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1

Artificial anal sphincter  

Microsoft Academic Search

PURPOSE: This study was undertaken to evaluate the use of a fully implanted artificial anal sphincter for management of severe fecal incontinence. METHODS: An artificial anal sphincter was implanted in 12 patients who failed conventional management for severe fecal incontinence. Careful patient follow-up was recorded during a mean 58-month follow-up. Patients underwent preoperative and postoperative manometric assessment. Functional and patient

W. Douglas Wong; Linda L. Jensen; David C. C. Bartolo; David A. Rothenberger

1996-01-01

2

Obstetric anal sphincter lacerations  

Microsoft Academic Search

OBJECTIVE:To estimate the frequency of obstetric anal sphincter laceration and to identify characteristics associated with this complication, including modifiable risk factors.METHODS:A population-based, retrospective study of over 2 million vaginal deliveries at California hospitals was performed, using information from birth certificates and discharge summaries for 1992 through 1997. We excluded preterm births, stillbirths, breech deliveries, and multiple gestations. The main outcome

Victoria L Handa; Beate H Danielsen; William M Gilbert

2001-01-01

3

Postpartum anal sphincter dysfunction  

Microsoft Academic Search

Faecal incontinence presents with a female to male ratio of 8:1 suggesting childbirth as the principal causative factor, although most women do not become symptomatic until after menopause. Obstetric injury may arise as a result of direct muscular damage to the anal sphincter, as occurs during a third-degree tear, and\\/or may be the result of cumulative damage to the pudendal

M. Fitzpatrick; C. O’Herlihy

1999-01-01

4

External anal sphincter function in spinal patients  

Microsoft Academic Search

Six patients with complete transection of the spinal cord and six healthy volunteers were examined by using anorectal manometry together with electromyographic (EMG) recording of the external anal sphincter composed of striated muscle. Anal pressure and EMG activity of the external anal sphincter were continuously-recorded at rest and during gradual rectal distention (10, 20, 30, 40, and 50 ml) by

J. Weber; F. Beuret-Blanquart; P. Ducrotte; J. Y. Touchais; P. Denis

1991-01-01

5

Evaluation of obstetric anal sphincter injury  

Microsoft Academic Search

Faecal incontinence presents with a female to male preponderance of 8:1 consistent with vaginal delivery as the principal causative factor. It results in serious social and psychological morbidity. Anal sphincter dysfunction following vaginal delivery generally results from direct muscular damage to the anal sphincter and\\/or cumulative damage to the pudendal nerves. Increasing attention is being focused on this relatively common

Rhona Mahony; Conor O'Brien; Colm O'Herlihy

2001-01-01

6

Should we care about the internal anal sphincter?  

PubMed

The internal anal sphincter is currently regarded as a significant contributor to continence function. Four physiological and morphological aspects of the internal anal sphincter are presented as part of the current evidence base for its preservation in anal surgery. 1) The incidence of continence disturbance following deliberate internal anal sphincterotomy is underestimated, although there is presently no prospective imaging or physiologic data supporting the selective use of sphincter-sparing surgical alternatives. 2) Given that the resting pressure is a measure of internal anal sphincter function, its physiologic representation (the rectoanal inhibitory reflex) shows inherent differences between incontinent and normal cohorts which suggest that internal anal sphincter properties act as a continence defense mechanism. 3) Anatomical differences in distal external anal sphincter overlap at the point of internal anal sphincter termination may preclude internal anal sphincter division in some patients where the distal anal canal will be unsupported following deliberate internal anal sphincterotomy. 4) internal anal sphincter-preservation techniques in fistula surgery may potentially safeguard postoperative function. Prospective, randomized trials using preoperative sphincter imaging and physiologic parameters of the rectoanal inhibitory reflex are required to shape surgical decision making in minor anorectal surgery in an effort to define whether alternatives to internal anal sphincter division lead to better functional outcomes. PMID:22156875

Zbar, Andrew P; Khaikin, Marat

2012-01-01

7

Anal sphincter imaging in fecal incontinence using endosonography  

Microsoft Academic Search

Clinical anal examination, manometry (resting and squeeze pressures), and single-fiber electromyography were compared with endosonography of the anal sphincters in 14 patients with fecal incontinence. Technical aspects of the procedure and normal imaging of the puborectal muscle and both sphincters were defined. Defects in both sphincters were seen in nine patients. The defect is visualized as a clear discontinuity in

M. A. Cuesta; S. Meijer; E. J. Derksen; H. Boutkan; S. G. M. Meuwissen

1992-01-01

8

[The treatment of postoperative anal sphincter insufficiency].  

PubMed

Postoperative anal sphincter insufficiency was revealed in 94 patients, ageing 14-64 yrs. Surgical treatment was conducted in 80 of them: sphincteroplasty--in 29, sphincterolevatoroplasty--in 37, sphincterogluteoplasty--in 8, plasty, using the m. gluteus maximus flap--in 6. Results of the patients treatment, followed up 1-4 yrs, were: good--in 54 (76.1%), fair--in 11 (15.5%) and poor--in 6 (8.4%) of them. PMID:22013668

Aliev, E A

2011-07-01

9

Risk factors for obstetrical anal sphincter lacerations.  

PubMed

The objective of this study was to identify the rate of anal sphincter lacerations in a large population-based database and analyze risk factors associated with this condition. Data were obtained from Pennsylvania Healthcare Cost Containment Council (PHC4) regarding all cases of obstetrical third and fourth degree perineal lacerations that occurred during a 2-year period from January 1990 to December 1991. Modifiable risk factors associated with this condition were analyzed, specifically episiotomy, forceps-assisted vaginal delivery, forceps with episiotomy, vacuum-assisted vaginal delivery, and vacuum with episiotomy. There were a total of 168,337 deliveries in 1990 and 165,051 deliveries in 1991 in Pennsylvania. Twenty-two percent (n = 74,881) of the deliveries were by cesarean section and were excluded from analysis. Among the remaining 258,507 deliveries, there were 18,888 (7.3%) third and fourth degree lacerations. Instrumental vaginal delivery, particularly with use of episiotomy, increased the risk of laceration significantly [forceps odds ratio (OR): 3.84, forceps with episiotomy OR: 3.89, vacuum OR: 2.58, vacuum with episiotomy OR: 2.93]. Episiotomy on the whole was associated with a threefold increase in the risk of sphincter tears. However, episiotomy in the absence of instrumental delivery seems to be protective with an OR of 0.9 [95% confidence interval (CI): 0.88-0.93]. Instrumental vaginal delivery, particularly forceps delivery, appears to be an important risk factor for anal sphincter tears. The risk previously attributed to episiotomy is probably due to its association with instrumental vaginal delivery. Forceps delivery is associated with higher occurrence of anal sphincter injury compared to vacuum delivery. PMID:15809773

Dandolu, Vani; Chatwani, Ashwin; Harmanli, Ozgur; Floro, Clara; Gaughan, John P; Hernandez, Enrique

2005-04-05

10

Effect of lateral sphincterotomy on internal anal sphincter function  

Microsoft Academic Search

PURPOSE: This study was designed to investigate the effect of lateral sphincterotomy on internal anal sphincter function in patients with chronic anal fssure. METHODS: Using an eight-channel perfusion catheter and computerized data analysis, a prospective manometric study was performed on patients with chronic anal fissure undergoing lateral sphincterotomy (LS). RESULTS: Mean resting pressure (MRP) in patients with anal fissure (85.1

N. Williams; N. A. Scott; M. H. Irving

1995-01-01

11

Assessment of a novel implantable artificial anal sphincter  

Microsoft Academic Search

PURPOSE: The aim of the study was to test a new implantable artificial anal sphincter in the porcine model. METHOD: The artificial\\u000a sphincter, which includes an inflatable expander that compresses and flattens the bowel against a pillow, was implanted in\\u000a 16 animals and studied for periods of up to 20 weeks. The anal sphincters were destroyed, and the efficacy of

Constantinos A. Hajivassiliou; Ken B. Carter; Iain G. Finlay

1997-01-01

12

Electromyography of the internal anal sphincter performed under endosonographic guidance description of a new method  

Microsoft Academic Search

PURPOSE: The aim of our study was to investigate internal anal sphincter electromyographic signals. METHODS: Electromyography of the internal anal sphincter was performed with platinum wire electrodes in six healthy volunteers (three males and three females), inserted under endosonographic guidance. Platinum wire electrodes were also inserted into the external anal sphincter. Activity of both the internal and external anal sphincter

Michael Sørensen; Michael Bachmann Nielsen; Jan Fog Pedersen; John Christiansen

1994-01-01

13

Myopathy of internal anal sphincter with polyglucosan inclusions.  

PubMed

In two members of an affected family with a hereditary syndrome of proctalgia fugax and constipation, a hypertrophied internal anal sphincter was found with histological features suggesting a myopathy of this muscle. In these two patients, and in an unrelated patient with a similar clinical syndrome, smooth muscle fibres of the internal anal sphincter showed numerous vacuoles, many of which contained ovoid inclusion bodies. The structural features and histochemical reactions of the inclusion bodies were consistent with a polyglucosan composition. Histological examination of the internal anal sphincter may reveal smooth muscle abnormalities in functional bowel disorders. PMID:2167961

Martin, J E; Swash, M; Kamm, M A; Mather, K; Cox, E L; Gray, A

1990-07-01

14

Anal sphincter repair for obstetric injury: Manometric evaluation of functional results  

Microsoft Academic Search

Anal manometry before and after surgical repair on a homogeneous group of patients with anterior sphincter defect caused by obstetric injury defined the parameters affected by the repair to achieve anal continence. Between November 1985 and April 1989, 28 patients who underwent anterior anal sphincter reconstruction were studied using anal manometry and were graded for continence. Anal function was improved

James W. Fleshman; Zeev Dreznik; Robert D. Fry; Ira J. Kodner

1991-01-01

15

Anal sphincter repair for fecal incontinence: effect on symptom severity, quality of life, and anal sphincter squeeze pressures  

PubMed Central

Introduction and hypothesis The objective of this study was to determine the effect of external anal sphincter repair on fecal incontinence symptoms, quality of life, and anal sphincter squeeze pressures. Methods The fecal incontinence symptoms and impact on quality of life, patient satisfaction, and anorectal manometry were assessed pre- and post-operatively. Results One hundred four women were eligible and 74/104 (71%) returned post-operative questionnaires. Fifty-four of 74 (73%) had pre- and post-operative questionnaires. Twenty-five of 74 (34%) had pre- and post-operative anorectal manometry measures. Mean length of follow-up for participants (n=54) was 32±19 months. Modified Manchester Health Questionnaire scores decreased from 47.3±21.9 to 28.4±24.3 (p<0.01) and Fecal Incontinence Severity Index scores from 30.6±13.0 to 21.6±15.5 (p<0.01). Seventy-seven percent of the participants was satisfied. Sphincter squeeze pressures increased from 53.4±25.0 to 71.8±29.1 mmHg (p<0.01). Conclusions External anal sphincter repair resulted in sustained improvements in fecal incontinence severity and quality of life along with improved anal sphincter squeeze pressures.

Gleason, Jonathan Lee; Markland, Alayne; Greer, Wm Jerod; Szychowski, Jeff M.; Gerten, Kimberly A.; Richter, Holly E.

2011-01-01

16

Thermal responses of shape memory alloy artificial anal sphincters  

NASA Astrophysics Data System (ADS)

This paper presents a numerical investigation of the thermal behavior of an artificial anal sphincter using shape memory alloys (SMAs) proposed by the authors. The SMA artificial anal sphincter has the function of occlusion at body temperature and can be opened with a thermal transformation induced deformation of SMAs to solve the problem of severe fecal incontinence. The investigation of its thermal behavior is of great importance in terms of practical use in living bodies as a prosthesis. In this work, a previously proposed phenomenological model was applied to simulate the thermal responses of SMA plates that had undergone thermally induced transformation. The numerical approach for considering the thermal interaction between the prosthesis and surrounding tissues was discussed based on the classical bio-heat equation. Numerical predictions on both in vitro and in vivo cases were verified by experiments with acceptable agreements. The thermal responses of the SMA artificial anal sphincter were discussed based on the simulation results, with the values of the applied power and the geometric configuration of thermal insulation as parameters. The results obtained in the present work provided a framework for the further design of SMA artificial sphincters to meet demands from the viewpoint of thermal compatibility as prostheses.

Luo, Yun; Takagi, Toshiyuki; Matsuzawa, Kenichi

2003-08-01

17

[Anal sphincter repair in the treatment of anal incontinence - when and how to do it?].  

PubMed

Anal incontinence is a disease of high prevalence. For many patients the disease causes severe stress and often results in social isolation. Whenever a sphincter lesion has been diagnosed by digital rectal examination and endosonographic access, anal sphincter reconstruction can be performed with the same results either in overlapping or in end-to-end suture technique. sing these procedures, in more than 60 % of patients the continence can be initially improved. However, benefit decreases after 5 years down to 40-50 %. The prognosis gets worse with increasing age and supplementary descending pelvic floor. Anal repair with reconstruction of internal and external sphincters is performed in neurogenic incontinence. This can be achieved by posterior or anterior anal repair (total pelvic floor repair). Nowadays these procedures are not common, due to unsuccessfulness. Instead, sacral nerve stimulation as a more expensive but less invasive method has displaced the anal repair on this indication. Interpretation of the published results remains delicate because of heterogenous evaluation criteria of postoperative outcome: subjective amelioration, postoperative satisfaction and quality of life, improvement of incontinence score or achievement of complete anal continence. However, it is proven that after immediate reconstruction of traumatic sphincter lesions the postoperative outcome is better than a two-step operation with primary ostomy. PMID:22933005

Kersting, S; Berg, E

2012-08-29

18

A New Implantation Procedure of Artificial Sphincter for Anal Incontinence: The Transvaginal Approach  

Microsoft Academic Search

A destroyed or severely scarred anterior perineum predicts difficult healing and risk of perineal erosion and remains a contraindication\\u000a for the implantation of an artificial anal sphincter via a perineal approach. This report describes the first implantations of an artificial anal sphincter via a transvaginal approach in female patients with anal incontinence. Between 2003 and 2005, the Acticon Neosphincter? was

Francis Michot; Jean-Jacques Tuech; Benoit Lefebure; Valerie Bridoux; Philippe Denis

2007-01-01

19

Early effect of external beam radiation therapy on the anal sphincter: A study using anal manometry and transrectal ultrasound  

Microsoft Academic Search

The early effect of pelvic irradiation on the anal sphincter has not been previously investigated. This study prospectively evaluated the acute effect of preoperative radiation on anal function. Twenty patients with rectal carcinoma received 4,500 cGy of preoperative external beam radiation. The field of radiation included the sphincter in 10 patients and was delivered above the anorectal ring in 10

Elisa H. Birnbaum; Zeev Dreznik; Robert J. Myerson; David L. Lacey; Robert D. Fry; Ira J. Kodner; James W. Fleshman

1992-01-01

20

Clinical, manometric and sonographic assessment of the anal sphinctersA comparative prospective study  

Microsoft Academic Search

.   One hundred patients with various anorectal disorders but intact anal sphincters were evaluated prospectively by three independent\\u000a observers to determine the specificity, sensibility and accuracy of digital exploration and anal ultrasound compared to anal\\u000a manometry, in assessing internal and sphincter hypertonicity (IH) and the relaxation of sphincters on straining (SR). Accuracy\\u000a of the digital examination in evaluating IH was

U. Favetta; A. Amato; A. Interisano; M. Pescatori

1996-01-01

21

Internal Anal Sphincter Function Following Lateral Internal Sphincterotomy for Anal Fissure  

PubMed Central

Background: Anal fissure is a common and painful disorder. Its relation to hypertonic anal sphincter is controversial. The most common surgical treatment of chronic anal fissure is lateral internal sphincterotomy. Objective: The aim of this study was to evaluate long-term manometric results of sphincter healing following lateral internal sphincterotomy. Patients and Methods: Between 2000 and 2003, 50 patients with anal fissure were included in this study and underwent sphincterotomy; 12 healthy patients served as controls. All patients with anal fissure underwent manometric evaluation using a 6-channel perfusion catheter. All patients were examined 1 month before surgery and 1, 3, 6, and 12 months following surgery. The control group had 3 manometric evaluations 6 months apart. Results: The mean basal resting pressure before surgery was 138 ± 28 mm Hg. One month after surgery, the pressure dropped to 86 ± 15 mm Hg (P < 0.0001) and gradually rose to a plateau at 12 months (110 ± 18 mm Hg, P < 0.0001). At 12 months, the manometric pressure was significantly lower than the baseline (P < 0.0001). However, manometric measurements in the fissure group were still significantly higher than in the control group (110 ± 18 versus 73 ± 4.8 mm Hg, P < 0.0001). All patients were free of symptoms at the 12-month follow-up. Conclusion: Lateral internal sphincterotomy caused a significant decline in the resting anal pressure. During the first year following surgery, the tone of the internal anal sphincter gradually increased, indicating recovery, but still remained significantly lower than before surgery. However, postoperative resting pressures were higher than those in the control, and no patient suffered any permanent problems with incontinence, so this decrease may not be clinically significant.

Ram, Edward; Alper, Dan; Stein, Gideon Y.; Bramnik, Zachar; Dreznik, Zeev

2005-01-01

22

Anal incontinence—sphincter ani repair: indications, techniques, outcome  

Microsoft Academic Search

Introduction  Fecal incontinence is a debilitating problem that has many different causes. There also are many treatments options, from\\u000a behavioral modification to sphincteroplasty to artificial anal sphincter and colostomy. In a society with an aging population,\\u000a fecal incontinence is an ever-increasing problem and will continue to grow.\\u000a \\u000a \\u000a \\u000a Discussion  Treatment plans need to be individually tailored for each patient. The surgeon should be

Susan Galandiuk; Leslie A. Roth; Quincy J. Greene

2009-01-01

23

Hereditary internal anal sphincter myopathy: the first Caribbean family.  

PubMed

Hereditary proctalgia is an extremely rare condition characterized by endosonographic evidence of internal anal sphincter (IAS) thickening and specific ultrastructural changes seen at light and electron microscopy (EM). We report the case of a 54-year-old Caribbean woman with severe proctalgia and IAS thickening, treated with IAS myectomy. Transmission EM showed PAS-positive inclusions and granulofibrillary smooth muscle inclusion bodies. Anal endosonography of 5 family members from 3 generations showed IAS thickening in all cases with reported proctalgia. The condition represents an isolated IAS myopathy which is a probable polysaccharide storage disease variant. This condition may require specific surgical therapy with specimen preservation and ultrastructural examination for optimal characterization and treatment. PMID:17357870

Zbar, A P; de la Portilla, F; Borrero, J J; Garriques, S

2007-02-16

24

Long-Term Outcome of Delayed Primary or Early Secondary Reconstruction of the Anal Sphincter after Obstetrical Injury  

Microsoft Academic Search

Purpose  Traditionally sphincter repair has not been performed during the puerperium. This prospective study was designed to determine\\u000a the long-term outcome of delayed primary or early secondary sphincteroplasty in the puerperium.\\u000a \\u000a \\u000a \\u000a Methods  Between 1991 and 2005, 22 females underwent delayed primary or early secondary repair after third-degree or fourth-degree\\u000a anal sphincter rupture. Delayed primary reconstruction was performed more than 72 hours after delivery.

Mette M. Soerensen; Karl M. Bek; Steen Buntzen; Karen-Elise Højberg; Søren Laurberg

2008-01-01

25

Anal sphincter biofeedback relaxation treatment for women with intractable constipation symptoms  

Microsoft Academic Search

Some constipated women have difficulty relaxing the striated muscles of the anal sphincters, sometimes called anismus. This study was developed to provide a biofeedback-based relaxation treatment to teach these patients to relax the “voluntary” anal sphincter muscle in order to assess whether this treatment would be effective in reducing symptomatology. Seven constipated patients who were unresponsive to a high-fiber diet

Geoffrey K. Turnbull; Paul G. Ritvo

1992-01-01

26

Injectable Silicone Biomaterial for Fecal Incontinence Caused by Internal Anal Sphincter Dysfunction Is Effective  

Microsoft Academic Search

PURPOSE  Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable silicone biomaterial, PTPTM (Bioplastique), used to augment the internal anal sphincter.METHOD  Eighty-two patients (64 females; median age, 66 years) with severe fecal incontinence and a low anal resting pressure caused

J. J. Tjandra; J. F. Lim; R. Hiscock; P. Rajendra

2004-01-01

27

Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects  

PubMed Central

BACKGROUND—Topical nitrates lower anal sphincter pressure and heal anal fissures, but a majority of patients experience headache. The internal anal sphincter has a calcium dependent mechanism to maintain tone, and also receives an inhibitory extrinsic cholinergic innervation. It may therefore be possible to lower anal sphincter pressure using calcium channel blockers and cholinergic agonists without side effects.?AIMS—To investigate the effect of oral and topical calcium channel blockade and a topical cholinomimetic on anal sphincter pressure.?METHODS—Three studies were conducted, each involving 10 healthy volunteers. In the first study subjects were given oral 60 mg diltiazem or placebo on separate occasions. They were then given diltiazem once or twice daily for four days. In the second and third studies diltiazem and bethanechol gels of increasing concentration were applied topically to lower anal pressure.?RESULTS—A single dose of 60 mg diltiazem lowered the maximum resting anal sphincter pressure (MRP) by a mean of 21%. Once daily diltiazem produced a clinically insignificant effect but a twice daily regimen reduced anal pressure by a mean of 17%. Diltiazem and bethanechol gel produced a dose dependent reduction of the anal pressure; 2% diltiazem produced a maximal 28% reduction, and 0.1% bethanechol a maximal 24% reduction, the effect lasting three to five hours.?CONCLUSIONS—Topical diltiazem and bethanechol substantially reduce anal sphincter pressure for a prolonged period, and represent potential low side effect alternatives to topical nitrates for the treatment of anal fissures.???Keywords: diltiazem; bethanechol; anal sphincter pressure; anal fissures

Carapeti, E; Kamm, M; Evans, B; Phillips, R

1999-01-01

28

Fetal surgery for repair of myelomeningocele allows normal development of anal sphincter muscles in sheep.  

PubMed

One major problem for patients with myelomeningocele (MMC) is fecal incontinence. To prevent this problem, fetal surgery for repair of MMC has been recently undertaken. The strategy behind this surgery is to allow normal development of anal sphincter muscles. The purpose of this study was to determine whether fetal surgery for repair of MMC allows normal development of anal sphincter muscles. Myelomeningocele was surgically created in fetal sheep at 75 days of gestation. At 100 days of gestation, fetal surgery for repair of the MMC lesion was performed. Three repair methods were used: standard neurosurgical repair (4 fetal sheep), covering the MMC lesion with Alloderm (2 fetal sheep), and covering the MMC lesion with Gore-Tex (2 fetal sheep). After the sheep were delivered (140 days of gestation), external and internal anal sphincter muscles were analyzed histopathologically. In control fetal sheep (not repaired) anal sphincter muscles did not develop normally. In contrast, in fetal sheep that underwent repair of the MMC, the external and internal anal sphincter muscles developed normally. Histopathologically, in the external sphincter muscles, muscle fibers were dense. In the internal sphincter muscles, endomysial spaces were small, myofibrils were numerous, and fascicular units were larger than those in unrepaired fetal sheep. There was no difference in muscle development for the repair methods. Fetal surgery for repair of MMC allows normal development of anal sphincter muscles. PMID:14689212

Yoshizawa, Jyoji; Sbragia, Lourenco; Paek, Bettina W; Sydorak, Roman M; Yamazaki, Yoji; Harrison, Michael R; Farmer, Diana L

2003-12-20

29

The prevalence of anal sphincter defects in faecal incontinence: a prospective endosonic study.  

PubMed Central

Forty six patients (median age 61 years; 42 women) with faecal incontinence and 16 age and sex matched controls undergoing a restorative proctocolectomy were assessed by clinical examination, anorectal physiology, and anal endosonography. Forty patients (87%) with faecal incontinence had a sphincter defect demonstrated on anal endosonography (31 external and 21 internal anal sphincter defects). The commonest cause of faecal incontinence was obstetric trauma. This occurred in 35 women, 30 of whom exhibited a morphological defect in the anorectal sphincter complex. In 22 of these patients with a history of a perineal tear or episiotomy, 21 (95%) had a sphincter defect. Sphincter defects were commonly located at the level of the midanal canal. Images Figure 1 Figure 2

Deen, K I; Kumar, D; Williams, J G; Olliff, J; Keighley, M R

1993-01-01

30

Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition.  

PubMed

A newly identified myopathy of the internal anal sphincter is described. In the affected family, at least one member from each of five generations had severe proctalgia fugax; onset was usually in the third to fifth decades of life. Three members of the family have been studied in detail. Each had severe pain intermittently during the day and hourly during the night. Constipation was an associated symptom, in particular difficulty with rectal evacuation. Clinically the internal anal sphincter was thickened and of decreased compliance. The maximum anal canal pressure was usually increased with marked ultraslow wave activity. Anal endosonography confirmed a grossly thickened internal anal sphincter. Two patients were treated by internal anal sphincter strip myectomy; one showed marked improvement and one was relieved of the constipation but had only slight improvement of the pain. The hypertrophied muscle in two of the patients showed unique myopathic changes, consisting of vacuolar changes with periodic acid-Schiff-positive polyglycosan bodies in the smooth muscle fibers and increased endomysial fibrosis. In vitro organ-bath studies showed insensitivity of the muscle to noradrenaline, isoprenaline, carbachol, dimethylpiperazinium, and electrical-field stimulation. Immunohistochemical studies for substance P, calcitonin gene-related peptide, galanin, neuropeptide Y, and vasoactive intestinal peptide showed staining in a similar distribution to that in control tissue. A specific autosomal-dominant inherited myopathy of the internal anal sphincter that causes anal pain and constipation has been identified and characterized. PMID:1993504

Kamm, M A; Hoyle, C H; Burleigh, D E; Law, P J; Swash, M; Martin, J E; Nicholls, R J; Northover, J M

1991-03-01

31

Reinnervation of Urethral and Anal Sphincters With Femoral Motor Nerve to Pudendal Nerve Transfer  

PubMed Central

Aims Lower motor neuron damage to sacral roots or nerves can result in incontinence and a flaccid urinary bladder. We showed bladder reinnervation after transfer of coccygeal to sacral ventral roots, and genitofemoral nerves (L1, 2 origin) to pelvic nerves. This study assesses the feasibility of urethral and anal sphincter reinnervation using transfer of motor branches of the femoral nerve (L2–4 origin) to pudendal nerves (S1, 2 origin) that innervate the urethral and anal sphincters in a canine model. Methods Sacral ventral roots were selected by their ability to stimulate bladder, urethral sphincter, and anal sphincter contraction and transected. Bilaterally, branches of the femoral nerve, specifically, nervus saphenous pars muscularis [Evans HE. Miller’s anatomy of the dog. Philadelphia: W.B. Saunders; 1993], were transferred and end-to-end anastomosed to transected pudendal nerve branches in the perineum, then enclosed in unipolar nerve cuff electrodes with leads to implanted RF micro-stimulators. Results Nerve stimulation induced increased anal and urethral sphincter pressures in five of six transferred nerves. Retrograde neurotracing from the bladder, urethral sphincter, and anal sphincter using fluorogold, fast blue, and fluororuby, demonstrated urethral and anal sphincter labeled neurons in L2–4 cord segments (but not S1–3) in nerve transfer canines, consistent with rein-nervation by the transferred femoral nerve motor branches. Controls had labeled neurons only in S1–3 segments. Postmortem DiI and DiO labeling confirmed axonal regrowth across the nerve repair site. Conclusions These results show spinal cord reinnervation of urethral and anal sphincter targets after sacral ventral root transection and femoral nerve transfer (NT) to the denervated pudendal nerve. These surgical procedures may allow patients to regain continence.

Ruggieri, Michael R.; Braverman, Alan S.; Bernal, Raymond M.; Lamarre, Neil S.; Brown, Justin M.; Barbe, Mary F.

2012-01-01

32

Hereditary vacuolar internal anal sphincter myopathy causing proctalgia fugax and constipation: a new case contribution.  

PubMed

Hereditary anal sphincter myopathy is rare. We present a family with one affected member with proctalgia fugax, constipation and internal anal sphincter hypertrophy. Ultrastructural findings show vacuolization of smooth muscle cells without the characteristic polyglucosan inclusion. Further relief of symptoms was obtained using an oral calcium antagonist. Based on clinical presentation, endosonography and morphological findings, we consider our case is a histological variant of the vacuolar myopathy originally described. PMID:15716662

de la Portilla, Fernando; Borrero, Juan José; Rafel, Enrique

2005-03-01

33

Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice  

Microsoft Academic Search

A study was conducted to describe the rate of obstetrical anal sphincter laceration in a large cohort of women and to identify\\u000a the characteristics associated with this complication. Data from all vaginal deliveries occurring between January 1996 and\\u000a December 2004 at one institution were used to compare women with and without anal sphincter lacerations. Among 16,667 vaginal\\u000a deliveries, 1,703 (10.2%)

Steven M. Minaglia; Begüm Özel; Nicole M. Gatto; Lisa Korst; Daniel R. Mishell Jr; David A. Miller

2007-01-01

34

Factors associated with anal sphincter laceration in 40,923 primiparous women  

Microsoft Academic Search

The objective of this study was to identify factors associated with anal sphincter laceration in primiparous women. A subpopulation\\u000a of 40,923 primiparous women at term with complete data sets was abstracted from a state-wide perinatal database in Germany.\\u000a Outcome variable was anal sphincter laceration. Independent variables were 17 known obstetrical risk factors\\/conditions\\/interventions\\u000a impacting childbirth recorded on the perinatal data collection

Peter Baumann; Ahmad O. Hammoud; Samuel Gene McNeeley; Elizabeth DeRose; Bela Kudish; Susan Hendrix

2007-01-01

35

Digital Rectal Examination of Sphincter Pressures in Chronic Anal Fissure Is Unreliable  

Microsoft Academic Search

PURPOSE: Chronic anal fissure is said to be associated with internal sphincter hypertonia. However, an unknown proportion of fissures may be associated with normal or even low resting pressures and may subsequently be resistant to pharmacological treatments or at risk from surgical treatments, both of which aim to reduce sphincter hypertonia. This study investigated the ability of surgeons to detect

Oliver M. Jones; Thanesan Ramalingam; Ian Lindsey; Chris Cunningham; Bruce D. George; Neil J. McC Mortensen

2005-01-01

36

Endoluminal ultrasound is preferable to electromyography in mapping anal sphincteric defects  

Microsoft Academic Search

Assessment of complex sphincteric defects in patients with fecal incontinence by digital rectal examination and intraoperative dissection can be difficult in the presence of excessive scarring. Adjunctive investigation such as endoluminal ultrasound (ELUS) and needle electromyography (EMG) may provide objective evidence of the nature and extent of the sphincteric defects. In a series of 11 patients, ELUS of the anal

Joe J. Tjandra; Jeffrey W. Milsom; Thomas Schroeder; Victor W. Fazio

1993-01-01

37

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence  

PubMed Central

While anal sphincter neurogenic injury documented by needle electromyography (EMG) has been implicated to cause fecal incontinence (FI), most studies have been uncontrolled. Normal values and the effects of age on anal sphincter motor unit potentials (MUP) are ill defined. The functional significance of anal sphincter neurogenic injury in FI is unclear. Anal pressures and EMG were assessed in 20 asymptomatic nulliparous women (age, 38 ± 5 yr; mean ± SE) and 20 women with FI (54 ± 3 yr). A computerized program quantified MUP duration and phases. These parameters and MUP recruitment were also semiquantitatively assessed by experienced electromyographers in real time. Increasing age was associated with longer and more polyphasic MUP in nulliparous women by quantitative analysis. A higher proportion of FI patients had prolonged (1 control, 7 patients, P = 0.04) and polyphasic MUP (2 controls, 9 patients, P = 0.03) at rest but not during squeeze. Semiquantitative analyses identified neurogenic or muscle injury in the anal sphincter (11 patients) and other lumbosacral muscles (4 patients). There was substantial agreement between quantitative and semiquantitative analyses (? statistic 0.63 ± 95% CI: 0.32–0.96). Anal resting and squeeze pressures were lower (P ? 0.01) in FI than controls. Anal sphincter neurogenic or muscle injury assessed by needle EMG was associated (P = 0.01) with weaker squeeze pressures (83 ± 10 mmHg vs. 154 ± 30 mmHg) and explained 19% (P = 0.01) of the variation in squeeze pressure. Anal sphincter MUP are longer and more polyphasic in older than younger nulliparous women. Women with FI have more severe neurogenic or muscle anal sphincter injury, which is associated with lower squeeze pressures.

Daube, Jasper; Litchy, William; Traue, Julia; Edge, Jessica; Enck, Paul; Zinsmeister, Alan R.

2012-01-01

38

Function of the Internal Anal Sphincter and Rectal Sensitivity in Idiopathic Constipation  

Microsoft Academic Search

Anal manometry was performed in 8 control individuals (group A) and in 13 patients with idiopathic constipation (group B), 6 of whom were grouped apart (group C) because of an elective delay of the intestinal transit in the rectum. The basal pressure of the internal anal sphincter, the rectal inflation volume necessary to elicit the rectoanal inhibitory reflex, and the

F. Baldi; F. Ferrarini; R. Corinaldesi; R. Balestra; M. Cassan; G. P. Fenati; L. Barbara

1982-01-01

39

Phosphodiesterase Inhibitors Cause Relaxation of the Internal Anal Sphincter In Vitro  

Microsoft Academic Search

PURPOSE: Pharmacologic treatments are gaining widespread acceptance as first-line therapy for anal fissure. However, existing treatments have limited clinical usefulness because of side effects and incomplete healing rates. METHODS: Fresh human surgical resection specimens containing internal anal sphincter and rectal circular muscle were collected. Strips of smooth muscle were cut from each muscle group and mounted in a superfusion organ

Oliver M. Jones; Alison F. Brading; Neil J. Mc C. Mortensen

2002-01-01

40

Internal anal sphincter augmentation for fecal incontinence using injectable silicone biomaterial  

Microsoft Academic Search

PURPOSE: A disrupted or weak internal anal sphincter can lead to passive fecal incontinence. This muscle is not amenable to direct surgical repair. Previous preliminary attempts to restore functional continuity have included a cutaneous flap to fill an anal canal defect, and injection therapy using polytetrafluoroethylene, collagen, or autologous fat. Urologists have also used injections of collagen or silicone to

Andrew J. Malouf; Carolynne J. Vaizey; Christine S. Norton; Michael A. Kamm

2001-01-01

41

Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence  

Microsoft Academic Search

Objective: To determine whether anal endosonography immediately after vaginal delivery can predict subsequent fecal incontinence.Methods: We studied nulliparas who delivered vaginally and had no anal sphincter tears (third- or fourth-degree perineal tears) diagnosed clinically by endosonography before any suture of the perineum. The sonographer was unaware of delivery details and the obstetrician and the women were not informed of endosonography

Daniel L Faltin; Michel Boulvain; Olivier Irion; Stéphane Bretones; Catalin Stan; Antoine Weil

2000-01-01

42

Magnetic Resonance Imaging and 3-Dimensional Analysis of External Anal Sphincter Anatomy  

PubMed Central

OBJECTIVE: To use magnetic resonance images of living women and 3-dimesional modeling software to identify the component parts and characteristic features of the external anal sphincter (EAS) that have visible separation or varying origins and insertions. METHODS: Detailed structural analysis of anal sphincter anatomy was performed on 3 pelvic magnetic resonance imaging (MRI) data sets selected for image clarity from ongoing studies involving nulliparous women. The relationships of anal sphincter structures seen in axial, sagittal, and coronal planes were examined using the 3-D Slicer 2.1b1 software program. The following were requirements for sphincter elements to be considered separate: 1) a clear and consistently visible separation or 2) a different origin or insertion. The characteristic features identified in this way were then evaluated in images from an additional 50 nulliparas for the frequency of feature visibility. RESULTS: There were 3 components of the EAS that met criteria as being “separate” structures. The main body (EAS-M) is separated from the subcutaneous external anal sphincter (SQ-EAS) by a clear division that could be observed in all (100%) of the MRI scans reviewed. The wing-shaped end (EAS-W) has fibers that do not cross the midline ventrally, but have lateral origins near the ischiopubic ramus. This EAS-W component was visible in 76% of the nulliparas reviewed. CONCLUSION: Three distinct external anal sphincter components can be identified by MRI in the majority of nulliparous women.

Hsu, Yvonne; Fenner, Dee E.; Weadock, William J.; DeLancey, John O. L.

2006-01-01

43

Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique?  

Microsoft Academic Search

Advanced obstetric anal sphincter tears are often associated with a high incidence of fecal and flatus incontinence. We aimed\\u000a to assess the clinical outcome of these repairs when done by the overlapping sphincteroplasty technique with reconstruction\\u000a of the internal anal sphincter and perineum. Between August 2005 and December 2006, all grades 3 and 4 obstetric anal sphincter\\u000a tears in our

Yoram Abramov; Beni Feiner; Thalma Rosen; Motti Bardichev; Eli Gutterman; Arie Lissak; Ron Auslander

2008-01-01

44

St. Mark’s incontinence score for assessment of anal incontinence following obstetric anal sphincter injuries (OASIS)  

Microsoft Academic Search

The aim of this study was to assess the correlation between St. Mark’s incontinence score (SMIS) for anal incontinence and\\u000a impact on quality of life (QoL), following primary repair of obstetric anal sphincter injuries (OASIS). Three hundred sixty-eight\\u000a women who sustained OASIS completed a Manchester Health Questionnaire (MHQ) and the clinician calculated a SMIS. Spearman’s\\u000a correlation coefficients were calculated, and

Anne-Marie Roos; Abdul H. Sultan; Ranee Thakar

2009-01-01

45

[Significance of nontraumatic anal sphincter relaxation for the success of plastic and miniinvasive interventions in coloproctology].  

PubMed

The investigation objective was to estimate the role of nontraumatic anal sphincter (AS) stretching, as a leading factor of success in minimally invasive and/or plastic proctological interventions. One-centre randomized investigation was performed in 83 patients: In 22 of them the AS fissura was revealed (in 16), suprasphincteric fistula (in 3) and coexistent rectocele 2-3 Ap (according to POP-Q classification) with thinning of the AS anterior segment, the degree III hemorrhoids and anterior AS fissure presence. Ninety units of botulotoxin preparation (Disport) were injected between internal and external AS portions 5-15 days preoperatively. The treatment results without botulotoxin injection were compared retrospectively. After botulotoxin injection performance the AS spasm elimination was noted, leading to the pain subsiding promotion before and postoperatively in all the patients observed. The spasm elimination have permitted to escape the anal high fistula recurrence as a result of the mucosal flap shift after intraluminal closure of the fistula or because of the fistula intermuscular electrowelding "suture" rupture, also have guaranteed the plastic sutures on AS, even while the stage II-III rectocele presence, not depending of performance of its simultant surgica correction. PMID:23718024

Podpriatov, S S; Korchak, V P; Ivanenko, S V; Stupak, M I; Zubariev, O V; Ivakha, V V; Sydorenko, O V; Shtaier, A A; Perekhrest, O V; Shchepetov, V V; Rostunov, V K; Bryzhatiuk, S V; Kozlov, V V

2013-03-01

46

Thermal control of shape memory alloy artificial anal sphincters for complete implantation  

NASA Astrophysics Data System (ADS)

This paper presents an approach for the thermal control of an artificial anal sphincter using shape memory alloys. An artificial anal sphincter has been proposed by the authors to resolve problems of severe fecal incontinence in patients. The basic design of the artificial sphincter consists of two all-round shape memory alloy plates as the main functional parts, and heaters that are attached to the SMA plates for generating the thermal cycles required for the phase transformation accompanied shape changes of the plates. The SMA artificial sphincter could be fitted around intestines, performing an occlusion function at body temperature and a release function upon heating. Thermal compatibility of such prostheses is most important and is critical for practical use. Since a temperature rise of approximately 20 °C from body temperature is needed to activate a complete transformation of SMA plates, an earlier model of ours allowed only a short period of heating, resulting in incomplete evacuation. In this work, a thermal control approach using a temperature-responsive reed switch has been incorporated into the device to prevent the SMA plates from overheating. Then, with thermal insulation the artificial anal sphincter is expected to allow a long enough opening period for fecal continence; without any thermal impact to the surrounding tissues that would be in contact with the artificial sphincter. Thermal control was confirmed in both in vitro and in vivo experiments, suggesting the effectiveness of the present approach. The modified SMA artificial anal sphincter has been implanted into animal models for chronic experiments of up to 4 weeks, and has exhibited good performance by maintaining occlusion and release functions. At autopsy, no anomaly due to thermal impact was found on the surfaces of intestines that had been in contact with the artificial anal sphincter.

Luo, Yun; Okuyama, Takeshi; Takagi, Toshiyuki; Kamiyama, Takamichi; Nishi, Kotaro; Yambe, Tomoyuki

2005-02-01

47

Compound muscle action potential of the external anal sphincter.  

PubMed

AIM: Pudendal nerve terminal motor latency (PNTML) assesses distal innervation of the external anal sphincter (EAS) but it is insensitive to early nerve damage. We propose to extend the assessment of PNTML to the measurement of the compound muscle action potential (CMAP) of the EAS to understand its progressive denervation. METHOD: 90 female patients with faecal incontinence were prospectively examined and compared with 36 asymptomatic women who acted as controls. PNTML was performed bilaterally and the muscle response analysed for CMAP to include amplitude, area and duration. Anorectal manometry was measured by a station-pull technique using a water-filled microballoon. SPSS Version 11.5 was used for statistical analysis. RESULTS: In asymptomatic females the CMAP on the left side was greater in nulliparous (n=7) than parous (n=27, p<0.05) individuals. There was a positive correlation with maximum squeeze pressure and Area on the left side (p<0.05, r=0.397). In women with faecal incontinence, CMAP on the left side had a negative correlation with age (n=75, p<0.05), there was no correlation with parity or anorectal manometry. Nulliparous asymptomatic females had a greater CMAP (p<0.05) on the left side than asymptomatic parous women and parous women with faecal incontinence. Right side measurements were not conclusive. CONCLUSION: CMAP demonstrated progressive denervation with age in women with faecal incontinence but did not reliably identify early signs of denervation in asymptomatic females. The area on the left side related to muscle function in asymptomatic females but not in women with faecal incontinence. CMAP can distinguish between parous women with faecal incontinence and nulliparous asymptomatic women but is not a useful test of EAS function. This article is protected by copyright. All rights reserved. PMID:23758958

Nockolds, C L; Hosker, G L; Kiff, E S

2013-06-12

48

Complete anal sphincter complex disruption from intercourse: A case report and literature review  

PubMed Central

INTRODUCTION Anal sphincter injuries are uncommon injuries outside of obstetric practice – but they may cause disastrous complications. PRESENTATION OF CASE We present a case of complete anal sphincter disruption from anal intercourse in a 25 year old woman. Clinical management is presented and technical details of the repair are discussed. She had an uneventful post-operative course and good continence after 154 days of follow up. DISCUSSION This is one of a handful of reported cases of anal sphincter disruption secondary to anal intercourse. The established risk factors in this case included receptive anal intercourse coupled with alcohol use. We review the pertinent surgical principles that should be observed when repairing these injuries, including anatomically correct repair and appropriate suture choice. There is little evidence to support simultaneous faecal diversion for primary repair of acute perineal lacerations. CONCLUSION Acute post-coital sphincter injuries should be treated operatively on an emergent basis, without diversion because they are low energy injuries with minimal tissue loss and excellent blood supply. Although repair of each injury should be individualized, the majority of these injuries do not require concomitant protective colostomy creation.

Cawich, S.O.; Samuels, L.; Bambury, I.; Cherian, C.J.; Christie, L.; Kulkarni, S.

2012-01-01

49

Early results of fissurectomy and advancement flap for resistant chronic anal fissure without hypertonia of the internal anal sphincter.  

PubMed

The aim of this study was to assess the efficacy of fissurectomy with skin advancement flap in healing chronic anal fissures without hypertonia of the internal anal sphincter. Twenty-six consecutive patients who failed healing after well-practiced topical medical therapy were enrolled. Anorectal manometry was performed preoperative and 6 months postoperatively. All patients were treated with fissurectomy and advancement flap through healthy skin tissue. All patients healed completely within 30 days from operation. The intensity and the duration of pain post-defecation was reduced significantly with respect to the preoperative values starting from the first defecation. One patient suffered urinary retention, two patients suffered infections, and two partial breakdowns were recorded. At 6 months the maximum resting pressure values were similar to those were detected preoperatively. One month after surgery, anal incontinence was reported in seven patients, four of whom complained about it preoperatively. At 12 months, only three subjects reported incontinence. No patients needed reoperation and no recurrences were detected. The fissurectomy, in combination with advancement flap, is a safe sphincter-saving procedure for the treatment of chronic anal fissures without hypertonia of internal anal sphincter that fails medical conservative treatment. PMID:20336902

Patti, Rosalia; Famà, Fausto; Tornambè, Antonino; Restivo, Margherita; Di Vita, Gaetano

2010-02-01

50

Preoperative Therapy for Lower Rectal Cancer and Modifications in Distance From Anal Sphincter  

SciTech Connect

Purpose: To assess the frequency and magnitude of changes in lower rectal cancer resulting from preoperative therapy and its impact on sphincter-saving surgery. Preoperative therapy can increase the rate of preserving surgery by shrinking the tumor and enhancing its distance from the anal sphincter. However, reliable data concerning these modifications are not yet available in published reports. Methods and Materials: A total of 98 cases of locally advanced cancer of the lower rectum (90 Stage uT3-T4N0-N+ and 8 uT2N+M0) that had undergone preoperative therapy were studied by endorectal ultrasonography. The maximal size of the tumor and its distance from the anal sphincter were measured in millimeters before and after preoperative therapy. Surgery was performed 6-8 weeks after therapy, and the histopathologic margins were compared with the endorectal ultrasound data. Results: Of the 90 cases, 82.5% showed tumor downsizing, varying from one-third to two-thirds or more of the original tumor mass. The distance between the tumor and the anal sphincter increased in 60.2% of cases. The median increase was 0.73 cm (range, 0.2-2.5). Downsizing was not always associated with an increase in distance. Preserving surgery was performed in 60.6% of cases. It was possible in nearly 30% of patients in whom the cancer had reached the anal sphincter before the preoperative therapy. The distal margin was tumor free in these cases. Conclusion: The results of our study have shown that in very low rectal cancer, preoperative therapy causes tumor downsizing in >80% of cases and in more than one-half enhances the distance between the tumor and anal sphincter. These modifications affect the primary surgical options, facilitating or making sphincter-saving surgery possible.

Gavioli, Margherita [Divisione di Chirurgia II, Nuovo Ospedale Civile S. Agostino-Estense, Modena (Italy)], E-mail: gavioli.margherita@libero.it; Losi, Lorena [Instituto di Anatomia Patologica, Universita di Modena e Reggio Emilia, Modena (Italy); Luppi, Gabriele; Iacchetta, Francesco; Zironi, Sandra; Bertolini, Federica [Dipartimento di Oncologia, Universita di Modena e Reggio Emilia, Modena (Italy); Falchi, Anna Maria; Bertoni, Filippo [Unita di Radioterapia Oncologica, Universita di Modena e Reggio Emilia, Modena (Italy); Natalini, Gianni [Divisione di Chirurgia II, Nuovo Ospedale Civile S. Agostino-Estense, Modena (Italy)

2007-10-01

51

Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States  

Microsoft Academic Search

ObjectiveThe purpose of this study was to estimate the incidence of urinary and bowel incontinence in relation to anal sphincter laceration in primiparous women and to identify factors that are associated with anal sphincter laceration in a unit that uses primarily midline episiotomy.

Dee E Fenner; Becky Genberg; Pavna Brahma; Lorri Marek; John O. L DeLancey

2003-01-01

52

Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery  

Microsoft Academic Search

Introduction and hypothesis  This study aims to estimate fecal, urinary incontinence, and sexual function 6 years after an obstetrical anal sphincter tear.\\u000a \\u000a \\u000a \\u000a Methods  Among 13,213 women who had a vaginal delivery of a cephalic singleton at term, 196 women sustained an anal sphincter tear.\\u000a They were matched to 588 controls. Validated questionnaires grading fecal and urinary incontinence, and sexual dysfunction\\u000a were completed

David Baud; Sylvain Meyer; Yvan Vial; Patrick Hohlfeld; Chahin Achtari

53

Outcome of obstetric anal sphincter injuries (OASIS)—role of structured management  

Microsoft Academic Search

Introduction and hypothesis  Prospective studies up to 1 year after repair of obstetric anal sphincter injuries (OASIS) report anal incontinence in 33%\\u000a of women and up to 92% have a sonographic sphincter defect. The aim of this study is to determine the outcome of repair by\\u000a doctors who have undergone structured training using a standardized protocol.\\u000a \\u000a \\u000a \\u000a Methods  Doctors repaired OASIS after attending a

Vasanth Andrews; Ranee Thakar; Abdul H. Sultan

2009-01-01

54

Mode of delivery after previous obstetric anal sphincter injuries (OASIS)—a reappraisal?  

Microsoft Academic Search

Introduction and hypothesis  To prospectively evaluate anorectal symptoms, quality of life (QoL), sphincter integrity and function after subsequent childbirth\\u000a following previous obstetric anal sphincter injuries (OASIS).\\u000a \\u000a \\u000a \\u000a Methods  A validated Manchester Health Questionnaire, endoanal sonography and manometry were performed during the third trimester and\\u000a 13 weeks postpartum. Women without objective compromise of anal function were recommended a vaginal delivery and the others\\u000a a caesarean

Inka Scheer; Ranee Thakar; Abdul H. Sultan

2009-01-01

55

The gonyautoxin 2/3 epimers reduces anal tone when injected in the anal sphincter of healthy adults.  

