1 / 26

The M.F.A.: a new device for an early selection of patients.

The M.F.A.: a new device for an early selection of patients. pp. Piercarlo Meinero M.D . Proctological visit for minor pathologies. Critical point. Negative anamnesis. Positive anamnesis. Routine exames. Other exames. Surgical treatment.

ramona
Télécharger la présentation

The M.F.A.: a new device for an early selection of patients.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The M.F.A.: a new device for an early selection of patients. pp PiercarloMeinero M.D.

  2. Proctologicalvisitfor minor pathologies Criticalpoint Negative anamnesis Positive anamnesis Routine exames Otherexames Surgical treatment

  3. What are the criticalpointsof the proctologicalexamination today? • We can only detect the morphological aspects of the anus and the rectum butnottheirfunctionality. • At present, a devicedoesnotexistthat, already at the first visit, allowsustosupect the presenceofattendantdiseases and alsotopredictpostoperatorycomplications. • Guidelinesdo notexistthatprovidefor the anorectalmanometry in patientswith minor diseases (mucosalrectalprolaps and/or haemorrhoids).

  4. The MeineroMulti-Functional Anoscope (MFA ) pp • It doesn’t replace manometry • Between nothing and manometry • It tests anorectal functionality • Early patients selection • It’s easy and fast to use

  5. pp MFA functions • Rectal Sensation Test (RST) • Balloon Expulsion Test (BET) • Extent of Prolapse Assessment (EPA) • Length Measurement of the Anal Canal (LMAC)

  6. Rectal Sensation Test (RST) FSFirst Sensation DDVDefecatoryDesire Volume MTVMaximum Tolerable Volume The same procedure like the manometry

  7. RST with the MFA: the method 1 2 3 4

  8. FS 30 - 60 DDV 60 - 160 MTV 160 - 270 Rectal sensitivity thresholds NORMAL VALUES FS < 30 DDV < 60 MTV < 160 Rectal sensitivity alterations HYPERSENSITIVITY FS > 60 DDV > 160 MTV > 270 HYPOSENSITIVITY

  9. The RST isimportantbecause… Externalsphincterdisfuncions IBD Faecalincontinence (FI e UFI) Pudendalneuropathy Hypersensitivity First visit Normal ODS IdiopaticFaecalIncontinence (IFI) PuborectalisSyndrome, Dissynergy SolitaryUlcer-Megarectum. Hyposensitivity Marc A. Gladman, M.R.C.O.G., M.R.C.S. (Eng), S. Mark Scott, Ph.D., Christopher L.H. Chan, F.R.C.S., Norman S. Williams, M.S., F.R.C.S., Peter J. Lunniss, M.S., F.R.C.S.: “Rectal Hyposensitivity. Prevalence and Clinical Impact in Patients With Intractable Constipation and Fecal Incontinence” D.C.R. 2003 Vol.46, N° 2:238-246. Christopher L.H. Chan, F.R.C.S., S. Mark Scott, Ph.D., Norman S. Williams, F.R.C.S., Peter J. Lunnis, F.R.C.S.“Rectal Hypersensitivity Worsens Stool Frequency, Urgency and Lifestyle in Patients With Urge Fecal Incontinence”. D.C.R. 2005 Vol. 48, N°1: 134-140.

  10. RST: the references EmanuelChrysos, M.D., Ph.D., Elias Athanasakis, M.D., John Tsiaoussis, M.D., Ph.D., OdysseasZoras, M.D., Ph.D., AntoniosNickolopoulos, M.D., JohoSophoclesVassilakis, M.D., Ph.D., EvaghelosXynos, M.D., Ph.D., F.A.C.S.: “RectoanalMotility in Crohn’s DiseasePatients”. D.C.R. 2001 Vol.44, N° 10: 1509-1513. TetsuoYamana, M.D., MasatoshiOya, M.D., JunjiKomatsu, M.D., YasuoTakase, M.D., NoboruMikuni, M.D., Hiroshi Ishikawa, M.D.: “PreoperativeAnalSphincter High Pressure Zone, MaximumTolerable Volume and AnalMucosalElectrosensitivityPredictEarlyPostoperativeDefecatoryFunctionAfter Low AnteriorResectionforRectalCancer”.D.C.R. 1999 Vol.42 N° 9: 1145-1151. Gloria Lacima, M.D., Miguel Pera, M.D., JosepValls-Solé, M.D., XavierGonzales-Argenté, M.D., MontserratPuig-Clota, M.D.: “ElectrophysiologicStudies and ClinicalFindings in FemalesWithCombinedFecal and UrinaryIncontinence: A prospectiveStudy”. D.C.R. 2006 Vol. 49 N° 3: 353-359. Paul Broens, M.D., DirkVanbeckevoort, M.D., Erwin Bellon, M.Sc., freddyPenninckx, M.D., Ph.D.: “CombinedRadiologic and ManometricStudyofRectalFillingSensation”. D.C.R. 2002 Vol. 45 N° 8: 1016-1022. M.J. Gosselink, M.D., Ph.D., W.R. Schouten, M.D., Ph.D.: “Rectal Sensory Perception in Females with Obstructed Defecation”. D.C.R.2001 Vol. 44 N° 9: 1337-1344. M.D. Crowell, Ph.D., B.E.Lacy, M.D., Ph.D., V.A.Schettler, B.S.N., T.N.Dineen, M.D., K.W.Olden, M.D., N.J. Talley, M.D., Ph.D.: “SubtypesofAnalIncontinenceAssociatedWithBowelDysfunction: Clinical, Physiologic, and PsychosocialCharacterization”. D.C.R. 2004 Vol. 47 N° 10 : 1627-1635.

