JOSE MARCIO NEVES JORGE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Role of radiation in rectal cancers(2015) HABR-GAMA, A.; JORGE, J. M. N.; BUSTAMANTE-LOPEZ, L. A.The management of rectal cancer has dramatically improved during the last two decades and therapeutic decisions should now be individualized and based on a multidisciplinary approach, involving radiation oncologists, medical oncologists, diagnostic radiologists, surgeons, pathologists, and primary care physicians. The benefits of preoperative chemoradiotherapy include downsizing, downstaging, improved sphincter-preservation rates, and reduced local recurrence. In addition, complete pathological response is possible in a significant percentage of patients. The combination of neoadjuvant radiotherapy and total mesorectal excision may result in significant long-term adverse effects, including sexual and anorectal sphincter dysfunction. This should be taken into account during selection of patients for radiotherapy. In addition, ongoing trials are addressing quality of life issues with modern radiation techniques and newer chemotherapeutic agents. © Springer Science+Business Media, LLC 2015.
- Prospective Multicenter Trial Comparing Echodefecography With Defecography in the Assessment of Anorectal Dysfunction in Patients With Obstructed Defecation(2011) REGADAS, F. Sergio P.; HAAS, Eric M.; ABBAS, Maher A.; JORGE, J. Marcio; HABR-GAMA, Angelita; SANDS, Dana; WEXNER, Steven D.; MELO-AMARAL, Ingrid; SARDINAS, Carlos; LIMA, Doryane M.; SAGAE, Evaldo U.; MURAD-REGADAS, Sthela M.BACKGROUND: Defecography is the gold standard for assessing functional anorectal disorders but is limited by the need for a specific radiologic environment, exposure of patients to radiation, and inability to show all anatomic structures involved in defecation. Echodefecography is a 3-dimensional dynamic ultrasound technique developed to overcome these limitations. OBJECTIVE: This study was designed to validate the effectiveness of echodefecography compared with defecography in the assessment of anorectal dysfunctions related to obstructed defecation. DESIGN: Multicenter, prospective observational study. PATIENTS: Women with symptoms of obstructed defecation. SETTING: Six centers for colorectal surgery (3 in Brazil, 1 in Texas, 1 in Florida, and 1 in Venezuela). INTERVENTIONS: Defecography was performed after inserting 150 mL of barium paste in the rectum. Echodefecography was performed with a 2050 endoprobe through 3 automatic scans. MAIN OUTCOME MEASURES: The kappa statistic was used to assess agreement between echodefecography and defecography in the evaluation of rectocele, intussusception, anismus, and grade III enterocele. RESULTS: Eighty-six women were evaluated: median Wexner constipation score, 13.4 (range, 6-23); median age, 53.4 (range, 26-77) years. Rectocele was identified with substantial agreement between the 2 methods (defecography, 80 patients; echodefecography, 76 patients; kappa = 0.61; 95% CI = 0.48-0.73). The 2 techniques demonstrated identical findings in 6 patients without rectocele, and in 9 patients with grade I, 29 with grade II, and 19 patients with grade III rectoceles. Defecography identified rectal intussusception in 42 patients, with echodefecography identifying 37 of these cases, plus 4 additional cases, yielding substantial agreement (kappa = 0.79; 95% CI = 0.57-1.0). Intussusception was associated with rectocele in 28 patients for both methods (kappa = 0.62; 95% CI = 0.41-0.83). There was substantial agreement for anismus (kappa = 0.61; 95% CI = 0.40-0.81) and for rectocele combined with anismus (kappa = 0.61; 95% CI = 0.40-0.82). Agreement for grade III enterocele was classified as almost perfect (kappa = 0.87; 95% CI = 0.66-1.0). LIMITATIONS: Echodefecography had limited use in identification of grade I and II enteroceles because of the type of probe used. CONCLUSIONS: Echodefecography may be used to assess patients with obstructed defecation, as it is able to detect the same anorectal dysfunctions found by defecography. It is minimally invasive and well tolerated, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved in defecation.
- Effects of radiation therapy for rectal cancer on anorectal function(2015) JORGE, J. M. N.; HABR-GAMA, A.; BUSTAMANTE-LOPEZ, L. A.Regardless of whether adjuvant or neoadjuvant radiotherapy is used, pelvic irradiation adversely affects anorectal function. Although survival remains the primary goal in treatment, maintaining adequate anal continence is necessary for good quality of life. Radiation damages to the internal anal sphincter and the myenteric cells are frequently seen. Other mechanisms of continence affected by radiotherapy include decreased stool consistency, impaired rectal capacity, and decreased anorectal sensation. These adverse effects are associated with an increasing indication of sphincter-preserving operations, and demand for improved radiation techniques and more favorable postoperative functional results. Symptoms of urgency and fecal incontinence are common after anterior resection with or without neoadjuvant chemoradiotherapy, but generally resolve within the first 2 years after surgery. In patients with persistent symptoms of fecal incontinence, conservative therapy including biofeedback should be offered. © Springer Science+Business Media, LLC 2015.