PubMed

The primary clinical symptom of Paralytic Shellfish Poisoning is acute paralytic illness produced by paralyzing toxins. Paralytic shellfish poison is formed by a mixture of phycotoxins and their toxicity is due to its reversible binding to a receptor site on the voltage-gated sodium channel on excitable cells, thus blocking neuronal transmission. We studied the effect of the gonyautoxin 2/3 epimers by local infiltration in the anal internal sphincter of healthy voluntary adults in order to reduce anal tone. The toxin was injected after prior clinical evaluation, anoscopy and anorectal manometry. Post injection clinical examination, electromyography and anorectal manometry were performed. Resting and voluntary contraction pressures were measured and the anorectal inhibitory and anocortical reflexes were tested by manometry. Blood and urine samples were obtained from each participant, and hemogram, basic metabolic panel, and urinalysis were done both before and one week after the injection. This study shows, for the first time, that gonyautoxin 2/3 reduces the anal tone by relaxing the anal sphincters in 100 % of the participants. Manometric recordings showed a significant decrease in anal maximal voluntary contraction pressure after the toxin injection, dropping to 55.2+/-6.2 % and 47.0+/-6.8% (Mean Value+/-Std.Dev.) of the baseline values at 2 minutes and at 24 hours respectively after the injection. Post-injection electromyography showed that activity of the muscle was abolished. We conclude that local administration of gonyautoxin 2/3 to the anal sphincter produces immediate relaxation and a statistically significant decrease in the anal tone (p <0.001). PMID:15515965

Garrido, Rogelio; Lagos, Néstor; Lattes, Karinna; Azolas, Carlos García Rodrigo; Bocic, Gunther; Cuneo, Aldo; Chiong, Hector; Jensen, Cristian; Henríquez, Ana I; Fernández, Cristian

2004-01-01

56

Manometric evaluation of internal anal sphincter after fissurectomy and anoplasty for chronic anal fissure: a prospective study.  

PubMed

Chronic anal fissure (CAF) is a common painful clinical disease and its pathogenesis remains poorly understood. After failure of pharmacological therapy, that is the first-line treatment, surgical sphincterotomy remains the treatment of choice although it is followed by a high rate of anal incontinence resulting from the sphincter damage; therefore, the research of a sphincter-saving surgical option has become an important goal. The aim of this study was to evaluate the manometric modifications and the incidence of anal incontinence after fissurectomy and anoplasty with advancement skin flap in patients affected by CAF with hypertonia of the internal anal sphincter (IAS). Fifteen patients affected by CAF with hypertonia of IAS, unresponsive to medical therapy, were enrolled. All subjects underwent fissurectomy and anoplasty with advancement skin flap. Anorectal manometry was performed preoperatively and after 6 and 12 months from surgery. Maximum resting pressure (MRP), maximum squeeze pressure (MSP), ultraslow wave activity (USWA), fissure healing, anal continence, and postoperative complications were recorded. All patients healed within 30 days from surgery. No intra- or postoperative complications were recorded except for a case of partial donor site break. No significant modifications of MSP were detected. Six months after surgery, MRP was higher with respect to healthy subjects but significantly reduced in comparison to baseline levels. At 12 months, it was higher have versus 6-month values but significantly lower versus preoperative values. USWA was significantly represented in patients with CAF versus healthy subject. Both at 6 and 12 months, they decreased significantly with respect to preoperative values without significant differences versus healthy subjects. Both at 6 and 12 months, anal continence did not differ with respect to preoperative time. The fissurectomy with anoplasty resulted in a high healing rate without surgical sequelae or anal incontinence. Also, it was able to reduce IAS pressure in the same manner as surgical sphincterotomy or forceful dilatation. PMID:22546122

Patti, Rosalia; Territo, Valentina; Aiello, Paolo; Angelo, Giuseppe Livio; Di Vita, Gaetano

2012-05-01

57

High-resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal receiver coil  

Microsoft Academic Search

.   The use of a surface coil in MR imaging improves signal-to-noise ratio of adjacent tissues of interest. We therefore devised\\u000a an endoanal receiver coil for imaging the anal sphincter. The probe is solid and re-usable: it comprises a saddle geometry\\u000a receiver with integral tuning, matching and decoupling. It is placed in the anal canal and immobilised externally. Both in

N. M. deSouza; A. D. Williams; D. J. Gilderdale

1999-01-01

58

Automatic localisation of innervation zones: A simulation study of the external anal sphincter  

Microsoft Academic Search

Traumas of the innervation zone (IZ) of the external anal sphincter (EAS), e.g. during delivery, can promote the development of faecal incontinence. Recently developed probes allow high-resolution detection of EMG signals from the EAS. The analysis of pelvic floor muscles by surface EMG (in particular, the estimation of the location of the IZ) has potential applications in the diagnosis and

Luca Mesin; Marco Gazzoni; Roberto Merletti

2009-01-01

59

Multichannel Surface EMG for the Non-Invasive Assessment of the Anal Sphincter Muscle  

Microsoft Academic Search

Background\\/Aims: This work focuses on recording, processing and interpretation of multichannel surface EMG detected from the external anal sphincter muscle. The aim is to describe the information that can be extracted from signals recorded with such a technique. Methods: The recording of many signals from different locations on a muscle allows the extraction of additional information on muscle physiology and

R. Merletti; A. Bottin; C. Cescon; D. Farina; M. Gazzoni; S. Martina; L. Mesin; M. Pozzo; A. Rainoldi; P. Enck

2004-01-01

60

Management of obstetric anal sphincter injury: a systematic review & national practice survey  

Microsoft Academic Search

BACKGROUND: We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists. METHODS: A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out. RESULTS: We found a wide variation

Ruwan J Fernando; Abdul H Sultan; Simon Radley; Peter W Jones; Richard B Johanson

2002-01-01

61

Changes in anal sphincter tone at induction of anaesthesia.  

PubMed Central

Changes in anal pressure have been monitored during the induction of anaesthesia. Falls in pressure accompany loss of consciousness following bolus doses of commonly used intravenous and inhalational anaesthetic agents. Subsequent rises in pressure towards pre-anaesthetic levels are usually associated with the time taken to correct responses and initial recovery. Premedication, including anticholinergic drugs in conventional dosage, does not affect anal pressure.

Harrison, M. J.; Tomlinson, P. A.; Ubhi, C. S.; Wright, J.; Hardcastle, J. D.

1988-01-01

62

Long-Term Outcome of Overlapping Anal Sphincter Repair  

Microsoft Academic Search

PURPOSE: This study reviews the long-term outcome of overlapping anal sphincteroplasty for acquired anal incontinence. METHODS: Seventy-one consecutive patients underwent overlapping sphincteroplasty from 1989 to 1996. Current degree of continence and associated quality of life were determined by telephone interview using the Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale, as validated by The American Society of

Amy L. Halverson; Tracy L. Hull

2002-01-01

63

Results of artificial sphincter in severe anal incontinence  

Microsoft Academic Search

PURPOSE AND METHODS: Fourteen AMS 800® (American Medical Systems, Minneapolis, MN) urinary artificial sphincters have been consecutively implanted in 13 patients with total incontinence for stool of various causes (traumatic or postoperative, 7; congenital, 3; neurologic, 2; idiopathic, 1). No proximal stoma was constructed but was already present in one patient before implantation. RESULTS: Sepsis occurred in two patients. Removal

Paul-Antoine Lehur; Francis Michot; Philippe Denis; Philippe Grise; Joël Leborgne; Paul Teniere; Jean-Marie Buzelin

1996-01-01

64

Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles.  

PubMed

In 26 volunteers without anorectal complaints, and in 31 patients with anorectal problems such as hemorrhoidal disease, anal fissure, and proctalgia fugax, baseline resting anal canal pressures were recorded manometrically for 5 minutes at room temperature (23 degrees C). In 16 volunteers (Group A) and 21 patients (Group B) anorectal manometry was then performed while the anus was immersed in water at varying temperatures (5 degrees C, 23 degrees C, and 40 degrees C). In ten volunteers (Group A') and ten patients (Group B') resting pressures were recorded for an additional 30 minutes following immersion for 5 minutes at 40 degrees C. In all subjects (at least P less than 0.01), resting anal canal pressures diminished significantly from baseline after immersion at 40 degrees C, but remained unchanged in all subjects after immersion at 5 degrees C and 23 degrees C. In Group A', anal canal pressures remained significantly reduced for 15 minutes (P less than 0.02). In Group B', significant reduction in resting pressure lasted 30 minutes (P less than 0.02). Wet heat applied to the anal sphincter apparatus significantly and reproducibly decreased resting anal canal pressures over time, and therefore was likely to benefit patients after anorectal operations and those with anorectal pain. PMID:3948615

Dodi, G; Bogoni, F; Infantino, A; Pianon, P; Mortellaro, L M; Lise, M

1986-04-01

65

Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair.  

PubMed Central

OBJECTIVES--To determine (i) risk factors in the development of third degree obstetric tears and (ii) the success of primary sphincter repair. DESIGN--(i) Retrospective analysis of obstetric variables in 50 women who had sustained a third degree tear, compared with the remaining 8553 vaginal deliveries during the same period. (ii) Women who had sustained a third degree tear and had primary sphincter repair and control subjects were interviewed and investigated with anal endosonography, anal manometry, and pudendal nerve terminal motor latency measurements. SETTING--Antenatal clinic in teaching hospital in inner London. SUBJECTS--(i) All women (n = 8603) who delivered vaginally over a 31 month period. (ii) 34 women who sustained a third degree tear and 88 matched controls. MAIN OUTCOME MEASURES--Obstetric risk factors, defecatory symptoms, sonographic sphincter defects, and pudendal nerve damage. RESULTS--(i) Factors significantly associated with development of a third degree tear were: forceps delivery (50% v 7% in controls; P = 0.00001), primiparous delivery (85% v 43%; P = 0.00001), birth weight > 4 kg (P = 0.00002), and occipito-posterior position at delivery (P = 0.003). No third degree tear occurred during 351 vacuum extractions. Eleven of 25 (44%) women who were delivered without instruments and had a third degree tear did so despite a posterolateral episiotomy. (ii) Anal incontinence or faecal urgency was present in 16 women with tears and 11 controls (47% v 13%; P = 0.00001). Sonographic sphincter defects were identified in 29 with tears and 29 controls (85% v 33%; P = 0.00001). Every symptomatic patient had persistent combined internal and external sphincter defects, and these were associated with significantly lower anal pressures. Pudendal nerve terminal motor latency measurements were not significantly different. CONCLUSIONS--Vacuum extraction is associated with fewer third degree tears than forceps delivery. An episiotomy does not always prevent a third degree tear. Primary repair is inadequate in most women who sustain third degree tears, most having residual sphincter defects and about half experiencing anal incontinence, which is caused by persistent mechanical sphincter disruption rather than pudendal nerve damage. Attention should be directed towards preventive obstetric practice and surgical techniques of repair. Images FIG 1 FIG 2

Sultan, A. H.; Kamm, M. A.; Hudson, C. N.; Bartram, C. I.

1994-01-01

66

Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice  

Microsoft Academic Search

We conducted an audit to evaluate how effective a structured course in the management of obstetric anal sphincter injuries\\u000a (OASIS) was at imparting knowledge. Training was undertaken using models and cadaveric pig’s anal sphincters. An anonymous\\u000a questionnaire was completed prior to and 8 weeks after the course. Four hundred and ninety seven completed the questionnaire\\u000a before and 63% returned it after

Vasanth Andrews; Ranee Thakar; Abdul H. Sultan

2009-01-01

67

Postpartum anal sphincter lacerations in a population with minimal exposure to episiotomy and operative vaginal delivery  

Microsoft Academic Search

This case–control study was designed to identify risk factors for anal sphincter lacerations (ASL) in a multicultural population\\u000a where episiotomies and operative vaginal deliveries are rarely performed. Cases were subjects with ASL delivered between July\\u000a 1997 and June 2003. Two controls were selected for each case matched for gestational age. Independent variables collected\\u000a included age, race\\/ethnicity, parity, tobacco use, medical

Cindi Lewis; Alana M. Williams; Rebecca G. Rogers

2008-01-01

68

The nerve branches to the external anal sphincter: the macroscopic supply and microscopic structure  

Microsoft Academic Search

Summary  The study was performed using 45 pelvic half section specimens (41 fetal ones and four adults). The macroscopic dissection\\u000a followed the nerve branches from their spinal roots up to the external anal sphincter. Three nerve branches were found: the\\u000a anterior ramus arising from the external perineal nerve, the inferior rectal nerve and an independent posterior branch. The\\u000a anterior and the

C Gagnard; G Godlewski; D Prat; O Lan; J Cousineau; Y Maklouf

1986-01-01

69

Urinary incontinence after obstetric anal sphincter injuries (OASIS)—is there a relationship?  

Microsoft Academic Search

This study aimed to compare urinary symptoms and its impact on women’s quality of life after obstetric anal sphincter injuries\\u000a (OASIS) with a matched control group in the short term. The study group consisted of 100 primiparous women with OASIS and\\u000a 104 controls who sustained a second-degree tear or had a mediolateral episiotomy performed. All women completed a validated\\u000a International

Inka Scheer; Vasanth Andrews; Ranee Thakar; Abdul H. Sultan

2008-01-01

70

Is there a nitrergic modulation of the rat external anal sphincter?  

PubMed

Nitric oxide is known to relax the internal anal sphincter, but its effect on the external anal sphincter (EAS) is unknown. The aim of this study was to investigate whether there is a nitrergic nerve plexus that modulates the EAS, similar to that found in oesophageal striated muscle. An in vitro ring preparation of rat anal canal was used to evaluate the effects of the nitric oxide synthase inhibitor N(?)-nitro-L-arginine (L-NNA) and the NO donor sodium nitroprusside (SNP) on the EAS in conditions of neuromuscular blockade and the effect of SNP on nerve-evoked contractions. Immunohistological experiments were conducted to determine whether the neuronal isoform of nitric oxide synthase (nNOS) is present in the EAS. During direct muscle stimulation neither L-NNA (P = 0.32) nor SNP (P = 0.19) significantly changed the EF(50), which is the frequency at which 50% of maximal contraction is reached, compared with a time-dependent control. Nerve-evoked contractions were also not altered by addition of SNP to the tissue bath. Immunohistohistological experiments clearly showed co-localization of nNOS-positive nerve fibres at motor endplates of the oesophagus but not in the EAS. The internal anal sphincter was richly innervated by nitrergic fibres, but these did not extend into the EAS. In conclusion, there are no nitrergic motor fibres innervating the EAS, neurotransmission at the motor endplates is not affected by NO, and NO does not affect muscle force directly in conditions of neuromuscular blockade. There is, therefore, no evidence that EAS contraction is directly modulated by NO or by pudendal nitrergic fibres or diffusion from neighbouring nitrergic plexuses of the anal canal. PMID:22872659

Evers, J; Buffini, M; Craven, S; O'Connell, P R; Jones, J F X

2012-08-07

71

Relation between electromyography and anal manometry of the external anal sphincter  

Microsoft Academic Search

Thirteen patients with faecal incontinence and 26 control subjects were studied to investigate whether a quantitative electromyographic (EMG) signal could be correlated to anal manometry. Three different electrodes were used--a concentric needle electrode, a disposable sponge electrode, and a hard anal plug electrode. The maximum amplitude of the EMG recording was used as a quantitative parameter. Linear regression showed significant

M Sørensen; T Tetzschner; O O Rasmussen; J Christiansen

1991-01-01

72

Internal anal sphincter myopathy causing proctalgia fugax and constipation: further clinical and radiological characterization in a patient.  

PubMed

We report a case of a distinctive familial internal anal sphincter myopathy with unique histological and radiological features. A 67-year-old woman presented with a 20-year history of proctalgia fugax and outlet obstruction; other family members were similarly affected. Computed tomograpy and magnetic resonance imaging demonstrated a grossly hypertrophied internal anal sphincter. Strip myectomy of the sphincter was carried out with improvement in evacuation but little relief of proctalgia. Further relief of symptoms was obtained using oral and transdermal nitrates and a calcium antagonist. Histological examination of the excised muscle revealed hypertrophy and an abnormal arrangement of fibres in whorls; many fibres contained vacuoles with inclusion bodies positive for periodic acid-Schiff. This description of a specific anal sphincter myopathy illustrates the potential importance of histopathological studies of smooth muscle in functional disorders of the gut. PMID:9058640

Guy, R J; Kamm, M A; Martin, J E

1997-02-01

73

Towards Safer Treatments for Benign Anorectal Disease: The Pharmacological Manipulation of the Internal Anal Sphincter  

PubMed Central

INTRODUCTION The internal anal sphincter (IAS) is an important structure that is responsible for the majority of resting tone of the sphincter complex. It has a central role in continence and damage to the muscle has serious implications. Injury is most frequently from obstetric trauma though iatrogenic injury from proctological surgery is also common. This review expands on how developments in understanding of the pharmacology of IAS might identify drug treatments as alternatives for proctological conditions such as anal fissure, avoiding the risk of sphincter injury. It also examines the role of pharmacology in treatment of those patients with established incontinence. RESULTS Much of the basic physiology and pharmacology of the IAS has been established through in vitro analysis, particularly in the superfusion organ bath. Further analysis has been undertaken using animal models such the pig. Clinical trials have established the efficacy of a number of agents for reducing IAS tone including glyceryl trinitrate and botulinum toxin. These drugs are probably safer, but less effective, than surgery for sphincter spasm, as is seen in anal fissure, though surgery alone or in combination with drug treatment may be appropriate for some patients. In vitro analysis and small-scale clinical trials suggest that phenylephrine and methoxamine may have a role in treating patients with incontinence primarily attributable to inadequate IAS function. CONCLUSIONS The pharmacology of IAS has been extensively studied in the laboratory, both in vitro and in animal models. In a short time, this laboratory work has been applied to clinical problems after testing in clinical trials. It is likely, however, that the best drugs and the optimal targets for manipulation have not yet been identified.

Jones, Oliver M

2007-01-01

74

Anal Fissure  

MedlinePLUS

... lining of the anus. Patients with tight anal sphincter muscles (i.e., increased muscle tone) are more ... anal pain can produce spasm of the anal sphincter muscle, resulting in a decrease in blood flow ...

75

Impact of pregnancy and parturition on the anal sphincters and pelvic floor.  

PubMed

Incontinence and defecatory difficulties are commonly reported among women and are often ascribed to traumas sustained during childbirth. Specifically, injuries to the anal sphincters (tears) and conformational changes in the various structures that comprise the pelvic floor (prolapse and perineal descent) have been considered as important contributors to the development of anal incontinence, or difficult defaecation (straining, incomplete evacuation), in later life. An understanding of both the effects of pregnancy and parturition on these structures and the natural history of any traumas sustained are, therefore, of key importance. Unfortunately, the literature on these issues, though vast, is far from complete. While it is evident that pregnancy, per se, imposes changes, primarily through hormonal influences, on colonic, ano-rectal and pelvic floor physiology, the long-term impact of such effects is far from clear. Risk factors for the occurrence of significant, though often occult, anal sphincter injuries during birth have been identified and the role of these tears in the etiology of post-partum incontinence has been well delineated. In contrast, the contribution of such intra-partum events to the later onset of incontinence is far from clear and may well have been over-estimated. PMID:17889813

Quigley, Eamonn M M

2007-01-01

76

Conventional cutting vs. internal anal sphincter-preserving seton for high trans-sphincteric fistula: a prospective randomized manometric and clinical trial  

Microsoft Academic Search

Background: Cutting setons have been used in complicated perirectal sepsis with good effect, although there is a moderately high incidence of fecal leakage after their use. The aim of this study was to compare a modified cutting seton, which repaired the internal anal sphincter muscle and re-routed the seton through the intersphincteric space, with a conventional cutting seton. Methods: A

A. P. Zbar; J. Ramesh; M. Beer-Gabel; R. Salazar; M. Pescatori

2003-01-01

77

Chemokine upregulation in response to anal sphincter and pudendal nerve injury: potential signals for stem cell homing  

Microsoft Academic Search

Purpose  Stromal derived factor-1 (SDF-1) and monocyte chemotactic protein-3 (MCP-3) are signals forcing the migration of bone marrow-derived\\u000a stem cells to ischemic tissue. This study investigates SDF-1 and MCP-3 expression following direct injury to the anal sphincter\\u000a and pudendal nerve and to determine if these same mechanisms have any role.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Chemokine expression was studied after anal sphincter injury in female rats

Levilester Salcedo; Nikolai Sopko; Hai-Hong Jiang; Margot Damaser; Marc Penn; Massarat Zutshi

78

Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation: further clinical and histological characterization in a patient.  

PubMed

Hereditary internal anal sphincter myopathy is a very rare condition, only three families have so far been described in the literature. In this case report further clinical and histological findings of one affected member of one of the above families are presented. PMID:10656223

König, P; Ambrose, N S; Scott, N

2000-01-01

79

Botulinum toxin injections in the internal anal sphincter for the treatment of chronic anal fissure: long-term results after two different dosage regimens.  

PubMed Central

OBJECTIVE: To investigate the effects of two different dosage regimens of botulinum toxin to induce healing in patients with idiopathic anal fissure. SUMMARY BACKGROUND DATA: Chronic anal fissure is maintained by contraction of the internal anal sphincter. Sphincterotomy, which is successful in 85% to 95% of patients, permanently weakens the sphincter and therefore might be associated with anal deformity and incontinence. METHODS: Fifty-seven consecutive outpatients were evaluated. Type A botulinum toxin was injected into the internal anal sphincter. RESULTS: Patients were divided into two treatment groups based on the number of botulinum toxin units injected. Patients in the first group were treated with 15 units and retreated with 20 units. Patients in the second group were treated with 20 units and retreated with 25 units. Two months after treatment, 10 patients in the first group and 23 patients in the second group had a healing scar. Symptomatic improvement was observed in 13 patients in the first group and in 24 patients in the second group. Statistical analysis showed that resting anal pressure varied from baseline values as a function of treatment; in contrast, the treatment had no effect on maximum voluntary pressure. Long-term healing was achieved in 13 patients in the first group and in all patients in the second group who underwent a complete treatment. CONCLUSIONS: Botulinum toxin is safe and effective in the treatment of anal fissure. It is less expensive and easier to perform than surgical treatment. No adverse effects resulted from injections of the toxin. The higher dosage is effective in producing long-term healing without complications.

Maria, G; Brisinda, G; Bentivoglio, A R; Cassetta, E; Gui, D; Albanese, A

1998-01-01

80

Investigation of the distribution and function of ?-adrenoceptors in the sheep isolated internal anal sphincter  

PubMed Central

BACKGROUND AND PURPOSE We have investigated the distribution of ?-adrenoceptors in sheep internal anal sphincter (IAS), as a model for the human tissue, and evaluated various imidazoline derivatives for potential treatment of faecal incontinence. EXPERIMENTAL APPROACH Saturation and competition binding with 3H-prazosin and 3H-RX821002 were used to confirm the presence and density of ?-adrenoceptors in sheep IAS, and the affinity of imidazoline compounds at these receptors. A combination of in vitro receptor autoradiography and immunohistochemistry was used to investigate the regional distribution of binding sites. Contractile activity of imidazoline-based compounds on sheep IAS was assessed by isometric tension recording. KEY RESULTS Saturation binding confirmed the presence of both ?1- and ?2-adrenoceptors, and subsequent characterization with sub-type-selective agents, identified them as ?1A- and ?2D-adrenoceptor sub-types. Autoradiographic studies with 3H-prazosin showed a positive association of ?1-adrenoceptors with immunohistochemically identified smooth muscle fibres. Anti-?1-adrenoceptor immunohistochemistry revealed similar distributions of the receptor in sheep and human IAS. The imidazoline compounds caused concentration-dependent contractions of the anal sphincter, but the maximum responses were less than those elicited by l-erythro-methoxamine, a standard non-imidazoline ?1-adrenoceptor agonist. Prazosin (selective ?1-adrenoceptor antagonist) significantly reduced the magnitude of contraction to l-erythro-methoxamine at the highest concentration used. Both prazosin and RX811059 (a selective ?2-adrenoceptor antagonist) reduced the potency (pEC50) of clonidine. CONCLUSIONS AND IMPLICATIONS This study shows that both ?1- and ?2-adrenoceptors are expressed in the sheep IAS, and contribute (perhaps synergistically) to contractions elicited by various imidazoline derivatives. These agents may prove useful in the treatment of faecal incontinence.

Rayment, SJ; Eames, T; Simpson, JAD; Dashwood, MR; Henry, Y; Gruss, H; Acheson, AG; Scholefield, JH; Wilson, VG

2010-01-01

81

Automatic localisation of innervation zones: a simulation study of the external anal sphincter.  

PubMed

Traumas of the innervation zone (IZ) of the external anal sphincter (EAS), e.g. during delivery, can promote the development of faecal incontinence. Recently developed probes allow high-resolution detection of EMG signals from the EAS. The analysis of pelvic floor muscles by surface EMG (in particular, the estimation of the location of the IZ) has potential applications in the diagnosis and investigation of the mechanisms of incontinence. An automatic method (based on matched filter approach) for the estimation of the IZ distribution of EAS from surface EMG is discussed and tested using an analytical model of generation of EMG signals from sphincter muscles. Simulations are performed varying length of the fibres, thickness of the mucosa, position of the motor units, and force level. Different distributions of IZs are simulated. The performance of the proposed method in the estimation of the IZ distribution is affected by surface MUAP amplitude (as the estimation made by visual inspection), by mucosa thickness (performance decreases when fibre length is higher) and by different MU distributions. However, in general the method is able to identify the position of two IZ locations and can measure asymmetry of the IZ distribution. This strengthens the potential applications of high density surface EMG in the prevention and investigation of incontinence. PMID:19269857

Mesin, Luca; Gazzoni, Marco; Merletti, Roberto

2009-03-09

82

A Study of Fecal Incontinence in Patients with Chronic Anal Fissure: Prospective, Randomized, Controlled Trial of the Extent of Internal Anal Sphincter Division During Lateral Sphincterotomy  

Microsoft Academic Search

Background  Troublesome fecal incontinence following a lateral internal sphincterotomy is often attributed to faulty surgical technique.\\u000a However, it may be associated with coexisting occult sphincter defects. Whether continence is related to the extent of sphincterotomy\\u000a remains debatable. The aim of the study is to identify fecal incontinence related to chronic anal fissure before and after\\u000a lateral internal sphincterotomy and its relationship

Magdy M. A. Elsebae

2007-01-01

83

Sacral nerve stimulation for the treatment of faecal incontinence related to dysfunction of the internal anal sphincter  

Microsoft Academic Search

Purpose  In patients with faecal incontinence related to isolated internal anal sphincter (IAS) disruption, conservative management\\u000a is the mainstay of treatment. Surgical repair of the internal sphincter is not successful. This study evaluated the use of\\u000a sacral nerve stimulation (SNS) in those with faecal incontinence and IAS disruption in whom medical and behavioural treatments\\u000a had failed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Nine patients (seven women, median

Thomas C. Dudding; David Parés; Carolynne J. Vaizey; Michael A. Kamm

2010-01-01

84

Lack of nitrate tolerance in isosorbide dinitrate- and sodium nitroprusside-induced relaxation of rabbit internal anal sphincter  

PubMed Central

AIM: To investigate the tolerance development against the relaxant effect of nitric oxide donating drug isosorbide dinitrate (ISDN) and sodium nitroprusside (SNP) in internal anal sphincter (IAS) smooth muscle. METHODS: Relaxation responses of ISDN, and electrical field stimulation (EFS) were obtained before and after tolerance induction by ISDN incubation. RESULTS: ISDN (10-7-10-4 mol/L) and SNP (10-8-10-4 mol/L) caused a concentration-dependent relaxation on the basal tonus of the isolated rabbit IAS strips. After a period of 2 h incubation of the 6 x 10-4 mol/L ISDN the relaxation effects of ISDN and SNP did not change compared to control strips. EFS evoked frequency-dependent relaxation in internal anal sphincter smooth muscle and Emax obtained from control strips were not changed in ISDN tolerance-inducing condition. In this study nitrate tolerance was not observed in rabbit IAS smooth muscle. CONCLUSION: This result shows that nitric oxide donating drugs relaxes the internal anal sphincter of the rabbits without the development of tolerance.

Koyuncu, Ayhan; Bagcivan, Ihsan; Sarac, Bulent; Aydin, Cengiz; Yildirim, Sahin; Sarioglu, Yusuf

2008-01-01

85

Prospective study of the influence of parity and operative technique on the outcome of primary anal sphincter repair following obstetrical injury  

Microsoft Academic Search

Objective: To determine the influence of parity and method of primary anal sphincter repair on outcome following obstetrical third degree perineal tear. Study design: Prospective study of 154 women after primary repair following third degree tear conducted over 2 years. Postpartum evaluation included a continence questionnaire, anal manometry and endoanal ultrasound. Results: Third degree tears occurred in 1.6% primiparae and

Myra Fitzpatrick; Michelle Fynes; Mary Cassidy; Michael Behan; P. Ronan O’Connell; Colm O’Herlihy

2000-01-01

86

Basal internal anal sphincter tone, inhibitory neurotransmission, and other factors contributing to the maintenance of high pressures in the anal canal.  

PubMed

Maintenance of the basal tone in the internal anal sphincter (IAS) is critical for rectoanal continence. Effective evacuation requires a fully functional rectoanal inhibitory reflex (RAIR)-mediated relaxation of the IAS via inhibitory neurotransmission (INT). Systematic studies examining the nature of the INT in different species have identified nitric oxide (NO) as the major inhibitory neurotransmitter. However, other mediators such as vasoactive intestinal polypeptide (VIP), ATP, and carbon monoxide (CO) may also play species-specific role under certain experimental conditions. Measurements of the intraluminal pressures in the IAS along with the force of the isolated IAS tissues are the mainstay in the basic studies for the molecular mechanisms underlying the basal tone and in the nature of the INT. The identification of NO as the inhibitory neurotransmitter has led to major advances in the diagnosis and treatment of a number of rectoanal motility disorders associated with the IAS dysfunction. Besides the IAS, the high pressures in the anal canal are affected by the external anal sphincter (EAS) function, and its malfunction may also lead to rectoanal incontinence. Different approaches including biofeedback have been attempted to improve the EAS function, with variable outcomes. There is a dire need for the innovative ways to improve the week high pressures zone in the anal canal. This viewpoint focuses on two studies that extend the above concept of multiplicity of inhibitory neurotransmitters (Neurogastroenterol Motil 2011 23 e11–25), and that high pressures in the anal canal can be improved by the EAS plication (Neurogastroenterol Motil 2011 23 70–5). PMID:21188800

Rattan, S; Singh, J

2011-01-01

87

The impact of an intervention programme employing a hands-on technique to reduce the incidence of anal sphincter tears: interrupted time-series reanalysis  

PubMed Central

Objective To re-evaluate previously published findings from an uncontrolled before–after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand. Design Interrupted time-series analysis using segmented regression modelling. Setting Obstetric departments of five Norwegian hospitals. Participants All women giving births vaginally in the study hospitals, 2002–2008. Methods The main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation. Main outcome measures Incidence of anal sphincter tears and episiotomies. Results There were 75?543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies. Conclusions The intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions.

Fretheim, Atle; Odgaard-Jensen, Jan; R?ttingen, John-Arne; Reinar, Liv Merete; Vangen, Siri; Tanbo, Tom

2013-01-01

88

Risk factors for obstetric anal sphincter injury after a successful multicentre interventional programme.  

PubMed

OBJECTIVE: To evaluate and compare the risk profile of sustaining obstetric anal sphincter injuries (OASIS) and associated risks in five risk groups (low to high), after the OASIS rate was reduced from 4.6% to 2.0% following an interventional programme. The main focus of the intervention was on manual assistance during the final part of second stage of labour. DESIGN: A multicentre interventional cohort study with before and after comparison. SETTING: Four Norwegian obstetric departments. SAMPLE: A total of 40 154 vaginal deliveries in 2003-09. METHODS: Pre-intervention and postintervention analyses. The associations of OASIS with possible risk factors were estimated using odds ratios obtained by logistic regression. MAIN OUTCOME MEASURE: Risk factors of OASIS. RESULTS: The risk of sustaining OASIS decreased by 59% (odds ratio [OR] 0.41; 95% confidence interval [95% CI] 0.36-0.46) after the intervention. Associations with obstetric risks for OASIS were largely unchanged after the intervention, including first vaginal delivery (OR 3.84; 95% CI 2.90-5.07), birthweight ?4500 g (OR 4.42; 95% CI 2.68-7.27), forceps delivery (OR 3.54; 95% CI 1.99-6.29) and mediolateral episiotomy (OR 0.89; 95% CI 0.70-1.12). However, the highest reduction of OASIS, (65%), was observed in group 0 (low-risk) (OR 0.35; 95% CI 0.24-0.51), and a 57% (OR 0.43; 95% CI 0.35-0.52), 61% (OR 0.39; 95% CI 0.31-0.48), and 58% (OR 0.42; 95% CI 0.30-0.60) reduction in groups with one, two and three risk factors, respectively. No change was observed in the group with four risk factors. CONCLUSION: After the intervention the most significant decrease of OASIS was observed in low-risk births, although the main risk factors for OASIS remained unchanged. PMID:23682573

Stedenfeldt, M; Oian, P; Gissler, M; Blix, E; Pirhonen, J

2013-05-20

89

Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study  

PubMed Central

Objectives To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40–60° are associated with fewer OASIS than episiotomies with more acute angles. Design Case–control study. Setting University Hospital of North Norway, Tromsø and Nordland Hospital, Bodø, Norway. Sample Seventy-four women who had one vaginal birth and episiotomy. Cases (n = 37) have sustained OASIS at birth, while controls (n = 37) had not. The groups were matched for instrumental delivery. Methods Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis. Main outcome measures Mean episiotomy angle, length, depth, incision point. Results The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14–0.66) for each 5.5-mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23–0.86) for each 4.5-mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10–0.61) for each 5.5-mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a “U-shaped” association between angle and OASIS (OR 2.09; 95% CI 1.02–4.28) with an increased risk (OR 9.00; 95% CI 1.1–71.0) of OASIS when the angle was either smaller than 15°or >60°. Conclusion The present study showed that scarred episiotomies with depth > 16 mm, length > 17 mm, incision point > 9 mm lateral of midpoint and angle range 30–60° are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered.

Stedenfeldt, M; Pirhonen, J; Blix, E; Wilsgaard, T; Vonen, B; ?ian, P

2012-01-01

90

Experimental Models of Neuropathic Fecal Incontinence: An Animal Model of Childbirth Injury to the Pudendal Nerve and External Anal Sphincter  

Microsoft Academic Search

Purpose  Childbirth is the most common cause of fecal incontinence and damage to the pudendal nerve is a major component of childbirth\\u000a injury. This study was designed to develop an acute animal model of injury to the innervation of the external anal sphincter.\\u000a \\u000a \\u000a \\u000a Methods  Forty-eight female virgin wistar rats were studied. Two models of neuropathic injury were developed. Bilateral inferior rectal\\u000a nerve

C. F. Healy; C. O’Herlihy; C. O’Brien; P. R. O’Connell; J. F. X. Jones

2008-01-01

91

[The colonosphincterometrogram (CSMG). An original method of simultaneous study of the motility of the left colon and of the anal sphincters].  

PubMed

Colonsphinctorometrography (CSMG) is a new, original method for the simultaneous investigation of the motility of the descending colon, sigmoid colon, rectosigmoid junction, rectum, and internal and external anal sphincters. A 60 cm open-ended tip sound with an external diameter of 10 mm is used. Three 3 cm long stimulating balloons are located at points 15 cm, 30 cm, and 50 cm along its length. A basal recording is taken for about 15 min with the patient absolutely at rest. The balloons are then inflated to measure the kinetic responses of colon and anal sphincters to stimuli of different volume. In addition to offering a pressure recording for the left colon and internal sphincter, the method also provides an EMG for the external sphincter and a pneumogram. PMID:7366870

Reboa, G; Giusto, F; Secco, G B; Terrizzi, A; Berti Riboli, E

1980-03-15

92

Risk factors associated with anal sphincter tear: A comparison of primiparous patients, vaginal births after cesarean deliveries, and patients with previous vaginal delivery  

Microsoft Academic Search

Objective: This study was conducted to identify obstetric risk factors for anal sphincter tear in primiparous patients, patients with a previous cesarean delivery (VBAC), and patients with a previous vaginal delivery (PVD). Study Design: An obstetrics automated record system was accessed to retrospectively review records of all singleton vaginal deliveries at greater than 36 weeks' gestation (excluding breech and stillbirth)

Holly E. Richter; Cynthia G. Brumfield; Suzanne P. Cliver; Kathryn L. Burgio; Cherry L. Neely; R. Edward Varner

2002-01-01

93

Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence  

Microsoft Academic Search

PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or

Anne-Marie Leroi; Marie-Paule Dorival; Marie-Françoise Lecouturier; Christine Saiter; Marie-Laure Welter; Jean-Yves Touchais; Philippe Denis

1999-01-01

94

Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study.  

PubMed Central

In 40 women with idiopathic (neurogenic) faecal incontinence, 20 of whom also had stress urinary incontinence, single fibre EMG studies showed an increased fibre density in the external anal sphincter muscle. All these patients showed excessive descent of the pelvic floor on straining. The mean terminal motor latencies in the pudendal and perineal nerves, measured by a digitally-directed intrarectal stimulating technique, were increased when compared with 20 control subjects (p less than 0.01). The perineal nerve terminal motor latency was more markedly increased in the 20 patients with double incontinence than in those with faecal incontinence alone (p less than 0.01). These results provide direct electrophysiological evidence of damage to the innervation of the pelvic floor musculature in idiopathic faecal and double incontinence, and imply that idiopathic stress urinary incontinence may have a similar cause.

Snooks, S J; Barnes, P R; Swash, M

1984-01-01

95

Artificial Bowel Sphincter  

Microsoft Academic Search

\\u000a Fecal incontinence is a socially devastating problem. The treatment algorithm depends on the etiology of the disease. Large\\u000a anal sphincter defects can be treated by sphincter replacement procedures: the dynamic graciloplasty and the artificial bowel\\u000a sphincter (ABS). The best indications for the ABS are lesions of the anal sphincters that are inaccessible to local repair\\u000a and not responsive to sacral

Giovanni Romano; Francesco Bianco; Luisa Caggiano

96

Anal sphincter lacerations and upright delivery postures—a risk analysis from a randomized controlled trial  

Microsoft Academic Search

Objective  To evaluate obstetric sphincter lacerations after a kneeling or sitting position at second stage of labor in a multivariate\\u000a risk analysis model.\\u000a \\u000a \\u000a \\u000a Materials and methods  Two hundred and seventy-one primiparous women with normal pregnancies and spontaneous labor were randomized, 138 to a kneeling\\u000a position and 133 to a sitting position. Medical data were retrieved from delivery charts and partograms. Risk factors

Daniel Altman; Inga Ragnar; Åsa Ekström; Tanja Tydén; Sven-Eric Olsson

2007-01-01

97

Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers.  

PubMed

Abstract Objective: Obstetric anal sphincter injury (OASIS) represents a major cause of maternal morbidity and is a risk factor for the development of fecal incontinence. We set out to analyze the incidence of OASIS and its association with mode of delivery in two large obstetric hospitals across an 8-year study period. Methods: This was a prospective observational study carried out at two large tertiary referral centers serving a single urban population, from 2003 to 2010. Incidence of OASIS was examined as well as the influence of parity and mode of delivery on the occurrence of OASIS. Results: During the study period, there were 100?307 vaginal deliveries at the two hospitals. There was a total of 2121 cases of OASIS from 2003 to 2010, giving an incidence of 2.1% of vaginal deliveries. Patients were more likely to suffer an OASIS when having a forceps delivery than when having a normal vaginal delivery (8.6% versus 1.3%, p?sphincter injury compared with normal delivery (3.7% versus 1.3%, p??4?kg). The rate of episiotomy during the study was 19.1%. Conclusion: These results demonstrate that OASIS remains an important cause of maternal morbidity in contemporary obstetric practice. These results will likely be of value in risk management planning and patient debriefing in what is a highly litigious area of obstetrics. PMID:23560551

Hehir, Mark P; O'Connor, Hugh D; Higgins, Shane; Robson, Michael S; McAuliffe, Fionnuala M; Boylan, Peter C; Malone, Fergal D; Mahony, Rhona

2013-05-02

98

Function of the striated anal sphincter during straining in control subjects and constipated patients with a radiologically normal rectum or idiopathic megacolon  

Microsoft Academic Search

The function of the striated anal sphincter during defaecation straining was recorded by manometry and electromyography (E.M.G.) in 31 constipated patients who were unable to expel a water-filled rectal balloon with effort. This group was divided on the basis of measurement of colonic diameter into those with megacolon and those with a normal sized colon. The latter group was further

P. R. H. Barnes; J. E. Lennard-Jones

1988-01-01

99

Anal Fissure  

PubMed Central

Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. Conservative management, using increased fiber and warm baths, results in healing of approximately half of all anal fissures. In fissures that fail conservative care, various pharmacologic and surgical options offer satisfactory cure rates. Lateral internal sphincterotomy remains the gold standard for definitive management of anal fissure. This review outlines the key points in the presentation, pathophysiology, and management of anal fissure.

Zaghiyan, Karen N.; Fleshner, Phillip

2011-01-01

100

RhoA/ROCK pathway is the major molecular determinant of basal tone in intact human internal anal sphincter  

PubMed Central

The knowledge of molecular control mechanisms underlying the basal tone in the intact human internal anal sphincter (IAS) is critical for the pathophysiology and rational therapy for a number of debilitating rectoanal motility disorders. We determined the role of RhoA/ROCK and PKC pathways by comparing the effects of ROCK- and PKC-selective inhibitors Y 27632 and Gö 6850 (10?8 to 10?4 M), respectively, on the basal tone in the IAS vs. the rectal smooth muscle (RSM). Western blot studies were performed to determine the levels of RhoA/ROCK II, PKC-?, MYPT1, CPI-17, and MLC20 in the unphosphorylated and phosphorylated forms, in the IAS vs. RSM. Confocal microscopic studies validated the membrane distribution of ROCK II. Finally, to confirm a direct relationship, we examined the enzymatic activities and changes in the basal IAS tone and p-MYPT1, p-CPI-17, and p-MLC20, before and after Y 27632 and Gö 6850. Data show higher levels of RhoA/ROCK II and related downstream signal transduction proteins in the IAS vs. RSM. In addition, data show a significant correlation between the active RhoA/ROCK levels, ROCK enzymatic activity, downstream proteins, and basal IAS tone, before and after ROCK inhibitor. From these data we conclude 1) RhoA/ROCK and downstream signaling are constitutively active in the IAS, and this pathway (in contrast with PKC) is the critical determinant of the basal tone in intact human IAS; and 2) RhoA and ROCK are potential therapeutic targets for a number of rectoanal motility disorders for which currently there is no satisfactory treatment.

Singh, Jagmohan

2012-01-01

101

Long-term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints  

Microsoft Academic Search

Results Sixty-one percent of the women responded to both questionnaires. Anorectal complaints were reported by 38% of case versus 16% of controls in 1996 (risk difference: 0.22, 95% CI 0.10- 0.34) and by 61% of cases versus 22% of controls in 2005 (risk difference: 0.41, 95% CI 0.29-0.53). In contrast to the control group, the increase of anorectal complaints in

M Mous; SA Muller; JW De Leeuw

2007-01-01

102

Development of a three-dimensional physiological model of the internal anal sphincter bioengineered in vitro from isolated smooth muscle cells.  

PubMed

Fecal incontinence affects people of all ages and social backgrounds and can have devastating psychological and economic consequences. This disorder is largely attributed to decreased mechanical efficiency of the internal anal sphincter (IAS), yet little is known about the pathophysiological mechanisms responsible for the malfunction of sphincteric smooth muscle at the cellular level. The object of this study was to develop a three-dimensional (3-D) physiological model of the IAS bioengineered in vitro from isolated smooth muscle cells. Smooth muscle cells isolated from the IAS of rabbits were seeded in culture on top of a loose fibrin gel, where they migrated and self-assembled in circumferential alignment. As the cells proliferated, the fibrin gel contracted around a 5-mm-diameter SYLGARD mold, resulting in a 3-D cylindrical ring of sphincteric tissue. We found that 1) the bioengineered IAS rings generated a spontaneous basal tone, 2) stimulation with 8-bromo-cAMP (8-Br-cAMP) caused a sustained decrease in the basal tone (relaxation) that was calcium-independent, 3) upon stimulation with ACh, bioengineered IAS rings showed a calcium- and concentration-dependent peak contraction at 30 s that was sustained for 4 min, 4) addition of 8-Br-cAMP induced rapid relaxation of ACh-induced contraction and force generation of IAS rings, and 5) bioengineered sphincter rings show striking functional differences when compared with bioengineered rings made from isolated colonic smooth muscle cells. This is the first report of a 3-D in vitro model of a gastrointestinal smooth muscle IAS. Bioengineered IAS rings demonstrate physiological functionality and may be used in the elucidation of the mechanisms causing sphincter malfunction. PMID:15774939

Hecker, Louise; Baar, Keith; Dennis, Robert G; Bitar, Khalil N

2005-03-17

103

Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery  

Microsoft Academic Search

Purpose. Disturbance of anal continence is a well-known problem after vaginal delivery. However, only few and incongruent data on the incidence and pathogenesis of postpartum incontinence are available. This study examined the effects of vaginal delivery on anal continence prospectively. Methods. In 42 unselected women anal vector manometry and endoanal ultrasonography were performed, and pudendal nerve terminal motor latency (PNTML)

S. Willis; A. Faridi; S. Schelzig; F. Hoelzl; R. Kasperk; W. Rath; V. Schumpelick

2002-01-01

104

Anal endosonography: Relationship with anal manometry and neurophysiologic tests  

Microsoft Academic Search

Thirty-seven patients were referred for evaluation of anal function; their clinical diagnoses were traumatic fecal incontinence (13), idiopathic (pudendal neuropathy) fecal incontinence (7), fecal soiling (9), and other (8). In all patients, anal endosonography (sphincter defects and internal sphincter thickness [IST]) and anal manometry (maximal basal pressure [MBP] and maximal squeeze pressure [MSP]) were performed. In 18 patients, neurophysiologic tests

R. J. F. Felt-Bersma; M. A. Cuesta; M. Koorevaar; R. L. M. Strijers; S. G. M. Meuwissen; E. J. Dercksen; R. I. C. Wesdorp

1992-01-01

105

Absence of effect of nicotine on rectal sensation, rectal compliance, and anal sphincter pressures in healthy subjects.  

PubMed

We examined the effect of nicotine on rectal sensation, rectal compliance, and anorectal sphincter function in healthy volunteers. Eleven healthy (ex-smoker) subjects were randomized in a double-blind, crossover, placebo-controlled study of 12 mg nicotine-containing chewing gum. All treatment periods (nicotine or placebo chewing gum) were preceded by a control period without chewing gum. Crossover study was done after a washout period of more than seven days. The following measurements were made: highest anorectal sphincter tone, highest anorectal sphincter squeeze tone, percentage relaxation of the anorectal sphincter with rectal balloon distension, threshold of rectal sensation, maximal tolerable volume of air inflation of a rectal balloon, and rectal compliance. There was no significant difference in the two control periods. Chewing placebo gum had no significant effect on any of the measurements when compared with control. Compared with placebo, nicotine did not significantly affect on any of the measurements. We conclude that neither nicotine nor the sham-feeding effect of chewing placebo gum appear to have any effect on anorectal sensorimotor function or on rectal compliance in healthy ex-smokers. PMID:7587796

Kavin, H; Shivley, S

1995-10-01

106

Non-Invasive Detection and Characterization of Anal Incontinence in the Parous Soldier.  

National Technical Information Service (NTIS)

Disruption of the anal sphincters or injury to the sphincter innervation during childbirth is an important cause of anorectal incontinence among female soldiers. This study sought to determine the incidence of damage to the anal sphincter and the relation...

R. L. Hays S. Benjamin H. L. Mulligan G. Davis

1998-01-01

107

Long-term seton drainage for high anal fistulas in Crohn's disease—A sphincter-saving operation?  

Microsoft Academic Search

METHODS: Forty-one consecutive patients with Crohn's disease who underwent long-term seton drainage for high transsphincteric, suprasphincteric, or extrasphincteric anal fistula from 1985 to 1993 were reviewed. The subsequent associated procedure was simple seton removal (18), secondary fistulotomy (7), rectal flap advancement (3), and proctectomy (2). Eleven patients still had the seton in place. RESULTS: Recurrence developed in seven patients (39

Jean-Luc Faucheron; Olivier Saint-Marc; Lionel Guibert; Rolland Parc

1996-01-01

108

Combined estrogen and ghrelin administration decreases expression of p27 kip1 and proportion of isomyosin type I in the striated urethral and anal sphincters and levator ani of old ovariectomized rats  

Microsoft Academic Search

We compared estrogen and\\/or ghrelin effects on pelvic floor muscles in old versus young adult ovariectomized rats. Ovariectomized\\u000a Fisher 344 rats (18 and 3 months old, n?=?24?×?2) received 42 daily intraperitoneal 17-? estradiol (10 ?g kg?1), ghrelin (2 ?g kg?1), both, or vehicle (n?=?6?×?4\\/group). Cytoplasmic p27kip1 expression and isomyosin I proportion in striated urethral and anal sphincters and levator ani were measured, respectively,

Diaa E. E. Rizk; Hazem A. Hassan; Ahmed H. Al-Marzouqi; Mohammed Shafiullah; Mohamed A. Fahim

2008-01-01

109

Occult anal sphincter trauma following randomized forceps and vacuum delivery 1 This article was presented at the Blair Bell Research Society Meeting, RCOG, London on 27 October 1995 and is published as an abstract in the British Journal of Obstetrics and Gynaecology 1996;103:845. 1  

Microsoft Academic Search

Objective: To determine the prevalence of occult anal sphincter trauma 5 years after randomization to forceps and vacuum delivery. Method: Anal endosonography and manometry was performed in 44 of 313 women who had originally participated in one center of the Keele University Multicenter Assisted Delivery Trial at the North Staffordshire Maternity Hospital between September 1989 and May 1990. Results: 50%

A. H Sultan; R. B Johanson; J. E Carter

1998-01-01

110

Up to seven-fold inter-hospital differences in obstetric anal sphincter injury rates- A birth register-based study in Finland  

PubMed Central

Background The occurrence of obstetric anal sphincter injuries (OASIS) - which may have serious, long-term effects on affected women, including faecal incontinence, despite primary repair - varies widely between countries and have been chosen one of the indicators for patient safety in Organisation for Economic Cooperation and Development (OECD) countries and in Nordic countries. Findings The aim of the study was to assess risks of OASIS among five university teaching hospitals and 14 non-university central hospitals with more than 1,000 deliveries annually during 1997-2007 in Finland. Women with singleton vaginal deliveries divided into two populations consisting of all 168,637 women from five university hospitals and all 255,660 women from non-university hospitals, respectively, derived from population-based register. Primiparous and multiparous women with OASIS (n = 2,448) were compared in terms of possible risk factors to primiparous and multiparous women without OASIS, respectively, using stepwise logistic regression analysis. The occurrences of OASIS varied from 0.7% to 2.1% in primiparous and from 0.1% to 0.3% in multiparous women among the university hospitals. Three-fold inter-hospital differences in OASIS rates did not significantly change after adjustment for patient mix or the use of interventions. In non-university hospitals OASIS rates varied from 0.2% to 1.4% in primiparous and from 0.02% to 0.4% in multiparous women, and the results remained virtually unchanged after adjustment for known risks. Conclusions Up to 3.2-fold inter-hospital differences in OASIS risk demonstrates significant differences in the quality of Finnish obstetric care.

