Pelvic floor rehabilitation for defecation disorders.

Pelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and agree on treatment protocols for pelvic floor rehabilitation of patients with defecation disorders.

Different perception of chronic constipation between patients and gastroenterologists.

Background: There is a certain number of subjects that consider themselves to be constipated (self diagnosed constipation; SDC). The Rome Criteria separate FC from IBS-C, but some SDC patients do not meet the Rome criteria (no Rome Constipation; NRC). Our aims were to evaluate the percentage of SDC subjects with a diagnosis of FC and IBS-C and to compare demographic and clinical features, symptoms, and quality of life in the different SDC groups (FC, IBS-C, NRC).

Chronic constipation diagnosis and treatment evaluation: the "CHRO.CO.DI.T.E." study.

Background: According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy.

Diagnosis and treatment of faecal incontinence: Consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists.

Faecal incontinence is a common and disturbing condition, which leads to impaired quality of life and huge social and economic costs. Although recent studies have identified novel diagnostic modalities and therapeutic options, the best diagnostic and therapeutic approach is not yet completely known and shared among experts in this field. The Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists selected a pool of experts to constitute a joint committee on the basis of their experience in treating pelvic floor disorders.

Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment).

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre.

Consensus statement AIGO/SICCR: diagnosis and treatment of chronic constipation and obstructed defecation (part I: diagnosis).

Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at which health care is sought for this condition. The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation. The commission presents its results in a "Question-Answer" format, including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.

The daily diary and the questionnaire are not equivalent for the evaluation of bowel habits.

Background: It is unclear whether questionnaires and diary cards, which are widely used to collect data on bowel habits, provide analogous information.

Aims: We verified the concordance between the data provided by a daily diary and a retrospective questionnaire.

Methods: A 4-week diary (DIARY) concerning bowel habits was compiled by 221 subjects.

Inadequate use of acid-suppressive therapy in hospitalized patients and its implications for general practice.

Acid-suppressive therapy (AST) is largely prescribed in both hospital and general practice setting but few data are available on appropriateness of AST use in hospitalized patients and its fallout on prescribing in general practice. We assessed AST in patients consecutively admitted to an internal medicine department to determine the type and timing of prescription and indication for use according to widely accepted guidelines. Prescriptions were rated as indicated, acceptable, or not indicated.

Self-perceived normality in defecation habits.

Background: Available information on normal bowel habits was mainly gathered by means of telephone interviews or mailed questionnaires.

Aims: We undertook a prospective study to evaluate the defecatory habits in subjects perceiving themselves as normal concerning this function.

Subjects And Methods: A questionnaire (4-week diary with "yes-no" daily answers to six questions concerning bowel habits) was distributed to 204 subjects perceiving their defecation behaviour as normal.

Fecal multiple molecular tests to detect colorectal cancer in stool.

Background & Aims: Evaluation of molecular alterations in fecal DNA is a potential, noninvasive, alternative tool for the detection of colorectal cancer. We analyzed a large panel of molecular alterations involved in tumor transformation and progression to define their single diagnostic contribution in terms of sensitivity, cost, and time required to carry out the different tests.

Methods: DNA was analyzed in stool from 38 healthy individuals and in paired stools and primary lesions from 56 patients with colorectal cancer.

An extended assessment of bowel habits in a general population.

Aim: Bowel habits are difficult to study, and most data on defecatory behaviour in the general population have been obtained on the basis of recalled interview. The objective assessment of this physiological function and its pathological aspects continues to pose a difficult challenge. The aim of this prospective study was to objectively assess the bowel habits and related aspects in a large sample drawn from the general population.

[Andersson's phenomenon in HLA-B27 negative ankylosing spondylitis].

A computed tomography (CT) and conventional radiography study is reported in a case of HLA-B27 negative ankylosing spondylitis. The value of CT in comparison with conventional radiography in evaluation of anatomic alterations is determined.

[Radiologic evaluation of ileal reservoirs. Our experience].

A radiological investigation was performed in 25 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. Radiology was of great value in the demonstration of post-operative complications.

[Male transsexualism and hormonal therapy: radiologic pictures of the breast].

Often the male transsexual takes hormonal drugs, sometimes under medical prescription but most frequently by his personal choice. They wish to obtain a development of mammary gland and the disappearance of hair from facial skin. Prolonged hormonal and incorrect treatments, mainly for too high dosage and absence of association with progesterone, assumption of oestrogens, can cause the growth of mammary tumours.

[Radiological characteristics of primary hyperoxaluria with oxalosis].

Oxalosis is a rare disorder, in which there are widely and evenly spread deposits of oxalate crystals in the kidneys with progressive renal failure. An inborn error of metabolism is the cause of oxalosis. The incidence of this disease in boys and girls is practically equal.

[Role of computerized tomography in Poland syndrome].

A morphological CT study in Poland syndrome is presented. The osteomuscular anomalies of the chest, which are not demonstrated by usual x-Ray, are well defined by CT scans. The usefulness of CT in postoperative controls of muscles transfers is stressed.

[A rare case of sirenomelia. Possibility of prenatal ultrasonic and radiologic diagnosis].

A rare case of sirenomelia malformation in a fetus of 33 weeks is reported. Besides typical fusion of the lower extremities, important alterations of the urogenital system and large intestine are present. A review of the literature on the subject is presented.

[X-ray computed tomography in latero-cervical lymph nodes, clinically undetectable, in preoperative staging of malignant neoplasms of the larynx].

Postoperative CT of the latero-cervical lymph nodes was carried out in 25 patients suffering from laryngeal cancer. The surgically removed lymph nodes themselves were measured and examined histologically. 529/621 removed lymph nodes (about 85%) were recognisable with CT.

[A case of giant lumbar neurinoma].

A rare case of a giant extradural neurinoma of the IV lumbar root with an anterior development and a soft neurological picture is reported. The Authors stress the important role of CT both in the neurinoma diagnosis and in the correct preoperative evaluation of its extension and its relationship with contiguous organs.

[Is it still useful to integrate cholecystography with direct radiography in the cholecystokinetic test?].

There are discordant opinions in literature on the techniques of execution of the cholecystography. The authors have examined 104 consecutive patients with the clinical suspicion of gallstones in order to verify the usefulness of the plain radiogram and of the cholecystokinetic test. All the patients have been studied systematically with the plain radiogram of the hepatic region, with cholecystography completed by cholecystokinetic test and with ultrasound.

Oesophagitis in Italian and Hungarian asymptomatic subjects.

It is known that chronic inflammatory phenomena of the gastric mucosa fairly often occur in asymptomatic subjects. Starting from this fact, the authors decided to investigate possible non-symptomatic oesophageal inflammatory lesions referable to oesophagitis and any other digestive and/or systemic pathology. Furthermore it was also intended to ascertain the possible existence of geographical differences.