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Biomedical subjects

J M Devesa

Publications and source records attributed to J M Devesa.

12 recordsLinked to original sources
PubMed2005

Total anorectal reconstruction: a novel technique.

The aim of this report is to describe a novel technical approach to total anorectal reconstruction after a Miles operation for rectal cancer. Recreation of an internal neosphincter with colonic muscle, the implant of an artificial bowel sphincter (ABS), and the association of a coloplasty constitute a complete substitution of the lost structures and functions. Although the patient developed a late complication which required removal of the ABS, the functional result of the technique can be considered as excellent, to be demonstrated by the incontinence score and quality of life with and without the colostomy.

Aged↗
PubMed1997

Bilateral gluteoplasty for fecal incontinence.

PURPOSE: This study describes our clinical experience with adynamic bilateral gluteoplasty in 20 patients with total fecal incontinence, in whom a sphincter repair had failed (n = 17) or was nonviable. METHODS: Between 1986 and 1995, 12 women and 8 men ranging in age from 15 to 58 (mean, 37) years underwent different techniques of adynamic gluteoplasty. The indications for the operation were congenital anomalies, denervation, or sphincter destruction. Postoperative evaluation was clinical (Pescatori grading; self-evaluation) and manometric. RESULTS: Morbidity was only related to wound infection (n = 7) requiring late reoperations for neosphincter repair (n = 5), anal stenosis (n = 2), and incisional hernia after colostomy closure (n = 1). Two other patients with no complications also had further surgery for tightening of the neosphincter; they had a successful outcome. Of the 17 evaluable patients, 9 (53 percent) achieved normal control or were graded as Pescatori A-1, A-2, B-1, or C-1, 1 (6 percent) as Pescatori C-2, and 7 (41 percent) as Pescatori C-3. Six patients (35 percent) judged their results as excellent, three (18 percent) as good, one (6 percent) as fair, and seven (41 percent) as bad. Eight patients are able to retain 200 ml of water instilled into the rectum for between five minutes and two hours. For the nine patients with better results, the mean +/- standard deviation of the differences between postgluteoplasty and pregluteoplasty anal pressures were 40 +/- 25 mmHg (resting pressure) and 122 +/- 85 mmHg (squeeze pressure). These findings demonstrate a tonic and voluntary activity of the plasty. The author's technique has less morbidity, and excellent or good results were achieved in 67 percent of the patients. Failures were attributable to suture disruption (n = 4), poor muscular contraction (n = 2), and intractable constipation (n = 1). CONCLUSIONS: Adynamic gluteoplasty is efficient for achieving good or very good continence status in a higher proportion of patients than with other adynamic muscle transfer procedures.

Adolescent↗
PubMed1993

[The ultrashort bowel syndrome: the surgical treatment of an exceptional case].

An exceptional case of a 16-year-old boy who accidentally lost all of the small bowel (except the proximal 5 cm. of jejunum), and also 10 cm of transverse colon and a small part of the middle and upper rectum, is presented. After suffering severe medical complications derived from prolonged and uninterrupted total parenteral nutrition for more than one year, with no oral intake except fluids, the patient underwent intestinal lengthening of all the residual bowel up to the sigmoid colon, with antiperistaltic anastomosis and sigmoid J pouch with myotomy. Several months after the operation the patient returned to his normal activities and is fed with a free-diet, complemented or not with nocturnal enteral and parenteral feeding, depending on the circumstances and weight variations. Lengthening of the large bowel together with the rest of surgical gestures here performed has not been published previously.

Accidental Falls↗
PubMed1993

[Ileoanal anastomosis with a J reservoir. The evolution of the technic and the results].

Beginning 1982, our group has been performing the technique of ileal pouch-anal anastomosis, changing the procedure for achieving better functional results, less morbidity and making it easier. Fifty patients operated on for ulcerative colitis and "polyposis coli" were grouped as follows: Group I (28): proctocolectomy, mucosectomy, handsewn anastomosis and temporary ileostomy; Group II (13): proctocolectomy without mucosectomy, leaving a rectal stump up to just the level of the puborectalis, instrumental anastomosis and no-ileostomy; Group III (9): Same as Group II but with the implant of an endoluminal prosthesis to defunction the pouch. From our results it is concluded that, provided an adequate selection of patients is done, the best technique is the one performed in Group III due to its simplicity, no morbidity related to the ileostomy, no risk of fistula and probably better functional results than in Group II.

Adenomatous Polyposis Coli↗
PubMed1992

Total fecal incontinence--a new method of gluteus maximus transposition: preliminary results and report of previous experience with similar procedures.