2010-01-01

111

Changing associations of episiotomy and anal sphincter injury across risk strata: results of a population-based register study in Finland 2004-2011  

PubMed Central

Objectives To evaluate the changing association between lateral episiotomy and obstetric anal sphincter injury (OASIS) for women with low and high baseline risk of OASIS. Design A population-based register study. Setting Data gathered from the Finnish Medical Birth Register for the years 2004?2011. Participants All women with spontaneous vaginal or vacuum-assisted singleton births in Finland (n=384?638). Main outcome measure OASIS incidence. Results During the study period, the incidence of OASIS increased from 1.3% to 1.7% in women with first vaginal births, including women admitted for first vaginal birth after a prior caesarean section and from 0.1% to 0.3% in women with at least one prior birth, whereas episiotomy rates declined from 56.7% to 45.5% and 10.1– 5.3%, respectively. At the study onset, when episiotomy was used more widely, it was negatively associated with OASIS in women with first vaginal births, but as episiotomy use declined it became positively associated with OASIS. Women with episiotomy were complicated by OASIS with clearly higher risk scores than women without episiotomy suggesting that episiotomy was clearly protective against OASIS. OASIS occurred with lower mean risk scores among women with and without episiotomy over time. However, OASIS incidences increased only among women with episiotomy, whereas it decreased or remained among women without episiotomy. Conclusions The cross-over effect between episiotomy and OASIS could be explained by increasing disparity in baseline OASIS risk between treated and untreated women, since episiotomy use declined most in women at low OASIS risk. Episiotomy rate can be safely reduced in low-risk women but interestingly along with the policy change the practice to cut the episiotomy became less protective among high-risk women.

Raisanen, Sari; Cartwright, Rufus; Gissler, Mika; Kramer, Michael R; Laine, Katariina; Jouhki, Maija-Riitta; Heinonen, Seppo

2013-01-01

112

Anal Cancer: Treatment Options by Stage  

MedlinePLUS

... or ½ inch) that do not involve the sphincter. In some cases, resection may be followed with ... can't be removed without harming the anal sphincter is radiation therapy combined with chemo (chemoradiation). Chemoradiation ...

113

Chronic anal fissure  

Microsoft Academic Search

Opinion statement  Diagnosis of chronic anal fissure is easy and common in clinical practice. Little is known about the etiology and pathogenesis\\u000a of this disorder. Current investigations consider anal sphincteric hypertonia and ischemia as primary factors in the appearance\\u000a and maintenance of this lesion. Recurrence rate after healing is high, so anal fissure may be a chronic disease that evolves\\u000a depending

Miguel Minguez; Belen Herreros; Adolfo Benages

2003-01-01

114

Anal function-preserving subtotal intersphincteric resection/partial external sphincteric resection with hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for very low stage I rectal cancer: A case report  

PubMed Central

A 62-year-old male patient underwent endoscopic mucosal resection (EMR). Additional hybrid 2-port hand-assisted laparoscopic surgery (HALS) (Mukai's operation) was performed for early rectal cancer located at the distal border of the rectum/below the peritoneal reflection (Rb) region [SM massive invasion/ly+/vertical margin (VM)X] via a small transverse incision, approximately 55 mm long, at the superior border of the pubic bone. After the pelvic floor muscles were dissected by laparoscopy-assisted manipulation, transanal subtotal intersphincteric resection (ISR) was performed under direct vision, securing a margin of more than 15 mm distal to the EMR scar. Partial external sphincteric resection (ESR) was also performed to obtain an adequate VM at the posterior region of the EMR scar. After bowel reconstruction, the layers were sutured transanally and a temporary covering colostomy was created. The resected specimen contained no residual tumor cells without lymph node metastasis. At 3 months after the operation, digital examination revealed good tonus of the anal muscles without stricture. The patient is currently undergoing rehabilitation of his anal sphincter muscles in preparation for the colostomy closure. In conclusion, subtotal ISR combined with partial ESR may decrease the need to perform Miles' operation for T1/2 stage I rectal cancer located at the distal border of the Rb region.

Mukai, Masaya; Sekido, Yasutomo; Fukumitsu, Hiroshi; Izumi, Hideki; Hoshikawa, Tatsuhiko; Tajima, Takayuki; Tobita, Kousuke; Sadahiro, Sotaro; Yasuda, Seiei; Ogoshi, Kyoji

2011-01-01

115

Glyceryl trinitrate for chronic anal fissure—Healing or headache?  

Microsoft Academic Search

PURPOSE: Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence. Reversible chemical sphincterotomy may be achieved by anal application of glyceryl trinitrate ointment (nitric oxide donor), which has been reported to heal the majority of patients with anal fissure by inducing sphincter relaxation and improving anodermal blood flow. This trial aimed to further clarify the role

Donato F. Altomare; Marcella Rinaldi; Giovanni Milito; Francesco Arcanà; Fernando Spinelli; Nicola Nardelli; Donato Scardigno; Antonio Pulvirenti-D'Urso; Corrado Bottini; Mario Pescatori; Roberta Lovreglio

2000-01-01

116

Perineal body measurement improves evaluation of anterior sphincter lesions during endoanal ultrasonography  

Microsoft Academic Search

Endoanal ultrasonography has become an important tool in the evaluation of patients with anal incontinence. However, the extent of anterior defects is sometimes difficult to quantitate during endoanal ultrasonography. PURPOSE: This study was designed to evaluate perineal body measurement during endoanal ultrasonography in assessing patients with obstetric anal sphincter injuries. METHODS: Forty-two patients with anal incontinence because of obstetric sphincter

Jan P. Zetterström; Anders Mellgren; Robert D. Madoff; Donald G. Kim; W. Douglas Wong

1998-01-01

117

[Acute anal pain].  

PubMed

Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically. PMID:23798022

Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

2013-07-01

118

Is there a role for concomitant pelvic floor repair in patients with sphincter defects in the treatment of fecal incontinence?  

Microsoft Academic Search

Background and aims  More than half of all patients who undergo overlapping anal sphincter repair for fecal incontinence develop recurrent symptoms. Many have associated pelvic floor disorders that are not surgically addressed during sphincter repair. We evaluate the outcomes of combined overlapping anal sphincteroplasty and pelvic floor repair (PFR) vs. anterior sphincteroplasty alone in patients with concomitant sphincter and pelvic floor

Scott R. Steele; Patrick Lee; Philip S. Mullenix; Matthew J. Martin; Eugene S. Sullivan

2006-01-01

119

[Continence of anorectal sphincter complex in the early postoperative period after direct colo-anal anastomoses with colo-colic J pouch].  

PubMed

According to up-to-date concepts for local spread of a rectal cancer it is possible to perform a radical rectal resection with a restorative anastomosis inspite of the fact that the tumor is located in the middle or the distal third of the rectum. Usually a total resection of the rectum and coloanal anstomosis have to be performed. There are two ways to restore the continuity of the gut: a straight coloanal anstomosis or J pouch anastomosis. 22 patients with rectal cancer localized between 4 and 9 cm from the anal verge, were operated and restorative anastomoses were performed. The first 18 patients were with a straight coloanal anastomosis. In the last 4 cases coloanal anastomoses were done between the anus and colocolic 7 cm J pouch. During the first month there were 6 patients with total and 9 with partial incontinence in the group with straight coloanal anastomosis. Transrectal sonography confirmed contractility of the puborectal muscle and sphinctermanometry showed lower resting tone and squeeze pressure in cases with incotinence. No incontinence was observed in the group with J pouch and the shinctermanometry data were the same as these of healthy controls. Conclusion: The rectal ampula has reservoir function and its loss after total resection of the rectum is the reason for frequent bowel movements, urgency and leakage. Reconstruction with a colonic J pouch is associated with better bowel function compared to the straight coloanal anastomosis. PMID:15587742

Damianov, N; Tankova, L; Draganov, V

2003-01-01

120

Sphincter repair for fecal incontinence  

Microsoft Academic Search

Twenty-seven patients who had sphincter repair by one surgeon over the last ten years were reviewed. Previous surgery, childbirth,\\u000a and perineal trauma were the most common causes. Twelve patients had been treated previously using an anal continence device\\u000a (N=6), postanal repair (N=5), and rectopexy (N=1). A covering colostomy was used in ten patients. At the initial operation\\u000a only 7 patients

Kazuhiko Yoshioka; Michael R. B. Keighley

1989-01-01

121

Sphincter tears in primiparous women: is age a factor?  

Microsoft Academic Search

Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients\\u000a were at increased risk for sphincter tears during vaginal delivery. Data from an obstetric automated record were analyzed.\\u000a Primiparous women delivering term infants (n?=?5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered:\\u000a young

C. Bryce Bowling; Thomas L. Wheeler II; Kimberly A. Gerten; Victoria R. Chapman; Kathryn L. Burgio; Holly E. Richter

2009-01-01

122

Paradoxical sphincter contraction is rarely indicative of anismus  

Microsoft Academic Search

Background—Anismus is thought to be a cause of chronic constipation by producing outlet obstruction. The underlying mechanism is paradoxical contraction of the anal sphincter or puborectalis muscle. However, paradoxical sphincter contraction (PSC) also occurs in healthy controls, so anismus may be diagnosed too often because it may be based on a non-specific finding related to untoward conditions during the anorectal

W A Voderholzer; D A Neuhaus; A G Klauser; K Tzavella; S A Müller-Lissner; N E Schindlbeck

1997-01-01

123

Treatment of benign anal disease with topical nitroglycerin  

Microsoft Academic Search

PURPOSE: Fissure-in-ano and acutely thrombosed external hemorrhoids are common, benign anal conditions, usually characterized by severe anal pain. Internal anal sphincter hypertonia appears to play a role in the etiology of this pain. Nitric oxide has recently been identified as the “novel biologic messenger” that mediates the anorectal inhibitory reflex in humans. This report documents a therapeutic role for nitroglycerin,

Stephen R. Gorfine; Richard P. Billingham

1995-01-01

124

Fistulotomy or seton in anal fistula: a decisional algorithm.  

PubMed

Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. The aim of the present study is to report our experience using a decisional algorithm on sphincter saving procedures that achieved us to obtain good results with low rate of complications. From 2008 to 2011, 206 patients underwent surgical treatment for anal fistula; 28 patients underwent perianal abscess drainage plus seton placement of trans-sphincteric or supra-sphincteric fistula (13.6 %), 41 patients underwent fistulotomy for submucosal or low inter-sphincteric or low trans-sphincteric anal fistula (19.9 %) and 137 patients underwent partial fistulectomy or partial fistulotomy (from cutaneous plan to external sphincter muscle plan) and cutting seton placement without internal sphincterotomy for trans-sphincteric anal fistula (66.50 %). Healing rates have been of 100 % and healing times ranged from 1 to 6 months in 97 % of patients treated by setons. Transient fecal soiling was reported by 19 patients affected by trans-sphincteric fistula (11.5 %) for 4-6 months and then disappeared or evolved in a milder form of flatus occasional incontinence. No major incontinence has been reported also after fistulotomy. Fistula recurred in five cases of trans-sphincteric fistula treated by seton placement (one with abscess) (1/28) (3.5 %) and four with trans-sphincteric fistula (4/137) (3 %). Our algorithm permitted us to reduce to 20 % sphincter cutting procedures without reporting postoperative major anal incontinence; it seems to open an interesting way in the treatment of anal fistula. PMID:23729353

Cariati, Andrea

2013-06-02

125

Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor  

Microsoft Academic Search

The aims of this study were to determine whether endoluminal ultrasound (ELUS) could identify various layers of the normal anal canal and to evaluate whether a 10-MHz probe provided better image resolution than a 7-MHz probe. Sonographic anatomy of the anal canal on ELUS was directly correlated with anatomic dissection of various layers (mucosa-submucosa, internal anal sphincter, and external anal

Joe J. Tjandra; Jeffrey W. Milsom; Vito M. Stolfi; Ian Lavery; John Oakley; James Church; Victor Fazio

1992-01-01

126

Inflatable artificial sphincter  

MedlinePLUS

Artificial sphincter (AUS) - urinary ... and you will not feel pain. An artificial sphincter has three parts: A cuff, which fits around ... Lower belly (men and women) Once the artificial sphincter is in place, you will use the pump ...

127

Sphincterolysis: A Novel Approach towards Chronic Anal Fissure  

Microsoft Academic Search

Background and Aims:The surgical approach in chronic anal fissure is often found associated with disturbed anal continence as well as recurrence. This report describes the author’s approach of ‘sphincterolysis’ or fragmentation of the fibers of the internal sphincter on the left lateral anal wall. Patients and Methods:132 patients with chronic anal fissures were treated with this technique. Pre- and postoperative

Pravin J. Gupta

2006-01-01

128

[Efficacy of anal dilators in the treatment of acute anal fissure. A controlled clinical trial].  

PubMed

Procedures involving the use of anal dilators or topical nitroderivatives for the treatment of anal fissure are efficacious, economic and safe. The aim of our study was to compare the efficacy of two conservative treatments - passive dilation with anal dilators or topical nitroderivatives - in reducing anal pressure and resolving anal fissures. A total of 40 patients with a clinical diagnosis of acute anal fissure in the absence of hypotonic anal sphincter, abscess or perianal fistula, haemorrhoidal thrombosis, chronic inflammatory bowel disease or lower gastrointestinal neoplasia were randomly assigned to treatment with dilators (20 patients) or topical nitroderivatives (20 patients). After 4 weeks of treatment, 90% of patients treated with dilators and only 45% treated with topical nitroderivatives showed complete resolution of their anal fissures and a reduction of sphincter hypertone. After 12 weeks, 2/18 patients successfully treated with dilators and 1/9 patients successfully treated with topical derivatives presented recurrence of the anal fissure. The use of anal dilators would appear to induce better resolution of acute anal fissures than topical nitroderivates, as confirmed by the low relapse rate at 12 weeks. PMID:17190281

Gaj, Fabio; Trecca, Antonello; Crispino, Pietro

129

Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women.  

PubMed

The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark's score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results. Prevalence of self-reported anal incontinence (St. Mark's score ? 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions. Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely the most important factor for reducing bothersome anal incontinence among fertile women. PMID:23819058

Laine, Katariina; Skjeldestad, Finn Egil; Sandvik, Leiv; Staff, Anne Cathrine

2013-05-29

130

[Anal fissure of cryptoglandular origin. Therapeutic options].  

PubMed

Anal fistula is a frequent condition. The most commonly accepted origin is infectious. The most widely used classification is based on cryptoglandular theory and on the position of the fistulous tract in relation to the anal sphincter. Physical examination will help to identify the type of fistula and allow its treatment to be planned. The most widely used complementary tests are endoanal ultrasound and magnetic resonance imaging. We review the various therapeutic options and their results, especially fistulotomy, endorectal advancement flap, use of sedal, anodermal advancement flap, sphincterorrhaphy with sphincter repair, and fibrin glue. PMID:16478613

Casal, Enrique; de San Ildefonso, Alberto; Sánchez, Juan; Facal, Cristina; Pampin, José

2005-12-01

131

Vaginal Delivery After Ileal Pouch-Anal Anastomosis: A Word of Caution  

Microsoft Academic Search

PURPOSE: This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch-anal anastomosis. METHODS: The patients who had at least one live birth after ileal pouch-anal anastomosis were asked to return for a comprehensive assessment. They were asked to complete the

Feza H. Remzi; Emre Gorgun; Jane Bast; Tom Schroeder; Jeffrey Hammel; Elliot Philipson; Tracy L. Hull; James M. Church; Victor W. Fazio

2005-01-01

132

Advancement flap in the management of chronic anal fissure: a prospective study.  

PubMed

Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. PMID:22488270

Patti, Rosalia; Guercio, Giovanni; Territo, Valentina; Aiello, Paolo; Angelo, Giuseppe Livio; Di Vita, Gaetano

2012-04-10

133

Audit of sphincter repair  

Microsoft Academic Search

PURPOSE: This study was designed to critically analyze the outcome of sphincter repair and, if possible, to identify high-risk factors. METHODS: Clinical and physiologic assessment was made of all sphincter repairs (42 patients) performed in one unit by two surgeons during five years. RESULTS: Forty-two patients (10 men, 32 women) underwent sphincter repair. Only three of five men with anterior

N. Nikiteas; S. Korsgen; D. Kumar; M. R. B. Keighley

1996-01-01

134

Anal tonometry in the neonatal period for the diagnosis of Hirschsprung's disease.  

PubMed

A double balloon technique was used for anal tonometry in 22 infants. The weight was less than 2,500 g in 10 of the infants. Ileus or delayed passage of meconium was seen in 9 infants. Thirteen infants had not revealed any symptoms of intestinal obstruction during the first week of life. In all cases, except one, it was possible to demonstrate reflexes from the internal anal sphincter. In 18 infants normal curves were registered from the internal anal sphincter. None of these developed Hirschsprung's disease. In 3 infants a pathological pattern of contractions of the internal anal sphincter was demonstrated. Two of them proved to have Hirschsprung's disease. In the third case normal reflexes were registered after one year. Possibly the innervation of rectum and the internal anal sphincter was disrupted during the neonatal period in connection with enterocolitis and ileus, thus representing a reversible case of achalasia. PMID:2028788

Verder, H; Petersen, W; Mauritzen, K

1991-01-01

135

Determinants of Fecal Continence in Healthy, Continent Subjects: A Comprehensive Analysis by Anal Manometry, Rectal Barostat and a Stool Substitute Retention Test  

Microsoft Academic Search

Background\\/Aims: This study aimed to identify anal sphincter and rectal factors that determine anorectal filling sensations and continence during rectal filling in health. Methods: Measurements of anorectal physiology were collected from 42 continent healthy subjects participating in a prospective trial. Rectal function and capacity were assessed by barostat. Anal sphincter functions were assessed by manometry. A validated stool substitute retention

Mark Fox; Miriam Thumshirn; Heiko Frühauf; Michael Fried; Werner Schwizer

2011-01-01

136

Long-term outcome after internal sphincter myectomy for internal sphincter achalasia.  

PubMed

Anal internal sphincter achalasia is a rare cause of refractory constipation. It is usually treated by internal sphincter myectomy (ISM). The aim of this study was to evaluate the long-term outcome of patients who had undergone ISM for internal sphincter achalasia. Bowel habits, fecal continence, and quality of life were evaluated using a questionnaire. Fecal continence was quantitatively assessed by a score described by Holschneider. A questionnaire was sent to 13 patients (11 male, two female) operated on by ISM for intractable constipation caused by internal sphincter achalasia between 1983 and 1993. Ten patients responded and were included in the study. At the time of the study, three of the 10 patients required oral medication for constipation and had one to three bowel movements per week. One of the 10 patients had three to five bowel movements per day, and the others had one to two bowel movements per day. Four patients had normal and six patients had good continence scores. Four of the patients reported mild social problems, and one had problems associated with sports. Refractory constipation in the majority of patients with internal sphincter achalasia can be treated by ISM. However, in the long term, a significant number of patients suffer from soiling-related social problems. PMID:15616817

Heikkinen, M; Lindahl, H; Rintala, R J

2004-12-23

137

Ischaemic nature of anal fissure.  

PubMed

Microvascular perfusion of the anoderm was assessed by laser Doppler flowmetry in 27 patients with anal fissure. Anal pressure was recorded simultaneously. Both measurements were repeated 6 weeks after lateral internal sphincterotomy and compared with those obtained from 27 controls. Means(s.d.) maximum anal resting pressure was significantly higher in those with a fissure than in controls (121.07(24.48) versus 68.78(16.97) mmHg, P < 0.001). Anodermal blood flow at the fissure site was significantly lower than at the posterior commissure of the controls (0.46(0.20) versus 0.76(0.28) V, P < 0.001). The fissure healed in 24 patients within 6 weeks of sphincterotomy. In these patients a significant pressure decrease was noted (35 per cent) which was accompanied by a consistent rise in blood flow (65 per cent) at the original fissure site. The increased internal sphincter tone in patients with a fissure reduces anodermal blood flow at the posterior midline. Reduction of anal pressure by sphincterotomy improves anodermal blood flow at the posterior midline, resulting in fissure healing. These findings provide evidence for the ischaemic nature of anal fissure. PMID:8653368

Schouten, W R; Briel, J W; Auwerda, J J; De Graaf, E J

1996-01-01

138

Anal pressure studies in spinal patients.  

PubMed

Maximal and sphincter pressure was measured in 22 patients with spinal cord lesions and in a group of 10 controls, using perfused sleeve manometry. The mean resting pressure of the spinal patients was 63+/-8 (SEM) mm Hg, and of the control group 116+/-14 (SEM) mm Hg, P less than 0-01. When the rectum was distended by a balloon inflated with 100 ml of air a fall in anal sphincter pressure to 33+/-6 (SEM) mm Hg in the spinal group and to 78+/-10 (SEM) mm Hg in the control group was observed. PMID:873331

Wheatley, I C; Hardy, K J; Dent, J

1977-06-01

139

Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence  

Microsoft Academic Search

The relation between sensory perception of rapid balloon distension of the rectum and the motor responses of the rectum and external and internal anal sphincters in 27 normal subjects and 16 patients with faecal incontinence who had impaired rectal sensation but normal sphincter pressures was studied. In both patients and normal subjects, the onset and duration of rectal sensation correlated

W M Sun; N W Read; P B Miner

1990-01-01

140

Progress in the understanding and treatment of chronic anal fissure  

PubMed Central

BACKGROUND—Chronic anal fissure is a common and painful condition associated with internal anal sphincter hypertonia. Reduction of this hypertonia improves the local blood supply, encouraging fissure healing. Surgical sphincterotomy is very successful at healing these fissures but requires an operation with associated morbidity. Temporary reduction in sphincter tone can be achieved on an outpatient basis by applying a topical nitric oxide donor (for example, glyceryl trinitrate) or injecting botulinum toxin into the anal sphincter.?METHODS—A Medline database was used to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure.?RESULTS—Review of the literature shows botulinum toxin injection to be more effective at healing chronic anal fissures than topical glyceryl trinitrate. Topical isosorbide dinitrate has not been directly compared with either of these two agents but has a healing rate approaching that of botulinum toxin injection. The main side effect of botulinum toxin injection is temporary faecal incontinence in approximately 2% of cases, whereas topical nitrates cause headaches in 20%-100% of cases. No long term side effects were identified with any of the medical treatments.?CONCLUSION—Chemical sphincterotomy is an effective treatment for chronic anal fissure and has the advantages over surgical treatment of avoiding long term complications (notably incontinence) and not requiring hospitalisation.???Keywords: chronic anal fissure; sphincterotomy; glyceryl trinitrate; botulinum toxin

McCallion, K; Gardiner, K

2001-01-01

141

Anal Cancer  

Microsoft Academic Search

\\u000a New terminology is necessary because true anal canal lesions may have a more aggressive biology requiring chemoradiotherapy\\u000a whereas lesions of the perianal skin may simply be treated with local excision. Thus, if the two classes of lesions are unwittingly\\u000a grouped together, the response rates of anal cancer to chemoradiation therapy may be overstated. The authors have proposed\\u000a a new classification

David E. Beck; Patricia L. Roberts; John L. Rombeau; Michael J. Stamos; Steven D. Wexner

142

Anal pressure in experimental diabetes  

Microsoft Academic Search

Purpose  Diabetes mellitus is a metabolic endocrine disorder that affects many systems, the gastrointestinal system often being among\\u000a the affected systems. This experimental study work was designed to demonstrate altered anal sphincter pressures in an experimental\\u000a model of diabetes mellitus (DM).\\u000a \\u000a \\u000a \\u000a Materials and methods  Male Wistar rats (mean weight?=?250 g) were used and randomized in two groups (n?=?10): CO?=?control and DM. DM was

Juliana Tieppo; Nélson A. Kretzmann Filho; Maura Seleme; Henrique S. Fillmann; Bary Berghmans; Norma Possa Marroni

2009-01-01

143

Diagnostic électrophysiologique de l’incontinence anale  

Microsoft Academic Search

\\u000a Résumé  Les tests neurophysiologiques sont des compléments de l’échoendoscopie et de la manométrie anorectale dans le diagnostic précis\\u000a de l’incontinence anale et contribuent en outre à déterminer la localisation, les mécanismes physiopathologiques et la sévérité\\u000a de différents types de lésions du système nerveux périphérique ou central. Les tests d’électrodiagnostic incluent: (i) l’électromyographie\\u000a (EMG) du sphincter anal externe au moyen d’aiguille concentrique

J. P. Lefaucheur

2004-01-01

144

Hemorrhoids and anal fissures. Common problems, current solutions.  

PubMed

Recent insights into the nature of hemorrhoids and anal fissures have led to specific strategies for treatment. Symptomatic hemorrhoids often result from prolapse of submucosal vascular cushions. Appropriate treatments include dietary change, injection therapy, rubber-band ligation, and hemorrhoidectomy. Patients with anal fissures usually have an abnormal contraction of the sphincter. Many fissures heal spontaneously. Treatment often centers on helping the patient avoid constipation, although surgery is indicated in some cases. PMID:2982135

Bubrick, M P; Benjamin, R B

1985-02-01

145

Biofeedback in the management of partial anal incontinence  

Microsoft Academic Search

Fifty patients with anal incontinence were treated by biofeedback as an office procedure. This took the form of an intra-anal\\u000a plug, containing two ring electrodes and connected to an electromyometer. In four or less sessions, patients were instructed\\u000a in sphincter contraction and extraneous muscle relaxation. All have been followed for at least one year, and in 74 per cent\\u000a there

James H. MacLeod

1983-01-01

146

Local nitroglycerin for treatment of anal fissures: An alternative to lateral sphincterotomy?  

Microsoft Academic Search

PURPOSE: Nitric oxide is an important neurotransmitter mediating internal anal sphincter relaxation. Patients suffering from fissure-in-ano were treated with topical nitroglycerine. The clinical evidence for therapeutic adequacy was examined in a prospective, randomized study. METHODS: The study included 35 patients with acute and chronic anal fissures. In Group A, including 20 patients with the clinical diagnosis of acute (12 patients)

Heinz Bacher; Hans-Jörg Mischinger; Georg Werkgartner; Herwig Cerwenka; Azab El-Shabrawi; Johann Pfeifer; Wolfgang Schweiger

1997-01-01

147

Fissurectomy as a treatment for anal fissures in children.  

PubMed Central

INTRODUCTION: Anal fissures, characterised by painful defecation and rectal bleeding, are common in both children and infants. A significant proportion are resistant to simple laxative therapy, and no simple surgical treatment has been described which does not risk compromising sphincteric function. This study reports the initial experience of fissurectomy as a treatment of this condition. PATIENTS AND METHODS: Over a 36 month period, 37 children with an anal fissure were treated by fissurectomy. There were 14 boys and 23 girls, with an age range of 17 weeks to 12 years. Fissurectomy was performed under general anaesthetic, with additional caudal anaesthesia. Stay sutures were used to avoid the need for an anal retractor, thereby preventing stretching of the internal anal sphincter. Of the 37 operations, 36 (97%) were performed as day cases and all children were discharged on laxative therapy. RESULTS: At review, 6 weeks postoperatively, 30 (81%) were asymptomatic. Six (16%) patients were symptomatic; however, 4 of these had failed to comply with the postoperative laxative regimen. One patient failed follow-up. CONCLUSIONS: Fissurectomy is a successful treatment for anal fissures, when combined with postoperative laxative therapy. As dilatation of the internal anal sphincter is not involved, the risk of iatrogenic faecal incontinence is obviated. Images Figure 1 Figure 2 Figure 3

Lambe, G. F.; Driver, C. P.; Morton, S.; Turnock, R. R.

2000-01-01

148

Anal tonometry in the neonatal period in mature and premature children.  

PubMed

Anal tonometry was performed during the first days of life in twelve premature and fourteen mature children without signs of gastrointestinal disease. A new tonometer with small dimensions was used. A pressure decrease of the internal anal sphincter after distension of the rectum could be demonstrated in all children examined and as early as two hours after birth. This was to be expected as the relaxation of the internal sphincter is part of the normal defecation reflex. Thus anal tonometry can be used in the early diagnosis of Hirschsprung's disease presumable already from the very first days of life. PMID:1155079

Verder, H; Krasilnikoff, P A; Scheibel, E

1975-07-01

149

One hundred cases of anal fissure treated with botulin toxin  

Microsoft Academic Search

PURPOSE: Sphincterotomy still is considered the therapy of choice to eliminate sphincter spasm in the treatment of uncomplicated chronic anal fissure. The surgery is weighted with the possible surgical risk and the risk of subsequent fecal incontinence. This study reports the effect of botulin toxin injections within the first six months. PATIENTS AND METHODS: One hundred patients were treated (43

W. H. Jost

1997-01-01

150

Inflatable artificial sphincter - series (image)  

MedlinePLUS

Urinary continence is maintained by a muscular sphincter that surrounds the urethra as it exits the bladder. ... An artificial urinary sphincter is used to treat stress incontinence in men that is caused by urethral dysfunction such as after prostate surgery. ...

151

Prosthetic Urinary Sphincter.  

National Technical Information Service (NTIS)

A pump/valve unit which requires a minimum of implant area and surgery is described for controlling bladder function by regulating the inflation and deflation of a urethral collar in a prosthetic urinary sphincter device. The pump has a press bulb of sili...

C. R. Helms H. M. Smyly

1978-01-01

152

The use of conventional electromyography to assess external sphincter neuropathy in man  

Microsoft Academic Search

Conventional electromyography was used to measure motor unit potential duration in the external anal sphincter in normal subjects and patients with idiopathic faecal incontinence. The results revealed a direct correlation between age and mean motor unit potential duration in control subjects, but no differences between age-matched male and female subjects. Patients with faecal incontinence exhibited prolongation of mean motor unit

D C Bartolo; J A Jarratt; N W Read

1983-01-01

153

The Safety and Efficacy of the Artificial Bowel Sphincter for Fecal Incontinence  

Microsoft Academic Search

PURPOSE: The aim of this trial was to evaluate the safety, efficacy, and impact on quality of life of the Acticon™ artificial bowel sphincter for fecal incontinence. METHODS: A multicenter, prospective, nonrandomized clinical trial was conducted under a common protocol. Patients were evaluated with anal physiology, endoanal ultrasonography, a fecal incontinence scoring system, fecal incontinence quality of life assessment, and

W. Douglas Wong; Susan M. Congliosi; Michael P. Spencer; Marvin L. Corman; Patrick Tan; Frank G. Opelka; Marcus Burnstein; Juan J. Nogueras; H. Randolph Bailey; Jose Manuel Devesa; Robert D. Fry; Burt Cagir; Elisa Birnbaum; James W. Fleshman; Mallory A. Lawrence; W. Donald Buie; John Heine; Peter S. Edelstein; Sharon Gregorcyk; Paul Antoine Lehur; Francis Michot; P. Terry Phang; David J. Schoetz; Fabio Potenti; Josephine Y. Tsai

2002-01-01

154

Posterior Compartment Disorders and Management of Acute Anal Sphincter Trauma  

Microsoft Academic Search

\\u000a Trauma sustained during childbirth is not always recognized, and damage to tissues and nerves may lead to long-term sequelae\\u000a that can have a huge impact on the physical, social, and psychological well-being of women. However, even when trauma is recognized\\u000a and repaired, the outcome may be suboptimal. Focused training in identification and appropriate repair is therefore mandatory.\\u000a The two most

Abdul H. Sultan; Ranee Thakar

155

Laparoscopic rectal resection with anal sphincter preservation for rectal cancer  

Microsoft Academic Search

Background  Total mesorectal excision (TME) is the surgical gold standard treatment for middle and low third rectal carcinoma. Laparoscopy\\u000a has gradually become accepted for the treatment of colorectal malignancy after a long period of questions regarding its safety.\\u000a The purposes of this study were to examine prospectively our experience with laparoscopic TME and high rectal resections,\\u000a to evaluate the surgical outcomes

J.-L. Dulucq; P. Wintringer; C. Stabilini; A. Mahajna

2005-01-01

156

Relationship between anal symptoms and anal findings  

PubMed Central

Background: The frequencies and types of anal symptoms were compared with the frequencies and types of benign anal diseases (BAD). Methods: Patients transferred from GPs, physicians or gynaecologists for anal and/or abdominal complaints/signs were enrolled and asked to complete a questionnaire about their symptoms. Proctologic assessment was performed in the knee-chest position. Definitions of BAD were tested in a two year pilot study. Findings were entered into a PC immediately after the assessment of each individual. Results: Eight hundred seven individuals, 539 (66.8%) with and 268 without BAD were analysed. Almost one third (31.2%) of patients with BAD had more than one BAD. Concomitant anal findings such as skin tags were more frequently seen in patients with than without BAD (<0.01). After haemorrhoids (401 patients), pruritus ani (317 patients) was the second most frequently found BAD. The distribution of stages in 317 pruritus ani patients was: mild (91), moderate (178), severe (29), and chronic (19). Anal symptoms in patients with BAD included: bleeding (58.6%), itch (53.7%), pain (33.7%), burning (32.9%), and soreness (26.6%). Anal lesions could be predicted according to patients' answers in the questionnaire: haemorrhoids by anal bleeding (p=0.032), weeping (p=0.017), and non-existence of anal pain (p=0.005); anal fissures by anal pain (p=0.001) and anal bleeding (p=0.006); pruritus ani by anal pain (p=0.001), itching (p=0.001), and soreness (p=0.006). Conclusions: The knee-chest position may allow for the accumulation of more detailed information about BAD than the left lateral Sims' position, thus enabling physicians to make more reliable anal diagnoses and provide better differentiated therapies.

Kuehn, Hans Georg; Gebbensleben, Ole; Hilger, York; Rohde, Henning

2009-01-01

157

Modern Perspectives in the Treatment of Chronic Anal Fissures  

PubMed Central

INTRODUCTION Anal fissures are commonly encountered in routine colorectal practice. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. Simple measures are often effective for early fissures. Glyceryl trinitrate is well established as a first-line pharmacological therapy. The roles of diltiazem and botulinum, particularly as rescue therapy, are not well understood. Surgery has a defined role and should not be discounted completely. METHODS Data were obtained from Medline publications citing ‘anal fissure’. Manual cross-referencing of salient articles was conducted. We have sought to highlight various controversies in the management of anal fissures. FINDINGS Acute fissures may heal spontaneously, although simple conservative measures are sufficient. Idiopathic chronic anal fissures need careful evaluation to decide what therapy is suitable. Pharmacological agents such as glyceryl trinitrate (GTN), diltiazem and botulinum toxin have been subjected to most scrutiny. Though practices in the UK vary, GTN or diltiazem would be suitable as first-line therapy with botulinum toxin used as rescue treatment. Sphincterotomy is indicated for unhealed fissures; fissurectomy has been revisited and advancement flaps have a role in patients in whom sphincter division is not suitable.

Bhardwaj, R; Parker, MC

2007-01-01

158

Sphincter-preserving surgery after preoperative radiochemotherapy for T3 low rectal cancers  

PubMed Central

The aim of this study was to evaluate the feasibility and the effectiveness of preoperative radiochemotherapy followed by total mesorectal excision (TME) and sphincter-preserving procedures for T3 low rectal cancer. Patients with rectal cancer and T3 tumors located within 1–6 cm of the dentate line received preoperative radiochemotherapy. Concurrent 5-fluorouracil-based radiochemotherapy was used. Radical resection with TME and sphincter-preserving procedures were performed during the six to eight weeks following radiotherapy. Survival was analyzed using the Kaplan-Meier method. The anal function was evaluated using the Wexner score. The clinical response rate was 83.5%, overall downstaging of T classification was 75.3% and pathological complete response was 15.3%. The anastomotic fistula rate was 4.7%. A median follow-up of 30 months showed the local recurrence rate to be 4.7% and the distant metastasis rate to be 5.9%. The three-year overall survival rate was 87%. The degree of anal incontinence as measured using the Wexner score decreased over time, and the anal sphincter function in the majority of patients gradually improved. Preoperative radiochemotherapy was found to improve tumor downstaging, reduces local recurrence, increase the sphincter preservation rate, and is therefore of benefit to patients with T3 low rectal cancer.

BAI, XUE; LI, SHIYONG; YU, BO; SU, HONG; JIN, WEISEN; CHEN, GANG; DU, JUNFENG; ZUO, FUYI

2012-01-01

159

Premalignant Lesions of the Anal Canal and Squamous Cell Carcinoma of the Anal Canal  

PubMed Central

Squamous cell carcinoma of the anus (SCCA) is a rare tumor. However, its incidence has been increasing in men and women over the past 25 years worldwide. Risk factors associated with this cancer are those behaviors that predispose individuals to human papillomavirus (HPV) infection and immunosuppression. Anal cancer is generally preceded by high-grade anal intraepithelial neoplasia (HGAIN), which is most prevalent in human immunodeficiency virus-positive men who have sex with men. High-risk patients may benefit from screening. The most common presentation is rectal bleeding, which is present in nearly 50% of patients. Twenty percent of patients have no symptoms at the time of presentation. Clinical staging of anal cancer requires a digital rectal exam and a positron emission tomography/computed tomography scan of the chest, abdomen, and pelvis. Endorectal/endoanal ultrasound appears to add more-specific staging information when compared with digital rectal examination alone. Treatment of anal cancer prior to the 1970s involved an abdominoperineal resection. However, the current standard of care for localized anal cancer is concurrent chemoradiation therapy, primarily because of its sphincter-saving and colostomy-sparing potential. Studies have addressed alternative chemoradiation regimens to improve the standard protocol of fluorouracil, misogynic, and radiation, but no alternative regimen has proven superior. Surgery is reserved for those patients with residual disease or recurrence.

Poggio, Juan Lucas

2011-01-01

160

Premalignant lesions of the anal canal and squamous cell carcinoma of the anal canal.  

PubMed

Squamous cell carcinoma of the anus (SCCA) is a rare tumor. However, its incidence has been increasing in men and women over the past 25 years worldwide. Risk factors associated with this cancer are those behaviors that predispose individuals to human papillomavirus (HPV) infection and immunosuppression. Anal cancer is generally preceded by high-grade anal intraepithelial neoplasia (HGAIN), which is most prevalent in human immunodeficiency virus-positive men who have sex with men. High-risk patients may benefit from screening. The most common presentation is rectal bleeding, which is present in nearly 50% of patients. Twenty percent of patients have no symptoms at the time of presentation. Clinical staging of anal cancer requires a digital rectal exam and a positron emission tomography/computed tomography scan of the chest, abdomen, and pelvis. Endorectal/endoanal ultrasound appears to add more-specific staging information when compared with digital rectal examination alone. Treatment of anal cancer prior to the 1970s involved an abdominoperineal resection. However, the current standard of care for localized anal cancer is concurrent chemoradiation therapy, primarily because of its sphincter-saving and colostomy-sparing potential. Studies have addressed alternative chemoradiation regimens to improve the standard protocol of fluorouracil, misogynic, and radiation, but no alternative regimen has proven superior. Surgery is reserved for those patients with residual disease or recurrence. PMID:22942800

Poggio, Juan Lucas

2011-09-01

161

Pneumatic Balloon Dilatation for Chronic Anal Fissure: A Prospective, Clinical, Endosonographic, and Manometric Study  

Microsoft Academic Search

PURPOSE  Pneumatic balloon dilation has been shown to be effective in the management of chronic anal fissure, but its effect on the anal sphincter has not been fully investigated. The aim of this study was to evaluate prospectively the clinical, anatomic, and functional pattern in a group of patients treated by pneumatic balloon dilation.METHODS  A series of 33 consecutive patients suffering from

A. Renzi; L. Brusciano; M. Pescatori; D. Izzo; V. Napoletano; G. Rossetti; G. del Genio; A. del Genio

2005-01-01

162

The value of anal endosonography compared with magnetic resonance imaging following the repair of anorectal malformations  

Microsoft Academic Search

Background. Surgery for anorectal malformations (ARMs) attempts to position the neo-anus anatomically within the anal sphincter complex. Currently, MRI is the imaging modality of choice in determining the position of the neo-anus after reconstructive surgery. Objective. The aim of this study was to compare the accuracy of anal endosonography (AES) with conventional MRI in demonstrating the anatomy of the neo-anus

Niall M. Jones; Smilgin M. Humphreys; Thomas R. Goodman; Peter B. Sullivan; Hugh W. Grant

2003-01-01

163

Changing patterns of treatment for chronic anal fissure.  

PubMed Central

To assess changing patterns of treatment for chronic anal fissure, a retrospective analysis of treatment for chronic anal fissure within one hospital between January 1990 and December 1996 was undertaken. A total of 221 patients received treatment for a chronic anal fissure in this period, of whom 209 had a surgical procedure. Manual dilatation of the anus was performed in 21 patients (10%) and has not been performed since 1995. Lateral internal sphincterotomy was performed in 183 patients (88%) and continues to be the mainstay of treatment. Five female patients (2%) were identified as having a sphincter defect by anal manometry combined with endoanal ultrasound and were treated by an anal advancement flap. From 1996 onwards, 15 patients (7%) were treated by topical glyceryl trinitrate (GTN) paste as the first line of treatment. Of these patients, nine have experienced healing of their fissure, and three have had relief of pain without healing of the fissure. Three have gone on to have a lateral internal sphincterotomy. Lateral internal sphincterotomy remains the primary form of treatment for chronic anal fissure. GTN cream has increasingly been offered as preliminary treatment over the last 12 months. Perioperative use of endoanal ultrasound allowed identification of patients who may be at high risk of postoperative incontinence from a sphincterotomy. An anal advancement flap has been used as an alternative surgical approach for these patients.

Farouk, R.; Gunn, J.; Duthie, G. S.

1998-01-01

164

Anorectal anomalies: anorectal manometric function and anal endosonography in relation to functional outcome  

Microsoft Academic Search

To assess the relation between continence and the manometric and endosonographic state of the anorectal segment after surgery for anorectal anomalies (ARA), 33 adolescents operated upon for ARA and 14 controls were examined. Seventeen patients had low and 16 intermediate or high ARA. Fecal continence was recorded, and anal canal manometry was performed by microtransducer. The sphincter muscle complex and

R. Emblem; T. Diseth; L. Mørkrid

1997-01-01

165

Simplified seton management for complex anal fistulas: A novel use for the rubber band ligator  

Microsoft Academic Search

The seton has been useful in the treatment of complex anal fistulas. Various complicated methods to enhance the advancement of the seton through the external sphincter muscles have been described. We use a common office implement, the rubber band ligator, to manage the seton in an outpatient setting.

William C. Cirocco; Lawrence C. Rusin

1991-01-01

166

Experience with staged mucosal advancement anoplasty for high trans-sphincteric fistula-in-ano.  

PubMed

Successful eradication of a complicated, recurrent fistula-in-ano with maintenance of anal continence, requires a specialized surgical approach. Mucosal advancement anoplasty is associated with acceptably low rates of recurrence and continence and is reported in this small series of 11 patients where it followed preliminary deployment of a loose guiding and drainage seton. The technique was also supplemented by internal anal sphincter repair at the time of the advancement anoplasty. Success was achieved in nine cases without any effect on reported continence. PMID:18303758

Zbar, A P

2007-10-01

167

Anal squamous carcinoma: a new AIDS-defining cancer? Case report and literature review.  

PubMed

Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response. PMID:23152321

Corti, Marcelo; Villafañe, María F; Marona, Esteban; Lewi, Daniel

2012-12-01

168

Novel options for the pharmacological treatment of chronic anal fissure--role of botulin toxin.  

PubMed

A chronic anal fissure (CAF) is commonly referred to as an ischemic ulcer. For many years it was thought that sphincteroctomy produces anal sphincter relaxation, enhances microcirculation and promotes CAF healing. The latest studies have shown that fissure healing does not appear to be dependent on reduction in mean resting anal pressure. Our description of the process of CAF healing is based on understanding the balance between nitric oxide (NO) concentration and a level of oxidative and nitroxidative stress in wounds, which is responsible for contraction of smooth muscles (also anal sphincters), endothelial/skeletal muscle cell remodelling and proliferation. Pharmacological sphincterotomy with botulinum toxin (BTX) has an effect on motor endplate but it also has an influence on nitric oxide synthase (NOS) and other agents. Hypoxia in contracted anal sphincters induces vasoconstriction, in part, by decreasing endothelial NOS expression. Clostridium botulinum C3 exoenzyme - Rho-kinase inhibitor reverses this vasoconstriction. CAF is a site where the haemostatic mechanisms are activated. Rho inactivator C3-transferase from Clostridium botulinum abolished thrombin - stimulated endothelial cell contraction. Attenuated biotransformation of Glyceryl trinitrate (GTN) by mitochondrial aldehyde dehydrogenase and suppression of cGMP-dependent protein kinase expression may play a key role in understanding the problem of synergistic action of BTX and GTN. BTX and GTN are different forms of pharmacological sphincterectomies. This mechanism could explain the potentiate effect of BTX action after NO donors application for CAF. The application of BTX releases the blockage in GTN bioactivation in smooth muscle cells and suppresses basal continuous sympathetic activity, causing modulation of anal sphincters. It is responsible for CAF healing. PMID:19149501

Madalinski, Mariusz; Kalinowski, Leszek

2009-01-01

169

Anal Warts and Anal Intradermal Neoplasia  

PubMed Central

For the last five millennia we have been dealing with the annoyance of verrucas. Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is increasing in incidence. As in other gastrointestinal conditions, HPV infection can lead to a stepwise transition from normal cells to dysplastic cells and then to invasive anal cancer. Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients. In this review, the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology.

Echenique, Ignacio; Phillips, Benjamin R.

2011-01-01

170

Artificial urinary sphincters. Radiographic evaluation.  

PubMed

A small selected group of patients with urinary incontinence can be treated effectively with an artificial urinary sphincter. Since the fluid in the hydraulic system of this device is radiopaque, radiography is useful in its evaluation. An immediate postoperative radiogram should be performed to control the position and integrity of the system. It also serves as a useful baseline study in case of later complications. It should include radiograms both in the deactivated and activated state. A few cases of tube kinking may be overlooked when exposures in only one projection are used. Experience with 110 implanted sphincters is presented. PMID:2952144

Lorentzen, T; Dorph, S; Hald, T

171

Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure  

PubMed Central

BACKGROUND—Anal fissure is perpetuated by high sphincter pressures and secondary local ischaemia. Pharmacological approaches include topical nitrates and botulinum toxin (BT) which act to reduce anal pressure. BT lowers anal pressure by preventing acetylcholine release from nerve terminals while topical nitrates act by donating nitric oxide (NO). The aims of the present study were to compare the therapeutic effect and lowering action on internal anal sphincter pressure of BT injection and local application of isosorbide dinitrate (ID) compared with BT given alone, in patients with chronic anal fissure (CAF) refractory to treatment with ID.?METHODS—Thirty consecutive patients with CAF who did not respond to previous topical ID treatments were randomly assigned to receive one of the following treatments: group A, injection of BT (20 U into the internal anal sphincter) and subsequent daily applications of ID (2.5 mg three times daily for three months); and group B, BT injection only (20 U). If at the end of six weeks following BT injection no improvement was seen in group B, ID was added. A series of anal pressure measurements, including resting basal pressure and resting pressure following topical ID (1.25, 2.5, and 3.75 mg), was carried out both before and two weeks after 20 U of BT injection into the internal anal sphincter. At the end of the trial, patients were followed up for an average period of 10 months.?FINDINGS—At six weeks the fissure healing rate was significantly higher in group A patients (10/15 (66%)) compared with group B (3/15 (20%)) (p=0.025). At eight and 12 weeks, no significant differences were seen: 11/15 (73%) v 11/15 (73%) and 9/15 (60%) v 10/15 (66%), group A v group B, respectively. Maximum anal resting pressure (MARP) was significantly lower two weeks after BT injection than baseline MARP (90 (4) v 110 (5) mm Hg; p<0.001). A significantly greater reduction in MARP following local application of ID was achieved after BT injection compared with that achieved before BT injection (p=0.037)?INTERPRETATION—(1) Combined BT injection and local application of ID in patients with CAF who failed previous treatment with ID was more effective than BT alone. This treatment modality appears to be safe and promising. (2) ID application induced a greater reduction in MARP following BT injection compared with ID application before BT injection. The improved potency of ID on MARP after BT injection suggests a primary cholinergic tonus dominance in some patients and not, as previously claimed, anal sphincter insensitivity to nitrates.???Keywords: nitrates; botulinum toxin; anal fissure

Lysy, J; Israelit-Yatzkan, Y; Sestiery-Ittah, M; Weksler-Zangen, S; Keret, D; Goldin, E

2001-01-01

172

Heterosexual Anal Sexuality and Anal Sex Behaviors: A Review  

Microsoft Academic Search

Little research addresses the role of anal sexuality and anal sexual behaviors as a widely practiced but relatively less frequent element of a heterosexual sexual repertoire. However, the importance of anal sex in sexual health is increasingly well-defined by epidemiological and clinical studies. This article reviews existing data on a range of heterosexual anal sex practices and provides conceptual and

Kimberly R. McBride; J. Dennis Fortenberry

2010-01-01

173

Anal fissure (chronic)  

PubMed Central

Introduction Anal fissures are a common cause of anal pain during, and for 1 to 2 hours after, defecation. The cause is not fully understood, but low intake of dietary fibre may be a risk factor. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments for chronic anal fissure? What are the effects of surgical treatments for chronic anal fissure? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 28 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: anal advancement flap, anal stretch/dilation, botulinum A toxin–haemagglutinin complex alone or with nitrates, calcium channel blockers, internal anal sphincterotomy, and nitric oxide donors.

2010-01-01

174

Preservation of anal function after total excision of the anal mucosa for Bowen's disease.  

