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
5 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.
- 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.
- 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.
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.- Pelvic floor anatomy(2022) JORGE, Jose Marcio N.; BUSTAMANTE-LOPEZ, Leonardo A.The pelvic floor is a complex mechanical apparatus composed by the levator ani, superficial perineal muscles, pelvic nerves, endopelvic fascia, and ligaments. The pelvic anatomy is somewhat challenging to both surgeons and anatomists. It is a narrow and deep region that encompasses intestinal, gynecologic, and urologic viscera, vessels, nerves, and fascial attachments. It is designed for content suspension and to promote coordinated action during bladder and rectal emptying. Support for the pelvic organs originates from connections to the pelvis and associated muscles. The pelvic muscles encompass five groups: levator ani, anal sphincter complex, pelvic sidewall, and anterior perineal muscles. Damage to structural and functional interactions of the pelvic floor can potentially lead to multi-compartmental dysfunction. Also, debilitating pelvic floor disorders such as pelvic organ prolapse and incontinence are usually related to injuries and deterioration of muscles, nerves, and ligaments that support and maintain normal pelvic function. The anorectum and pelvic floor are interconnected by the fascia and ligaments, which provide support for endopelvic viscera. In females, the pelvic floor is considered part of the birth canal and stretching and tearing of these structures during vaginal delivery are often underestimated causes of pelvic floor dysfunction. In addition, pelvic floor function can be affected by variation in bowel habits, particularly chronic excessive straining. Understanding pelvic floor anatomy is essential to fully diagnose and adequately treat these dysfunctions.