Rectal–vaginal pressure gradient in patients with pelvic organ prolapse and symptomatic rectocele

Objective The aim of this study is to examine the relationship between rectal–vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP). Method Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016–2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient. Results A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal–vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm H2O) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm H2O, p < 0.001), and patients without rectocele (17.1 ± 9.2 cm H2O, p < 0.001). Conclusion The rectal–vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal–vaginal pressure gradient of > 27.5 cm H2O was suggested as the cut-off point of the elevated pressure gradient.

Endoparasites of donkeys (Equus asinus) used in commercial skin exploitation in the Northeast of Brazil

The present study identified the main endoparasites present in donkeys (Equus asinus) used in skin exploitation located in Cando municipality, Bahia State, Northeast of Brazil. The samples were collected from September 2019. Feces were collected from the rectal ampulla of 34 animals, macroscopically visualized for parasitic forms, and microscopically evaluated to identify endoparasites forms using the McMaster method. Parasitological results were associated with sex, age, and bodyweight Stata Corp LLC 14. Endoparasites were found in 82.3% of the animals, with the egg count ranging from 50 to 1050 eggs per gram (EPG). The sole presence of superfamily Trichostronglylidae was observed in 67.6% of the donkeys, in 8.8% co-infected by Trichostronglylidae and Eimeria spp., while Trichostronglylidae and Strongyloides westeri was detected in 2.9%, and simultaneous infection by Trichostronglylidae, Strongyloides westeri, and Oxyuris equi was observed in 2.9%. The occurrence of parasitic infections varies according to nutritional status, age, sex, and environmental exposure (p>0.05). A high occurrence of infection was observed in young animals and those with lower body weight.

LATE ANASTOMOTIC LEAKAGE AFTER ANTERIOR RESECTION OF THE RECTUM

We analyzed literature data and our results of treatment of 37 patients with cancer of the middle and lower rectal ampulla (Т2-4аN0-2М0) who underwent low anterior resection of the rectum with colorectal anastomosis. The purpose of the study was to reveal characteristics of late colorectal anastomotic leakage. The results demonstrated differences in the clinical course of early and late colorectal anastomotic leakage, the site of anastomotic defect, anastomosis characteristics and the need for repeat surgery. There were some pathogenetic aspects distinguishing early and late anastomotic leakage, such as technical problems in early leakage and association with preoperative radiotherapy in late anastomotic leakage. Conclusions: timely diagnostics of microleakage of colorectal anastomosis will allow changing the further tactics of the patient management and avoiding the manifestation of late anastomotic leakage.

Cryptosporidium spp. infection in mares and foals of the northwest region of São Paulo State, Brazil

The present study aimed to analyze the occurrence of infection by Cryptosporidium spp. in mares and their respective foals. This study was carried out in 11 farms located in the municipalities of Araçatuba, Birigui, Guararapes and Santo Antônio do Aracangua, in the northwest region of the State of Sao Paulo, from November 2010 to March 2011. A total of 98 mares and 98 foals of several breeds were analyzed; among foals, 59 were males and 39 females, aged from three to 330 days. Feces were collected directly from the rectal ampulla, purified and processed according to modified Kinyoun stain. Occurrence of Cryptosporidium spp. was 21.4% (21/98) for foals and 18.4% (18/98) for mares. Occurrence of Cryptosporidium spp. had significant association with breeds and age of animals. Results obtained led to the conclusion that foals older than two months and Mangalarga animals are less susceptible to the occurrence of Cryptosporidium spp.

Standardization of transrectal ultrasound-guided biopsy

Ultrasound-guided biopsy is more sensitive to biopsy performed under the digital control, because 29% of prostatic cancers are not palpable. On the other hand, at least 30% of cancers are isoechogenic, so they cannot be viewed by transrectal ultrasound examination. It means that target biopsy is not sufficient for diagnosis of localized prostatic cancer, i.e., randomized samples are needed as well. More than ten years ago, the technique of sampling the six specimens became a standard procedure to which previously harvested target specimens from suspected growths were added. Today, the expansion of biopsy protocol is recommended, by obtaining the additional specimens from peripheral lateral area, four plus two samples if the prostate has volume over 50 ml. Larger number of biopsies requires anesthesia. In order to reduce complication, the cleaning of rectal ampulla and prophylactic use of quinolone are suggested.

Idiopathic Disorders of Fecal Continence in Children

A group of 176 patients aged 2 to 15 years was investigated for idiopathic disorders of bowel function other than Hirschsprung's disease. Anorectal motility, as well as colorectal transit of radiopaque markers, were investigated. Before the end of the first month of life, 70 of the patients were constipated. Resting pressure was more unstable (P &lt; 0.001) and higher than normal in the rectal ampulla and upper anal canal (P &lt; 0.01). Retardation of markers occurred in the proximal and/or distal large bowel of 61% of the patients. The existence of functional abnormalities was demonstrated in the majority of children with idiopathic disorders of fecal continence.

Foreign Bodies in the Rectum: A Review

Foreign bodies which lodge above the anal sphincter mechanism may arrive from one of two portals of entry, the mouth or the anal canal. Ingestion of a foreign body is usually unknown to the patient, who presents with symptoms due to impaction and minor injury to the rectal ampulla or anal canal. The patient may have severe anal pain or sepsis associated with the foreign body. The diagnosis is usually obvious on examination under an anaesthetic, but before this there may be a difficult diagnostic problem. Foreign bodies passed into the rectum through the anal sphincter are more common and show an extreme variety. The reasons for insertion are discussed. Management of the problem includes extraction of the foreign body and the recognition and treatment of any associated injury, both extraperitoneal and intraperitoneal. Minor extraperitoneal injuries may be treated expectantly, but in all intraperitoneal and major extraperitoneal injuries laparotomy and colostomy are required. It is stressed that most foreign bodies can be removed transanally, and laparotomy to remove the foreign body is rarely required.

Functional Evaluation of the Rectal Ampulla with Ampullometrogram

An ampullometrogram (AMG) was done in 20 patients to evaluate the rectal ampulla as a functional unit. Results were compared to a cystometrogram (CMG). The AMG displayed a normal curve (capacity 230 to 330 ml; pressure 47 to 80 cmH2O) in 14 of 16 patients having a normal CMG. The AMG was hyporeflexic (variable capacity; no increase in pressure at capacity) in 3 of 5 patients having a hyporeflexic CMG and hyperreflexic (capacity less than 175 ml, pressure over 80 cmH2O) in one patient having a hyperreflexic CMG. This technique might represent a useful clinical adjunct in the evaluation of bladder dysfunction, the evaluation of neurogenic type bowel dysfunction, and in the possible use of functional electrical stimulation for treatment of faecal incontinence or constipation.