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1
Content available remote Treatment of Perianal Fistulas in Poland
100%
EN
A perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management. The aim of the study was to determine the current condition of perianal fistula treatment methods in everyday surgical practice, considering members of the Society of Polish Surgeons. Material and methods. 1523 members of the Society of Polish Surgeons received an anonymous questionnaire comprising 15 questions regarding perianal fistula treatment in everyday practice. Results. Results were obtained from 807 (53%) members. After receiving answers, questionnaire results were collected, analysed, and presented in a descriptive form. Conclusions. Study results showed that most Polish surgeons choose the fistulectomy/fistulotomy method. Considering treatment of perianal fistulas the most important issue is to find the correct, primary fistula canal. Further methods should be individually selected for each patient. One should also remember that every fistula is different. Surgical departments that operate a small number of perianal fistulas should direct such patients to reference centers.
2
Content available Treatment of perianal fistulas in Po
100%
EN
A perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management. The aim of the study was to determine the current condition of perianal fistula treatment methods in everyday surgical practice, considering members of the Society of Polish Surgeons. Material and methods. 1523 members of the Society of Polish Surgeons received an anonymous questionnaire comprising 15 questions regarding perianal fistula treatment in everyday practice. Results. Results were obtained from 807 (53%) members. After receiving answers, questionnaire results were collected, analysed, and presented in a descriptive form. Conclusions. Study results showed that most Polish surgeons choose the fistulectomy/fistulotomy method. Considering treatment of perianal fistulas the most important issue is to find the correct, primary fistula canal. Further methods should be individually selected for each patient. One should also remember that every fistula is different. Surgical departments that operate a small number of perianal fistulas should direct such patients to reference centers.
EN
Introduction. The development of perianal fistulas are a risk factor in colonic and rectal disease. Perianal CD treatment requires a combination of surgical and therapeutic treatments aimed to prevent septic complications, reduce fistula discharge and ultimately heal fistulas. Aim. The purpose of the study was to evaluate the efficacy and safety of biosimilar IFX (CT-P13) and adalimumab in active fistulizing perianal Crohn’s disease (CD) in patients from the Subcarpathian Region (South-Eastern Poland). Material and methods. Thirty patients with CD with perianal fistulas naïve to anti-TNF therapy were enrolled (13 females/ 17males) ranging from 18 to 64 years of age. Twenty-one were treated with biosimilar infliximab (CT-P13), nine were treated with adalimumab (ADA). The treated patients had ileal CD (4), ileo-colonic CD (13) or colonic CD (13). All of them received standard immunosuppression with no additional steroid therapy. Response was evaluated at week 16 and 40 after the first CT-P13 dose, and 16 and 40 weeks after the first ADA dose. Remission was defined as the complete closure of all fistulas and partial response as a reduction (≥50%) in the number of draining fistulas. Results. Treatment outcomes with CT-P13 and ADA were both effective and similar in the percentage of patients with perianal fistula improvement, perianal fistula remission, no effect or observed adverse events. Conclusion. In patients with active fistulizing CD, both CT-P13 and ADA were effective and safe, however a slight superiority of CT-P13 was visible
EN
Treatment of perianal fistulizing Crohn’s disease is demanding and burdened with a high percentage of failures, which forces clinicians to search for new, more effective therapeutic options. One of these options is the use of adipose-derived mesenchymal stem cells in local administration. Due to their multipotentiality and complex mechanism of action, stem cells are the promising new therapeutic approach for the treatment-refractory complex perianal fistulas – demonstrating both high efficacy and a favorable safety profile. The paper presents current knowledge on the mechanisms of action and manner of administration of mesenchymal stem cells, as well as the effectiveness and safety of their use in the treatment of perianal Crohn’s disease based on available literature.
EN
Perirectal fistulas in the course of Crohn’s disease (CD) constitute an important problem in this group of patients. They are observed in a vast majority of patients with involvement through colorectal inflammation. Perirectal fistulas in CD present a great diagnostic and therapeutic challenge due to the intensified clinical symptoms and worse prognosis than in the case of crypt originating fistulas. The condition for implementation of effective treatment of perirectal fistulas in the course of CD is the correct diagnosis, defining the anatomy of fistulas, presence of potential stenoses and inflammation in the gastrointestinal tract. Treatment of these fistulas is difficult and requires close cooperation between the colorectal surgeon and the gastroenterologist. The combination of surgical and pharmacological treatment has higher efficacy compared to surgical treatment or pharmacotherapy alone. In conservative treatment, aminosalicylates and steroids are of minor importance, while chemotherapeutics, antibiotics, and thiopurines find application in daily clinical practice. TNF-α neutralizing antibodies such as infliximab (IFX), adalimumab (ADA) or certolizumab (CER) prove to be the most effective. Surgical treatment may be provided as ad hoc; in this case, drainage procedures are recommended, usually with leaving a loose seton. Planned procedures consist in the excision of fistulas (simple fistulas) or performing more complex procedures, such as advancement flaps or ligation of the intersphincteric fistula tract Surgical measures can be complemented by the use of video technology (video-assisted anal fistula treatment VAAFT) or vacuum therapy. In extreme cases, it may be necessary to create the stoma. Treatment of perirectal fistulas includes adhesives or so-called plugs. High hopes may be associated with the introduction of stem cells into clinical practice, which is the administration of non-hematopoietic multipotent cells to the fistulas to induce the phenomenon of immunomodulation and tissue healing.
PL
Praca poświęcona jest przedstawieniu własnych doświadczeń w leczeniu przetok okołoodbytniczych w Katedrze i Oddziale Klinicznym Chirurgii Ogólnej i Gastroenterologicznej ŚUM w Bytomiu w latach 2006-2009. Prezentowane są w niej trudności w leczeniu przetok, wielość ich postaci, stosowane zabiegi operacyjne, przyczyny niepowodzeń w leczeniu chirurgicznym przetok oraz czynniki decydujące o powodzeniu leczenia. Wyniki oparte są na analizie 56 operacji przetok okołoodbytniczych u 45 mężczyzn w wieku średnio 49,98(+/-14,5) lat i 11 kobiet średnia wieku 50,28(+/-13,51) lat. Z grupy wyłączono chorych leczonych z powodu przetok okołoodbytniczych w przebiegu choroby Leśniowskiego-Crohna (3 osoby).
EN
The paper presents the author's experience in the treatment of anal fistulas at the Faculty and Clinical Department of General and Gastroenterological Surgery, Silesian University of Medicine in Bytom during the years 2006-2009. The following problems are presented: difficulties in treating fistulas, the multiplicity of their forms, the surgical procedures performed, the main causes of failures in surgical treatments and the factors determining success in treatment. The results are based on the analysis of 56 operations of anal fistulas performed on 45 men at the mean age of 49.98 (+/-14,5) years and 11 women, at the mean age of 50.28 (+/-13.51) years. Three patients were excluded from the group due to anal fistulas that resulted in the course of Crohn's disease.
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