PubMed Central

Six women with Bowen's disease of the anogenital area were treated by total excision of the anal mucosa, perianal skin and, in some cases, partial vulvectomy. Two patients had foci of microinvasive squamous carcinoma. Adequate tumor margins were determined by frozen sections. The resulting mucosal and cutaneous defects were grafted with medium split-thickness skin grafts applied to the anal canal and sutured circumferentially to the rectal mucosa. Grafts were held in place by a finger cot inserted in the anal canal and stuffed with cotton balls. Patients were constipated five or six days with codeine. The skin grafts healed per primam. One additional patient was similarly treated for a chronic herpetic ulceration of the anus and healed. Contrary to dire predictions, all patients were able to distinguish between gaseous and solid rectal contents and sphincter function was preserved. In one patient, Bowen's disease has recurred in the grafted perianal skin. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6.

Reynolds, V H; Madden, J J; Franklin, J D; Burnett, L S; Jones, H W; Lynch, J B

1984-01-01

175

[Primary anal tuberculous fissure].  

PubMed

The anal tuberculous (TBC) fissure is infrequent. For this reason diagnosis is difficult. A case of a female adult patient with anal TBC fissure that consults for bleeding and perianal pain is presented. The perianal tuberculosis is a rare manifestation of the general disease. A routine biopsy must be performed, with the corresponding histopathologic study. A specific origin should be suspected when an anal chronic fissure, painful and bleeding, without response to the habitual treatment, is found. The primary TBC fissure can be cured with the administration of three drugs during 3 to 4 months. PMID:19845258

Ruiz, Hugo Daniel; Musso, Jorge; Ortega, Adrián; Moreno, Lisandro; Obredor, Carlos M; Zorraquín, Carlos

2009-09-01

176

Anal ultrasound and endosonographic measurement of perineal body thickness: a new evaluation for fecal incontinence in females  

Microsoft Academic Search

Background Perineal body thickness (PBT) is measured by endoanal ultrasonography. The literature has shown that women with obstetric trauma to the anal sphincter have decreased PBT, and a measurement of 10 mm or less has been proposed as abnormal. Therefore, this study aimed to compare the proposed definitions of normal to pathologic findings in patients with fecal incontinence (FI) and to

M. Oberwalder; K. Thaler; M. K. Baig; A. Dinnewitzer; J. Efron; E. G. Weiss; A. M. Vernava III; J. J. Nogueras; S. D. Wexner

2004-01-01

177

Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure.  

PubMed Central

BACKGROUND: Relaxation of the internal anal sphincter can be achieved by local application of exogenous nitric oxide donors. AIM: To evaluate the influence of topical application of isosorbide dinitrate (ISDN) on anal pressure, anodermal blood flow, and fissure healing. PATIENTS: Thirty four consecutive patients (male/female: 18/16; mean age (SEM): 39 (10)) with a chronic anal fissure were studied. METHODS: All patients were treated for at least six weeks or a maximum period of 12 weeks. Before treatment and at three and six weeks 22 patients underwent conventional anal manometry and laser Doppler flowmetry of the anoderm. RESULTS: Within 10 days the fissure related pain was resolved in all patients. At six, nine, and 12 weeks the anal fissure was completely healed in 14, 22, and 30 patients respectively. At three and six weeks manometry was performed at least one hour after the last application of ISDN. These recordings showed a reduction of the maximum resting anal pressure (mean (SD), pretreatment 111 (26) mm Hg; three weeks 86 (19); six weeks 96 (27), p < 0.001). Simultaneous recordings of anodermal blood flow showed a significant increase of flow (pretreatment 0.53 (0.17); three weeks 0.80 (0.16); six weeks 0.76 (0.31), p < 0.005). The mean (SEM) duration of follow up after successful outcome was 11 (5) months. Within this period fissure relapsed in two of 30 patients (7%), eight and 10 weeks after treatment had been stopped. CONCLUSIONS: Local application of ISDN reduces anal pressure and improves anodermal blood flow. This dual effect results in a fissure healing rate of 88% at 12 weeks. This new and simple treatment modality seems to be an attractive alternative for the current available surgical procedures.

Schouten, W R; Briel, J W; Boerma, M O; Auwerda, J J; Wilms, E B; Graatsma, B H

1996-01-01

178

[Sphincter-preserving surgery for lower rectal cancer aimed at improving postoperative bowel function].  

PubMed

Much attention has been focused on sphincter-preserving surgery for patients with lower rectal cancer, leading to renewed interest in the outcome of postoperative bowel function. Some patients who undergo sphincter-preserving surgery experience bowel dysfunction, such as frequent stools, severe constipation, soiling, and incontinence. These symptoms were thought to be correlate with lower resting pressure, lower rectal compliance, sensory disturbance of the anal canal, spasm, and delayed transit in the colon above the anastomosis. To improve postoperative bowel function, reconstruction with the colonic J-pouch has been performed, which results in a satisfactory functional outcome. About 80% of patients with a J-pouch were able to tolerate over 10 minutes after feeling the desire to defecate. An anorectal manometric study showed no abnormal spastic movement of the neorectum and a transit study showed that the J-pouch group was superior to the straight group with respect to the smoothness of movement of radiopaque markers from the cecum to anal ring, although a small number of markers were retained in the colonic J-pouch. Patients who received a colonic J-pouch had fewer defecation problems in daily life. Further study is need to improve postoperative bowel movement in patients who undergo sphincter-preserving surgery. PMID:10919155

Morita, T; Suzuki, J; Yoshizaki, T; Kimura, Y; Nakamura, F; Itoh, T; Murata, A; Nishi, T; Koyama, M; Sasaki, M

2000-06-01

179

Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence  

PubMed Central

INTRODUCTION—The internal anal sphincter receives a stimulatory alpha1 adrenergic innervation. Use of an adrenergic agonist may therefore have a role in treating patients with faecal incontinence.?METHODS—Ten patients (seven females, median age 66 years) with passive faecal incontinence related to weak internal anal sphincter were studied. All patients had intact anal sphincters as assessed by endoanal ultrasound. Phenylephrine gel was applied in a double blind manner in concentrations of 0%, 10%, 20%, 30%, and 40% (Slaco Pharma (UK) Ltd, Watford, UK) on separate days. Maximum resting anal pressure (MRP), anodermal blood flow, blood pressure, and pulse rate were measured before, and one and two hours after application.?RESULTS—All concentrations of phenylephrine gel increased median MRP (43, 48, 54, 65, and 70 cm H2O, for placebo, 10% (p=0.122), 20% (p=0.170), 30% (p=0.002), and 40% (p=0.004), respectively at one hour; comparisons with placebo). This was sustained at two hours. There was a clear dose-response relationship at one hour. Higher concentrations raised median MRP to within the normal range (> 60 cm H2O). At two hours, all concentrations greater than 20% increased the pressure to a similar degree, suggesting that the exact concentration may be important for the initial effect but given a certain threshold is less important after a period of time. Toxicity was rare. Two patients experienced transient perianal burning which settled within a few minutes. There was no significant effect on anodermal blood flow, blood pressure, or pulse rate.?CONCLUSION—This study has demonstrated the feasibility of using topical phenylephrine to raise resting anal tone in patients with faecal incontinence. Randomised controlled trials are required to assess the efficacy of this agent.???Keywords: phenylephrine; faecal incontinence; anal tone

Cheetham, M; Kamm, M; Phillips, R

2001-01-01

180

0.4% nitroglycerin ointment : in the treatment of chronic anal fissure pain.  

PubMed

0.4% Nitroglycerin ointment is an intra-anal formulation of nitroglycerin (glyceryl trinitrate) indicated for the treatment of chronic anal fissure pain.black triangle Nitroglycerin is a nitric oxide (NO) donor, which reduces the increased anal canal pressure caused by a hypertonic internal anal sphincter, improving anodermal blood flow. A twice-daily 375 mg application of 0.4% nitroglycerin ointment, delivering a daily nitroglycerin dose of 3mg, significantly increased the rate of decrease in mean visual-analogue-scale pain scores, recorded daily, versus placebo (actual vehicle) over the first 3 and 8 weeks of treatment in patients with chronic anal fissure pain participating in randomised double-blind trials. Most recipients of 0.4% nitroglycerin ointment experienced headache, which was transient but severe in 20-25% of patients in randomised double-blind trials; however, compliance was generally good with few study withdrawals. Features and properties of 0.4% nitroglycerin (Rectogesic) rectal ointment Indication Pain associated with chronic anal fissures Mechanism of action Donor of nitric oxide Mediates relaxation of internal anal sphincter Dosage and administration Dosage 375 mg of 0.4% nitroglycerin rectal ointment, delivering nitroglycerin 1.5 mg Frequency Twice daily Route of administration Intra-anal Pharmacokinetic profile Mean bioavailability (0.2% nitroglycerin ointment, 0.75 mg nitroglycerin dose)50%Maximum plasma concentration 0.1 to >1 microg/L Volume of distribution approximate, equals 3 L/kg Clearance approximate, equals 1 L/kg/min Elimination half-life approximate, equals 3 min Most common adverse event Headache. PMID:16526822

Fenton, Caroline; Wellington, Keri; Easthope, Stephanie E

2006-01-01

181

HIV-associated anal cancer.  

PubMed

HIV-associated anal carcinoma, a non-AIDS-defining cancer, is a human papillomavirus-associated malignancy with a spectrum of preinvasive changes. The standardized incidence ratio for anal cancer in patients with HIV/AIDS is 20-50. Algorithms for anal cancer screening include anal cytology followed by high-resolution anoscopy for those with abnormal findings. Outpatient topical treatments for anal intraepithelial neoplasia include infrared coagulation therapy, trichloroacetic acid, and imiquimod. The development of cost-effective national screening programs for HIV-associated anal cancer remains a challenge. PMID:21283597

Newsom-Davis, Thomas; Bower, Mark

2010-12-08

182

Electromagnetic assessment of embedded micro antenna for a novel sphincter in the human body.  

PubMed

This paper presents a wireless, miniaturized, bi-directional telemetric artificial anal sphincter system that can be used for controlling patients' anal incontinence. The artificial anal sphincter system is mainly composed of an executive mechanism, a wireless power supply system and a wireless communication system. The wireless communication system consists of an internal RF transceiver, an internal RF antenna, a data transmission pathway, an external RF antenna and an external RF control transceiver. A micro NMHA (Normal Mode Helical Antenna) has been used for the transceiver of the internal wireless communication system and a quarter wave-length whip antenna of 7.75 cm has been used for the external wireless communication system. The RF carrier frequency of wireless communication is located in a license-free 433.1 MHz ISM (Industry, Science, and Medical) band. The radiation characteristics and SAR (Specific Absorption Rate) are evaluated using the finite difference time-domain method and 3D human body model. Results show that the SAR values of the antenna satisfy the ICNIRP (International Commission on Nonionizing Radiation Protection) limitations. PMID:23706019

Zan, Peng; Liu, Jinding; Ai, Yutao; Jiang, Enyu

2013-05-24

183

Action of in situ nitroglycerin on upper anal canal pressure of patients with terminal constipation  

Microsoft Academic Search

Nitroglycerin (NTG)in situreduces the pressure of the upper anal sphincter (UAS). We have tested the effects of NTG on the UAS of patients with terminal constipation. We studied two groups of constipated patients. Group 1 consisted of 11 patients (nine females and two males) with hypertonicity of the UAS (>70 mm Hg); age was 49.5±15.6 years. Group 2 consisted of

François Guillemot; Henri Leroi; You Chen Lone; Corinne Gower Rousseau; Marie-Dominique Lamblin; Antoine Cortot

1993-01-01

184

[Anal intraepithelial neoplasia].  

PubMed

Anal intraepithelial lesions are caused by chronic infection with oncogenic types of human papillomavirus. Their incidence and prevalence are increasing, especially among patients with HIV infection. Their natural history is not well known, but high-grade intraepithelial lesions seem to have an important risk to progress to squamous cell carcinoma. Their treatment can be achieved by many ways (surgery, coagulation, imiquimod, etc.) but there is a high rate of recurrent lesions. Pretherapeutic evaluation should benefit from high-resolution anoscopy. Periodic physical examination and anal cytology may probably be interesting for screening the disease among patients with risk factors. Vaccine against oncogenic types of papillomavirus may prevent the development of anal intraepithelial neoplasia. PMID:23122632

de Parades, Vincent; Fathallah, Nadia; Barret, Maximilien; Zeitoun, Jean-David; Lemarchand, Nicolas; Molinié, Vincent; Weiss, Laurence

2012-10-31

185

Paroxysmal anal hyperkinesis: a characteristic feature of proctalgia fugax.  

PubMed Central

BACKGROUND AND AIMS: Proctalgia fugax is a common problem, yet its pathophysiology is poorly understood. The objective was to characterise colorectal disturbances in a paraplegic patient with a 10 year history of proctalgia fugax that began two years after an attack of transverse myelitis. METHODS: Standard anorectal manometry and prolonged 33 hour ambulatory colonic manometry at six sites in the colon were performed together with myoelectrical recording of the anus. Provocative tests designed to simulate psychological and physical stress and two types of meals were included. RESULTS: Anorectal manometry showed normal internal sphincter tone and normal rectoanal inhibitory reflex but an inability to squeeze or to bear down or to expel a simulated stool. Rectal sensation (up to 360 ml inflation) was absent. Pudendal nerve latency was prolonged (4.5 ms (normal < 2.2 ms). During colonic manometry, the patient reported 27 episodes of pain, of which 23 (85%) were associated with bursts (1-60 min) of a high amplitude (0.5 to > 3.2 mv), high frequency (5-50/min) anal myoelectrical activity, particularly after stress tests, meals, and at night. The myoelectrical disturbance only occurred with proctalgia. Intermittently, 16 bursts of 3 cycles/ min phasic rectal contractions were seen, but only six were associated with proctalgia. Colonic motility was reduced compared with normal subjects. CONCLUSIONS: The temporal association between a high amplitude, high frequency myoelectrical activity of the anal sphincter, and the occurrence of proctalgia suggests that paroxysmal hyperkinesis of the anus may cause proctalgia fugax.

Rao, S S; Hatfield, R A

1996-01-01

186

Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure.  

PubMed

The authors believed that it might be possible to explain the local frequency of the anal fissure at the posterior commissure by an anatomic relationship, and examined the blood supply of the anus. The inferior rectal artery is demonstrated by postmortem angiography and by manual preparations (N = 41) and histologic study after angiography of the vessels (N = 10). The blood supply at the different sites of the anal canal are demonstrated by a morphometric study (N = 20). The inferior rectal artery presents two variants in the postmortem angiographies, type 1 (85.4 percent) and type 2 (14.6 percent). In type 1, the posterior commissure is less perfused than the other sections of the anal canal. In addition, the blood supply may be more compromised by contusion of the vessels passing vertically through the muscle fibers of the sphincter ani internus muscle during increased sphincter tone. The role of topography in the pathogenesis of the primary anal fissure is illustrated in a model. PMID:2910660

Klosterhalfen, B; Vogel, P; Rixen, H; Mittermayer, C

1989-01-01

187

The effect of topical nifedipine in treatment of chronic anal fissure.  

PubMed

Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure. A single-blind randomized comparative trial was setup to compare traditional treatment with stool softeners and 2% lidocaine cream against 0.5% nifedipine cream for 4 weeks. 110 patients were included in this study, 60 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded. Healing had occurred in 70% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks treatment (P < 0.005). Recurrence of symptoms occurred in four of healed patients in the nifedipine group and three patients in the control group in two months. The final result of nifedipine application after 12 months follow up was recurrence in 11 patients (26.19%). Mild headache occurred in four patients (6.6%) of the nifedipine group. Patients in the nifedipine group showed significant healing and relief from pain compared with patients in the control group. Recurrence rate with nifedipine use in spite of control of predisposing factors such as constipation was significant. Another finding was low complication rate with this treatment. PMID:21287460

Golfam, Farzaneh; Golfam, Parisa; Khalaj, Alireza; Sayed Mortaz, Sayed Saaid

188

Uterine Rupture  

Microsoft Academic Search

\\u000a Uterine rupture may be defined as a disruption of the uterine muscle extending to and involving the uterine serosa or disruption\\u000a of the uterine muscle with extension to the bladder or broad ligament [1]. Uterine dehiscence is defined as disruption of\\u000a the uterine muscle with intact uterine serosa [1]. Uterine rupture is associated with severe maternal and perinatal morbidity\\u000a and

Sharon R. Sheehan; Deirdre J. Murphy

189

Modifications to the Saclantcen Sphincter Corer.  

National Technical Information Service (NTIS)

Modifications to the SACLANTCEN Sphincter Corer with Recoilless Piston reported in Technical Report 112 are described. These allow the interval between corings to be halved to about one hour and simplify the maintenance. (Author)

C. Gehin P. Blavier B. Matteucci

1969-01-01

190

Colposcopic appearance of anal squamous intraepithelial lesions  

Microsoft Academic Search

PURPOSE: The incidence of anal cancer is increased in men with a history of anal receptive intercourse. Analogous to cervical cancer, whose precursor is cervical high-grade squamous intraepithelial lesion (HSIL), anal cancer may be preceded by anal HSIL. Although not yet proven, detection, follow-up, and treatment of HSIL may prevent development of anal cancer. Cervical colposcopic methodology was used to

Naomi Jay; J. Michael Berry; Charissa J. Hogeboom; Elizabeth A. Holly; Teresa M. Darragh; Joel M. Palefsky

1997-01-01

191

An artificial sphincter: A preliminary report  

Microsoft Academic Search

Summary  A new method of providing continence to patients with fecal stomas is presented. The device, used as an artificial sphincter,\\u000a consists of an inflatable Silastic balloon, which is implanted in the subcutaneous tissue around the stoma; it is easily handled\\u000a by the patient. The artificial sphincter was used in six patients with colostomies. In all cases, satisfactory continence\\u000a of the

Manuel Heiblum; Alfonso Cordoba

1978-01-01

192

Diagnosis of hypertonic Oddi's sphincter dyskinesia  

SciTech Connect

The diagnostic possibility of hypertonic Oddi's sphincter dysfunction was evaluated in 100 cholecystectomized and 28 noncholecystectomized patients. An organic lesion interfering with free bile flow was ruled out in every case. The existence of the syndrome, i.e., the dysfunction of the Oddi's musculature, was verified using the morphine-choleretic test combined with either dynamic hepatobiliary scintigraphy or (in selected cases) percutaneous transhepatic cholangiography. Hypertonic Oddi's sphincter dyskinesia can be regarded as an independent clinical syndrome.

Varro, V.; Doebroente, Z.; Hajnal, F.; Csernay, L.; Nemessanyi, Z.; Lang, J.; Narai, G.; Szabo, E.

1983-11-01

193

Human papillomavirus and anal neoplasia  

Microsoft Academic Search

Anal cancer is a rare disease in the general population, but the incidence of anal cancer is higher in certain at-risk groups,\\u000a such as men who have sex with men (MSM), and immunosuppressed individuals, including those with HIV infection. Among HIV-positive\\u000a MSM, the incidence of anal cancer may be as high as 10 times greater than current rates of cervical

Joel Palefsky

2008-01-01

194

Surgical treatment of anal stenosis  

PubMed Central

Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.

Brisinda, Giuseppe; Vanella, Serafino; Cadeddu, Federica; Marniga, Gaia; Mazzeo, Pasquale; Brandara, Francesco; Maria, Giorgio

2009-01-01

195

[Acute anal fissures in puerperants].  

PubMed

The author shares his experiences with treatment of 236 puerperas with anal fissures. Three types of anal fissures are established. The appearance of anal fissures can be caused by precipitated labor, large fetus, episio- and perineotomy. The main attention in cases with postpartum anal fissures was given to local treatment by different means which included arrest of the pain syndrome and formation of the granulation barrier till the appearance of regular stool and prevention of constipation. Long-term results were good. PMID:10533232

Sariev, A A

1999-01-01

196

Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess–fistula  

Microsoft Academic Search

Background and aim  Concurrent definitive treatment of underlying fistulas from infected anal glands at the time when the anorectal abscesses are drained is controversial as this is associated with a higher incidence of faecal incontinence, failure and recurrence. This meta-analysis was conducted to determine the merits of drainage alone vs primary sphincter-cutting procedures (which includes fistulotomy and fistulectomy) for anorectal abscess–fistula.Methods  Medline,

H. M. Quah; C. L. Tang; K. W. Eu; S. Y. E. Chan; M. Samuel

2006-01-01

197

Can Anal Cancer Be Prevented?  

MedlinePLUS

... with many partners and those who have unprotected anal sex. In people infected with HIV, the use of ... use in both men and women to prevent anal cancers and pre-cancers. To work best, the vaccine should be given before a person starts having sex. Cervarix ® is an HPV vaccine that can also ...

198

Ileal pouch anal anastomosis: pregnancy--before, during and after.  

PubMed

Most females having surgery for ulcerative colitis are young and in the childbearing age years. Quality of life is usually improved following surgery as is sexual function. The improvement is likely related to an improvement in the physical well-being of individuals. On the other hand, recent evidence suggests that surgery has a significant negative effect on the ability of females to conceive, likely due to adhesion formation. Most women who do conceive have few or no problems with the pregnancy. Although some surgeons recommend that women have a caesarian section rather than delivering vaginally to avoid the risk of injury to the anal sphincter, there is little evidence to support this policy. In conclusion, most women can be assured that their overall well-being and sexual function will be improved following surgery for ulcerative colitis but must be counseled that they may experience difficulties conceiving. Strategies to minimize this complication are needed. PMID:18846408

McLeod, Robin S

2008-10-10

199

The effect of topical anal captopril on resting anal pressure in healthy volunteers: the first human pilot study.  

PubMed

BACKGROUND: Previous laboratory studies have shown that angiotensin II is produced locally in the rat internal anal sphincter causing potent contraction. The aim of this first human study was to evaluate the safety and manometric effects of topical application of captopril (an ACE inhibitor) on the resting anal pressure in healthy adult volunteers. METHODS: Ten volunteers, mean age 32.5 years (range, 19-48 years), underwent anorectal manometric evaluation of the mean anal resting pressure (MRAP) and the length of the high-pressure zone (HPZ) before 20 and 60 min after topical application of captopril (0.28 %) cream. Cardiovascular variables (systolic blood pressure, diastolic blood pressure and pulse) were measured before and for up to 1 h after cream application. Side effects were recorded. Adverse events and patient comfort after the cream application were evaluated within a 24-h period by completing a questionnaire. RESULTS: There was no significant change overall in MRAP following captopril administration, although in half the patients, there were reductions in MRAP after treatment. Half the patients had a reduction in the mean resting HPZ length; however, there was no overall difference between pre- and post-treatment values. There was no effect on basic cardiovascular parameters and no correlation between manometric and cardiovascular variables. CONCLUSIONS: Topical application of captopril cream may result in a reduction in MRAP in volunteers without anorectal disease. Its use is associated with minimal side effects. It may be a new potential therapeutic option in the treatment of anal fissure. Further studies are required to determine the optimal concentration, dose and frequency of application. PMID:23435971

Khaikin, M; Bashankaev, B; Sands, D; Weiss, E G; Zbar, A; Wexner, S D

2013-02-22

200

Lower esophageal sphincter pressure in histologic esophagitis.  

PubMed

The fasting lower esophageal sphincter pressure of 18 normal volunteers was compared to 22 patients with symptoms and objective evidence of gastroesophageal reflux. Lower esophageal sphincter pressure was measured by rapid pull-through using an 8-lumen radially perfused catheter that sampled pressure every45 degrees around the circumference of the sphincter. The 22 reflux patients were subdivided for analysis into two groups, those with an acute inflammatory infiltrate on biopsy and those without inflammation. Those patients without inflammatory esophagitis had normal sphincter pressures. Those with a definite inflammatory infiltrate had pressures significantly less than normal. The least reliable separation between normals and those with inflammatory esophagitis occurred in the anterior orientations. We conclude that while basal lower esophageal sphincter pressure measurement may identify patients with reflux and inflammatory esophagitis, it is of no help in identifying those patients with reflux unassociated with inflammation. Decreased basal fasting LESP does not appear to be the most important primary determinant of gastroesophageal reflux. PMID:7379675

Welch, R W; Luckmann, K; Ricks, P; Drake, S T; Bannayan, G; Owensby, L

1980-06-01

201

Nonsurgical treatment of chronic anal fissure: nitroglycerin and dilatation versus nifedipine and botulinum toxin  

PubMed Central

Background Surgical sphincterotomy for chronic anal fissure can cause fecal incontinence. This has led to the investigation of nonsurgical treatment options that avoid permanent damage to the internal anal sphincter. Methods We conducted a retrospective, ongoing chart review with telephone follow-up of 88 patients treated for chronic anal fissure between November 1996 and December 2002. During the first half of the study period, patients were treated with topical nitroglycerin and pneumatic dilatation. With the availability of new therapies in June 1999, subsequent patients received topical nifedipine and botulinum toxin injections (30–100 units). Lateral anal sphincterotomy was reserved for patients who failed medical treatment. Results In 98% of patients the fissure healed with conservative nonsurgical treatment. The combination of nifedipine and botulinum toxin was superior to nitroglycerin and pneumatic dilatation with respect to both healing (94% v. 71%, p < 0.05) and recurrence rate (2% v. 27%, p < 0.01). There was no statistical difference between the number of dilatations and botulinum toxin injections needed to achieve healing. Three patients who received botulinum toxin reported mild transient flatus incontinence. At an average telephone follow-up of 27 months, 92% of patients reported having no pain or only mild occasional pain with bowel movements. Conclusions Chronic anal fissures can be simply and effectively treated medically without the risk of incontinence associated with sphincterotomy. Topical nifedipine and botulinum toxin injections are an excellent combination, associated with a low recurrence rate and minimal side effects.

Tranqui, Philippe; Trottier, Daniel C.; Victor, J. Charles; Freeman, Joel B.

2006-01-01

202

Botulinum toxin for chronic anal fissure after biliopancreatic diversion for morbid obesity  

PubMed Central

AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate. CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.

Vanella, Serafino; Brisinda, Giuseppe; Marniga, Gaia; Crocco, Anna; Bianco, Giuseppe; Maria, Giorgio

2012-01-01

203

The management of patients with primary chronic anal fissure: a position paper.  

PubMed

Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. Nonresponding patients should undergo lateral internal sphincterotomy. The risk of incontinence after this procedure seems to have been overemphasized in the past. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty. PMID:21538013

Altomare, D F; Binda, G A; Canuti, S; Landolfi, V; Trompetto, M; Villani, R D

2011-05-03

204

Conservative versus surgical treatment for chronic anal idiopathic fissure: a prospective randomized trial.  

PubMed

Anal fissure is a tear in the lining of the anal canal distal to the dentate line, which most commonly occurs in the posterior midline. Anal fissure was defined chronic if the patient presented with history of anal pain during defecation for at least 2 months with the observation of sphincter fibers at the base of the lesion. One hundred and forty-two consecutive patients with a chronic anal fissure with hypertonicity of internal sphincter on proctological examination were selected for this study from October 2008 to October 2010. Patients enrolled for the study were randomized to two groups by using a computer-generated list. Patients who underwent lateral internal sphincterotomy (LIS) were operated as day surgery procedures under local or epidural anesthesia. Patients randomized to conservative treatment were prescribed to use warm anal dilator with a nifedipine ointment 5 min twice daily for 4 weeks. Patients were clinically examined after 2, 4 and 8 weeks of treatment to evaluate if there was complete healing of the fissure. All patients were required to record pain after the first defecation, on 3rd and 7th postoperative day on a self-administered VAS scale in cm (0-10). Sixty-eight patients were randomly assigned to LIS, 74 to the conservative approach. Fifty-one patients of topical nifedipine group (68.9 %) and 60 patients of LIS group (88.2 %) presented an anal fissure healed at 8 weeks with a p value of 0.0077. As regards post-operative pain, 43 patients of LIS group (63.2 %) and 25 patients of topical nifedipine group (33.7 %) referred first defecation as painless. In the topical nifedipine group 43 (58.1 %) after 3 days since treatment and 35 (47.3 %) after 7 days had pain. In the LIS group 22 (32.3 %) after 3 days and 9 (13.2 %) after 7 days referred pain. There was no statistical difference between LIS and topical nifedipine group concerning side effects. Lateral internal sphincterotomy is an effective, less painful, fast recovery treatment for chronic anal fissure. Incontinence rate is overestimated and often the fear of a continence disturbance, albeit with a low incidence following surgery, may obscure the need to relieve symptoms which may be so severe as to make the patient's life intolerable. PMID:23737323

de Rosa, Michele; Cestaro, Giovanni; Vitiello, Chiara; Massa, Salvatore; Gentile, Maurizio

2013-06-05

205

Urinary Incontinence: Sphincter Functioning from a Urological Perspective  

Microsoft Academic Search

Stress urinary incontinence (SUI) is a debilitating disorder caused by malfunctioning of the urethral sphincter. Anatomical and histological properties of the sphincter, its innervation and supporting structures are explained in relation to the closing mechanism of the bladder outlet. Urethral sphincter function is discussed from the passive concept of urethral pressure transmission to the ’hammock theory’ and the role of

John P. F. A. Heesakkers; Reza R. R. Gerretsen

2004-01-01

206

Rupture disc  

Microsoft Academic Search

The intermediate heat transport system for a sodium-cooled fast breeder reactor includes a device for rapidly draining the sodium therefrom should a sodium-water reaction occur within the system. This device includes a rupturable member in a drain line in the system and means for cutting a large opening therein and for positively removing the sheared-out portion from the opening cut

Robert G

1977-01-01

207

[Acute and chronic anal ulcers].  

PubMed

Classic types of anal ulcers are acute and chronic anal fissure. Characteristic symptoms of chronic fissures are severe pain during defecation accompanied by the triad of ulceration, hypertrophic anal papilla and external skin tag. If the symptoms deviate other causes of ulceration must be considered. Primarily, malignancies should be excluded. The special setting in the anal fold, especially with concurrent immunosuppression, could lead to nonspecific manifestations of different proctological, dermatological and infectious diseases, which can only be clarified by further diagnostic workup and histopathology. Only the correct diagnosis will lead to causal and effective therapy. Successfully treated inflammatory dermatoses and precancerous lesions require regular follow-up because a recurrent or persistent course of the disease may result in malignant transformation. PMID:19997893

Weyandt, G H

2010-01-01

208

Pharmacological Sphincterotomy for Chronic Anal Fissures by Botulinum Toxin A  

PubMed Central

Chronic anal fissure is a common proctologic disease. Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The mode of action, application techniques, and possible complications or adverse effects of BTX therapy are discussed in this report. The healing rate is dependent on the BTX dosage. The short-term healing rate (? 6 months) is 60–90%, whereas about 50% of the patients show a complete response in long-term follow-up studies (> 1 year). Adverse effects are generally mild, but relapses occur more often than with surgery. Conservative therapy is currently considered as a first-line treatment. With increasing evidence for its efficacy, BTX can now be considered among the first-line nonsurgical treatements. Although, surgical management by lateral sphincterotomy is the most effective treatment, it shows a higher incidence of incontinence and greater general morbidity rate than BTX. BTX is a useful alternative to surgery and in many cases, surgery can be avoided with the use of BTX.

Wollina, Uwe

2008-01-01

209

[Novel techniques in the treatment of anal incontinence].  

PubMed

Fecal incontinence can negatively affect the patient's occupational and social life. Until recently, most patients with severe anal incontinence unresponsive to conservative medical and/or surgical treatments underwent colostomy. Currently, these patients can benefit from one of the innovative techniques that have recently been developed. Thus, the artificial anal sphincter and dynamic graciloplasty are now available, each with specific indications. Both procedures achieve good functional results but complication and reintervention rates are not inconsiderable. Sacral neuromodulation represents an important advance due to its relative simplicity and because, through a period of test stimulation, patients who can definitively benefit from its application can be identified. Other techniques, such as injectable bulking agents or radiofrequency ablation are so recent that experience is limited and their role remains to be defined. Since these techniques are so novel and their economic cost is high, their use should be restricted to study groups with an anorectal physiology laboratory and within the context of clinical trials until experience shows whether or not their application can become widespread. PMID:16478615

Alós, Rafael; Solana, Amparo; Ruiz, María Dolores; Moro, David; García-Armengol, Juan; Roig-Vila, José Vicente

2005-12-01

210

Cutting seton for anal fistulas  

Microsoft Academic Search

PURPOSE: Long-term results of cutting seton in the treatment of anal fistulas were studied. METHODS: Of the 44 patients with anal fistulas, mainly of the high variety, managed with this method, 35 (25 men) attended a clinical and manometric follow-up examination on average 70 (range, 28–184) months after operation. Fistula distribution was high transsphincteric (25), low transsphincteric (5), extrasphincteric (3),

Kari-Pekka J. HÄmÄlÄinen; A. Peter Sainio

1997-01-01

211

Fibrin Glue for Anal Fistulas  

Microsoft Academic Search

PURPOSE: The aim of this study was to evaluate the long-term success and complication rate of fibrin-glue treatment of anal fistulas. METHODS: Patients with an anal fistula presenting to a single surgeon over a three-year period were enrolled in this study. At their first operation, all 48 patients (26–72 years old) underwent anoscopy, biopsy, destruction of the internal gland, and

Stephen M. Sentovich

2003-01-01

212

[Rare anorectal malformations. Intermediate-type anal agenesis with a rectocutaneous fistula].  

PubMed

A case of anal agenesia with recto-cutaneous fistula is presented. The recto-cutaneous fistula in an intermediate or high anomaly seldom noticed so that it is not included in the common classifications. The surgical approach performed by us was that described by Mollard. The anterior perineal pull-through, under proximal protective enterostomy, allow to reduce the rate of postoperative complications and sequences and obtain--as in our patient--a normal continence and sphincteric function with an excellent esthetic outcome. PMID:9973796

Ghandour, H M; Spalletta, M; Giacomello, L; Balducci, T; Bettili, G; Ottolenghi, A

1998-11-01

213

Sphincter of Oddi and its Dysfunction  

PubMed Central

Sphincter of Oddi though mostly heard about in ‘anatomy textbooks’ is making its way into surgical practice due to various disease states affecting it and its dysfunction seems to be an important condition to be observed while treating patients with abdominal pain. In this review, we have attempted to discuss all the relevant conditions affecting it, particularly the dysfunction with a detailed literature review.

Seetharam, Prasad; Rodrigues, Gabriel

2008-01-01

214

[Treatment of the urethral sphincter insufficiency].  

PubMed

The intrinsic sphincter insufficiency is a cause of stress urinary incontinence. Its definition is clinical and based on urodynamics. It is mostly met with women, in context of the post-obstetrical period or older women in a multifactorial context. For men, it occurs mainly as complication of the surgery of the cancer of prostate or bladder. An initial, clinical and paraclinical assessment allows to confirm the diagnosis of intrinsic sphincter insufficiency, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment. The perineal reeducation is the treatment of first intention in both sexes. At the menopausal woman, the local hormonotherapy is a useful additive. In case of failure or of incomplete efficiency, the treatment of the intrinsic sphincter insufficiency is surgical. Bulking agents, urethral slings, peri-urethral balloons and artificial sphincter are 4 therapeutic options to discuss according to history, the severity of the incontinence, the expectations of the patient. PMID:24176408

Boissier, R; Karsenty, G

2013-09-24

215

Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure.  

PubMed

Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The maximum number of patients was encountered in the age group of 20 to 40 years with mean duration of age 34.14 years. In all three groups symptoms like pain, bleeding, constipation and sphincter spasm were present. Sentinel pile was present in 56% of the patients. Common site of fissure was found to be posterior in 94% of patients. Observations with respect to relief of pain, no bleeding and healing were recorded at 2, 6 and 12 weeks of duration. Lateral sphincterotomy remains effective but should be reserved for the patients who fail to respond to initial chemical sphincterotomy or GTN therapy. GTN is good alternative mode of therapy for patients who refuse surgery and prefer medical line of treatment. PMID:22851840

Tauro, Leo Francis; Shindhe, Vittal V; Aithala, P Sathyamoorthy; Martis, John J S; Shenoy, H Divakar

2011-05-08

216

Bladder substitutes controlled by the anal sphincter: A comparison of the different absorption potentials  

SciTech Connect

A comparative study of the absorption potentials of the simple rectal bladder (10 patients), modified rectal bladder (20) and ureterosigmoidostomy (10) was done with intrarectal instillation of 22sodium. Results indicate that absorption is significantly greater among patients with ureterosigmoidostomy. The emptying patterns of ureterosigmoidostomy and the modified rectal bladder were also studied by ascending scintigraphy with 99mtechnetium. Evidence was provided that in cases with ureterosigmoidostomy the isotope is distributed throughout the entire colon. These studies proved the role of the colorectal valve in preventing reflux of urine from the rectum to the proximal colon. Consequently, the surface area of colonic mucosa exposed to urine is decreased and the rate of reabsorption is limited.

el-Mekresh, M.M.; Shehab el-Din, A.B.; Fayed, S.M.; Brevinge, H.; Kock, N.G.; Ghoneim, M.A. (Department of Urology, Urology-Nephrology Center, Mansoura (Egypt))

1991-10-01

217

[Experience with a biological plug for biological in complex anal fistula].  

PubMed

Treatment of complex anal fistula is a surgical challenge because the risk of sphincter injury with the possibility of developing fecal incontinence. There are many techniques for the treatment of anal fistulas such as fistulotomy, fistulectomy, seton, endorectal advancement flap and fibrin glue, with different rates of recurrence and fecal incontinence. The biologic plug Surgisis® AFP it's being used since 2006 and produces the closure of the fistula in approximately 12 weeks, without surgery, by replacement of the fistulous tract by cells of the patient, apparently having advantages over other techniques.We retrospectively reviewed the results of 46 patients with complex anorectal fistula treated with the biological plug over a period of 4 years. Of these, 34 were men (73.9%) and 12 women, the mean age was 47.2 years. According the type of fistula, 41 were recurrent fistulas (89.1%) and 5 high transsphincteric fistulas (10.8%). Patients underwent surgery on average 2.2 times previously. The anal fistula plug was successful in 73.9% of cases with a median follow-up 29.8 months. Use of anal fistula plug Surgisis® AFP is a new alternative with acceptable results in terms of recurrence comparable to other techniques, but with no incontinence. PMID:22476123

Borda Mederos, Luis A; Chiroque Benites, Luis I; Pinto Elera, Jesús O; Manzaneda Pineda, Ana J

218

Human sphincter of oddi motility and cholecystokinin response following liver transplantation  

Microsoft Academic Search

The reported incidence of sphincter of Oddi dysfunction following orthotopic liver transplantation has ranged from 3% to 7%. If sphincteric dysfunction is unrecognized, therapy may be inappropriate; when recognized, extensive surgery may be required. To prospectively identify patients with sphincteric dysfunction, we performed sphincter of Oddi motility studies through the t-tube tract three months after transplantation. Baseline sphincter motility and

Robert D. Richards; Paul Yeaton; Hubert A. Shaffer; Daniel J. Pambianco; Timothy L. Pruett; William C. Stevenson; Ravinder K. Mittal; Richard W. McCallum

1993-01-01

219

Anorectal atresia treated with non-continent pull through and artificial bowel sphincter: a case report.  

PubMed

Anorectal atresia, which is classified as a low anorectal malformation, is characterised by the absence of the anal verge and by variable rectal atresia. In some cases, which have been classified as rectal agenesis, the atresia is associated with the absence of the internal sphincter. The therapeutic options are definitely surgical, aiming to relieve the bowel occlusion and to restore faecal continence by lowering the cul-de-sac to the perineum. We present the case of an adult patient with congenital rectal agenesis, double fistula (cul-de-sac-urethra and cul-de-sac-perineum) and caecostomy since birth. The patient was treated with a resection of sigmoid-rectum for the presence of a 20-cm faecaloma in the cul-de-sac, with a non-continent pull-through, and with implantation of an artificial bowel sphincter. Despite some difficulties in managing the device and a slight symptomatic mucosal prolapse, the results after 30 months have so far satisfied both the patient and the medical staff, especially in consideration of the limited number of alternative therapies. PMID:15868499

Bracale, U; Nastro, P; Beral, D L; Romano, G; Renda, A

2005-04-01

220

Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: a non-randomized controlled trial  

PubMed Central

Background Although lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure. Methods Patients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months. Results Twenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 ± 22 mmHg to 86 ± 15 mmHg in the surgery group (p < 0.05) and from 101 ± 23 mmHg to 83 ± 24 mmHg in the botulinum toxin group (p < 0.05). The mean maximal squeeze pressures were reduced from 70 ± 27 mmHg to 61 ± 32 mmHg (p > 0.05) in the surgery group, and from 117 ± 62 mmHg to 76 ± 34 (p < 0.01) in the botulinum toxin group. The fissures were healed in 70 percent of patients in the botulinum group and 82 percent in the surgery group (p > 0.05). There were no relapses during the 14 months of follow up. Conclusion Lateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure.

Giral, Adnan; Memisoglu, Kemal; Gultekin, Yucel; Imeryuz, Nese; Kalayc?, Cem; Ulusoy, Nefise B; Tozun, Nurdan

2004-01-01

221

Histological assessment of the distal 'doughnut' in patients undergoing stapled restorative proctocolectomy with high or low anal transection.  

PubMed

A non-randomized prospective study of 38 patients, 32 with ulcerative colitis and six with familial adenomatous polyposis (FAP), who underwent high or low anal transection during stapled restorative proctocolectomy was undertaken. The median (range) height of the staple line 6 months after operation was 5.2 (3.2-6.0) cm after high transection compared with 2.9 (1.8-3.6) cm after low transection. Nineteen of 20 patients after high anal transection had columnar epithelium in the distal 'doughnut' versus 16 of 18 after low transection. Active colitis was present in 12 of 19 'doughnuts' in patients with high anal transection and columnar mucosa and in seven of 16 after low transection. Nine patients (high transection two, low transection seven; P < 0.05) had striated muscle in the stapled distal 'doughnut'. Dysplasia was found in the resected colon in one patient with ulcerative colitis and adenocarcinoma in two colectomy specimens (ulcerative colitis, one; FAP, one). No dysplasia or carcinoma was seen in any of the 'doughnuts' from patients with ulcerative colitis. Four patients with FAP (high transection, two; low transection, two) had microadenoma in the distal 'doughnut'. Despite attempts to place a stapled pouch-anal anastomosis below the anal transition zone, it was not possible to remove columnar mucosa completely from the remaining anal canal in most patients (16 of 18). High anal transection and pouch-anal anastomosis should be the preferred option in restorative proctocolectomy, as a dentate-line anastomosis may not fully eliminate columnar epithelium and may involve resection of some of the external sphincter. PMID:8044617

Deen, K I; Hubscher, S; Bain, I; Patel, R; Keighley, M R

1994-06-01

222

Do We Know What Causes Anal Cancer?  

MedlinePLUS

... is good evidence that HPV causes many anal squamous cell carcinomas. But the role of this virus in causing ... known as HPV-16 is often found in squamous cell carcinoma and is also found in some anal warts. ...

223

Sphincter repair for fecal incontinence after obstetrical or iatrogenic injury  

Microsoft Academic Search

Forty patients with fecal incontinence underwent sphincter repair between 1975 and 1984. Divided sphincter musculature resulted\\u000a from obstetrical injury in 23 and previous anorectal surgery in 17. Eighteen had undergone a previous attempt at repair. Fifteen\\u000a patients experienced seepage of stool and 25 had gross incontinence. In nine patients, reconstruction of the external sphincter\\u000a was by overlap of the muscle

Michael E. Pezim; Robert J. Spencer; C. Robert Stanhope; Robert W. Beart; Roger L. Ready; Duane M. Ilstrup

1987-01-01

224

Division and repair of the sphincteric mechanism at the gastric outlet in emergency operations for bleeding peptic ulcer. A new technique for use in combination with suture ligation of the bleeding point and highly selective vagotomy.  

PubMed

In three of 26 patients who were treated by highly selective vagotomy (HSV) plus suture of the bleeding point for massive hemorrhage from peptic ulceration, access to the ulcer could not be obtained by means of a duodenotomy or gastrotomy which spared the pylorus. Instead, a wide gastroduodenotomy was performed, the artery in the base of the ulcer underrun and HSV performed. The gastroduodenotomy incision was closed longitudinally, rather than as a pyloroplasty. In this way, the integrity of the antral mill and of the pyloric sphincter was restored. The patients were followed up for six months, one year and three years respectively, and were found to be in good health, without clinical or radiological evidence of gastric retention or of recurrent ulceration. Thus the sphincteric mechanism at the exit of the stomach can, like the anal sphincter, be divided and subsequently repaired with good restoration of function. PMID:341823

Johnston, D

1977-12-01

225

Division and repair of the sphincteric mechanism at the gastric outlet in emergency operations for bleeding peptic ulcer. A new technique for use in combination with suture ligation of the bleeding point and highly selective vagotomy.  

PubMed Central

In three of 26 patients who were treated by highly selective vagotomy (HSV) plus suture of the bleeding point for massive hemorrhage from peptic ulceration, access to the ulcer could not be obtained by means of a duodenotomy or gastrotomy which spared the pylorus. Instead, a wide gastroduodenotomy was performed, the artery in the base of the ulcer underrun and HSV performed. The gastroduodenotomy incision was closed longitudinally, rather than as a pyloroplasty. In this way, the integrity of the antral mill and of the pyloric sphincter was restored. The patients were followed up for six months, one year and three years respectively, and were found to be in good health, without clinical or radiological evidence of gastric retention or of recurrent ulceration. Thus the sphincteric mechanism at the exit of the stomach can, like the anal sphincter, be divided and subsequently repaired with good restoration of function. Images Fig. 1. Fig. 2. Fig. 3.

Johnston, D

1977-01-01

226

Management of patients with biliary sphincter of Oddi disorder without sphincter of Oddi manometry  

Microsoft Academic Search

BACKGROUND: The paucity of controlled data for the treatment of most biliary sphincter of Oddi disorder (SOD) types and the incomplete response to therapy seen in clinical practice and several trials has generated controversy as to the best course of management of these patients. In this observational study we aimed to assess the outcome of patients with biliary SOD managed

Evangelos Kalaitzakis; Tim Ambrose; Jane Phillips-Hughes; Jane Collier; Roger W Chapman

2010-01-01

227

Low-Lying Rectal Cancer With Anal Canal Involvement: Abdominoperineal or Low Anterior Resection After Neoadjuvant Chemoradiotherapy  

PubMed Central

ABSTRACT Background: Rectal cancer with anal involvement is typically treated with abdominoperineal resection (APR). However, patients treated with neoadjuvant chemoradiotherapy with good clinical response and tumor regression from the anus present a controversial management dilemma. This is a report of patients treated with low anterior resection (LAR) versus APR. Methods: Patients with T2–3N0–2M0 (IIA-IIIC) rectal cancer with anal canal involvement were eligible. Anal canal involvement was determined by sigmoidoscopy/colonoscopy or endoscopic ultrasound. Patients were treated in the prone position with the three-field technique to 45–50.4 Gy at 1.8 Gy/fraction given concurrently with 5-fluorouracil. Patients then underwent APR/LAR via total mesorectal excision 4–6 weeks after chemoradiotherapy. LAR was performed in patients with good sphincter function at presentation, in those with sufficient tumor regression away from anal canal to permit LAR, and in those compliant with close follow-up. Results: A total of 32 patients with rectal cancer with anal canal involvement were treated with neoadjuvant chemoradiotherapy. Local control was 85% and 89% for patients treated with APR and LAR, respectively. Overall survival was 76% and 86% in patients treated with APR and LAR, respectively. Pathologic complete response was seen in 24% of patients who underwent APR and 27% of patients who underwent LAR. Conclusion: Rectal cancers with anal involvement with good clinical response after neoadjuvant chemoradiotherapy are typically treated with APR. However, LAR may be a feasible alternative, particularly in those with excellent clinical response to neoadjuvant treatment with sufficient tumor regression away from the anal canal. In these patients close follow-up is necessary, and APR may be reserved as salvage when needed.

Syed, Nisar; Puthawala, Ajmel; Azawi, Samar; Shbeeb, Imad; Gong, I-yeh

2011-01-01

228

Anal Incontinence and Evacuation Difficulties  

Microsoft Academic Search

Many patients with fecal incontinence (FI), anal incontinence (AI), which includes loss of flatus or mucus, or evacuation\\u000a difficulties can be helped by conservative measures.1,2 This often involves several different elements, rather than a single definitive intervention, and in clinical practice it\\u000a makes sense to combine approaches in a retraining program to maximize patient benefit. Uncomplicated mild-to-moderate constipation\\u000a will often

Christine Norton

229

[Treatment of chronic anal fissure].  

PubMed

Current treatment of chronic anal fissure continues to be based on conventional conservative measures in a high percentage of cases. What is known as chemical sphincterotomy aims to achieve a temporary decrease of anal pressures that allows fissures to heal. There are various alternatives such as nitroglycerine or diltiazem ointment and botulinum toxin injections. However, because of collateral effects and recurrences in the medium term, the definitive role of these treatments remains to be elucidated. Nevertheless, chemical sphincterotomy should be the first option in patients with a high risk of incontinence. "Open" or "closed" lateral internal sphincterotomy performed in the ambulatory setting with local anesthesia can currently be considered the ideal treatment of chronic anal fissure refractory to conservative measures so long as the patient is informed about the risk of minor incontinence. This procedure provides rapid and permanent recovery in more than 95% of patients. There is evidence demonstrating that the incontinence rate is related to the extent of the lateral internal sphincterotomy and consequently the extent of this procedure should be reduced to the length of the fissure. PMID:16478612

García-Granero, Eduardo; Muñoz-Forner, Elena; Mínguez, Miguel; Ballester, Cristina; García-Botello, Sthefanie; Lledó, Salvador

2005-12-01

230

Elements of an anal dysplasia screening program.  

PubMed

The incidence of anal cancer in HIV-infected men who have sex with men (MSM) is highly elevated compared to the general population, as is the incidence of its precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN). MSM in general and other immunocompromised populations are also at higher risk. Treatment of HGAIN may prevent development of cancer, similar to the decrease in cervical cancers that has occurred since the advent of cervical cancer screening programs in women. Cervical cancer screening tools have been adapted and validated for screening, diagnosis, and treatment of anal HGAIN. Anal cancer screening programs have now been available for more than a decade, although they are not yet standards of care. Incorporating screening procedures into practice depends on the available resources in a particular community. This article discusses the procedures for anal cancer screening including cytology, digital anal rectal examinations, high-resolution anoscopy, and biopsy. PMID:22035526

Jay, Naomi

231

Recurrent spontaneous esophageal rupture  

Microsoft Academic Search

Spontaneous esophageal rupture is an uncommon and poorly understood condition. Recurrent rupture is extremely rare, with only one previously reported case in the literature. Here, we present a case series of two patients who had recurrent ruptures, and discuss the principles underlying the management of such cases.

