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
7 resultados
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- Are Obese Patients at an Increased Risk of Pelvic Floor Dysfunction Compared to Non-obese Patients?(2017) CORREA NETO, Isaac Jose Felippe; PINTO, Rodrigo Ambar; JORGE, Jose Marcio Neves; SANTO, Marco Aurelio; BUSTAMANTE-LOPEZ, Leonardo Alfonso; CECCONELLO, Ivan; NAHAS, Sergio CarlosFactors associated with increased intra-abdominal pressure such as chronic cough, morbid obesity, and constipation may be related to pelvic floor dysfunction. In this study, we compared anorectal manometry values and clinical data of class II and III morbidly obese patients referred to bariatric surgery with that of non-obese patients. We performed a case-matched study between obese patients referred to bariatric surgery and non-obese patients without anorectal complaints. The groups were matched by age and gender. Men and nulliparous women with no history of abdominal or anorectal surgery were included in the study. Anorectal manometry was performed by the stationary technique, and clinical evaluation was based on validated questionnaires. Mean age was 44.8 +/- 12.5 years (mean +/- SD) in the obese group and 44.1 +/- 11.8 years in the non-obese group (p = 0.829). In the obese group, 65.4% of patients had some degree of fecal incontinence. Mean squeeze pressure was significantly lower in obese than in non-obese patients (155.6 +/- 64.1 vs. 210.1 +/- 75.9 mmHg, p = 0.004), and there was no significant difference regarding mean rest pressure in obese patients compared to non-obese ones (63.7 +/- 23.1 vs. 74.1 +/- 21.8 mmHg, p = 0.051). There were no significant differences in anorectal manometry values between continent and incontinent obese patients. The prevalence of fecal incontinence among obese patients was high regardless of age, gender, and body mass index. Anal squeeze pressure was significantly lower in obese patients compared to non-obese controls.
- CONSTIPATION SCORING SYSTEM VALIDATED FOR THE PORTUGUESE LANGUAGE (ÍNDICE DE GRAVIDADE DA CONSTIPAÇÃO INTESTINAL): IS IT RELIABLE IN ASSESSING THE SEVERITY OF INTESTINAL CHRONIC CONSTIPATION IN OUR POPULATION?(2023) FROEHNER JUNIOR, Ilario; JORGE, Jose Marcio Neves; MARQUES, Carlos Frederico Sparapan; SANTOS, Vera Lucia Conceicao de Gouveia; JUKEMURA, JoseBACKGROUND: There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS: To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS: Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS: Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS: The Constipation Scoring System (indice de Gravidade da Constipacao Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.
- Constipation: Prevalence and Associated Factors in Adults Living in Londrina, Southern Brazil(2016) SCHMIDT, Fernanda Mateus Queiroz; SANTOS, Vera Lucia Conceicao de Gouveia; DOMANSKY, Rita de Cassia; NEVES, Jose Marcio JorgeThe aims of this study were to estimate the prevalence of constipation and identify associated factors among adults living in an urban area in Londrina, Brazil. This was a secondary analysis of an epidemiological, population-based study on bowel habit performed in 2008 with 2,162 individuals selected through cluster sampling. Interviews were administered using a sociodemographic questionnaire and the adapted and validated Brazilian version of the ""Bowel Function in the Community"" tool. Variables from the original database were used to determine the prevalence of constipation (according to the Rome Criteria III) and associated factors. The chi-square test and multivariate logistic regression were used for data analysis. The overall prevalence of constipation (14.6%; n = 315) was higher among women than among men (21.9% vs. 5.3%), increased with age among men, and was inversely related to family income. Overall, female gender, low socioeconomic status, history of anal fi ssure, anorectal surgery, stroke, nervous system disease, fi stulae, and hemorrhoids were factors signifi cantly associated with constipation. The variables low social economic status, stroke, anal fi ssure history, and anorectal surgery were statistically signifi cant in all three tested statistical models.
- 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.
conferenceObject DO MORBID OBESE PATIENTS HAVE MORE CLINICAL AND MANOMETRIC PLEVIC FLOOR ABNORMALITIES IN COMPARISON TO NONOBESE PATIENTS? RESULTS OF A CASE-MATCHED STUDY(2015) CORREA NETO, I.; PINTO, R.; NAHAS, S.; JORGE, J.; BUSTAMANTE-LOPEZ, L.; NAHAS, C.; MARQUES, C. Sparapan; CECCONELLO, I.- Self-reported Fecal Incontinence in a Community-Dwelling, Urban Population in Southern Brazil(2014) SANTOS, Vera Lucia Conceicao de Gouveia; DOMANSKY, Rita de Cassia; HANATE, Cintia; MATOS, Danilo Soares; BENVENUTO, Carla Virginia Cordeiro; JORGE, Jose Marcio NevesPURPOSE: To assess the prevalence of self-reported fecal incontinence (FI) in a sample of community-dwelling adults residing in an urban area of southern Brazil. The study also aimed to determine the demographic and clinical factors associated with FI. DESIGN: This secondary data analysis used an exploratory, descriptive, and cross-sectional design to guide data collection and analysis. SUBJECTS AND SETTING: Two thousand one hundred sixty-two adults, including 1203 women (55.6%) and 979 men with a mean age of 40.6 years, were randomly selected from 390 census tracts in the city of Londrina (Parana, Brazil) using a stratified cluster sampling design. METHODS: Subjects were interviewed; the instrument was the culturally adapted and validated Brazilian-Portuguese version of the Bowel Function in the Community. Statistical analysis was performed using the Pearson chi-square test, the Fisher exact test, and forward stepwise logistic regression analysis. RESULTS: The prevalence of FI was 3.6% (n= 77; women 4%; men 3%); 70.1% (54/77) of the participants with FI reported liquid stool incontinence. Predictors of FI were aged between 40 and 60 years, anal fissure, previous colorectal or urogynecologic surgery, neurological diseases, cerebral vascular accident, and diarrhea or constipation. CONCLUSION: Our results revealed prevalence rates smaller than those reported in the Brazilian and international literature. The study broadens the knowledge on the epidemiology of FI in Brazil and the world. These results may be used to guide the implementation of public health policies for the prevention and early diagnosis of FI.
- Influence of perineal prostatectomy on anal continence(2011) GUILGER, Nadia Ricci; JORGE, Jose Marcio Neves; COSTA, Renato Prado; SALLA, Fernando Cesar; TEIXEIRA, Magaly Gemio; NAHAS, Sergio Carlos; CECCONELLO, IvanOBJECTIVE: Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy. METHODS: From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry. RESULTS: The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean +/- standard deviation) values were 0.9 +/- 1.9 and 0.7 +/- 1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64 +/- 23 mmHg and 65 +/- 17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130 +/- 41 mmHg and 117 +/- 40 mmHg (p = 0.259), High Pressure Zones of 3.0 +/- 0.9 cm and 2.7 +/- 0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76 +/- 25 ml and 71 +/- 35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157 +/- 48 ml and 156 +/- 56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4 +/- 9% and 14.4 +/- 5% (p = 0.003). CONCLUSION: There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.