreatic infections].

Acute pancreatitis is a disease capable of the widest clinical expression, ranging from mild discomfort to multiorgan failure and death. Moreover, the process may remain localized in the pancreas, or spread to regional tissues, or even involve remote organs. Despite several efforts, the pathophysiology of acute pancreatitis and its complications remains obscure. In the absence of an understanding of the pathogenesis and the reasons for the variations in severity, the study and management of acute pancreatitis has necessarily been empirical. There is little doubt that the development of pancreatic necrosis in patients with acute pancreatitis results in an increase in clinical severity and an escalation of the mortality risk when compared to interstitial pancreatitis. Furthermore, the mortality risk of patients with sterile pancreatic necrosis is markedly different from that of patients developing secondary infections in pre-existing pancreatic necrosis. Infected pancreatic necrosis is uniformly fatal, if untreated. While most authorities agree that surgical debridement is required for survival in patients with secondary pancreatic infections, the precise form of the subsequent drainage has become a matter of some controversy. In this paper we discuss the most recent insights relating to the nosographical classification of pancreatic necrosis and secondary pancreatic infections, along with an analysis of the findings in the literature regarding the surgical treatment of these conditions.

Abscess↗
PubMedDate not supplied

Laparoscopic fenestration of symptomatic non-parasitic cysts of the liver.

BACKGROUND/AIMS: The use of laparoscopic technique for management of symptomatic liver cysts is documented to be a feasible and safe procedure with proved symptomatic relief. In the present study, we reviewed the results of this approach in the management of symptomatic liver cysts. METHODOLOGY: Retrospective review of all patients with symptomatic liver cysts that were treated by laparoscopic fenestration in our department over a 3-year period from 1999 to 2001. RESULTS: Ten patients were treated using a laparoscopic approach. All patients achieved short-term alleviation of symptoms and an uneventful postoperative course. The mean hospital stay was 3 days. Long-term follow-up (24 months) was available for all the patients. In all the patients, there was no clinical and radiographical recurrence. CONCLUSIONS: The present study confirms that relief of symptoms can be achieved with the laparoscopic approach for non-parasitic liver cysts. Omental packing is not necessary to prevent recurrence of simple hepatic cysts.

Aged↗