Omar A. Khan; Clifford W. Barlow; David F. Weeden; Khalid M. Amer

2005-01-01

232

Spontaneous Kidney Allograft Rupture  

Microsoft Academic Search

Spontaneous renal allograft rupture is one of the most dangerous complications of kidney transplantation, which can result in graft loss.This condition needs immediate surgical intervention. Conservative management has dismal results. Its prevalence varies from 0.3% to 3%. Rupture occurs in first few weeks after transplantation. Predisposing factors for graft rupture are acute rejection, acute tubular necrosis, and renal vein thrombosis.

H. Shahrokh; H. Rasouli; M. A. Zargar; K. Karimi; K. Zargar

2005-01-01

233

Optimization of the artificial urinary sphincter: modelling and experimental validation  

NASA Astrophysics Data System (ADS)

The artificial urinary sphincter should be long enough to prevent strangulation effects of the urethral tissue and short enough to avoid the improper dissection of the surrounding tissue. To optimize the sphincter length, the empirical three-parameter urethra compression model is proposed based on the mechanical properties of the urethra: wall pressure, tissue response rim force and sphincter periphery length. In vitro studies using explanted animal or human urethras and different artificial sphincters demonstrate its applicability. The pressure of the sphincter to close the urethra is shown to be a linear function of the bladder pressure. The force to close the urethra depends on the sphincter length linearly. Human urethras display the same dependences as the urethras of pig, dog, sheep and calf. Quantitatively, however, sow urethras resemble best the human ones. For the human urethras, the mean wall pressure corresponds to (-12.6 ± 0.9) cmH2O and (-8.7 ± 1.1) cmH2O, the rim length to (3.0 ± 0.3) mm and (5.1 ± 0.3) mm and the rim force to (60 ± 20) mN and (100 ± 20) mN for urethra opening and closing, respectively. Assuming an intravesical pressure of 40 cmH2O, and an external pressure on the urethra of 60 cmH2O, the model leads to the optimized sphincter length of (17.3 ± 3.8) mm.

Marti, Florian; Leippold, Thomas; John, Hubert; Blunschi, Nadine; Müller, Bert

2006-03-01

234

Glass rupture disk  

DOEpatents

A frangible rupture disk and mounting apparatus for use in blocking fluid flow, generally in a fluid conducting conduit such as a well casing, a well tubing string or other conduits within subterranean boreholes. The disk can also be utilized in above-surface pipes or tanks where temporary and controllable fluid blockage is required. The frangible rupture disk is made from a pre-stressed glass with controllable rupture properties wherein the strength distribution has a standard deviation less than approximately 5% from the mean strength. The frangible rupture disk has controllable operating pressures and rupture pressures.

Glass, S. Jill (Albuquerque, NM); Nicolaysen, Scott D. (Albuquerque, NM); Beauchamp, Edwin K. (Albuquerque, NM)

2002-01-01

235

Full Functional-Length Urethral Sphincter Preservation During Radical Prostatectomy  

Microsoft Academic Search

BackgroundA key prerequisite for urinary continence after radical prostatectomy (RP) is the functional length of the urethral sphincter and the stabilisation of its anatomic position within the pelvic floor.

Thorsten Schlomm; Hans Heinzer; Thomas Steuber; Georg Salomon; Oliver Engel; Uwe Michl; Alexander Haese; Markus Graefen; Hartwig Huland

2011-01-01

236

Anal canal carcinoma treatment results: the experience of a single institution  

PubMed Central

BACKGROUND AND OBJECTIVES: Prior to the mid-1980s, the treatment of choice for anal cancer was abdominoperineal resection. Currently, combined chemoradiation is the standard of care. Or objective was to analyze results of treatment for anal canal carcinoma treated with combined chemoradiation. DESIGN AND SETTING: 0Retrospective review of data in local cancer registry at King Faisal Specialist Hospital and Research Centre (KFSHRC) from a 12-year period (1993 to 2005). METHODS: We identified patients with confirmed diagnosis of anal canal squamous cell carcinoma. RESULTS: Of 40 patients identified, 33 were considered eligible for our analysis. All patients were treated by concurrent chemoradiation with mandatory treatment break (MTB) There were 10 (30%) local recurrences. Five-year progression-free survival (PFS) was 50.9%; overall survival (OS) at 5 years was 73.4%. Patients with stage II disease had a median PFS period of 10 years, with no relapses until their last follow-up. There was no statistically significant difference in PFS between patients with stage IIIA disease and those with stage IIIB disease—44.7% and 45%, respectively (P=.8). Five-year PFS according to ‘T’ stages was as follows: T1, 66%; T2, 71%; T3, 59%; T4, 30% (P>.05). The 5-year colostomy-free survival (CFS) for all patients was 74%. Distant metastases were observed in 4 patients. CONCLUSION: Combined chemoradiation in treatment of anal cancer is effective in terms of local control and sphincter preservation. Five-year estimates of PFS, OS, as well as CFS, in patients treated with a MTB were surprisingly comparable to those determined in most non-MTB series. However, we reported a higher local failure rate, for which we are reevaluating our treatment protocol.

El-Haddad, Mostafa; Ahmed, Raef S.; Al-Suhaibany, Abdallah; Al-Hazza, Manal; Al-Sanae, Nasser; Al-Jabbar, Alaa Abd; Hamoud, Samar; Ashaary, Loay; Bazerbashy, Shouky; Balaraj, Khaled

2011-01-01

237

Nocturnal faecal soiling and anal masturbation  

Microsoft Academic Search

Two cases of late onset faecal soiling as a result of anal masturbation in children who were neither mentally handicapped nor psychotic were studied. The role of soiling in aiding the young person and his family to avoid separating and maturing is highlighted. We suggest that the association of anal masturbation and resistant nocturnal soiling may be unrecognised.

A F Clark; P J Tayler; S R Bhate

1990-01-01

238

Sphincter EMG as a diagnostic tool in autonomic disorders  

Microsoft Academic Search

Multiple system atrophy (MSA) is a neurodegenerative disease presenting with a combination of parkinsonian, cerebellar, and\\u000a autonomic (including cardiovascular, urinary, and anorectal) dysfunction. It is pathologically defined, but at present lacks\\u000a a definitive clinical diagnostic test. The majority of patients with probable MSA have an abnormal sphincter EMG. Patients\\u000a with idiopathic Parkinson’s disease do not show marked sphincter EMG abnormalities.

Ryuji Sakakibara; Tomoyuki Uchiyama; Tomonori Yamanishi; Masahiko Kishi

2009-01-01

239

A new catheter for endoscopic manometry of Oddi's sphincter.  

PubMed

With a newly designed manometry catheter and a modified pull-through maneuver a high presure zone can reproducibly be recorded between the duodenum and the pancreato-biliary tree corresponding to Oddi's sphincter. Catheter marking allows in addition calculation of the length of this zone. Since the sealed end of the catheter remains during pressure recording within the ductal system repeated push-and-pull maneuvres can be performed through the sphincter area. PMID:862584

Rösch, W; Lux, G; Seuberth, K

1977-03-01

240

Treatment of detrusor sphincter dyssynergia with baclofen and doxazosin  

Microsoft Academic Search

Detrusor sphincter dyssynergia (DSD) is an involuntary contraction of the external urethral sphincter during detrusor contraction.\\u000a A high proportion of patients needing repeat surgery and long term failure have both been described in the literature. In\\u000a the present study, we evaluated clinical characteristics, underlying disorders and outcomes of conservative medical treatment\\u000a in 21 female patients. Two patients were newly diagnosed

H. Kilicarslan; S. Ayan; H. Vuruskan; G. Gokce; E. Y. Gultekin

2006-01-01

241

Characterization of basal hepatic bile flow and the effects of intravenous cholecystokinin on the liver, sphincter, and gallbladder in patients with sphincter of Oddi spasm  

Microsoft Academic Search

The major objectives of this project were to establish the pattern of basal hepatic bile flow and the effects of intravenous administration of cholecystokinin on the liver, sphincter of Oddi, and gallbladder, and to identify reliable parameters for the diagnosis of sphincter of Oddi spasm (SOS). Eight women with clinically suspected sphincter of Oddi spasm (SOS group), ten control subjects

Gerbail T. Krishnamurthy; Shakuntala Krishnamurthy; Randy D. Watson

2004-01-01

242

Optimal treatment duration of glyceryl trinitrate for chronic anal fissure: results of a prospective randomized multicenter trial  

PubMed Central

Background Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal treatment duration is unknown. Methods To assess the effect of different treatment durations on CAF, we designed a prospective randomized trial comparing 40 versus 80 days with twice daily topical 0.4% GTN treatment (Rectogesic®, Prostrakan Group). Chronicity was defined by the presence of both morphological (fibrosis, skin tag, exposed sphincter, hypertrophied anal papilla) and time criteria (symptoms present for more than 2 months or pain of less duration but similar episodes in the past). A gravity score (1 = no visible sphincter; 2 = visible sphincter; 3 = visible sphincter and fibrosis) was used at baseline. Fissure healing, the primary endpoint of the study, maximum pain at defecation measured with VAS and maximum anal resting pressure were assessed at baseline and at 14, 28, 40 and 80 days. Data was gathered at the end of the assigned treatment. Results Of 188 patients with chronic fissure, 96 were randomized to the 40-day group and 92 to the 80-day group. Patients were well matched for sex, age, VAS and fissure score. There were 34 (19%) patients who did not complete treatment, 18 (10%) because of side effects. Of 154 patients who completed treatment, 90 (58%) had their fissures healed and 105 (68%) were pain free. There was no difference in healing or symptoms between the 40- and the 80-day group. There was no predictor of fissure healing. A low fissure gravity score correlated with increased resolution of pain (P < 0.05) and improvement of VAS score (P < 0.05) on both univariate and multivariate analysis. A lower baseline resting pressure was associated with better pain resolution on univariate analysis (P < 0.01). VAS at defecation and fissure healing significantly improved until 40 days (P < 0.001), while the difference between 40 and 80 days was not significant. Conclusion We found no benefits in treating CAF with topical GTN for 80 days compared to 40 days. Fissure healing and VAS improvement continue until 6 weeks of treatment but are unlikely thereafter.

Pascariello, A.; Altomare, D. F.; Arcana, F.; Cafaro, D.; La Torre, F.; De Nardi, P.; Basso, L.; De Stefano, I.; Greco, V. J.; Vasapollo, L.; Amato, A.; Pulvirenti D'Urso, A.; Aiello, D.; Bove, A.

2010-01-01

243

Screening and management of anal dysplasia and anal cancer in HIV-infected patients: a guide for practice.  

PubMed

People living with HIV infection have a significantly higher rate of anal cancer as compared with that of uninfected people. It is believed that high-grade anal dysplasia secondary to human papillomavirus infection is a precursor to anal cancer. Considering this, screening and treatment of high-grade anal dysplasia is a possible means of preventing the development of anal cancer. No national or international guidelines exist to guide practice for screening and management of anal dysplasia. On the basis of a review of research and expert recommendations, a guide to practice for screening and management of anal dysplasia and anal cancer is made for clinicians. PMID:20409734

Moran, Matt G; Barkley, Thomas W; Hughes, Cynthia B

2010-04-21

244

Anal intraepithelial neoplasia: review and recommendations for screening and management.  

PubMed

Anal cancer is a rare malignancy of the distal gastrointestinal tract, often associated with human papillomavirus, the most common sexually transmitted infection worldwide. Currently available screening methods for anal intraepithelial neoplasia, a precursor for anal cancer, combine anal Papanicolaou cytology and high resolution anoscopy with biopsy of suspicious lesions. Significant barriers to establishing anal cancer screening programmes include the small number of healthcare professionals performing high resolution anoscopy and the lack of data showing that anal cancer screening can reduce morbidity and mortality related to anal carcinoma. Despite several controversies surrounding anal cancer screening, the rising incidence of this disease in some groups supports routine screening programmes in high-risk populations, especially in HIV-positive men who have sex with men. This review outlines the epidemiology of anal intraepithelial neoplasia and anal cancer and summarizes issues related to the introduction of anal cancer screening programmes. PMID:23970583

Smyczek, Petra; Singh, Ameeta E; Romanowski, Barbara

2013-07-10

245

Normal values in anal manometry and rectal sensation: a problem of range.  

PubMed

Anal manometry was performed in 80 individuals, mainly healthy volunteers, 40 men and 40 women aged 20-87, mean 45 years. An open-tip perfusion system employing a catheter with 4 sideports and a terminal balloon (to be inflated with air) was used. The maximum basal pressure (MBP) showed no significant difference between men and women (68 +/- 21 and 63 +/- 19 mmHg). With respect to the maximum squeeze pressure (MSP) a significant difference was found between men and women (183 +/- 73 and 102 +/- 36 mmHg, p less than 0.001). Both MBP and MSP decreased significantly with age (both p less than 0.001). The sphincter length was larger in men than in women (4.1 +/- 0.7 and 3.5 +/- 0.5 cm, p less than 0.001) and was related to BMP (p less than 0.002). The distension reflex seemed to change with age: the threshold volume increased (p less than 0.02), the pressure drop decreased (p less than 0.03), and the recovery time increased (p less than 0.001). The pressure drop was also related to MBP (p less than 0.005). The volume of rectal perception increased with age (p less than 0.005). Ultra-slow waves were related to MBP, and were only seen when MBP greater than 70 mmHg. No relationship was to be found between parity and MBP or MSP in women. In conclusion, anal pressures and sphincter length in normal individuals have a large range and vary with age and sex. The sensitivity of the rectum to balloon inflation decreases with age. When making therapeutic decisions in patients with anorectal disorders all these factors should be taken into account. PMID:1765365

Felt-Bersma, R J; Gort, G; Meuwissen, S G

1991-10-01

246

Do bladder neck mobility and urethral sphincter function differ during pregnancy compared with during the non-pregnant state?  

PubMed

The aim of the study was to assess and compare urethral sphincter (US) function and bladder neck (BN) behavior in pregnant and non-pregnant women. Urethral pressure profile parameters, intravaginal-anal pressures and BN position/mobility were compared in both pregnant and non-pregnant women. It was found that pregnancy results in a decreased maximal urethral closure pressure (MUCP)/area of continence at rest and at stress, decreased pressure-transmission ratio (PTR) values and backwards displacement of the bladder neck. No significant changes in intravaginal-anal pressures and BN mobility/downwards displacement were seen. Compared with stress continent pregnant patients, pregnant patients with stress urinary incontinence (SUI) have a lower MUCP at rest/stress and area of continence at stress, but show no difference in BN behavior. Regression analysis shows no correlation between advancing pregnancy and any of these parameters. It was concluded that pregnancy induces diminished US function and backwards displacement of the BN. Compared to continent pregnant patients, pregnant women with SUI also have a diminished US function. US parameters are not significantly modified by advancing pregnancy. PMID:9891962

Meyer, S; Bachelard, O; De Grandi, P

1998-01-01

247

Three-dimensional imaging of the lower esophageal sphincter in gastroesophageal reflux disease.  

PubMed Central

The resistance of the lower esophageal sphincter to reflux of gastric juice is determined by the integrated effects of radial pressures exerted over the entire length of the sphincter. This can be quantitated by three-dimensional computerized imaging of sphincter pressures obtained by a pullback of radially oriented pressure transducers and by calculating the volume of this image, in other words, the sphincter pressure vector volume. Validation studies showed that sphincter imaging based on a stepwise pullback of a catheter with four or eight radial side holes is superior to a rapid motorized pullback. Compared with 50 healthy volunteers, the total and abdominal sphincter pressure vector volume was lower in 150 patients with increased esophageal acid exposure (p less than 0.001) and decreased with increasing esophageal mucosal damage (p less than 0.01). Calculation of the sphincter pressure vector volume was superior to standard techniques in identifying a mechanically defective sphincter as the cause of increased esophageal acid exposure, particularly in patients without mucosal damage. The Nissen and Belsey fundoplication increased the total and intra-abdominal sphincter pressure vector volume (p less than 0.001) and normalized the three-dimensional sphincter image. Failure to do so was associated with recurrent or persistent reflux. These data indicate that three-dimensional imaging of the lower esophageal sphincter improves the identification of patients who would benefit from an antireflux procedure. Analysis of the three-dimensional sphincter pressure profile should become the standard for evaluation of the lower esophageal sphincter.

Stein, H J; DeMeester, T R; Naspetti, R; Jamieson, J; Perry, R E

1991-01-01

248

HPV in anal squamous cell carcinoma and anal intraepithelial neoplasia (AIN)  

Microsoft Academic Search

Background and aims  Majority of cases of anal squamous cell carcinoma are human papilloma virus (HPV)-induced and result from anal intraepithelial neoplasia (AIN). This study was conducted to examine methods which may enable the routine diagnosis of HPV-induced changes in the anal rim and the consequences of such detection especially in view of a more sensitive diagnosis of AIN. Results were

A. D. Varnai; M. Bollmann; H. Griefingholt; N. Speich; C. Schmitt; R. Bollmann; Dorothee Decker

2006-01-01

249

Vagal control of lower oesophageal sphincter motility in the cat  

PubMed Central

1. The effects of vagal efferent fibre stimulation on the smooth muscle of the lower oesophageal sphincter have been studied on the anaesthetized animal and on the isolated and perfused organ. 2. In both muscle layers (longitudinal and circular) vagal stimulation elicits two types of electromyographic (e.m.g.) potentials: (a) excitatory junction potentials (e.j.p.s) where there is a depolarization of the smooth muscle fibres. E.j.p.s can give rise to spike potentials inducing a contraction of the sphincter; (b) inhibitory junction potentials (i.j.p.s) where there is hyperpolarization of the smooth muscle fibres, often followed by a transient depolarization which may initiate spikes (post-inhibitory rebound). 3. Pure i.j.p.s are observed after atropine treatment which suppresses e.j.p.s. Under these conditions, a long lasting vagal stimulation induces a long duration hyperpolarization concomitant with an opening of the lower oesophageal sphincter followed after the cessation of stimulation by a powerful rebound leading to a strong contraction which closes the sphincter. 4. Several arguments, pharmacological (action of acetylcholine (ACh), atropine and hexamethonium) and physiological (threshold and latency of responses) lead to the following conclusions. Preganglionic vagal fibres are cholinergic and they activate (a) intramural excitatory cholinergic neurones; (b) intramural non-adrenergic inhibitory neurones (purinergic neurones). Preganglionic fibres leading to inhibition have a higher threshold than those leading to excitation. Both excitatory and inhibitory pathways are interconnected inside the intramural network. In particular, activation of intramural inhibitory neurones, by relaxing the oesophagus orally to the lower oesophageal sphincter, inhibits intramural excitatory neurones and subsequently blocks vagal excitatory responses. 5. Two functions may be attributed to the vagal extrinsic innervation: (a) closure of the lower oesophageal sphincter by maintaining the basal tone of the sphincter; this would imply that at rest the inhibitory control is supplanted by the excitatory one; (b) sphincter opening during swallowing by suppressing the excitatory stimulus and reinforcing the inhibitory one (it may be recalled that after bilateral vagotomy, swallowing is no longer followed by a relaxation of the sphincter).

Gonella, J.; Niel, J. P.; Roman, C.

1977-01-01

250

Designing micro- and nanostructures for artificial urinary sphincters  

NASA Astrophysics Data System (ADS)

The dielectric elastomers are functional materials that have promising potential as actuators with muscle-like mechanical properties due to their inherent compliancy and overall performance: the combination of large deformations, high energy densities and unique sensory capabilities. Consequently, such actuators should be realized to replace the currently available artificial urinary sphincters building dielectric thin film structures that work with several 10 V. The present communication describes the determination of the forces (1 - 10 N) and deformation levels (~10%) necessary for the appropriate operation of the artificial sphincter as well as the response time to master stress incontinence (reaction time less than 0.1 s). Knowing the dimensions of the presently used artificial urinary sphincters, these macroscopic parameters form the basis of the actuator design. Here, we follow the strategy to start from organic thin films maybe even monolayers, which should work with low voltages but only provide small deformations. Actuators out of 10,000 or 100,000 layers will finally provide the necessary force. The suitable choice of elastomer and electrode materials is vital for the success. As the number of incontinent patients is steadily increasing worldwide, it becomes more and more important to reveal the sphincter's function under static and stress conditions to realize artificial urinary sphincters, based on sophisticated, biologically inspired concepts to become nature analogue.

Weiss, Florian M.; Deyhle, Hans; Kovacs, Gabor; Müller, Bert

2012-03-01

251

Neoplasms of Anal Canal and Perianal Skin  

PubMed Central

Tumors of the anus and perianal skin are rare. Their presentation can vary and often mimics common benign anal pathology, thereby delaying diagnosis and appropriate and timely treatment. The anatomy of this region is complex because it represents the progressive transition from the digestive system to the skin with many different co-existing types of cells and tissues. Squamous cell carcinoma of the anal canal is the most frequent tumor found in the anal and perianal region. Less-frequent lesions include Bowen's and Paget's disease, basal cell carcinoma, melanoma, and adenocarcinoma. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for neoplasms of the anal canal and perianal skin.

Leonard, Daniel; Beddy, David; Dozois, Eric J.

2011-01-01

252

[Animal experiment studies on the treatment of fecal incontinence by means of artificial sphincter].  

PubMed

Animal experiments concerning replacing the intestinal sphincter by a hydraulic system are reported. The investigations were carried out an minipigs. The sphincter system functioned well. Several complications occurred, however, which are described in detail. PMID:136817

Schöning, G V; Zühlke, H; Langbein, L

1976-01-01

253

The S ileal pouch-anal anastomosis  

Microsoft Academic Search

In order to determine the results with the S ileal pouch-anal anastomosis, 116 consecutive patients who had undergone total abdominal colectomy with rectal mucosectomy and endorectal ileal pouch-anal anastomosis were assessed following ileostomy closure. In 11 patients (9.5%) pouch removal and\\/or conversion to permanent ileostomy was necessary because of Crohn's disease (3), pelvic sepsis (3), pouchitis (2), incontinence (2), or

Carol-Ann Vasilevsky; David A. Rothenberger; Stanley M. Goldberg

1987-01-01

254

Preoperative anal sphincter high pressure zone, maximum tolerable volume, and anal mucosal electrosensitivity predict early postoperative defecatory function after low anterior resection for rectal cancer  

Microsoft Academic Search

PURPOSE: The aims of this study were to correlate postoperative defecatory function after low anterior resection with clinical factors and physiologic parameters and to explore the possibility of predicting early postoperative defecatory function after low anterior resection. METHODS: Thirty-two patients who underwent low anterior resection for rectal cancer were studied. Anorectal physiologic studies were performed preoperatively and six months postoperatively;

Tetsuo Yamana; Masatoshi Oya; Junji Komatsu; Yasuo Takase; Noboru Mikuni; Hiroshi Ishikawa

1999-01-01

255

Botulinum toxin A with fissurectomy is a viable alternative to lateral internal sphincterotomy for chronic anal fissure.  

PubMed

Lateral internal sphincterotomy (LIS) is the gold standard surgical treatment for anal fissure. However, it carries potential complications, including fecal incontinence. The goal of this retrospective study was to compare the outcome of botulinum toxin A injection coupled with fissurectomy ([BTX + FIS) versus LIS. There were 59 patients who underwent BTX + FIS or LIS over a 5-year period. LIS was performed in the standard fashion without fissurectomy. BTX + FIS entailed internal sphincter injection with 80 units of botulinum toxin A coupled with fissurectomy. Forty patients underwent LIS and 19 had BTX + FIS. The choice of operation was based on the patient's preference. Primary healing rate was 90 and 74 per cent in the LIS and BTX + FIS groups, respectively (P = 0.13). The complication rate was 10 per cent in the LIS vs 0 per cent in the BTX + FIS groups (P = 0.29). Complications of LIS included anal sepsis in one patient and flatal and/or fecal incontinence in three patients. During a mean follow up of 19 months; recurrence rate was 0 and 5 per cent in the LIS and BTX+FIS groups, respectively (P = 0.32). The results of this study demonstrate that BTX + FIS is a viable alternative to LIS for patients with chronic anal fissure and should be considered as an alternative first-line surgical therapy. PMID:19886136

Aivaz, Ohara; Rayhanabad, Jessica; Nguyen, Vincent; Haigh, Philip I; Abbas, Maher

2009-10-01

256

Gallbladder ejection fraction and its relationship to sphincter of Oddi dysfunction  

Microsoft Academic Search

Theoretically, relative distal common bile duct obstruction due to sphincter of Oddi dysfunction may be a cause of poor gallbladder evacuation observed on quantitative cholescintigraphy. In this study, the relationship of sphincter of Oddi dysfunction to the gallbladder ejection fraction by quantitative cholescintigraphy was explored. Eighty-one patients with biliary-type pain and otherwise normal evaluations underwent quantitative cholescintigraphy, sphincter of Oddi

Thomas A. Ruffolo; Stuart Sherman; Glen A. Lehman; Robert H. Hawes

1994-01-01

257

Sphincter of Oddi dysfunction: an evidence-based review.  

PubMed

Sphincter of Oddi dysfunction is a painful syndrome that presents as recurrent episodes of right upper quadrant biliary pain, or recurrent idiopathic pancreatitis. It is a disease process that has been a subject of controversy, in part because its natural history, disease course and treatment outcomes have not been clearly defined in large controlled studies with long-term follow-up. This review is aimed at clarifying the state-of-the-art with an evidence-based summary of the current diagnostic and therapeutic approaches and modalities for sphincter of Oddi dysfunction. PMID:24161134

Rehman, Abdul; Affronti, John; Rao, Satish

2013-11-01

258

[Ruptured abdominal aortic aneurysm].  

PubMed

Rupture of the abdominal aortic aneurysm is a high lethal risk pathology, which requires precise diagnosis and urgent and efficient surgical treatment. Despite improved diagnostic capabilities (echoscopy, in specialized departments--angiography, computed tomography, magnetic nucleus resonance), mortality related to this pathology remains high in intensive care units. In the present article data concerning prevalence and clinical outcomes of the rupture of the abdominal aortic aneurysm for 1999-2001 is presented in detail. During this period 22 patients have undergone surgery due to abdominal aortic aneurysm rupture. Described are most prevalent complications, mortality rates and causes, analyzed are treatment strategy and tactics. PMID:12474751

Urbonavicius, Sigitas; Antusevas, Aleksandras

2002-01-01

259

Upper esophageal sphincter during transient lower esophageal sphincter relaxation: effects of reflux content and posture  

PubMed Central

Although some studies show that the upper esophageal sphincter (UES) contracts during transient lower esophageal sphincter relaxation (TLESR), others show that it relaxes. We hypothesized that the posture of the subject and constituents of gastroesophageal reflux (GER) may determine the type of UES response during the TLESR. High-resolution manometry and esophageal pH/impedance recording were performed in 10 healthy volunteers in the right recumbent (1 h) and upright (1 h) positions following the ingestion of a 1,000-Kcal meal. The UES pressure response during TLESR and constituents of GER (liquid, air, and pH) were determined. 109 TLESRs (58 upright and 51 recumbent) were analyzed. The majority of TLESRs were associated with GER (91% upright and 88% recumbent) events. UES relaxation was the predominant response during upright position (81% of TLESRs), and it was characteristically associated with presence of air in the reflux (92%). On the other hand, UES contraction was the predominant response during recumbent position (82% of TLESRs), and it was mainly associated with liquid reflux (71%). The rate of esophageal pressure increase (dP/dt) during the GER, but not the pH, had major influence on the type of UES response during TLESR. The dP/dt during air reflux (127 ± 39 mmHg/s) was significantly higher than liquid reflux (31 ± 6 mmHg/s, P < 0.0001). We concluded that the nature of UES response during TLESR, relaxation or contraction, is related to the posture and the constituents of GER. We propose that the rapid rate of esophageal pressure increase associated with air reflux determines the UES relaxation response to GER.

Babaei, Arash; Bhargava, Valmik

2010-01-01

260

Management of patients with biliary sphincter of Oddi disorder without sphincter of Oddi manometry  

PubMed Central

Background The paucity of controlled data for the treatment of most biliary sphincter of Oddi disorder (SOD) types and the incomplete response to therapy seen in clinical practice and several trials has generated controversy as to the best course of management of these patients. In this observational study we aimed to assess the outcome of patients with biliary SOD managed without sphincter of Oddi manometry. Methods Fifty-nine patients with biliary SOD (14% type I, 51% type II, 35% type III) were prospectively enrolled. All patients with a dilated common bile duct were offered endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy whereas all others were offered medical treatment alone. Patients were followed up for a median of 15 months and were assessed clinically for response to treatment. Results At follow-up 15.3% of patients reported complete symptom resolution, 59.3% improvement, 22% unchanged symptoms, and 3.4% deterioration. Fifty-one percent experienced symptom resolution/improvement on medical treatment only, 12% after sphincterotomy, and 10% after both medical treatment/sphincterotomy. Twenty percent experienced at least one recurrence of symptoms after initial response to medical and/or endoscopic treatment. Fifty ERCP procedures were performed in 24 patients with an 18% complication rate (16% post-ERCP pancreatitis). The majority of complications occurred in the first ERCP these patients had. Most complications were mild and treated conservatively. Age, gender, comorbidity, SOD type, dilated common bile duct, presence of intact gallbladder, or opiate use were not related to the effect of treatment at the end of follow-up (p > 0.05 for all). Conclusions Patients with biliary SOD may be managed with a combination of endoscopic sphincterotomy (performed in those with dilated common bile duct) and medical therapy without manometry. The results of this approach with regards to symptomatic relief and ERCP complication rate are comparable to those previously published in the literature in cohorts of patients assessed by manometry.

2010-01-01

261

Gore BioA Fistula Plug in the treatment of high anal fistulas - initial results from a German multicenter-study  

PubMed Central

Background: Treatment of high anal fistulas may be associated with a high risk of continence disorders. Beside traditional procedure of flap-reconstruction the occlusion of the fistula tract using fistula-plugs offers a new sphincter-saving treatment option. In this study for the first time results from Germany are described. Patients and method: 40 patients (30 male, 10 female, age 51±12 years) underwent closure of a high trans-sphincteric (n=28) or supra-sphincteric (n=12) fistula with Gore BioA Fistula Plug® in three surgical departments. The surgical procedures had been performed by five colorectal surgeons. Four patients had Crohn’s disease. Preoperatively 33 patients were completely continent; seven patients complained of minor continence disorders. Treatment of the patients was performed on a intent-to-treat basis and evaluation of the results was retrospective using pooled data from each center. Results: Postoperatively one patient developed an abscess, which had to be managed surgically. In two patients the plug had fallen out within the first two weeks postoperatively. Six months after surgery the fistula has been healed in 20 patients (50.0%). Three additional fistulas healed after 7, 9 rsp. 12 months. The overall healing-rate was 57.5% (23/40). The healing rate differs considerably between the surgeons from 0 to 75% and depends on the number of previous interventions. In patients having only drainage of the abscess success occurred in 63.6% (14/22) whereas in patients after one or more flap fistula reconstruction the healing rate decreased slightly to 50% (9/18). No patient complained about any impairment of his preoperative continence status. Conclusion: By occlusion of high anal fistulas with a plug technique definitive healing could be achieved in nearly every second patients. Previous surgery seems to have a negative impact on success rate. We have not observed any negative impact on anal continence. From that point of view anal fistula plugs might be discussed as a treatment option for high anal fistulas, but further studies are needed to gain conclusive evidence.

Ommer, A.; Herold, A.; Joos, A.; Schmidt, C.; Weyand, G.; Bussen, D.

2012-01-01

262

[Knee extensor mechanism ruptures].  

PubMed

Knee extensor mechanism is composed of the quadriceps and its tendon, patella and patellar tendon. Rupture of either the quadriceps or patellar tendon, or of the patella itself, lead to a disruption of the knee extensor mechanism. Clinical examination reveals an inability to actively extend the knee. Standard radiographs of the knee show a suprapatellar swelling of the soft tissues in case of quadriceps tendon rupture, or a displaced patellar fracture, or a patella alta in case of patellar tendon rupture. Echography and MRI confirm the diagnosis and may reveal associated injuries. In case of knee extensor mechanism rupture, early surgical reconstruction of quadriceps or patellar tendon, or patella osteosynthesis, are mandatory to achieve early functional recovery. PMID:21919393

Duthon, V B; Fritschy, D

2011-08-10

263

Partial Rotator Cuff Ruptures  

Microsoft Academic Search

\\u000a Partial rotator cuff ruptures are not rare and occur mainly in the supraspinatus tendon and may extend to that of infraspinatus,\\u000a but rarely to the tendon of subscapularis. Isolated lesions in the tendons of infraspinatus, teres minor or subscapularis\\u000a are rare. Partial ruptures usually occur before the sixth decade of life and can be a cause of unexplained pain in

Antonio Cartucho

264

Anal carcinoma--a histological review.  

PubMed

Epidemiological evidence of an association between anal carcinoma and symptomatic HIV-related disease suggests that the number of cases of this disease may increase significantly over the next few years. The role of oncogenic HPV types in the pathogenesis of anal carcinoma is substantiated by both epidemiological evidence that tumours are associated with a past history of anal warts and by experimental evidence showing that over 85% of tumours contain HPV 16/18 DNA on PCR. The physical state of the virus in the tumour cell genome is currently under investigation, and cellular interactions between HPV, HIV and other sexually transmitted viruses require further research. Clinical studies have shown that patients with anal warts and those who are HIV positive also show an increased tendency to develop dysplasia within the anal epithelium. However, the malignant potential of dysplasia remains unclear and, it presents problems in management, particularly when multifocal and high grade. Problems in classification of anal carcinomas involve both the site of the tumours and the histological appearance. Despite the difficulties which exist in estimating the origin of a tumour from canal or margin, this information does appear to have clinical significance and should therefore continue to be assessed. Recent morphological and keratin studies have emphasized the heterogeneity of these tumours and have revealed a similar heterogeneous profile of keratin expression in the normal anal epithelium. These results support the body of opinion which suggests that, with the exception of small cell carcinoma and adenocarcinoma, anal carcinomas should be considered as squamous cell tumours which are able to display a range of further morphological characteristics within which ductal differentiation and mucin production appear to carry the worst prognosis. Although there is no universally accepted staging system for anal carcinoma, depth of invasion and extent of spread at the time of diagnosis are the most important clinical factors determining survival and response to therapy. Randomized clinical trials are now under way to compare the outcome of various combinations of radiotherapy and chemotherapy, which have replaced radical surgery as a first line treatment and resulted in a significant decrease in patient morbidity from this disease. PMID:7698728

Williams, G R; Talbot, I C

1994-12-01

265

Effects of Larkspur (Delphinium barbeyi) on Heart Rate and Electrically Evoked Electromyographic Response of the External Anal Sphincter in Cattle.  

Technology Transfer Automated Retrieval System (TEKTRAN)

Norditerpenoid alkaloids of larkspur (Delphinium spp.) are competitive antagonists of nicotinic cholinergic receptors and poison cattle with, high mortality. Of the norditerpenoids, the N-(methylsuccinimido) anthranoyllycoctonine type (MSAL-type) alkaloids are most toxic. This study tested the hyp...

266

The effect of regular antenatal perineal massage on postnatal pain and anal sphincter injury: A prospective observational study  

Microsoft Academic Search

Objective. Antenatal perineal massage has been shown to reduce the incidence of perineal tears in primiparous women. The aim of this study was to determine whether perineal massage impacts on primary prevention of symptomatic disruption of the fecal continence mechanism. Methods. An observational study recruited two cohorts of women. The first, massage group (MG) chose to perform daily perineal massage

Maeve Eogan; Leslie Daly; Colm O'Herlihy

2006-01-01

267

Electroacupuncture may relax the sphincter of Oddi in humans  

Microsoft Academic Search

Background: This study was designed to evaluate the effects of electroacupuncture on sphincter of Oddi (SO) motility in humans and to associate the manometric findings with cholecystokinin (CCK) plasma levels. Methods: Eleven patients (M:F = 5:6) with various kinds of biliary disorders were enrolled. SO motility was monitored with conventional low-compliance, continuous perfusion technique at ERCP (n = 9) or

Sung-Koo Lee; Myung-Hwan Kim; Hong-Ja Kim; Dong-Wan Seo; Kyo-Sang Yoo; Yun-Ho Joo; Young-Il Min; Ji-Hoon Kim; Byung-Il Min

2001-01-01

268

Upper esophageal sphincter dysfunction: diverticula-globus pharyngeus.  

PubMed

The following discussion of upper esophageal sphincter dysfunction includes commentaries on the role of the cricopharyngeus muscle in reflux disease; the etiology and treatment of Zenker diverticulum; the use of videofluoroscopy in patients with dysphagia, suspicion of aspiration, or globus; the role of pH-impedance monitoring in globus evaluation; and treatment for reflux-associated globus. PMID:24117647

Schindler, Antonio; Mozzanica, Francesco; Alfonsi, Enrico; Ginocchio, Daniela; Rieder, Erwin; Lenglinger, Johannes; Schoppmann, Sebastian F; Scharitzer, Martina; Pokieser, Peter; Kuribayashi, Shiko; Kawamura, Osamu; Kusano, Motoyasu; Zelenik, Karol

2013-10-01

269

A Recoilless Piston for the Saclantcen Sphincter Corer.  

National Technical Information Service (NTIS)

A modification to the SACLANTCEN 'Sphincter' corer reported in Technical Report 34 is described. It consists of a simple system for positioning the piston relatively to a fixed platform lying on the sea floor, thereby eliminating recoil during deep-sea co...

A. Kermabon U. Cortis

1968-01-01

270

Celecoxib (Celebrex) Increases Canine Lower Esophageal Sphincter Pressure  

Microsoft Academic Search

Background. Prostaglandins inhibit the contraction of gastrointestinal smooth muscle and may decrease lower esophageal sphincter tone. The purpose of this study was to determine whether the cyclooxygenase-2 inhibitor celecoxib (Celebrex) could increase lower esophageal pressure (without affecting gastric emptying) compared to placebo and cisapride (Prepulsid), a compound previously used to treat reflux disease.Materials and methods. Six mongrel dogs were assigned

Sebastian G. de la Fuente; Ross L. McMahon; Erik M. Clary; Mary B. Harris; D. Curtis Lawson; James D. Reynolds; W. Steve Eubanks; Theodore N. Pappas

2002-01-01

271

Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate  

PubMed Central

BACKGROUND—Topical application of glyceryl trinitrate (GTN) ointment heals chronic anal fissures, providing an alternative to the traditional first line treatment of surgical sphincterotomy. ?AIMS—To determine the most effective dose of topical GTN for treatment of chronic anal fissures and to assess long term results. ?METHODS—Seventy consecutive patients with chronic anal fissure, were randomly allocated to eight weeks treatment with placebo, 0.2% GTN three times daily, or GTN starting at 0.2% with weekly 0.1% increments to a maximum of 0.6%, in a double blind study. ?RESULTS—After eight weeks fissure had healed in 67% of patients treated with GTN compared with 32% with placebo (p=0.008). No significant difference was seen between the two active treatments. Headaches were reported by 72% of patients on GTN compared with 27% on placebo (p<0.001). Maximum anal sphincter pressure reduced significantly from baseline by GTN treatment (p=0.02), but not placebo (p=0.8). Mean pain scores were lower after treatment with GTN compared with placebo (NS). Of fissures healed with placebo 43% recurred, compared with 33% of those healed with 0.2% GTN and 25% healed with escalating dose GTN (p=0.7). ?CONCLUSIONS—GTN is a good first line treatment for two thirds of patients with anal fissure. An escalating dose of GTN does not result in earlier healing. Significant recurrence of symptomatic fissures and a high incidence of headaches are limitations of the treatment. ?? Keywords: glyceryl trinitrate; anal fissures

Carapeti, E; Kamm, M; McDonald, P; Chadwick, S; Melville, D; Phillips, R

1999-01-01

272

Anal pressure studies in spinal patients  

Microsoft Academic Search

Maximal and sphincter pressure was measured in 22 patients with spinal cord lesions and in a group of 10 controls, using perfused sleeve manometry. The mean resting pressure of the spinal patients was 63+\\/-8 (SEM) mm Hg, and of the control group 116+\\/-14 (SEM) mm Hg, P less than 0-01. When the rectum was distended by a balloon inflated with

I C Wheatley; K J Hardy; J Dent

1977-01-01

273

Fibroepithelial polyp in an anal fistulous track: a sign of chronic pathology  

PubMed Central

Hypertrophied anal papillae and fibroepithelial polyps are benign acquired polypoid lesions of the anal canal. The development and protrusion of a fibroepithelial polyp in an anal fistulous track is described. This is a rare physical sign of chronic anal pathology.

Papadopoulos, Iordanis N; Danias, Nikolaos

2010-01-01

274

HPV infection, anal intra-epithelial neoplasia (AIN) and anal cancer: current issues  

PubMed Central

Background Human papillomavirus (HPV) is well known as the major etiological agent for ano-genital cancer. In contrast to cervical cancer, anal cancer is uncommon, but is increasing steadily in the community over the last few decades. However, it has undergone an exponential rise in the men who have sex with men (MSM) and HIV?+?groups. HIV?+?MSM in particular, have anal cancer incidences about three times that of the highest worldwide reported cervical cancer incidences. Discussion There has therefore traditionally been a lack of data from studies focused on heterosexual men and non-HIV?+?women. There is also less evidence reporting on the putative precursor lesion to anal cancer (AIN – anal intraepithelial neoplasia), when compared to cervical cancer and CIN (cervical intraepithelial neoplasia). This review summarises the available biological and epidemiological evidence for HPV in the anal site and the pathogenesis of AIN and anal cancer amongst traditionally non-high risk groups. Summary There is strong evidence to conclude that high-grade AIN is a precursor to anal cancer, and some data on the progression of AIN to invasive cancer.

2012-01-01

275

Randomized prospective trial comparing ileal pouch-anal anastomosis performed by excising the anal mucosa to ileal pouch-anal anastomosis performed by preserving the anal mucosa.  

PubMed Central

OBJECTIVE: The purpose of the study is to compare the results of ileal pouch-anal anastomosis (IPAA) in patients in whom the anal mucosa is excised by handsewn techniques to those in whom the mucosa is preserved using stapling techniques. SUMMARY BACKGROUND DATA: Ileal pouch-anal anastomosis is the operation of choice for patients with chronic ulcerative colitis requiring proctocolectomy. Controversy exists over whether preserving the transitional mucosa of the anal canal improves outcomes. METHODS: Forty-one patients (23 men, 18 women) were randomized to either endorectal mucosectomy and handsewn IPAA or to double-stapled IPAA, which spared the anal transition zone. All patients were diverted for 2 to 3 months. Nine patients were excluded. Preoperative functional status was assessed by questionnaire and anal manometry. Twenty-four patients underwent more extensive physiologic evaluation, including scintigraphic anopouch angle studies and pudendel never terminal motor latency a mean of 6 months after surgery. Quality of life similarly was estimated before surgery and after surgery. Univariate analysis using Wilcoxon test was used to assess differences between groups. RESULTS: The two groups were identical demographically. Overall outcomes in both groups were good. Thirty-three percent of patients who underwent the handsewn technique and 35% of patients who underwent the double-stapled technique experienced a postoperative complication. Resting anal canal pressures were higher in the patients who underwent the stapled technique, but other physiologic parameters were similar between groups. Night-time fecal incontinence occurred less frequently in the stapled group but not significantly. The number of stools per 24 hours decreased from preoperative values in both groups. After IPAA, quality of life improved promptly in both groups. CONCLUSIONS: Stapled IPAA, which preserves the mucosa of the anal transition zone, confers no apparent early advantage in terms of decreased stool frequency or fewer episodes of fecal incontinence compared to handsewn IPAA, which excises the mucosa. Higher resting pressures in the stapled group coupled with a trend toward less night-time incontinence, however, may portend better function in the stapled group over time. Both operations are safe and result in rapid and profound improvement in quality of life.

Reilly, W T; Pemberton, J H; Wolff, B G; Nivatvongs, S; Devine, R M; Litchy, W J; McIntyre, P B

1997-01-01

276

What's New in Anal Cancer Research and Treatment?  

MedlinePLUS

... Next Topic Additional resources for anal cancer What`s new in anal cancer research and treatment? Important research ... cancer cells is expected to help scientists develop new drugs to fight this disease. Early detection Ongoing ...

277

Benign anal lesions, inflammatory bowel disease and risk for high-risk human papillomavirus-positive and -negative anal carcinoma.  

PubMed Central

A central role in anal carcinogenesis of high-risk types of human papillomaviruses (hrHPV) was recently established, but the possible role of benign anal lesions has not been addressed in hrHPV-positive and -negative anal cancers. As part of a population-based case-control study in Denmark and Sweden, we interviewed 417 case patients (93 men and 324 women) diagnosed during the period 1991-94 with invasive or in situ anal cancer, 534 patients with adenocarcinoma of the rectum and 554 population controls. Anal cancer specimens (n = 388) were tested for HPV by the polymerase chain reaction. Excluding the 5 years immediately before diagnosis, men, but not women, with anal cancer reported a history of haemorrhoids [multivariate odds ratio (OR) 1.8; 95% confidence interval (CI) 1.04-3.2] and unspecific anal irritation (OR 4.5; CI 2.3-8.7) significantly more often than controls. Women with anal cancer did not report a history of benign anal lesions other than anal abscess to any greater extent than controls, but they had used anal suppositories more often (OR 1.5; CI 1.1-2.0). Patients with hrHPV in anal cancer tissue (84%) and those without (16%) reported similar histories of most benign anal lesions, but anal fissure or fistula was more common among hrHPV-positive cases. Ulcerative colitis and Crohn's disease, reported by <1% of study participants, were not associated with anal cancer risk. The higher proportion of hrHPV-positive anal cancers among case patients with anal fissure or fistula suggests that such mucosal lesions may provide direct viral access to basal epithelial layers. Since risk associations with benign anal lesions in men may be confounded by unreported sexual behaviour, and since risk associations in women were generally negative, it seems unlikely that benign anal lesions act as promoters in hrHPV-associated anal carcinogenesis. Moreover, benign anal lesions appear not to be linked to an alternative, hrHPV-unassociated causal pathway to anal cancer. Ulcerative colitis and Crohn's disease were not supported as causal factors for anal cancer.

Frisch, M.; Glimelius, B.; van den Brule, A. J.; Wohlfahrt, J.; Meijer, C. J.; Walboomers, J. M.; Adami, H. O.; Melbye, M.

1998-01-01

278

Complications After Sphincter-Saving Resection in Rectal Cancer Patients According to Whether Chemoradiotherapy Is Performed Before or After Surgery  

SciTech Connect

Purpose: The aim of the present study was to compare the influence of preoperative chemoradiotherapy (CRT) with postoperative CRT on the incidence and types of postoperative complications in rectal cancer patients who underwent sphincter-saving resection. Patients and Methods: We reviewed 285 patients who received preoperative CRT and 418 patients who received postoperative CRT between January 2000 and December 2006. Results: There was no between-group difference in age, gender, or cancer stage. In the pre-CRT group, the mean level of anastomosis from the anal verge was lower (3.5 {+-} 1.4 cm vs. 4.3 {+-} 1.7 cm, p < 0.001) and the rate of T4 lesion and temporary diverting ileostomy was higher than in the post-CRT group. Delayed anastomotic leakage and rectovaginal fistulae developed more frequently in the pre-CRT group than in the post-CRT group (3.9% vs. 1.2%, p = 0.020, 6.5% vs. 1.3%, p = 0.027, respectively). Small bowel obstruction (arising from radiation enteritis) requiring surgical intervention was more frequent in the post-CRT group (0% in the pre-CRT group vs. 1.4% in the post-CRT group, p = 0.042). Multivariate analysis identified preoperative CRT as an independent risk factor for fistulous complications (delayed anastomotic leakage, rectovaginal fistula, rectovesical fistula), and postoperative CRT as a risk factor for obstructive complications (anastomotic stricture, small bowel obstruction). The stoma-free rates were significantly lower in the pre-CRT group than in the post-CRT group (5-year stoma-free rates: 92.8% vs. 97.0%, p = 0.008). Conclusion: The overall postoperative complication rates were similar between the pre-CRT and the Post-CRT groups. However, the pattern of postoperative complications seen after sphincter- saving resection differed with reference to the timing of CRT.

Kim, Chan Wook [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Kim, Jong Hoon [Department of Radiation Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Yu, Chang Sik, E-mail: csyu@amc.seoul.k [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Shin, Ui Sup; Park, Jin Seok; Jung, Kwang Yong [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Kim, Tae Won [Department of Medical Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Yoon, Sang Nam; Lim, Seok-Byung; Kim, Jin Cheon [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of)

2010-09-01

279

Routine Use of Setons for the Treatment of Anal Fistulae  

Microsoft Academic Search

Aim: Anal fistula is usually treated by either fistulotomy or fistulectomy. We described the routine use of setons to treat anal fistula without any surgery. Method: Forty-seven consecutive patients with diagnosed anal fistulae were treated using setons alone. Results: The median age of the patients was 41 (range: 18-70). Of the 47 patients, 15 had surgery previously for fistula and

S S Ngoi

280

Botulinum toxin A and chronic anal fissures – a literature review  

Microsoft Academic Search

Summary  BACKGROUND: The Botulinum toxin A is used in the management of chronic anal fissures. This review is aimed at consolidating the available evidence in the various aspects of the use of BT-A in the treatment of anal fissures. METHODS: A Medline search of studies related to effects of Botulinum toxin on anal fissures was performed. All relevant trials, studies, experiences

R. Rajasundaram; R. Ayyathurai; S. Narayanan; A. Maw

2006-01-01

281

Ruptured jejunal artery aneurysm.  

PubMed

Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs. PMID:23771962

Costa, Sílvia; Costa, Alexandre; Pereira, Tiago; Maciel, Jorge

2013-06-13

282

Incomplete Cesarean Scar Rupture  

PubMed Central

Background Uterine rupture at the site of a previous cesarean scar is an uncommon but catastrophic complication of pregnancy, which is associated with significant maternal and fetal morbidity and mortality. Case Presentation A 30-year old woman at 24th week of gestation and complaint of pain, contractions and spotting was admitted in Royan Institute in Tehran, Iran. She had a past medical history of an EP and a cesarean section delivery, respectively 4 and 2 years before hospitalization. Herniation of an amniotic membrane into the maternal bladder was found on ultrasound examination. Conclusion Risk factors of cesarean scar rupture should be considered in women undergoing subsequent pregnancies as they need extra care. Ultrasonography can be used to evaluate women with previous cesarean section to assess the risks of scar rupture during subsequent pregnancies.

