PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 12791022

One-step vs two-step procedure in dynamic graciloplasty.

M J Rongen·E M Adang·A G van der Hoop·C G Baeten
View original source ↗Export metadata ↓

Abstract

OBJECTIVE: Dynamic graciloplasty, a proven treatment for end-stage faecal incontinence, requires transposition of the gracilis muscle around the anal canal and implantation of a pulse generator and intramuscular electrodes. In view of the risk of infection around the implanted material the implantation was initially not performed in combination with the perineal procedure but 6 weeks later. Sparing the patients an extra operation, however, might be justified if morbidity is not increased. This study aimed to compare the combined single-stage with the two-stage procedures. PATIENTS AND METHODS: Two groups of 13 patients were admitted to this prospective, matched control study according to waiting list ranking. They were matched for age, gender and aetiology. Group I had transposition and transplantation combined, group II underwent these procedures separately with a 6-week interval. Continence, manometry, stimulation parameters, quality of life results and adverse events were recorded. RESULTS: After a mean 521-day follow up infection rates were comparable in both groups, as were continence rates, morbidity, anal manometry, stimulation parameters and quality of life. CONCLUSION: Outcome, morbidity and quality of life seem to be comparable. A single procedure avoids the need for an extra admission and operation, so the one-stage approach should be the standard procedure in dynamic graciloplasty.

Explore related subjects

Clinical TrialControlled Clinical TrialJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

M J Rongen, E M Adang, A G van der Hoop, C G Baeten. 2001. One-step vs two-step procedure in dynamic graciloplasty.. https://doi.org/10.1046/j.1463-1318.2001.00161.x

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2004

Randomised, controlled trial of N-acetylcysteine for treatment of acute exacerbations of chronic obstructive pulmonary disease [ISRCTN21676344].

BACKGROUND: Prophylactic treatment with N-acetylcysteine (NAC) for 3 months or more is associated with a reduction in the frequency of exacerbations of chronic obstructive pulmonary disease (COPD). This raises the question of whether treatment with NAC during an acute exacerbation will hasten recovery from the exacerbation. METHODS: We have examined this in a randomised, double-blind, placebo controlled trial. Subjects, admitted to hospital with an acute exacerbation of COPD, were randomised within 24 h of admission to treatment with NAC 600 mg b.d. (n = 25) or matching placebo (n = 25). Treatment continued for 7 days or until discharge (whichever occurred first). To be eligible subjects had to be > or = 50 years, have an FEV1 < or = 60% predicted, FEV1/VC < or = 70% and > or = 10 pack year smoking history. Subjects with asthma, heart failure, pneumonia and other respiratory diseases were excluded. All subjects received concurrent treatment with prednisone 40 mg/day, nebulised salbutamol 5 mg q.i.d and where appropriate antibiotics. FEV1, VC, SaO2 and breathlessness were measured 2 hours after a dose of nebulised salbutamol, at the same time each day. Breathlessness was measured on a seven point Likert scale. RESULTS: At baseline FEV1 (% predicted) was 22% in the NAC group and 24% in the control group. There was no difference between the groups in the rate of change of FEV1, VC, SaO2 or breathlessness. Nor did the groups differ in the median length of stay in hospital (6 days for both groups). CONCLUSIONS: Addition of NAC to treatment with corticosteroids and bronchodilators does not modify the outcome in acute exacerbations of COPD.

Clinical Trial↗
PubMed2004

The need for a large-scale trial of fibrate therapy in diabetes: the rationale and design of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. [ISRCTN64783481].

BACKGROUND: Fibrates correct the typical lipid abnormalities of type 2 diabetes mellitus, yet no study, to date, has specifically set out to evaluate the role of fibrate therapy in preventing cardiovascular events in this setting. METHODS: Subjects with type 2 diabetes, aged 50-75 years, were screened for eligibility to participate in a long-term trial of comicronized fenofibrate 200 mg daily compared with matching placebo to assess benefits of treatment on the occurrence of coronary and other vascular events. People with total cholesterol levels 3.0-6.5 mmol/L plus either a total-to-HDLc ratio > 4.0 or triglyceride level > 1.0 mmol/L with no clear indication for lipid-modifying therapy were eligible. RESULTS: A total of 9795 people were randomized into the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial. All received dietary advice, followed by a 6-week single-blind placebo run-in, then a 6-week active run-in period before randomization. Participants are being followed up every 6 months for outcome events and safety assessments. The study is designed to yield at least 500 coronary events (primary endpoint: first nonfatal myocardial infarction or coronary death) over 5 years, to have 80% power to identify as statistically significant at 2P = 0.05 a 22% reduction in such events, using intention-to-treat methods. CONCLUSIONS: Type 2 diabetes is the most common endocrine disorder worldwide, and its prevalence is increasing. The current evidence about use of fibrates in type 2 diabetes, from around 2000 people treated, will increase with FIELD to evidence from around 12000. FIELD will establish the role of fenofibrate treatment in reducing cardiovascular risk in people with type 2 diabetes. The main results are expected to be available in late 2005.

Clinical Trial↗