  11. 2) Balloon Expulsion Test by MFA (BET) 60 cc of air – Sitting position – MaximumExpulsionTime 60 sec.

  12. 3) Extent of Prolapse Assessment (EPA) • Without the anoscope • 150-160 cc of air • Traction during the squeeze • Perineal information • Vaginal exploration

  13. 4) Length Measurement of the Anal Canal (LMAC) It is possible thanks to graduated scale in centimeters. Useful in case of operation for faecal incontinence. It can predict the biofeedback failure in the cases of anismus. Poong-Lyul Rhee, M.D., Moon SeokChoi, M.D., Young Ho Kim, M.D., Hee Jung Son, M.D., Jae Jun Kim, M.D., KwangCheolKoh, M.D., SeungWoon Paik, M.D., JongChul Rhee, M.D., Kyoo Wan Choi, M.D.:“An Increased Rectal Maximum Tolerable Volume and Long Anal Canal Are Associated with Poor Short-Term Response to Biofeedback Therapy for patients with Anismus with Decreased Bowel Frequency and Normal Colonic Transit Time”.D.C.R. 2000 Vol. 43 N° 10: 1405-1411.

  14. Myownstudy: 218 patientsJan. 2006 / Sept. 2008 189 patients: 128 PMRE; 61 ODS Todemostratethat: • The rectal sensitivity thresholds are the same with MFA and anorectalmanometry. • The RST alterated values, detected with the MFA during the first visit, could be an expression of attendant diseases and they could predict post-operatory complications.

  15. FS DDV First aim. The correlation on the threeparametersrelatedto the measuresdetectedwith MFA and manometry, isvery high(R=Pearson’s correlationcoefficient). ByBiostatisticUnitoftha Genova University – DoctorMariapiaSormani. Rectal sensitivity thresholds are the same if detected with MFA or anorectalmanometry (R = 0,99 p<0,001). MTV

  16. Identification of patients with hyper or hyposensitivity Total RST

  17. DiagnosticAssessment (US, EMG, PNTML, Defecography, Coloscopy, Manovolumetry)

  18. Surgical treatment selectionof the 189 patientsof the first group

  19. Complication: the urgency (DU) thatresolvesitselfwithinthreeweekswithoutconsequences Temporary (TU) that continues up to three months but also resolves itself without consequences Permanent (PU) UD that lasts more than three months and shows itself in an increase of the daily evacuations but the urgency decreases or disappears completely. Severe (SU)

  20. OR correlationbetweenrectalhypersensitivity and Urgency OR: OddsRatioCI: ConfidentialInterval Thereisanimportantcorrelationbetweenhypersensitivity and PermanentUrgency (p=0.02), betweenhypersensitivity and Severe Urgency (p=0.01) and not so importantbetweenhypersensitivity and TemporaryUrgency (p=0.07). As a whole the correlationbetweenHypersensitivity and Urgencyisasbolutelysignificant (p> 0,001)

  21. MFA test plan + -

  22. Conclusions The use of the MFA at the first proctological visit allows: • To perform Rectal Sensation Test in case of minor pathologies, too; • To suspect attendant diseases; • To foresee postoperatory complications; • To avoid hurried surgical decisions; • To assess the correct prolapse extent; • To foresee biofeedback results.

  23. MFA COURSES Ifyou are interested in attendingsuchcoursespleaseget in touchwith the Sapi-Med stand.

  24. MyFamily

  25. Thankyouallforyourattention.

More Related