Ahmadi, Firoozeh; Siahbazi, Shiva; Akhbari, Farnaz

2013-01-01

283

Incidence and natural history of dysplasia of the anal transitional zone after ileal pouch-anal anastomosis  

Microsoft Academic Search

PURPOSE: Preservation of the anal transitional zone during ileal pouch-anal anastomosis is still controversial because of the risk of dysplasia and the theoretical risk of associated cancer. Without long-term follow-up data, the natural history and optimal treatment of anal transitional zone dysplasia are unknown. The aim of this study was to determine the long-term risk of dysplasia in the anal

M. G. O'Riordain; V. W. Fazio; I. C. Lavery; F. Remzi; N. Fabbri; J. Meneu; J. Goldblum; R. E. Petras

2000-01-01

284

Anal bulking agents for faecal incontinence.  

PubMed

The aim of this review was to assess and evaluate reports of studies on the efficacy of anal bulking agents used in the treatment of faecal incontinence. A systematic review of the literature was carried out to identify studies that have reported on the use of anal bulking agents. A variety of biomaterials have been employed for anal bulking. These include autologous fat, bovine glutaraldehyde cross-linked collagen, carbon-coated zirconium oxide beads, dextranomer microspheres in a gel, hydrogel cross-linked with polyacrylamide, polydimethylsiloxane elastomer in a gel, porcine dermal collagen and synthetic calcium hydroxylapatitie ceramic microspheres. Although the ideal site of injection (submucosal or intramuscular) and the mechanism of action remain the subject of debate, most published studies report a significant improvement in continence in at least 50% of subjects with mild to moderate symptoms with little or no associated morbidity.We concluded that anal bulking agents may be used to alleviate symptoms of faecal seepage and soilage. PMID:23136822

Watson, N F S; Koshy, A; Sagar, P M

2012-12-01

285

Midwestern Rural Adolescents' Anal Intercourse Experience  

ERIC Educational Resources Information Center

|Purpose: The purpose of this study was to examine the prevalence of anal intercourse and its associated risk behaviors in a sample of Midwestern, predominantly white rural adolescents. Most of the research on this activity has been local or regional studies, with urban East and West Coast racial and ethnic minority adolescents. Methods: A…

Dake, Joseph A.; Price, James H.; McKinney, Molly; Ward, Britney

2011-01-01

286

Anal incontinence among Igbo (Nigerian) women.  

PubMed

Anal incontinence in patients who present to the gynaecology clinic for symptoms other than pelvic organ prolapse dysfunction is fairly common. A structured pre-tested 41-item pelvic organ prolapse questionnaire was administered by doctors to 3963 gynaecological patients, recruited from three states of south-eastern Nigeria, who were in the clinic for reasons other than pelvic organ prolapse dysfunction. This report considers only anal incontinence. We found a prevalence of 6.96% for anal incontinence. Of these, 2.67% were incontinent for liquid stool, 2.17% for solid stool and 2.12% for flatus. There appears to be a higher frequency of flatus incontinence in the reproductive years: 36.6% of primiparas aged <30 years had faecal incontinence. Flatus incontinence was present in 28 (43.7%) of 198 para 4 and below, and in 36 (56.3%) of 78 para 5 and above. There was thus a significant association between flatus incontinence and parity (chi2=32.4; p<0.001). Spontaneous vaginal delivery had a significant effect on anal incontinence (p=0.04). Physicians should, be able to detect this embarrassing condition and be alert to factors that may avert or ameliorate it. PMID:12018821

Okonkwo, J E; Obionu, C N; Okonkwo, C V; Obiechina, N J

2002-04-01

287

Stapled ileal pouch-anal anastomosis with resection of the anal transition zone  

Microsoft Academic Search

We assessed the outcome of stapled ileal J-pouch-anal anastomosis with intersphincteric resection of the anal transition zone in 83 consecutive patients with ulcerative colitis (n=71) or familial adenomatous polyposis (n=12). There was no postoperative mortality. Two patients (2.4%) required permanent ileostomy for manifestation of unsuspected Crohn's disease. Major postoperative complications consisted of pelvic sepsis, anastomotic leakage, and pancreatitis with 3.6%

J. Braun; K. H. Treutner; V. Schumpelick

1995-01-01

288

Human papillomavirus genotypes in anal intraepithelial neoplasia and anal carcinoma as detected in tissue biopsies.  

PubMed

Human papillomavirus (HPV) infection strongly correlates with the development of anal intraepithelial neoplasias and carcinomas; however, few studies have characterized the distribution of the specific subtypes of the virus in the varying grades of dysplasia. This report characterizes the distribution of HPV 16/18 in surgical specimens with anal intraepithelial neoplasia (AIN) I-III and histological variants of anal carcinoma. A total of 111 anal surgical specimens with no dysplasia (10), AIN I-III (53), and anal carcinomas (48) were evaluated for the presence of high-risk HPV infection and subtyped by nested PCR or the Invader Assay. High-risk virus types were detected in progressively greater number of anal intraepithelial lesions from 56% in low grade to 88% in high grade. Type 16 was the prevalent subtype and was noted in 28% of low grade and 68% of high-grade lesions. Moderate dysplasias showed type 16 in 20%, a prevalence similar to that in low-grade lesions. The non-16/18 subtypes of the virus predominated and were present in 50% of the cases. Most (89%) squamous carcinomas were associated with high-risk viruses, 68% with type 16, a prevalence similar to that noted in high-grade dysplasia. Non-16/18 subtypes were encountered more frequently in squamous carcinomas from immunodeficient individuals (57% cases) as compared with immunocompetent individuals (18% cases). The similarity in the prevalence of type 16 in high-grade dysplasia and squamous carcinomas suggests that anal intraepithelial lesion III is the true precursor of squamous carcinoma and warrants aggressive management. Anal intraepithelial lesions II showed a virus distribution that was similar to low-grade dysplasia. In addition, a subset of these that were associated with type 16 or 18 showed progression, whereas those associated with non-16/18 subtypes regressed, thereby raising the possibility of conservative management for these lesions. PMID:19838162

Wong, Anna K; Chan, Raymond C; Aggarwal, Nidhi; Singh, Manoj K; Nichols, W Stephen; Bose, Shikha

2009-10-16

289

Anal endosonography for assessment of anal incontinence with a linear probe: relationships with clinical and manometric features  

Microsoft Academic Search

Background and aims: This study determined correlations of clinical and manometric features with those of anal endosonography (AES). Patients and methods: Between 1996 and 1999 we examined 58 patients suffering from anal incontinence (AI) by AES using a linear probe and anorectal manometry following a standardized protocol. Results: Twelve of the 58 patients (21%) had a history of anal surgery.

M. Barthet; P. Bellon; E. Abou; F. Portier; S. Berdah; N. Lesavre; P. Orsoni; M. Bouvier; J. C. Grimaud

2002-01-01

290

Ruptured extrauterine pregnancy  

Microsoft Academic Search

Extrauterine pregnancies contribute substantially to maternal mortality in all parts of the world. The most common cause of these deaths is massive bleeding after rupture of the ectopic pregnancy. The advent of transvaginal ultrasonography in early pregnancy and the use of quantitative measurement of the ?-unit of human chorionic gonadotropin have revolutionized the management of this condition. These diagnostic modalities

D. R. Slabbert; T. F. Kruger

2006-01-01

291

Transient Lower Esophageal Sphincter Relaxation in Morbid Obesity  

Microsoft Academic Search

Background  There is strong evidence that morbid obesity is often accompanied by gastroesophageal reflux. Gastroesophageal reflux is caused\\u000a predominantly by transient lower esophageal sphincter relaxations (TLESRs). Only few data are available about TLESRs in patients\\u000a with stage III obesity (body mass index?>?35). The aim of this study was to analyze the frequency and types of TLESRs in patients\\u000a with morbid obesity

J. H. Schneider; M. Küper; A. Königsrainer; B. Brücher

2009-01-01

292

Sphincter Preservation for Distal Rectal Cancer: Paradise Lost?  

Microsoft Academic Search

In this issue of the Annals of Surgical Oncology , Dr. Steele and colleagues report the long awaited results of the only multi-institutional prospective controlled trial of sphincter-sparing treatment for distal rectal carcinoma in the literature. The objectives of the study were clearly delineated and included: (1) determination of whether survival of patients with T1 and T2 adenocarcinomas who are

Nicholas J. Petrelli; Thomas K. Weber

1999-01-01

293

Ambulatory High Resolution Manometry, Lower Esophageal Sphincter Lift and Transient Lower Esophageal Sphincter Relaxation  

PubMed Central

Introduction Lower esophageal sphincter (LES) lift seen on high resolution manometry (HRM) is a possible surrogate marker of the longitudinal muscle contraction of the esophagus. Recent studies suggest that longitudinal muscle contraction of the esophagus induces LES relaxation. Aim Our goal was to determine, 1) the feasibility of prolonged ambulatory HRM and 2) to detect LES lift with LES relaxation using ambulatory HRM color isobaric contour plots. Methods In vitro validation studies were performed to determine the accuracy of HRM technique in detecting axial movement of the LES. Eight healthy normal volunteers were studied using a custom designed HRM catheter and a 16 channel data recorder, in the ambulatory setting of subject’s home environment. Color HRM plots were analyzed to determine the LES lift during swallow-induced LES relaxation as well as during complete and incomplete transient LES relaxations. Results Satisfactory recordings were obtained for 16 hours in all subjects. LES lift was small (2 mm) in association with swallow-induced LES relaxation. LES lift could not be measured during complete transient LES relaxations (TLESR) because the LES is not identified on the HRM color isobaric contour plot once it is fully relaxed. On the other hand, LES lift, mean 7.6 ± 1.4 mm, range 6–12 mm was seen with incomplete TLESRs (n = 80). Conclusions Our study demonstrates the feasibility of prolonged ambulatory HRM recordings. Similar to a complete TLESR, longitudinal muscle contraction of the distal esophagus occurs during incomplete TLESRs, which can be detected by the HRM. Using prolonged ambulatory HRM, future studies may investigate the temporal correlation between abnormal longitudinal muscle contraction and esophageal symptoms.

Mittal, Ravinder K.; Karstens, Anna; Leslie, Eric; Babaei, Arash; Bhargava, Valmik

2011-01-01

294

Anal cancer and screening guidelines for human papillomavirus in men.  

PubMed

The association between human papillomavirus (HPV) and anal cancer and the similarities between the "transitional zones" within the cervix and anus have raised questions regarding the medical biology of anal cancer. In recent years, increased rates of HPV infection and anal cancer among men have encouraged the medical community to search for causes and ways to identify the less insidious precursor, anal intraepithelial neoplasia. The "alphabet soup" terminology describing anal cytologic findings obtained by Papanicolaou (Pap) tests and the anal histologic findings obtained from biopsy specimens need to be better understood as distinct entities. Risk factors for the development of anal cancer have been identified and should be discussed with patients--especially those infected with human immunodeficiency virus--who have a much higher than normal risk of anal cancer. The anal Pap test has been used by the Northwest Pennsylvania Rural AIDS Alliance to detect potential precursors to cancer and degrees of anal dyplasia in patients with HIV infection. The Alliance has been instrumental in creating guidelines for anal Pap testing and encouraging other medical professionals and clinics to do the same, and these guidelines are provided herein. PMID:21415379

Ortoski, Richard A; Kell, Christine S

2011-03-01

295

Primary and secondary adenocarcinomas associated with anal fistulae.  

PubMed

PURPOSE: The purpose of this study was to evaluate the clinical features, pathology, and etiology of adenocarcinoma in patients with anal fistulae. METHODS: We identified seven patients diagnosed with adenocarcinoma associated with anal fistulae from a retrospective chart review. RESULTS: Five patients were diagnosed with primary adenocarcinoma associated with anal fistulae. Two patients were diagnosed with secondary adenocarcinoma associated with anal fistulae originating from rectal cancer on the proximal side. The primary adenocarcinomas included cancers arising from long-standing anal fistulae fulfilling established diagnostic criteria in two patients, and cancer arising from short-duration anal fistulae in three patients. Excision of the fistula was performed based on the initial diagnosis of the anal fistula for all five patients. Increased suspicion of cancer was due to the existence of gelatinous material in the anal fistula in three patients and induration in the resected specimens in two patients. The etiologies of the secondary adenocarcinomas associated with anal fistulae included implantation in the anal fistula from rectal cancer and fistula formation originating due to the progression of rectal cancer. CONCLUSION: Anal fistulae are commonly seen in the coloproctology clinic, but special attention to similar conditions associated with malignant disease is needed. PMID:23722283

Yamada, Kyoko; Miyakura, Yasuyuki; Koinuma, Koji; Horie, Hisanaga; Lefor, Alan T; Yasuda, Yoshikazu; Fukushima, Noriyoshi; Oyama, Yusuke; Nemoto, Yuta; Azuma, Hiroshi

2013-05-31

296

Oddi: the paradox of the man and the sphincter.  

PubMed

Ruggero Oddi was born of a modest family in the small town of Perugia, Italy, in 1866. While still a young medical student, he identified the sphincter and in addition characterized its physiological properties. At the early age of 29 years, he was appointed as the director of the Physiological Institute at Genoa, but a dalliance with drugs and fiscal improprieties resulted in his being relieved of this eminent position in Italian Physiology. He subsequently sought employment as a physician in the Belgian colonial medical service and briefly spent time in the Congo. The deterioration of his physical status and his use of Vitaline, a homeopathic preparation, led to the demise of his medical career. For reasons that are unclear, he then traveled to Africa where he died in Tunisia. In the last 50 years, the use of sophisticated methodology has allowed delineation of aspects of the neural and hormonal regulatory mechanisms of the sphincter. Its exact role in disease has not been determined, although its relationship to the putative entity of biliary dyskinesia has been suggested. The paradox of both the sphincter and its original discoverer remain to be resolved. PMID:8185478

Modlin, I M; Ahlman, H

1994-05-01

297

Vagal afferent innervation of the lower esophageal sphincter.  

PubMed

To supply a fuller morphological characterization of the vagal afferents innervating the lower esophageal sphincter (LES), specifically to label vagal terminals in the tissues forming the LES in the gastroesophageal junction, the present experiment employed injections of dextran biotin into the nodose ganglia of rats. Four types of vagal afferents innervated the LES. Clasp and sling muscle fibers were directly and prominently innervated by intramuscular arrays (IMAs). Individual IMA terminals subtended about 16° of arc of the esophageal circumference, and, collectively, the terminal fields were distributed within the muscle ring to establish a 360° annulus of mechanoreceptors in the sphincter wall. 3D morphometry of the terminals established that, compared to sling muscle IMAs, clasp muscle IMAs had more extensive arbors and larger receptive fields. In addition, at the cardia, local myenteric ganglia between smooth muscle sheets and striated muscle bundles were innervated by intraganglionic laminar endings (IGLEs), in a pattern similar to the innervation of the myenteric plexus throughout the stomach and esophagus. Finally, as previously described, the principle bundle of sling muscle fibers that links LES sphincter tissue to the antropyloric region of the lesser curvature was innervated by exceptionally long IMAs as well as by unique web ending specializations at the distal attachment of the bundle. Overall, the specialized varieties of densely distributed vagal afferents innervating the LES underscore the conclusion that these sensory projections are critically involved in generating LES reflexes and may be promising targets for managing esophageal dysfunctions. PMID:23583280

Powley, Terry L; Baronowsky, Elizabeth A; Gilbert, Jared M; Hudson, Cherie N; Martin, Felecia N; Mason, Jacqueline K; McAdams, Jennifer L; Phillips, Robert J

2013-04-11

298

Normal Function of the Colon and Anorectal Area  

MedlinePLUS

... by contraction of the internal and external anal sphincters. Anatomy of the Rectum and Anal Canal The ... the rectum causes relaxation of the internal anal sphincter. For defecation to proceed, the external anal sphincter ...

299

Female Longitudinal Anal Muscles or Conjoint Longitudinal Coats Extend into the Subcutaneous Tissue along the Vaginal Vestibule: A Histological Study Using Human Fetuses  

PubMed Central

Purpose It is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor. Materials and Methods Using immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology. Results In late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue. Conclusion In terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani.

Arakawa, Takashi; Abe, Hiroshi; Rodriguez-Vizquez, Jose Francisco; Murakami, Gen; Sugihara, Kenichi

2013-01-01

300

Elevated anal squamous cell carcinoma risk associated with benign inflammatory anal lesions  

PubMed Central

Background The association between benign anal lesions and anal cancer is still unclear. Few data from large cohort studies are available. Methods We conducted a register based retrospective cohort study including 45?186 patients hospitalised for inflammatory anal lesions (anal fissures, fistulas, and perianal abscesses) as well as 79?808 haemorrhoid patients, from 1965 to 2002. Multiple record linkages identified all incident anal (squamous cell carcinoma only) and colorectal cancers through to 2002. Relative risk was estimated by standardised incidence ratio (SIR), the ratio of observed number of cases divided by that expected in the age, sex, and calendar year?matched general Swedish population. Results There was a distinct incidence peak in the first three years of follow up among patients with inflammatory lesions. SIR then levelled off at around 3 and remained at this level throughout follow up (SIR during years 3–37 of follow up was 3.3 (95% confidence interval 1.8–5.7)). A similar initial incidence peak was observed among haemorrhoid patients but was confined to the first year; SIR was 2.8 in the second year, and then it decreased further and was close to unity in the following years (SIR during years 3–37 was 1.3 (95% confidence interval 0.7–2.1)). Among inflammatory lesion and haemorrhoid patients, a significantly increased risk of colorectal cancer was observed only in the first year after hospitalisation. Conclusions Inflammatory benign anal lesions are associated with a significantly increased long term risk of anal cancer. In contrast, haemorrhoids appear not to be a risk factor for this malignancy.

Nordenvall, C; Nyren, O; Ye, W

2006-01-01

301

Nature of the vagal inhibitory innervation to the lower esophageal sphincter.  

PubMed Central

The purpose of the present study was to investigate the nature of the vagal inhibitory innervation to the lower esophageal sphincter in the anesthetized opossum. Sphincter relaxation with electrical stimulation of the vagus was not antagonized by atropine, propranolol, phentolamine, or by catechloamine depletion with reserpine. A combination of atropine and propranolol was also ineffective, suggesting that the vagal inhibitory influences may be mediated by the noncholinergic, nonadrenergic neurons. To determine whether a synaptic link with nicotinic transmission was present, we investigated the effect of hexamethonium on vagal-stimulated lower esophageal sphincter relaxation. Hexamethonium in doses that completely antagonized the sphincter relaxation in response to a ganglionic stimulant, 1,1-dimethyl-4-phenylpiperazinium iodide (DMPP), did not block the sphincter relaxation in response to vagal stimulation at 10 pulses per second, and optimal frequency of stimulation. A combination of hexamethonium and catecholamine depletion was also ineffective, but hexamethonium plus atropine markedly antagonized sphincter relaxation (P less than 0.001). Moreover, 4-(m-chlorophenyl carbamoyloxy)-2-butyltrimethylammonium chloride (McN-A-343), a muscarinic ganglionic stimulant, also caused relaxation of the lower esophageal sphincter. We suggest from these results that: (a) pthe vagal inhibitory pathway to the sphincter consists of preganglionic fibers which synapse with postganglionic neurons: (b) the synaptic transmission is predominantly cholinergic and utilizes nicotinic as well as muscarinic receptors on the postganglionic neuron, and; (c) postganglionic neurons exert their influence on the sphincter by an unidentified inhibitory transmitter that is neither adrenergic nor cholinergic.

Goyal, R K; Rattan, S

1975-01-01

302

Total colectomy, mucosal proctectomy, and an ileal reservoir to an anal anastomosis. A comparison of short and long efferent legs.  

PubMed

In a consecutive series of 46 possible candidates for total colectomy, mucosal proctectomy, and ileal reservoir to an anal anastomosis, we have compared the clinical outcome of group I, with a long efferent leg (12 cm), and group II, with a short efferent leg (3-5 cm). The surgical procedure was done in three steps: first, a total colectomy; second, mucosal proctectomy and construction of an 'S-shaped' ileal reservoir with a temporary loop ileostomy; and, third, closing of the ileostomy. Nine patients with a long efferent leg and eight patients with a short leg were observed for 2-51 months with a functioning ileal reservoir. The overall mortality was zero. The results showed that the short efferent leg was important for low fecal urgency, spontaneous evacuation of stools, minimal soiling, independence of reservoir catheterization, and use of antidiarrheal drugs. The length of the efferent leg did not influence the function of the anal sphincter itself. The postoperative sexual life was unchanged, and all patients in group II had a better resocialization than those in group I. The selection of candidates for ileal reservoir operations from among patients with ulcerative colitis or familiar polyposis is most important because of a relatively long postoperative course and high incidence of surgical complications. PMID:4089520

Hansen, L K; Olsen, P R; Simonsen, L

1985-11-01

303

Anal Cancer: An Examination of Radiotherapy Strategies  

SciTech Connect

The Radiation Therapy Oncology Group 9811, ACCORD-03, and ACT II Phase III trials in anal cancer showed no benefit for cisplatin-based induction and maintenance chemotherapy, or radiation dose-escalation >59 Gy. This review examines the efficacy and toxicity of chemoradiation (CRT) in anal cancer, and discusses potential alternative radiotherapy strategies. The evidence for the review was compiled from randomized and nonrandomized trials of radiation therapy and CRT. A total of 103 retrospective/observational studies, 4 Phase I/II studies, 16 Phase II prospective studies, 2 randomized Phase II studies, and 6 Phase III trials of radiotherapy or chemoradiation were identified. There are no meta-analyses based on individual patient data. A 'one-size-fits-all' approach for all stages of anal cancer is inappropriate. Early T1 tumors are probably currently overtreated, whereas T3/T4 lesions might merit escalation of treatment. Intensity-modulated radiotherapy or the integration of biological therapy may play a role in future.

Glynne-Jones, Rob; Lim, Faye [Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom)

2011-04-01

304

Rust and Rupture: Atherosclerosis  

Microsoft Academic Search

\\u000a This chapter provides an overview of the pathogenesis of atherosclerosis, and integrates the latest clinical guidelines and\\u000a trials into a concise and practical guide to cardiovascular risk reduction and the management of dyslipidemia. These measures\\u000a form the basis for a management strategy aimed at halting the progression of atherosclerosis, stabilizing rupture-prone plaques,\\u000a preventing arterial thrombosis, and improving cardiovascular prognosis.

Justin T. Saunders; Christie M. Ballantyne

305

Premature rupture of membranes.  

PubMed Central

The management of patients with premature rupture of membranes has changed markedly in the past several years. The basis for this is a combination of a better understanding of newborn physiology, improved neonatal care, refinements in antibiotic therapy, and the widespread use of maternal and fetal monitoring. The best outcome for both mother and infant undoubtedly reflects data based on a combination of factors, among which are gestational age survival, evidence of fetal distress, presence or absence of labor and sepsis, and of course, the cervical condition as it is related to labor-readiness. An important recent advance is the recognition that an active observation management program is associated with less morbidity and mortality than the classic management course of delivery within 12 hours of membrane rupture. The fact that preterm premature rupture of membranes tends to recur in subsequent pregnancies offers an opportunity for prevention. Moreover, advances in perinatal and neonatal care will continue to improve the outcomes of these women and their children.

Poma, P. A.

1996-01-01

306

Ileal pouch-anal anastomosis in patients with colorectal cancer  

Microsoft Academic Search

When colorectal cancer complicates chronic ulcerative colitis or familial adenomatous polyposis, the role of ileal pouch-anal anastomosis is uncertain because of concerns that the procedure may compromise oncologic therapy and that oncologic therapy may compromise ileal pouch-anal anastomosis function. AIM: This study was undertaken to investigate the impact both of ileal pouch-anal anastomosis on cancer outcomes and of cancer treatments

Elisabetta Radice; Heidi Nelson; Richard M. Devine; Roger R. Dozois; Santhat Nivatvongs; John H. Pemberton; Bruce G. Wolff; J. Basil J. Fozard; Duane Ilstrup

1998-01-01

307

Botulinum toxin and anal fissure: Efficacy and safety systematic review  

Microsoft Academic Search

Purpose  The main purpose of this study was to investigate the efficacy and safety of botulinum toxin in the treatment of anal fissure.\\u000a An answer was attempted to the following research questions: (i) what is the efficacy of botulinum toxin in healing of anal\\u000a fissure compared to placebo, (ii) what is the efficacy of botulinum toxin in healing of anal fissure

Eugenia Yiannakopoulou

308

Inhibition of the lower oesophageal sphincter by fat— a mechanism for fatty food intolerance  

Microsoft Academic Search

The effect of fat and protein meals on the lower oesophageal sphincter pressure was tested in normal subjects using an infused open-tipped manometric system. After ingestion of a minced beef meal, the mean peak pressure at the lower oesophageal sphincter increased 5·8 ± 1·5 mm Hg (± 1 SE). By contrast, ingestion of a corn oil meal resulted in a

Otto T. Nebel; Donald O. Castell

1973-01-01

309

Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction  

Microsoft Academic Search

Background & Aims: Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis after endoscopic biliary sphincterotomy. Impaired pancreatic drainage caused by pancreatic sphincter hypertension is the likely explanation for this increased risk. A prospective, randomized controlled trial was conducted to determine if ductal drainage with pancreatic stenting protects against pancreatitis after biliary sphincterotomy in patients with

Paul R. Tarnasky; Yuko Y. Palesch; John T. Cunningham; Patrick D. Mauldin; Peter B. Cotton; Robert H. Hawes

1998-01-01

310

Blood vessel rupture by cavitation  

Microsoft Academic Search

Cavitation is thought to be one mechanism for vessel rupture during shock wave lithotripsy treatment. However, just how cavitation\\u000a induces vessel rupture remains unknown. In this work, a high-speed photomicrography system was set up to directly observe\\u000a the dynamics of bubbles inside blood vessels in ex vivo rat mesenteries. Vascular rupture correlating to observed bubble dynamics\\u000a were examined by imaging

Hong Chen; Andrew A. Brayman; Michael R. Bailey; Thomas J. Matula

2010-01-01

311

Carcinoma of the anal canal: radiation or radiation plus chemotherapy  

SciTech Connect

An editorial is presented which discusses the treatment of carcinoma of the anal canal. Following the initial report of the successful preoperative use of combined chemotherapy and radiation by Nigro in 1974, several centers have confirmed the effectiveness of such combinations either as preoperative or as definitive treatment of anal carcinomas, and many patients are now being referred for radiation therapy. The article by Cantril in this issue describe the successful treatment of anal carcinomas by radiation alone, and raises the important issue of whether radiation plus chemotherapy is more effective treatment than radiation alone for squamous or cloacogenic carcinomas arising in the anal canal or perianal area. Several studies are cited.

Cummings, B.J.

1983-09-01

312

Fatal subarachnoid hemorrhage during sexual anal self-stimulation in a female: a case report.  

PubMed

Sudden death after sexual activity is a well-known entity, but it is rare in females. Herein we present a case of fatal, massive subarachnoid hemorrhage from a ruptured berry-shaped aneurysm, during sexual anal self-stimulation. A 39-year-old woman was found dead on a couch, with the wooden handle of a spring twirl whisk inserted inside her anus and rectum as a dildo-like object. External examination was unremarkable with no signs of injuries. Intracranial examination showed a massive subarachnoid hemorrhage, up to 6 mm in thickness, especially around the brainstem and the inferior side of the brain. After removing the blood clots, the saccular aneurysm was found at the site of the bifurcation of the left internal carotid. In this case study, we underline the utility of forensic autopsy, as well as death scene investigation, in reconstructing the mechanism of death, as well as the dynamics of the event. PMID:22104332

Nikoli?, Slobodan; Živkovi?, Vladimir

2012-06-01

313

Rupture of an oxide blister  

SciTech Connect

Expressions have been derived which describe the critical stress and pressure necessary to rupture oxide blisters which form on aluminum during the growth of corrosion pits. These expressions have been derived and evaluated for radial cracks in the oxide blister. The critical stress and corresponding pressure for rupture decrease with increasing blister radius and decrease with increasing crack length. The critical stress is independent of the ratio of oxide film thickness to blister radius, whereas the rupture pressure increases with this ratio. The critical stress is independent of Poisson`s ratio for the oxide film whereas the rupture pressure is weakly dependent on Poisson`s ratio for the oxide film.

Ryan, R.L.; McCafferty, E. [Naval Research Lab., Washington, DC (United States)

1995-08-01

314

[Achilles tendon rupture].  

PubMed

The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques. PMID:10798233

Thermann, H; Hüfner, T; Tscherne, H

2000-03-01

315

Anal findings in children with and without probable anal penetration: a retrospective study of 1115 children referred for suspected sexual abuse.  

PubMed

Interpreting the significance of anal findings in child sexual abuse can be difficult. The aim of this study is to compare the frequency of anal features between children with and without anal penetration. This is a retrospective blinded review of consecutive charts of children seen for suspected sexual abuse at a regional referral center from January 1. 2005 to December 31. 2009 Based on predetermined criteria, children were classified into two groups: low or high probability of anal penetration. The charts of 1115 children were included, 84% girls and 16% boys with an age range from 0.17 to 18.83 years (mean 9.20 year). 198 children (17.8%) were classified as belonging to the anal penetration group. Bivariate analysis showed a significant positive association between the following features and anal penetration: Anal soiling (p=0.046), fissure (p=0.000), laceration (p=0.000) and total anal dilatation (p=0.000). Logistic regression analysis and stratification analysis confirmed a positive association of soiling, anal lacerations and anal fissures with anal penetration. Total anal dilation was significantly correlated with a history of anal penetration in girls, in children examined in the prone knee chest position and in children without anal symptoms. Several variables were found to be significantly associated with anal penetration, including the controversial finding of total anal dilatation. Due to limitations in the study design, this finding should still be interpreted with caution in the absence of a clear disclosure from the child. PMID:23618719

Myhre, Arne K; Adams, Joyce A; Kaufhold, Marilyn; Davis, Jennifer L; Suresh, Premi; Kuelbs, Cynthia L

2013-04-22

316

[Pelvic floor and anal incontinence. Conservative therapy].  

PubMed

Conservative treatment of fecal incontinence and obstructive defecation can be treated by many conservative treatment modalities. This article presents the options of medication therapy, spincter exercises, electric stimulation, transcutaneous tibial nerve stimulation, anal irrigation and injection of bulking agents. These methods are presented with reference to the currently available literature but the evidence-based data level for all methods is low. For minor disorders of anorectal function these conservative methods can lead to an improvement of anorectal function and should be individually adapted. PMID:23329310

Kroesen, A J

2013-01-01

317

Factors influencing lower esophageal sphincter relaxation after deglutition  

PubMed Central

AIM: To study the relationship between upper esophageal sphincter (UES) relaxation, peristaltic pressure and lower esophageal sphincter (LES) relaxation following deglutition in non-dysphagic subjects. METHODS: Ten non-dysphagic adult subjects had a high-resolution manometry probe passed transnasally and positioned to cover the UES, the esophageal body and the LES. Ten water swallows in each subject were analyzed for time lag between UES relaxation and LES relaxation, LES pressure at time of UES relaxation, duration of LES relaxation, the distance between the transition level (TL) and the LES, time in seconds that the peristaltic wave was before (negative value) or after the TL when the LES became relaxed, and the maximal peristaltic pressure in the body of the esophagus. RESULTS:Relaxation of the LES occurred on average 3.5 s after the bolus had passed the UES and in most cases when the peristaltic wave front had reached the TL. The LES remained relaxed until the peristaltic wave faded away above the LES. CONCLUSION: LES relaxation seemed to be caused by the peristaltic wave pushing the bolus from behind against the LES gate.

Tibbling, Lita; Gezelius, Per; Franzen, Thomas

2011-01-01

318

Creep Rupture Modelling of Polymers  

Microsoft Academic Search

Damage by creep related fracture process is of primary importance in en gineering polymers and their composites. Modelling of creep rupture is useful for engi neering design especially in obtaining design stresses. Previously, the creep rupture times of polyethylene and polypropylene have been described successfully using a three element model with a critical elastic stored energy criterion. The modelling is

S. H. Teoh; B. W. Cherry; H. H. Kausch

1992-01-01

319

Creep Ruptures in Heterogeneous Materials  

Microsoft Academic Search

We present creep experiments on fiber composite materials with different controlled heterogeneity. All samples exhibit a power-law relaxation of the strain rate in the primary creep regime (Andrade's law) followed by a power-law acceleration up to rupture. We discover that the rupture time is proportional to the duration of the primary creep regime, showing the interplay between the two regimes

H. Nechad; A. Helmstetter; R. El Guerjouma; D. Sornette

2005-01-01

320

Anodyspareunia: a novel sexual dysfunction? An exploration into anal sexuality  

Microsoft Academic Search

Mounting evidence suggests anal intercourse amongst both heterosexual and homosexual persons is an increasingly prevalent form of sexual expression, yet associated problems presenting to psychosexual services are a relative rarity. What constitutes ‘normal’ sexual satiety within the realms of anal sexuality remains an enigma to many, both therapists and clients alike. The term anodyspareunia has been proposed to denote a

Karl Hollows

2007-01-01

321

Relationship characteristics associated with anal sex among female drug users  

PubMed Central

Background Anal sex is an important yet little studied HIV risk behavior for women. Methods Using information collected on recent sexual encounters, we examined the influence of sex partner and relationship characteristics on the likelihood of engaging in anal sex among women with a high risk of HIV infection. Results Anal sex was nearly three times more common among actively bisexual women (OR = 2.96, 95% CI 2.17 – 4.03). Women were more likely to have anal sex with partners who injected drugs (OR = 2.32, 95% CI 1.44 – 3.75), were not heterosexual (OR = 1.85, 95% CI 1.18 – 2.90), and with whom they exchanged money or drugs for sex (OR = 1.79, 95% CI 1.10 – 2.90). The likelihood of anal sex also increased with the number of nights sleeping together (OR = 1.15, 95% CI 1.06 – 1.24). In contrast, emotional closeness and social closeness were not associated with anal sex. Condom use during anal sex was uncommon, and did not vary according to partner or relationship characteristics. Conclusions Our findings support the need for HIV prevention interventions that target anal sex among heterosexuals, particularly in drug-using populations residing in neighborhoods with elevated levels of HIV prevalence.

Mackesy-Amiti, Mary Ellen; McKirnan, David J.; Ouellet, Lawrence J.

2012-01-01

322

The male orgasm: Pelvic contractions measured by anal probe  

Microsoft Academic Search

Pelvic muscle contractions during sexual response can be monitored conveniently by the anal probe method described. Eleven young adult male subjects were each recorded for three sessions of masturbation to orgasm. Electrical signals from an anal pressure probe were automatically digitized by computer. Orgasmic contractions were easily distinguished from voluntary contractions by the steadily increasing intervals and complete muscle relaxation

Joseph G. Bohlen; James P. Held; Margaret Olwen Sanderson

1980-01-01

323

Ten years' experience with botulin toxin in anal fissure  

Microsoft Academic Search

Background and aims. Botulin toxin therapy has become established for various indications over the past 20 years. Treatment of anal fissure with botulin toxin began 10 years ago, and since then numerous studies with more than 300 patients have been published. Results. The healing rate in uncomplicated chronic anal fissure is about 60-80%. The injection is well tolerated, can be

Wolfgang H. Jost

2002-01-01

324

Perceptions of anal sex in rural South Africa.  

PubMed

As part of the Microbicides Development Programme, we conducted formative research to explore perceptions of anal sex at a site in rural KwaZulu-Natal. We were interested in the practice of anal sex because of its potential role in HIV transmission. Eleven focus group discussions were conducted with men and women from rural areas and in a semi-urban township. Participants were asked about their knowledge of and attitudes towards anal sex, and its practice in the local population. Findings indicate that in discussion anal sex was confused with other non-traditional sexual practices like vaginal sex 'dog-style' and with oral sex. Discussion of anal sex among those who had heard about it linked it to socially marginal groups and asymmetrical power relations. PMID:18247212

Ndinda, Catherine; Chimbwete, Chiweni; McGrath, Nuala; Pool, Robert

2008-02-01

325

Update on anal fistulae: Surgical perspectives for the gastroenterologist  

PubMed Central

Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands. For many years, the treatment of choice was to lay open the fistula; however, this risks causing incontinence with potentially devastating consequences. Alternative surgical treatments include setons, fibrin glue, collagen plugs and flaps to cover the internal fistula opening. These have achieved varying degrees of success, as will be discussed. The present review also discusses anal fistulae in light of much recently published literature. Currently, anal fistulae remain challenging and require specialist expertise; however, new treatment options are on the horizon.

Tabry, Helena; Farrands, Paul A

2011-01-01

326

Vagal mechanoreceptors located in the lower oesophageal sphincter of the cat.  

PubMed Central

In anaesthetized cats, sixty-two vagal sensory units with afferent endings in the lower oesophageal sphincter were recorded by means of extracellular glass micro-electrodes implanted in the nodose ganglion. All the receptors had non-medullated fibres, with conduction velocities ranging from 0.8 to 1.2 m/s. From the direct stimulation of the lower oesophageal sphincter, three types of mechanoreceptors were identified. Thirty-one were activated by natural stimuli:tonic contraction of the sphincter and distension elicited by the passage of a bolus. Artificial stimulation effected by digital compression was also effective. These receptors were similar to muscular endings already described in the digestive tract. Their main characteristic, i.e. their slow adaptation, suggests that they act as sensors of sphincter opening and closure. This was corroborated by observations obtained during distension of the cervical or thoracic oesophagus; a maximum decrease occurred in the lower oesophageal sphincter mechanoreceptor discharge when the distension was produced between 9 and 12 cm from the lower oesophageal sphincter. Twenty-nine endings were found in the superficial layers (mucosae). Contrary to the muscular receptors, the mucosal receptors were not affected by normal contractions or distensions of the lower oesophageal sphincter. They were activated only by strong stimuli like digital compression or distension achieved with a balloon. In addition, mucosal stroking was a potent stimulus. Whatever the stimulus used, the mucosal receptors showed rather rapidly adapting discharges. These receptors should be considered to be sensors of bolus consistency. Two mechanoreceptors, located in the serous membrane of the lower oesophageal sphincter, were identified by touching or by stretching. Their discharges showed that they belonged to the rapidly adapting type. A comparison of the three types of receptors found in the lower oesophageal sphincter is made with known digestive endings and their possible role is discussed.

Clerc, N; Mei, N

1983-01-01

327

Spontaneous Rupture of Pyometra  

PubMed Central

Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.

Mallah, Fatemeh; Eftekhar, Tahere; Naghavi-Behzad, Mohammad

2013-01-01

328

Anal avulsion caused by abdominal crush injury  

Microsoft Academic Search

We report the case of a pelvic and lower abdomen crushing trauma in 37-year-old male patient. The patient had an open lumbar\\u000a wound, laceration of the psoas muscle, pelvic fracture, a ruptured urogenital diaphragm, and extensive urogenital lacerations.\\u000a An emergency laparotomy was performed with debridment, urethral reconstruction, and osteosynthesis of the pubic bone. The\\u000a mobilization of the patient revealed a

G. Terrosu; A. Rossetto; E. Kocjancic; P. Rossitti; V. Bresadola

329

A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures  

PubMed Central

Background: Anal fissure is a common painful condition affecting the anal canal. The majority of acute fissures heal spontaneously. However, some of these acute fissures do not resolve but become chronic. Chronic anal fissures were traditionally treated by anal dilation or by lateral sphincterotomy. However, both of these surgical treatments may cause a degree of incontinence in up to 30% of patients. Several recent trials have shown that nitric oxide donors such as glyceryl trinitrate (GTN) can reduce sphincter pressure and heal up to 70% of chronic fissures. Aim: This study addressed the dose-response to three different concentrations of GTN ointment compared with placebo in a double blind randomised controlled trial. Method: A double blind, multicentre, randomised controlled trial was set up to compare placebo ointment against three active treatment arms (0.1%, 0.2%, and 0.4% GTN ointment applied at a dose of 220 mg twice daily) in chronic anal fissures. The primary end point was complete healing of the fissure. Results: Two hundred patients were recruited over an eight month period from 18 centres. After eight weeks of treatment the healing rate in the placebo group was 37.5% compared with 46.9% for 0.1%, 40.4% for 0.2%, and 54.1% for 0.4% GTN. None was significantly better than the placebo response. A secondary analysis excluded fissures without secondary criteria for chronicity. Healing rates were then found to be 24% in the placebo group compared with 50% in the 0.1% GTN group, 36% in the 0.2% group, and 57% in the 0.4% GTN group. These values were statistically significantly different for the placebo group compared with 0.1% GTN, 0.4% GTN, and for the GTN treated group as a whole. Conclusions: The results of this study have demonstrated the significant benefit of topical GTN when applied to patients suffering from chronic anal fissures but acute fissures showed a tendency to resolve spontaneously. The high proportion of fissures which healed in the placebo group suggests that the definition of “chronicity” needs to be reassessed. Further studies are required to confirm the optimal therapeutic strategy.

Scholefield, J H; Bock, J U; Marla, B; Richter, H J; Athanasiadis, S; Prols, M; Herold, A

2003-01-01

330

Anal Myolipoma: A New Benign Entity in Patients with an Anal Tumor?  

PubMed Central

A myolipoma is an extremely rare benign neoplasm, occurring most frequently in adults in the deep soft tissue of the abdomen or retroperitoneum. We experienced a case of an anal myolipoma occurring in a 30-year-old woman, and it was surgically resected. To our knowledge, this is the first reported case of a myolipoma arising from the anus, so such a possibility needs to be considered in the differential diagnosis.

Huh, Moo Ryang; Kim, Su Jin

2012-01-01

331

Creep Ruptures in Heterogeneous Materials  

NASA Astrophysics Data System (ADS)

We present creep experiments on fiber composite materials with different controlled heterogeneity. All samples exhibit a power-law relaxation of the strain rate in the primary creep regime (Andrade's law) followed by a power-law acceleration up to rupture. We discover that the rupture time is proportional to the duration of the primary creep regime, showing the interplay between the two regimes and offering a method of rupture prediction. These experimental results are rationalized by a mean-field model of representative elements with nonlinear viscoelastic rheology and with a large heterogeneity of strengths.

Nechad, H.; Helmstetter, A.; El Guerjouma, R.; Sornette, D.

2005-01-01

332

Creep ruptures in heterogeneous materials.  

PubMed

We present creep experiments on fiber composite materials with different controlled heterogeneity. All samples exhibit a power-law relaxation of the strain rate in the primary creep regime (Andrade's law) followed by a power-law acceleration up to rupture. We discover that the rupture time is proportional to the duration of the primary creep regime, showing the interplay between the two regimes and offering a method of rupture prediction. These experimental results are rationalized by a mean-field model of representative elements with nonlinear viscoelastic rheology and with a large heterogeneity of strengths. PMID:15783567

Nechad, H; Helmstetter, A; El Guerjouma, R; Sornette, D

2005-01-31

333

Partial ACL rupture: an MR diagnosis?  

Microsoft Academic Search

Purpose. We sought to clarify the ability of magnetic resonance imaging (MR) to show partial ante- rior cruciate ligament (ACL) ruptures and to allow dis- tinction of partial from complete ACL ruptures. Materials and methods. Eighty-eight patients were stud- ied by arthroscopy and MR (36 with normal ACLs, 21 with partial ACL ruptures, and 31 with complete ACL ruptures). MR

Lawrence Yao; Amilcare Gentili; Leonard Petrus; Joong K. Lee

1995-01-01

334

Human Umbilical Cord Blood Mononuclear Cell Transplantation in Rats with Intrinsic Sphincter Deficiency  

PubMed Central

To evaluate the effectiveness of the human umbilical cord blood (HUCB) transplantation for the treatment of intrinsic sphincter deficiency (ISD), we analyzed the short term effects of HUCB mononuclear cell transplantation in rats with induced-ISD. ISD was induced in rats by electro-cauterization of periurethral soft tissue with HUCB mononuclear cell injection after 1 week. The sphincter function measured by mean leak point pressure was significantly improved in the experimental group compared to the control group at 4 weeks. (91.75±18.99 mmHg vs. 65.02±22.09 mmHg, P=0.001). Histologically, the sphincter muscle was restored without damage while in the control group it appeared markedly disrupted with atrophic muscle layers and collagen deposit. We identified injected HUCB cells in the tissue sections by Di-I signal and Prussian blue staining. HUCB mononuclear cell injection significantly improved urethral sphincter function, suggesting its potential efficacy in the treatment of ISD.

Lim, Joa-Jin; Jang, Jin-Beum; Kim, Ji-Young; Moon, Sung-Hwan; Lee, Chung-No

2010-01-01

335

Cisapride restores the decreased lower oesophageal sphincter pressure in reflux patients.  

PubMed Central

The effect of the new prokinetic drug cisapride on the resting lower oesophageal sphincter pressure and on the strength of peristaltic contractions was studied in 10 healthy controls and in 10 reflux patients with abnormally low (less than 10 mm Hg) basal lower oesophageal sphincter pressure. A slow intravenous injection of cisapride 10 mg significantly increased the sphincter pressure in the controls but even more in the patients in whom it almost doubled the resting lower oesophageal sphincter pressure of 8.7 (0.5) mm Hg to between 15 and 20 mm Hg for at least 90 min. Results are expressed as mean (SE). Cisapride also significantly increased the amplitude of peristaltic contractions in controls and reflux patients. Therefore, cisapride might be useful in the treatment of reflux.

Ceccatelli, P; Janssens, J; Vantrappen, G; Cucchiara, S

1988-01-01

336

Bladder augmentation and artificial sphincter implantation: Urodynamic behavior and effects on continence  

Microsoft Academic Search

ObjectiveTo quantify changes in bladder capacity, pressure and compliance after isolated bladder augmentation or augmentation associated with implantation of an artificial sphincter, and to compare the various types of augmentation.

Juan S. Rodó; Freud A. Cáceres; Javier R. Lerena; Enrica Rossy

2008-01-01

337

New Artificial Urinary Sphincter Devices in the Treatment of Male Iatrogenic Incontinence  

PubMed Central

Severe persistent stress incontinence following radical prostatectomy for prostate cancer treatment, although not very common, remains the most annoying complication affecting patient's quality of life, despite good surgical oncological results. When severe incontinence persists after the first postoperative year and conservative treatment has been failed, surgical treatment has to be considered. In these cases it is generally accepted that artificial urinary sphincter is the gold standard treatment. AUS 800 by American Medical Systems has been successfully used for more than 35 years. Recently three more sphincter devices, the Flow-Secure, the Periurethral Constrictor, and the ZSI 375, have been developed and presented in the market. A novel type of artificial urinary sphincter, the Tape Mechanical Occlusive Device, has been inserted in live canines as well as in human cadavers. These new sphincter devices are discussed in this paper focusing on safety and clinical results.

Vakalopoulos, Ioannis; Kampantais, Spyridon; Laskaridis, Leonidas; Chachopoulos, Vasileios; Koptsis, Michail; Toutziaris, Chrysovalantis

2012-01-01

338

Vaginal Wall Sling for Anatomical Incontinence and Intrinsic Sphincter Dysfunction: Efficacy and Outcome Analysis  

Microsoft Academic Search

PurposeA prospective cohort study was done to determine the efficacy and clinical outcome of a new technique for anterior vaginal wall sling construction to treat urinary incontinence due to intrinsic sphincter dysfunction or anatomical incontinence.

Shlomo Raz; Lynn Stothers; George P. H. Young; Julie Short; Barbara Marks; Ashok Chopra; Gregory R. Wahle

1996-01-01

339

Anal transition zone in the surgical management of ulcerative colitis  

PubMed Central

Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis; these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.

Holder-Murray, Jennifer; Fichera, Alessandro

2009-01-01

340

Pharmacological dissection of the human gastro-oesophageal segment into three sphincteric components  

PubMed Central

Quantifications of gastro-oesophageal anatomy in cadavers have led some to identify the lower oesophageal sphincter (LOS) with the anatomical gastric sling-clasp fibres at the oesophago-cardiac junction (OCJ). However, in vivo studies have led others to argue for two overlapping components proximally displaced from the OCJ: an extrinsic crural sphincter of skeletal muscle and an intrinsic physiological sphincter of circular smooth-muscle fibres within the abdominal oesophagus. Our aims were to separate and quantify in vivo the skeletal and smooth muscle sphincteric components pharmacologically and clarify the description of the LOS. In two protocols an endoluminal ultrasound-manometry assembly was drawn through the human gastro-oesophageal segment to correlate sphincteric pressure with the anatomic crus. In protocol I, fifteen normal subjects maintained the costal diaphragm at inferior/superior positions by full inspiration/expiration (FI/FE) during pull-throughs. These were repeated after administering atropine to suppress the cholinergic smooth-muscle sphincter. The cholinergic component was reconstructed by subtracting the atropine-resistant pressures from the full pressures, referenced to the anatomic crus. To evaluate the extent to which the cholinergic contribution approximated the full smooth-muscle sphincter, in protocol II seven patients undergoing general anaesthesia for non-oesophageal pathology were administered cisatracurium to paralyse the crus. The smooth-muscle sphincter pressures were measured after lung inflation to approximate FI. The cholinergic smooth-muscle pressure profile in protocol I (FI) matched closely the post-cisatracurium smooth-muscle pressure profile in protocol II, and the atropine-resistant pressure profiles correlated spatially with the crural sling during diaphragmatic displacement. Thus, the atropine-resistant and cholinergic pressure contributions in protocol I approximated the skeletal and smooth muscle sphincteric components. The smooth-muscle pressures had well-defined upper and lower peaks. The upper peak overlapped and displaced rigidly with the crural sling, while the distal peak separated from the crus/upper-peak by 1.1 cm between FI and FE. These results suggest the existence of separate upper and lower intrinsic smooth-muscle components. The ‘upper LOS’ overlaps and displaces with the crural sling consistent with a physiological LOS. The distal smooth-muscle pressure peak defines a ‘lower LOS’ that likely reflects the gastric sling/clasp muscle fibres at the OCJ. The distinct physiology of these three components may underlie aspects of normal sphincteric function, and complexity of sphincter dysfunction.

Brasseur, James G; Ulerich, Rhys; Dai, Qing; Patel, Dalipkumar K; Soliman, Ahmed M S; Miller, Larry S

2007-01-01

341

[Splenic rupture and anticoagulant therapy].  