Since 1986, different procedures of gluteus maximus transposition have been performed, by one of the authors, in 10 patients with total anal incontinence not amenable to sphincter repair, due to congenital anomalies (four), sphincteric denervation (three) or after severe trauma (three). Variable degrees of long-lasting fecal control were obtained in all but one patient, with great improvement in six. Difficulties for achieving a closed anus without muscular tension of the neosphincter, together with the morbidity associated with anal wound infection, determined the reasons for the successive use of different techniques (Biström, Hentz, Schoamaker) until the authors, in 1990, designed a new procedure (Devesa). Although the reported experience with this technique described here is limited to only four patients, our impression is that the method is easier, has less morbidity, and achieves better short-term functional results, derived from a thick, tension-free neosphincter.

Adolescent↗
PubMed1991

Value of follow-up in the management of recurrent colorectal cancer.

The purpose of this article was to study the effectiveness of a prospective follow-up programme in patients after curative surgery for colorectal cancer. Of the initial 151 selected patients, 61 (40%) developed a recurrence in whom only six cases (10%) of potentially curable recurrent lesions were detected. The first clues to recurrence in the 61 patients were history or physical examination in 49%, a rising CEA in 29% and a positive imaging finding in 10%, being difficult to decide which test first signalled a recurrent cancer in an additional 11%. Endoscopy and CEA determinations were the most rewarding investigations. CEA was a sensitive means of identifying disseminated recurrent disease and liver metastases compared with liver function tests or liver ultrasound every 3 months. Endoscopy was useful in the diagnosis of local recurrences. However no follow-up test was capable of detecting recurrent colorectal cancer when it might still have been curable. As a direct result of this follow-up programme 15 patients (23%) underwent re-exploration. No symptomatic patients were candidates for curative re-operation. Of the asymptomatic patients six (four colonic and two rectal cancers) (19.5%) were re-resected for cure. Only three of these were alive and without evidence of disease, 40, 43 and 69 months later so that long term survivors after curative re-resection represent only 5% of all patients with recurrences (7.2% of the recurrent colonic cancer and 3% of the rectal cancer). Our follow-up programme did not permit us to alter the incidence of disseminated recurrent disease, and the effectiveness of the curative re-resection represents an increase of only 1.3% in the global 5-year survival rates for colorectal cancer. Our study does not demonstrate any great value of 'classical' postoperative follow-up programme.

Adult↗
PubMed1989

[Morphologic changes in ileoanal reservoirs 2 years after their construction].

A study was made of the histologic changes in the mucosa of the ileoanal reservoirs of 10 patients who 2 years earlier had undergone ileoanal anastomosis with a J reservoir for ulcerative colitis (CU). In biopsies of the reservoirs were evaluated: 1) basic morphologic changes; 2) morphometric differences with respect to normal ileal mucosa; 3) the immunohistochemical pattern (IHQ) (IgA, IgG, IgM and CEA) of the reservoir mucosa as compared to normal ileum, active ulcerative colitis. Crohn's disease and celiaca; 4) the possible existence of atypias or dysplasias of the reservoir mucosa; and 5) the number of argentaffin cells per field. The basic morphologic alteration consisted of colonic metaplasia. Reservoir biopsies exhibited partial (8 cases) or subtotal atrophy (2 cases) of the mucosa. With respect to the normal ileum there was a decrease in villi height (p less than 0.05), an increase in crypt depth (p less than 0.05) and a higher index of mucosal regeneration, with a larger number of cells and mitoses per crypt (p less than 0.05). Fifty percent of the reservoirs presented a chronic inflammatory pattern with an acute component in 30% of them. The immunohistochemical pattern of the reservoirs not inflamed was similar to that of normal ileum (IgA much greater than IgM greater than IgG) and that of the inflamed reservoirs was similar to that of intestinal inflammatory disease (marked increase in the IgG. CEA (similar to what?) an alteration of local immune homeostasis could have of the genesis of pictures of "pouchitis". No alarming signs of atypia or dysplasia were found, nor changes in the population of argentaffin cells.

Anal Canal↗
PubMed1988

Colorectal cancer. The bases for a comprehensive follow-up.

The purpose of this article was to review the effectiveness of follow-up in patients with colorectal cancer submitted to curative treatment. A comprehensive follow-up involves rational initial management of the primary tumor, knowledge of prognostic factors, selection of the patient to be followed, determination of the time for follow-up, use of the most appropriate tests for early diagnosis of recurrence, and eventual curative treatment. The updated answers to all these questions are given through an extensive review of the world literature and confronted with the authors' experience of eight years of follow-up in a series of 170 colorectal cancer patients treated for cure. Although the future might be more promising, past world experience suggests only a few patients could be saved. It is concluded that there is no place for incomplete and disperse screening tests, and only comprehensive, intensive, and very well-coordinated follow-up programs should be undertaken if better results are hoped to be achieved.

Colonic Neoplasms↗