PubMed

Splenic rupture associated with anticoagulant therapy is a rare entity. We report a case of spontaneous splenic rupture in a 62-year-old man who was treated by acenocoumarol orally after an aortic-valve replacement. Unrecognised, minor trauma may lead to splenic haemorrhage in patients receiving anticoagulant therapy. The symptoms and signs may mimic those of acute myocardial infarction and cardiogenic shock. Early diagnosis is essential. Reversal of the anticoagulant and emergent splenectomy are the treatments of choice. PMID:15324967

Badaoui, R; Chebboubi, K; Delmas, J; Jakobina, S; Mahjoub, Y; Riboulot, M

2004-07-01

342

Creep rupture of polymer composites  

Microsoft Academic Search

A creep-rupture model, based on a creep model which was successfully applied in a previous paper to model and predict the creep of a unidirectional carbon-fiber-reinforced epoxy composite and that of the epoxy matrix, and a critical energy fracture criterion, are presented. The results of the successful application of this model to predict the creep rupture of AS4\\/3501-6 composite specimens

J. Raghavan; M. Meshii

1997-01-01

343

Experience with the AS-800 artificial urinary sphincter in myelodysplastic children.  

PubMed

The authors describe their experience with an artificial urinary sphincter (model AS-800; American Medical Systems, Minnetonka, Minn.) in treating urinary incontinence in children. Twenty-eight sphincters were implanted in 27 boys between May 1986 and June 1989. All the boys had neurogenic bladders secondary to myelomeningocele or sacral agenesis. The mean age at the time of initial implantation was 14 years (range from 9 to 19 years), and the median follow-up was 12 months (range from 6 to 31 months). The sphincters were implanted initially around the bladder neck in 25 cases. Three required reimplantation around the bulbous urethra. The complication rate was 39% (11 of 28 cases). There were two cases of erosion, two cases of infection without erosion and seven cases of device-related problems. The artificial sphincter had to be removed in four cases. There were no deaths. The revision rate was 25% (7 of 28 cases). Continence was evaluated in 22 (88%) of 25 boys who had functional sphincters in place. Five boys required oxybutinin chloride to maintain continence. Ten boys required augmentation cystoplasty before (3), after (6) and combined with (1) sphincter implantation. Eight of these 10 children were able to void spontaneously and were continent. One required intermittent catheterization twice a day and another six times a day. The authors conclude from their experience that the artificial urinary sphincter (model AS-800) can establish continence in boys with neurogenic bladders. Proper selection of the ideal patient for the artificial sphincter is essential to avoid complications. PMID:1498739

Aprikian, A; Berardinucci, G; Pike, J; Kiruluta, G

1992-08-01

344

Effect of intravenous diazepam on human lower oesophageal sphincter pressure under controlled double blind crossover conditions  

Microsoft Academic Search

The effect of diazepam on the lower oesophageal sphincter (LOS) pressure is controversial. Therefore, a double-blind crossover study was performed on 18 healthy volunteers to determine the sphincter response to intravenous diazepam--70, 140, 280 microgram\\/kg, which correspond to a total dose of 5, 10, and 20 mg. respectively. After the 5 and 10 mg dose no signficant effect on LOS

T R Weihrauch; C F Förster; H Köhler; K Ewe; J Krieglstein

1979-01-01

345

Urodynamic analysis in multiple system atrophy: characterisation of detrusor-sphincter dyssynergia  

Microsoft Academic Search

In multiple system atrophy (MSA), parkinsonism and a cerebellar syndrome are associated with autonomic dysfunction. Both bladder\\u000a neck dysfunction and external sphincter denervation have been implicated in detrusor-sphincter dyssynergia. However, urethral\\u000a dysfunction may not be adequately reflected by a single global measurement of urethral pressure. Pressure assessment at several\\u000a levels of the urethra is needed to unravel the mechanisms of

Frédéric Bloch; Bertrand Pichon; Anne-Marie Bonnet; Jacques Pichon; Marie Vidailhet; Emmanuel Roze; Michel Perrigot

2010-01-01

346

Anatomy and physiology of the male urethral sphincter and its preservation in prostatic surgery  

Microsoft Academic Search

Radical prostatectomy is commonly used in the management of localized prostate cancer. Urinary incontinence after prostatectomy\\u000a is of great concern to many patients. Improved understanding of the anatomy of the external urethral sphincter complex has\\u000a resulted in a statistically significant decrease in the incidence of postprostatectomy incontinence. Most recent anatomic\\u000a studies have described the external urethral sphincter complex as consisting

H. Heinzer; P. G. Hammerer; H. Huland

1999-01-01

347

Human immunodeficiency virus infection in Mexico City. Rectal bleeding and anal warts as risk factors among men reporting sex with men.  

PubMed

The objectives of this study were to evaluate the frequency and determinants of rectal bleeding and the association between rectal bleeding and risk of human immunodeficiency virus (HIV) infection among homosexual/ bisexual men in Mexico City. Men who requested anonymous HIV testing at a public clinic in Mexico City and who reported engaging in any homosexual behavior were eligible to participate in this study. Trained staff collected information on demographic factors, sexual behavior, psychological states, and HIV serostatus from all consenting, eligible clients. Logistic regression modeling was used to investigate the independent effect of risk factors among 2,758 men who were tested between June 1991 and December 1992. Bleeding during anal intercourse was a common occurrence: More than one third of the men in the study reported some bleeding, and 8% reported bleeding in half or more of their intercourse episodes. The prevalence of HIV infection among bleeders was 42% as compared with 28% in nonbleeders (p < 0.0001), and the adjusted odds ratio was 1.8 (95% confidence interval (CI) 1.1-2.8) for men who bled in more than half of their anal intercourse episodes relative to nonbleeders. There was a trend of increasing HIV seroprevalence with increasing frequency of rectal bleeding (p = 0.001). Nine percent of all HIV infections and 42% of infections among frequent bleeders were attributable to rectal bleeding. Men who reported both rectal bleeding and anal warts were 3.5 (95% CI 2.1-5.8) times more likely to be HIV-infected in multivariate analysis than men reporting neither rectal bleeding nor anal warts. Determinants of rectal bleeding included older age, more education, more receptive anal intercourse than insertive intercourse, receptive digital-anal contact, anal warts, and genital ulcers. Among men reporting sex with men in Mexico City, rectal bleeding is common. It is an independent risk factor for HIV infection, and warrants attention in acquired immunodeficiency syndrome prevention efforts. Rectal bleeding that results from rupture of anal warts may be an especially effective portal of HIV transmission. PMID:8890660

Coplan, P M; Gortmaker, S; Hernandez-Avila, M; Spiegelman, D; Uribe-Zuñiga, P; Mueller, N E

1996-11-01

348

Effect of modern analgesic drugs (tramadol, pentazocine, and buprenorphine) on the bile duct sphincter in man.  

PubMed Central

Modern narcotic analgesic drugs, such as tramadol, pentazocine, and buprenorphine share similarities of molecular structure with morphine which is widely believed to cause spasm of the bile duct sphincter and so impede bile flow. This study assessed the effects of intravenously administered analgesics on bile duct sphincter motor activity measured by ERCP manometry. Ten minutes after pentazocine injection the duration of contractions and baseline pressure of the bile duct sphincter rose from 6.2 +/- 0.2 to 8.2 +/- 0.27 s and from 5.1 +/- 0.6 to 8.8 +/- 0.4 mmHg respectively. Tramadol, buprenorphine and saline showed no such effect. These data indicated that the effects of such drugs on bile duct sphincter function can be safely assessed by ERCP manometry and that pentazocine adversely affects the bile duct sphincter, whilst tramadol and buprenorphine do not. We consider therefore that pentazocine is not the premedication of first choice for endoscopic procedures involving the sphincter of Oddi and should also be avoided in patients with pancreatic and biliary disorders.

Staritz, M; Poralla, T; Manns, M; Meyer Zum Buschenfelde, K H

1986-01-01

349

Electrocautery Superior to Topical Treatments for Precancerous Anal Lesions  

Cancer.gov

Results from a randomized clinical trial conducted in Amsterdam suggest that electrocautery is better than topical imiquimod or fluorouracil at treating potentially precancerous anal lesions in HIV-positive men who have sex with men.

350

[Botulotoxin A in the treatment of chronic anal fissures].  

PubMed

During the year 2003, based on the literature data and on the experience with application of the botulotoxin in other indications, our team treated 21 patients with chronic anal fissures. PMID:15615344

Foldyna, A; Novák, J

2004-09-01

351

Fault Branching and Rupture Directivity  

NASA Astrophysics Data System (ADS)

Can the rupture directivity of past earthquakes be inferred from fault geometry? Nakata et al. [J. Geogr., 1998] propose to relate the observed surface branching of fault systems with directivity. Their work assumes that all branches are through acute angles in the direction of rupture propagation. However, in some observed cases rupture paths seem to branch through highly obtuse angles, as if to propagate ``backwards". Field examples of that are as follows: (1) Landers 1992. When crossing from the Johnson Valley to the Homestead Valley (HV) fault via the Kickapoo (Kp) fault, the rupture from Kp progressed not just forward onto the northern stretch of the HV fault, but also backwards, i.e., SSE along the HV [Sowers et al., 1994, Spotila and Sieh, 1995, Zachariasen and Sieh, 1995, Rockwell et al., 2000]. Measurements of surface slip along that backward branch, a prominent feature of 4 km length, show right-lateral slip, decreasing towards the SSE. (2) At a similar crossing from the HV to the Emerson (Em) fault, the rupture progressed backwards along different SSE splays of the Em fault [Zachariasen and Sieh, 1995]. (3). In crossing from the Em to Camp Rock (CR) fault, again, rupture went SSE on the CR fault. (4). Hector Mine 1999. The rupture originated on a buried fault without surface trace [Li et al., 2002; Hauksson et al., 2002] and progressed bilaterally south and north. In the south it met the Lavic Lake (LL) fault and progressed south on it, but also progressed backward, i.e. NNW, along the northern stretch of the LL fault. The angle between the buried fault and the northern LL fault is around -160o, and that NNW stretch extends around 15 km. The field examples with highly obtuse branch angles suggest that there may be no simple correlation between fault geometry and rupture directivity. We propose that an important distinction is whether those obtuse branches actually involved a rupture path which directly turned through the obtuse angle (while continuing also on the main fault), or rather involved arrest by a barrier on the original fault and jumping [Harris and Day, JGR, 1993] to a neighboring fault on which rupture propagated bilaterally to form what appears as a backward-branched structure. Our studies [Poliakov et al., JGR in press, 2002; Kame et al, EOS, 2002] of stress fields around a dynamically moving mode II crack tip show a clear tendency to branch from the straight path at high rupture speeds, but the stress fields never allow the rupture path to directly turn through highly obtuse angles, and hence that mechanism is unlikely. In contrast, study of fault maps in the vicinity of the Kp to HV fault transition [Sowers et al., 1994], discussed as case (1) above, strongly suggest that the large-angle branching occurred as a jump, which we propose as the likely general mechanism. Implications for the Nakata et al. [1998] aim of inferring rupture directivity from branch geometry is that this will be possible only when rather detailed characterization (by surface geology, seismic relocation, trapped waves) of fault connectivity can be carried out in the vicinity of the branching junction, to ascertain whether direct turning of the rupture path through an angle, or jumping and then propagating bilaterally, were involved in prior events. They have opposite implications for how we would associate past directivity with a (nominally) branched fault geometry.

Dmowska, R.; Rice, J. R.; Kame, N.

2002-12-01

352

Anal Cancer Incidence and Mortality in Puerto Rico  

PubMed Central

Objective Anal cancer is a rare tumor that is associated with oncogenic HPV genotypes. This study aims to compare the age-standardized rates (ASRs) of anal cancer incidence and mortality in men and women living in Puerto Rico (PR) with those of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanics (USH) living in the continental United States (US). Methods ASRs were calculated based on cancer data that came from the PR Cancer Central Registry and from the Surveillance, Epidemiology, and End Results (SEER) program. The age-specific relative risks (RR) and 95% Confidence Interval (95% CI) were estimated using Poisson regression models. Results Comparing the period of 2001 to 2004 to that of 1992 to 1996, the incidence of anal cancer increased among NHW, NHB, and PR men. In females, an increase in the incidence was observed for all racial groups except for Puerto Rican women. When evaluating findings by age groups, Puerto Rican men younger than 60 years old had a 20% higher incidence of anal cancer than did USH men of the same age strata (RR: 2.20; 95% CI = 1.48–3.29). However, Puerto Rican females had a lower incidence of anal cancer than NHW and NHB women. An increased percent change in mortality was observed only in NHW and NHB men. A decreasing trend was observed in all racial/ethnic groups except for NHW women. Conclusion Our results support the notion that there are racial/ethnic differences in anal cancer incidence and mortality, with potential disparities among men and women in PR compared with USH men and women. Given the increasing incidence trends in anal cancer, particularly among PR, NHW, and NHB men, further investigation is needed to better elucidate screening practices that can aid in the prevention of anal cancer.

Colon-Lopez, Vivian; Ortiz, Ana P.; Soto-Salgado, Marievelisse; Torres-Cintron, Mariela; Mercado-Acosta, Juan Jose; Suarez, Erick

2013-01-01

353

C-myc oncogene expression in anal squamous neoplasia  

Microsoft Academic Search

AIMS: To determine the pattern of c-myc oncogene expression in anal squamous neoplasia and to determine if this could be used as a marker of disease progression. METHODS: The presence and localisation of the c-myc gene product p62 in archival specimens of anal squamous epithelium, normal and neoplastic, was examined using immunohistochemical staining with the monoclonal antibody Myc1-6E10. Ten normal

O A Ogunbiyi; J H Scholefield; K Rogers; F Sharp; J H Smith; S V Polacarz

1993-01-01

354

[Proctalgia fugax. Differential diagnosis and therapy of fleeting anal cramp].  

PubMed

Proctalgia fugax--short-lived anal spasm--is a common, extremely unpleasant, painful condition that occurs completely unexpectedly, often waking the victim at night. Scientific assessment is difficult on account of the functional nature of the condition and its multifactorial genesis. Before the patient is labeled "anal neurotic", however, he/she should be investigated by a specialist. The results of treating the rarely absent pathological organic findings give rise to optimism. PMID:1634166

Staude, G

1992-05-30

355

Time for a strategic research response to anal cancer.  

PubMed

Anal cancer was until recently regarded as a rare cancer of little consequence. The articles in this special edition of Sexual Health clearly demonstrate that anal cancer is increasing in incidence and, in some populations, it has become an urgent public health priority. In this summary paper, we will review the data presented in this issue and elsewhere on the magnitude of the issue, the means of prevention and treatment, and suggest a way forward. PMID:23380237

Grulich, Andrew E; Hillman, Richard; Brotherton, Julia M L; Fairley, Christopher K

2012-12-01

356

Perceptions of anal sex in rural South Africa  

Microsoft Academic Search

As part of the Microbicides Development Programme, we conducted formative research to explore perceptions of anal sex at a site in rural KwaZulu?Natal. We were interested in the practice of anal sex because of its potential role in HIV transmission. Eleven focus group discussions were conducted with men and women from rural areas and in a semi?urban township. Participants were

Catherine Ndinda; Chiweni Chimbwete; Nuala McGrath; Robert Pool

2008-01-01

357

Anal Incontinence after Childbirth: Incidence in the Korean Population  

Microsoft Academic Search

Aims: To investigate the incidence and risk factors for anal incontinence after childbirth in Korea. Methods: We retrospectively examined the records of 1,123 unselected women who delivered live infants at the KyungHee University Hospital between January 2006 and December 2006. Symptoms of anal incontinence were assessed by telephone interview using standard questionnaires. Results: A total of 966 women (86%) responded

Eui Jung; Chu Yeop Huh; Bong-Keun Choe

2008-01-01

358

[Anal incontinence: proposal of an evaluation score].  

PubMed

Anal incontinence is a shameful disease in which degree of severity must be assessed to design a suitable treatment and to be able to quantly the degree of relief or cure of this ailment. Therefore we have set a score table on basis of: physical features of the leakage (gas, liquid or solid) relating it to the frequency (daily, weekly or monthly) (10 to 20 points), during night time, daily light or both (1 to 3 points), hability to perceive the leakage (1 to 2 points), diapers needed (0 to 1 point), social or work limitations (0 to 2 points) (see table N. 1). Adding point, 4 degrees of severity are determinated: 1. light (type 1): less then 5 points, 2. moderate (type 2): 6 to 10 points, 3. moderately severe (type 3): 11 to 15 points, 4. quite severe (type 4): 16 to 20 points, Comparing the score of the patient before and after treatment we shall be able to know whether he has cured, just relieved, or whether there been no response. PMID:9926206

Curi, L A

1998-01-01

359

Traumatic Rupture of the Aorta  

PubMed Central

Objective To determine whether delay of the repair of the ruptured thoracic aorta in patients with other major injuries is safe and has a potential positive impact on survival. Summary Background Data The accepted treatment for acute traumatic rupture of the thoracic aorta has been repair of the injury as soon as possible. This form of management, however, has been accompanied by a death rate of 0% to 54% mortality, often related to the presence of other injuries. Methods The records of 30 consecutive patients with rupture of the thoracic aorta from blunt trauma treated from 1995 to 2001 were retrospectively reviewed. Two of them died shortly after admission and were excluded from further consideration. The remaining 28 patients were divided according to the time of the repair of the rupture into two groups. Group 1 patients underwent repair of the rupture immediately after the diagnosis was made. Group 2 patients, who had associated injuries that were likely to increase the risk of surgical death, had either repair more than 48 hours after injury (subgroup 2A) or had no repair (subgroup 2B). The patients in group 2 had their mean arterial pressure maintained at less than 70 mm Hg with medication to eliminate shear stress on the aortic tear while being observed. Results Twenty-eight patients (22 men, 6 women) with an average age of 36 years (range 19–76) were treated. Twenty-five had rupture of the descending thoracic aorta and three had rupture in the ascending thoracic aorta. Group 1 comprised 14 patients, 5 of whom died during surgery or in the early postoperative period. Group 2 comprised 14 patients, 9 in subgroup 2A and 5 in subgroup 2B. Two patients in subgroup 2A and three patients in subgroup 2B died of associated injuries or illnesses. Rupture of the traumatic pseudoaneurysm of the thoracic aorta did not occur in any of the patients in group 2. Conclusions Delayed repair of acute traumatic aortic rupture is safe under appropriate treatment and should be considered in selected patients.

Symbas, Panagiotis N.; Sherman, Andrew J.; Silver, Jeffery M.; Symbas, John D.; Lackey, Jodi J.

2002-01-01

360

Rupture of the tracheobronchial tree.  

PubMed Central

Eleven cases of tracheobronchial rupture are described. Nine were the result of external non-penetrating trauma and all but three had other serious injuries. The remaining two were caused by endobronchial intubation. Of the cases caused by external injury, respiratory tract injury was confined to the cervical trachea in three. Two required tracheostomy and repair and the third was managed conservatively; all made satisfactory recoveries. Intrathoracic rupture was recognised on or soon after admission in three cases. One patient died of uncontrollable pulmonary haemorrhage before he could be operated on; immediate repair gave good long term results in the other two. In three cases rupture of the main bronchus was not recognised until complete obstruction developed three, five, and 12 weeks after the accidents. The strictures were resected and the lung re-expanded. Robertshaw endobronchial tubes ruptured the left main bronchus in two patients undergoing oesophageal surgery. Uneventful recovery followed immediate repair. The difficulty of confirming rupture of a major airway is discussed and the importance of conserving the lung when the diagnosis has been missed is emphasised. Images

Roxburgh, J C

1987-01-01

361

Combined Diagnostic Modalities Improve Detection of Detrusor External Sphincter Dyssynergia  

PubMed Central

Introduction. The diagnosis of detrusor-external sphincter dyssynergia (DESD) is a clinically relevant finding during urodynamic testing. However, there is no consensus regarding diagnostic specifics of electromyography (EMG) or voiding cystourethrography (VCUG). We evaluated the concordance of the two modalities most commonly used in clinical practice for the diagnosis of DESD. Methods. Patients were prospectively evaluated by a single urodynamicist at an academic center and retrospectively re-evaluated by an independent urodynamicist for agreement. DESD was determined by increased patch EMG activity or a dilated bladder neck/proximal urethra on VCUG during detrusor contraction. Minimal acceptable criterion for agreement was set at 70%. Results. Forty-six patients were diagnosed with DESD with both modalities available. Of these 46 patients, 25 were diagnosed by both tests, 11 by VCUG alone and 10 by patch EMG alone. Binomial testing demonstrated the proportion of agreement was 54% (95% CI 39% to 68%). Conclusion. We found significant disagreement between the two modalities, similar to previously reported findings using needle EMG, and we expand the applicability of our data to the majority of clinicians who use patch EMG electrodes. This further supports the idea that the combined use of EMG and VCUG for diagnosis can identify more cases of DESD than either modality alone.

Spettel, Sara; Kalorin, Carmin; De, Elise

2011-01-01

362

5-HT is present in nerves of guinea pig sphincter of Oddi and depolarizes sphincter of Oddi neurons.  

PubMed

This study involved immunohistochemistry and intracellular electrophysiology to investigate serotonergic neurotransmission in the sphincter of Oddi (SO). 5-Hydroxytryptamine (HT)-positive neurons (14 cells/preparation) and nerve fibers were observed in the ganglionated plexus. Serotonergic nerve fibers, which persisted under 2- to 6-day organ culture, were densely distributed, with varicose endings encircling some SO neurons. When 5-HT was applied to SO neurons, it elicited three different responses: 1) a fast depolarization to 5-HT in 31 of 62 cells was mimicked by 2-methyl-5-HT and blocked by LY-278584 (1 microM); 2) a prolonged depolarization to 5-HT in 21 of 62 cells evoked an increase in input resistance and was attenuated by the 5-HT1P antagonist renzapride (1 microM) but not by the 5-HT4 antagonist SDZ-205557 (0.1-10 microM); and 3) an indirect depolarization blocked by TTX or atropine was observed in 32 of 62 cells. 5-HT superfusion elicited a dose-dependent monophasic depolarization (EC50 = 2 microM, n=14). In conclusion, 5-HT is present in nerves of the SO and elicits both 5-HT3 and 5-HT1P receptor-mediated depolarizations, supporting the concept that 5-HT plays a role in SO regulation. PMID:9815032

Hillsley, K; Mawe, G M

1998-11-01

363

Current treatment options for management of anal intraepithelial neoplasia  

PubMed Central

Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN), the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5-fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects.

Weis, Stephen E

2013-01-01

364

Videourodynamic and sphincter motor unit potential analyses in Parkinson's disease and multiple system atrophy  

PubMed Central

OBJECTIVES—Urinary dysfunction is a prominent autonomic feature in Parkinson's disease (PD) and multiple system atrophy (MSA), which is not only troublesome but also a cause of morbidity in these disorders. Recent advances in investigative uroneurology offer a better insight into the underlying pathophysiology and appropriate management for urinary dysfunction.?METHODS—twenty one patients with PD (15 men, six women, mean age 64 (49-76), mean disease duration 4 years (1-8 years), median Hoehn and Yahr grade 3 (1-4), all taking 300 mg/day of levodopa (100-500 mg)) and 15 with MSA (eight men, seven women, mean age 59 (48-72), mean disease duration 3 years (0.5-6 years)) were recruited. Videourodynamic and sphincter motor unit potential analyses in the patients with PD and MSA were carried out, looking for distinguishing hallmarks that might be useful in the differential diagnosis of these two diseases.?RESULTS—Urinary symptoms were found in 72% of patients with PD and in 100% with MSA. Filling phase abnormalities in the videourodynamic study included detrusor hyperreflexia in 81% of patients with PD and 56% with MSA, and uninhibited external sphincter relaxation in 33% of patients with PD and 33% of those with MSA. However, open bladder neck at the start of filling was not seen in patients with PD but was present in 53% of those with MSA, suggestive of internal sphincter denervation. Sphincter motor unit potential analysis showed neurogenic motor unit potentials in 5% of patients with PD and in 93% of those with MSA, suggestive of external sphincter denervation. On voiding, detrusor-external sphincter dyssynergia was not seen in patients with PD but was present in 47% of those with MSA. Pressure-flow analysis showed that the Abrams-Griffiths number, a grading of urethral obstruction (outflow obstruction >40), in PD (40 in women and 43 in men) was larger than that in MSA (12 in women and 28 in men). Weak detrusor in PD (66% of women and 40% of men) was less common than that in MSA (71% of women and 63% of men). Postmicturition residuals >100 ml were absent in patients with PD but were present in 47% of patients with MSA.?CONCLUSION—Patients with PD had less severe urinary dysfunction with little evidence of internal or external sphincter denervation, by contrast with the common findings in MSA. The findings of postmicturition residuals >100 ml, detrusor-external sphincter dyssynergia, open bladder neck at the start of bladder filling, and neurogenic sphincter motor unit potentials are highly suggestive of MSA.??

Sakakibara, R; Hattori, T; Uchiyama, T; Yamanishi, T

2001-01-01

365

Gender influences sphincter of Oddi response to cholecystokinin in the prairie dog.  

PubMed

Although gallstones and disorders of biliary tract motility are both more common in women than men, sphincter of Oddi motility has not previously been compared between the sexes. In this study, cholescintigraphy (under ketamine and diazepam anesthesia) was used to determine gallbladder emptying rate and ejection fraction in response to cholecystokinin (CCK) in eight male and six female prairie dogs fed a nonlithogenic diet. Ten days later, under alpha-chloralose anesthesia, sphincter of Oddi phasic wave activity was monitored for 10-min intervals before (control), during 20 min of CCK infusion, and for 20 min after infusion. Gallbladder emptying rate and ejection fraction and baseline sphincter of Oddi frequency, amplitude, and motility index (= frequency x amplitude) did not differ significantly between the sexes. Sphincter of Oddi phasic wave frequency was increased during CCK infusion in both males and females, but the change in amplitude was significantly greater in females, than males. We conclude that the increased incidence of biliary tract disease in women may be due to altered sphincter of Oddi hormonal response. PMID:7485498

Tierney, S; Qian, Z; Yung, B; Lipsett, P A; Pitt, H A; Sostre, S; Lillemoe, K D

1995-10-01

366

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2011 CFR

...SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS AND CARGO HANDLING SYSTEMS Pressure Relief Devices and Vacuum Relief Devices for MPTs § 64.61 Rupture disc. If a rupture disc is the only pressure relief device on the tank,...

2011-10-01

367

Traumatic duodenal rupture in a soccer player  

PubMed Central

Traumatic duodenal rupture resulting from blunt trauma during soccer is an extremely rare occurrence. A case report of this unusual condition is presented together with a review of the literature. Key Words: soccer; football; duodenal rupture; trauma

Houshian, S.

2000-01-01

368

Chordal rupture. I: aetiology and natural history.  

PubMed Central

Between 1970 and 1981, 12% of patients undergoing mitral valve surgery were found to have chordal rupture. Spontaneous or primary rupture accounted for 74.6% of patients (primary group); in the remainder (secondary group) chordal rupture complicated chronic rheumatic valvular disease (8.9%), bacterial endocarditis on both normal (8.5%) and rheumatic valves (4.7%), ischaemic heart disease (2.3%), acute rheumatic fever (0.5%), and osteogenesis imperfecta (0.5%). Isolated posterior rupture was seen most frequently (54%), with anterior rupture in 36% and rupture of both mitral cusps in 10% of patients. A short symptomatic history of acute mitral regurgitation was rare, occurring in only 4% of patients in either the primary or secondary groups, suggesting that mitral regurgitation due to ruptured chordae is a progressive disease. In contrast to previous reports the clinical presentation did not help to differentiate the aetiology of the chordal rupture.

Oliveira, D B; Dawkins, K D; Kay, P H; Paneth, M

1983-01-01

369

Why a special issue on anal cancer and what is in it?  

PubMed

This editorial describes the contents of this special issue of Sexual Health devoted to anal cancer. The aim of the issue is to provide readers with information to assist them in making decisions about what to do about detecting anal cancer early in men who have sex with men with HIV. Should they be advocating screening? It discusses the epidemiology of HPV infection, anal intraepithelial neoplasia, and anal cancer in MSM, heterosexual men and women; anal cancer screening and treatment of anal cancer. And most importantly, what should be done about vaccinating boys with the HPV vaccine. PMID:23380233

Fairley, Christopher K; Brotherton, Julia M L; Hillman, Richard; Grulich, Andrew E

2012-12-01

370

Open repair of acute Achilles tendon ruptures.  

PubMed

Although the Achilles tendon is the strongest in the body, it also is the most often ruptured. Achilles tendon rupture most often occurs during sports activities in middle-aged men. Operative repair of a ruptured Achilles tendon can be accomplished with a variety of techniques, ranging from open repair, to minimally invasive technique, to endoscopic-assisted repair. This article focuses on open repair of acute Achilles tendon rupture. Surgical techniques, rehabilitation protocol, and the authors' preferred method are described. PMID:19857843

Rosenzweig, Seth; Azar, Frederick M

2009-12-01

371

Rupture dimensions and rupture processes of fluid-induced microcracks in salt rock  

Microsoft Academic Search

We developed and applied a simple empirical Green function method to study induced microcracks observed during hydraulic fracturing experiments in salt rock. Either unidirectional ruptures on rectangular faults or allround ruptures on elliptical faults are tested to explain the observed directivity effects in body-wave amplitude spectra. Mostly, the rectangular rupture model and horizontal fault planes are favored. The average rupture

T. Dahm

2001-01-01

372

Histopathological findings in spontaneous tendon ruptures.  

PubMed

A spontaneous rupture of a tendon may be defined as a rupture that occurs during movement and activity, that should not and usually does not damage the involved musculotendinous units (1). Spontaneous tendon ruptures were uncommon before the 1950s. Böhler found only 25 Achilles tendon ruptures in Wien between 1925 and 1948 (2). Mösender & Klatnek treated 20 Achilles tendon ruptures between 1953 and 1956, but 105 ruptures between 1964 and 1967 (3). Lawrence et al. found only 31 Achilles tendon ruptures in Boston during a period of 55 years (1900-1954) (4). During the recent decades tendon ruptures have, however, become relatively common in developed countries, especially in Europe and North America. A high incidence of tendon ruptures has been reported in Austria, Denmark, Finland, Germany. Hungary, Sweden, Switzerland and the USA; somewhat lower incidences have been reported in Canada, France, Great Britain and Spain. On the other hand, Greece, Japan, the Netherlands and Portugal have reported a clearly lower incidence. Interestingly, Achilles tendon ruptures are a rarity in developing countries, especially in Africa and East-Asia (5). In many developed countries, the increases in the rupture incidence have been dramatic. In the National Institute of Traumatology in Budapest, Hungary, the number of patients with an Achilles tendon rupture increased 285% in men and 500% in women between two successive 7-year periods, 1972-1978 and 1979-1985 (5). PMID:9211612

Józsa, L; Kannus, P

1997-04-01

373

Case report Recurrent spontaneous esophageal rupture  

Microsoft Academic Search

Spontaneous esophageal rupture is an uncommon and poorly understood condition. Recurrent rupture is extremely rare, with only one previously reported case in the literature. Here, we present a case series of two patients who had recurrent ruptures, and discuss the principles underlying the management of such cases. Q 2005 Elsevier B.V. All rights reserved.

Omar A. Khan; Clifford W. Barlow; David F. Weeden; Khalid M. Amer

374

Blunt Traumatic Rupture of the Aorta  

Microsoft Academic Search

Objective: Aortic rupture is a potentially fatal complication in trauma. We report our surgical result in the treatment of traumatic aortic rupture in eastern Taiwan. Patients and Methods: From August 1996 to October 2000, six patients with traumatic aortic rupture had surgery at Tzu Chi General Hospital. Five had a widened mediastinum on chest X-ray examination. They were diag- nosed

Shen-Feng Chao; Bee-Song Chang

375

Fractal avalanche ruptures in biological membranes  

Microsoft Academic Search

Bilayer membranes envelope cells as well as organelles, and constitute the most ubiquitous biological material found in all branches of the phylogenetic tree. Cell membrane rupture is an important biological process, and substantial rupture rates are found in skeletal and cardiac muscle cells under a mechanical load. Rupture can also be induced by processes such as cell death, and active

Irep Gözen; Paul Dommersnes; Ilja Czolkos; Aldo Jesorka; Tatsiana Lobovkina; Owe Orwar

2010-01-01

376

Traumatic pericardial rupture with skeletonized phrenic nerve  

Microsoft Academic Search

BACKGROUND: Traumatic pericardial rupture is a rare presentation. Pericardial rupture itself is asymptomatic unless complicated by either hemorrhage or herniation of the heart through the defect. Following diagnosis surgical repair of the pericardium is indicated because cardiac herniation may result in vascular collapse and sudden death. OBJECTIVES: Here we present a case of traumatic, non-herniated pericardial rupture with complete skeletonization

Zain Khalpey; Taufiek K Rajab; Jan D Schmitto; Philipp C Camp

2011-01-01

377

Helical CT of Blunt Diaphragmatic Rupture  

Microsoft Academic Search

OBJECTIVE. This study evaluated CT findings for signs of blunt diaphragmatic rupture. MATERIALS AND METHODS. CT examinations of 179 blunt trauma patients, includ- ing 11 with left-sided and five with right-sided blunt diaphragmatic rupture, were reviewed by two staff radiologists who first decided by consensus on the presence or absence of 11 pub- lished signs of blunt diaphragmatic rupture and

Alain Nchimi; David Szapiro; Benoît Ghaye; Valérie Willems; Jamil Khamis; Luc Haquet; Charlemagne Noukoua; Robert F. Dondelinger

378

Spontaneous rupture of a splenotic nodule.  

PubMed Central

A case is presented of spontaneous rupture of splenic tissue occurring 14 years after a splenectomy was carried out for trauma. Spontaneous rupture of a splenotic nodule has not previously been described and it may be added to the list of causes of spontaneous haemoperitoneum. The incidence and function of residual splenic tissue are briefly discussed and other causes of splenic rupture are outlined.

Lanigan, D. J.

1990-01-01

379

MRI of tibialis anterior tendon rupture  

Microsoft Academic Search

Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58–67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of

Robert A. Gallo; Brett H. Kolman; Richard H. Daffner; Robert L. Sciulli; Catherine C. Roberts; Patrick J. DeMeo

2004-01-01

380

Rupture of spleen post colonoscopy.  

PubMed

We review an interesting case of elective colonoscopy for rectal bleeding in a 68-year-old woman complicated by splenic rupture. She was managed by aggressive fluid and blood resuscitation followed by splenectomy. She had a smooth recovery and was discharged home 4 days after admission. The extreme rarity and interesting clinical course of the patient are discussed. PMID:19668895

Younes, Nidal A; Al-Ardah, Mahmoud I; Daradkeh, Salam S

2009-08-01

381

CHANGE IN URETHRAL SPHINCTER NEUROMUSCULAR FUNCTION DURING PREGNANCY PERSISTS AFTER DELIVERY  

PubMed Central

Objective Assess the effect of pregnancy and first vaginal delivery on urethral striated sphincter neuromuscular function. Study Design Quantitative electromyographic (EMG) interference pattern analysis of the urethral sphincter of 23 nulligravidas and 31 third trimester primigravidas allowed comparison of mean motor unit parameters before term vaginal delivery and post partum. Results Mean electromyographic interference pattern parameters in the primigravidas were significantly lower than nulligravidas even antepartum, with decreased turns, lower amplitude, and less activity. The only significant change at 6 months post partum was further decline in number of turns resulting in a further decrease in turns:amplitude. All other electromyographic abnormalities persisted at six months post partum and remained abnormal compared to the nulligravidas. Conclusion Urethral sphincter neuromuscular function changed significantly during pregnancy and these changes persisted post partum. Lack of recovery 6 months post partum suggests a physiologic impact of pregnancy itself on future risk of urinary incontinence.

Weidner, Alison C.; South, Mary M.T.; Sanders, Donald B.; Stinnett, Sandra S.

2009-01-01

382

[The morphological characteristics of the parasympathetic innervation of the pyloric sphincter in the cat].  

PubMed

The method of axonal transport of horse-radish peroxidase was used to detect the localization of neurons in the dorsal motor nucleus of the vagus nerve sending the axons to the pyloric sphincter. The investigation was carried out in cats. Under study were also morphological features of the nodular ganglion responsible for afferent innervation of the sphincter. The maximum amount of the corresponding cells are found in the dorsomedial part of the dorsal motor nucleus in the area from +1.0 to +2.0 mm (with respect to obex). The afferent neurons to which information comes from interoceptors of the sphincter zone along the vagus nerve fibers, are distributed in the left and right nodular ganglia almost evenly. The major part of these cells have the area of 300-800 mkm2. PMID:7516790

Bagaev, V A; Filippova, L V; Makarov, F N

383

Sphincteric incontinence: the primary cause of post-prostatectomy incontinence in patients with prostate cancer.  

PubMed

Post-prostatectomy incontinence in patients with cancer of the prostate is often the result of sphincteric injury. However, recent studies have emphasized the role of detrusor instability and decreased bladder compliance in the etiology of post-prostatectomy incontinence. To further clarify the primary cause of incontinence, we reviewed the urodynamic studies of 39 patients referred for evaluation of incontinence after prostatectomy (35 radical, 4 TURP and radiation) for prostate cancer. Multichannel videourodynamic studies were performed to characterize bladder function, and sphincteric incontinence was assessed by Valsalva leak point pressure (VLPP). Flexible cystourethroscopy was used to evaluate the vesicourethral anastomosis. A pad scoring system was used to measure symptom severity. Sphincteric damage was found to be the sole cause of urinary incontinence in 23 patients (59%) and a major contributor in 14 others (36%). Twenty-seven patients (69%) had VLPP less than 103 cmH2O (mean = 55) with a urethral urodynamic catheter in place. An additional 10 (26%) had VLPP less than 150 cmH2O (mean = 63) upon removal of the catheter. VLPP is an indication of the severity of sphincteric damage. The importance of removing the urodynamic catheter during measurement of the VLPP is emphasized. Urethral fibrosis was confirmed by cystourethroscopy in 26 (67%) patients. Bladder dysfunction characterized by detrusor instability and/or decreased bladder compliance was seen in 15 patients (39%). In contrast to previous studies, our results indicate that sphincteric damage, and not bladder dysfunction, accounts for the vast majority of post-prostatectomy incontinence in patients with prostate cancer. However, it is essential to identify and treat bladder dysfunction in order to optimize the outcome of treatment for sphincteric incontinence. PMID:9136137

Desautel, M G; Kapoor, R; Badlani, G H

1997-01-01

384

Ileal Pouch Anal Anastomosis Without Ileal Diversion  

PubMed Central

Objective To evaluate continued experience with a one-stage stapled ileoanal pouch procedure without temporary ileostomy diversion. Summary Background Data Most centers perform colectomy, proctectomy, and ileal pouch anal anastomoses (IPAA) with a protective ileostomy. Following a previous report, the authors performed 126 additional stapled IPAA procedures for ulcerative colitis and familial adenomatous polyposis, of which all but 2 were without an ileostomy. Outcomes in these patients question the need for temporary ileal diversion, with its complications and need for subsequent surgical closure. Methods Two hundred one patients underwent a stapled IPAA since May 1989, 192 as a one-stage procedure without ileostomy, and 1 with a concurrent Whipple procedure for duodenal adenocarcinoma. Patient charts were reviewed or patients were contacted by phone to evaluate their clinical status at least 1 year after their surgery. Results Among the patients who underwent the one-stage procedure, 178 had ulcerative colitis (38 fulminant), 5 had Crohn’s disease (diagnosed after IPAA), 1 had indeterminate colitis, and 8 had familial adenomatous polyposis. The mean age was 38 ± 7 (range 7–-70) years; there were 98 male patients and 94 female patients. The average amount of diseased tissue between the dentate line and the anastomosis was 0.9 ± 0.1 cm, with 35% of the anastomoses at the dentate line. With 89% follow-up at 1 year or more (mean 5.1 ± 2.4 years) after surgery, the average 24-hour stool frequency was 7.1 ± 3.3, of which 0.9 ± 1.4 were at night. Daytime stool control was 95% and night-time control was 90%. Only 2.3% needed to wear a perineal pad. Average length of hospital stay was 10 ± 0.3 days, with 1.5 ± 0.5 days readmission for complications. Abscesses or enteric leaks occurred in 23 patients; IPAA function was excellent in 19 of these patients (2 have permanent ileostomies). In patients taking steroids, there was no significant difference in leak rate with duration of use (29 ± 8 with vs. 22 ± 2 months without leak) or dose (32 ± 13 mg with vs. 35 ± 3 mg without leak). Two (1%) patients died (myocardial infarction, mesenteric infarction). Conclusions The triple-stapled IPAA without temporary ileal diversion has a relatively low complication rate and a low rate of small bowel obstruction, provides excellent fecal control, permits an early return to a functional life, and can be performed in morbidly obese and older patients.

Sugerman, Harvey J.; Sugerman, Elizabeth L.; Meador, Jill G.; Newsome, Heber H.; Kellum, John M.; DeMaria, Eric J.

2000-01-01

385

Multiple tendon ruptures of unknown etiology.  

PubMed

Tendon ruptures are common findings in foot and ankle practice. The etiology of tendon ruptures tends to be multifactorial-usually due to a combination of trauma, effects of systemic diseases, adverse effects of medications, and obesity. We present an unusual case of right Achilles tendinitis, left Achilles tendon rupture, bilateral peroneus longus tendon rupture, and left peroneus brevis tendon rupture of unknown etiology. This case report highlights the need for research for other possible, lesser known etiologies of tendon pathology. Level of Evidence: Therapeutic, Level IV, Case Study. PMID:23966259

Axibal, Derek P; Anderson, John G

2013-08-21

386

[Mechanisms of compensating the evacuatory function of the stomach after exclusion of the pyloric sphincter].  

PubMed

The rate of solid food evacuation from the stomach was investigated in chronic experiments on dogs with the stomach and the duodenum (its first part) fistulae. It was found that in exclusion of the pyloric sphincter (operations of pyloroplastics or gastroduodenostomy) the stomach evacuation was mainly compensated. However, judging by the free passage of rubber balls (3 mm in diameter) into the duodenum no structures replacing the pyloric sphincter formed in the stomach. The compensation of the stomach evacuatory function under these conditions was provided by a significant increase of the enterogastric reflex. PMID:884292

Gro?sman, S D; Kharchenko, N M

1977-06-01

387

[The treatment plan for squamous cell anal canal carcinoma].  

PubMed

The current treatment plan for squamous cell anal canal carcinoma using chemoradiotherapy (CRT) is becoming more standardized. We use CRT rather than surgery to select the appropriate treatment. We experienced 4 patients treated with abdominoperineal resection(APR), of which 1 underwent adjuvant CRT. We also experienced 3 patients treated with radiotherapy(RT) and 2 treated with CRT. A patient treated with RT underwent APR because of radiation colitis. RT and CRT are advantageous for quality of life and are expected to be effective for controlling the disease. We hope that the standard treatment plan for anal cancer in Japan will be determined on the basis of histological features. PMID:23268095

Shimobayashi, Takayoshi; Inatsugi, Naoki; Yoshikawa, Shusaku; Masuda, Tsutomu; Uchida, Hideki; Kuge, Hiroyuki; Yamaoka, Kentaro; Inagaki, Mizumi; Yokoo, Takashi

2012-11-01

388

Steinert's syndrome presenting as anal incontinence: a case report  

PubMed Central

Introduction Myotonic dystrophy (MD) or Steinert's syndrome is a rare cause of chronic diarrhea and anal incontinence. In the presence of chronic diarrhea and fecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis. Case Presentation We present the case of a 45-year-old Turkish man with Steinert's syndrome, who was not diagnosed until the age of 45. Conclusions In clinical practice, the persistence of diarrhea and fecal incontinence with muscle weakness should suggest that the physician perform an anal manometric study and electromyography. Neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.

2011-01-01

389

Rupture directivity of small earthquakes at Parkfield  

NASA Astrophysics Data System (ADS)

AbstractTheoretical modeling of strike-slip <span class="hlt">ruptures</span> along a bimaterial interface suggests that earthquakes initiating on the interface will have a preferred <span class="hlt">rupture</span> direction. We test this model with 450 small earthquakes (2 < M < 5) from Parkfield, California, to look for evidence of consistent <span class="hlt">rupture</span> directivity along the San Andreas Fault. We analyze azimuthal variations in earthquake source spectra after applying an iterative correction for wave propagation effects. Our approach avoids directly modeling source spectra because these models generally assume symmetric <span class="hlt">rupture</span>; instead, we look for azimuthal variations in the amplitudes of the source spectra over specified frequency bands. Our overall results show similar proportions of events exhibiting characteristics of <span class="hlt">rupture</span> directivity toward either the southeast or northwest. However, the proportion of events with southeast <span class="hlt">rupture</span> directivity increases as we limit the data set to larger magnitudes, with 70% of the 46 events M > 3 exhibiting southeast <span class="hlt">rupture</span> characteristics. Some spatial and temporal variability in <span class="hlt">rupture</span> directivity is also apparent. We observe a higher proportion of northwest directivity <span class="hlt">ruptures</span> following the 2004 M 6 Parkfield earthquake, which <span class="hlt">ruptured</span> toward the northwest. Our results are generally consistent with the preferred southeast <span class="hlt">rupture</span> directivity model but suggest that directivity is likely due to several contributing factors.</p> <div class="credits"> <p class="dwt_author">Kane, Deborah L.; Shearer, Peter M.; Goertz-Allmann, Bettina P.; Vernon, Frank L.</p> <p class="dwt_publisher"></p> <p class="publishDate">2013-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">390</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/28902168"> <span id="translatedtitle">A Pilot Study of the Effects of Sildenafil on Stool Characteristics, Colon Transit, <span class="hlt">Anal</span> <span class="hlt">Sphincter</span> Function, and Rectal Sensation in Healthy Men</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Nitric oxide is an important mediator of gut smooth muscle relaxation and visceral sensation. Sildenafil results in stimulation of the nitric oxide-cyclic GMP pathway. We sought to determine the effects of daily sildenafil administration on colorectal function. Over a 4-week period, sildenafil was administered during weeks 2 and 3. Stool frequency and consistency were assessed daily. Anorectal manometry, rectal sensation,</p> <div class="credits"> <p class="dwt_author">Mark Milone; John K. Dibaise</p> <p class="dwt_publisher"></p> <p class="publishDate">2005-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">391</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/56475725"> <span id="translatedtitle"><span class="hlt">Anal</span> HPV Infection in HIV-Positive Men Who Have Sex with Men from China</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Background<span class="hlt">Anal</span> HPV infection, which contributes to the development of <span class="hlt">anal</span> warts and <span class="hlt">anal</span> cancer, is well known to be common among men who have sex with men (MSM), especially among those HIV positives. However, HIV and <span class="hlt">anal</span> HPV co-infection among MSM has not been addressed in China.MethodsA cross-sectional study was conducted in Beijing and Tianjin, China. Study participants were recruited</p> <div class="credits"> <p class="dwt_author">Lei Gao; Feng Zhou; Xiangwei Li; Yu Yang; Yuhua Ruan; Qi Jin; Rupert Kaul</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">392</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.hawaii.edu/hivandaids/Predictors_of_Unprotected_Anal_Intercourse_Among_HIV-Positive_Latino_Gay_and_Bisexual_Men.pdf"> <span id="translatedtitle">Predictors of Unprotected <span class="hlt">Anal</span> Intercourse Among HIV-Positive Latino Gay and Bisexual Men</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">This study examined sexual behaviors in a sample of 155 HIV-positive Latino gay and bisexual men. Nearly half the sample had engaged in unprotected <span class="hlt">anal</span> intercourse in the past 12 months; unprotected <span class="hlt">anal</span> intercourse was more likely when the partner was also HIV-positive. Separate regression models predicted the number of receptive and insertive partners for unprotected <span class="hlt">anal</span> intercourse. Participants reported</p> <div class="credits"> <p class="dwt_author">Paul J. Poppen; Carol A. Reisen; María Cecilia Zea; Fernanda T. Bianchi; John J. Echeverry</p> <p class="dwt_publisher"></p> <p class="publishDate">2004-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">393</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2531173"> <span id="translatedtitle">Extrinsic post burn peri-<span class="hlt">anal</span> contracture leading to sub acute intestinal obstruction: A case report</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p class="result-summary">Peri-<span class="hlt">anal</span> contracture lead to intestinal obstruction whenever there is involvement of <span class="hlt">anal</span> orifice. In this case anus and peri-<span class="hlt">anal</span> skin up to two cm was normal; however both gluteal folds were fused because of post burn scar leaving a very small opening which lead to faecal impaction and sub acute intestinal obstruction.</p> <div class="credits"> <p class="dwt_author">Thakur, Jagdeep S; Chauhan, CGS; Diwana, Vijay K; Thakur, Anamika</p> <p class="dwt_publisher"></p> <p class="publishDate">2008-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">394</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/42776270"> <span id="translatedtitle">The Danger of Desire: <span class="hlt">Anal</span> Sex and the Homo\\/Masculine Subject</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary"><span class="hlt">Anal</span> eroticism between men has been a recurrent focus in psychoanalytic theory for over a century. Many theorists conflate <span class="hlt">anal</span> eroticism with danger, particularly danger to masculinity and male gender identity. Defensive resistance to aggressive penetration and fear of receptivity are repeatedly invoked to understand <span class="hlt">anal</span> erotic excitement and actions. The author reviews numerous papers on this topic from a</p> <div class="credits"> <p class="dwt_author">Jeffrey R. Guss</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">395</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/23517694"> <span id="translatedtitle">[<span class="hlt">Ruptured</span> cerebral artery blister aneurysm].</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">We report the case of a young patient with subarachnoid haemorrhage secondary to a <span class="hlt">ruptured</span> blister-like aneurysm. Since this kind of aneurysms have fragile walls without a well-defined neck, their treatment is difficult. We initially planned the deployment of a flow-diverter stent, but an angiogram obtained after 10 days revealed a morphological change of the aneurysm. Therefore, we finally deployed a conventional stent and introduced 2 micro coils into the point of <span class="hlt">rupture</span>, obtaining a good morphological result without rebleeding. Follow-up at 1 and 6 months did not observe regrowth of the aneurysm. We offer a brief introduction and discussion of this pathology and its treatment. PMID:23517694</p> <div class="credits"> <p class="dwt_author">Vega Valdés, Pedro; Murias Quintana, Eduardo; Meilán Martínez, Angela; Gutiérrez Morales, Julio; Lopez Garcia, Antonio</p> <p class="dwt_publisher"></p> <p class="publishDate">2013-03-19</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">396</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/21934278"> <span id="translatedtitle">Traumatic <span class="hlt">rupture</span> of horseshoe kidney.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">We present the case of a 25-year-old male who came to the emergency room for pain and abdominal distension following trauma to the mesogastrium. A CT scan was performed, revealing a voluminous retroperitoneal hematoma with laceration of both inferior renal poles with regard to <span class="hlt">rupture</span> of the isthmus of a horseshoe kidney. The patient presented anemization and increased pain, requiring selective embolization by means of arteriography of a branch of the right renal artery and placement of a double J stent due to urinary extravasation in the lower left kidney pole. Following 1 year of monitoring, the patient has maintained normal renal function. Renal affection in blunt abdominal trauma is frequent, occurring in 7% of previously pathological kidneys. The traumatic <span class="hlt">rupture</span> of horseshoe kidney is facilitated by its particular anatomical characteristics, constituting an infrequent entity, knowledge of which is necessary to achieve conservative management that renders it possible to preserve renal function. PMID:21934278</p> <div class="credits"> <p class="dwt_author">Molina Escudero, R; Cancho Gil, M J; Husillos Alonso, A; Lledó García, E; Herranz Amo, F; Ogaya Piniés, G; Ramón Botella, E; Simó, G; Navas Martínez, M C; Hernández Fernández, C</p> <p class="dwt_publisher"></p> <p class="publishDate">2011-09-17</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">397</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/7837018"> <span id="translatedtitle">Traumatically <span class="hlt">ruptured</span> globes in children.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">This retrospective study was designed to document the etiology of traumatically <span class="hlt">ruptured</span> globes in children and to determine the prognostic value of several clinical parameters with respect to visual outcome. Forty-six children 16 years of age and under seen in the emergency room over a 2-year period were found to have full thickness penetration of the globe. Fifty-nine percent of injuries occurred during recreational activities, and 59% occurred outside of the home. Boys outnumbered girls by a 6:1 ratio. For children, initial visual acuity proved to be less valuable as a prognostic indicator with regard to final vision than has been reported in adults. Smaller corneal wounds offered better visual outcomes. Four eyes were enucleated. Ten <span class="hlt">ruptures</span> (22%) were related to activity involving guns. Four of six BB gun injuries were the result of a ricocheted BB. Visual outcomes in gun-related injuries were particularly poor. PMID:7837018</p> <div class="credits"> <p class="dwt_author">Rudd, J C; Jaeger, E A; Freitag, S K; Jeffers, J B</p> <p class="dwt_publisher"></p> <p class="publishDate"></p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">398</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.springerlink.com/index/qdxab49ewngwk33d.pdf"> <span id="translatedtitle">Contribution of posture to the maintenance of <span class="hlt">anal</span> continence</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">The anorectal angle (ARA) is believed to provide one of the most important contributions to <span class="hlt">anal</span> continence. The normal resting angle is approx. 90°, but the erect position may modify the ARA and other parameters usually considered in a proctometrogram. We compared the proctometrogram in different postures to elucidate the role of changes in the ARA in maintaining fecal continence.</p> <div class="credits"> <p class="dwt_author">Donato F. Altomare; Marcella Rinaldi; Antonella Veglia; Altomarino Guglielmi; Pier Luca Sallustio; Gaetano Tripoli</p> <p class="dwt_publisher"></p> <p class="publishDate">2001-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">399</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/28715777"> <span id="translatedtitle">Treatment of transsphincteric <span class="hlt">anal</span> fistulas by the seton technique</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Twenty-one patients with high transsphincteric fistulas treated by the seton technique were re-examined after two to 14 years.\\u000a None had recurrent fistulas, but 13 (62 percent) had some degree of continence disturbances. All patients with <span class="hlt">anal</span> deformities\\u000a had continence disorders.</p> <div class="credits"> <p class="dwt_author">Asbjørn Christensen; Lisbeth Nilas; John Christiansen</p> <p class="dwt_publisher"></p> <p class="publishDate">1986-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">400</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.springerlink.com/index/u361440785q7j0v0.pdf"> <span id="translatedtitle">Ileal pouch-<span class="hlt">anal</span> anastomosis function following childbirth</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">PURPOSE: Women undergoing Ileal pouch-<span class="hlt">anal</span> anastomosis (IPAA) are frequently within reproductive years and eager to bear children. Management issues have been raised regarding the effects of pregnancy and delivery on the pouch, particularly with respect to obstetric care. Our experience is updated to search for delayed sequelae of pregnancy and delivery and to establish whether other factors have an adverse</p> <div class="credits"> <p class="dwt_author">Eva S. Juhasz; Basil Fozard; Roger R. Dozois; Duane M. Ilstrup; Heidi Nelson</p> <p class="dwt_publisher"></p> <p class="publishDate">1995-01-01</p> </div> </div> </div> </div> <div id="filter_results_form" class="filter_results_form floatContainer" style="visibility: visible;"> <div style="width:100%" id="PaginatedNavigation" class="paginatedNavigationElement"> <a id="FirstPageLink" onclick='return showDiv("page_1");' href="#" title="First Page"> <img id="FirstPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.first.18x20.png" alt="First Page" /></a> <a id="PreviousPageLink" onclick='return showDiv("page_19");' href="#" title="Previous Page"> <img id="PreviousPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.previous.18x20.png" alt="Previous Page" /></a> <span id="PageLinks" class="pageLinks"> <span> <a onClick='return showDiv("page_1");' href="#">1</a> <a onClick='return showDiv("page_2");' href="#">2</a> <a onClick='return showDiv("page_3");' href="#">3</a> <a onClick='return 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Page" /></a> <a id="LastPageLink" onclick='return showDiv("page_25.0");' href="#" title="Last Page"> <img id="LastPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.last.18x20.png" alt="Last Page" /></a> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">401</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/48515983"> <span id="translatedtitle">Tumeur du canal <span class="hlt">anal</span> révélée par une fistule rectovaginale</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">\\u000a Résumé  La fistule rectovaginale (FRV) est une pathologie rare, une cause néoplasique en est exceptionnellement responsable. Nous\\u000a rapportons un cas de tumeur avancée du canal <span class="hlt">anal</span>, révélée par une grosse FRV associée à de multiples fistules périnéales\\u000a externes.</p> <div class="credits"> <p class="dwt_author">M. Tamzaourte; I. Errabih; M. Fadlouallah; S. Tahri; H. Elkoundi; M. Lahmiri; H. Krami; H. Ouazzani</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">402</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/42776264"> <span id="translatedtitle">Thinking the Unthinkable: <span class="hlt">Anal</span> Sex in Theory and Practice</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">This essay takes up the issue of <span class="hlt">anal</span> sexuality among gay men in order to consider the relationship between bodily and psychic penetrability. The lack of recognition some gay men may experience with this aspect of their sexuality suggests the importance that feeling “mentalized” (e.g., Fonagy and Target, 1993) may play in adult life. Drawing on early gay liberation and</p> <div class="credits"> <p class="dwt_author">Steven Botticelli</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">403</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/30209297"> <span id="translatedtitle">Gastrointestinal stromal tumor of the <span class="hlt">anal</span> canal: an unusual presentation</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">BACKGROUND: Gastrointestinal stromal tumors (GIST) of the stomach are the most frequent followed by those of the intestinal tract, while colon and rectum represent rare sites. GIST of the <span class="hlt">anal</span> canal are extremely rare. They have been studied along with GIST of the rectum, as a single entity, and along with them they represent 5% of GIST. GIST arising from</p> <div class="credits"> <p class="dwt_author">Giuseppe R Nigri; Mario Dente; Stefano Valabrega; Paolo Aurello; Francesco D'Angelo; Giuseppe Montrone; Giorgio Ercolani; Giovanni Ramacciato</p> <p class="dwt_publisher"></p> <p class="publishDate">2007-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">404</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/9101903"> <span id="translatedtitle">[Is <span class="hlt">sphincter</span>-plasty for treatment of fecal incontinence in patients older than 60 justified?].</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">Overlapping sphincteroplasty is the method of choice for isolated anterior <span class="hlt">sphincter</span> defects. Patients over 60 years of age can undergo this operation with similar good results as in younger patients. However, preoperative physiologic assessment of the pelvic floor is necessary for a good postoperative outcome. PMID:9101903</p> <div class="credits"> <p class="dwt_author">Pfeifer, J; Rabl, H; Uranüs, S; Wexner, S D</p> <p class="dwt_publisher"></p> <p class="publishDate">1996-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">405</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/32023360"> <span id="translatedtitle">Urethral <span class="hlt">Sphincteric</span> Insufficiency in Postmenopausal Females: Treatment with Phenylpropanolamine and Estriol Separately and in Combination</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">A randomized open comparative cross-over trial was carried out in 20 postmenopausal women, mean age 69 years, suffering from urinary incontinence due to urethral <span class="hlt">sphincteric</span> insufficiency. They were treated with phenylpropanolamine (PPA) 50 mg p.o. twice daily or estriol vaginal suppositories 1 mg daily separately and in combination for periods of 4 weeks. Urodynamic investigations were carried out before and</p> <div class="credits"> <p class="dwt_author">H. O. Beisland; E. Fossberg; A. Moer; S. Sander</p> <p class="dwt_publisher"></p> <p class="publishDate">1984-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">406</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/29175031"> <span id="translatedtitle">The artificial urinary <span class="hlt">sphincter</span> in the treatment of incontinence in the female patient</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Technical developments have led to a reliable artificial urinary <span class="hlt">sphincter</span> prosthesis for female patients with otherwise intractable urinary incontinence. Candidates include patients with post-operative stressincontinence or congenital or acquired neuropathic dysfunction. Proper patient selection requires extensive urologic examinations in order to guarantee a high success rate. The most serious complications are due to cuff erosion or infection. With proper operative</p> <div class="credits"> <p class="dwt_author">P. J. M. Kil; J. D. M. De Vries</p> <p class="dwt_publisher"></p> <p class="publishDate">1993-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">407</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/30208716"> <span id="translatedtitle">Diagnosing intrinsic <span class="hlt">sphincteric</span> deficiency: Comparing urethral closure pressure, urethral axis, and Valsalva leak point pressures</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">OBJECTIVES: Our purpose was to compare three measures proposed to diagnose intrinsic <span class="hlt">sphincteric</span> deficiency: maximum urethral closure pressure, Valsalva leak point pressure, and straining urethral axis. STUDY DESIGN: A total of 159 women with pure genuine stress incontinence had the three measures determined in a standardized fashion. Critical cutoff values for the Valsalva leak point pressure (52 cm) and urethral</p> <div class="credits"> <p class="dwt_author">Richard C. Bump; Kimberly W. Coates; Geoffrey W. Cundiff; Robert L. Harris; Alison C. Weidner</p> <p class="dwt_publisher"></p> <p class="publishDate">1997-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">408</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.osti.gov/scitech/biblio/6132691"> <span id="translatedtitle">Dilated common duct sign. A potential indicator of a <span class="hlt">sphincter</span> of Oddi dyskinesia</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.osti.gov/scitech">SciTech Connect</a></p> <p class="result-summary">The cholescintigraphic findings of a <span class="hlt">Sphincter</span> of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the <span class="hlt">Sphincter</span> of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. It was postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the <span class="hlt">Sphincter</span> of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a <span class="hlt">Sphincter</span> of Oddi dyskinesia.</p> <div class="credits"> <p class="dwt_author">DeRidder, P.; Fink-Bennett, D.</p> <p class="dwt_publisher"></p> <p class="publishDate">1984-05-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">409</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/48720096"> <span id="translatedtitle">Visceral Algesia in Irritable Bowel Syndrome, Fibromyalgia, and <span class="hlt">Sphincter</span> of Oddi Dysfunction, Type III</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Visceral hyperalgesia has been demonstrated inpatients with irritable bowel syndrome who are seen intertiary care centers. It has been hypothesized thatvisceral hyperalgesia may be related to psychological distress associated with health care seekingbehavior in these patients. Patients with fibromyalgiaand <span class="hlt">sphincter</span> of Oddi dysfunction, type III, share manydemographic and psychosocial characteristics with patients with irritable bowel syndrome andprovide an opportunity to</p> <div class="credits"> <p class="dwt_author">Andrew Chun; Steven Desautels; Adam Slivka; Carlos Mitrani; Terence Starz; Carlo Dilorenzo; Arnold Wald</p> <p class="dwt_publisher"></p> <p class="publishDate">1999-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">410</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.springerlink.com/index/m277n0uh2213w327.pdf"> <span id="translatedtitle">A Synthetic Prostaglandin E1 Analog, Alprostadil Alfadex, Relaxes <span class="hlt">Sphincter</span> of Oddi in Humans</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">It is well established that prostaglandins (PGs) exert potent pharmacological actions on vascular and nonvascular smooth muscle, although their effects on the <span class="hlt">sphincter</span> of Oddi (SO) remain to be elucidated. The aim of this study was to investigate the effect of PGE1 on motility of the human SO. Twenty patients appearing for routine endoscopic retrograde cholangiopancreatography (ERCP) examination were studied.</p> <div class="credits"> <p class="dwt_author">Tatsuya Koshitani; Tadashi Kodama; Hideki Sato; Junpei Takaaki; Yoichi Imamura; Keimei Kato; Naoki Wakabayashi; Kazuhiko Tokita; Shoji Mitsufuji</p> <p class="dwt_publisher"></p> <p class="publishDate">2002-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">411</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ntis.gov/search/product.aspx?ABBR=PB90240722"> <span id="translatedtitle">Tripod Modification of <span class="hlt">Sphincter</span> Corer: Construction, Operation, Core Extrusion and Sampling Efficiency.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ntis.gov/search/index.aspx">National Technical Information Service (NTIS)</a></p> <p class="result-summary">A 21-cm diameter <span class="hlt">sphincter</span> corer has been modified by mounting it in a tripod frame. This modification results in more dependable recovery of undisturbed surficial sediment and greater penetration into firm sediment. The device is useful in water depths f...</p> <div class="credits"> <p class="dwt_author">J. C. Burke S. A. Casso R. E. Hamblin</p> <p class="dwt_publisher"></p> <p class="publishDate">1983-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">412</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://eric.ed.gov/?q=%22sphincter%22&id=EJ990280"> <span id="translatedtitle">Current Evaluation of Upper Oesophageal <span class="hlt">Sphincter</span> Opening in Dysphagia Practice: An International SLT Survey</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p class="result-summary">Background: The assessment of adequate upper oesophageal <span class="hlt">sphincter</span> (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…</p> <div class="credits"> <p class="dwt_author">Regan, Julie; Walshe, Margaret; McMahon, Barry P.</p> <p class="dwt_publisher"></p> <p class="publishDate">2012-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">413</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/57376931"> <span id="translatedtitle">Assessment of Lower Urinary Tract Dysfunction in Children with Non-Neuropathic Bladder <span class="hlt">Sphincter</span> Dysfunction</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Although nonneuropathic bladder <span class="hlt">sphincter</span> dysfunction in children is frequently encountered, there is no consensus on the assessment of children presenting with this problem. An example is given of how these children can be assessed. After a noninvasive screening consisting of history, voiding diary, clinical examination, urinalysis, ultrasound and uroflowmetry, those children that will benefit from further videourodynamic studies are selected.</p> <div class="credits"> <p class="dwt_author">P. Hoebeke; J. Vande Walle; K. Everaert; E. Van Laecke; J. D. Van Gool</p> <p class="dwt_publisher"></p> <p class="publishDate">1999-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">414</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/57380566"> <span id="translatedtitle">Effects of Cannabinoid Agonists on Sheep <span class="hlt">Sphincter</span> of Oddi in vitro</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Background\\/Aims: According to recent studies, the endocannabinoid system plays an important role in both physiological and pathophysiological situations. The purpose of the present study was to investigate the effects of cannabinoid (CB) agonists on isolated sheep <span class="hlt">sphincter</span> of Oddi (SO)in vitro. Methods: The isolated sheep SO tissues were mounted in organ baths and tested for isometric tension and cyclic GMP</p> <div class="credits"> <p class="dwt_author">Bulent Sarac; Nedim Durmus; Ahmet Altun; Mustafa Turan; Tijen Kaya; Mehmet Sencan; Ihsan Bagcivan</p> <p class="dwt_publisher"></p> <p class="publishDate">2011-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">415</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1821025"> <span id="translatedtitle">Gastrointestinal stromal tumor of the <span class="hlt">anal</span> canal: an unusual presentation</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p class="result-summary">Background Gastrointestinal stromal tumors (GIST) of the stomach are the most frequent followed by those of the intestinal tract, while colon and rectum represent rare sites. GIST of the <span class="hlt">anal</span> canal are extremely rare. They have been studied along with GIST of the rectum, as a single entity, and along with them they represent 5% of GIST. GIST arising from the <span class="hlt">anal</span> canal account for only 2%–8% of the anorectal GIST. Thus <span class="hlt">anal</span> GIST must be considered an exceptional case. Case presentation A 78-year-old man was referred to our Institution for an <span class="hlt">anal</span> mass, in absence of any symptom. The patient was treated by local excision. An histological diagnosis of a low grade GIST was made. No further treatment was necessary. No local recurrence of distant metastases were found at follow-up. Conclusion At the moment, only ten cases of c-kit positive <span class="hlt">anal</span> GIST are reported in the literature. These few data are not sufficient to establish a widely accepted approach for this neoplasia. We recommend to perform an initial local excision, to define the risk of aggressive behavior and the resection margins and proceed to a more aggressive treatment, if the GIST belongs to high or very high risk group. The role of adjuvant therapy is still uncertain. Although inhibitors of tyrosine-kinase receptor needs further studies before their routine use, their role in case of distant or local recurrence has been accepted. Patients' close follow up is mandatory to disclose as soon as possible local recurrences or metastases.</p> <div class="credits"> <p class="dwt_author">Nigri, Giuseppe R; Dente, Mario; Valabrega, Stefano; Aurello, Paolo; D'Angelo, Francesco; Montrone, Giuseppe; Ercolani, Giorgio; Ramacciato, Giovanni</p> <p class="dwt_publisher"></p> <p class="publishDate">2007-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">416</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3091162"> <span id="translatedtitle">Identifying the best therapy for chronic <span class="hlt">anal</span> fissure</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p class="result-summary">Chronic <span class="hlt">anal</span> fissure (CAF) is a painful tear or crack which occurs in the anoderm. The optimal algorithm of therapy for CAF is still debated. Lateral internal sphincterotomy (LIS) is a surgical treatment, considered as the ‘gold standard’ therapy for CAF. It relieves CAF symptoms with a high rate of healing. Chemical sphincterotomy (CS) with nitrates, calcium blockers or botulinum toxin (BTX) is safe, with the rapid relief of pain, mild side-effects and no risk of surgery or anesthesia, but is a statistically less effective therapy for CAF than LIS. This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy. Aspects of <span class="hlt">anal</span> fissure etiology, epidemiology and pathophysiology are considered with their meaning for further management of CAF. A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined. Its application may influence the development of optimal therapy for CAF. BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically. Although the effectiveness of BTX vs. LIS has been discussed, the essential focus of the article concerns identifying the best therapy application for <span class="hlt">anal</span> fissure. Elements are presented which may help us to predict CAF healing. They provide rationale for the expansion of the CAF therapy algorithm. Ethical and economic factors are also considered in brief. As long as the patient is willing to accept the potential risk of fecal incontinence, we have grounds for the ‘gold standard’ (LIS) as the first-line treatment for CAF. The author concludes that, when the diagnosis of the <span class="hlt">anal</span> fissure is established, CS should be considered for both ethical and economic reasons. He is convinced that a greater understanding and recognition of benign <span class="hlt">anal</span> disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier, more practical stage with improved outcomes for the patient.</p> <div class="credits"> <p class="dwt_author">Madalinski, Mariusz H</p> <p class="dwt_publisher"></p> <p class="publishDate">2011-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">417</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/21577312"> <span id="translatedtitle">Identifying the best therapy for chronic <span class="hlt">anal</span> fissure.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">Chronic <span class="hlt">anal</span> fissure (CAF) is a painful tear or crack which occurs in the anoderm. The optimal algorithm of therapy for CAF is still debated. Lateral internal sphincterotomy (LIS) is a surgical treatment, considered as the 'gold standard' therapy for CAF. It relieves CAF symptoms with a high rate of healing. Chemical sphincterotomy (CS) with nitrates, calcium blockers or botulinum toxin (BTX) is safe, with the rapid relief of pain, mild side-effects and no risk of surgery or anesthesia, but is a statistically less effective therapy for CAF than LIS. This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy. Aspects of <span class="hlt">anal</span> fissure etiology, epidemiology and pathophysiology are considered with their meaning for further management of CAF. A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined. Its application may influence the development of optimal therapy for CAF. BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically. Although the effectiveness of BTX vs. LIS has been discussed, the essential focus of the article concerns identifying the best therapy application for <span class="hlt">anal</span> fissure. Elements are presented which may help us to predict CAF healing. They provide rationale for the expansion of the CAF therapy algorithm. Ethical and economic factors are also considered in brief. As long as the patient is willing to accept the potential risk of fecal incontinence, we have grounds for the 'gold standard' (LIS) as the first-line treatment for CAF. The author concludes that, when the diagnosis of the <span class="hlt">anal</span> fissure is established, CS should be considered for both ethical and economic reasons. He is convinced that a greater understanding and recognition of benign <span class="hlt">anal</span> disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier, more practical stage with improved outcomes for the patient. PMID:21577312</p> <div class="credits"> <p class="dwt_author">Madalinski, Mariusz H</p> <p class="dwt_publisher"></p> <p class="publishDate">2011-04-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">418</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2746096"> <span id="translatedtitle">A Missing <span class="hlt">Sphincteric</span> Component of the Gastro-Esophageal Junction in Patients with GERD</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p class="result-summary">Background It was recently shown that the tonic pressure contribution to the high-pressure zone (HPZ) of the esophagogastric segment (EGS) contains contributions from three distinct components, two of which are smooth muscle intrinsic <span class="hlt">sphincter</span> components, a proximal and a distal component (1). Aim To compare the pressure contributions from the three <span class="hlt">sphincteric</span> components in normal subjects with those in GERD patients. Methods A simultaneous endoluminal ultrasound (EUS) and manometry catheter was pulled through the esophago-gastric segment in 15 healthy volunteers and 7 patients with symptomatic GERD, before and after administration of atropine. Pre-atropine (complete muscle tone), postatropine (non-muscarinic muscle tone plus residual muscarinic tone), and subtracted (pure muscarinic muscle tone) pressure contributions to the <span class="hlt">sphincter</span> were averaged after referencing spatially to the right crural diaphragm (RCd) and the pull-through start position. Results In the normal group the atropine-resistant and atropine-attenuated pressures identified the crural and two smooth muscle <span class="hlt">sphincteric</span> components respectively. The subtraction pressure curve contained proximal and distal peaks. The proximal component moved with the crural sling between FI and FE and the distal component coincided with the gastric sling-clasp fiber muscle complex. The subtraction curve in the GERD patients contained only a single pressure peak that moved with the crural <span class="hlt">sphincter</span>, while the distal pressure peak of the intrinsic muscle component, which was previously recognized in the normal subjects, was absent. Conclusions We hypothesize that the distal muscarinic smooth muscle pressure component (gastric sling/clasp muscle fiber component) is defective in GERD patients.</p> <div class="credits"> <p class="dwt_author">Miller, Larry; Dai, Qing; Vegesna, Anil; Korimilli, Annapurna; Ulerich, Rhys; Schiffner, Bryan; Brassuer, James</p> <p class="dwt_publisher"></p> <p class="publishDate">2009-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">419</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.osti.gov/scitech/biblio/7116984"> <span id="translatedtitle">Earthquake fault <span class="hlt">rupture</span> propagation through soil</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.osti.gov/scitech">SciTech Connect</a></p> <p class="result-summary">The phenomenon of earthquake fault <span class="hlt">rupture</span> propagation through soil is quite complex and is not well understood at this time. This paper presents the results of an integrated investigation of this problem. Insights are developed from the examination of surface fault <span class="hlt">rupture</span> field case histories, laboratory physical model tests, and physical analogies to the earthquake fault <span class="hlt">rupture</span> process. Field observations and experimental results illustrate the typical patterns of behavior developed in the soil overlying a base rock fault displacement. Evidence suggests that differential movement across the distinct fault <span class="hlt">rupture</span> dissipates as the fault <span class="hlt">rupture</span> propagates toward the ground surface through unconsolidated earth materials, and that the characteristics of the soil overlying the bedrock fault strongly influence the observed earthquake fault <span class="hlt">rupture</span> propagation behavior.</p> <div class="credits"> <p class="dwt_author">Bray, J.D.; Seed, R.B.; Seed, H.B. (Univ. of California, Berkeley, CA (United States)); Cluff, L.S. (Pacific Gas Electric, San Francisco, CA (United States))</p> <p class="dwt_publisher"></p> <p class="publishDate">1994-03-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">420</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/21549964"> <span id="translatedtitle">A case of 'second <span class="hlt">rupture</span>' following open repair of a <span class="hlt">ruptured</span> Achilles tendon.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">We present a case of Achilles tendon <span class="hlt">rupture</span> in a 54-year-old man whilst rehabilitating following end-to-end open repair of an acute Achilles tendon <span class="hlt">rupture</span>. Re-<span class="hlt">rupture</span> following surgical repair of Achilles tendon is well known. This case however, is atypical as the second <span class="hlt">rupture</span> occurred significantly proximal to the first <span class="hlt">rupture</span>. To our knowledge this is the first time this has been described in the English literature. We have termed this incident a 'second <span class="hlt">rupture</span>'. We describe the surgical technique used by the operating surgeon during open repair of this 'second <span class="hlt">rupture</span>', involving a gastrocnemius flap turndown. This has lead to the patient making a good recovery, despite complications. This case report serves to inform surgeons of the existence of this type of Achilles tendon <span class="hlt">rupture</span>, whilst considering possible aetiologies and suggesting a technique for repair of the injury. PMID:21549964</p> <div class="credits"> <p class="dwt_author">Rushton, P R P; Singh, A K; Deshmukh, R G</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-09-09</p> </div> </div> </div> </div> <div id="filter_results_form" class="filter_results_form floatContainer" style="visibility: visible;"> <div style="width:100%" id="PaginatedNavigation" class="paginatedNavigationElement"> <a id="FirstPageLink" onclick='return showDiv("page_1");' href="#" title="First Page"> <img id="FirstPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.first.18x20.png" alt="First Page" /></a> <a id="PreviousPageLink" onclick='return showDiv("page_20");' href="#" title="Previous Page"> <img id="PreviousPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.previous.18x20.png" alt="Previous Page" /></a> <span id="PageLinks" class="pageLinks"> <span> <a onClick='return showDiv("page_1");' href="#">1</a> <a onClick='return showDiv("page_2");' href="#">2</a> <a 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onclick='return showDiv("page_1");' href="#" title="First Page"> <img id="FirstPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.first.18x20.png" alt="First Page" /></a> <a id="PreviousPageLink" onclick='return showDiv("page_21");' href="#" title="Previous Page"> <img id="PreviousPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.previous.18x20.png" alt="Previous Page" /></a> <span id="PageLinks" class="pageLinks"> <span> <a onClick='return showDiv("page_1");' href="#">1</a> <a onClick='return showDiv("page_2");' href="#">2</a> <a onClick='return showDiv("page_3");' href="#">3</a> <a onClick='return showDiv("page_4");' href="#">4</a> <a onClick='return showDiv("page_5");' href="#">5</a> <a onClick='return showDiv("page_6");' href="#">6</a> <a onClick='return showDiv("page_7");' href="#">7</a> <a onClick='return showDiv("page_8");' href="#">8</a> <a onClick='return showDiv("page_9");' href="#">9</a> <a onClick='return showDiv("page_10");' href="#">10</a> <a onClick='return showDiv("page_11");' href="#">11</a> <a onClick='return showDiv("page_12");' href="#">12</a> <a onClick='return showDiv("page_13");' href="#">13</a> <a onClick='return showDiv("page_14");' href="#">14</a> <a onClick='return showDiv("page_15");' href="#">15</a> <a onClick='return showDiv("page_16");' href="#">16</a> <a onClick='return showDiv("page_17");' href="#">17</a> <a onClick='return showDiv("page_18");' href="#">18</a> <a onClick='return showDiv("page_19");' href="#">19</a> <a onClick='return showDiv("page_20");' href="#">20</a> <a onClick='return showDiv("page_21");' href="#">21</a> <a style="font-weight: bold;">22</a> <a onClick='return showDiv("page_23");' href="#">23</a> <a onClick='return showDiv("page_24");' href="#">24</a> <a onClick='return showDiv("page_25");' href="#">25</a> </span> </span> <a id="NextPageLink" onclick='return showDiv("page_23");' href="#" title="Next Page"> <img id="NextPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.next.18x20.png" alt="Next Page" /></a> <a id="LastPageLink" onclick='return showDiv("page_25.0");' href="#" title="Last Page"> <img id="LastPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.last.18x20.png" alt="Last Page" /></a> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">421</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/22055493"> <span id="translatedtitle">A case of "fresh <span class="hlt">rupture</span>" after open repair of a <span class="hlt">ruptured</span> Achilles tendon.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">We present the case of Achilles tendon <span class="hlt">rupture</span> in a 54-year-old man while rehabilitating after end-to-end open repair of an acute Achilles tendon <span class="hlt">rupture</span>. Re-<span class="hlt">rupture</span> after surgical repair of Achilles tendon is well known. The present case, however, is atypical, because the second <span class="hlt">rupture</span> occurred significantly proximal to the first <span class="hlt">rupture</span>. To our knowledge, this is the first time this has been described in English language studies. We have termed this incident a fresh <span class="hlt">rupture</span>. A gastrocnemius turndown flap was used to repair the fresh <span class="hlt">rupture</span>, which led to a satisfactory recovery. This case report serves to inform surgeons of the existence of this type of Achilles tendon <span class="hlt">rupture</span>, while considering the possible etiologies and suggesting a technique that has been shown to be successful in the present case. PMID:22055493</p> <div class="credits"> <p class="dwt_author">Rushton, Paul R P; Singh, Alok K; Deshmukh, Rajiv G</p> <p class="dwt_publisher"></p> <p class="publishDate">2011-11-04</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">422</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/23681437"> <span id="translatedtitle">Human papillomavirus, <span class="hlt">anal</span> cancer, and screening considerations among HIV-infected individuals.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">Invasive <span class="hlt">anal</span> cancer has become an important cause of non AIDS-related cancer among HIV-infected individuals. Human papillomavirus is the main etiological agent. This review explains the pathophysiologic role of human papillomavirus in the development of invasive <span class="hlt">anal</span> cancer, summarizes recent epidemiological trends of invasive <span class="hlt">anal</span> cancer, and reviews the evidence to address common clinical questions posed when screening for <span class="hlt">anal</span> cancer in HIV-infected patients. The effect of highly active antiretroviral therapy on human papillomavirus oncogenesis is still unclear, but given the increased clinical burden of invasive <span class="hlt">anal</span> cancer among HIV-infected patients, many clinics have implemented screening programs for <span class="hlt">anal</span> cancer and its precursors. Despite the availability of several modalities for treatment of precursors of <span class="hlt">anal</span> cancer, evidence that current treatment modalities favorably alter the natural history of human papillomavirus oncogenesis in the <span class="hlt">anal</span> and perianal regions is still inconclusive. However, there is sufficient evidence to state that the accuracy of <span class="hlt">anal</span> cancer screening procedures (cytology and high-resolution anoscopy directed biopsy) is comparable to the accuracy of those used in screening for cervical cancer precursors. Studies that systematically assess the efficacy of these <span class="hlt">anal</span> cancer screening programs in reducing the incidence of and morbidity and mortality from invasive <span class="hlt">anal</span> cancer among HIV-infected patients are needed. PMID:23681437</p> <div class="credits"> <p class="dwt_author">Cachay, Edward R; Mathews, William Christopher</p> <p class="dwt_publisher"></p> <p class="publishDate"></p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">423</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.springerlink.com/index/k9wj3p82pt46w82r.pdf"> <span id="translatedtitle">Delayed presentation of traumatic intraperitoneal bladder <span class="hlt">rupture</span></span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">A child with urine ascites as a delayed manifestation of post-traumatic intraperitoneal bladder <span class="hlt">rupture</span> is presented. The\\u000a diagnosis was suggested by abdominal CT scan and confirmed with a cystogram. While uncommon, late presentation of intraperitoneal\\u000a bladder <span class="hlt">rupture</span> following trauma may occur from masking of a primary laceration or development of secondary <span class="hlt">rupture</span> at the\\u000a site of a hematoma in the</p> <div class="credits"> <p class="dwt_author">D. Brown; H. L. Magill; T. L. Black</p> <p class="dwt_publisher"></p> <p class="publishDate">1986-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">424</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/23155099"> <span id="translatedtitle">Association between smoking and size of <span class="hlt">anal</span> warts in HIV-infected women.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">While the association between smoking and human papillomavirus infection, cervical cancer, and <span class="hlt">anal</span> cancer has been well studied, evidence on the association between cigarette smoking and <span class="hlt">anal</span> warts is limited. The purpose of this study was to investigate if cigarette smoking status influences the size of <span class="hlt">anal</span> warts over time in HIV-infected women in a sample of 976 HIV-infected women from the Women's Interagency HIV Study (WIHS). A linear mixed model was used to determine the effect of smoking on <span class="hlt">anal</span> wart size. Even though women who were currently smokers had larger <span class="hlt">anal</span> warts at baseline and slower growth rate of <span class="hlt">anal</span> wart size after each visit than women who were not current smokers, there was no association between size of <span class="hlt">anal</span> wart and current smoking status over time. Further studies on the role of smoking and interaction between smoking and other risk factors, however, should be explored. PMID:23155099</p> <div class="credits"> <p class="dwt_author">Luu, H N; Amirian, E S; Beasley, R P; Piller, L; Chan, W; Scheurer, M E</p> <p class="dwt_publisher"></p> <p class="publishDate">2012-11-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">425</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/29298585"> <span id="translatedtitle">Extracellular matrix content of <span class="hlt">ruptured</span> anterior cruciate ligament tissue</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Anterior cruciate ligaments (ACLs) can <span class="hlt">rupture</span> with simple movements, suggesting that structural changes in the ligament may reduce the loading capacity of the ligament. We aimed to investigate if proteoglycan and collagen levels were different between <span class="hlt">ruptured</span> and non-<span class="hlt">ruptured</span> ACLs. We also compared changes in <span class="hlt">ruptured</span> tissue over time.During arthroscopic knee reconstruction surgery 24 <span class="hlt">ruptured</span> ACLs were collected from participants</p> <div class="credits"> <p class="dwt_author">Kate Young; Tom Samiric; Julian Feller; Jill Cook</p> <p class="dwt_publisher"></p> <p class="publishDate">2011-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">426</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/23707180"> <span id="translatedtitle">Acute achilles tendon <span class="hlt">rupture</span> in athletes.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">The incidence of AT <span class="hlt">rupture</span> has increased in recent decades. AT <span class="hlt">ruptures</span> frequently occur in the third or fourth decade of life in sedentary individuals who play sport occasionally. <span class="hlt">Ruptures</span> also occur in elite athletes. Clinical examination must be followed by imaging. Conservative management and early mobilization can achieve excellent results, but the rerupture rate is not acceptable for the management of young, active, or athletic individuals. Open surgery is the most common option for AT <span class="hlt">ruptures</span>, but there are risks of superficial skin breakdown and wound problems. These problems can be prevented with percutaneous repair. PMID:23707180</p> <div class="credits"> <p class="dwt_author">Longo, Umile Giuseppe; Petrillo, Stefano; Maffulli, Nicola; Denaro, Vincenzo</p> <p class="dwt_publisher"></p> <p class="publishDate">2013-03-20</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">427</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/30734380"> <span id="translatedtitle">Intraoperative Nerve Stimulation With Measurement of Urethral <span class="hlt">Sphincter</span> Pressure Changes During Radical Retropubic Prostatectomy: A Feasibility Study</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">PurposeWe evaluated the feasibility of using intraoperative nerve stimulation and real-time urodynamic monitoring to identify the intrapelvic innervation of the urethral <span class="hlt">sphincter</span> during radical retropubic prostatectomy.</p> <div class="credits"> <p class="dwt_author">CALEB P. NELSON; JAMES E. MONTIE; EDWARD J. McGUIRE; GARY WEDEMEYER; JOHN T. WEI</p> <p class="dwt_publisher"></p> <p class="publishDate">2003-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">428</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.springerlink.com/index/c8v8t9680m6ma69m.pdf"> <span id="translatedtitle">Relationship between <span class="hlt">anal</span> canal diameter and pressure evaluated simultaneously by endosonography and manometry in normal human subjects</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">The study investigated the relationship be-tween <span class="hlt">anal</span> canal size and <span class="hlt">anal</span> canal pressure measured simultaneously by <span class="hlt">anal</span>\\u000a endosonography and an electronic pressure probe. Twelve normal subjects were studied. <span class="hlt">Anal</span> endosonography was performed using\\u000a a 7.5-Mhz rotating transducer of 2 – 5 cm focal length covered with a sylastic balloon filled with degassed water (25 ml).\\u000a During <span class="hlt">anal</span> endosonography an electronic</p> <div class="credits"> <p class="dwt_author">L. Marzio; F. A. Ciccaglione; M. Falcucci; M. G. Malatesta; L. Grossi; N. Travaglini; S. Guerri</p> <p class="dwt_publisher"></p> <p class="publishDate">1998-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">429</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/21160880"> <span id="translatedtitle">Innovations in chronic <span class="hlt">anal</span> fissure treatment: A systematic review.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">A chronic <span class="hlt">anal</span> fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincterotomy remains the gold standard for treatment. <span class="hlt">Anal</span> dilatation has no role in treatment. New therapies include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Further research is required comparing these new therapies with existing established therapies. This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy. Perineal support may offer a new dimension in improving healing rates. Lateral sphincterotomy should be offered if pharmacological therapy fails. New therapies are not suitable as first line treatments, though they can be considered if conventional treatment fails. PMID:21160880</p> <div class="credits"> <p class="dwt_author">Poh, Aaron; Tan, Kok-Yang; Seow-Choen, Francis</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-07-27</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">430</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2999245"> <span id="translatedtitle">Innovations in chronic <span class="hlt">anal</span> fissure treatment: A systematic review</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p class="result-summary">A chronic <span class="hlt">anal</span> fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincterotomy remains the gold standard for treatment. <span class="hlt">Anal</span> dilatation has no role in treatment. New therapies include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Further research is required comparing these new therapies with existing established therapies. This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy. Perineal support may offer a new dimension in improving healing rates. Lateral sphincterotomy should be offered if pharmacological therapy fails. New therapies are not suitable as first line treatments, though they can be considered if conventional treatment fails.</p> <div class="credits"> <p class="dwt_author">Poh, Aaron; Tan, Kok-Yang; Seow-Choen, Francis</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">431</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/34900512"> <span id="translatedtitle">Study of the mechanisms involved in the bradykinin-induced contraction of the pig iris <span class="hlt">sphincter</span> muscle in vitro</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">This study was designed to investigate the mechanisms by which bradykinin induces contraction of the pig iris <span class="hlt">sphincter</span> muscle in vitro. Addition of bradykinin, Lys-bradykinin and Met-Lys-bradykinin to the pig iris <span class="hlt">sphincter</span> resulted in a graded contraction with a mean EC50s of 21, 11 and 5 nM, respectively. The bradykinin B1 receptor agonist des-Arg9-bradykinin only caused a slight contraction, measured</p> <div class="credits"> <p class="dwt_author">Mariem El Sayah; João B Calixto</p> <p class="dwt_publisher"></p> <p class="publishDate">2003-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">432</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.springerlink.com/index/f3xc226lf1l8h9c8.pdf"> <span id="translatedtitle">High-magnification chromoscopic pouchoscopy: a novel in vivo technique for surveillance of the <span class="hlt">anal</span> transition zone and columnar cuff following ileal pouch-<span class="hlt">anal</span> anastomosis</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Background Persistence of underlying disease in the residual rectal mucosa and <span class="hlt">anal</span> transition zone (ATZ) following ileal pouch-<span class="hlt">anal</span> anastomosis (IPAA) for ulcerative colitis and familial adenomatous polyposis provides a site for potential malignancy. For this reason endoscopic surveillance is performed, although conventional assessment may be unreliable. We hypothesized that the novel technique of high-magnification chromoscopic pouchoscopy (HMCP) may permit accurate</p> <div class="credits"> <p class="dwt_author">D. P. Hurlstone; A. J. Shorthouse; S. S. Cross; S. Brown; D. S. Sanders; A. J. Lobo</p> <p class="dwt_publisher"></p> <p class="publishDate">2004-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">433</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/22824099"> <span id="translatedtitle">Suppurative granulomatous inflammation in the ileo-<span class="hlt">anal</span> pouch.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">Restorative proctocolectomy with ileal pouch-<span class="hlt">anal</span> anastomosis (IPAA) is commonly performed for medically refractory ulcerative colitis (UC), however with multiple possible complications, most notably pouchitis, cuffitis, Crohn's disease of the pouch and irritable pouch syndrome. We present a unique case of suppurative granulomatous inflammation in the ileal pouch mucosa, most likely infective in nature, that is unrelated to recognised causes of such pathology, especially yersiniosis. PMID:22824099</p> <div class="credits"> <p class="dwt_author">So, Kenji; Shepherd, Neil A; Mandalia, Trupti; Ahmad, Tariq</p> <p class="dwt_publisher"></p> <p class="publishDate">2012-07-21</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">434</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/29201007"> <span id="translatedtitle"><span class="hlt">Rupture</span> of the uterus: A changing picture</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Eighty nine cases of <span class="hlt">rupture</span> of the gravid uterus occurring over a period of 15 years with 77,133 deliveries, were analysed. The overall incidence of <span class="hlt">ruptured</span> uteri was 1 per 866 deliveries. The patients were devided into two groups, those with a scarred uterus (47) and those with an unscarred uterus (42). Distinct differences in terms of parity, age, aetiology</p> <div class="credits"> <p class="dwt_author">J. V. Van der Merwe; W. U. A. M. Ombelet</p> <p class="dwt_publisher"></p> <p class="publishDate">1987-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">435</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.agu.org/journals/jb/v081/i032/JB081i032p05679/JB081i032p05679.pdf"> <span id="translatedtitle"><span class="hlt">Rupture</span> Velocity of Plane Strain Shear Cracks</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Propagation of plane strain shear cracks is calculated numerically by using finite difference equations with second-order accuracy. The <span class="hlt">rupture</span> model, in which stress drops gradually as slip increases, combines two different <span class="hlt">rupture</span> criteria: (1) slip begins at a finite stress level; (2) finite energy is absorbed per unit area as the crack advances. Solutions for this model are nonsingular. In</p> <div class="credits"> <p class="dwt_author">D. J. Andrews</p> <p class="dwt_publisher"></p> <p class="publishDate">1976-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">436</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/10680095"> <span id="translatedtitle">Traumatic <span class="hlt">rupture</span> of the innominate artery</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Objective: Blunt traumatic <span class="hlt">rupture</span> of the innominate artery is uncommon. We reviewed our experience to correlate the impact of patient stability, presence of associated injuries and location of the injury within the artery with outcome. Methods: A retrospective review was performed of patients admitted between January 1, 1998 and December 17, 2002 with traumatic innominate artery <span class="hlt">rupture</span>. Injuries were defined</p> <div class="credits"> <p class="dwt_author">Riyad Karmy-Jones; Robert DuBose; Stephen King</p> <p class="dwt_publisher"></p> <p class="publishDate">2003-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">437</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/60403918"> <span id="translatedtitle">Capacity credit calculation for exchanger tube <span class="hlt">rupture</span></span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">This paper reports that overpressure relieving in heat exchanger tube <span class="hlt">rupture</span> case is quite different from other cases, such as fire, utility failure, inadvertent valve opening\\/closure, etc., when designing a pressure relief valve (PRV). In most cases, it is quite straightforward. The calculated relief load is the capacity that needs to be relieved. But, in heat exchanger tube <span class="hlt">rupture</span> cases,</p> <div class="credits"> <p class="dwt_author"></p> <p class="dwt_publisher"></p> <p class="publishDate">1992-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">438</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/55725946"> <span id="translatedtitle">Dynamic Interface <span class="hlt">Rupture</span> in Extremely Heterogeneous Media</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Fracture experiments of monolithic brittle materials usually show the maximum speed of smooth <span class="hlt">rupture</span> at some 30 % of the relevant shear wave speed. This experimental maximum <span class="hlt">rupture</span> speed is by far lower than those predicted by theories and inferred from inversions of seismograms, and some seismic inversions (e.g., the 1979 Imperial Valley, 1992 Landers, 1999 Izmit, 2001 the central</p> <div class="credits"> <p class="dwt_author">K. Uenishi; K. Tsuji</p> <p class="dwt_publisher"></p> <p class="publishDate">2007-01-01</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">439</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3085625"> <span id="translatedtitle">Superficial Dorsal Vein <span class="hlt">Rupture</span> Imitating Penile Fracture</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p class="result-summary">Dorsal vein <span class="hlt">rupture</span> of the penis is a rare condition, and few cases have been reported in the literature. Herein we report a 41-year-old man who presented with mildly painful and acute swollen penis, which initially imitated a penile fracture but was surgically explored and shown to be a superficial dorsal vein <span class="hlt">rupture</span>.</p> <div class="credits"> <p class="dwt_author">Topsakal, Medih; Kavukcu, Ender; Karadeniz, Tahir</p> <p class="dwt_publisher"></p> <p class="publishDate">2011-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">440</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/28955380"> <span id="translatedtitle">Posterior tibial tendon <span class="hlt">rupture</span> in athletic people</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">We present our findings in six athletic patients with a <span class="hlt">ruptured</span> or partially <span class="hlt">ruptured</span> posterior tibial tendon. Pain in the midarch region, difficulty pushing off while running, and a pronated flattened longitudinal arch are the usual symptoms and physical findings of this injury. Surgical treatment, including reattachment of the rup tured posterior tibial tendon, is effective in restoring some but</p> <div class="credits"> <p class="dwt_author">Lee Woods; Robert E. Leach</p> <p class="dwt_publisher"></p> <p class="publishDate">1991-01-01</p> </div> </div> </div> </div> <div id="filter_results_form" class="filter_results_form floatContainer" style="visibility: visible;"> <div style="width:100%" id="PaginatedNavigation" class="paginatedNavigationElement"> <a id="FirstPageLink" onclick='return showDiv("page_1");' href="#" title="First Page"> <img id="FirstPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.first.18x20.png" alt="First Page" /></a> <a id="PreviousPageLink" onclick='return showDiv("page_21");' href="#" title="Previous Page"> <img id="PreviousPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.previous.18x20.png" alt="Previous Page" /></a> <span id="PageLinks" class="pageLinks"> <span> <a onClick='return showDiv("page_1");' href="#">1</a> <a onClick='return showDiv("page_2");' href="#">2</a> <a onClick='return showDiv("page_3");' href="#">3</a> <a onClick='return showDiv("page_4");' 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showDiv("page_12");' href="#">12</a> <a onClick='return showDiv("page_13");' href="#">13</a> <a onClick='return showDiv("page_14");' href="#">14</a> <a onClick='return showDiv("page_15");' href="#">15</a> <a onClick='return showDiv("page_16");' href="#">16</a> <a onClick='return showDiv("page_17");' href="#">17</a> <a onClick='return showDiv("page_18");' href="#">18</a> <a onClick='return showDiv("page_19");' href="#">19</a> <a onClick='return showDiv("page_20");' href="#">20</a> <a onClick='return showDiv("page_21");' href="#">21</a> <a onClick='return showDiv("page_22");' href="#">22</a> <a style="font-weight: bold;">23</a> <a onClick='return showDiv("page_24");' href="#">24</a> <a onClick='return showDiv("page_25");' href="#">25</a> </span> </span> <a id="NextPageLink" onclick='return showDiv("page_24");' href="#" title="Next Page"> <img id="NextPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.next.18x20.png" alt="Next Page" /></a> <a id="LastPageLink" onclick='return showDiv("page_25.0");' href="#" title="Last Page"> <img id="LastPageLinkImage" class="Icon" src="http://www.science.gov/scigov/images/icon.last.18x20.png" alt="Last Page" /></a> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">441</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://academic.research.microsoft.com/Publication/32203434"> <span id="translatedtitle">Arachnoid Cyst <span class="hlt">Rupture</span> with Concurrent Subdural Hygroma</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://academic.research.microsoft.com/">Microsoft Academic Search </a></p> <p class="result-summary">Arachnoid cysts (ACs) are relatively common intracranial mass lesions, which occur most often in the middle cranial fossa. While these lesions can present as a mass lesion, many are asymptomatic. Rarely, posttraumatic or spontaneous <span class="hlt">rupture</span> of ACs can result in intracystic hemorrhage, subdural hematoma or subdural hygroma. We have encountered two cases of <span class="hlt">ruptured</span> arachnoid cysts that resulted in subdural</p> <div class="credits"> <p class="dwt_author">Jill W. Donaldson; Mary Edwards-Brown; Thomas G. Luerssen</p> <p class="dwt_publisher"></p> <p class="publishDate">2000-01-01</p> </div> </div> </div> </div> <div class="floatContainer result " lang="en"> <div class="resultNumber element">442</div> <div class="resultBody element"> <p class="result-title"><a target="resultTitleLink" href="http://science.gov/scigov/link.html?type=RESULT&redirectUrl=http://www.ncbi.nlm.nih.gov/pubmed/20537884"> <span id="translatedtitle">Acute closed <span class="hlt">rupture</span> of EHL revisited.</span></a>  </p> <div class="result-meta"> <p class="source"><a target="_blank" id="logoLink" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p class="result-summary">Isolated closed injuries to the EHL are rare. Traumatic closed <span class="hlt">rupture</span> of EHL in the absence of diabetes mellitus, arthritis or local steroid injections is hitherto unreported. We present a case of closed EHL <span class="hlt">rupture</span> after a hyperflexion injury to the interphalangeal joint of the big toe, successfully managed with surgery, along with review of existing literature. PMID:20537884</p> <div class="credits"> <p class="dwt_author">Shah, K; Carter, Bob</p> <p class="dwt_publisher"></p> <p class="publishDate">2010-05-26</p> </div> </div> </div> </div> <div class="floatContainer result odd" lang="en"> <div class="resultNumber element">443</div> <div class="resultBody element"> <p